What's a better pain reliever than opioids?

Morphine, oxycodone, Oxycontin, hydromophone, and Sophidone are all types of pain relieving drugs known as "opioids". These drugs have long been thought to be the most effective of all pain relieving drugs, and they are now being used for an ever growing list of painful conditions (sciatica, fibromyalgia, acute low back pain, post-surgery pain, etc... )

However, along with their increased use, have also come increased side effects. In the U.S. in 2013, there were 16,235 prescribed opioid related deaths, which was a 1% increase from the previous year. It is also estimated that among those taking opioid drugs for pain, as much as 30% of those people will become medically addicted (which would amount to 15 million people!) and opioid use has been linked to heroin addiction.

Most people (and unfortunately many of their doctors) believe these terribly severe and extremely prevalent side-effects are worth the risk because nothing else can decrease their pain as well as these drugs. But is that true? And what studies have been done to prove this?

Well, according to a new review study recently published in Joint Bone Spine Journal, there have been shockingly few studies done to justify such a wide-spread treatment, and the results of those studies that have been done are equivocal at best. This recent review could only find 1 randomized trial comparing morphine for sciatica treatment and the results of that study found that morphine was only 7% more effective than a placebo! One study of acute low back pain patients in an emergency room setting found that intravenous morphine was NOT more effective than intravenous acetaminophen. And another review found neither opioids nor NSAIDs to be very effective for treatment of chronic low back pain, but out of those two, the NSAIDs did better.

So, do these 'benefits' justify the extreme risks opioids have? Or should we do a better job educating patients and doctors on what the evidence actually shows for these deadly drugs? Compared to the benign side-effects of conservative pain management techniques (chiropractic care, acupuncture, massage, cognitive therapy) it is hard to understand why opioid use continues to remain prevalent. And with pain increasingly being recognized as a serious public health issue, hopefully we will see more education for all on the nature of pain and we get to a day when we don't have millions of people in our society dependent on pills everyday to live without pain.

  1. Berthelot J-M, et al. Strong Opioids for noncancer pain due to musckuloskeletal diseases: Not more effective thatn acetaminophen or NSAIDS. Joint Bone Spine (2015), http://dx.doi.org/10.1016/j.jbspin.2015.08.003

Meeting the "Triple Aim" for Spine Pain

The buzz word (or phrase) in the health care industry these days is what is known as the "Triple Aim". The "Triple Aim" refers to the need to improve three things in health care simultaneously, and those three things are:

  1. Improving patient satisfaction
  2. Improving patient outcomes
  3. Decreasing health care costs

A recent study, published in the Journal of Manipulative and Physiological Therapeutics, compared the "Triple Aim" measures between two avenues of treatment for spine, hip, and shoulder pain. One avenue of treatment was patients who initially visited an M.D. and the second avenue of treatment was patients who initially visited a D.C. (chiropractor).

This retrospective study used self-administered questionnaires and insurance claims data from over 700 patients with spinal, hip, or shoulder pain. The results found that the group who visited the D.C. first did better on all 3 "Triple Aim" measures. These patients were significantly more satisfied with their care (51% very satisfied vs. 33% very satisfied). The cost of care for these patients was significantly lower ($506/patient vs. $922/patient). And also, the patients who sought care from a D.C. first also had a greater reduction in their pain, although these differences were not as clinically significant. Notably too, the patients in the D.C. group also spent half as many day off work due to pain.

So when it comes to making our health care system (and your personal care) less expensive, more satisfying, and more effective, the results of this study suggest that anyone with spinal, hip, or shoulder pain would be wise to visit a D.C. (chiropractor) first.

  1. Houweling TA, Braga AV, Hausheer AV, et al. First-Contact Care With a Medical vs Chiropractic Provider After Consultation With a Swiss Telemedicine Provider: Comparison of Outcomes, Patient Satisfaction, and Health Care Costs in Spinal, Hip, and Shoulder Pain Patients. J Manipulative Physiol Ther. 2015 Aug 15.

Are Chiropractic Adjustments a Good Idea for Cervical Disc Herniations?

Everyone knows what a "pain in the neck" feels like, and we all have our preferred ways of dealing with it (Chiropractic Adjustments are at the top of that list). But what about when that pain in the neck is traveling down your arm and maybe even causing numbness, or worse weakness in your arm/hand? And what if that pain is being caused by a disc herniation in your neck that is pinching a nerve? What is the best treatment then, to help get better fast and avoid surgery?

Chiropractic Adjustments for this type of injury can be a controversial topic, with many people having had great results, while others are more skeptical. But a new study being published this month looked closely at this treatment.

In this study, 50 patients with acute or chronic cervical radiculopathy caused by a disc herniation (diagnosed via exam and MRI) were treated with chiropractic adjustments of the neck. Their pain levels and functional outcome scores were measured before treatment began, at 1-month post treatment, and again at 3-months post treatment.

The results of this study found that at 1-month, 68.9% of patients achieved clinically significant improvements and there were also statistically significant improvements in functional outcomes. At 3-months, 85.7% of patients achieved clinically significant improvements and no adverse effects were reported!

Therefore, the authors of this study concluded that Chiropractic Adjustments provided high levels of clinically significant improvements for patients with acute or chronic cervical disc herniation.

  1. Peterson CK, Schmid C, Leeman S, Anklin B, Humphreys BK. Outcomes from magnetic resonance imaging-confirmed symptomatic cervical disk herniation patients treated with high-velocity low-amplitude spinal manipulative therapy: A prospective cohort study with 3-month follow-up. J Manipulative Physiol Ther 2013;xx:1-8

Can Kinesiotaping improve shoulder movement?

Kinesiotaping is a popular tool in the athletic world these days, and it is also becoming a common therapeutic tool for injury rehabilitation as well. The theory is that the elasticity of the tape can (when applied correctly) slightly elevate the skin and in doing so, potentially decrease pain, improve muscle strength, and increase circulation. However, like many "fashionable" trends in sports medicine and health care, to this date there is not a lot of published research to prove OR negate these theories.

Fortunately, one new study has recently helped shed some more light on this intriguing topic. The paper was recently in the journal Manual Therapy and it looked to see if kinesiotaping was able to improve shoulder function by increasing the acromiohumeral distance (AHD) during normal shoulder ranges of motion.

In this study 49 people had their AHDs measured twice, with their shoulder at 60 degrees and 0 degrees of elevation. These measurements were taken before kinesiotape was applied and immediately after the kinesiotape was applied. There was also a sham kinesiotape application that was used as a placebo comparison.

The results of this study found that acromiohumeral distance was increased after the kinesiotape was applied to the shoulders and the results were statistically significant. There was no change in AHD seen in the sham kinesiotape group.

Therefore, this study demonstrates that kinesiotape does have the ability to improve shoulder joint function, and as such could be a useful tool in the treatment of a wide variety of shoulder injuries.

  1. Luque-Suarez A, Navarro-Ledesma S, Petocz P, Hancock MJ, Hush J. Short term effects of kinesiotaping on acromiohumeral distance in asymptomatic subjects: A randomised controlled trial. Man Ther. 2013 Jul 4. pii: S1356-689X(13)00115-X. doi: 10.1016/j.math.2013.06.002. [Epub ahead of print]

Can Tennis Elbow be Treated with Low-Level Laser Therapy?

Lateral epicondylitis, better known as "tennis elbow", is inflammation and damage of the tendons in your arm that you use to extend your wrist and forearm (yes, those muscles you're using right now to move your mouse). This injury is commonly seen in racquet-sport athletes, but is also common among in the "office athlete" population or others who overuse some of the smaller muscles in our forearms. Initially this injury starts out as inflammation of a normal tendon, but over time this can become a chronic injury that actually changes the physical composition of the tendons involved (tendinosis). Some of the common techniques to treat chronic tennis elbow include eccentric exercises and soft-tissue mobilization. However many people have had good results using low-level Laser to treat chronic tennis elbow.

Recently a new study was published in the journal Lasers in Surgery and Medicine (one of the coolest journal names out there) looking at treatment of tennis elbow with low-level Laser therapy. In this study they treated 16 patients with the real Laser or a fake laser (placebo=normal LED light) for 8 sessions over the course of three weeks. At the beginning of the study all patients had severe pain and significant weakness in their elbows. These patients were then re-evaluated after the intial treatment, and again 3 months, 6 months, and 12 months after the treatments ended.

The results of this study found no initial significant differences between the two groups at the end of the treatments. However, at the 3, 6 and 12 month follow ups the group treated with the real Lasers had significant improvements in their pain and strength, while the group treated with the fake laser had not significant improvements until the 12 month follow up.

Therefore the authors of this study concluded that low-level Laser therapy can be an effective treatment for chronic tennis elbow (lateral epicondylitis).

  1. Roberts DB, Kruse RJ, Stoll SF. The Effectiveness of Therapeutic Class IV (10 W) Laser Treatment for Epicondylitis. Lasers Surg Med. 2013 Jul;45(5):311-317. doi: 10.1002/lsm.22140. Epub 2013 Jun 3.

Can Antibiotics Cure Chronic Low Back Pain?

Herniated discs are a common cause of low back pain. However, not all herniated discs cause pain, and even painful herniated discs can go away or stop causing problems with the right treatment given at the right time. However, sometimes the pain from a herniated disc doesn't go away and it becomes chronic pain. Scientists still don't fully understand how or why that occurs, but one new theory has come about recently with some interesting research to support it.

Some physicians have begun using antibiotics to treat chronic low back pain patients who have a history of disc herniations. The theory is that sometimes when the disc herniates bacteria may have an opportunity to enter the disc and over time that bacteria may cause chronic inflammation in the disc and the adjacent vertebrae. Last month a randomized double blind study was published that compared the treatment of chronic low back pain by antibiotics and placebo medication.

In this study 162 patients were divided into 2 groups. The first group received special antibiotic treatment for 100 days, and the second group received a placebo treatment. Participants were then re-evaluated one-year after the study began and the results found that the patients with the antibiotic treatments were significantly more effective at decreasing these patient's pain levels.

Therefore these authors concluded that bacterial infections may be the cause of some types of low back pain, and more research needs to be done to see if antibiotic treatment can prevent expensive and riskier treatment options such as surgery or steroid injections.

  1. Hanne B. Albert, Joan S. Sorensen, Berit Schiott Christensen, Claus Manniche Antibiotic treatment in patients with chronic low back pain and vertebral bone edema (Modic type 1 changes): a double-blind randomized clinical controlled trial of efficacy. European Spine Journal April 2013, Volume 22, Issue 4, pp 697-707

Does Hip Weakness Cause Runner's Knee pain?

Patellofemoral pain syndrome (PFPS), aka "Runner's knee", is one of the most common sports related injuries out there. PFPS accounts for almost 25% of all knee injuries seen in sports medicine clinics, yet debate still remains on what the best treatment options are, and there is even uncertainty over what tissues are actually causing the pain. One theory about what causes the condition is that dysfunction of certain hip muscles (gluteus maximus; gluteus medius) can lead to abnormal motion at the knee and ultimately increased joint stress.

A new journal article recently reviewed previous studies that measured the timing and activity levels of these hip muscles in patients with PFPS. There were 13 studies that were reviewed for this article, and unfortunately most of them had small sample sizes. However, some trends were seen that might have clinical implications for the treatment and prevention of PFPS.

This article found moderate evidence that gluteus medius activation was delayed and shortened in people who suffered with PFPS. This was correlation was especially seen when walking up and down stairs (one legged exercises that require more hip strength). However, they did not find much evidence to show any changes in the timing of gluteus maximus activity in those with PFPS.

So, this new evidence suggests, but does not prove, that delayed and shortened activation of gluteus medius might be a cause of PFPS, and therefore prevention or treatment of this common knee injury might be improved by including proper hip strength training.

  1. Barton CJ, Lack S, Malliaras P, Morrissey D. Gluteal muscle activity and patellofemoral pain syndrome: a systematic review. Br J Sports Med. 2013 Mar;47(4):207-14.

Spinal Manipulation vs. Diclofenac for Acute Low Back Pain

Statistics show that at any given time 31% - 47% of Americans are suffering from some degree of low back pain, and in 2005 annual health care costs for neck and back pain averaged $6096 per patient!

These costs have been rising steadily, possibly because of the increasing amounts of back surgeries, prescription drug use, and epidural injections that are performed each year (which are not really improving the overall rate of back pain, but that's a topic for another article…) In 2011, 61% of patients received Medical treatment (M.D.) for their spinal pain, while only 28% of patients received Chiropractic treatment (D.C.). Among the Medical treatments offered, one of the most common is prescription non-steroidal anti-inflammatory drugs (NSAIDs).

One recent study, published in Spine, was a double-blinded randomized controlled comparing the effects of one of the most common prescription NSAIDs, Diclofenac, to chiropractic adjustments (aka spinal manipulation). In this study patients with acute low back pain were divided into 3 groups: one group receiving Diclofenac and a sham adjustment; one group receiving a placebo pill and a chiropractic adjustment; and one group receiving a placebo pill and a sham adjustment.

The results of this study found that the group receiving the chiropractic adjustment had significantly greater improvements in their levels of pain and also needed less days off work than the group prescribed Diclofenac.

Therefore the results of this study suggest that 61% of patients with acute low back pain are probably making the wrong choice when they seek medical treatment first for their injury if they are given the common treatment - prescription NSAIDs. However, those patients who seek chiropractic treatment for their acute low back pain are, based on the results of this rigorous study, making the best choice.

1. Von Heymann WJ, Schloemer P, Timm J, Muehlbauer B. Spinal high-velocity low amplitude manipulation in acute nonspecific low back pain: a double-blinded randomized controlled trial in comparison with diclofenac and placebo. Spine (Phila Pa 1976). 2013 Apr 1;38(7):540-8.

What is THE Best treatment for Low Back Pain?

There are many different treatment options available for those suffering with low back pain, and it only takes a quick Google search to learn that they all claim to be the best. But is low back pain really so straightforward that one type of treatment can be the best for everyone? The answer (hint: "no") may seem obvious to many, but unfortunately many health care providers seem to think that their treatment, whether it is medication, surgery, manipulation, exercise, massage, duct tape, or whatever, will be THE BEST for everyone. Why does this happen so often? Well, to paraphrase an old saying- if all you have is a hammer, everything starts to look like a nail.

Fortunately, a new study, published in the journal Spine, may have the ability to help shake some of those people out of their bad habits by reminding them that every case of low back pain is unique. In this study, the biomechanics (movement patterns, muscle forces, range of motion) were measured in 4 different individuals suffering with low back pain. Based on these findings, each person was given a treatment plan which included a unique combination of manual therapies (manipulation, exercise, massage) to help improve that person's movements in order to decrease their low back pain. The results of this study found that all 4 subjects significantly reduced their pain immediately once the specific mechanical changes were made!

The authors of this study conclude;

"Immediate pain reduction can be achieved by altering muscle-activation and movement patterns. However, the combination for optimal success seems to be different for every individual."

Therefore, this study highlights the importance of a thorough examination to determine the different underlying factors that cause each person's low back pain. Every episode of back pain may be unique, but when the cause can be specifically determined, finding the best treatment for that person becomes easy!

  1. Ikeda DM, McGill SM. Can altering motions, postures, and loads provide immediate low back pain relief: a study of 4 cases investigating spine load, posture, and stability. Spine (PhilaPa1976). 2012 Nov 1;37(23):E1469-75.

Why does Whiplash Hurt?

Car crashes represent one of the most common causes of injury in society today. Most of these crashes occur at low speeds (a.k.a. "fender benders"), but even these low speed collisions result in Whiplash injuries that have serious negative impacts on quality of life. But why do whiplash injuries hurt so much, and what exactly happens that causes so much pain and disability?

Recently a study published in the Journal of Orthopedic and Sports Physical Therapy analyzed the presence of Trigger Points (TrP) in people who had suffered a Whiplash injury compared to people who had not. In this study TrPs were measured in several muscles of the head, neck, and shoulders. Neck ranges of motion and overall pain sensitivity to pressure in different areas of the body were also measured.

The results of this study found that the patients in the Whiplash group had, on average, 7.3 TrPs in the muscles of their head, neck, and shoulders compared with only 1.7 TrPs found in the normal population. They also found that there were strong links between an increased number of TrPs and an increased sensitivity to pain, as well as a decrease in neck range of motion.

Therefore the authors of this study conclude that Whiplash injuries cause an increase in trigger points in the muscles of the head, neck, and shoulders. This increase in trigger points is also related to a decreased range of motion in the neck and a widespread increased sensitivity to pain throughout the body.

So, to prevent Whiplash injuries from developing into chronic life altering conditions, treatments aimed at healing trigger points and maintaining neck range of motion, such as chiropractic adjustments, soft-tissue mobilization, rehabilitative exercises, and massage therapy will provide the best long-term solutions.

  1. Fernández-Pérez AM, Villaverde-Gutiérrez C, Mora-Sánchez A, Alonso-Blanco C, Sterling M, Fernández-de-Las-Peñas C. Muscle trigger points, pressure pain threshold, and cervical range of motion in patients with high level of disability related to acute whiplash injury. J Orthop Sports Phys Ther. 2012;42(7):634-41.

Is your Scapula causing your Chronic Neck Pain?

Some people with chronic neck pain have difficulty finding relief through traditional routes (chiropractic adjustments, medication, massage, physical therapy, etc…). If serious disease processes are ruled out, this mechanical type of neck pain will continue to occur because the offending cause is never addressed. There is usually some factor beneath the surface that persists in putting stress on the neck and bringing the pain back again. One activity that can often cause the recurrent type of neck pain is known as scapulo-thoracic dysfunction (translation = shoulder blade problems).

One recent study compared trapezius muscle activation during scapular (aka shoulder blade) movements in people with chronic neck pain to those without neck pain. In this study muscle activation of the upper trapezius, middle trapezius, and lower trapezius muscles were all measured during three different shoulder movements.

The results of this study found that the lower trapezius muscle behaved significantly different in those patients with chronic neck pain compared to those without, especially in the movements of abduction and external rotation.

Therefore the authors concluded that alterations in scapular function may play a large role in the persistence of chronic neck pain, and that those suffering from this condition may benefit from re-training their scapular movements with an emphasis on strengthening the lower trapezius muscle.

  1. Zakharova-Luneva E, Jull G, Johnston V, O'Leary S. Altered trapezius muscle behavior in individuals with neck pain and clinical signs of scapular dysfunction. J Manipulative Physiol Ther. 2012 Jun;35(5):346-53.

How to Prevent ACL Injuries

Anterior Cruciate Ligament (aka ACL) injuries are relatively common in athletes of all ages. The consequences of this serious impairment include short-term pain and disability, and, even with corrective surgery, most will develop knee arthritis at a young age as a result. Therefore, anything that can be done to prevent these injuries can have a dramatic impact on quality of life, and for athletes, prolonging their athletic careers.

One recent study from the Journal of Clinical Orthopedics and Related Research reviewed the best evidence to date on risk factors of ACL injuries, best ways to decrease those risk factors, and when is the optimal time to maximally decrease risk factors.

The results of this study found that some of the biggest risk factors for ACL injuries are: decreased hamstring strength, poor core stability and balance, knee abduction ("knocked knees") during landing or cutting movements, and a history of low back pain.

The best techniques to minimize these risk factors were found to be: plyometric & balance training, specific leg strength training (especially the hamstrings), and exercises aimed at improving the coordination of muscle and joint movement.

Research was also found that demonstrated early puberty may be the best time to begin these training techniques in order to best decrease the risk of ACL injury, especially in female athletes.

Therefore the conclusions of this study suggest that ACL injuries CAN be prevented with proper training focused on controlling knee movements and balancing muscle strength, and the best time for athletes to start is early puberty.

  1. Hewett TE, Myer GD, Ford KR, Paterno MV, Quatman CE. The 2012 ABJS Nicolas Andry Award: The Sequence of Prevention: A Systematic Approach to Prevent Anterior Cruciate Ligament Injury. Clin Orthop Relat Res. 2012 Jun 29.

All Calories are NOT Created Equal

One of the hardest challenges of losing weight, is keeping that weight off for good. This is such a difficult feat, that only 1 in 6 people who lose weight will keep it off long-term. One reason is because as a person's body weight decreases, so does their metabolism. In other words, as they lose weight their body becomes more efficient and does not need to burn as many calories in their day to day activities.

Recently one study, published in the prestigious Journal of the American Medical Association, compared the effects different weight loss diets have on the metabolisms of people who had recently lost weight. In this study a "low-fat diet", a "low-glycemic index diet", and a "low carbohydrate diet" were compared. Each diet contained the same amount of total calories, and were administered over the course of 4 weeks to participants who had recently lost 10-15% of their body weight. At the end of the four weeks, each person had their blood tests, and ad their metabolic rates measured.

The results of this study found that the greatest decrease in metabolism was seen in the "low-fat diet" group who burned on average 423 less calories per day. The "Low-carbohydrate diet" had the least amount of change in their metabolic rate, however, this group showed significant increases in inflammatory components in their blood that have been linked to heart disease and diabetes (increased C reactive protein, and increased cortisol levels)

Therefore the results of this study suggest that, all calories are NOT created equal. In fact these findings suggest that, with total calorie consumption equal between each diet, the traditional "low-fat diet" will slow down metabolism, thus making it harder to maintain weight loss. A "low-carbohydrate diet", similar to Atkins or Paleo, will prevent this slow down in metabolism, but may increase inflammation. The "low-glycemic diet" is recommended by the authors of this research on the basis that still prevents a large decrease in metabolism without an increase in inflammatory markers, and also may be the easiest for most people to comply with over a long period of time.

  1. Ebbeling CB, Swain JF, Feldman HA, et al. Effects of Dietary Composition on Energy Expenditure During Weight-Loss Maintenance. JAMA. 2012;307(24):2627-2634.

Should you drink a Slurpee before Running?

We may not have this problem here in Olympia, but this time of year many athletes in other parts of our country have the challenge of exercising in the summer heat. Besides being more uncomfortable, higher temperatures also increase fatigue during exercise, primarily due to dehydration and increase body temperature. The obvious way to prevent this problem is by drinking cold water. However, there is also a less obvious solution might prove to be a better choice.

A recent study looked at the performances of runners in a hot environment after drinking water or a flavored icy slushy (like a Slurpee). In this study each runner ran until exhaustion in 93 degree heat, on a treadmill with a progressive speed increase. One day the runners drank cold water 30 minutes before they ran, and the other day they drank the same amount of a flavored icy slushy. Body temperature was taken before drinking, before the beginning of the run, and immediately after the runner reached exhaustion.

