Tips for a Healthier Back

Eat more vegetables. Stress less. Take the kids out to the park more often. You may already have a long list of resolutions for the new year. This year, honor your spine, too. With the help of your doctor of chiropractic, these simple steps can promote a healthier back for the new year.




Consider replacing your pillow or mattress.



Do you wake up with aches and pains? It could be time to purchase a new mattress or pillow. The American Chiropractic Association (ACA) recommends finding a mattress that evenly supports your whole body. There should be no gaps between you and the mattress when you lie down. When choosing a pillow, select one that supports your head and neck in alignment with the rest of the spine, whether you sleep on your side or back. Keep in mind that what works for your partner may not work for you— there isn’t one mattress or pillow that fits everyone. Simple adjustments, such as adding foam padding, can help tremendously.



Re-evaluate your posture at work.



Americans spend an average of 44 hours at work every week— often behind a desk. To avoid poor posture that can lead to tension, back pain, and joint problems such as carpal tunnel syndrome, check that your chair is the right size and adjusted correctly, says the ACA. Do your feet rest comfortably on the ground? Does the chair offer lumbar support? Are you able to tilt or swivel easily while performing tasks at your desk? Also, be sure you have adequate light (so that you aren’t straining to see documents or a computer screen), adjust your computer monitor so that it is at eye level, and wear a headset for longer telephone conversations. And don’t forget to take frequent breaks and stretch throughout the day.



Learn how to lift correctly.



Many back injuries are caused by improper lifting of items such as luggage, backpacks or briefcases, storage boxes, or even groceries. But knowing how to lift properly can prevent serious injury. First and foremost, don’t bend from the waist. Keep your back straight, and squat to reach the item. Then, keep it close to your body as you lift, and avoid twisting motions. When traveling, check all bags that weigh more than 10 percent of your body weight.



Eat right and exercise well.



Eating a balanced diet and getting regular exercise helps your body stay toned and tension-free— and promotes a healthy weight and a happier spine. Smart exercise and a good diet can also prevent osteoporosis, which affects over 20 million American women. To start, the ACA recommends eating out at restaurants less (to reduce the amount of unhealthful fats and sugars you consume) and adding more fresh fruits, vegetables, and whole grains to your diet. Aim for a minimum of 20 to 30 minutes of exercise, three or four days a week.

What's Your Body Type?

An old cliche for getting to know someone in a new social situation entails asking, "What's your sign?" The notion, of course, is that a simple identifier such as astrological sign would provide grounding for a potential relationship - romance, friendship, or even a new bowling partner. As there are only twelve signs of the zodiac, the odds were good that you'd be able to make something out of your respective astrological signs and go from there. Many marriages, businesses, and contract bridge teams can trace their origins to what were considered favorable astrological pairings.

Although many believe that astrology can offer sound advice regarding matters of health and well-being, there are other more quantifiable categorizations that do impact your health and are backed by reproducible scientific study and research. One such series classifies physical body type into three groupings - ectomorphic, mesomorphic, and endomorphic. These body types are termed somatotypes. This useful classification is both predictive and prescriptive with respect to a person's current and future levels of health.¹

Ectomorphs are those people who are relatively long and lean. Ballet dancers, competitive figure skaters, and distance runners are almost always ectomorphs. Fashion models are usually ectomorphs, as are many professional beach volleyball players. In baseball, shortstops, second basemen, and center fielders are typically ectomorphs. The character Dr. Gregory House is a typical ectomorph.

Mesomorphs are those people who are more heavily muscled. In football, running backs, linebackers, and safeties are usually metamorphs. Powerlifters are metamorphs, as are shotputters, discus and javelin throwers, and sprinters. Star Trek's Lieutenant Worf is a typical metamorph.²

Endomorphs are those people who have proportionately more body fat than muscle, with more of the body mass concentrated in the abdominal area. Endomorphs are more typically engaged in sedentary occupations. The fictional detective Nero Wolfe and Count Fosco of Wilkie Collins's "The Woman in White" are famous endomorphs.

