Plantar fasciitis is a common affliction affecting many athletes, in particular runners. Adam Smith has written a great piece in the September issue of Sports Injury Bulletin outlining the relevant anatomy, how the injury occurs, how to differentiate from other similar pathologies, such as neural irritation in the tarsal tunnel, and finally how to manage it.
Speaking from experience as a former sufferer of plantar fasciitis, it can be a frustratingly recalcitrant condition and I have heard of some extreme measures to manage it. Read on for a story on the drastic measures an AFL player took to overcome the problem, and to understand more about the condition.
Many years ago an elite level AFL player had suffered a 2 year history of plantar fasciitis with no relief from any form of treatment. In the end the sports doctor at the club involved injected the plantar fascia origin with a corticosteroid injection the day before a game.
The hope was that as the plantar fascia weakened due to the steroid injection, the player would rupture it, go through the standard week rehab protocol, and then be pain free for ever more.
And yes, the player did rupture the plantar fascia during during the game and was consequently placed in a boot for about 10 days. He soon was walking, then running, and was playing again within four weeks with no more problems. The podiatrist made an orthotic to control the dropped arch and all the problems went away.
What has happened to that player now is anyone’s guess. He may now suffer from long term issues due to a poorly controlled arch that have caused other issues such as achilles tendon, knee pain and/or hip pain.
So do we really need the plantar fascia and why is it such a problem when it is injured?
Being bipedal (walking on two leg) animals, the plantar fascia gives the natural plantar arch support in weight bearing positions. It is a passive structure that acts like a high tension wire to keep the arch bones supinated as we push off.
Without a plantar fascia in place, we would need a better active system to create the arch support, such as the intrinsic plantar arch muscles, and also the extrinsic long arch support muscles such as the tibialis posterior, flexor hallucis longus (FHL) and the flexor digitorum longus (FDL). These muscles would need extra work to improve their arch control abilities. Alternatively, we could use a passive support mechanism in the form of an orthotic to control the arch position.
The majority of plantar fascia problems stem from a build up of tensile and compressive forces that degenerate the plantar fascia origin against the heel bone. The combination of tensile (stretch) force due to overpronation and the added compressive force as the plantar fascia is pushed against the heel bone leads to a pathological state whereby the plantar fascia degenerates and creates dysfunction and pain.
Therefore like other degenerative tendon issues (such as Achilles tendons) once the patient starts to feel pain often the injury has been building for months to years. Which explains why it then becomes so problematic to deal with.
Proper management takes time to not only correct the muscle imbalances that cause it � such as tight calves, poor hip control, poor pronation control � but due to its degenerative nature it requires a huge amount of time to even slightly change the existing pathology.
For more information, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .
Additional Topics: What is Chiropractic?
Chiropractic care is an well-known, alternative treatment option utilized to prevent, diagnose and treat a variety of injuries and conditions associated with the spine, primarily subluxations or spinal misalignments. Chiropractic focuses on restoring and maintaining the overall health and wellness of the musculoskeletal and nervous systems. Through the use of spinal adjustments and manual manipulations, a chiropractor, or doctor of chiropractic, can carefully re-align the spine, improving a patient�s strength, mobility and flexibility.
Stress fractures to the ribs occur in rowers, golfer, canoeists, lacrosse players and baseball pitchers. They are more common in sports involving an element of trunk rotation with scapula movement across the rib cage.
A stress fracture is described as an overload to the bone caused by repetitive loading due to a particular movement. Any load on the bone will create a stress in the bone. However, given enough recovery time the bone heals and ends up stronger. This is known as Wolfe�s law. But, if the bone load is too high or too frequent, then the bone does not repair quickly enough, a stress response occurs and a fracture follows.
In rowing, the repetitive loading is created by a number of factors. Muscles such as the serratus anterior and abdominals that directly attach to the ribs can lead to loading on the ribcage due to contraction. Bad rowing technique, perhaps caused by poor hip flexibility, which then requires an excessive compensatory thoracic rotation, may then lead to rib breakdown.
Other causes include equipment issues such as the oar type (lighter carbon oars increase rib loading), bigger boats with more drag and position in the boat (bow rowers have less incidence due to lower stroke rate and force). Rib cross section and density also influence the chance of stress fractures, and women have a higher chance due to greater likelihood of bone density issues. Finally, training variables such as volume, intensity, type of loading and off water training can also be factors in stress fracture development.
The signs and symptoms are usually straight forward. These include generalised rib pain with a focused spot of tenderness, pain rolling onto the ribs whilst sleeping and pain with deep breathing. They can be confirmed with bone scan (black spot) and/or MRI (white spot).
Unfortunately for the rower, the immediate management of the injury involves rest. Usually 4-6 weeks away from rowing will be enough to allow some bone healing and this is followed by a progressive increase in rowing load over another 4 weeks before the athlete is back to full training.
The scope of our information is limited to chiropractic and spinal injuries and conditions. To discuss options on the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .
Additional Topics: Chiropractic and Athletic Performance
Chiropractic care is a popular, alternative treatment option which focuses on the diagnosis, treatment and prevention of injuries and/or conditions associated to the musculoskeletal and nervous system, primarily the spine. Many athletes, and civilians alike, seek chiropractic care to restore their natural health and wellness, however, chiropractic has been demonstrated to benefit athletes by increasing their athletic performance.
The talk in soccer circles this week is the imminent return to action of Theo Walcott, the Arsenal and England star who damaged his knee back at the start of 2014. After 286 days of rehab, Walcott made a return to Arsenal’s Under 21 team last week. This has left journalists salivating at finding out when he will be returning to the main team.