The results of this study found the runners were able to run, on average, 10 minutes longer (50 min vs. 40 min) after drinking the flavored icy slurry. They also found that the icy slurry lowered body temperature more than the cold water before the run began. Conversely, the runner's body temperature was higher at the end of the run in the group that drank the flavored icy slurry.

Therefore the results of this study suggest that drinking a Slurpee, or similar icy drink before exercising in hot weather can increase your endurance, and help you last longer.

  1. Dugas J. Ice slurry ingestion increases running time in the heat. Clin J Sport Med. 2011 Nov;21(6):541-2.

Do Viruses Like Vitamin D?

Vitamin D has long been known for helping build strong bones, but in the past decade research has shown that this vitamin plays an important role in a much wider range of functions than previously thought. One of the major sources of Vitamin D is sunlight, and the reasons more people get sick in the winter might be related to the decreased exposure to sunlight during the darker, shorter days resulting in lower Vitamin D levels.

One new experiment published recently looked at how Vitamin D levels change as we age, and the effect Vitamin D in our blood can have on our immune system. In this study, vitamin D levels were measured in over 70 persons of varying ages. The function and production of certain immune system proteins known as toll-like receptors were also measured in these same people.

The results of this study found that Vitamin D levels decreased in older persons and decreases in Vitamin D levels were correlated with a decrease in the function of toll-like receptors (specifically TLR7, which fight viruses).

Therefore, this study concludes that Vitamin D certainly plays a role in our immune function, and supplementing with Vitamin D may help us resist viral infections, especially in older populations and in the winter months.

  1. Alvarez-Rodriguez L, Lopez-Hoyos M, Garcia-Unzueta M, Amado JA, Cacho PM, Martinez-Taboada VM. Age and low levels of circulating vitamin D are associated with impaired innate immune function. J Leukoc Biol. 2012 May;91(5):829-38.

The Right Warm-up to Increase Vertical Jump

Athletes may be some of the most superstitious people on the planet. Their beliefs can lead them to wear the same pair of socks for an entire season or take shots of hot sauce before a game. For the most part these superstitions are harmless, but one area where superstition may actually be detrimental to their performance is their warm-up routine.

Most warm-up routines are not given much thought by athletes, and usually just consist of doing whatever they have always done. But new research is showing that not all warm-up routines are created equal, and certain warm-ups might improve strength, vertical jump, and explosiveness.

One recent study published this month in the Journal of Strength and Conditioning Research compared two stretching warm-up protocols in female soccer and rugby players. In this study, each athlete participated in 3 different test sessions. Each session was begun with a different warm-up routine. One session warm-up was 10 mintues on a stationary bicycle. Another session began with 10 minutes on a stationary bicycle followed by traditional static stretching. The other session was begun with 10 minutes on a stationary bicycle followed by a dynamic stretching routine. In each of these test sessions, after the warm-up, vertical jump flight time and a measurement of explosiveness (reactive strength index) was measured.

The results of this study found that the athletes performed significantly better on their vertical jump flight time and explosiveness tests after performing the dynamic stretching routine, when compared with the other two warm-up routines.

Therefore this study concludes that a dynamic stretching warm-up routine can help improve the performance of athletes, especially in sports requiring jumping and explosiveness (basketball, volleyball).

  1. Werstein KM,LundRJ. The effects of two stretching protocols on the reactive strength index in female soccer and rugby players. J Strength Cond Res. 2012 Jun;26(6):1564-7.

Can Laser Therapy Improve Bone Healing?

Fig. 1: Low-Level Laser Therapy Treatment

Bone injuries can come in all shapes, sizes, and locations. They can range in severity from a minor bone bruise all the way to a complete fracture (aka break). We can have overuse injuries leading to stress fractures, or freak accidents leading to severe deformities. Therefore it is obvious that the recovery time from these injuries will also vary greatly. Generally speaking an injury to a bone can heal in as fast as 3 weeks or take as long as 6 months. But what if there was a way to accelerate the healing in bone and reduce this recovery time for any type of bone injury?

A recent study in the journal Photochemistry and Photobiology looked at the effects Low Level Laser Therapy (LLLT) has on injured bone tissue in rats. In this study fractures of the femur were treated with LLLT and biopsies were periodically taken and compared to femur fractures that were not being treated with LLLT. The results of this study found that many of the chemicals and substances that are needed to repair bone were significantly increased in the bones being treated with LLLT. Overall time required for the bone repair was less in the group treated with LLLT.

Therefore the authors of this study conclude that Low Level Laser Therapy can significantly decrease the recovery time from broken bones by accelerating the bone repair on a cellular level.

  1. de Souza Merli LA, de Medeiros VP, Toma L, Reginato RD, Katchburian E, Nader HB, Faloppa F. The Low Level Laser Therapy Effect on the Remodeling of Bone Extracellular Matrix. Photochem Photobiol. 2012 May 14. doi: 10.1111/j.1751-1097.2012.01172.x

How You can Make your Baby a Good Sleeper?

As the father of a 2 year old boy, and with another newborn on the way, I am very familiar with the 'unique' sleeping schedules that come with being a parent. I am also familiar with no less than a dozen different theories on the best techniques to get your child sleeping through the night. Each of these techniques is espoused as the best by their particular followers. But a recent look at the scientific literature on this subject revealed that quite a lot of research has been done and not all techniques are created equal.

One of the largest research studies to date was a review published in the journal Sleep looking at different behavioral treatments for sleep problems in infants. This paper reviewed all the major experiments that had been previously published and compared their results. The types of treatment strategies used in these experiments were broken down into 5 different categories.

  1. Extinction –a.k.a. "cry it out"
  2. Graduated Extinction a.k.a. "ferberizing" or cry it out for specific amounts of time
  3. Positive Bedtime routines
  4. Scheduled awakenings: waking baby up at night before they wake up on their own
  5. Parent education & prevention –teaching the parents good habits from the beginning

The results of this study found that all of these approaches improved the sleeping in infants and young children at least a little. Very good results were seen with the "cry it out" experiments, but this technique proved challenging for many parents to be consistent with. Ultimately however, the technique that produced the most dramatic results was "Parent education & prevention". In one of these experiments, 100% of the babies in the Parent education & prevention group were sleeping through the night by 8 weeks of age compared to only 23% of the control group! Another experiment in this approach found that 72% of babies were able to sleep through the night at 3 weeks of age!

The major component of the "Parent education & prevention" treatment was an emphasis on training the baby shortly after birth to begin to recognize the difference between night and day. This was accomplished by giving the baby a focal feed every night between 10:00PM and midnight starting in the first few days of life, and only picking the child up at night if they were crying for more than a minute. At 3 weeks the parents were then instructed to avoid any feedings between midnight and 5:00 AM. If the baby began crying during that time, alternative soothing strategies were used (re-swaddling, patting, diapering, walking) and only if all of these failed to soothe the baby would feeding be allowed.

So the results of this study conclude that behavioral approaches can make a difference in how well your baby sleeps at night, and starting the "Parent education & prevention" approach at an early age might be the best approach for both the parents and the baby.

  1. Jodi Mindell et al. "Behavioral treatment of bedtime problems and night wakings in young children: An AmericanAcademyofSleep Medicine Review." Sleep 29 (2006):1203-76

Icy Hot versus Bengay?

There are dozens of different pain relieving creams, gels, and ointments available in drug stores and doctors offices everywhere. And they all claim to be more effective than the other "leading brands". But which one works the best for muscle soreness and trigger points that make up the most common consumer complaints?

A new study published this month compared the effectiveness of 5 of the most popular over-the-counter topical pain relievers for neck and shoulder muscle pain. The products studied in this experiment were: Bengay Ultra Strength Muscle Pain ointment, Professional Therapy MuscleCare Roll-on, Motion Medicine cream, Icy Hot Extra Strength Cream, and Biofreeze Roll-on gel. All of which, were also compared to a placebo ointment with no medicinal properties.

In this study, 120 people had painful trigger points located in their upper trapezius muscle. Range of motion and pressure sensitivity measurements were taken before a mystery pain reliever (one of the six) was applied their muscle. Approximately 10 minutes later, new measurements were taken to see if any improvements had occurred.

The results of this study found that the only pain relievers significantly better than placebo at decreasing pain were Bengay Ultra Strength Muscle Pain ointment and Professional Therapy MuscleCare Roll-on. Additionally, only the Professional Therapy MuscleCare Roll-on had statistically significant advantages over the Icy Hot Extra Strength Cream.

Therefore, this study concludes that Bengay Ultra Strength Muscle Pain ointment is more effective than Icy Hot Extra Strength Cream, but Professional Therapy MuscleCare Roll-on outperformed them all.

  1. Avrahami D, Hammond A, Higgins C, Vernon H. A randomized, placebo-controlled double-blinded comparative clinical study of five over-the-counter non-pharmacological topical analgesics for myofascial pain: single session findings. Chiropr Man Therap. 2012 Mar 21;20:7.

Are You Stronger Wearing a Mouth Guard?

We have all seen mouth guards used in athletics to protect teeth, especially in contact sports like football. These traditional mouth guards offer protection from heads, shoulders, knees, and yes, even toes. But a new type of mouth guard is becoming popular lately claiming that it can not only protect your mouth, but it might even make you a better athlete. The theory is that with a properly fitted piece, your jaw and spine can be properly aligned helping keep a stronger posture and ultimately providing improved athletic performance.

This month a new study was published in the Journal of Strength and Conditioning Research that examined the effects of different mouth guards on strength and power in athletic men and women. In this study 26 men and 24 women underwent exercise tests on three separate occasions. During one test they would wear a customized Power Balance performance mouth guard, another test they would wear a regular over the counter mouth guard, and the other testing session they would wear no mouth guard. Among the exercise tests they performed included sit and reach flexibility, balance testing, vertical jump, 10 meter sprint, bench throw, and a plyometric press test.

The results of this study found there was no difference between the groups for most tests. However, bench throw strength was greater for both men and women while wearing the Power Balance performance mouth guard, and men also seemed to show some increases in vertical jump and plyometric press tests while wearing the Power Balance performance mouth guard.

Therefore this study concludes that there may be some truth behind the claims that certain mouth guards can improve athletic performance by increasing strength and power in upper body exercises and perhaps even vertical jumping.

  1. Dunn-Lewis C, et al. The Effects of a Customized Over-the-Counter Mouth Guard on Neuromuscular Force and Power Production in Trained Men and Women. J Strength Cond Res. 2012 Apr;26(4):1085-93.

Can Omega-3 Fatty Acids Protect your Brain from Obesity?

Fig. 1: A man using a large percentage of his brain.

Metabolic syndrome is defined as a group of risk factors that are usually seen in combination and all cause an increase in heart attacks, strokes, and type II diabetes. The prevalence of metabolic syndrome is rising dramatically in our country and the most common symptoms include "apple-shaped" obesity, insulin resistance, and high blood pressure. But could this condition actually cause brain damage as well…and is there anything we can do to prevent it?

Recently a report published in the Journal of Physiology studied the effects metabolic syndrome and changes in dietary levels of omega-3 fatty acid can have on brain function.

What the researchers found is that a diet deficient in omega-3 fatty acids makes it harder for the brain to build new connections (in other words – learn new things) and it also resulted in memory impairment in rats. When this omega-3 fatty acid deficient diet was combined with metabolic syndrome each of these brain problems worsened significantly. However, when the metabolic syndrome remained, and omega-3 fatty acid levels were returned to normal in the diet, all of the brain deficiencies disappeared. Therefore the authors concluded that omega-3 fatty acids offer a protective benefit to your brain against the harmful effects of metabolic syndrome.

So the results of this study suggest that omega-3 fatty acids are important for optimal brain function in everyone; but for those suffering from metabolic syndrome related conditions such as obesity, diabetes, or high blood pressure the argument is even stronger for making sure this valuable nutrient plays a prominent role in what you eat.

  1. Agrawal R, Gomez-Pinilla F. "Metabolic syndrome" in the brain: Deficiency in omega-3-fatty acid exacerbates dysfunctions in insulin receptor signaling and cognition. J Physiol. 2012 Apr 2. [Epub ahead of print]

Can you treat Chronic Low Back Pain with Knowledge?

Chronic low back pain is the most common cause of long term disability among workers today, and the costs to society are enormous. Seven to ten percent of every case of back pain will become chronic, and these chronic conditions account for 80% of all costs associated with low back pain. This problem is confounded by the wide disagreement over what are the best treatments for people suffering with chronic low back pain. What has become clear is that traditional medical management of chronic low back pain is ineffective.

A new study looked at the ability of a multi-disciplinary treatment regimen in reducing pain and disability associated with chronic low back pain. This multi-disciplinary approach focused on combining physical treatments and exercise with educational treatments aimed at helping patients better understand their pain, reducing their fear of movement, and learning techniques to protect their back in their daily life.

The results of this study, which included almost 400 patients who had missed at least 6 weeks of work due to back pain, found that improvements in pain, disability, and overall quality of life were significant and most of the improvements remained 6 months after the treatments ended as well.

This is an important study because it sheds light on the huge role the brain plays in chronic low back pain. Oftentimes in these cases there are no injured tissues in our backs, but our bodies have maladapted in a way that causes our brains to interpret normal stimulus as painful. If this aspect of chronic low back pain is neglected, which is traditionally what happens, chronic low back pain will continue to be a disproportionate cost to health care and society.

Therefore, the conclusions of this study show multi-disciplinary treatments can be a very effective approach for treating chronic low back pain, and this study reminds us that patients will feel better when they are given better information to help them understand the pain they may be feeling.

  • Here is a short video that does a good job explaining chronic pain in an easy to understand way.
  1. Moradi B, Hagmann S, Zahlten-Hinguranage A, Caldeira F, Putz C, Rosshirt N, Schönit E, Mesrian A, Schiltenwolf M, Neubauer E. Efficacy of multidisciplinary treatment for patients with chronic low back pain: a prospective clinical study in 395 patients. J Clin Rheumatol. 2012 Mar;18(2):76-82.

Which Manual Therapies are best for Cervicogenic Headaches?

Headaches can be one of the most frustrating illnesses to deal with. Even a mild headache can make it difficult to concentrate or perform simple daily routines. What can make headaches even more frustrating on top of that is that often there is little a person can do to find any relief. Certain types of headaches, such as cervicogenic headaches, can not usually be treated effectively by medication or other traditional approaches. However, chiropractic adjustments have long been proposed as a helpful remedy to these types of headaches which don't seem to respond to anything else.

This month a new study was published by the Journal of Headache and Pain reviewing all the research currently available on chiropractic adjustments and cervicogenic headaches. The researchers found several studies that experimented with this treatment. Their results found that most studies demonstrated significant decreases in headache frequency, headache intensity, and neck pain when treated with chiropractic adjustments. The chiropractic adjustment groups also outperformed groups receiving massage, physical therapy, and placebo treatments.

Therefore the results of this new study show there is a growing body of evidence demonstrating that Chiropractic Adjustments are the most effective treatment for cervicogenic headache.

  1. Chaibi A, Russell MB. Manual therapies for cervicogenic headache: a systematic review. J Headache Pain. 2012 Mar 30. [Epub ahead of print]

Do Curveballs Injure Little League Baseball Pitchers?

Injuries of little league baseball players, and especially pitchers, have been a major concern in athletics for a long period of time. The motion of throwing a baseball puts a large demand on the muscles and joints of the shoulder and elbow. These stressful effects are magnified in younger athletes who throw the ball a lot, such as the pitchers and catchers. For a long time it has been thought that throwing curveballs, which involve more twisting of the arm and shoulder during the throwing motion, was the predominant cause of pitching injuries to little league players. Therefore, players were told not to start throwing curveballs before the age of 13 years old.

However, despite these warnings, the incidence of pitching injuries and their associated surgeries has continued to rise in young athletes. Recently a large, 10-year study was published by the American Journal of Sports Medicine that shed some light on the possible explanation for this phenomenon.

In this study, 480 little league pitchers, ages 9-14, were tracked over the course of 10 years. Injuries (defined as shoulder surgery, elbow surgery, or retirement due to throwing injury) were recorded and the overall data was analyzed to discover trends that could help predict future injuries.

The results of this study found that the overall risk of serious injury was 5%. Players who began throwing curveballs before the age of 13 were found to have no additional risk of pitching injury. However, players who pitched more than 100 total innings in 1 calendar year were 3.5 times more likely to suffer a serious injury!

Therefore this study concludes that the main cause of serious injury to little league pitchers, is not throwing curveballs, but rather it is more likely caused by throwing too many pitches overall in a single year.

  1. Fleisig GS, et al. Risk of serious injury for young baseball pitchers: a 10-year prospective study. Am J Sports Med. 2011 Feb;39(2):253-7. Epub 2010 Nov 23.

Is Beef Still for Dinner?

From fast food drive-in hamburgers to ground beef tacos to that juicy steak for dinner; no source of protein may be more of a fixture in the standard American diet than Beef. This, and other sources of red meat are not the only sources of high-quality protein available for us to choose from, but they are by far our most common choice. However, more and more research is suggesting this may not be a smart choice on our part, and the evidence continues to pile up demonstrating how red meat may play a role in many chronic health conditions.

One study published this month in the Archives of Internal Medicine looked at the health and eating habits of over 100,000 Americans through the course of more than 20 years. Death rates from cardiovascular disease and cancer were collected and compared to other health and diet measures.

The results of this study found that, on average, every 1 serving per day of red meat increased each person's risk of death from cardiovascular disease by 18% and risk of death from cancer by 10%. The authors conclude that substituting 1 serving per day of red meat with a healthier protein source (for example fish, nuts, or legumes) can offer an even greater protective benefit against these fatal diseases.

Therefore the results of this study strongly suggest that red meat is an unhealthy choice of protein to be regularly included in our diets, and high intakes over a lifetime puts people at a significantly greater risk of dying from cardiovascular disease or cancer.

  1. Pan A, et al. Red Meat Consumption and Mortality: Results From 2 Prospective Cohort Studies. Arch Intern Med. 2012 Mar 12.

Do Ice Baths Decrease Muscle Soreness?

Many people know that putting ice on an injury is an important step to help reduce inflammation and help improve the healing process. However many athletes have, for years, subjected themselves to the uncomfortable feeling of sitting in an ice bath after workouts even when no injury took place, with the hope of decreasing soreness in the coming days. But do these ice baths actually have any effect on reducing muscle soreness after exercise?

A new review study recently compiled all the research that has been done up to this point looking at the effect of these ice baths on reducing muscles soreness in athletes after exercise. They found studies comparing ice baths to active recovery, ibuprofen, compression garments, hot/cold alternation, and to passive rest. Over 14 studies compared ice baths to passive rest, and the combined results found that there is a significant decrease in soreness 1, 2, and even 4 days after exercise for the athletes using the ice baths compared to passively resting. There were also studies that found the ice baths reduced the amount of fatigue in athletes and helped improve their perceived physical recovery.

So the results of this study suggest that sitting in an ice bath after exercise is an effective strategy to reduce delayed onset muscle soreness in the following days, and may help decrease fatigue as well.

  1. Bleakley C, McDonough S,GardnerE, Baxter GD,HopkinsJT, Davison GW. Cold-water immersion (cryotherapy) for preventing and treating muscle soreness after exercise. Cochrane Database Syst Rev. 2012 Feb 15;2:CD008262.

How Little Exercise Do You Need?

The American Heart Association and many other groups recommend 30 minutes of exercise 5 days per week for good overall health (150 minutes per week total). Unfortunately, despite mountains of evidence showing us the clinically proven, cost-effective benefits of exercise, most Americans do not come close to this mark when it comes to their routine physical activity. The biggest barrier for most people when it comes to exercise is a perceived lack of time. But do we really need this much exercise, or is there a better, more efficient way to achieve good health?

Recently high-intensity interval training has begun to gain popularity as more research demonstrates the benefits of this unique approach. A new study looked at the effects of this training approach on the metabolism of sedentary adults. In this study each person completed 6 training session over 2 weeks. Each session lasted only 20 minutes and consisted of stationary cycling at 60% of maximum power for 1 minute, followed by 1 minute of rest, repeated 10 times. Metabolic measurements were taken before and after the 2 week exercise program.

The results found that this 2 week training session significantly increased each person's ability to burn calories and dramatically decreased their insulin sensitivity, among other positive metabolic changes.

Therefore, the results of this study conclude that high-intensity interval training performed for 3 times per week for 20 minutes each session (60 minutes per week total) can significantly improve metabolism and likely decrease the risk of lifestyle diseases like diabetes and cardiovascular disease.

  1. Hood MS, Little JP, Tarnopolsky MA, Myslik F, Gibala MJ. Low-volume interval training improves muscle oxidative capacity in sedentary adults. Med Sci Sports Exerc. 2011 Oct;43(10):1849-56.

Is Diet Soda good for your Heart?

Many people drink diet soda as an alternative to traditional soda in an attempt to lose weight or prevent weight gain. The benefits of maintaining a healthy weight are well known and too numerous to list, but include a lower risk of all the major causes of death in our country such as cancer, stroke, diabetes, and heart attacks. So therefore, in theory, drinking diet soda should also indirectly help reduce these lifestyle diseases.

Well a new study looked at the health of diet soda drinkers over the course of 10 years to see if there was an association with rates of cardiovascular disease (heart attacks and strokes). In this study over 2500 participants were divided into three groups based on their dietary assessments: 1) No diet soda consumption 2) Light diet soda consumption 3) Daily diet soda consumption

The results of this study found that daily diet soda drinkers were 40% more likely to have a heart attack or stroke during the 10 year study period. This increased risk for cardiovascular disease was still seen when results were adjusted to account for differences in age, weight, smoking, physical activity, and other known health risk factors. There was no increased risk associated with light diet soda drinkers.

So, the results of this study indicate that daily consumption of diet sodas will actually increase your risk of developing cardiovascular disease and suffering from a heart attack or stroke.

  1. Gardener H, Rundek T, Markert M, Wright CB, Elkind MS, Sacco RL . Diet Soft Drink Consumption is Associated with an Increased Risk of Vascular Events in the Northern Manhattan Study. J Gen Intern Med. 2012 Jan 27.

The Back Bone's Connected to the Neck Bone

Has your neck been killing you, but you've been afraid to let anyone touch it because you've seen too many Steven Seagal movies? Well, remember that song, "The hip bone's connected to the back bone. The back bone's connected to the neck bone…."? Well it turns out that song your child's been singing since kindergarten may be able to help you get rid of that neck pain you've been having without even touching your neck.