Overall, mesomorphs are characterized by musculoskeletal robustness and endomorphs are characterized by subcutaneous adipose tissue accumulation.³ In comparison to either group, ectomorphs are characterized by an increased tendency to musculoskeletal injury, including muscle and tendon strains and joint and ligament sprains. Overall, there is an increased risk for cardiovascular disease in those who are thin as well as in those who are more-than-moderately obese.

Chiropractic care can provide benefit to persons of any body type. By optimizing the flow of health-promoting information between your nerve system and the rest of your body, chiropractic care helps you function at peak efficiency. Your body type is a physical expression of the interaction between your genetic inheritance and innumerable environmental factors. Regular chiropractic care helps you make the most out of your physical structure and helps improve your health and well-being.

¹Yeung EH, et al: Childhood size and life course weight characteristics in association with the risk of incident type 2 diabetes. Diabetes Care, March 9, 2010 (Epub ahead of print)

²Singh AP, Singh SP: Somatotypic variations. An analysis of some traditional occupation. J Hum Ecol 19(4):249-251, 2006

³Peeters MW, et al: Heritability of somatotype components: a multivariate analysis. Int J Obesity 31:1295-1301, 2007

Elbow Reconstruction vs. Shoulder Surgery: Which has the better outcome for Pitchers?

When you are a pitcher, the absolute last thing that you ever want to hear from your doctor is that you need surgery. However, if the damage is bad enough, that may be exactly what is necessary to get you back on the field. With pitchers though, especially the ones that do it for a living, surgery is never a guarantee.

More often than not, the damage done to a pitcher's throwing arm, occurs due to repetive trauma of throwing a little, white, roughly 5.25 ounce ball over many years, at high speeds. The terms "Tommy John" (now more often associated in the minds of this generation of fans with an elbow surgery than with the individual after whom the procedure is named), "rotator cuff repair" and "torn labrum" have all made their way into the baseball vernacular, perhaps desensitizing us to just how serious these procedures are. While much progress has been made both in terms of surgical technique and in the rehabilitation parameters following surgery, we have not yet arrived at a place in medicine where a return to play is assured. 

That said, the outcomes for elite pitchers following ulnar collateral ligament (UCL) reconstruction (more commonly referred to as Tommy John surgery) are quite good. In a study published in the American Journal of Sports Medicine in 2007 that looked specifically at return to play for major league pitchers following UCL reconstruction, 82 percent successfully returned at an average of 18.5 months after surgery. The term "successfully returned" is key since no pitcher wants to come back a lesser version of his former self. In the AJSM study, reconstructed pitchers were followed for seven consecutive seasons and demonstrated no significant change in mean ERA or WHIP when compared to their pre-injury numbers. While good outcomes following Tommy John surgery have been widely reported, this study was unique in that it focused specifically on major league baseball pitchers. This data is extremely encouraging for pitchers facing elbow surgery.

If a pitcher is facing shoulder surgery however, the outcome is not nearly as promising. Only 35 percent to 50 percent of throwing athletes return to their previous level of performance following shoulder surgery. One study presented at the 2008 American Orthopaedic Society for Sports Medicine Specialty Day Meeting indicated that of 12 players at the high professional level (major league baseball, Triple-A and Double-A) who underwent shoulder surgery, only one made it back to that high level of play.

This might explain why former pitching phenoms like Mark Prior and Brandon Webb have been unsuccessful thus far in recapturing their glory days.

One factor has to do with the basic anatomy and biomechanics of the two joints. The elbow is a hinge joint with primary movement in one direction that allows for bending and straightening. The shoulder, however, is a more complex joint that allows for significant movement in three planes.

In fact, the human shoulder is so mobile, we can practically make a 360-degree circle with the arm. Pitchers, as a function of their position, have even more mobility in their throwing shoulder. Just look at any still image of a pitcher when his arm is in the late-cocking position (just before he begins the forward motion of his delivery) and it seems as if his arm is on backward.