For a young professional sports person, nine months is a long time out of the game. For Walcott, missing out on this Summer’s soccer World Cup in Brazil was perhaps more than just rubbing salt into the wound.
In issue 139 of Sports Injury Bulletin, I present a case study of a similar problem in a rugby player of identical age. This big lump of a kid ruptured his lateral meniscus in the knee — a bit different to Walcott’s ACL injury. However, this player also missed a big chunk of the season (17 weeks) and I had to live with his personal frustrations, and the yo-yo of daily emotions.
The piece shows the knee anatomy, details the types, clinical features and management of meniscus tears, and the required post-surgical rehabilitation.
On a recent Rehab Trainer course, one of the participants asked me what she should do about the small lateral meniscal tear in her knee. This is a bit like answering “how long is a piece of string?”, as it depends on so many things.
But to wrap it up in a nutshell, the surgeon will use a set of criteria to determine if a meniscal tear needs repairing, removing, or to be left well alone.
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Criteria for Surgery
1. Age
The younger the patient, the more comfortable surgeons are about operating. Often the small degeneration tears in older patients are just a precursor to a knee that is about to become arthritic. With older patients, many surgeons will try for rehab first.
2. Function
This depends on what the knee has to do. If the patient does nothing but collect stamps all day and the knee does not bother them, then clearly the surgeon will want to leave it alone. But if the patient is an athlete with a repetitive catching and locking knee due to a meniscal tear, they will be more comfortable about operating.
3. Type of tear
Issue 139 of Sports Injury Bulletin details the types of tears we see in meniscus. In short, tears such as bucket handle tears do not do well without surgery, while small longitudinal tears can do well without surgery.
4. Location of tear
The outer portion of the meniscus has a nice, rich blood supply (hence, called the “red-red zone”). These areas can do well if left alone. Inner third zone tears (the “white zone”) with no blood supply don’t heal, so they need repairing or removing.
So, if the patient is lucky and fits the criteria for conservative management, or let’s say they simply don’t want surgery, then what options do we have to prevent the injury from getting worse?
Suggestions to Avoid Further Meniscus Injuries
Avoid positions that catch the meniscus. For example, full squatting may catch the posterior horn of the meniscus and flare it up, so the patient has to learn to avoid these positions if possible.
Keep the quadriceps working. If the quads remain strong and active then the shearing effect of the tibia moving across the femur is reduced. This will limit the stress to the meniscus.
Watch for swelling. Regular assessments for a knee effusion (called a “fluctuation test”) may need to be done a few times a week to make sure the knee stays dry. The knee’s biggest enemy is an effusion as it shuts off the quads straight away.
Intervene if the knee has an effusion. Donut felt compression, regular icing, NSAIDS if indicated, needle aspiration if indicated. Avoiding an effusion at all costs is pretty important for any knee injury.
For more information, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .
Preventing Sports Injuries
Many athletes largely depend on chiropractic care to enhance their physical performance. New research studies have determined that aside from maintaining overall health and wellness, chiropractic can also help prevent sports injuries. Chiropractic is an alternative treatment option utilized by athletes to improve their strength, mobility and flexibility. Spinal adjustments and manual manipulations performed by a chiropractor can also help correct spinal issues, speeding up an athlete’s recovery process to help them return-to-play as soon as possible.
Perhaps you bent the wrong way while lifting something heavy. Or you�re dealing with a degenerative condition like arthritis. Whatever the cause, once you have low back pain, it can be hard to shake. About one in four Americans say they�ve had a recent bout of low back pain. And almost everyone can expect to experience back pain at some point in their lives.
Sometimes, it�s clearly serious: You were injured, or you feel numbness, weakness, or tingling in the legs. Call the doctor, of course. But for routine and mild low back pain, here are a few simple tips to try at home.
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Chill It
Ice is best in the first 24 to 48 hours after an injury because it reduces inflammation, says E. Anne Reicherter, PhD, PT, DPT, associate professor of Physical Therapy at the University of Maryland School of Medicine. �Even though the warmth feels good because it helps cover up the pain and it does help relax the muscles, the heat actually inflames the inflammatory processes,� she says. After 48 hours, you can switch to heat if you prefer. Whether you use heat or ice � take it off after about 20 minutes to give your skin a rest. If pain persists, talk with a doctor.
Keep Moving
�Our spines are like the rest of our body � they�re meant to move,� says Reicherter. Keep doing your daily activities. Make the beds, go to work, walk the dog. Once you�re feeling better, regular aerobic exercises like swimming, bicycling, and walking can keep you � and your back � more mobile. Just don�t overdo it. There�s no need to run a marathon when your back is sore.
Stay Strong
Once your low back pain has receded, you can help avert future episodes of back pain by working the muscles that support your lower back, including the back extensor muscles. �They help you maintain the proper posture and alignment of your spine,� Reicherter says. Having strong hip, pelvic, and abdominal muscles also gives you more back support. Avoid abdominal crunches, because they can actually put more strain on your back.
Stretch
Don�t sit slumped in your desk chair all day. Get up every 20 minutes or so and stretch the other way. �Because most of us spend a lot of time bending forward in our jobs, it�s important to stand up and stretch backward throughout the day,� Reicherter says. Don�t forget to also stretch your legs. Some people find relief from their back pain by doing a regular stretching routine, like yoga.
Think Ergonomically
Design your workspace so you don�t have to hunch forward to see your computer monitor or reach way out for your mouse. Use a desk chair that supports your lower back and allows you to keep your feet planted firmly on the floor.