Recently researchers published a study in the Journal of Orthopedic and Sports Physical Therapy that looked at the effects of thoracic spine adjustments (mid-back adjustments) on neck pain. In this study they reviewed over 40 different experiments looking at this treatment option and its effects on neck pain, range of motion and quality of life.

What they found was that there was a significant decrease in neck pain levels and an improvement in quality of life after thoracic spine adjustments. In fact, there were also improvements in neck ranges of motion after the mid-back adjustments!

So, the researchers concluded that getting your mid-back adjusted can be an effective treatment for mechanical neck pain, thereby once again proving that everything we need to know we learned in kindergarten!

  1. Cross KM, et al. Thoracic spine thrust manipulation improves pain, range of motion, and self-reported function in patients with mechanical neck pain: asystematic review. J Orthop Sports Phys Ther. 2011;41(9):633-42. Epub 2011 Aug 31.

Do iPads equal Neck Pain?

Ipads and other tablet computers have exploded onto the scene of the personal technology revolution. This new breakthrough has made it easier than ever to carry a computer with us everywhere, thus allowing us to access the internet, watch movies, and even predict the future from wherever you are. But does all this new power come with a cost? Well, to your neck and the muscles in your upper back the answer may be yes.

A new study published by researchers from Harvard School of Public Health, in the journalWORK: A Journal of Prevention, Assessment, and Rehabilitation, looked at the effects using ipads and other tablet computers have on your head, neck, and upper back. Researchers found that there are 4 common positions people use their tablet computers which are: held with hands on the lap, on the lap in a case, on a table set in a case, and on a table in a case set at a high angle.

During the study subjects were asked to perform simple computer tasks such as surfing the internet and playing games. While this was being done measurements were taken to record the position of the head and neck posture. Researchers found that all the positions except one consistently put people's posture at extreme angles of head and neck flexion that are associated with neck and upper back pain. The tablet position that appears to be safest for head and neck posture is on a table in a case set at a high angle.

Therefore, the results of this study conclude that setting your tablet computer on a table at a high angle while in use is the best position to prevent neck and upper back pain.

  1. J.G. Young, M. Trudeau, D. Odell, K. Marinelli and J.T. Dennerlein. Touch-Screen Tablet User Configurations and Case-Supported Tilt Affect Head and Neck Flexion Angles.WORK41(1) (2012), pp. 81-91. DOI 10.3233/WOR-2012-1337.

How to Run Faster

Every athlete is always looking for an extra edge, no matter which sport they play. But what that edge is exactly may can vary from sport to sport. Speed, however, is one strength that will help just about any athlete in every sport.

This month the Journal of Strength and Conditioning Research published a study that reviewed all the current research available looking at the effect of plyometric training on sprint performance. Plyometric training exercises are high intensity explosive movements, and have traditionally been used for training quickness and jumping ability. In this new study researchers looked to see what specific type of plyometric training programs had the largest effect on improving speed and sprinting performance.

After compiling the results from 26 different experiments, the authors found three major training trends for the athletes who made the biggest gains: plyometric training for less than 10 weeks consecutively; at least 15 plyometric sessions during the period; high intensity programs with more than 80 total jumps per session. Also, the authors found that no additional benefits were seen when plyometrics were performed with added weight.

So, the authors of this study concluded that plyometric training is an effective strategy for significantly increasing sprinting speed when done with enough frequency during a period lasting no longer than 10 weeks.

  1. De Villarreal ES, Requena B, Cronin JB. The effects of plyometric training on sprint performance: a meta-analysis. J Strength Cond Res. 2012 Feb;26(2):575-84.

Chiropractic adjustments or Medication for Neck Pain?

What gives you a pain in your neck? Maybe it's your job, maybe it's something else, but either way, you're not alone. Almost 75% of our population will have neck pain at some point in their life, and the possibilities for treatments are nearly as varied as the causes. However, most people usually turn to medication first to try and fix their neck pain. But recent research is casting doubts on that habit, suggesting that there are safer and more effective alternatives available.

This month the journal "Annals of Internal Medicine" published a study comparing the effectiveness of chiropractic adjustments, medication, and exercise for subacute neck pain. In this study, over 300 people with neck pain were divided into three groups for a 12 week course of treatment. One group received chiropractic adjustments. The second group received medication as prescribed by a medical doctor. The third group was assigned a series of home exercises to complete. After 12 weeks pain levels and functional measurements were taken and follow up measurements were also recorded 6 months and 1 year following the end of the treatment.

The results of this study found that both chiropractic adjustment and the exercise groups did better than the medication group. However, the chiropractic adjustment group did the best overall and was significantly better than the medication group. Also, the most serious side effects were seen in the medication group, with 60% of patients reporting side effects of some kind.

Therefore the conclusions of this study suggest that chiropractic adjustments are the safest and most effective treatment for subacute neck pain, followed closely by exercise. So if you can't get rid of that pain in your neck on your own, chiropractic adjustments can help you get to the root of the problem.

  1. Bronfort G, Evans R,AndersonAV, Svendsen KH, Bracha Y, Grimm RH. Spinal manipulation, medication, or home exercise with advice for acute and subacute neck pain: a randomized trial. Ann Intern Med. 2012 Jan 3;156(1 Pt 1):1-10.

How to avoid a Weight Loss Roller Coaster

One of the most challenging aspects of losing weight is avoiding the dieting rollercoaster, where your weight yo-yos back and forth with each new fad diet that comes along. Not only does this usually lead to a gradually escalating bodyweight overtime, it also has the psychological effect of making people feel as if there is no hope and that nothing will work.

recently the american journal of preventative medicine published a study attempting to understand why this diet rollercoaster phenomenon exists, and to see if different strategies are required to maintain weight-loss versus the strategies required to lose the weight in the first place. in this study researchers surveyed over 1100 american adults to identify what practices were associated with successful weight loss, and which practices were associated with success at maintaining the weight-loss.

the results of this study found that many of the strategies that are successful in losing weight do not appear to be successful for maintaining that weight-loss. instead they found there are unique strategies consistently used by those who successfully maintain their weight-loss (defined as a 30lb weight decrease maintained longer than 1 year).

strategies for successful weight loss (but not weight-loss maintenance):
  • participate in a weight loss program
  • eat healthy snacks
  • limit the amount of sugar you eat or drink
  • plan what you'll eat ahead of time
  • look for information about weight loss, nutrition, or exercise
  • avoid skipping a meal, including breakfast
  • do different types of exercise
  • do exercise that you enjoy
  • think about how much better you will feel when thinner
strategies for successful weight-loss maintenance (but not initial weight loss):
  • eat plenty of low-fat sources of protein
  • follow a consistent exercises routine
  • reward yourself for sticking to your diet and exercise plan
  • remind yourself why you need to control your weight

so the conclusions of this study suggest that people trying to lose weight will be successful at maintaining their weight-loss when they adopt strategies that are better equipped for long-term weight control versus short-term weight loss.

  1. sciamanna cn, kiernan m, rolls bj, boan j, stuckey h, kephart d, miller ck, jensen g, hartmann tj, loken e, hwang ko, williams rj, clark ma, schubart jr, nezu am, lehman e, dellasega c. practices associated with weight loss versus weight-loss maintenance results of a national survey. am j prev med. 2011 aug;41(2):159-66.

Can Eggs help you Lose Weight?

The common saying "breakfast is the most important meal of the day" has even more truth when trying to lose weight. Skipping breakfast can sabotage even the most dedicated attempts to lose weight because it lays the foundation for a day of unhealthy binge eating. On the other hand, eating a good breakfast can help lay the foundation for a day of moderate and balanced eating that will make it much easier to lose weight. But what are the best types of food to eat at breakfast to help lose weight?

A study published in the journal Nutrition Research recently looked to see what effect eating eggs for breakfast would have on food intake and hunger levels throughout the day. In this study researchers fed two different breakfasts to men on different weeks. Each breakfast had the same total amount of calories, but one breakfast had eggs while the other had a bagel. Each person had their blood drawn every 30 minutes after breakfast and had their hunger levels measured. Three hours after eating their test breakfast, they were given a buffet lunch and asked to eat until satisfied. Total food intake was also recorded for the days before and after the test breakfasts.

The results found when the men ate the egg breakfast they were less hungry later in the day and ended up eating less total calories in the next 24 hours compared to when they ate the bagel breakfast.

So, this study concluded that eating eggs for breakfast can significantly decrease the amount of calories and food eaten throughout the course of the entire day, thereby helping people reach their weight loss goals.

  1. Ratliff J, Leite JO, de Ogburn R, Puglisi MJ, VanHeest J, Fernandez ML. Consuming eggs for breakfast influences plasma glucose and ghrelin, while reducing energy intake during the next 24 hours in adult men. Nutr Res. 2010 Feb;30(2):96-103.

Mom was right, "Chew your food"

Remember when your mom always had to remind you to slow down when eating, and to chew your food properly? Well, it turns out she was right in more ways than she may have known.

Researchers recently tested a theory that obese people may chew differently than others, and wanted to see if changing chewing patterns would affect food intake. The study, published in the American Journal of Clinical Nutrition, measured chewing styles in 30 young men.

The researchers found the obese participants ate food at a much faster rate and chewed their food much less than others. The second phase of the study fed each participant the exact same meal on two separate occasions. Once while instructed to take 15 chews per bite, and again when instructed to take 40 chews per bite. The results found that every person consumed about 12% fewer calories in the meals where they took 40 chews per bite, and hormones that make you feel full where also higher when chewing the food more.

The conclusions of this study show that if you slow yourself down while eating and chew your food about 40 times per bite, you will end up eating less and feeling fuller…a great combination to help lose weight!

So if you are trying to lose weight, or avoid gaining weight, remember what you mom always told you, "Chew your food!"

P.S. Here's a video your mom would want you to watch about chewing your food.

  1. Li J, Zhang N, Hu L, Li Z, Li R, Li C, Wang S. Improvement in chewing activity reduces energy intake in one meal and modulates plasma gut hormone concentrations in obese and lean young Chinese men. Am J Clin Nutr. 2011 Sep;94(3):709-16. Epub 2011 Jul 20.

How can Grapefruit help you Lose Weight?

Losing weight is one of the most popular New Year's resolutions each year. It is also probably one of the single best things many people can do for their health. As we all know by now, obesity dramatically increases the rates of the most common and expensive medical conditions in our country (think diabetes, heart disease, stroke, hypertension, many forms of cancer, and more…). Unfortunately, research tells us that most people who make this resolution will fail. So to help you reach your goal this year, all this month we will look at new and interesting breakthroughs in the field of weight loss research.

We'll start with a study that outlines an easy action step we all can take, before we dive into our meals, which has the promise to help decrease how much food we eat and not leave us feeling hungry afterwards.

A recent experiment published in the journal Nutrition and Metabolism looked at the effects of grapefruit, grapefruit juice, and water on food intake and weight loss. In this study over 80 obese participants were divided into three groups over the course of 12 weeks. One group was instructed to eat a 1/2 grapefruit immediately before each meal. The second group was instructed to drink 5 oz of grapefruit juice immediately before each meal. The third group was instructed to drink 5 oz of water immediately before each meal.

At the end of 12 weeks the results showed that all participants who consumed a low energy-dense preload (grapefruit, grapefruit juice, or water) before eating their meals lost between 12 and 15 pounds and reduced their waste circumference by 3cm to 6cm on average! The participant's total food intake was also significantly decreased despite the fact that they reported their hunger levels unchanged from before the study began. Also, the grapefruit and grapefruit juice groups had significant increases in their good cholesterol levels too, which lowers their risk of heart disease even more.

So, the results of this study suggest that consuming a low-energy dense pre-load (grapefruit, grapefruit juice, or water) before eating your regular meal will help keep you eating less, feeling full, and reaching your weight loss goals.

  1. Silver HJ, Dietrich MS, Niswender KD. Effects of grapefruit, grapefruit juice and water preloads on energy balance, weight loss, body composition, and cardiometabolic risk in free-living obese adults. Nutr Metab (Lond). 2011 Feb 2;8(1):8..

Does Acetaminophen cause Childhood Asthma?

The prevalence of childhood asthma in the United States has nearly doubled since the 1980s. Many attempts have been made to understand what has caused this dramatic increase, with theories ranging from improved hygiene in our homes, to air pollution, or dozens of other possibilities. However, an increasing amount of evidence has begun to link one of the most common over the counter drugs to this asthma epidemic.

The use of acetaminophen in children has also increased considerably since the 1980s, when the dangerous side effects of aspirin in children were discovered. Now acetaminophen is the most commonly used pain relieving and anti-fever medication in children.

A new report published this month in the journal Pediatrics analyzed the most current research available outlining the potential link between acetaminophen and childhood asthma. One study looked at over 500,000 children between the ages of 6-13 years old and found a 50% increase in the rates of asthma in children who had taken acetaminophen in the last year, and a 300% increase in the asthma rate in children who reported taking acetaminophen at least once per month! This link was also seen in rural settings and low income countries where environmental triggers would be less likely to be present. Another study of over 80,000 children ages 6 months to 12 years found that the children who were prescribed acetaminophen were twice as likely to go to the doctor or emergency room for an asthma attack compared to those who were prescribed ibuprofen.

So, the results of this study suggest that there is strong evidence linking acetaminophen use in children to significantly higher rates of asthma. Therefore, the authors recommend in most children, short-term management of fever or moderate pain is best accomplished with nonpharmacologic interventions or ibuprofen.

  1. McBride JT. The association of acetaminophen and asthma prevalence and severity. Pediatrics. 2011 Dec;128(6):1181-5

Will Bon Jovi make You Run Faster?

With the explosion in widespread use of portable music devices such as the ipod in gyms everywhere, headphones are now becoming more popular than shoes. Listening to personal music during warm-ups, lifting weights, and on the treadmill is ever-present. But besides being an enjoyable distraction or a motivational tool, could listening to music actually help you perform better in your activity?

The journal of strength and conditioning research recently asked this question in a study of college running on a treadmill in a high performance lab, with and without personal music listening. Each student performed two 1.5 mile treadmill runs on different weeks, once while listening to music, and once without listening to music. Each subject rated how difficult the run was during and afterwards (their rating of perceived exertion) and their times to complete the 1.5 mile run were also recorded. The results found that the runners performed significantly better on the run while listening to music, shaving almost 30 seconds off their time on average. However, the ratings of perceived exertion was found to be about the same whether they were listening to music or not.

So, the conclusions of this study suggest that, when practical, listening to music during your work-out will help you perform at a higher level (example: run faster), and you won't feel like you're working any harder than usual!

  1. Bonette, Randy et al. The Effect Of Music Listening On Running Performance And Rating Of Percieved Exertion Of College Students. J Strength Cond Res. 2010 Jan; 24:1

Which vegetable can prevent arthritis?

Everyone knows eating vegetables is good for you. A list of all the benefits of vegetables is so long that most people tend to "tune out" any new information that comes up on the topic. Its easiest just to lump it all in to that general category of "vegetables are good for everything" (right next to the category – "exercise is good for everything"). But occasionally new research comes out that is so unexpected, it catches our attention just long enough to hopefully make a little difference in how we eat.

Recently the journal Spine published such a study, which links low back arthritis to specific anti-oxidants found in vegetables. In this study researchers took low back x-rays of over 280 people looking for certain markers of arthritis known as "osteophytes". They then compared these x-ray findings to each persons anti-oxidants levels in their bloodstream. What they found was that people with lower levels of antioxidants were more likely to have signs of arthritis in their back. Even more specifically, the strongest correlation was seen between deficiencies of B-carotene and arthritis.

So, the results of this study suggest that increasing dietary intake of the antioxidant B-carotene is important for preventing low back arthritis in our society. Of course, the best way to increase your levels of B-carotene is by adding more vegetables to your diet. Vegetables that contain some of the highest B-carotene levels include: sweet potatoes, kale, carrots, and spinach.

  1. Imagama S, et al. The effect of β-carotene on lumbar osteophyte formation. Spine (PhilaPa1976). 2011 Jun 13.

Why should You wear Compression Pants?

Trends in sports come and go, with every athlete always trying to get that extra edge over their opponent. Eventually the trend either dies out and becomes forgotten (Reebok Pumps), or establishes itself as a legitimate performance enhancer (weight lifting). One trend on the upswing in sports is the use of compression garments to improve performance and speed up recovery.

Recently the Journal of Strength and Conditioning Research studied the effects these compression garments have on recovery from bouts of high-intensity running. In this study, semiprofessional rugby players performed two 30-minutes treadmill runs, once wearing regular running shorts and once wearing waist-to-ankle compression garments. Lactic acid levels, heart rate, and other metabolic byproducts were measured every 5 minutes during the runs. The results found that when wearing the compression garments the athletes had lower lactic acid levels during and after the run and their heart rate slowed more during the recovery session when wearing the compression garments.

So, since lower lactic acid levels are an indication of muscle recovery, and lower heart rate shows a quicker return to full strength, these results suggest that wearing compression garments may speed up the active recovery process after high-intensity exercise. Ultimately this ability to recharge your body faster when wearing compression garments could improve athletic performance in sports that are made up of short stints of high-intensity action mixed with low-intensity or recovery periods (e.g. football, soccer, hockey).

    Lovell DI, Mason DG, Delphinus EM, McLellan CP. Do compression garments enhance the active recovery process after high-intensity running? J Strength Cond Res. 2011 Dec;25(12):3264-8.

A Heavy Subject: Holiday Weight Gain?

Christmas presents aren't the only thing we gain during the holiday season. Between the time of thanksgiving and New Year's, and all the holidays in between, most Americans will eat more than their fill of turkey, potatoes, stuffing, sweets, pies, and more! All of this, combined with less exercise during the cold dark winter months (I'm looking at you San Diego) leads to the unhealthiest holiday tradition of them all - weight gain. But how much weight do most people actually gain during the holidays?

A study published by the prestigious New England Journal of Medicine looked at this problem and measured the weight gained by healthy subjects during the holidays and compared this to weight gained throughout the year. The results of this study found that the average weight gained between October and the beginning of January was 1.1 pounds. Throughout the rest of the year, there was no trend towards any weight gain or loss.

So, the results of this study suggest that weight gained during the holiday season is usually here to stay and may be almost entirely responsible for the American average of 0.8-1.5 pounds of weight gain per year in adulthood!

However, this research should not be viewed as bad news brought to us by scrooge-like scientists ruining our holidays. Rather, it can help us realize that yes we do tend to gain weight during the holidays, but not a dramatic amount (like the 5-10 pounds some people claim). And with this understanding we can identify small steps to prevent ourselves from falling into this yearly ritual weight gain.

4 Simple Steps to Prevent Holiday Weight Gain:

  1. Walk After You Eat
    • It may be cold, but bundle up once a day, go for a 15-30 minute walk, return and warm-up by the fire. (Walking to your car in the parking lot of the mall doesn't count)
  2. Eat your Veggies First
    • Fill up on the green beans, yams, and salad first so there's less room for mash potatoes, stuffing, and pie.
  3. Drink More Water
    • Choose water, because the empty calories from alcohol and soda add -up more quickly during the holidays.
  4. Avoid Buffets
    • At home or in a restaurant, avoid eating buffet style.
  1. Yanovski JA et al. A prospective study of holiday weight gain. N Engl J Med. 2000 Mar 23;342(12):861-7.

Why I'm thankful to live in Olympia: (scientifically speaking)

Normally, in this blog we review medical research that has the potential to help people improve their health, and hopefully live healthier and happier lives. But recently I came across a report that attempts to actually quantify and study the overall quality of life in America. Reading this report made me thankful to live in Olympia.

The Gallup-Healthways Well-being Index is a research project that has now been ongoing for three years which surveys 1,000 Americans daily from different backgrounds all across the country. This survey measures the overall quality of life by assessing six categories of well-being which are scored based upon the scientific analysis of survey responses. These six categories are:

  • Life Evaluation
  • Emotional Health
    • Measures citizens' daily experiences. (smiling, laughing, stress, etc...)
  • Physical Health
    • Measures physical health markers. (sick days, obesity, headaches, etc…)
  • Healthy Behavior
    • Measures lifestyle habits. (smoking, exercise frequency, diet ,etc…)
  • Work Environment
    • Measures perceptions of work environment. (job satisfaction, etc…)
  • Basic Access
    • Citizen's access to necessities. (clean water, safe place to exercise, access to a doctor, etc…)

Recently, the Gallup-Healthways Well-Being Index compiled all the surveys from 2010 and ranked cities, states, and congressional districts based on their overall well-being score. The results concluded that Olympia, Washington had the second highest quality of life among all small cities in the USA! Additionally, Olympia was ranked as the 23rd city overall in the USA for quality of life! The categories that Olympia scored highest on included emotional health, and basic access.

So, during this season of thanksgiving, all of us here in Olympia and the greater South Sound area have one more thing to be thankful this year – that we are fortunate to live in area that has been shown (through research of course!) to have one of the highest quality of life scores in America!

Do you live somewhere else? Click here to find out where your city ranks or to see a more detailed breakdown of the rankings.

Do you live in Olympia? What's your favorite thing about living here?

SOURCE: www.well-beingindex.com

The prevalence of Vitamin D deficiency in America:

Vitamins and nutritional supplements have become big business, with hundreds of choices for consumers to choose from. Some of these supplements are useful for very specific conditions or certain people, while others may have benefits for almost everyone. So how do we know which ones are the most important for us? Well, some of these nutrients can be measured in our bodies and compared to recommended values. Vitamin D is one such nutrient and it has become increasingly popular with every year revealing more information about its importance. But should everyone take Vitamin D supplements?

Earlier this year the journal of Nutrition Research published a study examining the prevalence of vitamin D deficiency in theUnited States. Researchers analyzed Vitamin D levels in over 4400 Americans of varying backgrounds. The overall results found that 41.6% of all people were deficient in Vitamin D, as defined by blood levels less than 50 nmol/L (many experts now consider 75nmol/L the minimum healthy level). The risk of this Vitamin D deficiency was increased in minorities (especially African-Americans and Hispanics), the obese, pregnant women, and those without daily milk consumption.

So, this research shows that Vitamin D deficiency is widespread in our country. These conclusions suggest that at least 4 out of 10 Americans (an underestimation) could benefit from increasing their vitamin D levels with supplementation or other lifestyle changes. Some of these lifestyle changes could include spending more time outside (preferably in the sun) or eating more Vitamin D rich foods.

  • Forrest KY, Stuhldreher WL. Prevalence and correlates of vitamin D deficiency in US adults. Nutr Res. 2011 Jan;31(1):48-54.