But that mobility comes at a price. Increased range of motion translates to less stability in the joint, which is why shoulders are one of the most easily dislocated joints in the body. Although technically a ball and socket joint, the shoulder is somewhat unusual. The "ball" portion of the shoulder formed by the humerus or arm bone rests on a very shallow "socket" formed by the outer facing aspect of the shoulder blade. Were it not for the labrum (a ring of cartilage that lines the shoulder) -- ligaments in the joint, a fibrous capsule around the joint and finally all of the surrounding shoulder musculature -- the ball portion would fall off the socket with only minimal movement.

Consequently, any disruption of those surrounding tissues can not only cause pain, it can also spell trouble for shoulder stability. And when it comes to pitchers' shoulders, a torn labrum, ligament damage, capsular tears and rotator cuff strains can all be part of the picture. With the combination of power and finesse demanded of the shoulder in an elite thrower, compromising any of these structures can certainly alter his performance. Surgical repair may help provide stability, but the challenge is doing so while allowing the pitcher to retain enough mobility to resume pitching.

Because of the complex interrelationship of all this structures, surgery can sometimes be an educated guess. According to Dr. Jeff Guy, team physician and medical director at the University of South Carolina. Guy, who trained under and now teaches with the renowned Dr. James Andrews, says that whereas Tommy John surgery primarily involves replacing a single ligament, most shoulder problems are complex and involve multiple structures. For a surgeon, the goal is to do enough to address the damage without overdoing it.

"It really comes down to clinical judgment at the time," Guy said. He describes shoulders that exhibit signs of severe wear and tear with fronds of tissue hanging inside the joint. "When the tissue is frayed you try to clean it up as best you can and hope that you've addressed what's causing the [athlete's] pain." The scary thing is, that if the surgeon is clinically wrong, he/she cannot put the structures back.

One of the challenges when it comes to pitchers and shoulder surgeries, according to Los Angeles Dodgers medical director Stan Conte, is while there are numerous outcome studies related to Tommy John surgery, good shoulder outcome studies are lacking in professional baseball.

"We talk about Mark Prior, we talk about Chris Carpenter, we look at how individuals have done," Conte said, "but we don't have very many good studies with large sample sizes. We really need a study with not 20, not 40, but 100 to 200 pitchers to find out what the outcomes truly are in professional baseball players.

Major League Baseball is working on putting together just such a study and is issuing grants to promote research. Currently, a database of player injuries does not exist in MLB as it does in the NFL and the NCAA. MLB's research committee (of which Conte is a member) is trying to change this. Gathering data would allow for retrospective studies, which could provide insight into the complex questions surrounding these pitching injuries, including how to better prevent them from occurring.

Until there are more definitive answers, baseball medical and coaching staffs will continue to tweak all the potential variables that influence the shoulder as best they can, maintaining shoulder range of motion, strengthening the shoulder, trunk and legs and examining pitching mechanics.

So while we wait for Major League Baseball to develop these definitive answers, it appears as though if you were a pitcher and had to choose between Tommy John Surgery or Shoulder Surgery, Tommy John Surgery has the best outcomes.

And while we wait, pitchers will still push the biomechanics envelope and see what the human body can withstand.

1. Stephania Bell, ESPN
2. Dr. Jeff Guy, University South Carolina
3. Dr. Stan Conte, Medical Director LA Dodgers

Slipped Disc: Questions and Answers

You may have heard the term “slipped disc” used to describe a low back injury.  Discs do not actually “slip”.  Rather, they may herniate or bulge out from between the bones.  A herniation is a displaced fragment of the center part or nucleus of the disc that is pushed through a tear in the outer layer or annulus of the disc.  Pain results when irritating substances are released from this tear and also if the fragment touches or compresses a nearby nerve.  Disc herniation has some similarities to degenerative disc disease and discs that herniate are often in an early stage of degeneration.  Herniated discs are common in the low back or lumbar spine.

What causes discs to herniate?

Many factors decrease the strength and resiliency of the disc and increase the risk of disc herniation.  Life style choices such as smoking, lack of regular exercise, and inadequate nutrition contribute to poor disc health.  Poor posture, daily wear and tear, injury or trauma, and incorrect lifting or twisting further stress the disc. If the disc is already weakened, it may herniate with a single movement or strain such as coughing or bending to pick up a pencil.

