I've Moved - Come Check Out My New Office!

Well it is official! I have opened my own office in Sand Springs. I have manage to find a couple of amazing doctors who are backing  and helping me in opening this space. 

I am taking over an existing clinic from Dr. Brandi Wilcox who is looking to reopen closer to her home. The new clinic is Wilcox Chiropractic which will be renamed Sand Springs Chiropractic sometime in the next year or so.

I invite everyone to come over, say hi, and check out the new space. I hope to see  you soon!

- Dr. Alex (The Doc)

For Bad Backs, It May Be Time to Rethink Biases About Chiropractors

This article was past on to me and I thought every one should see what we already know. Chiropractic WORKS.

Thanks for reading.

- Dr. Alex (The Doc)

Written By: Aaron E. Carroll

THE NEW HEALTH CARE MAY 1, 2017

Spinal manipulation or physical therapy such as heat and stretches (above) seem as effective as traditional approaches to help lower back pain. Credit Joshua Bright for The New York Times

About two of every three people will probably experience significant low back pain at some point. A physician like me might suggest any number of potential treatments and therapies. But one I never considered was a referral for spinal manipulation.

It appears I may have been mistaken. For initial treatment of lower back pain, it may be time for me (and other physicians) to rethink our biases.

Spinal manipulation — along with other less traditional therapies like heat, meditation and acupuncture — seems to be as effective as many other more medical therapies we prescribe, and as safe, if not safer.

Most back pain resolves over time, so interventions that focus on relief of symptoms and allow the body to heal are ideal. Many of these can be nonpharmacological in nature, like the work done by chiropractors or physical therapists.

Physicians are traditionally wary of spinal manipulation (applying pressure on bones and joints), in part because the practitioners are often not doctors and also because a few chiropractors have claimed they can address conditions that have little to do with the spine. Patients with back pain haven’t seemed as skeptical. A large survey of them from 2002 through 2008 found that more than 30 percent sought chiropractic care, significantly more than those who sought massage, acupuncture or homeopathy.

Researchers have been looking at the evidence supporting spinal manipulation for some time. Almost 35 years ago, a systematic review evaluated the available research, most of which was judged to be low in quality, and found that there might be some short-term benefits from the procedure. Two reviews from 2003 agreed for the most part, finding that spinal manipulation worked better than a “sham procedure”, or placebo, but no better or worse than other options.

Almost a decade later, a Cochrane review assessed the literature once more, and found 12 new trials had been conducted. This review was more damning. It found that spinal manipulation was no better than sham interventions.

But since then, data have accumulated, as more higher-quality studies have been performed. Recently, in The Journal of the American Medical Association, researchers looked for new studies since 2011, as well as those that had been performed before.

The evidence from 15 randomized controlled trials, which included more than 1,700 patients, showed that spinal manipulation caused an improvement in pain of about 10 points on a 100-point scale. The evidence from 12 randomized controlled trials — which overlapped, but not completely with the other trials — of almost 1,400 patients showed that spinal manipulation also resulted in improvements in function.

In February, in Annals of Internal Medicine, another systematic review of nonpharmacologic therapies generally agreed with the other recent trials. Based upon this review, and other evidence, the American College of Physicians released new clinical practice guidelines for the noninvasive treatment of subacute back pain. They recommended that patients should try heat, massage, acupuncture or spinal manipulation as first-line therapies.

The only things that might detract from the use of spinal manipulation in this situation would be its cost and potential harms.

Because they fear those potential harms, some physicians are hesitant to refer patients to chiropractors or physical therapists for care. But in all the studies summarized above, there were really no serious adverse events reported. It’s possible to find anecdotes of harm to the spinal cord from improper manipulations, but these are rare, and almost never involve the lower spine.

Some physicians are concerned about the cost of spinal manipulation, especially since most insurance carriers don’t cover it. Visiting a chiropractor costs more than taking many non-narcotic pain medications. But more invasive interventions can cost a lot of money. In addition, studies have shown that, in general, users of complementary and alternative medicine spend less over all for back pain than users of only traditional medicine.