Is Turmeric an Effective Treatment for Arthritis?

The joints in your body come in all shapes and sizes. They have different functions, different strengths, and different weaknesses. But one thing that all joint shave is the ability to become arthritic if not taken care of properly. In any joint, arthritis (osteoarthritis, to be specific) results from and increased bony growth and a decreased gap between the bones. However, what causes the pain felt by arthritis sufferers is usually inflammation resulting from these physical changes within the joint. This is what makes anti-inflammatory drugs like ibuprofen effective pain relievers. But these drugs are not suitable for everyone and so natural alternative are good to know.

Recently an experiment published by the Journal of Alternative and Complementary Medicine studied the efficacy of Turmeric supplements for patients suffering from knee osteoarthritis. In this study, 107 patients were divided into two groups for a 6 week trial. One group was given 800mg of ibuprofen daily and the second group was given 2g of turmeric supplement daily. At the end of 6 weeks both groups showed a significant decrease in pain levels and a significant functional improvement. There was no statistical difference found between the ibuprofen and turmeric group.

Therefore the results of this study suggest that turmeric supplements can be equally effective as traditional anti-inflammatory medications for people suffering with knee osteoarthritis.

  1. Kuptniratsaikul V, et al. Efficacy and safety of Curcuma domestica extracts in patients with knee osteoarthritis. J Altern Complement Med. 2009 Aug;15(8):891-7.

Does Sports Chiropractic Care Reduce Athletic Injuries?

Australian Rules football players may be some of the toughest athletes on the planet. Their sport is like American football played without pads. Naturally athletes such as these are going to suffer high rates of injury. It is estimated that Australian Rules football players have the highest rates of non-contact injuries when compared to similar sports such as rugby and American football, and 35% of players will suffer a hamstring strain over the course of one season. But even in a sport as physical and rough as Australian Rules football, there are ways for athletes to prepare themselves to prevent and reduce the number of injuries that occur.

A recent study published in the journal BMC Musculoskeletal Disorders looked at the ability of preventative sports chiropractic care to reduce injuries in Australian Rules football players over the course of one season. The sports chiropractic care in this study included primarily chiropractic adjustments (aka chiropractic manipulation) combined with soft-tissue therapy. Sixty athletes from the semi-professional Victorian Football League (VFL) were recruited for this study and divided into two groups. All athletes received current best practices in medical and sports management, but one group was assigned to also receive chiropractic care in addition. This group received 1 chiropractic treatment per week for 6 weeks, followed by 1 treatment every two weeks for 3 months, and finally 1 treatment per month for the final 3 months of the study.

At the end of the season the different injuries were compared between the groups. The results found that the group receiving sports chiropractic care had a significantly reduced number of lower-limb muscle strains and missed less playing time from non-contact knee injuries.

Therefore, the results of this study show that chiropractic care was effective at reducing the number of injuries in Australian Rules football players and speeding up the recovery process for those players who had knee pain.

  1. Hoskins W, Pollard H. The effect of a sports chiropractic manual therapy intervention on the prevention of back pain, hamstring and lower limb injuries in semi-elite Australian Rules footballers: a randomized controlled trial.BMCMusculoskelet Disord. 2010 Apr 8;11:64.

Do Vitamins Increase the Risk of Prostate Cancer?

Prostate cancer is one of the most common cancers seen in the United States affecting about 16% of all American men in their lifetime. Because of this high prevalence, finding successful methods of preventing this disease can make a profound impact on society. One suggested method of prostate cancer prevention has been supplementing our diets with the antioxidants Vitamin E and Selenium.A study published this month by the Journal of the American Medical Association tested this particular prevention strategy. In this study more than 35,000 men over the age of 50 were divided into four groups. One group began supplementing daily with 400 IU of vitamin E and 200 micrograms Selenium. The second group supplemented with vitamin E and a placebo. The third group supplemented with Selenium and placebo. And the fourth group supplemented with only placebo. These men were followed over the course of 7-10 years and monitored for prostate cancer.

The results of this study found that the risk of prostate cancer was not significantly different in the two groups taking Selenium when compared to the placebo group. But the group supplementing with vitamin E only had a 17% greater risk of developing prostate cancer than those who were only taking a placebo!

Therefore the results of this study suggest that vitamin E supplementation of 400 IU per day does not prevent prostate cancer and can actually increase the risk of men developing this disease. This evidence indicates that when it comes to vitamin E, it may be possible to have too much of a good thing.

  1. Klein EA, et al. Vitamin E and the risk of prostate cancer: the Selenium and Vitamin E Cancer Prevention Trial (SELECT). JAMA. 2011 Oct 12;306(14):1549-56.

Do Multivitamins Make Women Live Longer?

Vitamins are essential nutrients that our body can not produce on its own (with some exceptions), so therefore they must be consumed in our diets or else disease will occur. The food and drug administration has created a recommended daily value for vitamins and other nutrients to help guide people in making healthy diet choices. But it is hard to deny the appealing logic that "if a little vitamin X is good for me, than a lot of vitamin X must be even better!", and this has lead to the widespread popularity of vitamin supplements. However, not all vitamins are created equal, and we are only still beginning to learn how our body deals with excesses of certain nutrients.

One long term study looking at the effects of vitamin supplementation followed older women from Iowa over the course of 22 years. In this study more than 38,000 women self reported their vitamin uses in 1986, 1997, and 2004. Deaths among these individuals were recorded and vitamin users were compared to those who did not take any vitamin supplements. The results of this study found that taking a daily multivitamin seemed to increase risk of death by 2.9% and iron supplements increased risk of death by 3.9%. However calcium supplementation decreased risk of death by 3.8%.

Therefore the results of this study suggest that taking a daily multivitamin or iron supplement does NOT make women live longer, in fact it may increase the risk of death. On the other hand, daily supplementation with calcium does seem to offer protective benefits that may increase life span.

*Authors note: These conclusions should be interpreted cautiously and not be taken to mean that vitamins are bad for your health. Here are a few possible explanations that could explain these surprising conclusions:
  • 2 x as many of the women taking multivitamins were also taking hormone replacement therapy, which has been shown to increase risk of death.
  • The low quality vitamins taken in supplement form were unable to be absorbed and used by their bodies in the same way they are when digested as part of normal food.
  • Taking the multivitamins may give people a false sense of security and make them less likely to make other healthy lifestyle choices in addition to their vitamins, such as exercising, eating healthy, managing stress.
  • Extra intake of vitamins caused harm to the women's bodies.
  1. Mursu J, et al. Dietary Supplements and Mortality Rate in Older Women: The Iowa Women's Health Study. Arch Intern Med. 2011 Oct 10;171(18):1625-33.

How Back Pain Affects Coordination

Every muscle in your body is controlled by specific areas of your brain. The muscles in your body that require fine motor skills and delicate movements take up larger amounts of real estate in your brain. And the more you use/train certain muscles, the more area your brain devotes to that particular muscle group. For example, a guitar player will have a larger area of their brain devoted to controlling the muscles in the hands and fingers, whereas a soccer player will have a larger area of their brain used for the muscles in their feet and ankles. Thus, the amount of brain space used for a specific muscle determines how coordinated that muscle will be.

We have previously reviewed research about how back pain changes your brain, but are people with back pain less coordinated too?

A new study from the journal Spine looked at the areas of the brain that control low back muscles, specifically the multifidus and lumbar erector spinae. These muscles are required for fine control of low back movement and play a large role in low back/core stability. Researchers examined these brain areas in people with and without recurrent low back pain. What they found was that in healthy subjects these two muscle groups were controlled by two distinct areas of the brain. But in those suffering from recurrent back pain, these two muscles began to be controlled by the same area of the brain, thus preventing the muscles from being used individually.

Therefore, the results of this study show that recurrent low back pain is accompanied by changes in the brain that cause a loss of low back muscle coordination. Fortunately, correcting the source of the pain and exercising these specific low back muscles can help restore coordination and break the cycle of recurrent pain.

  1. Tsao H, Danneels LA, Hodges PW. ISSLS Prize Winner: Smudging the Motor Brain in Young Adults With Recurrent Low Back Pain. Spine (Phila Pa 1976). 2011 Oct 1;36(21):1721-7.

How to Predict Shoulder and Elbow Injuries in Baseball and Softball Players

The extreme combination of force, velocity, and range of motion during overhand throwing pushes shoulder and elbow joints to their limits. It's not surprising then that shoulder and elbow injuries are so common in baseball and softball. Fortunately, research is showing us that with proper training, the risk of these injuries can be dramatically decreased.

Fig. 1: External Rotation (ER) and Internal Rotation (IR)

A new study published last month in the American Journal of Sports Medicine studied attempted to determine if shoulder range of motion is predictive of shoulder and elbow injuries in high school softball and baseball players. In this study 246 athletes had their shoulder external rotation (ER), internal rotation (IR), total range of motion (ER+IR), and horizontal adduction (HA) ranges of motion measured prior to their season. All shoulder and elbow injuries were recorded during the season, and the results were compared with the uninjured players. The results found that the players who had a decrease of 25 degrees of IR in their dominant arm were 4 times more likely to suffer an injury, and a 10-20 degree loss of total range of motion doubled the risk of injury.

Therefore, the results of this study indicate that decreases in dominant arm shoulder ranges of motion (specifically internal rotation) is a strong predictor of future shoulder or elbow injury in baseball and softball players, and proper training to maintain healthy range of motion could reduce the risk of injury significantly.

  1. Shanley E, et al. Shoulder range of motion measures as risk factors for shoulder and elbow injuries in high school softball and baseball players. Am J Sports Med. 2011 Sep;39(9):1997-2006. Epub 2011 Jun 17.

Do Heavier People ALWAYS have more Back Pain?

Everyone knows that obesity can lead to many chronic diseases, and it seems intuitive that a heavier person will have more back and joint pain because of that extra pressure from increased weight-bearing. But is total body weight really a predictor for increased back pain? So far most research has revealed surprisingly little correlation between BMI(body mass index) and back pain. A new study however was the first of its kind to examine different types of body weights (total body fat, muscle, arm fat, leg fat) and their relationships to back pain.

In this study participants answered questions about their histories of back pain and disability and had their total body compositions carefully analyzed. The results of this study found a strong correlation between between back pain and the following: total body fat, upper limb fat, lower limb fat, and trunk fat. There was no correlation found between back pain and the amount of muscle mass or lean tissue.

What is interesting about this study is that it does not appear to be the extra weight alone that leads to back pain. But rather these results suggest that the fatty tissue itself has some metabolic properties that may release chemicals associated with inflammatory conditions leading to back and joint pain.

Therefore the results of this study conclude that heavier people are not always at increased risk for back pain, but the more body fat a person has does put them at greater risk for back and joint pain.

  1. Urquhart et al. 2011 Young Investigator Award Winner: Increasing Fat Mass Is Associated With High Levels of Low Back Pain Intensity and Disability. SPINE 2011;36:1320-1325

Do Lace-up Ankle Braces Prevent Ankle Sprains?

Ankle sprains are like Lays Potato chips...it is hard to stop at just one. Each time you sprain your ankle, your risk of another ankle sprain increases. Proper rehab exercise can help after an injury, making it less likely to re-occur, but the best treatment of ankle sprains is to prevent them in the first place. Common methods of preventing ankle sprains include athletic taping and the use of ankle braces.

But how effective are lace-up ankle braces in preventing ankle sprains?

Recently, a study published in the American Journal of Sports Medicine researched this question in the population at greatest risk for ankle sprains, high school basketball players. This study randomly divided 1460 male high school basketball players into an ankle brace group and a control group who did not wear ankle braces. Ankle injuries were recorded for the entire basketball season, and afterwards rates of injury, and injury severity were compared.

The results of this study found that the players who did not wear ankle braces were almost 3 times more likely to suffer an ankle sprain. Ankle sprains were also prevented by the braces in players whom had a history of ankle sprains. However, the severity (days unable to play) of ankle injuries that did occur was similar in both groups.

Therefore, the results of this study suggest that wearing lace-up ankle braces when playing basketball is effective at reducing the prevalence of ankle sprain injuries, but does not effect the severity of the injury once it occurs.

  1. McGuine TA, Brooks A, Hetzel S. The Effect of Lace-up Ankle Braces on Injury Rates in High School Basketball Players. Am J Sports Med. 2011 Sep;39(9):1840-8. Epub 2011 Jul 27.

Can You Predict Weight Loss?

What's more frustrating than trying to lose weight? How about learning that the model clinicians and scientists have been using for decades to predict weight loss is wrong.

It has been widely accepted for some time now that there is a linear (straight line) relationship between how much food you eat and the weight you lose (or gain). So, by this theory, if a pound of fat contains 3500 calories your body can use for energy, then every 3500 calories you cut from your diet would cause you to lose that 1 pound of fat. Proving if this theory was accurate has always been difficult because it is hard to measure exactly how much energy a person's body burns, and it is also hard to measure exactly how much energy a person consumes in their diet. But there have been indications that this model does not tell the whole story.

Now researchers have come up with a mathematical model to more accurately predict weight-loss based on dietary changes. The largest difference between this new method, and the traditional approach, is that the new model takes into account the dynamic characteristics of how your body burns energy. Namely, as you lose weight, your body begins to burn less energy because your metabolism slows down immediately and this decrease in metabolism continues as weight is lost until steady-state equilibrium is reached between your new energy intake (sustained diet) and your new energy output (metabolism).

Therefore, previous predictions for weight-loss tended to overestimate how much weight could be lost for a given calorie restriction, and it would also overestimate the speed at which these changes would be reached.

Based upon this new model, a more accurate rule of thumb would be that a permanent decrease of every 10 calories per day will result in a 1 pound weight loss. Of that 1 pound lost, half of it will be achieved in the first year and the remaining half will be reached within 3 years.

The scientists behind this research have created an online program to use this newer and better model for predicting your own weight-loss, setting goals, or planning your diet. Post your comments to let us know what you think of this research-based weight-loss website.

  1. Hall, K. et al. Quantification of the effect of energy imbalance on bodyweight The Lancet -27 August 2011( Vol. 378, Issue 9793, Pages 826-837 )

Can Sit-Ups Shrink your Beer Belly?

Pot belly, beer belly, central obesity, abdominal obesity- all different names to describe the build-up of fat in the stomach. This type of fat deposition pattern is associated with greater health risks because the lipids (a.k.a. fat) get packed around and between all the organs in your abdomen (e.g. liver, kidneys, pancreas, colon). But aside from the health risks, beer bellies are probably most feared because of their unattractiveness that is hard to hide unless you wear a lot of muumuus.

So, it comes as no surprise that many people begin exercising with the goal of losing their beer belly. Oftentimes sit-ups are the first exercises people go to for this problem because they want their ab muscles to get larger than the fat that lives behind them, and down-size from a "keg" to a "six-pack".

But do sit-ups actually decrease the size of a beer belly? Scientists asked this question in a recent experiment looking at abdominal exercises and abdominal fat. In this study, participants were asked to begin a 6 week abdominal exercise program. Nothing else was changed in their daily routine, so they ate the same amount of food, and exercised as normally as they had before the study began. After the 5 week session, participants had their body weight, fat percentage, android fat, abdominal circumference, and abdominal strength measured and compared to before the study began. The results found that beginning an abdominal exercise routine did not lower body fat, or abdominal fat, or decrease abdominal circumference.

Therefore this study concludes that to shrink your beer-belly, sit-ups may make your abs stronger, but alone they will not decrease the size of your stomach.

Losing a beer-belly ultimately requires that your body needs to consistently burn more energy than it takes in. Abdominal exercises can be part of the solution, but will not do enough by themselves to make any meaningful impact.

  1. Vispute SS, Smith JD, Lecheminant JD,HurleyKS. The effect of abdominal exercise on abdominal fat. J Strength Cond Res. 2011 Sep;25(9):2559-64.

Can Water Prevent Migraines?

People suffering from migraines have learned that there can be many different types of triggers that lead to a migraine attack. Weather, lights, noise, stress, sleeping problems, alcohol, caffeine, and many others can affect migraine sufferers in different ways. And while the exact mechanism of what causes a migraine remains unclear, scientists have begun finding certain risk factors that, when avoided, offer the potential to provide effective natural treatments for migraines.

One such natural remedy that has begun to be researched is water. Researchers have found a strong correlation between an increased prevalence of migraine attacks, and an increase in temperature. This might be due to more dehydration when the weather gets hot.

One study published in the European Journal of Neurology examined whether increasing water intake in migraine patients would help prevent future attacks. In this study 18 patients were divided into two groups. The first group received a placebo medication, while the second group was instructed to drink 1.5 additional Liters of water on top of their normal intake every day. After 12 weeks of the experimental treatment, each group had their migraine headache symptoms measured. The results of this study found that the group who increased their water intake, reduced their total hours of headaches in a two-week period by 21 hours. This group also had a significant decrease in the intensity of their headache pain.

Therefore, the results of this study suggest that, if you suffer from migraine headaches, increasing your water intake by about 6 cups per day can dramatically reduce the frequency and intensity of your migraine headaches.

  1. Spigt MG, Kuijper EC, Schayck CP, Troost J, Knipschild PG, Linssen VM, Knottnerus JA. Increasing the daily water intake for the prophylactic treatment of headache: a pilot trial. Eur J Neurol. 2005 Sep;12(9):715-8.

Do Hip Strengthening Exercises Decrease Knee Pain?

Most people have all had knee pain at some point in their life. And there are man different types of knee pain that can occur. One specific type of knee pain is known as patellofemoral pain syndrome (PFPS), which is when the pain is located in the front of the knee or underneath the kneecap. Exercises designed to strengthen leg muscles can sometimes help with knee pain, but what are the best types of exercises to heal fastest?

Well, a study published this month by the Journal of Orthopedic & Sports Physical Therapy compared quadriceps strengthening exercises to hip strengthening exercises for the treatment of PFPS. In this experiment, 33 female patients with PFPS were divided into a hip group, or a quadriceps group. Each group began a 4-week rehab program focused on training either their hip muscles, or their quadriceps.

At the end of four weeks, pain levels and muscle strength were compared. As expected, the hip group demonstrated greater increases in strength of hip muscles. Surprisingly however, the patients in the hip group had decreased their knee pain by 43%, compared to only a 3% decrease in the quadriceps group.

Therefore the results of this study suggest that when beginning a rehab program to treat patellar femoral pain syndrome (knee pain), exercises for hip strength should be added first.

  1. Dolak KL, Silkman C,MedinaMcKeon J, Hosey RG, Lattermann C, Uhl TL. Hip strengthening prior to functional exercises reduces pain sooner than quadriceps strengthening in females with patellofemoral pain syndrome: a randomized clinical trial. J Orthop Sports Phys Ther. 2011;41(8):560-70

Is Chocolate good for your Fitness?

Whey protein. Creatine. Nitric oxide. HMB.

Chocolate?? Yes, new research suggests that Chocolate may soon be joining these items on the list of nutritional supplements that increase fitness and improve athletic performance.

In a study published this July by The Journal of Physiology, scientists examined the effect of Epicatechin (the primary nutritional component in cacao) on exercise performance and muscle composition in mice. In this experiment mice were given a small liquid supplement of purified Epicatechin. Another group of mice were given equal amounts of water. Both of these groups were further divided into two groups, an exercise group and a sedentary group. After 15 days all the mice were given a treadmill exhaustion test to measure their fitness levels and biopsies of their leg muscles were sampled.

The results found that the mice given the water supplement performed significantly worse than the Epicatechin mice, regardless of if they were in the exercise group or not. The Epicatechin mice in the exercise group covered approximately 50 percent more distance in the treadmill test than the control group. In fact, even the non-exercising Epicatechin mice performed better on the fitness test than did the exercising control mice. The researchers also found that the muscles of the mice given the Epicatechin supplement contained more capillaries (blood vessels) and there were signs they had an increased ability to create energy as well.

However, as exciting as this study may seem, there are a few limitations. First, this study was performed on mice, so these effects may or may not be seen in humans. Second, pure Epicatechin is destroyed by most food processing, so milk chocolate will have little, if any of the potent chemical. And third, the amounts of Epicatechin given the mice each day were such a small dose that is would equate to us eating one half square (~5g or 1/6 oz) of dark chocolate per day. Eating more may actually negate some of the positive effects too.

But nonetheless, the results of this study conclude the Epicatechin, a substance found in cacao and dark chocolate, has the potential to increase fitness levels and muscle capacity in small doses.

  1. Nogueira L, Ramirez-Sanchez I, Perkins GA, Murphy A, Taub PR, Ceballos G, Villarreal FJ, Hogan MC, Malek MH. EPICATECHIN ENHANCES FATIGUE RESISTANCE AND OXIDATIVE CAPACITY IN MOUSE MUSCLE. J Physiol. 2011 Jul 25

Does Back Pain shrink your Brain?

Everyone knows that pain in their back can negatively effect their golf game, but can it also effect their Scrabble score? Recent research has shown that chronic pain can actually change the size, shape, and activity of different areas in the brain. Chronic back pain has been linked with decreased brain size and abnormal brain function, but until now it has been unclear whether these changes can be reversed.

Fortunately, a new study published in the Journal of Neuroscience asked that question. In this study, traditional brain MRI scans and functional MRI scans during a cognitive challenge (puzzle) were obtained from patients with chronic low back pain and compared to healthy control subjects. The MRIs of the patients with back pain showed a decreased thickness in the cortex of certain areas of the brain and abnormal brain activity in the left dorsolateral prefrontal cortex. 6 months after successful treatment of the chronic back pain, these subjects had new brain scans performed to search for changes. These follow-up studies in the patients with improved back pain symptoms demonstrated that their brain cortex thickness had increased to standard levels, and their functional MRI showed normal activity patterns.

Therefore the authors concluded that chronic back pain does cause a decrease in cortical brain thickness and abnormal function, but with successful treatment these changes can be reversed and will increase brain size while normalizing brain activity. So if you are suffering from chronic back pain, don't "just live with it"…. find the cause of the problem and fix it….your brain will thank you!

  1. Seminowicz DA, Wideman TH, Naso L, Hatami-Khoroushahi Z, Fallatah S, Ware MA, Jarzem P, Bushnell MC, Shir Y, Ouellet JA, Stone LS. Effective treatment of chronic low back pain in humans reverses abnormal brain anatomy and function. J Neurosci. 2011 May 18;31(20):7540-50

How much TV increases risk of Diabetes and Heart Disease?