How do I know if I have a disc herniation?

Herniated discs are most likely to affect people between the ages of 30 and 40.  Disc herniations may be present without causing pain.  The most common symptom will be pain in the area of the herniation that may radiate across the hips or into the buttocks.  You may also experience numbness or pain radiating down your leg to the ankle or foot.  If the herniation is large enough, you may notice weakness with extension of your big toe and you may be unable to walk on your toes or heels.  In severe cases of lumbar disc herniation, you may experience changes in your bowel or bladder function and may have difficulty with sexual function.

How is a disc herniation treated?

Mild to moderate disc herniations can usually be treated conservatively with stretching, exercise therapy and chiropractic care.  More advanced cases will often require some form of spinal decompression, such as traction or mechanical decompression, in conjuction with chiropractic care. 
Occasionally, a herniation may be severe enough to warrant surgical intervention.  These cases are usually reserved as a last resort when other forms of therapy have failed to relieve pain, or if there is significant compression of the spinal cord or nerves.

Exercising Alfresco

In "The Producers", the riotous Mel Brooks movie classic from 1968, the wily and almost washed-up Broadway producer Max Bialystock (played famously by Zero Mostel) takes timid accountant Leo Bloom (Gene Wilder) to lunch. Bialystock steers Bloom to a hotdog vendor's run-down sidewalk stand just outside an entrance to New York City's Central Park. "We're dining alfresco" Bialystock pompously intones, sardonically tracing a big, broad semicircle with his hotdog to symbolically include all the glories of being outdoors.
Of course, "alfresco" means out-of-doors or in the open air. In Italian, "fresco" means cool or fresh. Dining in the open air is often much more fun than having a meal indoors. The same may be said for exercise - whenever you have a choice, exercising "alfresco" is often much more enjoyable. Exercising outdoors is more rewarding for many people and also provides a wide range of unexpected benefits.

According to Federal agencies, the average American spends about 90% of her time indoors. Coupled with this assessment is the fact that three-quarters of Americans and one billion people worldwide have deficiencies in Vitamin D, a prime life-supporting and health-enhancing nutrient. Exercising outdoors for 30 minutes several times per week will assist your body in manufacturing more sufficient quantities of this important vitamin.

Additionally, spending time outside helps improve both physical and mental health. Regular exercise is associated with helping to prevent numerous health disorders, including obesity, diabetes, colon cancer, hip fracture, high blood pressure,1 cardiovascular conditions, and inflammatory conditions such as arthritis.

Sunlight tends to improve a person's mood, so being outdoors is a natural boost to one's frame of mind. Adding exercise to the mix naturally enhances this psychologically elevated state. Since 2005 researchers at the University of Essex in the United Kingdom have focused on the benefits of "green exercise". In one study, participants engaging in a green outdoor walk described improvements in self-esteem, overall mood, and vigor. Confusion, fatigue, anger, and tension were all substantially reduced.

Even viewing green and rural environments reduced blood pressure measurements by almost 9% in 100 treadmillers compared to those viewing blank screens or viewing urban images. If viewing green spaces is beneficial, actually being out-of-doors is likely to provide even greater benefit.

The bottom line? Being outdoors will enhance the value of most exercise activities. Green exercise will often impact a person's life in ways unlooked-for and by means unexpected.

Do You Suffer from Neck Pain?

Do you suffer from neck pain? If you do, you’re not alone. Nearly 75 percent of American adults will suffer from neck pain at some point in their lives. And, looking at our anatomy, it’s no wonder so many of us do. Though having your head perched on top of your spine gives you a great view of your environment, the set-up is rather like propping a bowling ball atop a tower of blocks. The price? Our necks are prone to injury of the muscles, ligaments, tendons, and joints. But by paying attention to our posture, doing regular stretching and strengthening exercises, and visiting our chiropractors, we can help keep our necks pain-free.

