This week from Dr. Cerami and Utah Sports and Wellness

From: Spine, September 2017

Quick Summary:

This study was performed to determine if there is a correlation between multiple MRI findings or single MRI findings in cases of low back pain. With data collected from more than 400 subjects, the authors concluded that, “The risk of LBP outcome increased with increasing numbers of different MRI findings.” The four MRI findings that were most likely to be found in these low back pain subjects were; modic change, high intensity zone, disc height narrowing and spondylolisthesis. Importantly, “spondylolisthesis had a statistically significant univariate association with LBP in the last year.” The “finding showed that the odds of having LBP in the last year increased with the number of MRI findings present.” “In those with 3 or 4 MRI findings present, the odds of LBP in the last year were 14.1 times greater [1,410%] than in people with no MRI findings.”

Abstract:

A cross-sectional and longitudinal analysis using 2 different data sets OBJECTIVE.: To investigate if the number of different MRI findings present is more strongly associated with low back pain (LBP) than single MRI findings. Summary of background data: Most previous studies have investigated the associations between single MRI findings and back pain rather than investigating combinations of MRI findings. If different individuals have different pathoanatomic sources contributing to their pain, then combinations of MRI findings may be more strongly associated with LBP. Methods: This study used data from two previous studies that investigated the association between single MRI findings and LBP. One study was a cross-sectional population cohort of 412 forty-year old people, the second was a longitudinal cohort of 76 people recently recovered from LBP who were followed for 12 months. The outcome for the cross-sectional study was presence of LBP during the last year. The outcome for the longitudinal study was days to recurrence of activity limiting LBP. In both data sets we created an aggregate score of the number of different MRI findings present in each individual and assessed the relationship between this aggregate score and LBP. Results: The risk of LBP outcome increased with increasing numbers of different MRI findings. Compared to those with no MRI findings, those with 3 MRI findings were at substantially greater risk of LBP in the last year (Odd Ratio = 14.1; 95%CI 4.32 to 49.47) in the cross-sectional study, or of future recurrence of LBP (Hazard Ratio = 12.2; 95%CI 1.26 to 118.21) in the longitudinal study. Conclusions: The aggregate MRI score was more strongly associated with LBP outcomes than single MRI findings in both data sets. Further investigation of this approach is indicated. Level of evidence: 2.

These authors also note:

• Studies indicate that single pathology on MRI is “only weakly related to LBP and of little importance.” As such, this study investigated combinations of MRI findings.
• The authors concluded that the “aggregate MRI score was more strongly associated with LBP outcomes than single MRI findings in both datasets.”
• “The risk of LBP outcome increased with increasing numbers of different MRI findings.”
• “Compared with those with no MRI findings, those with three MRI findings were at substantially greater risk of LBP in the last year.” [In one study it was a 1400% increased risk, and in the other study it was 1200% increased risk]
• The “finding showed that the odds of having LBP in the last year increased with the number of MRI findings present.”
• “In those with 3 or 4 MRI findings present, the odds of LBP in the last year were 14.1 times greater [1,410%] than in people with no MRI findings.”
• The risk of “having a future recurrence of LBP was 12.2 times [1,220%] greater in those people with three MRI findings present than in those people with no MRI findings.”
• “Our results suggest that those at high risk of recurrences may be able to be better identified and prevention approaches could be tested in these individuals. Patients with widespread MRI pathology may represent a specific phenotype, who require different interventions to those with localized or no pathology.”
• “This study found an aggregate MRI score of the number of different MRI findings was more strongly associated with LBP outcomes than single MRI findings.”
• “The risk of previous and future LBP increased with increasing numbers of different MRI findings.”
• “Compared with those with no MRI findings, those with three MRI findings were at substantially greater risk of LBP in the last year.”

This week from Dr. Cerami and Utah Sports and Wellness

From: Canadian Medical Association Journal, July 1958

Quick Summary:

These physicians describe how manipulation can provide back pain relief, even to those patients whom have failed to respond to routine medical treatment. Most symptoms that will respond to manipulation are due to the presence of degenerative disease, which can be managed but not cured. More and more authorities are leaning to the belief that disturbances in the disc mechanism are responsible for the majority of backaches. Studies also show that another common cause of backache is faulty posture. No matter what the cause of back pain, exercises designed to build up the back and abdominal muscles and chiropractic manipulation are of the greatest value. This approach to backache has proved most gratifying and more important, has brought comfort to a large group of patients who have not been able to achieve it before.

Abstract:

A concept of the mechanism of production of many backaches is presented. This offers a rational approach to treatment by mechanical methods-either manipulation or mechanical traction. The selection of suitable cases is discussed and some of the more successful manipulative procedures are outlined. In our hands this approach to backache has proved most gratifying and, more important, has brought comfort to a large group of patients who have not been able to achieve it before.