A large meta-analysis study by the Journal of the American Medical Association last month has firmly linked our nation's true pastime to two of our nation's largest medical challenges today. On average, Americans spend 2.7 hours of their day passing their time by watching television. Currently, 25.8 million Americans have diabetes, 79 million are pre-diabetic, and almost one in every three US deaths is related to cardiovascular disease. So therefore, the findings from this most recent large scale medical study, if not surprising, should at least be eye-opening for anyone with an interest in their own health.

This research combined the results of 8 previous large cohort studies looking at the association between TV watching and diabetes, cardiovascular disease, or all-cause mortality. Based on these results, the authors calculated the relative risks per 2 hours of television watching per day for each of these conditions. Their results indicated that for every 2 hours of TV watching per day a person is about 20% more likely to develop type II diabetes, 15% more likely to develop cardiovascular disease, and 13% more likely to die from any health related-cause.

Therefore, the authors of this study conclude that prolonged television watching is significantly associated with an increased risk of developing diabetes or heart disease, two of the largest contributors to an early death or low health-related quality of life in our country today.

  1. Anders Grøntved, Frank B. Hu Television Viewing and Risk of Type 2 Diabetes, Cardiovascular Disease, and All-Cause Mortality. JAMA. 2011 Jun 15;305(23):2448-55

Can You Lose Weight Without Counting Calories?

"Exercise more and eat less." - wise common sense advice for losing weight that every person has been told before. But despite this obvious, well-known, and seemingly simple strategy, preventing long-term weight gain in our country continues to be a problem while obesity has become an epidemic in both children and adults that threatens to bankrupt our healthcare system.

We have been told that there are no such things as "bad foods," just eat a little less of everything and count your calories. But what if there are foods that lead to weight gain despite how many calories are consumed?

A large ambitious study published last month in the prestigious New England Journal of Medicine attempted to single out foods and other lifestyle activities that may have a larger influence on weight gain and to quantify their effects.

This study analyzed data from three other large, long-term research projects. The Nurses Health Study, The Nurses Health Study II, and the Health Professionals Follow-up Study collectively followed 120,877 U.S Men and Women over the course of 12 to 20 year periods and included a plethora of data including weight changes, dietary habits, and lifestyle activities.

The results of this study looked at weight gain over the course of 4-year periods. They found that on average participants gained 3.35 pounds during that time. This slow steady increase of 0.8 pounds per year on average would equate to eating only 50-100 calories extra per day. What was more surprising was that higher levels of weight gain were specifically linked to increased servings per day of certain foods regardless of caloric amounts.

Every increase of one serving per day of the following foods was significantly correlated with WEIGHT GAIN: potato chips (+1.69lb/4yr), potatoes/French fries (+1.28lb/4yr), sugar-sweetened beverages (+1.00lb/4yr), unprocessed red meats (+0.95lb/4yr), processed meats (+0.93lb/4yr), and alcohol (+0.41lb/4yr).

Every increase of one serving per day of the following foods was significantly correlated with WEIGHT LOSS: yogurt (-0.82lb/4yr), nuts (-0.57lb/4yr), fruits (-0.49lb/4yr), whole grains (-0.37lb/4yr), vegetables (-0.22 lb/4yr).

Additionally, it was found that every hour per day of television watching correlated to weight gain (+0.31 lb/4yr), increasing physical activity regardless of total amount correlated with weight loss (-1.76 lb/4yr), and 6-8 hours of sleep per night was also associated with less weight gain.

So based on this research, the next time someone asks how to lose weight, you can tell them "If you eat one less serving of potatoes, red meat, and soda each day plus one more serving of yogurt, nuts, and fruit each day, plus slightly increasing your physical activity you can expect to lose 1.59 pounds per year and maintain those changes."

Therefore, this study concludes that focusing on small concrete changes like these will make it easier for people to lose and maintain their weight rather than the tried and failed method of counting abstract calories, trying to eat less of everything, and making unsustainable dramatic lifestyle changes.

  1. Mozaffarian D, Hao T, Rimm EB, Willett WC, Hu FB. Changes in diet and lifestyle and long-term weight gain in women and men. N Engl J Med. 2011 Jun 23;364(25):2392-404.

Do Unstable Toning Shoes really help you "Shape-Up"?

The shoes people wear when exercising have changed a lot over the past 50 years, and people are always looking for a new edge to help them perform better and get the most out of their exercise. One of the most recent "advances" in shoe technology has been the rise in popularity of the unstable toning shoes. Every brand has a different name for these such as Sketchers Shape-ups or Reebok's EasyTone, but they are all built in a similar fashion.

The theory is that the rounded bottom will change the way you walk and take pressure of you back while also focusing more work (and strengthening) on the calves, thighs, and buttocks.

Until recently there has been little research into the actual effect these shoes have on energy and muscle work. But one study published last year by the journal Gait & Posture examined the effect these unstable shoes have on muscle activity and energy consumption. This study had 28 subjects stand in an unstable MBT (Masai Barefoot Technology) shoe during their work day for 6 weeks. Before the 6 week trial was begun each individual had their balance and muscle activity measured while standing barefoot, in normal shoes, and in the MBT shoes. These results were compared to their measurements that were taken after the 6 week trial had concluded.

The results of this study found that before the 6 week trial, standing in the unstable shoe increased muscle activity in several of the smaller muscles in the foot and ankle, but not in the larger calf or thigh muscles. They also found that after the 6 week trial period the subject's total balance had increased, but energy consumption had not.

Therefore this study concludes that wearing unstable toning shoes does not increase muscle activity in the large calf muscles or increase the amount of calories burned, but it does help improve balance over the course of 6 weeks.

  1. Landry SC, Nigg BM, Tecante KE. Standing in an unstable shoe increases postural sway and muscle activity of selected smaller extrinsic foot muscles. Gait Posture. 2010 Jun;32(2):215-9. Epub 2010 May 23.

Can Chiropractic Adjustments Increase Low Back Muscle Size and Strength?

Chiropractors may be best known for treating low back pain, neck pain, and headaches. And research has demonstrated that combining chiropractic care with appropriate exercise therapy produces greater improvements than either one alone. Researchers have also found a link between low back pain and the size and function of one particular muscle in the low back, the Lumbar Multifidus. But the exact effect that chiropractic adjustments have on these muscles in your back has been unclear until recently.

Thankfully a new study, published in June by the Journal of Orthopedic & Sports Physical Therapy, looked at this connection between spinal adjustments, increased Lumbar Multifidus size, and low back pain. In this study 81 patients with low back pain were treated with two sessions of spinal manipulation (aka chiropractic adjustments) over the course of one week. Before the first treatment, immediately after the first treatment, and again one week after the last treatment, each patient had the size of their low back muscles measured with ultrasound imaging. These patients also completed pain questionnaires before the first treatment and again one week following the last treatment.

The results of the study found that there was a significant correlation between the patients who showed the largest decreases of low back pain and the size of their Lumbar Multifidus after spinal manipulation.

Therefore this study suggests that an increased size and thickness of Lumbar Multifidus muscles after chiropractic adjustments is associated with significant decreases in low back pain.

  1. Koppenhaver SL, Fritz JM, Hebert JJ, Kawchuk GN, Childs JD, Parent EC, Gill NW, Teyhen DS. Association between changes in abdominal and lumbar multifidus muscle thickness and clinical improvement after spinal manipulation. J Orthop Sports Phys Ther. 2011 Jun;41(6):389-99. Epub 2011 Apr 6.

Does "Muscle Confusion" Work?

Crossfit. P90X. Insanity. These are just a few of the new breed of exercise "brands" gaining popularity in gyms and garages around the world today. The common theme between all of these is a high intensity workout using multiple body parts and muscle groups to create what is becoming known as "muscle confusion". Some people are drawn towards these styles because of their competitive nature and athletic background, while others are simply looking to fit a great workout into a short time period. But what does the research say about these routines? Is there an advantage to this type of exercise compared to traditional exercise? Does it build better fitness? Does it burn more calories, make muscles stronger?

Recently an experiment published in the Journal of Strength and Conditioning Research attempted to answer some of these questions. The study compared the metabolic costs (energy expenditure) of reciprocal supersets vs. traditional resistance exercise. Reciprocal supersets are a method of resistance training that alternates multiple sets of high-intensity agonist-antagonist muscle groups with limited recovery, like the ones done in Crossfit, P90X, and other "muscle confusion" workouts. This study had 10 men each participate in a reciprocal superset protocol and a traditional resistance training protocol on different weeks. Measurements were taken of the amount of energy burned, oxygen consumed, and blood lactate levels during the workout and 60 minutes after completion of the workout.

The results found that there was no difference in total energy burned during the workout. However the reciprocal superset group had higher rates of energy expenditure, oxygen consumption, and blood lactate levels one hour after the workout, and their workout was completed in a significantly shorter time period.

Therefore the results of this study support the idea that a high-intensity short duration interval-training program increases energy expenditure rate (calories burned) in a shorter amount of time while also increasing metabolism after the workout as well.

  1. Kelleher AR, Hackney KJ, Fairchild TJ, Keslacy S, Ploutz-Snyder LL. The metabolic costs of reciprocal supersets vs. traditional resistance exercise in young recreationally active adults. J Strength Cond Res. 2010 Apr;24(4):1043-51.

New Report: Pesticide Contamination in Produce

Have you ever wondered if it is important to buy ALL your produce from the Organic section? Is an organic apple worth a much as an organic orange? Well, for many people the cost of an all-organic diet can be too high. Lucky for us, not all organic produce is created equal. Some conventionally grown fruits and vegetables contain high levels of pesticides and toxins, while others show almost zero contamination. So with a little research and thought, you can get the benefit of eating organic at a much lower cost.

This week the Environmental Working Group (EWG) published their 2011 report on pesticides in produce. The results of this study were compiled from 51,000 tests for pesticides on 53 popular fruits and vegetables conducted by the USDA and FDA from 2000-2009. The pesticide levels were almost always measured after the produce had been rinsed or peeled, and the contamination was measured in six different ways, such as percent of samples tested with detectable pesticides or average number of pesticides found on a single sample.

In order to make the results of the report accessible to users, the EWG summarized their findings by creating two lists. First the "Clean 15", made up of the foods least likely to test positive for pesticides. Second, the "Dirty Dozen", made up of the 12 most contaminated foods.

The EWG estimates that if you choose your servings of fruits and vegetables per day from their "Clean 15" list, you will decrease the total amount of pesticides you consume by 92 percent and you will also significantly eat fewer types of pesticides!

Therefore, based on the results of this report, the "Dirty Dozen" would be the most important foods to buy organically to reduce your exposure to pesticides because of their high levels of contamination, while the "Clean 15" can be considered the safest to eat conventionally grown because of their low levels of contamination.

  1. Source: http://www.ewg.org/foodnews/summary/

Can Whole Body Vibration Training Prevent Ankle Injuries?

Ankle instability can result from many common ankle and foot injuries, for example an ankle sprain or a broken foot. This functional instability can be caused by a lengthening and loosening of the ligaments that support the ankle or also by a loss of muscle coordination (balance and proprioception) following the initial injury. Both of these can lead to an increase of future, and often more severe, ankle injuries.

But fear not!

There is plenty of evidence that proper ankle rehabilitation, focused on strengthening the muscles that support the ankle and also improving the proprioceptive (balance+ coordination) sense can significantly reduce the occurrence of re-injury and even strengthen the ankle beyond pre-injury status.

One specific type of rehabilitation technique focusing on muscle coordination is "whole body vibration therapy". Recently the International Journal of Sports Medicine published an experiment to see if foot and ankle balance was improved by this new technique.

In this study, 38 female dancers with a history of repetitive ankle injuries and instability were divided into two groups. One group began a 6-week vibration training session, while the other group maintained their normal routine. Before the training began, and again after the six weeks were up, each dancer had single leg balance score, "star excursion balance test", and ankle muscle endurance measured. At the end of the study the results found that the dancers who used the whole body vibration training for their therapy had significant increases in single leg balance and star excursion balance test, but not in ankle muscle endurance.

Therefore the results of this study suggest that people who have had ankle or foot injuries in the past could improve their balance and coordination by training with whole body vibration therapy, and thereby decrease their risk of further ankle and foot injuries.

  1. Cloak R, Nevill AM, Clarke F, Day S, Wyon MA. Vibration training improves balance in unstable ankles. Int J Sports Med. 2010 Dec;31(12):894-900.

Can Fish Oil Decrease Back Pain?

Omega-3 fatty acids, which are found in fish oil, have become one of the trendiest supplements on the market. Part of this reason is because there has been a plethora of research into the wide variety of benefits this essential nutrient offers. Omega-3 fatty acids are important throughout our lifespan and potential effects range from Alzheimers disease prevention to prenatal brain development. But can these special fats found in fish also help back pain?

Non-steroidal anti-inflammatory medications are well established for the treatment of non-specific neck and back pain, but long term use can have dangerous side-effects including ulcers, heart attack, and stroke. Omega-3 fish oils have a similar anti-inflammatory effect with fewer side-effects and may provide a safer alternative for the treatment of inflammatory conditions.

A recent study published in the journal of Surgical Neurology looked at the effects of omega-3 fatty acids (fish oil) as an alternative to NSAIDs for the treatment of back and neck pain. In this study 250 patients with nonsurgical neck or back pain were prescribed 1200 mg per day of omega-3 fatty acids found in fish oil supplements. These patients were given a questionnaire after one month of treatment to track their progress. Of these patients, 60% reported their overall pain was improved and their joint pain was significantly better, 80% said they were satisfied with their improvement, and 88% said they would continue to take the fish oil.

Therefore, the results of this small controlled study suggest that omega-3 fatty acid supplementation might be as effective as NSAID medications for the reduction of low back and neck pain.

  1. Maroon JC, Bost JW. Omega-3 fatty acids (fish oil) as an anti-inflammatory: an alternative to nonsteroidal anti-inflammatory drugs for discogenic pain. Surg Neurol. 2006 Apr;65(4):326-31.

Can mushrooms and green tea combined prevent breast cancer?

Breast cancer is the most common form of cancer in women around the world. The rate of breast cancer has been increasing in developed and developing countries world-wide, and as such there has been much research for new breast cancer treatments and prevention strategies. One prevention strategy that is not new, but has been attracting interest in the research community recently, is the intake of mushrooms and green tea. There has been a significant amount of research linking green tea to the prevention of several types of cancers, and there has also been some research suggesting mushrooms may offer some preventative cancer properties as well. However, one recent study looked at the combined effects of these common foods.

A recent study in the International Journal of Cancer compared over 1,000 Chinese women who had been diagnosed with breast cancer (study-group) to over 1,000 Chinese women who had never had breast cancer and had been selected to match the ages and demographic factors of the study group (control-group). Every person had their personal health histories recorded as well as a standardized estimation of their dietary habits, including the amounts of fresh or dried mushrooms and green tea consumed.

The results of this study, after controlling for other known breast cancer risk factors such as weight, physical activity, smoking, and others, found that there was a dose-dependent relationship between how much mushrooms were eaten and the risk of breast cancer. That means that the more mushrooms eaten, the less likely that person was to have breast cancer. The greatest benefits were seen in the women who ate 7 grams or more of fresh mushrooms or 4 or more grams of dried mushrooms.

More interestingly were the results that showed women who consumed high amounts of mushrooms and green tea, had a larger reduction in breast cancer risk than the sum of either item alone! This suggests that there is a synergistic effect between some property in mushrooms and green tea that work together to help prevent cancer to a greater degree than either alone.

Therefore the results of this study suggest that if you are interested in preventing breast cancer, in addition to other healthy lifestyle choices, eating more mushrooms and drinking green tea may reduce your risk significantly!

  1. Zhang M, Huang J, Xie X, Holman CD. Dietary intakes of mushrooms and green tea combine to reduce the risk of breast cancer in Chinese women. Int J Cancer. 2009 Mar 15;124(6):1404-8.

Wii-hab? Can video games improve your balance?

Wii-hab, or Wii-habilitation, is a new therapy technique that utilizes the Nintendo Wii and Wii balance board for rehabilitation. This technique is becoming popular because of its ability to keep patients motivated and enjoying their rehab experience. One of the most common challenges in the rehabilitation filed is getting patients to actually do their exercises. Wii-hab has the potential to help this problem, but the question remains, are the exercises effective for rehabilitation?

A recent study published by the Journal of NeuroEngineering and Rehabilitation looked at the effectiveness of a Wii balance board-based game system for balance rehabilitation in patients with brain inuries. This study used a Wii balance board with custom games designed by specialists to help patients improve their balance and quality of life. In this study 18 patients who had suffered from severe balance deficits for over 6 months were divided between a Wii-hab group and a group that underwent traditional physical therapy. Both groups had their balance abilities and quality of life scores measured before the study began and again after receiving 20 one-hour sessions of their particular balance rehabilitation program.

The results of this study found that patients in both groups had significant improvements in all balance tests performed as well as their quality of life scores. There was no significant difference between the groups indicating that both methods of balance rehabilitation were comparable.

Therefore the results of this study suggest that the Wii balance board can be an equally effective tool as traditional physical therapy in the rehabilitation of patients with balance deficits. It is important to note that this study used custom games designed by specialists, but it is encouraging that this equipment has he potential to be physically beneficial when used with well designed games.

  1. Gil-Gomez JA, Llorens R, Alcaniz M, Colomer C. Effectiveness of a Wii balance board-based system (eBaViR) for balance rehabilitation: a pilot randomized clinical trial in patients with acquired brain injury. J Neuroeng Rehabil. 2011 May 23;8(1)

Is Chiropractic Care Effective for Migraine Headaches?

The estimated cost of migraines in the United States is over 17 billion dollars annually and produces much disability. The effect of manipulation in the treatment of migraines was examined in 127 patients in a randomized control trial that consisted of a 2 month data collection period, 2 months of treatment followed by another 2 months of data collection for both a treatment and control group who reported at least one migraine per month. To determine outcome, participants completed headache diaries noting frequency, intensity, duration, disability, associated symptoms and use of medication per migraine. The authors reported the results as follows:

"The average response of the treatment group (n=83) showed statistically significant improvement in migraine frequency (P<.005), duration (P<.01), disability (P<.05) and medication use (P<.001) when compared with the control group (n=40). Four persons failed to complete the trial because of a variety of causes, including change in residence, a motor vehicle accident, and increased migraine frequency. Expressed in other terms, 22% of participants reported more than a 90% reduction of migraines as a consequence of the 2 months of SMT. Approximately 50% more participants reported significant improvement in the morbidity of each episode."

The majority of the patients in this trial reported migraines for 18 years. The number of migraines per month went down to 4 from 8. Perhaps one of the most meaningful findings was the following:

"The greatest area for improvement was medication use (P<.001), for which participants recorded that their medication use had reduced to zero by the end of the 6-month trial."

As the authors state it is important to note that 83% of patients reported stress as a major factor for their migraines and it is probably that chiropractic care has an effect on the physical conditions related to stress and that in these people the effects of the migraine are reduced. Therefore, if you or someone you knows is suffering with chronic and frequent migraines a conservative trial of chiropractic manipulation may be worth considering.

  1. P. Tachina, H. Pollard, R. Banally. A Randomized Controlled Trial of Chiropractic Spinal Manipulative Therapy for Migraine. J Manipulative Physiol Ther 2000;23:91-5

Is Chocolate Milk the New Gatorade?

Recently chocolate milk has become a symbol of poor school nutrition in the U.S., and has stirred up controversy around the country with people on both sides of the argument trying to weigh pros (kids drink dairy) with the cons (more sugar than soda). However, chocolate milk may have its place, even if it is not in school cafeterias.

A new study was just published by the Journal of Strength and Conditioning Research that examined the possible benefits of drinking chocolate milk after exercise. The study compared chocolate milk to a carbohydrate only beverage (similar to Gatorade) with an equal amount of calories, and a placebo beverage. The study used cyclists who performed a 1.5 hour interval time trial. Immediately after the ride they were given one of the three experimental drinks and muscle measurements were taken during the course of a 4-hour recovery period. After the recovery period each cyclist performed a 40km time trial.

The results of this study found that the cyclists who were given chocolate milk performed significantly better on the post-recovery time trial than cyclists given the carbohydrate or placebo beverage, and the chocolate milk drinkers also showed indications of greater muscle protein synthesis after exercise.

Therefore, the results of this study suggest that after moderate-intense exercise, the consumption of a carbohydrate-protein supplement, like chocolate milk, will improve subsequent performance and help build more muscle mass.

  1. Ferguson-Stegall L, McCleave EL, Ding Z, Doerner PG 3rd, Wang B, Liao YH, Kammer L, Liu Y, Hwang J, Dessard BM, Ivy JL. Postexercise carbohydrate-protein supplementation improves subsequent exercise performance and intracellular signaling for protein synthesis. J Strength Cond Res. 2011 May;25(5):1210-24.

Is Carpal Tunnel Coming From Your Neck?

Carpal Tunnel Syndrome (CTS), caused by compression of the median nerve, is a notorious condition that affects many people, causing numbness, tingling, pain, and weakness in the wrist and hand. CTS is also a very expensive condition to treat and over their lifetime an average patient suffering with CTS loses about $30,000 in medical expenses and lost wages. This expense is partly due to the difficulty of determining the true causative factor of the injury and finding the best treatment option possible.

This month, The Journal of Orthopedic and Sports Physical Therapy, published a study that examined the relationship between CTS and neck range of motion. This was done by measuring the ranges of motion in the cervical spine (neck) of women who suffered from CTS compared to women who were healthy and symptom-free.

The results of this study found that individuals with CTS had significant decreases in all ranges of motion compared to the healthy patients. Also, it was found that the intensity of pain was specifically correlated to a reduced ability to laterally flex the neck away from the side of pain.

Therefore, the results of this study suggest that decreased cervical (neck) range of motion may play a role in the development of Carpal Tunnel Syndrome. However, this study can not determine whether the range of motion decrease preceded the CTS of is a result of CTS. Either way, this evidence supports the importance of addressing neck range of motion (chiropractic adjustments) when treating carpal tunnel syndrome.

  1. De-la-Llave-Rincón AI, Fernández-de-Las-Peñas C, Laguarta-Val S, Ortega-Santiago R, Palacios-Ceña D, Martínez-Perez A. Women with carpal tunnel syndrome show restricted cervical range of motion. J Orthop Sports Phys Ther. 2011 May;41(5):305-10. Epub 2011 Apr 6.

Is Rock Climbing Good for Your Back?