Watch Your Posture
Slumping makes it harder for your back to support your weight. Be especially careful of your posture when lifting heavy objects. Never bend over from the waist. Instead, bend and straighten from the knees.
Wear Low Heels
Exchange your four-inch pumps for flats or low heels (less than 1 inch). High heels may create a more unstable posture, and increase pressure on your lower spine.
These could be signs that you have a nerve problem or another underlying medical condition that needs to be treated.
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Are Functional Orthotics Part of Your Wellness Protocol?
Most Chiropractors advertise pain relief without drugs and care for injuries. Recently, some doctors and practices have begun labeling and promoting themselves as Wellness Centers. A wellness practice is focused on both maintaining a pre-existing level of musculoskeletal balance and postural health and preventing conditions that might alter this state of health. The challenge is, how can healthy patients be protected from problems that might arise in the future? The answer is simple: custom-made orthotics. Custom orthotics may be traditionally seen as a preventative measure, but so are most treatments of old. They are the perfect, foundational support your patients will never want to go without.
Wellness is a great concept�one of those �win-win� situations for doctor and patient. Orthotics are the perfect way to implement this concept and help establish a �preventative� approach, in addition to the traditional reactive ones, if need be. Let�s take at a look at the foundation of the body, and see just how useful they can be.
Look To The Feet
The feet are the foundation of the body. By age 40, nearly everyone has a foot condition of�some sort, many of which eventually contributing to health concerns farther up the Kinetic Chain (Figure 1). Therefore, it�s in the best interest of healthy patients to be offered a wellness program which stresses preventative care for normal, healthy feet, in order to prevent foot problems from occurring later in life.
�Pictured above, patient with severe bunions, or Hallux Valgus.
Figure 1. While 99% of all feet are normal at birth, 8% develop troubles by the first year of age, 41% at age 5, and 80% by age 20 (Fig. 1).�By age 40, nearly everyone has a foot condition of some sort.
How Can Orthotics Help?
Patients who participate in Chiropractic wellness programs can benefit from custom-made orthotics nearly as much as patients who seek Chiropractic care for musculoskeletal injuries and conditions. Foot Levelers� custom orthotics have been shown to effectively support the pedal foundation for both categories of patients, and can prevent problems well into the future with static and dynamic support.
Static support.Static support. A 1999 study using radiographic measurements found that custom-made, flexible orthotics can significantly improve the alignment of the arches when standing.2 In the wellness-practice concept of orthotic use, custom-made, flexible orthotics can be used to maintain a properly functioning arch alignment.
Dynamic support. During gait, the foot undergoes substantial changes and must permit a smooth transfer of the body�s center of mass over the leg in order to conserve energy and keep the work expenditure to a minimum.3 This requires a flexible, yet supportive orthotic that accommodates varying weights and forces and allows proper movement and function of the foot, while supporting all three arches�in order to prevent eventual arch collapse.
Postural benefits. Since the entire body structure is balanced on one foot at a time when walking and running, improving foot alignment can help maintain knee, hip, pelvic and even spinal postural alignment,4 and prevent joint degeneration (of the hip, knee, or spinal joints). A pelvic or spinal tilt or recurrent subluxations will often respond rapidly to orthotic support of the arches in the feet.
Orthotics For Everyone
Custom-made, flexible orthotics have long been recognized as a valid adjunct to Chiropractic care for many musculoskeletal conditions. In the wellness model of Chiropractic care, Foot Levelers� custom-made, flexible orthotics (Fig. 2) can be utilized as a preventative modality for the preservation of optimal arch support and the postponement or prevention of joint imbalances in later years. Therefore, orthotics are appropriate for virtually all Chiropractic patients.
The truth: How much water you should drink each day really, truly depends on the person, Robert A. Huggins, PhD, of the University of Connecticut explained to Health. �Fluid needs are dynamic and need to be individualized from person to person. Factors such as sex, environmental conditions, level of heat acclimatization, exercise or work intensity, age, and even diet need to be considered.�
What this means is that simply listening to your thirst is the best way to gauge when to drink. Another way to monitor hydration is to look at your pee before you flush. You want it to look like lemonade; if it’s darker than that, you should down a glass.
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Drinking Water and Exercise
To gauge how much water you specifically should take in during exercise, Huggins recommends doing a small experiment on yourself.
First, before you work out weigh yourself wearing with little to no clothing. �If you can, [make sure you’re hydrated beforehand] and avoid drinking while you exercise to make the math easy,” Huggins says. But if you get thirsty, don’t ignore it: drink some and make sure to measure the amount.
After you’re done exercising, weigh yourself again. Then, take your first weight and subtract the second weight, and you�ll end up with how much fluid you lost. Convert this to kilograms (if you search it, Google will return the number for you or try a metric converter), then drink that amount in liters. (If you drank some water during exercise, subtract the amount of water you drank from your final total.)
This is your “sweat rate,” Huggins says. It’s the amount of water you should drink during or after your next workout to replace what you’ve lost. (You can also use an online calculator for sweat rate; just plug in your numbers.)
Complicated much? We agree. Huggins estimates that most people lose between one to two liters of sweat for each hour of moderate intensity exercise. But ultimately thirst should still be your guide.
Why It’s Essential to Drink the Right Amount
You already know that dehydration can be dangerous, but over-hydrating may actually be just as bad.
In fact, a new consensus report in the British Journal of Sports Medicine found that many athletes are at risk of exercise-associated hyponatremia, which is an electrolyte imbalance that can be caused by drinking too much liquid. This can lead to nausea and vomiting, headaches, fatigue, and in serious cases, coma and even death.
