This week from Dr. Cerami and Utah Sports and Wellness

From: Annals of Thoracic Surgery, January 2017 (https://www.sciencedirect.com/science/article/abs/pii/S0003497516314382)

Quick Summary:

The aim of this study was to assess whether osteopathic manipulative treatment (OMT) contributes to post heart surgical sternal pain relief and improves postoperative outcomes. Eighty post-sternotomy patients were randomly allocated to receive a standard cardiorespiratory rehabilitation program alone (control group) or standard cardiorespiratory rehabilitation with spinal manipulation. Controlling sternal pain after heart surgery is important to reduce the risk of postoperative complications, but pain is often undertreated because of contraindications and side effects of analgesic drugs. Postoperative pain diminishes patients’ ability to cooperate, delays recovery and may lead to worse outcomes. Inadequately controlled postoperative pain negatively affects the immune system, wound healing, and pulmonary function. The manipulation in this study began the day after being discharged from the surgery department, and was administered for 5 days. The improvement in respiratory function was more marked in the [manipulation] group. The inspiratory volume was significantly greater in the [manipulation] group. Hospitalization was significantly shorter in the [manipulation] group than in the control group (19.1 ± 4.8 versus 21.7 ± 6.3 days). At the end of the rehabilitation program, the reduction in perceived pain was more marked in the [manipulation] group and the VAS score was significantly lower in [manipulation] patients than in controls. The combination of standard care with [manipulation] is effective in inducing pain relief and functional recovery, and significantly improves the management of patients after heart surgery with sternotomy.

Abstract:

Controlling sternal pain after heart surgery is important to reduce the risk of postoperative complications, but pain is often undertreated because of contraindications and side effects of analgesic drugs. Recently, osteopathic manipulative treatment (OMT) was demonstrated to reduce pain in different clinical contexts, suggesting its potential utility after cardiac surgery. The aim of this open-label, controlled study is to assess whether OMT contributes to sternal pain relief and improves postoperative outcomes. Eighty post-sternotomy adult inpatients were randomly allocated one to one to receive a standardized cardiorespiratory rehabilitation program alone (control group) or combined with OMT. Pain intensity and respiratory functional capacity were quantified by the Visual Analogue Scale score and by a standardized breathing test, at the start and end of rehabilitation. At the start of rehabilitation, the control group and the OMT group had similar Visual Analogue Scale median scores (controls 4, interquartile range [IQR]: 2 to 5; OMT 4, IQR: 3 to 5; p = not significant) and mean inspiratory volumes (controls 825 ± 381 mL; OMT 744 ± 291 mL; p = not significant). At the end of rehabilitation, the OMT group had a lower Visual Analogue Scale median score (controls 3, IQR: 2 to 4; OMT 1, IQR: 1 to 2; p < 0.01) and higher mean inspiratory volume (controls 1,400 ± 588 mL; OMT 1,781 ± 633 mL; p < 0.01). The analgesic drug intake was similar in the two groups. The hospitalization was shorter in the OMT group than in the control group (19.1 ± 4.8 versus 21.7 ± 6.3 days; p < 0.05). The combination of standard care with OMT is effective in inducing pain relief and functional recovery, and significantly improves the management of patients after heart surgery with sternotomy.

These authors also note:

• “Uncontrolled postoperative pain is often responsible for neurologic complications, episodes of delirium, and other acute confusional states with a multifactorial pathogenesis.”
• “In addition to discomfort and suffering, pain may cause sleep deprivation, may delay return to normal functioning, and may have nociception-induced adverse effects on cardiovascular functioning and pulmonary morbidity.”
• Pain intensity was measured using a 10-cm visual analogue scale (VAS) ranging from “no pain at all” to “unbearable pain.”
• “Anti-inflammatory drugs may impair renal function, interact with platelet aggregation, and increase the risk of gastrointestinal damage and bleeding; analgesic drugs have detrimental neurologic effects and negatively affect visceral motility; and opioids may decrease survival during in-hospital resuscitation and increase duration of hospitalization.”
• “The combination of standard care with [manipulation] is effective in inducing pain relief and functional recovery, and significantly improves the management of patients after heart surgery with sternotomy.”