Causes of Neck Pain

Neck pain ranges from mild (annoying and distracting) to severe (incapacitating). Poor posture during normal, everyday activities such as watching TV, using a computer, reading a book, or talking on the phone can easily trigger minor neck pain. TV watching can be particularly bad for the neck if you’re lying on a couch, with your head propped at an awkward angle for a prolonged period of time. Holding the phone between the jaw and shoulder (rather than in your hand), reading at a desk or table with your head hung over a book, or working with a computer monitor below eye level can also be particularly stressful for the neck. By resting and making efforts not to repeat the offending stresses on the neck, minor neck pain usually disappears on its own within a day or so.

Neck pain that won’t go away or keeps coming back can signal a more serious underlying problem. Subluxations or joint restrictions; injuries such as whiplash; diseases like osteoarthritis, meningitis and tumors; congenital malformation; and degeneration (such as that in arthritis) require more than rest. A trained healthcare professional such as a doctor of chiropractic (DC) can help. He or she can determine whether the cause of your neck pain is minor and easily treatable or more serious and requiring more intensive, extended treatment. Then he or she may recommend chiropractic adjustment, massage, natural anti-inflammatory supplements, and/or strengthening and stretching exercises.

Prevention is Key

How can you avoid the need for treatment in the first place? The first step is to take note of your everyday posture. If your job requires a lot of phone use, consider wearing a headset. Do you slouch when you watch TV? Lie on the couch? Choose to sit upright, in a posture-supporting chair. When studying or reading, avoid putting the book or magazine on a flat surface. Instead, consider using a book prop. And, if you notice your computer monitor is below eye level, elevate it by placing it on top of a shelf or tower.

If you experience neck pain that doesn’t abate within 24 hours, seek the advice of a trained healthcare specialist for the appropriate diagnosis and treatment. And remember, because chiropractors specialize in the neuromusculoskeletal system, they are some of the most well-trained healthcare professionals to consult about neck pain.

When Parents Get Older

The average age of Americans is increasing year-by-year. Approximately 77 million babies were born in the United States during the boom years of 1946 to 1964. In 2011, the oldest will turn 65, and on average can expect to live to 83. Many will continue well into their 90s.  Most people continue to retain the habits they developed as children and teenagers. For many Americans, these habits included lack of regular exercise, sedentary activities, and poor nutrition. 

As adults we no longer possess the free pass we had when we were kids. If we continue to eat high-fat and high-carbohydrate foods, we'll gain more and more weight. If we persist in viewing regular exercise as an unnecessary indulgence, we'll continue to experience high blood pressure, heart disease, and weakened immune systems. Older adults who resist the importance of good nutrition and regular exercise are also missing the thrill and sheer joy of having a vibrantly healthy, high-efficiency body. In contrast, older adults can achieve high levels of fitness, or even satisfactory levels, and feel much more youthful than they have in years.

Young adults who are the children of older adults can set a good example for fitness. Of course, this strategy is the reverse of what we're used to - our parents setting the example for us. But good examples work both ways, and smart parents may be willing to take a tip from their kids.

The first good example is regular exercise. The U.S. Department of Health and Human Services recommends 30 minutes of exercise five times per week. Most Americans do no exercise at all. Get your parents into the routine by inviting them to go for a walk or bringing them to the gym and showing them a few basic exercises. For our parents, the key is to get them started. Keep encouraging them - not as something they "should" do, but rather as something they could bring into their lives as a "choice". No one wants to do what they "should". Make it an invitation - make it fun.

Also, begin to set a good example with nutrition. Take your parents out to dinner at a healthy place - talk to them about eating smaller portions, avoiding fried and processed foods, and food combining. Food combining means eating a portion of protein and a portion of carbohydrate at every small meal. For most people, altering their food habits-of-a-lifetime is pretty radical. Help your parents learn how to take small steps in the direction of healthy nutrition, rather than attempting to change everything at once. Again, help them have fun with it. Good nutrition is a choice.

For all of us, it's important to walk the talk. Our kids - and even our parents sometimes - will mimic what we do. We want our own lifestyle choices to be healthy and life-promoting, so our kids and our parents have a good example to follow.

A chiropractic physician is an expert in using exercise and nutrition as a means of helping patients restore good health. She will be glad to provide valuable information on both of these topics for you and your whole family.