While it was previously thought to only be a concern for long-distance athletes competing in events like marathons and Ironmans, the paper (which was funded by CrossFit, Inc.) concluded that many athletes are actually dangerously over-drinking during events as short as 10K races and even bikram yoga classes, Tamara Hew-Butler, PhD, lead author of the paper, explained to Health.
Because “it is impossible to recommend a generalized range especially during exercise when conditions are dynamic and changing, there is not one size that fits all!” she adds.
So the best method to keep you in that sweet spot between over- and under-hydrated is, as with many things, to listen to your body.
The scope of our information is limited to chiropractic and spinal injuries and conditions. To discuss options on the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .
Additional Topics: Whole Body Wellness
Chiropractic care is well-known as a safe and effective alternative treatment option utilized to improve as well as maintain whole body health and wellness. Common chiropractic treatment methods and techniques, such as spinal adjustments and manual manipulations, can be used to treat a variety of injuries and/or conditions, including neck pain and back pain. Regular chiropractic care along with a balanced nutrition and physical exercise is a natural approach to ensure the body’s overall health and wellness, restoring the individual’s original well-being.
Wondering exactly how much protein you should be consuming each day? The Recommended Dietary Allowance (RDA), which is the minimum amount you need to be healthy, is 0.8 grams per kilogram (0.36 grams per pound) of body weight per day�46 grams for an average woman. That equals as little as 10% of daily calories. If you’re not super active, that’s likely adequate, and you’ll hit the target effortlessly if you follow a typical Western diet.
To get your personal protein “RDA,” multiple the number 0.36 by your weight in pounds. (For a sedentary 150-pound woman, that would be 54 grams.) Double it if you’re very active or aiming for “optimal protein,” which can help you maintain muscle as you age and support weight loss.
American women already eat about 68 grams a day, according to the latest data from the National Health and Nutrition Examination Survey. “There’s no reason to go out of your way to get protein,” says Dariush Mozaffarian, MD, dean of the Tufts Friedman School of Nutrition Science & Policy. “Just eat a variety of fish, nuts, beans, seeds, and dairy, including yogurt.” However, increasing your protein well above the RDA may make sense if…
That means getting at least 35 to 40 minutes of moderate exercise four or five days a week, including resistance training two or more times a week. Consider eating 1.2 to 2 grams of dietary protein per kilogram (or about 0.5 to 0.9 grams per pound) of body weight each day, says Nancy Rodriguez, PhD, professor of nutritional sciences at the University of Connecticut. That amount is best for rebuilding muscle tissue, especially if you do a lot of high-intensity workouts, research suggests.
Protein takes longer to digest than carbs, helping you feel full, and also pushes your body to secrete the gut hormone peptide YY, which reduces hunger. “When you bring protein to about 30% of your daily calories, you’ll naturally eat less,” says Lauren Slayton, RD, founder of Foodtrainers, a nutrition practice in New York City, and author of The Little Book of Thin. “Protein decreases appetite and also, in my experience, helps you manage cravings.”
While studies are mixed about whether consuming more protein leads to weight loss, research is pretty clear that protein can help you retain more of your lean muscle as you lose fat. One 2011 study suggests amping up protein to as much as 1.8 to 2 grams per kilogram (roughly 0.8 to 0.9 grams per pound) of body weight per day to stave off muscle loss when restricting calories. Cut back on refined carbs to balance out the extra calories from adding protein.
Eating more protein as you get older may help you maintain muscle and ward off osteoporosis, “so you can stay stronger and more functional,” says Rodriguez. In a 2015 study, adults over the age of 50 who roughly doubled the RDA (eating 1.5 grams of protein per kilogram, or 0.68 grams per pound, of body weight) were better able to rebuild and retain muscle after only four days, compared with control groups eating the RDA.
Doubling the RDA gives you “optimal protein,” a concept that Rodriguez and more than 40 nutrition scientists advanced at a recent Protein Summit, the findings from which were published in 2015 in The American Journal of Clinical Nutrition. Optimal protein works out to be about 15% to 25% of your daily calories, still below the level recommended by many popular high-protein diets. Over a day, that could look like 20-30 grams per meal and 12 to 15 grams per snack, for a total of 90 to 105 grams daily.
Be sure to consult your healthcare provider on the proper nutrition and diet according to your specific needs.
For more information, please feel free to ask Dr. Jimenez or contact us at 915 850-0900 .
Additional Topics: What is Chiropractic?
Chiropractic care is an well-known, alternative treatment option utilized to prevent, diagnose and treat a variety of injuries and conditions associated with the spine, primarily subluxations or spinal misalignments. Chiropractic focuses on restoring and maintaining the overall health and wellness of the musculoskeletal and nervous systems. Through the use of spinal adjustments and manual manipulations, a chiropractor, or doctor of chiropractic, can carefully re-align the spine, improving a patient�s strength, mobility and flexibility.
We all know to go easy on the sweet stuff, but what actually happens to your system when you indulge? Here are eight ways sugar affects the body.
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Brain Issues
Fructose�the sugar that naturally occurs in fruit and is a component, with glucose, of high fructose corn syrup (HFCS) and table sugar�lights up the brain’s reward center, says pediatric endocrinologist Robert Lustig, MD, of UCSF Benioff Children’s Hospital in San Francisco. But over time, a diet packed with fructose (especially from HFCS) can make it tougher to learn and remember, animal research suggests. To stay in peak mental shape, try sticking with savory snacks.