This week from Dr. Cerami and Utah Sports and Wellness

From: Frontiers in Neurology, March 2016

Quick Summary:

The purpose of this article, was to investigate the effects of cervical mobilization and manipulation on pain intensity and headache frequency, compared to traditional physical therapy in patients diagnosed with cervicogenic headache. Officially, cervicogenic headache is a “secondary headache arising from musculoskeletal disorders in the cervical spine and is frequently accompanied by neck pain.” Around 4.1% of the total population have cervicogenic headache, with its accounting for nearly 15% of the headache population. The symptoms of CH may arise from any of the components of the cervical spine, including vertebrae, disks or soft tissue. However, CH pain “most commonly arises from the second and third cervical spine (C2/3) facet joints, followed by C5/6 facet joints.” Cervical mobilization and manipulation are frequently used to treat patients diagnosed with CH, and many studies on the effectiveness of such treatment have found it to be beneficial in reducing headache pain or disability, intensity, frequency and duration. The benefits of manual therapy for CH have also shown to be maintained at long-term follow up assessments.

Abstract:

Cervical mobilization and manipulation are frequently used to treat patients diagnosed with cervicogenic headache (CEH); however, there is conflicting evidence on the efficacy of these manual therapy techniques. The purpose of this review is to investigate the effects of cervical mobilization and manipulation on pain intensity and headache frequency, compared to traditional physical therapy interventions in patients diagnosed with CEH. A total of 66 relevant studies were originally identified through a review of the literature, and the 25 most suitable articles were fully evaluated via a careful review of the text. Ultimately, 10 studies met the inclusion criteria: (1) randomized controlled trial (RCT) or open RCT; the study contained at least two separate groups of subjects that were randomly assigned either to a cervical spine mobilization or manipulation or a group that served as a comparison; (2) subjects must have had a diagnosis of CEH; (3) the treatment group received either spinal mobilization or spinal manipulation, while the control group received another physical therapy intervention or placebo control; and (4) the study included headache pain and frequency as outcome measurements. Seven of the 10 studies had statistically significant findings that subjects who received mobilization or manipulation interventions experienced improved outcomes or reported fewer symptoms than control subjects. These results suggest that mobilization or manipulation of the cervical spine may be beneficial for individuals who suffer from CEH, although heterogeneity of the studies makes it difficult to generalize the findings.

These authors also note:

• Women may be affected with cervicogenic headache four times more frequently than men.
• Patients who have sustained concussion or whiplash injuries with neck pain and limitation of movement often develop cervicogenic headache.
• “The symptoms of cervicogenic headache may arise from any of the components of the cervical spine, including vertebrae, disks, or soft tissue.”
• However, cervicogenic headache pain “most commonly arises from the second and third cervical spine (C2/3) facet joints, followed by C5/6 facet joints.”
• “The afferent fibers of the trigeminal nerve and the upper three cervical nerves converge on second-order sensory neurons at the dorsal horn of the upper cervical spinal cord. This convergence is the anatomical basis for the clinical observation that patients with cervicogenic headache often present with headache at both cervical and trigeminal dermatomes.”
• “Upper cervical spine mobility restriction (hypomobility), cervical pain, and muscle tightness are clinical findings associated with cervicogenic headache during physical examination.”
• The neurophysiological benefit for cervicogenic headache may be that the “afferent input induced by manual therapy may stimulate neural inhibitory pathways in the spinal cord and can also activate descending inhibitory pathways in the lateral periaqueductal gray area of the midbrain.”
• “Cervical mobilization and manipulation are frequently used to treat patients diagnosed with cervicogenic headache.”
• “Many studies on the short-term effectiveness of manual therapy to the cervical spine (mobilization and manipulative therapy) have found it beneficial in reducing headache pain or disability, intensity, frequency, and duration.”
• The benefits of manual therapy for cervicogenic headache have been shown to be maintained at long-term follow-up assessments.
• There is evidence that the lasting benefits of manipulation for cervicogenic headache is enhanced by combining therapeutic exercise.