These authors also note:

• “That manipulation will relieve back pain in many instances, few will argue.”
• Irritation of any of the deeper structures in the back can cause backache together with referred pain. Thus irritation of muscles, ligaments, synovium, dura and bone can cause backache and referred pain.
• In the zygapophysial joints, “adhesions may produce symptoms.”
  • There is a binding of joint surfaces which can be freed by manipulation.
  • A “facet synovial impingement” where there is a “nipping of synovium between joint surfaces” can be relieved by manipulation.
  • A mechanical disturbance of the posterior [facet] articulation can cause back pain
• Low back pain may be due to pressure on the dura mater by a central displacement of the intervertebral disc.
• “By 20 years of age the nucleus has started to degenerate, and by 50 it is pretty well cicatrized [scarred-up, fibrosed].”
• The true sprain of the back “is produced by tremendous force and is a relatively uncommon injury.” [A sprain occurs when the joint goes completely
  through the normal range of motion and then is forced further.]
• Studies show that another common cause of backache is faulty posture, responsible for 5-47%.
• In over 2000 cases whose presenting complaint was pain in the back, or pain that arose from the back, a “diagnosis of disc syndrome was made in over 90%.”
• “Pain coming on instantaneously on a bend or twist is usually considered to indicate displacement of a fragment of annulus that can be manipulated back into place.”
• There are few contraindications to spinal manipulation.
• The main after-treatment in prevention of recurrence is avoiding flexion.
• “All [manipulated patients] are advised to carry out extension exercises while lying on the abdomen. This, it is thought, forces the nucleus and fragments of annulus forwards into the interspace where they do not impinge and are less likely to be protruded.”
• Four manipulation attempts (on consecutive days) is our limit. If the pain is not relieved, the patient is then sent for mechanical traction.
• “Pain so severe as to keep the patient in bed is no contraindication to manipulation.”
• “We see many patients who are afraid to make an effort to get out of bed but who, following manipulation, get up and move with ease.”
• “In our hands this approach to backache has proved most gratifying and, more important, has brought comfort to a large group of patients who have not been able to achieve it before.”

This week from Dr. Cerami and Utah Sports and Wellness

From: Nature Research Journal, December 2017

Quick Summary:

In this day and age, technology has become just as important to our survival as the air we breathe and with this, it becomes easy to forget the negative effects it can have on our biological health. Magnetic field (MF) non-ionizing radiation can come from power lines, wireless networks, appliances and even the cell phone in your pocket yet the association between MF exposure and the risk of miscarriage has been manly unconsidered. From this study they found, an almost three-fold increase in risk of miscarriage was found in pregnant women exposed to higher MF levels compared to women with lower MF exposure.

Abstract:

Magnetic field (MF) non-ionizing radiation is widespread and everyone is exposed to some degree. This prospective cohort study of 913 pregnant women examined the association between high MF exposure and miscarriage risk. Cox (proportional hazards) regression was used to examine the association. After controlling for multiple other factors, women who were exposed to higher MF levels had 2.72 times the risk of miscarriage (hazard ratio = 2.72, 95% CI: 1.42–5.19) than those with lower MF exposure. The increased risk of miscarriage associated with high MF was consistently observed regardless of the sources of high MF. The association was much stronger if MF was measured on a typical day of participants’ pregnancies. The finding also demonstrated that accurate measurement of MF exposure is vital for examining MF health effects. This study provides fresh evidence, directly from a human population, that MF non-ionizing radiation could have adverse biological impacts on human health.

These authors also note:

• All participating pregnant women used an EMDEX Lite meter, which is specifically designed to measure MF, which is measured in milligauss (mG). MF exposure levels were measured from all emitting sources and locations (at home, at home in bed, at work, in transit, or from other sources).
• “The vast majority of epidemiological studies on MF health effects in the literature so far have been based on subjective and unreliable MF measurements. Thus, it is not surprising that many of the past studies failed to detect MF health effects.”
• “The focus on studying MF effects on cancer has exacerbated the problem, since the development of cancer usually has a long latency period between exposure and outcome that could span several decades. This has made accurately measuring MF exposure in the etiologically relevant period (decades before the diagnosis of cancer) almost impossible. Those ‘null findings’ have left a false impression of the ‘safety’ of MF exposure.”
• “Magnetic field (MF) non-ionizing radiation is widespread and everyone is exposed to some degree.”
• “A recent NIEHS multi-year project conducted by the National Toxicology Program (NTP) has revealed an increased risk of cancer associated with MF non- ionizing radiation exposure.”
• “The International Agency for Research on Cancer (IARC) has classified MF as a possible carcinogen.”
• “A study examined human embryonic tissues to assess the association between EMF exposure and embryonic growth and observed an increased risk of impaired embryonic bud growth and apoptosis associated with exposure to higher MF level, providing some direct evidence of adverse biological impact of EMF exposure on embryonic development.”
• Four other studies published during the past 15 years have shown a relationship between high MF exposure and increased risk of miscarriage.
• “Two other studies examined the impact of EMF emitted from cell phones and wireless networks and observed that more frequent cell phone use and close proximity to wireless base stations were both associated with an increased risk of miscarriage.”
• “The increased risk of miscarriage associated with high MF was consistently observed regardless of the sources of high MF.”
• “This study provides fresh evidence, directly from a human population, that MF non-ionizing radiation could have adverse biological impacts on human health.”
• “Given the ubiquitous nature of exposure to this non-ionizing radiation, a small increased risk due to MF exposure could lead to unacceptable health consequences to pregnant women.”