Increased Appetite
By revving the brain’s reward and appetite center, fructose can interfere with feelings of satiety, research reveals. Translation: That extra cookie may not curb your craving after all.
Faster Aging
Too much sugar can hinder the repair of collagen, the buzzed-about protein that keeps skin looking plump, studies show. A steady diet of sugary treats can result in reduced elasticity and premature wrinkles. Indulge your sweet tooth with fruit instead. Experts say it’s A-OK to eat two to four servings of the natural sugar source each day.
Pause before you slip that additional packet into your a.m. coffee. The liver has an innate capacity to metabolize sugar and use it for energy�but only to an extent, explains Dr. Lustig. The fructose that’s left over is converted into fat in the liver, raising your risk of obesity, type 2 diabetes, and cardiovascular disease.
Cell Damage
Fructose accelerates the usual oxidation process in our cells, says Dr. Lustig. The result? Proteins, tissues, and organs can become damaged, and our risk of health conditions, including liver disease, kidney failure, and cataracts, rises.
Addiction to Sugar
Eating sugar leads to the release of dopamine, the neurotransmitter that makes us like something and want more of it. “As dopamine receptor neurons get overstimulated, the number of receptors to bind to decreases, so you’ll need a bigger hit of dopamine to get the same rush,” explains Dr. Lustig.
Sweets can lower levels of the stress hormone cortisol in the near term, research shows. But continue OD’ing on sugary refined carbs and your risk of insulin resistance, which stresses the body from the inside, goes up. To find your calm, sweat instead: “Exercise is the best treatment for stress. It makes you feel good and reduces cortisol,” says Dr. Lustig.
Ineffective for Energy Production
Refined carbs, like those in white bread and pasta, quickly cause a rise in glucose in the bloodstream, so you might feel extra energized�for a while. But this short-term fix can actually leave you more sluggish later on (when you eventually crash). Instead, opt for protein-rich snacks between meals, such as Greek yogurt with fresh berries or fresh veggies and hummus. They help stabilize blood sugar and keep you going longer.
For more information, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .
Additional Topics: What is Chiropractic?
Chiropractic care is an well-known, alternative treatment option utilized to prevent, diagnose and treat a variety of injuries and conditions associated with the spine, primarily subluxations or spinal misalignments. Chiropractic focuses on restoring and maintaining the overall health and wellness of the musculoskeletal and nervous systems. Through the use of spinal adjustments and manual manipulations, a chiropractor, or doctor of chiropractic, can carefully re-align the spine, improving a patient�s strength, mobility and flexibility.
If you want to reduce the number of opioid prescriptions and pills being used, and potentially misused, you need alternative pain management. And chiropractors say that�s what they�ve been providing for decades.
�It gives people options, and that�s probably the most important thing right now is to give people options for treatment,� Dr. Mark Stagnone, president of the New Hampshire Chiropractic Association said.
At its annual meeting, the association is pointing to a trio of recent studies showing that chiropractic care cuts down on the use of opiate pain medicines.
In one of the studies, a former Dartmouth doctor analyzed 33,000 cases of lower back pain in a New Hampshire database.
�His preliminary research is indicating that there�s about a 56-57 percent reduction in opioid use when chiropractic care has been utilized in a patients treatment,� Stagnone said.
James Vara, the governor�s adviser on addiction and behavorial health, said the state needs more alternative pain management.
�It becomes a question of what insurance covers it and how long they cover it for, and that�s certainly something I�ve looked at and will continue to,� said Vara.
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The Current Insurance Model Puts Patients On A Path To Prescription Drugs
�The problem that it produces is that the average individual who�s trying to treat a condition is faced with paying a high co-pay to visit a chiropractor or paying a considerably lower one to see a primary care physician,� Stagnone said.
Changing that dynamic will require legislation that has failed in the past. But chiropractors said in this ongoing addiction crisis, it�s time for adjustment.
Chiropractic care is covered under the New Hampshire Health Protection program, or expanded Medicaid. And if the program lapses, so does that coverage.
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Painkillers Sometimes Increase Chronic Pain
We’re facing an opioid addiction crisis in America. Opioid (narcotic) pain medications killed an estimated 14,000 people in the U.S. in 2014 through overdose. A further 14,000 people overdosed on heroin, another opioid that many people turn to when they can’t access prescription painkillers.
This epidemic is why physicians and pharmacists are increasingly raising the bar on who can receive opioid medications, how much, and for how long. It’s not just the addiction risk that calls for caution when using opioids to treat chronic pain though�long-term use of opioids can actually make pain worse.
Becoming addicted to pain medication is a disease. This is because these painkillers (oxycodone, hydrocodone, methadone, fentanyl) cause a change in your brain chemistry that is not under your control.
Most people who take opioids for more than 2 to 4 weeks will develop a tolerance to the medication. Tolerance means your body may need an increased dosage to feel the same effect. Opioid tolerance can cause withdrawal symptoms when the medication is stopped. This is a natural process, and it is not to be confused with addiction.
In his recent blog on the subject, Dr. Ullrich explains: “Pain medication addiction is a more complicated process. It involves manipulative behavior to obtain narcotic medications and a refusal to discontinue a medication even though it is no longer being used for a medical purpose. Some, including those at significant risk of overdosing, will go to multiple doctors to get medications.”
For those who are addicted to opioid medications, a detoxification program is often needed. Painkiller addiction is a chemical, physical disease, one that requires expert medical treatment in a safe, humane environment.