Medication and surgery can also lead to harms. We shouldn’t forget that prescription pain medications, like opioids, can lead to huge costs, especially when they’re misused.

Some physicians are uncomfortable that we don’t have a clear picture of how spinal manipulation actually works to reduce pain. It’s also possible that some chiropractors do it “better” than others, and we can’t tell. This concern should be tempered by the fact that we don’t have a great understanding of why many other therapies work either. Some of the more traditional things we recommend don’t even work consistently. 

Still, there is no merit to many other claims about spinal manipulation — that it has been proved to work for things like infantile colic, painful periods, asthma, gastrointestinal problems, and more. For most conditions, the therapy lacks a good evidence base.

But given the natural course of back pain — that most of it goes away no matter what you do — the ideal approach is to treat the symptoms and let the body heal. Noninvasive therapies seem to do that well enough.

Cyclist’s Hands, Overcoming Overuse Injuries

After a ride on your bike, have you experienced numbness, tingling, or pain in your arm, hand, wrist, or little finger? If you have, you could be suffering from an overuse injury. Approximately one-third of all bicycling overuse injuries involves the hands.  The 2 most common are what we call “handlebar palsy” and carpal tunnel syndrome. By making some adjustments to your bike, posture, and by wearing some protective equipment, you can prevent these injuries from occurring.

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Handlebar palsy

Ulnar neuropathy, known to cyclists as handlebar palsy, is caused by compression of the ulnar nerve at the hand and wrist. The ulnar nerve controls sensation in your ring and little finger and controls most of the muscular function of your hand. Compression of the ulnar nerve is a common problem for competitive and recreational cycle enthusiasts, alike. Compression is the result of direct pressure on the ulnar nerve from the grip on the handlebars. Often, the nerve may be over stretched or hyperextended (extension beyond its normal limit) when a drop-down handlebar is held in the lower position. The pressure placed on the ulnar nerve results in numbness and tingling in the ring and little fingers or hand weakness, or a combination of both. Symptoms can take from several days to months to resolve, but surgical treatment is rarely necessary. Rest, stretching exercises, and anti-inflammatory medications, such as aspirin, usually help relieve the symptoms. Applying less pressure or weight to the handlebars and avoiding hyperextension can help to prevent a recurrence.

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Carpal tunnel syndrome

Although it is less common than handlebar palsy, carpal tunnel syndrome (compression of the median nerve at the wrist) is another overuse injury that cyclists often experience. Injury often occurs when a cyclist holds the handlebars on top and applies pressure directly on the median nerve. Symptoms include numbness and tingling in the thumb, index, middle, and ring fingers and weakness of the hand. Symptoms usually resolve quickly once you stop cycling for a short period of time. Although handlebar pressure contributes to these symptoms, there can be other causes for hand pain and numbness; therefore, an evaluation for other possible causes of carpal tunnel syndrome should be performed by your health-care professional.

Prevention with Equipment

Adjust your handlebars, seat and pedals to best suit your body and allow you to sit in a more upright position. Sitting upright will take the weight and pressure off of your hands and wrists. Wearing padded gloves may also reduce shocks and jolts to your body, which travel into your wrist joints from the road and can lead to pain.

The Correct Position for the Wrist

The carpel tunnel is a small gap between the many small wrist bones and a flat ligament at the base of the wrist. Ten tendons go through this small tunnel and are responsible for flexing the hand and fingers. A nerve also passes through this tunnel. Degeneration or mechanical stress can easily injure these small tissues resulting in a loss of function of the hand.

Riding with the wrist flexed like this stresses these small tissues:

I see this position quite often when I conduct rider assessments.

This hand position can lead to injury for two reasons:

1. The tendons are stretched to near full length.

2. Vibration or impact from the front wheel, such as a bump in the road, can then cause a trauma as the wrist is forced to extend too far.