Recently many "alternative" exercises and sports have become popular in the rehab world, such as yoga, qigong, and pilates to name a few. However, not many people think of rock climbing when they think of rehab. Despite this, therapeutic rock climbing has been suggested to increase muscle strength and offer psychological effects to patients undergoing a rehabilitative exercise program.

Recently a study published in the journal Spine, compared the effectiveness of therapeutic rock climbing to traditional physical therapy exercises for patients with back pain. This study divided 28 people with chronic low back pain into two groups. The first participated in a therapeutic climbing program, four sessions per week for four weeks. The second group began a traditional exercising program that was also performed four days per week for four week. At the end of the study, quality of life and back-pain disability questionnaires were given to each participant and compared to their scores before treatment had begun.

The results of this study found that back pain related disability was not changed in either group. Quality of life scores were significantly increased in both groups, with the largest gains in the general health perception category seen by the therapeutic climbing group.

Therefore this study concludes that both traditional exercise and therapeutic rock climbing can improve the quality of life in people suffering with chronic low back pain, but with those exercises alone, back pain related disability might not be affected.

  1. Engbert K, Weber M. The effects of therapeutic climbing in patients with chronic low back pain: a randomized controlled study. Spine (Phila Pa 1976). 2011 May 15;36(11):842-9.

Low-Level Laser Therapy or Chiropractic Adjustments for Neck Pain?

Chiropractic adjustments have proven to be one of the most effective treatments for many types of neck pain. Recently much interest has been generated by the new technique "low level laser therapy" aka "cold laser" for treating a wide variety of musculoskeletal injuries. But these two therapies have never been compared to each other for neck pain, and it is also unknown whether the combination of both can lead to better patient outcomes.

One recent study published in the Journal of Manipulative and Physiological Therapeutics addressed this question by examining the effects of chiropractic neck adjustments and low level-laser therapy (LLLT) on pain and range of motion in patients with cervical facet pain (local neck pain).

Patients with neck pain in this study were assigned to 1 of 3 treatment groups. The first group received adjustments of the neck. The second group received LLLT applied to the cervical facet joints. The third group received a combination of adjustments and LLLT. All patients were given 6 treatments over the course of 3 weeks.

At the end of the study period patients were re-assessed and measured for levels of pain, neck range of motion, and total neck disability. The results found that all groups showed improvement in both pain and neck ranges of motion. However the group that received the combination of both adjustments and LLLT had a significantly greater improvement in all outcome measures than the groups that only received one or the other.

Therefore, the results of this study suggests that the addition of Low Level Laser Therapy to treatment with Chiropractic Adjustments for neck pain will lead to greater decreases in pain and greater increases in neck range of motion than either therapy alone.

  1. Saayman L, Hay C, Abrahamse H. Chiropractic manipulative therapy and low-level laser therapy in the management of cervical facet dysfunction: a randomized controlled study. J Manipulative Physiol Ther. 2011 Mar-Apr;34(3):153-63.

Chiropractic Care for Chronic Lower Back Pain

Chronic lower back pain can be frustrating for both patients and physicians. As a billion dollar health care crisis identifying a cost effective, non invasive therapy to limit time on disability and restore quality of life are important public health issues.

In 2004, the Journal of Manipulative and Physiologic Therapeutics published a long term non-randomized practice based observational study involving over 2800 patients with acute and chronic lower back pain. Patients attending primary care and chiropractic physicians were examined for pain and disability outcomes.

Chiropractic care consisted of manipulation, physical therapy, exercises and self care advice. Medical care consisted of prescription medication, exercise, self care advice and 25% were referred for physical therapy. The results illustrated:

"Most improvement was seen by 3 months and sustained for 1 year; exacerbation was seen thereafter. A clinically important advantage for chiropractic patients was seen in chronic patients in the short-term ( > 10 VAS points), and both acute and chronic chiropractic patients experienced somewhat greater relief up to 1 year ( P < .000). The advantage for DC care was prominent for chronic patients with leg pain below the knee ( P < .001)."

Therefore, this study concludes that for patients who have been suffering from chronic low back pain of 1 year duration or longer, chiropractic care can significantly reduce time on disability and have a robust impact on decreasing pain.

  1. Haas M, Goldberg B, Aickin M, Ganger B, Attwood M. A Practice-based Study of Patients with Acute and Chronic Low Back Pain Attending Primary Care and Chiropractic Physicians: Two-Week to 48-Month Follow-up. J Manipulative Physiol Ther 2004;27:160-9

Can Ginger decrease Pain and Inflammation?

In my previous article I discussed a recent medical review about non-steroidal anti-inflammatory medications (NSAIDS) and their alarming correlation to to an increased risk of heart attacks, strokes, and cardiovascular deaths. Many of these medications are available over the counter a staple in the diets of patients with chronic pain. But what if there were natural products that could also decrease pain through anti-inflammatory mechanisms?

Recently an experiment had their results published in the journal Phytotherapy Research which looked at the ability of Ginger to decrease muscle pain and inflammation caused by exercise. This study included 27 participants who performed a specific routine of arm exercises designed to induce delayed-onset muscle soreness. Each participant was then given a 2 gram supplement of ginger or placebo 24 hours and 48 hours after the exercise. Measurements were taken each day to record each individual's pain level, elbow range of motion, and arm circumference. The results found that the individuals who received the ginger supplementation 24 hours after the exercising had a decrease in pain the following day. Participants who received the placebo 24 hours after exercising did not see any decrease in pain the following day.

Therefore, the results of this study suggest that a 2 gram dose of ginger is effective at decreasing muscle pain related to exercise and activity. While this study was not able to directly measure the inflammation at a cellular level, this type of pain is usually attributable to inflammatory changes and NSAIDs are the most common therapy used. As a ingredient found in many foods, ginger is also far more likely to be a safer alternative to NSAIDs for muscle and other inflammatory types of pain.

  1. Black CD, O'Connor PJ. Acute effects of dietary ginger on muscle pain induced by eccentric exercise. Phytother Res. 2010 Nov;24(11):1620-6. doi: 10.1002/ptr.3148.

Which Pain Medications Increase Risk of Heart Attack and Stroke?

Non-Steroidal Anti-Inflammatory Drugs (NSAIDS) are some of the most popular pain medications throughout the world, and many are available over-the-counter without a prescription. These drugs work by decreasing inflammation in the body and around injured/damaged areas, thereby decreasing pain. Included in this category of drugs are; Aleve, Motrin, Advil, Celebrex, ibuprofen, naproxen, celecoxib, and diclofenac. The controversial drug, Vioxx, which was recently withdrawn from the market due to safety concerns, is also in this class of medication. It has been largely assumed that most of these drugs have few side effects, and most are relatively minor. However, recent evidence has raised new concerns.

A large research study published in 2010 by the journal Circulation: Cardiovascular Quality and Outcomes analyzed the cardiovascular risks of the most common NSAID medications when used by healthy people. This study compiled the entire health care records of the people of Denmark from 1997-2005. The data received was analyzed to compare the amount of strokes and heart attacks suffered by people who had taken some form of NSAID versus people who had not taken any NSAID medication.

The results found that use of diclofenac (aka "Voltaren" or "Cataflam") nearly doubled the risk of suffering a fatal cardiovascular accident, heart attack, or stroke. The use of celecoxib (aka Celebrex) increased the risk of heart attack by over 50%. And alarmingly, the use of ibuprofen (aka "Motrin" or "Advil") was associated with an increased risk of stroke. One NSAID that was not associated with an increased of any cardiovascular accident was naproxen (aka "Aleve"). Another noteworthy point of this study was that the relationship between NSAID use and cardiovascular death was does dependent. That means that the higher dosages taken and the longer duration the medications were taken for also created the highest amount of risk.

Therefore the results of this study suggest that all NSAID medications were associated with an increased risk of cardiovascular mortality and morbidity, and that chronic users were at an even greater risk. So, if you or someone you know is a habitual NSAID user for all of your aches and pains, this research suggests you are putting yourself at risk for a more serious health condition and you might be better off trying to get treatment and rehabilitation to correct the underlying cause of your pain.

  1. Emil Loldrup Fosbøl, Fredrik Folke, Søren Jacobsen, et al. Cause-Specific Cardiovascular Risk Associated With Nonsteroidal Antiinflammatory Drugs Among Healthy Individuals. Circ Cardiovasc Qual Outcomes. 2010;3:395-405

Can You Exercise Your Liver?

Your liver is the Tim Duncan of your organs. Not flashy, like the brain or heart, but just as vital to your life (Or winning NBA titles). Your liver is responsible for an incredibly wide range of functions in your body ranging from detoxification, to protein synthesis, energy storage, and digestive function. There is no replacement for your liver, which makes it even more serious that Non-Alcoholic Fatty Liver Disease (NAFLD) is now the most common liver disease in the world. NAFLD has also been recently shown to be a risk factor for heart attacks and cardiovascular disease and will progress to fibrosis and cirrhosis in about 10% of cases.

A recent research review summarized current evidence of certain lifestyle changes and their effects on NAFLD. They found several studies that demonstrated prescriptive diets were effective for preventing progression of the disease as long as the diets were followed, but long term dietary changes were difficult to get patients to comply with. More encouragingly, they also found that physical activity (with or without weight loss) was effective at improving liver enzymes and reducing liver fat.

The authors concluded that research shows it is not easy for patients to make dramatic lifestyle changes on their own, but when given the proper strategies to improve their diet and increase their physical activity, liver function can be improved, liver fat can be decreased, and NAFLD progression can be slowed.

Therefore, the best strategy to prevent or reverse NAFLD is a combination of a healthy diet and moderate physical activity. And if you or someone you know is suffering from NAFLD it is reassuring to know that regardless of weight loss (which can often be difficult and discouraging) increasing your physical activity levels alone will make your liver healthier.

  1. Centis E, Marzocchi R, Di Domizio S, Ciaravella MF, Marchesini G. The effect of lifestyle changes in non-alcoholic fatty liver disease. Dig Dis. 2010;28(1):267-73. Epub 2010 May 7.

Is Television Really Bad For Your Health?

Surveys in Australia, America, and the United Kingdom have shown that people spend more time watching television than any other one activity outside of sleeping and working. And while the link between obesity, physical inactivity, and poor health has been well established, could watching television be an unhealthy activity on its own?

Last year, a study published in the medical journal Circulation asked this question when looking at possible associations of prolonged television viewing with cardiovascular disease, cancer, and total mortality. This study compared 8800 adults over the age of 25 during a 6-8 year span. A detailed medical history, measurements of dietary calorie intake, and television viewing time were recorded for each individual. At the end of the study total deaths and cause of death were also recorded.

The results showed that every 1hour per day increase in television watching was associated with an 11% increase in all cause mortality and an 18% increase in cardiovascular disease. Additionally, people who watched more than 4 hours of television per day increased their total risk of dying by 46% compared to people who watched less than 2 hours per day.

In conclusion, this study found that prolonged television watching is associated with an increase in all-cause mortality and cardiovascular disease mortality independent of traditional risk factors such as smoking, blood pressure, cholesterol, diet, physical activity, and waist circumference. Therefore, evidence suggests that decreasing television time should be a public (and individual) health goal along with traditional efforts to increase physical activity and decrease smoking.

  1. Dunstan DW, et al. Television viewing time and mortality: the Australian Diabetes, Obesity and Lifestyle Study (AusDiab). Circulation. 2010 Jan 26;121(3):384-91

Which Gastrointestinal Cancers are prevented by Exercise?

Today's article is the second in a series addressing some "common sense" issues that are not so common.

Gastrointestinal cancers include stomach and colorectal cancers. Each of these cancers contribute significantly to global cancer rates, with colorectal cancer being the third most common cause of cancer for both men and women in the United States. Diet is obviously one of the biggest factors when considering digestive system health, but exercise can play a larger role too.

Recently the journal Recent Results in Cancer Research published a review that analyzed previous studies regarding the effect exercise had on the various cancers affecting our digestive system. Out of 52 studies found that looked at exercise effects on colon cancer, 37 found a statistically significant association the exercise was preventative. This trend was seen regardless of whether the physical activity was job-related or recreational. The accumulated evidence found a 25% reduction in colon cancer risk with regular physical activity. This review did not find evidence that physical activity is preventative for stomach or rectal cancers.

Therefore the results of this study clearly show that regular physical activity is an effective tool for people who want to decrease their risk of colon cancer.

  1. Wolin KY, Tuchman H. Physical activity and gastrointestinal cancer prevention. Recent Results Cancer Res. 2011;186:73-100.

Physical (In-)Activity and Mortality Risk:

Today's article is a first in a series addressing some "common sense" issues that are not common enough.

Many people today think they will live a long and healthy life because their parents did and their parent's parents did before them. And while genetics does play some role in determining our overall health, the importance of the lifestyle differences between today's generation and previous ones is overlooked too often. Even as early as 30 years ago, the types of foods eaten were more wholesome and the 'normal' amount of daily physical activity was greater.

It is these lifestyle choices that have been increasingly shaped by our faster and faster-paced society which are becoming too heavy of an influence for good genes to resist (ex: increasing rates of diabetes, obesity, and cancer).

One large study recently reviewed the current collective research on physical activity's effect on risk of death (mortality). This report found an overwhelming trend that physical activity is associated with a decreased risk of mortality (duh!). However, looking at the more specific findings included in the report might be even more powerful and motivating for people who think that being active will help only if they run a marathon or that their health fate is already sealed by their genes.

  • Burning 2000 calories or more per week resulted in 25-33% lower mortality rate
  • 3-5 One hour sessions of moderate-vigorous activity (walking, stairs, or sports) per week resulted in 40% decrease in mortality rate
  • Compared to the sedentary twin, the mortality risk was 33% lower among twins who exercised occasionally and 44% lower among the physically active twin (30 minute brisk walk 6x month)

All of the above statistics are relative risks for all adult ages. Therefore, this review authoritatively concludes that moderate levels of physical activity (that everyone can fit in their schedule) can reduce the risk of death from all causes. Future articles will look at research linking specific diseases to physical inactivity.

  1. Kokkinos P, et al. Physical inactivity and mortality risk. Cardiol Res Pract. 2011 Jan 20:924-945.

Which Sports Drink Enhances Performance?

Sports drinks have become a common sight in athletic events, health clubs, and even homes and schools. Products like Gatorade and Powerade have become popular because of their tastes, but also because of the claim that they improve performance and maximize rehydration with their special formula of sugars and electrolytes.

But do sports drinks really improve exercise performance? And if so which drinks are the best?

A recent study published by Journal of the International Society of Sports Nutrition asked these questions and compared the effects of non-caffeinated rehydration sports drinks on short-term performance following dehydration. In this study, subjects initially completed 60 minutes of exercise in hot conditions followed by 60 minutes of recovery at room temperature prior to taking a standardized treadmill test to exhaustion (7-10minutes). After the first treadmill test, subjects were given 60 more minutes of recovery and allowed to fully replace fluid losses with the given sports drink before taking another standardized treadmill test to exhaustion. This routine was conducted on three separate days by each subject, and three sports drinks were tested; "Crystal Light", "Gatorade", and "Rehydrate Electrolyte Replacement Drink".

The results of this study found that dehydration caused a 6.5% decrease in treadmill test performance compared to baseline measurements. Rehydration with Crystal Light resulted in an additional 5.3% decrease compared to the dehydrated performance. Rehydration with Gatorade resulted in a slightly lower performance when compared to the dehydrated state (2.1%). However, rehydration with the Rehydrate Electrolyte Replacement Drink resulted in a 7.3% increase in treadmill test performance compared to the dehydrated state.

Therefore, the results of this study suggest that Gatorade does not improve performance in dehydrated runners, but performance is increased when Rehydrate Electrolyte Drink is used to replace fluid loss.

  1. Snell PG. et al. Comparative effects of selected non-caffeinated rehydration sports drinks on short-term performance following moderate dehydration. J Int Soc Sports Nutr. 2010 Aug 22;7:28.

Does HMB Supplementation Increase Muscle Mass?

Most people think ergonomic aids and nutritional supplements are only for high level competitive athletes. But anyone who has set new physical fitness goals for themselves, regardless of training levels, can potentially benefit from sports performance supplements that have shown to be effective in clinical trials.

Beta-Hydroxy-Beta-Methylbutyric acid (HMB) is one supplement that has been popular in bodybuilding communities for some time, and has recently shown promise for people looking to increase their lean body mass (aka "fat-free mass" or "muscle mass"). HMB is a compound naturally synthesized in your body from the amino acid Leucine.

A recent study published by the European Journal of Applied Physiology looked at the effect of HMB supplementation on body composition, fitness, hormonal, and inflammatory chemicals in competitive volleyball players. This study included male and female adolescent volleyball players divided into two groups over the course of 7 weeks of training. One group received 3grams/day of HMB supplementation, and the other half received a placebo supplementation during the same time. At the end of 7 weeks the measurements found that the HMB group had statistically significant increases in fat-free mass, knee flexion strength, and peak aerobic power. There were no changes seen between groups in knee extension strength, elbow flexion or extension strength, aerobic performance, or hormonal and inflammatory chemicals.

This study concludes that 3g/day HMB supplementation for 7 weeks can improve some strength gains, muscle mass, and power in competitive athletes, but aerobic conditioning and hormonal changes were not found.

This paper specifically studied an athletic population, but previous research has indicated even larger gains are seen in the general population over the first 2 months of a strength training program while supplementing with HMB. Therefore, short-term HMB supplementation might be beneficial for anyone wanting to increase muscle mass and power.

  1. Portal S, et. al. The effect of HMB supplementation on body composition, fitness, hormonal and inflammatory mediators in elite adolescent volleyball players: a prospective randomized, double-blind, placebo-controlled study. Eur J Appl Physiol. 2011 Feb 16.

Can a Special Shoe Designed to Improve Knee Balance also Increase Vertical Jump?

Vertical jumping is a major asset in athletics. But it can be challenging to effectively train for. Every basketball player in the world wants to increase their "vert". And you don't have to talk to too many before you hear some crazy stories about things they have done to try and improve their jumping ability (this author included).

But vertical jumping is important in almost all sports, not just basketball, and coaches and players of all sorts are always looking for new, more effective training methods to improve their leaping abilities.

A new experiment published this month by the British Journal of Sports Medicine may have found the newest breakthrough in vertical jump training. This study examined the effects of wearing special shoes that train for dynamic knee balance during a specific 15-minute warm-up program. These shoes (called ReaLine BalanceShoes) force the athlete to keep their knee aligned over their foot in order to balance.

In this experiment all athletes performed the same 15 minute warm-up routine 3 times per week for 4 weeks. The warm-up consisted of slow closed-chain strengthening, joint realignment, balancing, landing, and jumping exercises. Twenty-nine athletes wore the special shoes during the routines, and the other 28 just wore their usual shoes. At the end of the 4 weeks, vertical jump height and single leg hop distances were measured and compared to the athletes' original measurements.

The results found that the athletes wearing the special balance shoes had an average increase of 4.5 cm in vertical jump height and 10 cm in single leg hop distance compared to only 0.9 cm and 4.0 cm in the control group!!! Therefore, the results of this study suggest that performing a warm-up routine that emphasizes balance control of the knee while wearing specially designed shoes can dramatically increase vertical jump height and single leg hop distance over the course of 4 weeks.

  1. Kubota S, Sugino S, No Y, Ishizuka T, Gamada K. Balanceshoes training for correcting dynamic knee abduction: effect of a 15-minute warm-up program on improving athletic performance in volleyball players. Br J Sports Med. 2011 Apr;45(4):358-9.

Does a Comprehensive Warm-Up Routine Prevent Athletic Injuries?

Almost every athlete, competitive and recreational, will deal with a sports injury at some point in their playing career. In sports such as soccer it is estimated 16% of females will incur a lower extremity injury over the course of one season. The high injury rates in some of our most popular sports can be a significant problem to the players and teams. These consequences are not just seen in the short term either, because some sports injuries can dramatically increase the risk of developing arthritis at a young age.

One recent study published in the British Medical Journal looked at the ability of a scientifically designed comprehensive warm-up program to prevent injuries in young female soccer players. This study evaluated 1,892 female soccer players aged 13-17, and compared the injury rates over the course of one season from the players who used the specific warm-up routine versus the players who warmed up as usual.

The comprehensive warm-up routine included 11 exercises designed to improve awareness and body control during standing, running, planting, cutting, jumping, and landing. During each exercise players were instructed to concentrate on the quality of their movements, core-stability, hip control, and proper knee-alignment.

The results of this study found that the athletes using the comprehensive warm-up routine had less lower extremity injuries and significantly less overuse injuries, severe injuries, and injuries overall.

Therefore, this study offers a great resource for any athlete or coach wishing to decrease the risk of injury for themselves or their team. The comprehensive warm-up outlined in this study can be applied for almost any sport to reduce injuries and improve performance.

  1. Soligard, T et al. Comprehensive warm-up programme to prevent injuries in young female footballers: cluster randomised controlled trial. BMJ. 2008 Dec 9;337

Is High-Intensity Interval Training the best Exercise for overall Wellness?

Research has proven that poor cardiovascular fitness, decreased insulin sensitivity, high blood pressure, and atherosclerosis all increase the risk for premature death as well as increase the risk of developing chronic disease (heart disease, diabetes, cancer). Fortunately there is one therapy that has proven effective countless times for positively effecting all of these conditions!


And even though all exercise is good, scientists and other inquiring minds still want to know, which type of exercise is best?

One recent experiment compared high intensity interval training versus prolonged exercise versus strength training for promoting overall health and wellness.

This study, published in the journal Medicine and Science in Sports and Exercise, divided 36 untrained men into three exercise groups where they trained 3 sessions per week over the course of 12 weeks. The interval training sessions consisted of a 5 minute jogging warm-up followed by five intervals of near maximal running for 2 minutes each. The prolonged exercise sessions consisted of 1 hours of continuous jogging. The strength training sessions consisted of 3-4 sets of 6 lower body strengthening exercises.

At the end of 12 weeks, subjects had their cardiovascular fitness, metabolic fitness, and body compositions measured and compared to before they began their exercise programs. The results showed that improvement in cardiovascular fitness was superior in the interval training group; Insulin sensitivity was similarly improved in the interval training group and the prolonged exercise group; Heart rate, fat percentage, and cholesterol ratios were improved most in the prolonged exercise group; Bone density and muscle mass were both improved in the strength training group.

In conclusion, the results show that high intensity interval training is effective at improving cardiovascular fitness, but not as effective as prolonged running for improving metabolic fitness (high cholesterol, insulin resistance, heart rate), and interval training is not as effective as strength training for increasing bone density and muscle mass.