Most people know that painkillers can be addictive, but they don’t know that taking opioids over a long period of time may in fact increase a patient’s sensitivity to pain (hyperalgesia). This happens because long-term use of opiate painkillers causes a decrease in your ability to tolerate pain and an increase in sensitivity to pain. In fact, people taking opioids long term may keep having pain, or may see their pain increase, long after the original cause of pain has healed.
Stopping opioid use can solve this problem�but it may not seem as if the pain is gone at first, because the discomfort of withdrawal can mimic the original pain. Dependency is not easy to deal with, but it shouldn’t be an excuse to stay on the opioid medication and raise the risk for addiction. This is why physicians are encouraged to only prescribe opioids for short durations and be cautious when using them to treat chronic pain.
Since long-term use of opioid painkillers is a risky option for controlling chronic pain, patients are often advised to focus on other safe, proven methods for managing chronic pain, such as:
Exercise to maintain motion and release endorphins
Cognitive therapy to develop coping techniques
Relaxation and meditation techniques to distract the brain from pain
Six Things Every Chiropractor Should Know About Opioids
Men health concept. Portrait of 50s mature Asian man reading the label on bottle medicine, sitting on sofa at home.
An increase in addictions and deaths due to opioids has raised significant concern and media attention. We offer this brief overview on this important public health problem for the practicing chiropractor.
1. What Are Opioids?
Opioid medications are prescribed to reduce pain; however, they are addictive and can be dangerous. Although some suggest there is �no safe dose� for opioids, these drugs may be helpful for people with severe pain, such as those experiencing pain from cancer. However, over the past several decades, more patients have been prescribed opioids for musculoskeletal pain, such as back or neck pain, instead of being provided with nondrug therapies.
As with any drug, opioids have side effects and may �adversely affect respiratory, gastrointestinal, musculoskeletal, cardiovascular, immune, endocrine, and central nervous systems.�1 �As the dose increases, the risks for overdose and health concerns also increase, including �fractures, addiction, intestinal blockages, and sedation.�1 If too high a dose is consumed or if opioids are taken with certain other drugs or alcohol, death may result.
2. Why Is Opioid Use / Overuse Problematic?
Since 1999, prescription opioid sales have increased fourfold, along with a surge in the use of opioids as a first line for pain management, rather than only for severe cancer-related pain. This trend has led to burgeoning opioid prescribing in the U.S.:2
? One in five people with non-cancer pain have been prescribed opioids.
? More than 165,000 prescription opioid-related deaths occurred between 1999 and 2014.
? An estimated 2 million people were addicted to opioids as of 2014.
3. Who Is Addressing This Health Crisis?
Currently, many professions are seeking ways to address this national epidemic. The medical profession has launched various initiatives to help medical doctors (MDs) reduce prescriptions. These include an initiative to remove pain as the 5th�vital sign, and promoting guidelines for when to prescribe and how to better manage patients in pain without the use of opioids.
The Centers for Disease Control and Prevention (CDC) has�released guidelines�to curb opioid prescriptions, with the following categories of recommendations to those who prescribe opioids: 1) determine when to initiate or continue opioids for chronic pain; 2) opioid selection, dosage, duration, follow-up, discontinuation, and assessing risk; and 3) addressing harms of opioid use.
In addition to these efforts, even more focus is needed to assist people who seek help for pain and to provide them with nonpharmacological alternatives.
4. What Can Doctors of Chiropractic Do?
Chiropractic care can be part of the solution. DCs can work with other health care providers and support policy to offer alternatives to opioids for addressing patients in pain, especially chronic non-cancer pain.
Although there are no large trials comparing outcomes of chiropractic care to opioids, we do know opioid use is associated with worse functioning in back pain patients at six-month follow-up3 �and greater disability;4 �and that injured workers whose first health care visit is to a DC have better outcomes.5 �We also know that the per-capita supply of DCs and higher use of manipulative therapy is associated with lower rates of opioid prescriptions among Medicare recipients.6
All this suggests chiropractic care may help reduce the use of and need for opioid prescriptions for back pain sufferers; and may play an important role in reducing the opioid epidemic by helping to prevent patients from ever getting an opioid prescription in the first place.
Important resources DCs should be aware of include:
? Chiropractic: A Safer Strategy Than Opioids:�www.f4cp. com/f4cp_opioid_white_paper.pdf
? Centers for Disease Control and Prevention (CDC): Opioid Overdose:�www.cdc.gov/drugoverdose/ Six Things Every Chiropractor Should Know About Opioids By Claire Johnson, DC, MSEd, PhD, Bart N. Green, DC, MSEd, PhD and Michael Haneline, DC, MPH Reprinted with permission from Dynamic Chiropractic, Sept. 1, 2016, Vol. 34, Issue 15 (www.dynamicchiropractic.com/digital/index.php?i=1220&r=t#19)
5. What Can We Do If a Patient Is Already Taking Opioids?
Most chiropractors take a history and ask patients what medications they are taking. The first step is to recognize that the following are opioid-class drugs: hydrocodone (Vicodin), ultram (Tramadol), oxycodone (OxyContin, Percocet), morphine (Kadian, Avinza) and codeine.7
Once we know a patient is taking opioids, we must first seek to understand the situation before we provide education.
Questions we can ask include:
? For what condition is the patient taking the medication?
? How long has the patient been taking opioids and at what daily dose?
? Who is the provider watching over their prescription? Is more than one provider prescribing opioids?
? When was the last time the patient saw the prescribing physician and when is the next appointment?