The correct position is with the wrist straight like this:

This position allows shock to travel up the arm while supported by the bones and cartilage, which are much stronger tissues than the fine tendons and ligaments supporting the fingers.

 

Assess and Control Weak Wrist Flexors

One reason we ride incorrectly is simply due to lack of knowledge or bad habits. But another reason can be weak wrist flexors. If you are a regular gym-goer, there are some tests you can do with pressing exercises to assess and control these flexors.

To conduct the test of your hand position you will need a set of grips, a suspension trainer, or a set of rings. You are going to check for correct wrist alignment while you perform a push up on this gear.

Correct wrist position:

Incorrect wrist position:

Elbow Position Is Important, Too

Avoiding injury doesn’t end at hand position, though. Should you hit a large bump in the road, and you manage to avoid wrist injury, the shock will continue to travel up the arm to the elbow. This is the second potential area of injury due to incorrect position.

Elbows should be slightly flexed like the cyclist shown here:

This allows any movement of the handlebars to be taken up by the elbow flexing. If you ride with your elbows stiff or locked, then vibration and shocks may extend the elbow too far and lead to trauma.

So please remember to keep your wrists straight and elbows flexed when out on the bike. 

- Dr. Alex (The Doc)

Sources: http://www.hughston.com/wp-content/uploads/Health-Alerts/vol15no3.pdf

https://breakingmuscle.com/fitness/pain-free-cycling-avoiding-wrist-and-elbow-injury

What was that POP? Is it BAD? Did they just break something?

If you have more questions feel free to ask them in the comment section or better yet come in and ask me in person.

- Alex The Doc

The Physical Side of Stress

I found this article online and I believe it needs to be shared. We as a society have too much stress and do not do enough to relieve our anxieties. What I find so fascinating about this article is that it talks about what the body goes through when stressed and the diseases it can cause.

Hope you enjoy the read.

• By Clare Kittredge
• Reviewed by Lindsey Marcellin, MD, MPH

Stress can take a toll on our health causing anything from eating disorders to heart diseases.

From 75 to 90 percent of primary care visits are for stress-related issues.

Lower your stress by finding time for both exercise and relaxation each day.

Although female sex hormones and brain chemistry offer some protection from stress, women are more deeply affected by the physical and emotional effects of stress than men.

Women’s reactions to stress are rooted in their body chemistry. Men have higher androgen levels, while women have higher estrogen levels, says Paul J. Rosch, MD, FACP, president of the American Institute of Stress (AIS).

“Their brains are also wired differently,” says Dr. Rosch, who is also a clinical professor of medicine and psychiatry at New York Medical College, and honorary vice president of the International Stress Management Association. “Women tend to react to stress differently than men. They don’t respond with the fight or flight response — they’re more apt to negotiate.”

Stress: How Women Are Affected

The effects of the natural anti-stress hormone oxytocin, produced during childbirth, breastfeeding, and in both sexes during orgasm, are enhanced by estrogen and reduced by testosterone.

This helps women more than men, Rosch says. And nurturing activities boost oxytocin levels in women.

The catch-22 is that women need more oxytocin than men to maintain their emotional health. For example, Rosch explains, women are more negatively affected when they’re not touched, and also feel more stress than men in relationships.

According to the American Academy of Family Physicians (AAFP), stress is an expression of the body’s natural instinct to protect itself. While this may warn a woman of immediate danger, like a fast-approaching car, prolonged stress effects can negatively affect your physical and emotional health.

“Our stress response was exquisitely honed over millions of years as a protective mechanism,” said Rosch. “That was OK for our ancestors who ran into saber-toothed tigers. The tragedy is that today, it’s not that, but hundreds of things like getting stuck in traffic jams. Our bodies respond in the same unfortunate fashion, with hypertension, strokes, and ulcers.”