“Sit up straight! Stop slouching!” 

How many times did we hear that while we were young? The trouble with poor posture is that it is not just a reflection on one’s manners or looking one’s best. While standing tall and sitting up straight can imbue a sense of confidence in ourselves that is visible to those around us, the benefits of a good posture go much deeper than that. The health benefits are striking.

Because everything in the body is connected, each action we take or do not take has lasting effects on the rest of the system. Poor posture can cause misalignment that results in pain, while improving posture is a simple and drug-free way to reduce discomfort and pain and prevent more serious health issues. At Utah Sports and Wellness, we can help you correct your posture, which can lead to regaining your mobility, and come up with a treatment plan that best suits you.

The Manifestations of Poor Posture

In the world we live in, endorsing poor posture has never been easier. Our society is more sedentary and technology-centric than any before, and while this offers many benefits of its own, not many of them fall in the posture department. There are many different ways in which poor posture can affect the body, including the cleverly nicknamed Tech Neck. Here we focus on two others.

Upper Cross Syndrome

Upper Cross Syndrome is so named because, when the problem exists, the overactive muscles in the back form a crossing pattern over the counter-crossed underactive muscles. The overactive upper trapezius and levator muscles down through the pectorals cross over the underactive sternocleidomastoid and lower trapezius, forming an ‘X’ in a cross-section of the neck and upper back. 

The syndrome is associated with the forward and downward placement of the head, especially from the prolonged use of devices. Significant time with one’s head bent over a screen can weaken muscles and cause imbalances in toning. This puts stress and strain on the head, neck, and shoulders and can cause a number of symptoms:

• Frequent neck pain in the absence of apparent injury
• Soreness in the shoulder blades
• Difficulty moving the shoulders, arms, or neck because of tightness or pain
• Feeling like you must constantly shift positions while sitting at your desk or computer 
• Feeling like your head is continuing to roll forward
• Frequent headaches

The misalignment or disproportionate toning of muscles in the shoulders and back can trickle-down effect affecting more peripheral parts of the body, so the symptoms here are not an exhaustive list. In order to determine that symptoms are truly caused by Upper Cross Syndrome, you and your chiropractor can also look for these poor posture patterns:

• Head protruding forward
• Shoulders rounded forward
• Ears forward of the shoulders
• Inward curvature of the neck
• Protruding shoulder blades

Lower Cross Syndrome

If the pain poor posture causes is in your lower body, Lower Cross Syndrome is more likely to be the culprit. Often the result of a sedentary lifestyle, the crisscrossing of over- and underactive muscles in cases of Lower Cross Syndrome occurs across the hip region. Without corrective action, weak muscles become weaker while short muscles get shorter and tighter. The cycle perpetuates the misalignment of pelvic joints and brings a bevy of symptoms in the hips and pelvic region:

• Pain in the hips, hip flexors, pelvis, or groin not associated with injury
• Pain in the lumbar spine or buttocks
• Tightness or stiffness in the low back, hips, or hamstrings

As with Upper Cross Syndrome, Lower Cross Syndrome can be observed by a few posture tells:

• Protruding stomach from an arched lower back
• Hips lined up incorrectly, tilting forward to increase the curve in the lumbar spine

Correcting Upper and Lower Cross Syndrome

The underlying problems in these syndromes can be corrected, and we recommend looking to your chiropractor for help. A tailored corrective exercise strategy can strengthen muscles that have been weakened by habitual poor posture. It can also serve as a warm-up before more intensive exercise. Your chiropractor or physical therapist will recommend exercises that both improve flexibility in overactive muscles and strengthen underactive muscles.

Poor posture won’t be fixed overnight, but consistent care and exercise can strengthen your muscles in a way that allows them to work together harmoniously. Work with your chiropractor to strengthen weak muscles and stretch those that are overwrought. The daily small efforts build upon each other to relieve pain now and promote a healthy body moving forward.