? Does the patient have any safety issues? For example, does the patient operate machinery? Is the patient experiencing side effects such as �sedation, dizziness, nausea, vomiting, constipation, physical dependence, tolerance, or respiratory depression�?8
? What is the patient�s level of function? Are there any psychological flags or addictive behaviors?
? Is the patient taking any other substances or drugs that may have deadly interactions, such as alcohol, benzodiazepines and/or other opioids?
As chiropractors, we can discuss treatment goals, such as reasonable functional activity; and pain goals with and without medication. We also can discuss potential adverse events, including the risks for side effects, addiction and death.
We can inform patients of other dangers they may not be aware of, such as the deadly combination of opioids when combined with other drugs that depress CNS activity (e.g., alcohol or drugs for anxiety such as benzodiazepines). We can encourage patients to contact the prescribing provider to discuss reducing and stopping opioid use, and to ask for safer alternatives for pain control, such as chiropractic care, physical therapy, acupuncture and mind-body methods. If a patient is already addicted, we can encourage the patient to seek a specialist provider and addiction care program. (Note that some patients may need to remain on opioids, such as for cancer pain or end-of-life care.)
Most importantly, we can work with the patient and their prescribing provider to offer them nonpharmacological care to help reduce their pain and help them reach their functional goals.
6. How Can We Collaborate More on Solutions?
As DCs, we can work more closely with local MDs and discuss better ways to collaborate concerning patients with pain. Remember that MDs are not the enemy, but are an essential component of the solution to this epidemic. Most MDs are also extremely concerned about the opioid epidemic, and are looking for efficient and cost-effective ways of helping their patients. We should remain professional when speaking about MDs with our patients, as our patients likely have good relations with them.
We can be part of the safety net to help reduce the number of people who become addicted or die from overdose. As we work with other health care professionals and our patients, we can remind them that the first recommendation per the CDC�s�Guideline for Prescribing Opioids for Chronic Pain�is �Nonpharmacologic therapy and nonopioid pharmacologic therapy are preferred for chronic pain.�9 �Thus, through collaboration, the chiropractic profession can be a part of the solution.
By now you may have heard the shocking news: Subway’s �chicken� may contain just 50 percent chicken. The rest is filler, according to a report published by Time Magazine.
According to tests performed at Trent University in Canada, the company�s chicken strips and oven-roasted chicken contained just 43 percent and 54 percent chicken DNA, respectively, consisting otherwise of soy and other filler ingredients.
Subway denies the charges and has demanded a retraction from CBC Marketplace, yet admits it is �concerned by the alleged findings.� According to Subway, its chicken strips and oven-roasted chicken contain less than 1 percent soy protein.
The filler, it turns out, is a very long list of ingredients, however, a majority of it is soy protein. John Coupland, president of the Institute of Food Technologists, told Time Magazine.
�Based on the data, that is a surprisingly large amount of soy � And it�s astonishingly high for something that you�re supposed to think is a real, whole piece of chicken.�
On average, fast food chicken contains about one-quarter less protein than home-cooked chicken breast, thanks to water infusions and fillers, and up to eight times more sodium.
Moreover, as noted in the program, while you�d never expect chicken to be a source of carbohydrates, fast food chicken, such as that from Subway, contain surprisingly high amounts of refined starches and sugars.
Contents
Soy Protein May be Linked to Health Issues
Based on these test results, there are many reasons for concern. Not only are you being ripped off, paying for chicken that turns out to be 50 percent soy, which is dirt-cheap in comparison, but you�re also eating something that could be hazardous to your health, even if you�re not outright allergic to soy.
Unlike the Asian culture, where people eat small amounts of whole, fermented non-GMO soybean products, western food processors separate the soybean into two golden commodities � protein and oil. And there is nothing natural or safe about either.
Unfermented soy foods contain anti-nutritional factors such as soyatoxin, phytates, protease inhibitors, oxalates, goitrogens and estrogens � some of which actually interfere with the enzymes you need to digest protein.
While a small amount of these anti-nutrients would not likely cause a problem, the amount of soy many Americans now eat is extremely high.
What�s worse, the vast majority of soy grown in the U.S. is genetically engineered (GE) to be herbicide resistant and contaminated with the well-documented carcinogenic herbicide, Roundup.
Soybeans are also processed by acid washing in aluminum tanks, which can leach aluminum into the final soy product, and may contain unsafe levels of manganese as well.
According to Kaayla Daniel, Ph.D., author of �The Whole Soy Story,� thousands of studies link unfermented soy to a wide range of health problems, including:
Malnutrition
Kidney stones
Breast Cancer
Reproductive disorders
Infertility
Immune system impairment
Thyroid dysfunction
Heart disease
Cognitive decline (dementia)
Brain damage
Digestive problems
Food allergies
Soy for Dinner
A recent report by Mighty Earth, highlights the environmental impact of soybeans. More specifically, the report accuses Burger King of buying soy from plantations created by burning down tropical forests.
�To examine the impact of Burger King�s operations, we focused on the ultimate source of much of their meat: the soybeans that feed the livestock that the company uses to make its meals. Soy is an important base ingredient of the world�s meat. Approximately three-quarters of the world�s soy goes to animal feed,� the report notes.
��Burger King has a lot to hide: The fast food giant has failed to adopt any serious policies to protect native ecosystems in the production of its food. Despite pressure from consumers, it continues to rank dead last among its competitors � when it comes to protecting the environment.
Companies found in Burger King�s supply chain have been linked to ongoing destruction of forests and native prairies � habitat for wildlife like sloths, jaguars, giant anteaters and other species.