Therefore, in order to best promote overall wellness in the most efficient exercise program should contain a combination of all three types of exercise: prolonged cardiovascular, high-intensity interval, and strength training.

  1. Nybo L, et al. High-intensity training versus traditional exercise interventions for promoting health. Med Sci Sports Exerc. 2010 Oct;42(10):1951-8.

Is Qigong better than exercise for chronic neck pain?

Chronic neck pain is a problem that affects 6-22% of the population at any given time, and statistics show that 48.5% of the general public will suffer from an extended duration of neck pain some point in their life. There is a wide variety of treatment options for people with neck pain to choose from, with chiropractic adjustments and exercise usually found the most effective in research. One additional alternative therapy that is gaining popularity with neck pain sufferers is Qigong.

Qigong is an oriental practice aimed at controlling and manipulating the practitioner's qi. There are many forms of Qigong which include styles of Tai Chi Chuan and meditation.

A new study published by the scientific journal Spine this month (March 2011) compared the effectiveness of Qigong to exercise and to no therapy for patients with chronic neck pain.

This study divided 123 people into three groups. The Qigong group practiced a silent and slow form known as Neiyanggong 2 sessions per week for 3 months followed by 1 session per week for 3 more months. The exercise group participated in the same amount of exercise sessions during that 6 month period which consisted of traditional strengthening and stretching exercises. The no therapy group received no treatment for their neck pain during that time.

Results of this study found that the Qigong group and the exercise group both had significant improvements in their neck pain compared to the no therapy group at 3 and 6 months. No statistically significant differences were seen between the Qigong group and the exercise group.

Therefore the results of this study suggest that if you are suffering from chronic neck pain, beginning a trial of Qigong could be equally as effective as exercise in decreasing your neck pain. And either option, exercising or Qigong, will be more effective than doing nothing.

  1. Rendant D. et al. Qigong versus exercise versus no therapy for patients with chronic neck pain: a randomized controlled trial. Spine (Phila Pa 1976). 2011 Mar 15;36(6):419-27

Can the Piriformis muscle cause Sciatica?

The term sciatica is broadly used to describe any pain that shoots down the back of the leg from the hip. The name sciatica comes from the "Sciatic Nerve" which is actually a collection of nerves that run from the low back all the way down to the feet. Compression or irritation of this nerve can cause sharp shooting pain all along its path.

Traditionally the cause of sciatica has always been assumed to be either a herniated disc or a narrow spinal canal. However, some people have contended that some sciatica is actually caused by compression from the piriformis muscle.

There are three variations of the piriformis muscle found in people. In some the sciatic nerve runs on top of the muscle, in others the sciatic nerve runs directly below the muscle, and in others the sciatic nerve actually runs through the center of the muscle (see picture). Unfortunately the notion that the piriformis muscle can cause sciatica is still not widely recognized because it can not be determined by x-ray or other diagnostic imaging procedures.

However, one recent research article published by the European Spine Journal collected all the previous research and analyzed the conclusions in their review. This study found that approximately 18% of all sciatic patients failed to show a herniated disc or narrow spinal canal, and therefore the cause of their pain was attributed to something outside of the spine. The most common signs of piriformis syndrome were severe buttock pain, tenderness over the greater sciatic notch, aggravation of pain with sitting, and increase of pain when piriformis muscle tension was increased.

Therefore the results of this study conclude that the cause of approximately 18% of sciatic patients' pain is located outside of the spine, and that the piriformis muscle which is located outside of the spine can cause sciatic leg and buttock pain.

Treatment for sciatic pain caused by the piriformis muscle must be focused on reducing tension in the muscle, lengthening the muscle, and restoring balanced biomechanics in the low back and hips. This can be effectively accomplished with massage, stretching, exercise, and chiropractic adjustments.

  1. Hopayian, K et al. The clinical features of the piriformis syndrome: a systematic review. Eur Spine J 2010; 19:2095-2109

Is Low Back Pain connected to Arthritis of the Hip?

Arthritis is a common cause of hip and knee pain and is especially prevalent in people over the age of 55. Oftentimes people with hip or knee arthritis also report having back pain that further limits their mobility and quality of life. Studies have shown that 40% of patients with hip or knee arthritis suffer from chronic low back pain, but it has been unclear whether these problems are related or if they can help us predict the progression of the arthritis.

A recent study published by the Journal of Manipulative and Physiologic Therapeutics in 2010 examined the relationship between patients with back pain and hip or knee arthritis. This study aimed to determine if the presence of back pain could predict future arthritis-related pain and disability in individuals with hip and knee arthritis.

During the study 983 people aged 55 or over with hip/knee pain were surveyed to establish the severity of their condition as well as any back pain symptoms they did or did not have. After 4-5 years, a follow-up survey was conducted with the same people to assess how their hip/knee pain had progressed. After standardizing the data and controlling for certain variables that could skew the data, the results found that the presence of low back pain at the baseline measurement was significantly correlated with higher hip and/or knee arthritis pain at the follow-up. This relationship was strongest for predicting hip pain. However, low back pain was not associated with increased pain and disability of the knee.

The results of this large population-based study conclude that individuals suffering from arthritis related hip and/or knee pain and low back pain are more likely to have a worse prognosis for their hip pain, but not their knee pain. Therefore, if you are suffering from hip pain and back pain, addressing only the hip pain may result in poorer outcomes and an increased severity of symptoms if the back pain is not corrected.

  1. Maja Stupar, Pierre Côté, Melissa R. French, Gillian A. Hawker The Association Between Low Back Pain and Osteoarthritis of the Hip and Knee: A Population-Based Cohort Study. JMPT June 2010 Vol. 33, Issue 5, Pages 349-354.

How effective is Surgery for Low Back Pain?

Low back pain is one of the most difficult conditions for physicians of all specialties to treat. Unlike pain and injuries in other parts of the body, it is often difficult to determine the exact anatomical cause of the patient's pain, and this uncertainty can result in frustration in both the patient and provider. Oftentimes the last result is seen as surgery. The use of Lumbar spine fusion surgery for chronic low back pain has increased rapidly over the past two decades. Despite this dramatic rise in surgery, the success of treating back pain has not improved much over that time. This has lead to controversy over the effectiveness of this procedure.

One study recently published by the journal Annals of the Rheumatic Diseases was the first ever to compare the long-term results of surgery to non-surgical therapy for chronic low back pain. In this experiment, 150 patients with chronic low back pain were divided into one group that initially received surgery and another group that received cognitive therapy (learning about what causes their pain) and an exercise program.

The status of each patient's condition were reviewed at a 1 year and 4 year follow up. These results demonstrated that there was no significant difference between the two groups in regards to relieving symptoms, improving function, and returning to work at 4-years. Also, 15 member of the surgical group underwent a second surgery during the same time period, compared to only 14 from the non-surgical group who were ever referred for surgery.

Therefore, the conclusion of this study, which is the first to ever compare the long term effects of low back surgery to non-surgical therapy, is that lumbar fusion surgery is no better than exercise and education for patients with chronic low back pain.

  1. Brox JI, Nygaard ØP, Holm I, Keller A, Ingebrigtsen T, Reikerås O. Four-year follow-up of surgical versus non-surgical therapy for chronic low back pain. Ann Rheum Dis. 2010 Sep;69(9):1643-8. Epub 2009 Jul 26.

Are Chiropractic Adjustments Effective for Treating Chronic Cervicogenic Headaches?

Approximately 16% of the general population will be suffering from headaches at any time. Roughly 1/3rd of those headache sufferers will have a certain type of headache known as a cervicogenic headache (which is basically a fancy term for saying 'your neck is causing your headache'). This problem can occur from tight, injured, or stressed muscles in your neck which will cause pain to radiate up into your head and often towards your eyes.

There has been a lot of research showing chiropractic adjustments to be a very safe and effective treatment for this condition. But there are still some unanswered questions, such as how many adjustments are needed to provide the best outcome, and how many adjustments provide the most efficient outcome?

Recently a study published by The Spine Journal in 2010 asked the question is there a "Dose-response" for chiropractic adjustments and treatment of chronic cervicogenic headaches?

This study was conducted over the course of 8 weeks and included 80 patients divided up into four groups. One group received 2 chiropractic treatments per week. The second group received 1 chiropractic treatment and 1 manual exam per week. The third group received 2 massage treatments per week. Finally, the fourth group received 1 massage treatment and 1 manual exam per week.

Over the course of the 8 weeks, and then for the additional 24 weeks, patients' symptoms were monitored and compared. The results found that both groups receiving chiropractic adjustments had significant improvement in their headache and neck pain symptoms, with more improvement seen in the group that received 2 chiropractic treatments per week. They also found that patients in the chiropractic treatment groups lowered their over-the-counter medication usage during the trial and maintained a lower medication usage 24 weeks after treatments ended.

Therefore, the results of this study indicate that chiropractic care is effective for treating chronic cervicogenic headache and reducing over-the-counter medication usage over the course of an 8 week session. More improvement was found in the group that received 2 treatments per week and these results were maintained at a 24 week follow up survey for both chiropractic groups.

  1. Haas M, Spegman A, Peterson D, et al. Dose response and efficacy of spinal manipulation for chronic cervicogenic headache: a pilot randomized controlled trial. Spine J 2010; February 10(2): 169-71.

How to Prevent Long-Distance Running Injuries

The previous two articles this week have looked at the research behind the new barefoot running trend. We have seen that this style of running reduces impact on joints and probably leads to increased running efficiency as well. Many people claim that this form of running can prevent injuries, but no high-quality prospective studies have yet been published that answers this question.

However, there have been studies that attempted to look at other risk factors involved in preventing injuries in long distance runners.

One large review study published by the Canadian Family Physician journal attempted to analyze the current scientific evidence to present a practical approach for preventing running injuries. Ultimately, this review concluded that the following strategies can be effective for improving injury prevention:

  1. Gradually increase running program to allow time for tissues to adapt to new demands.
    1. When beginning or increasing a running program, do not increase the total distance or intensity by more than 10% each week.
    2. Gradually introduce new running surfaces and choose softer surfaces when possible.
  2. Select running shoes appropriate to the runner's foot type.
    1. Running shoes are designed with specific combinations of support and stability which are appropriate for certain foot types. Many running shoes stores can assist you with this decision.
  3. Incorporate a separate strengthening and stretching program to help balance muscles and enable quality movement patterns.
    1. Many running injuries are due to muscle weakness or imbalances, a functional movement screen from a trained professional can help identify the areas of insufficiency.
  4. Optimize running biomechanics by correcting any lower extremity misalignments.
    1. A chiropractic evaluation can determine joint dysfunction and use adjustments or other techniques (orthotics, soft-tissue therapy) to correct the misalignments.

These strategies combined can provide a solid foundation to help significantly decrease the risk of injury in long-distance runners.

  1. Johnston CA, Taunton JE, Lloyd-Smith DR, McKenzie DC. Preventing running injuries. Practical approach for family doctors. Can Fam Physician. 2003 Sep;49:1101-9.

Shoes vs. Barefeet: Which Running Style is More Efficient?

Barefoot running has become a popular topic in athletics. There have been claims that it can prevent injuries, and claims that it can improve performance. Research has shown that there is a mechanical difference with barefoot running that results in less force transmitted to the joints upon impact. Today, we will review a research article that attempted to determine whether running barefoot is a more efficient style that could lead to improved performance.

In 2009, the Journal of Sports Medicine and Physical Fitness published a study that compared barefoot runners, shoed runners, and runners wearing a special lightweight shoe (Vibram Fivefingers). The researchers collected data to determine pressure and impact on the foot, lower limb mechanics, VO2 (a measurement of physical exertion), and heart rate while the runners all ran the same speed and duration.

The results found that compared to the shoed runners, the barefoot runners (and to a lesser extent the runners who wore the special lightweight shoe) had an altered running stride which resulted in reduced impact forces. They also found the barefoot runners and runners who wore the special lightweight shoe had significantly decreased VO2 values, which indicates they had to expend less energy than runners wearing shoes.

Therefore, the results of this study agree with previous research that documented barefoot runners experiencing decreased impact forces, but this article also shows that running barefoot or with special lightweight shoes could help improve performance by decreasing the amount of effort needed to complete a given run.

  1. Squadrone R, Gallozzi C. Biomechanical and physiological comparison of barefoot and two shod conditions in experienced barefoot runners. J Sports Med Phys Fitness. 2009 Mar;49(1):6-13.

Shoes vs. Barefeet: Is there a Difference in Running Mechanics?

Since the publication of Christopher McDougall's book "Born to Run", barefoot running has become a popular topic in the endurance athletic world. There have been many claims made that barefoot running is healthier, faster, and leads to less injuries in long distance runners. But what does the evidence say? So this week we will be looking at research related to barefoot running and long distance injury prevention.

The first question that should be brought up in this debate is, "What are the mechanical differences between running in shoes versus running in barefeet?"

A study from the journal Nature published in 2010 looked at this question and used advanced biomechanical measuring techniques to evaluate the two running styles. This experiment was performed with 5 different groups running on a track at endurance running speeds: (1) Habitually shoed athletes from the USA; (2) Athletes from Kenya whom grew up running barefoot, but now use shoes; (3) US runners who grew up running with shoes, but now run barefoot; (4) Kenyan adolescents who have never worn shoes; (5) Kenyan adolescents who have worn shoes most their lives.

The results of this analysis demonstrated that runners habitually used to wearing shoes (Groups 1 & 5) primarily landed on the heel of their foot ("rear-foot strike") while running. However the runners with barefeet (Groups 2 and 4) landed more often on the front of their foot ("fore-foot strike") or the middle of their foot ("mid-foot strike"). They also found that during running, the peak force of impact between the ground and foot was three times higher in habitually barefoot runners with fore-foot strike. The significant force differences result from increased ankle motion, knee flexion, and medial foot arch cushion during impact with a fore-foot strike.

Therefore, this study concludes that there is a significant difference in the biomechanics of shoed runners compared to habitually barefoot runners. These differences lead to varying rates and magnitudes of force on the body during long distance running. The role these force differences may play in injury was not examined in this study and the authors conclude that controlled prospective studies are needed to test the idea that barefoot running can decrease injuries.

  1. Lieberman DE, Venkadesan M, Werbel WA, Daoud AI, D'Andrea S, Davis IS, Mang'eni RO, Pitsiladis Y. (2010) Foot strike patterns and collision forces in habitually barefoot versus shod runners. Nature 463: 531-5.

Cell Phone Use Shown to Change Brain Cell Metabolism:

We live in an era where technologies of all kinds are accelerating at an ever increasing pace. But maybe no technology has become a part of so many people's daily life as quickly as cell phones. According to the Neilsen 2010 Media Industry Fact Sheet, there were over 223 million cell phone users in America over the age of 13 last year. Therefore the results of a study published this week in the Journal of the American Medical Association could have implications for the over two thirds of Americans who are cell phone users (myself included).

The research article, titled "Effects of Cell Phone Radiofrequency Signal Exposure on Brain Glucose Metabolism", was the most rigorous study to date questioning if cell phone use can have an effect on brain cells. This study included 47 participants and was conducted by using two cell phones, with one placed at each ear. The phones were held in place for two 50 minute sessions. One 50 minute session, neither phone was receiving a signal. In the second 50 minute session, the right sided phone was receiving a recorded phone call with the volume placed on 'mute' (this way the person was not actually hearing any sounds from the phone). After each 50 minute session, PET brain scans were performed to look at the activity of the brain cells.

The results found that overall, the whole-brain metabolism did not change between the "on" and "off" phones. However, in the area of the brain closest to the phone's antenna metabolism was significantly higher. Therefore, in healthy people, 50 minutes of cell phone exposure was shown to increase brain cell metabolism in the area closest to the antenna.

It is unclear what can be extrapolated from these findings and the long-term effects that increased brain cell metabolism may have. Nonetheless, this study will change the way cell phone safety is discussed and may send a strong signal to the public encouraging cell phone users to take advantage of the safety benefits of headsets and hands-free pieces.

  1. Volkow, N. et al. Effects of Cell Phone Radiofrequency Signal Exposure on Brain Glucose Metabolism JAMA. 2011;305(8):808-813.

Alternative treatments for Migraine prevention?

Migraine headaches occur in approximately 15% of the population. These headaches can be extremely severe and cause nausea, hyper-sensitivity to light, and hyper-sensitivity to sound. Migraines are usually treated with medication, but there are alternatives for those who prefer to avoid the medications or are experiencing side effects.

One recent research paper, published February 2011 in the Journal of Headache and Pain, reviewed a collection of studies that looked at three different manual therapies for migraine prevention. This paper compared the effectiveness of massage therapy or physiotherapy or chiropractic adjustments to the usual migraine medications, propranolol and topiramate (Topamax).

Only one experiment with physiotherapy for migraines met the qualifications to be included in this review and it found that only 13% of migraine patients had a significant response to the physiotherapy treatment provided two days per week for 13 months.

The reviewed studies that looked at massage therapy found that when provided once or twice per week for 5-13 weeks approximately 27-28% of patients achieved a meaningful reduction in their migraine symptoms. This level of improvement is comparable to the accepted figure of 6-29% of patients treated preventatively with topiramate.

All four studies of chiropractic adjustments for migraine treatment found significant improvements at rates comparable to medication. In one of the studies 35% of the patients had significant decreases in the frequency and duration of their migraine headaches with 2 chiropractic treatments per week for 2 months.

Therefore, this systematic scientific review concluded that massage therapy and chiropractic adjustments can be equally as efficient as the traditional prescription medication in the preventative treatment of migraine headaches.

  1. Chaibi A, Tuchin PJ, Russell MB. Manual therapies for migraine: a systematic review. J Headache Pain. 2011 Feb 5.

Is Glucosamine as effective as Celebrex for Knee Arthritis?

Glucosamine and chondoitin sulphate are two of the most popular dietary supplements sold today. They are most famous for treating arthritis and other joint pain conditions. However, the research on its effectiveness is markedly mixed. There have been some studies that show significant benefit, and others that do not.

One recent double-blind placebo-controlled study evaluated the efficacy of glucosamine and chondroitin sulphate compared to Celebrex or a placebo for painful knee arthritis over the course of two years. This study divided 662 patients with knee arthritis into five different treatment groups. The groups were: glucosamine (1500mg/day), chondroitin sulphate (1200mg/day), glucosamine + chondroitin sulphate, celecoxib (Celebrex 200mg/day), and placebo. After two years results were collected to evaluate which patients achieved a meaningful improvement in their arthritis symptoms.

The results found that none of the groups achieved statistically significant improvement compared to the placebo treatment. However, the celecoxib and the glucosamine groups did have the highest percentage of patients achieve a meaningful improvement in arthritis symptoms.

Therefore, the results of this trial do NOT confirm that a significantly greater effectiveness is seen with glucosamine and chondroitin sulphate supplementation compared to celecoxib or a placebo for the treatment of knee arthritis. However, due to its comparable effectiveness to traditional pharmacologic treatment as well as its increased safety, it is reasonable to recommend a trial course of use for people suffering from arthritic knee pain.

  1. Sawitzke AD et al. Clinical efficacy and safety of glucosamine, chondroitin sulphate, their combination, celecoxib or placebo taken to treat osteoarthritis of the knee: 2-year results from GAIT. Ann Rheum Dis. 2010 Aug;69(8):1459-64. Epub 2010 Jun 4.

Can Tai Chi fight off Fibromyalgia?

Tai Chi Chuan literally translates from Chinese as the "supreme ultimate fist". It is a very strong name for a practice that is often quite gentle and is now used frequently in the rehabilitation of the elderly. This martial arts practice has been around since the 1500s in China, but is now becoming very popular in the medical community for its ability to improve the quality of life for people suffering from a wide range of illness and injury.

One recent randomized controlled trial published in the prestigious New England Journal of Medicine in 2010 studied the effects of tai chi on the quality of life for people with fibromyalgia.

This study included 66 participants who were randomly assigned to either the tai chi group or a control group. The tai chi group participated in two 60 minute classes per week over the course of 12 weeks. The control group attended two 60 minute wellness education and stretching classes per week over the course of 12 weeks.

Before the trial began measurements were taken to establish each person's physical and mental quality of life and the severity of their fibromyalgia symptoms. After the 12 week trial was over, the measurements were retaken to observe the total change.

At 12 weeks, the tai chi group had significantly more improvement in their physical and mental quality of life as well as a significantly greater decrease in the severity of their fibromyalgia symptoms. Therefore the results of this study indicate that a 12 week course of tai chi can help people suffering from fibromyalgia, by decreasing their pain and improving their quality of life.

  1. Wang C, Schmid CH, Rones R, Kalish R, Yinh J, Goldenberg DL, Lee Y, McAlindon T. A randomized trial of tai chi for fibromyalgia. N Engl J Med. 2010 Aug 19;363(8):743-54.

Exercise vs. Zoloft for treating Depression

Authors note: This article is part 3 of this week's series exploring recent research studies documenting healthy, natural, and free ways to decrease stress, anxiety, and depression.

Major Depressive Disorder (also known as clinical depression) is a condition that affects millions of people every day. In 2005 it was estimated that 3-5% of males and 8-10% of females in the North America will suffer from depression in any given year. Common treatments include medications, counseling, and even electroconvulsive therapy.

One treatment for depression that is not as commonly prescribed, but has no side effects and an extremely low cost, is exercise.

Recently the Journal of Psychosomatic Medicine published an extensive and well designed study to compare the effectiveness of a supervised aerobic exercise class, a home-based aerobic exercise program, sertraline (Zoloft) medication, and a placebo-pill for the treatment of depression. The intent of this study was to compare the effectiveness of exercise vs. medication for the treatment of depression over the course of a 4 month treatment program in.

This study found that after 4 months depression was in remission for:

  • 47% of patients treated with medication
  • 45% of patients in the supervised exercise class
  • 40% of patients in the home exercise program
  • 31% of patients taking placebo-pill

The statistical analysis calculated that there was no significant difference in effectiveness between the medication and any of the exercise groups. Therefore, exercise was shown to be equally effective as medication for the treatment of depression.

In February 2011, this same journal published a follow-up to their original study that looked at how these patients were doing 1 year after the study ended. They found, at 1 year later, that the patients who had been originally assigned to the exercise groups had less depressive symptoms and most continued to exercise between 0-180 minutes per week.