Stress Effects: The Physical Side

“Your stress may vary, but if you have stress with your work, your kids, your neighbors, and marriage all at once, that’s a big deal,” said Lori Heim, MD, president-elect of the AAFP and a hospitalist (a family physician who works only in a hospital) at Scotland Memorial Hospital in Laurinburg, N.C. “In women, I see this in changes in menstrual patterns — nothing else is going on except a huge increase in stress, and all of a sudden, they may be losing their hair or having menstrual irregularities, and everything points to stress as a factor.”

The AIS reports that some surveys show 75 to 90 percent of visits to primary care physicians are for stress-related complaints. According to the National Women’s Health Information Center, the effects of stress on women’s physical and emotional health can range from headaches to irritable bowel syndrome. Specific stress effects include:

• Eating disorders. Anorexia and bulimia are 10 times more common in women than in men, says Rosch, and this may have something to do with stress levels. Like depression, this illness has been linked to low levels of serotonin and is often treated with serotonin-boosting antidepressant drugs.
• Stomach ailments. Stress can make you reach for junk or comfort foods, or upset your stomach to the point that you feel like you can’t eat. Common stress-related stomach troubles include cramps, bloating, heartburn, and even irritable bowel syndrome (IBS). Depending on how you respond, these can lead to weight loss or weight gain.
• Skin reactions. Stress can lead to breakouts and even itchy rashes and hives in some people.
• Emotional conditions. From being in a blue or irritable mood to more serious mental issues like depression, your emotional health suffers when there’s stress in your life. Women are better than men at hiding some emotions like anger and aggressiveness because the parts of their brains responsible for these emotions are larger than men's, but depression strikes women twice as often as men, says Rosch, adding, “The emotional effects of stress on women can range from postpartum depression after pregnancy to depression after menopause.”
• Sleep problems. Trouble falling or staying asleep is common in women affected by stress, and this is particularly counterproductive since a good night’s sleep can help ease stress.
• Concentration difficulty. Stress makes it hard to focus and be effective in your responsibilities at home or work, and that can compound your problems if your stress comes from your job to begin with.
• Heart disease. The stress of competing in today’s job market has increased women’s heart disease risk, Rosch says. Stress can negatively affect the entire cardiovascular system, and lead to high blood pressure, stroke, and heart attack.
• Lowered immune response. One of the more complicated physical reactions to stress is your body’s lessened ability to fight off disease, whether it’s a cold or a flare-up of a chronic condition.
• Cancer. Some studies have suggested a link between stress and the development of breast and ovarian cancer. In one study, researchers found that the risk of breast cancer was increased by 62 percent in women who had experienced more than one highly stressful life event, like divorce or the death of a spouse.

Stress Effects: Stress-Lowering Techniques

Research presented at the most recent Western Psychological Association meeting found that 25 percent of happiness hinges on how well you handle stress. And what was the most important stress management strategy? Planning — or anticipating what's going to stress you out — and having the tools in place to tamp down the tension. Here are some more tips for managing stress:

• Improve your diet. By eating well-balanced meals and skipping junk food, you can improve your physical well-being and, in turn, your emotional health.
• Make time for exercise. “We do know that exercise is a phenomenal way of dealing with stress and depression,” said Dr. Heim. Research shows that getting active can lift your spirits and increase the release of endorphins, a natural chemical associated with mood.
• Find fun ways to relax. Connect with family and friends and people you enjoy being around. Rediscover favorite hobbies; recent studies link a resurgence in knitting and needlepoint to their stress-reducing effects. Other popular stress-busters include yoga, meditation, and tai chi.

Finally, if you feel overwhelmed by stress and its effects, talk to your doctor about ways to deal with it. You may learn new techniques for managing stress on your own, or you may find that therapy with a mental health professional will better help you to get it all under control.

This Article is from: http://www.everydayhealth.com/womens-health/physical-side-of-stress.aspx

-Alex The Doc