Unlike many of its competitors, Burger King has repeatedly turned down requests from civil society organizations to commit to only buying from suppliers who don�t engage in destruction of forests, or to provide information about where its commodities originate � Burger King scored a zero on the Union of Concerned Scientists� 2016 scorecard of major beef sellers� deforestation profiles, significantly lagging behind other major players like Wal-Mart, McDonald�s and Wendy�s.�
Soy Is Bad, But Roundup Is Even Worse
Glyphosate � the active ingredient in Monsanto�s wide-spectrum herbicide Roundup and other pesticides � is the most widely used agricultural chemical in the world. The first glyphosate-tolerant soybeans were introduced in the U.S. in 1994. By 2015, 83 percent of the soy grown worldwide was GE soy and in the U.S. more than 90 percent of soybeans grown are GE.
Less than 1 percent are organic, with the remaining 9 percent being conventionally grown which, like GE varieties, involves the use of herbicides like Roundup. Glyphosate-contamination is in and of itself a major reason to avoid foods containing soy protein. And if Subway chicken really contains as much soy as the Canadian test suggests, it would be a significant reason to avoid it too. Remember that less than 1 percent of soy is organic and free of pesticides.
In March, 2015, the International Agency for Research on Cancer (IARC), a research arm of the World Health Organization (WHO) and the �gold standard� in carcinogenicity research, reclassified glyphosate as a �probable human carcinogen� (Class 2A). Research scientist and consultant Anthony Samsel has also reported he uncovered evidence showing Monsanto knew glyphosate promotes cancer as far back as 1981.
Based on the IARC�s determination, the California agency of environmental hazards (OEHHA) has declared glyphosate a carcinogen under Proposition 65, and will require all glyphosate-containing products to carry a cancer warning. Monsanto attempted to overturn the OEHHA�s decision, but a Fresno County Superior Court Judge ruled against it.
Where Can You Find Real, Whole Food
We like to think that we can make healthy choices while eating out and save time in our hectic schedules. Afterall, who has time to cook anymore? Well, the reality is that the wool is being pulled over our eyes. It is next to impossible to eat healthy wholesome foods at fast food chains or even upper scale restaurants. There is simply too much out of your control- from MSG, preservatives, trans fats and gluten (these are just a few of the toxins we�re exposed to).
With all the drawbacks associated with conventional agriculture, factory farmed meats and processed fast food, your best bet is to forgo restaurants and choose fresh, locally produced foods. You can also grow some of your own. Remember to choose organic, grass-fed/pasture-raised beef, poultry and dairy, in addition to organic produce. If you live in the U.S., the following organizations can help you locate farm-fresh foods:
American Grassfed Association
EatWild.com
Weston A. Price Foundation
Grassfed Exchange
Local Harvest.org
Farmers Markets
Eat Well Guide: Wholesome Food from Healthy Animals
FoodRoutes
The Cornucopia Institute
RealMilk.com
OrganicPastures.com
For more information, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .
Whole Body Wellness
Overall health and wellness can be achieved by following a proper nutrition and engaging in regular exercise and/or physical activities. While these are some of the most common ways to ensure whole body health and wellness, visiting a qualified and experienced healthcare professional can also grant your body additional benefits. Chiropractic care, for instance, is a safe and effective alternative treatment option utilized by people to maintain well-being.
After pulling out a tree root Muntathar experienced excruciating pain which forced him into a extreme hunched position. If he tried to stand up he would get terrible pain and numbness all down his leg. Despite being to emergency 9 times, he had found no help in the medical world. So as a last resort he decided to travel from America to Australia to see Dr. Ian. Watch as after 2 weeks of specific Gonstead Chiropractic care, Mun stands straight and tall once more and gets his life back. We hope you enjoy this very special case.
The video�(see at bottom of post) was posted on Reddit by user Duggerdean with the comment: �I used to be a skeptic about chiropractic care until I started watching this channel. His latest video is so amazing.�
The video they refer to is that of Dr Ian Watch, who practices at Gonstead Chiropractic in Victoria, Australia � and his teenage patient�Muntathar Altaii from the US.
Despite going to A&E nine times, he says no one was able to help him.
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Day 1
Dr Ian X-rays Mun�s back and sees one of the joints isn�t functioning properly. The measurements are also quite a long way out which suggests the sacrum (the large triangular bone at the base of the spine) has rotated.
Mun Also Has No Feeling In His Right Leg
Dr Ian makes what he calls �a very small correction� at the first appointment. After just 10 minutes, he�s already got a small amount of feeling back in his leg.
Mun then confesses he hopes to be better by his graduation � on June 17. No pressure.
Day 2
Mun Reports He�s Slept Well For The First Time In Three Months
Dr Ian identifies a huge amount of upper cervical nerve pressure in his neck. His head sits higher on one side than the other. So, Dr Ian makes another �adjustment�.
Day 4
Mun has a lot more movement. He can move his leg easily, whereas before he would have to pick it up even to walk.
Day 7
After further manipulation of Mun�s spine (with assistance to keep it stable), Mun tells Dr Ian how desperate he�d become after his injury. �At first I didn�t want to even live anymore,� he says, �because I couldn�t walk anywhere.�
Day 10
‘Now he just walks like he�s been playing too much X-Box� jokes Dr Ian.
For The First Time, Mun�s Taller Than The Doctor
Transformation In Just 10 Days Is Pretty Incredible
Call Today!
Photo Mun Sent Back To His Family That Night
Before & After
Mun�s High School Graduation Picture � He Got His Wish Last Week
Mun, Second From Left, With His Dad
Now Mun Wants To Be A Chiropractor When He�s Older, Of Course!
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