  1. Blumenthal JA, et al. Exercise and pharmacotherapy in the treatment of major depressive disorder. Psychosom Med. 2007 Sep-Oct;69(7):587-96. Epub 2007 Sep 10.
  2. Hoffman BM, et al. Exercise and Pharmacotherapy in Patients With Major Depression: One-Year Follow-Up of the SMILE Study. Psychosom Med. 2011 Feb;73(2):127-33. Epub 2010 Dec 10.

Aerobic exercise or weight training to decrease anxiety?

Authors note: This article is part 2 of this week's series exploring recent research studies documenting healthy, natural, and free ways to decrease stress, anxiety, and depression.

Everyone has had moments where they felt overly apprehensive, tense, nervous, and/or fearful in certain situations. In science this is known as "state anxiety". Normally these feelings are transient and disappear on their own. However in some people these feelings become too common and this can lead to the diagnosis of "anxiety disorder". When this occurs often the first line of treatment is medication. These medications have become so common that the brands Prozac, Zoloft, and Xanax have become household names.

Fortunately, there are natural treatments (exercise, sleep hygiene, dietary changes) for anxiety that have been demonstrated to be substantially effective in reducing the symptoms of anxiety.

One recent study published in the Journal of Sports Medicine and Physical Fitness asked the question, what type of exercise is best for improving "state anxiety"? In this experiment they assigned 42 people to participate in either an introductory resistance exercise class (50 min) or and introductory aerobics class (50 min). The people were also divided into two groups, a high baseline state anxiety and a low baseline state anxiety. Each person was assessed for their levels of state anxiety immediately before the class began, and then 5 minutes after the class ended, and measurements were taken three separate occasions 1, 4 and 8 weeks into the class.

The results of this study found that all participants with high anxiety had significantly reduced levels of anxiety after both the aerobic exercise class and the weight training class. The amount of improvement did not differ significantly between the different forms of exercise. The group of people classified in the low anxiety group improved with aerobic exercise, but did not improve with the weight training class.

Therefore, if you or someone you know suffers with anxiety and is looking for a natural (and free!) way to decrease their symptoms, this study suggests that starting an exercise program (aerobic or resistance training) could provide significant benefit.

  1. Hale BS, Raglin JS. State anxiety responses to acute resistance training and step aerobic exercise across eight weeks of training. J Sports Med Phys Fitness. 2002 Mar;42(1):108-12.

Can walking decrease stress and increase happiness?

Authors note: This is part 1 of this week's series exploring recent research studies documenting healthy, natural, and free ways to decrease stress, anxiety, and depression.

Technology has allowed modern lifestyles to evolve at a breakneck pace over the past decades. This evolution has brought many new tools that have helped improve overall quality of life (re: internet), but many of these changes (re: internet) have also dramatically increased the amount of stress individuals face on a daily basis. The negative consequences of our modern lifestyle are reflected in the increasing rates of anxiety, depression, and other psychological illnesses among the general population.

This week we will look at a growing trend in research examining the link between physical activity and mental health.

One large population-based study recently published in the Scandinavian Journal of Medicine & Science in Sports looked at the relationship between leisure time physical activity and people's stress levels and life dissatisfaction. In this study 12,028 men and women 20-79 years of age were given a detailed survey that collected general demographic data, a physical activity profile, and a psychological profile. In order to standardize the data, results were adjusted for the individual's particular demographics such as age, sex, income, education, and others.

The results of this study demonstrated that with increasing physical activity in leisure time there was a statistically significant decrease in both stress levels and life dissatisfaction. Also, the most pronounced improvements were seen in the people categorized in the low to moderate level of physical activity groups (2-4 hours per week walking).

In conclusion, this was a large study which showed statistical differences between sedentary and physically active people's quality of life. Also encouraging was the fact that the largest differences were seen in groups that spent low-moderate amounts of time exercising. Therefore, if you or someone you know is under a lot of stress, one of the best things you could do is to start a moderate physical activity program such as walking 2-4 hours per week.

  1. Schnohr P, Kristensen TS, Prescott E, Scharling H. Stress and life dissatisfaction are inversely associated with jogging and other types of physical activity in leisure time--The Copenhagen City Heart Study. Scand J Med Sci Sports. 2005 Apr;15(2):107-12.

Can low level laser therapy heal shoulder impingement?

The shoulder is one of the most complex joints in our body. Unlike other joints, our shoulder depends almost entirely on a few muscles (the rotator cuff) to maintain stability. This unique structure combined with its extreme range of motion, makes the shoulder prone to a wide variety of injuries. One common shoulder injury is sub-acromial impingement. This is a condition that can be caused abnormal shoulder biomechanics and leads to pinching of the rotator cuff tendons. If left untreated, sub-acromial impingement can result in rotator cuff tears.

Low level laser therapy (therapeutic laser) is used to treat a wide variety of musculoskeletal conditions. One recent study attempted to compare the effects of therapeutic laser to a placebo for the treatment of sub-acromial impingement. This study divided 52 patients into two groups. Each group had 5 treatment sessions per week for 3 weeks which included a cold pack for 10 minutes, an exercise program, and finally either the true laser or the placebo laser treatment.

At the end of three weeks results were collected that demonstrated significant improvement in pain, range of motion, and daily shoulder function for both treatment groups. However, no significant difference was seen between the true laser or placebo laser group. The authors concluded that the effects of the laser may have been overshadowed by the positive effects both groups received from the cold packs and therapeutic exercises.

  1. Dogan SK, Ay S, Evcik D. The effectiveness of low laser therapy in subacromial impingement syndrome: a randomized placebo controlled double-blind prospective study. Clinics (Sao Paulo). 2010;65(10):1019-22.

Dr. Golob and Tumwater Chiropractic Center are proud to offer therapeutic laser in combination with specifically designed exercise programs for patients whom are most likely to benefit from this approach.


Call today to schedule an appointment and see if an exercise program and therapeutic laser can help your shoulder injury!

Does yoga decrease stress AND chronic low back pain?

Chronic low back pain can impact a person's quality of life in many ways. Not only might the person find it difficult to go about their daily routine, but depression and high stress levels are often associated with this debilitating condition. In recent years more research has supported a theory known as the "biopsychosocial" model as an effective way to approach chronic pain patients.

This approach is similar to what alternative and holistic health practitioners have been practicing for decades. That is the recognition that the mind and body are connected and the best results come when the person is treated as a whole person rather than a set of individual symptoms.

One popular activity that has the potential to help positively affect all aspects of a biopsychosocial problem is yoga. A carefully designed yoga program can help people physically and emotionally.

One study from 2010 published in the International Journal of Yoga looked at the effectiveness of a residential short term intensive yoga program on improving the quality of life in patients with chronic low back pain. The 7-day yoga program consisted of asanas (yoga postures), pranayama (breathing techniques), meditations, and lectures on yogic lifestyle.

After 7 days measurements were obtained and compared to a similar group that had underwent 7 days of physical therapy exercises. The results indicated that patients in both groups had improved physical function and range of motion in their backs. However, the yoga group had significantly greater improvements in range of motion as well as significant improvements in psychological quality of life indicators such as perceived stress levels.

Summary: It is not realistic that everyone with back pain participates in an intense 7-day yoga retreat. However, the amount of positive gains seen in this study support the theory that physical impairments and quality of life will improve faster and further when the problem is addressed from a holistic approach.

  1. Tekur P. et al. Effect of yoga on quality of life of CLBP patients: A randomized control study. Int J Yoga. 2010 Jan;3(1):10-7.

Does Vitamin D deficiency cause tension headaches?

Vitamin D is found in many foods and is also made in our bodies when we are exposed to ultraviolet light (sunlight). Extreme deficiency in this vitamin results in the disease osteomalacia which causes weakening of bones and muscle aches, but headaches have never been traditionally considered to be related to vitamin D levels.

However, a recent series of case reports published in the journal Headache, suggests that vitamin D deficiency may play a role in causing certain types of headaches. This report outlined the cases of 8 people who all had been suffering from chronic tension type headaches. Tension headaches are different than other headaches such as migraine or cluster headaches, and often times tension headaches do not respond well to medication.

The cases studied in this report looked at patients suffering from chronic headaches that had not improved with traditional medications and, after receiving a thorough examination, showed moderate signs of vitamin D deficiency and osteomalacia.

The patients were given doses of vitamin D ranging from 1000 – 1500 IU/day and calcium doses of 1000mg/day. All patients had complete or marked improvement in their headache symptoms within 4-6 weeks program, and each patient also had improvement of their associated muscle aches.

Case reports are not the strongest form of evidence because they do not prove causation, but they can provide insight into possible correlations. Therefore if you suffer from chronic tension type headaches that have failed to respond to medication, you may be showing signs of vitamin D deficiency and should be sure to talk to your chiropractor or other health care professional about beginning a trial of vitamin D and calcium supplementation.

  1. Prakash S, Shah ND. Chronic tension-type headache with vitamin D deficiency: casual or causal association? Headache. 2009 Sep;49(8):1214-22.

Can creatine help muscle strength if you don't move?

Creatine has been a popular supplement among athletes and weight lifters for several years. It has been shown to increase muscle mass and power in individuals undergoing a strength training program. Now a recent study looked at the ability of creatine to preserve the size and strength of muscles that are unused due to immobilization in a cast.

This experiment, published in the Journal of Strength and Conditioning Research, included 7 men who had never taken creatine previously. Each person had their muscle mass, strength, and endurance tested in both arms. After these baseline measures were taken, each subject had one of their arms immobilized in a long arm plaster cast for seven days on two separate occasions. First, subjects were given a placebo supplement followed by cast removal for one week. This procedure was then repeated with creatine supplementation.

After each cast removal, muscle measurements were taken to compare the effects of creatine supplementation versus placebo. The results found that when the men supplemented with creatine they retained significantly more size and strength of the muscles in their arms.

This study suggests that during prolonged immobilization (>7days), creatine supplementation can be used effectively to diminish muscle loss.

  1. Johnston, A. et al. Effect of Creatine Supplementation During Cast-Induced Immobilization on the Preservation of Muscle Mass, Strength, and Endurance. J Strength Cond Res. 2009 Jan;23(1):116-20

Best Treatments for Chronic Whiplash Neck Pain?

Unfortunately whiplash is a common neck problem that accounts for a large percentage of neck pain patients. When the individual takes care of themselves in a timely manner with good treatment and rehab, the outcomes are usually very good. However, there are some cases where the neck pain caused by the whiplash becomes chronic and can last for years.

One recent report published in the journal of Pain Research & Management in 2010 analyzed all the previous experiments from 1980-2009 that looked at treatment methods for chronic whiplash pain. In this study a wide variety of non-invasive techniques were looked at. This study concluded that there is evidence that exercise programs, interdisciplinary care, and manual joint manipulation (chiropractic adjustments) are effective in relieving whiplash-related pain. Of these exercise was shown to be the most beneficial.

Therefore, if you are suffering from chronic whiplash-related neck pain, this comprehensive report suggests that you should see a health care professional about beginning a specific exercise program and a trial of manual joint manipulation.

  1. Teasell RW. Et al. A research synthesis of therapeutic interventions for whiplash-associated disorder (WAD): part 4 - noninvasive interventions for chronic WAD. Pain Res Manag. 2010 Sep-Oct;15(5):313-22

Dr. Golob and Tumwater Chiropractic Center are proud to offer chiropractic adjustments and design specific exercise programs for injuries that are most likely to benefit.


Call today to schedule an appointment and see if an exercise program and chiropractic adjustments can help your injury!

Laser Cut business cards

Fig. 1: My laser-cut business card

Check out my new laser-cut business cards!

I had these cards cut at Metrix Create:Space in Seattle. A great shop where you can make almost anything you can imagine (http://metrixcreatespace.com/).

These cards were designed by Vinz Fredrix Studio and anyone wishing to purchase similar cards should contact the designer at


New study finds effective treatment of plantar heel pain!

Plantar Fasciitis is a common problem for people with foot and leg pain that literally translates into inflammation of the bottom of the foot. There are many popular methods of "curing" this condition. However, many of these methods simply treat the site of the pain (the foot and heel), but fail to identify and correct the cause of dysfunction.

Many times the cause of the fascial inflammation is poor lower extremity biomechanics leading to abnormal muscle function in the calf. Therefore, if the dysfunctional cause (ie: poor mechanics and tight muscles) is not corrected, the pain will continue to return.

One recent study published this month in the Journal of Orthopedic & Sports Physical Therapy examined the effectiveness of treating this type of pain with stretching combined with "Myofascial Trigger Point Manual Therapy" (which I refer to on my site as "Soft-tissue mobilization"). This study divided 60 patients into two groups. One that was given stretching exercises only and one that was given stretching exercises combined with soft-tissue mobilization. The results found that the group given stretching combined with soft-tissue mobilization experienced a significantly greater improvement in physical function and a greater reduction in pain.

Therefore, if you are suffering from plantar fasciitis, research suggests you begin a stretching program and combine it with soft-tissue mobilization.

  1. Romulo R. et al. Effectiveness of Myofascial Tirgger Point Manual Therapy Combined with a Self-Stretching Protocol for the Management of Plantar Heel Pain: A Rondomized Controlled Trial. J Orthop Sports Phys Ther 2011;41(2):43-50.

Dr. Golob and Tumwater Chiropractic Center are proud to offer soft-tissue mobilization to patients suffering from foot and leg pain whom are most likely to benefit from this technique.


Call today to schedule an appointment and see if an exercise program and soft-tissue mobilization can help your injury!

Which type of stretching improves muscle strength and power?

Stretching is a common warm-up activity that most of us have been taught since elementary school P.E. class. However, the benefit of stretching is somewhat controversial in the scientific community and some researchers have shown that certain types of stretching may actually decrease athletic performance.

One recent study published in the Journal of Strength and Conditioning Research aimed to determine if different methods of stretching can be better. This question was looked at by examining three different types of stretching and their immediate effects on muscle strength.

The three methods of stretching used were Static Stretching, Dynamic Stretching, and Proprioceptive Neuromuscular Facilitation (PNF). Static stretching is what most people think of when they stretch, ex: "bend over and touch your toes". Dynamic stretching is an active stretch where the opposite muscles are actively pulling. PNF is a combination of both dynamic and static stretching.

This study had women warm-up on a stationary bicycle for 5 minutes, perform the designated stretching routine, and then knee extension power was measured. The results found that none of the stretching routines decreased maximal knee extension power, and a 6-9% increase in muscle power was seen when the women preformed the dynamic stretching routine.

So the next time you are warming-up for an athletic event, try to include some dynamic stretching into your routine and you might find yourself performing a little better.

  1. Manoel, M. et al. Acute Effects of Static, Dynamic, and Proprioceptive Neuromuscular Facilitation Stretching on Muscle Power in Women. J Strength Cond Res. 2008 Sep;22(5):1528-1534

Dr. Golob and Tumwater Chiropractic Center teach specific stretching protocols and encourage active care in all patient treatment plans.


Call today to schedule an appointment and learn the stretches and exercises that can help you perform your best!

Chiropractic Adjustments vs Microdiscectomy Surgery for Sciatica

Sciatica is a catch-all term that usually refers to sharp shooting pain down the back of the leg. Often times this type of pain is caused by irritation to the Sciatic Nerve, and sometimes that irritation is caused by a herniated disc in the lumbar spine.

In October of 2010, an experiment was published in the Journal of Manipulative and Physiological Therapeutics that compared the effectiveness of chiropractic care versus orthopedic surgery for patients with sciatica due to herniated discs. One requirement of the study was that only patients who had failed traditional medical care (pain medications, physical therapy, massage therapy) were allowed to participate.

Overall the study included 40 patients and randomly assigned each to either the chiropractic treatment or surgical treatment. The results demonstrated that both groups showed significant improvement in pain and function, and after 1 year there was no difference between patients who were adjusted by a chiropractor or had surgery. Overall, sixty percent of patients who failed medical management benefited from chiropractic manipulation as much as if they would have had surgery.

  1. McMorland G. et al. Manipulation or microdiskectomy for sciatica? A prospective randomized clinical study. J Manipulative Physiol Ther, 2010 Oct;33(8):576-84

Dr. Golob and Tumwater Chiropractic Center are proud to offer chiropractic adjustments to patients suffering from back pain whom are most likely to benefit from this technique.


Call today to schedule an appointment and see if chiropractic adjustments can help your injury!

Can Lasers help those suffering with knee osteoarthritis?

Most people think of evil supervillains when they hear the word laser, but in the health care arena laser is making a new, more friendly, name for itself.

Low level laser therapy (LLLT), also known as "cold laser", is a technique that uses the unique physical properties of laser (certain wavelengths and frequencies) to help speed up our body's natural healing process. A wide variety of benefits have been reported on in the scientific literature ranging from accelerated wound healing to treatment of frozen shoulder and plantar fasciitis.

Recently an experiment was conducted in the journal of Photomedicine and Laser Surgery to look at treating arthritis in the knee with low level laser therapy. This study examined 35 patients suffering from knee arthritis and the effects of laser treatment on pain, range of motion, and knee circumference. Each patient received their designated treatment twice per week for four weeks. The results found that the patients who received low level laser therapy had an immediate decrease in pain and improvement in their knee range of motion. These improvements were still maintained 2 months after the treatment sessions ended.

  1. Hegedus B. et al. The effect of low level laser therapy in knee osteoarthritis: a double-blind, randomized, placebo-controlled trial. Photomed Laser Surg. 2009 Aug:27(4):577-84.

Dr. Golob and Tumwater Chiropractic Center use Low Level Laser Therapy in their treatment protocols for the patients whom are most likely to benefit from this technique.


Call today to schedule an appointment and see if laser therapy can help your injury!

Does Kinesio Tape help patients with Whiplash Injuries?

Kinesiologic taping, or "Kinesio Tape", has became very popular in the sports world following the 2008 Bejing Olympics, where gold medal volleyball player Kerri Walsh was seen using the tape. Since then it has been used to treat more conditions in a non-athletic population as well.

The theory of Kinesio Tape is that the adhesive stretch of the tape can help activate the adjacent musculature, decrease pain, improve circulation, and even decrease swelling and inflammation. One new study that was published in 2009 looked at the effects of Kinesio Tape in patients with whiplash injury.

This experiment compared patients who had the tape applied correctly (with stretch) to patients who had the tape applied without any stretch at all. The results found that the patients who received the correct Kinesio Tape application immediately showed a greater decrease in pain and a greater increase in cervical (neck) range of motion. The study concludes that Kinesio Tape could also provide even greater relief when combined with other traditional treatments for whiplash injuries, such as chiropractic adjustments and exercise.

  1. Gonzalez-Iglesias J. et al. Short-term Effects of Cervical Kinesio Taping on Pain and Cervical Range of Motion in Patients With Acute Whiplash Injury: A Randomized Clinical Trial. J Orthop Sports Phys Ther 2009;39(7):515-521

Dr. Golob and Tumwater Chiropractic Center use Kinesiologic Taping in their treatment protocols for the patients whom are most likely to benefit from this technique.


Call today to schedule an appointment and see if your injury can benefit from Kinesio Tape!

Does Lumbar Traction Reduce the Size of Herniated Discs?

Traction, also referred to as spinal decompression, has been a common treatment for low back pain. This treatment is most commonly used with patients who have evidence of a herniated intervertebral disc.

The theory is that the distraction forces can help relieve pressure on the disc herniation, thereby allowing the disc to return to its normal shape and position.

However, a recent study published last year used 'pre' and 'post' MRIs to evaluate whether that claim was true. This report examined 26 patients with Lumbar disc herniations before and after a 3 week course of physical therapy combined with lumbar traction.

The results found decreased pain, decreased disability, improved sleep, and increased ranges of motion in 100% of the patients. But there was no consistent significant changes in the size of the patient's disc herniations. Therefore, the mechanism by which traction helps patients with lumbar disc herniations is still uncertain, but this study also reminds us that a patient's ability to function does not always correlate with the size of the disc herniation seen on MRI.

  1. Kamanli A. et al. Conventional physical therapy with lumbar traction: clinical evaluation and magnetic resonance imaging for lumbar disc herniation. Bratisl Lek Listy 2010;111(10):541-4

Dr. Golob and Tumwater Chiropractic Center use Lumbar Traction in their treatment protocols for the patients whom are most likely to benefit from this therapy.


Call today to schedule your appointment and see if your back condition is a candidate for lumbar traction!

Can Chili Peppers help burn fat and speed up weight loss??

Everyone knows that diet and exercise are essential to losing weight. But often, when a person dramatically changes their diet and lowers their calorie intake, their body will respond by slowing their metabolism.

This metabolic change makes it harder to lose as much weight, and has been partially responsible for the popularity of weight loss drugs. Unfortunately most of these weight-loss drugs have dangerous side effects that outweigh their potential benefits.

However, a new experiment recently looked at a natural substance found in chili peppers that has the potential to safely increase resting metabolism and fat burning. This study, published in the journal Nutrition & Metabolism looked at the effects of capsinoid supplementation on metabolism at rest and during exercise.

The results found that subjects taking 10mg of capsinoids had higher levels of oxygen consumption and fat metabolism while resting, but not during exercise.

These results suggest that supplementing with capsinoids (or eating more peppers) may be a safe alternative to dangerous weight loss drugs for people in conjunction with an exercise and dietary weight loss program.

Capsinoid Supplement

  1. Josse AR. Et al. Effects of capsinoid ingestion on energy expenditure and lipid oxidation at rest and during exercise. Nutr Metab (Lond) Aug 3;7:65.

Does Smoking Cause Back Pain?

Many people are aware that obesity, stress, and lack of exercise can all contribute towards back pain. But what about smoking tobacco?

A study published in the Journal of Pain Research August 2010 has looked at this question and attempted to determine the effects that smoking cigarettes has on the prevalence of low back pain.

This research study analyzed the health history of 132,947 Canadians. Each subject was categorized as a daily smoker, non-smoker, or occasional smoker and if they had low back pain for the previous 6 months. After adjusting and standardizing for each patient's other risk factors (such as age, BMI, activity level) it was found that smoking does increase the prevalence of low back pain.

In fact, this study concluded that daily smokers are approximately 50% more likely to have back pain than non-smokers. Occasional smokers do not have as much back pain as smokers, but are still more likely to have low back pain than non-smokers. This effect was most extreme in men and women ages 20-29 but was seen at all ages.

So now we have one more decision that many of us can make to help reduce our chances of suffering from chronic low back pain. Quitting (or refraining from) smoking will help reduce current and prevent future episodes of low back pain.

  1. Alkherayf F. et al. Daily smoking and lower back pain in adult Canadians: the Canadian Community Health Survey. J Pain Res. 2010 Aug 26:3 155-60