So You Have a Disc Problem Part 2: The Bulging Disc

May 10, 2011 By

In the first part of the disc series I covered the degenerated disc. In this column I will address the bulging disc. Please refer back to my earlier column for normal disc anatomy.

In a normal disc the gel-like center, the nucleus, is contained within the tough fibrous rings that make up the annulus. As the fibrous rings become unhealthy due to trauma or even normal wear, they can tear, allowing the inner gel material to go out into the tear. If the tear is big enough it can cause the remaining intact outer ring of the disc to pouch outward or bulge due to the amount of pressure the gel is under (as it is bearing the weight of your body above it). The gel can then put pressure on the sensitive outer ring which has nerve endings that can cause you to feel pain. Thus, a bulging disc can cause you to have back pain. Also, these nerve endings have attachments to the exiting spinal nerves that can cause you to feel pain into your arm or leg. This would be a referred pain into the extremity rather than a radiating or pinched nerve pain.

The typical age for someone to experience a disc bulge is 20 to 50 and most often occurs at the lowest level of the spine, L5/S1. Although, it can occur at pretty much any age and at different spinal levels. An acute disc bulge usually occurs suddenly and is usually without any provocation at that moment, although it is essentially the end result of prior wear and tear or traumas. You may be just bending over to pick something up or sneeze or twist- the straw that broke the camel’s back. It is among the most painful and debilitating of the spinal disorders. The pain can be sudden and severe and may cause you to become “crooked” or unable to stand up straight. Many patients have related going to their knees due to the intensity of the pain. Other common symptoms are difficulty bending forward, difficulty on arising from sitting or especially on getting out of bed in the morning. Prolonged sitting or standing gives increased pain. Sneezing or coughing can be very painful. You may also have pain going into the arms or legs and/or tingling or numbness.

The only way to image a bulging disc is through a MRI. You cannot see the disc on plain x-rays as the disc is soft tissue and will not show up. An interesting phenomenon with disc bulges is that they may show up on the MRI but not be symptomatic or you may have all the symptoms of an acute disc bulge and it will not show up on the MRI. You don’t treat from the image however; you treat from the patient’s history and symptoms.

One of the first things I recommend my patient’s to do to treat a disc bulge is to use ice. A good rule of thumb is 20 minutes on/ 2 hours off as much as possible. I also may put a lumbar brace on the patient which can be quite comforting. I am hesitant to do this if the patient has pain into the leg as I have found the brace can increase the pain in the extremity. You also want to avoid prolonged sitting and lying especially in the initial onset phase as to get up from such can be quite difficult. You want to have some degree of movement for the spine; walking is good if you can tolerate it. You especially want to avoid sneezing or coughing, good luck with that, as that can send you to your knees. Disc bulges respond well to chiropractic care. It is somewhat amazing to see the patient barely able to walk into the office for their initial visit and with time and treatment they become pain free again. In my office I treat disc bulges with manipulation primarily in the form of flexion/distraction for which I use a specific table for such. My job is to reduce the disc bulge by inducing the gel material to go back towards the center of the disc and to keep it their while the torn rings undergo healing around it. Even though this can occur and the patient gradually becomes more functional and in less and less pain the tissue healing that occurs is with scar tissue and it is never quite as strong as the original. When I see someone with an apparent acute disc bulge I will ask them if they have ever had this happen before. Many of them will answer yes as it is a problem that will tend to recur over the years of time. If they answer no, then I inform them that unfortunately it will tend to recur periodically and usually without any provocation. Once you have it once you will probably have it again. The typical disc bulge patient can do about anything they want in terms of physical activity without any problem then one day on bending over to pick up a penny off the floor their back will “go out”.

My advice to a recovered disc bulge patient is to get into a Yoga program or a stretching class. Back strengthening exercises are also in order as well as to keep their weight down. One of my best suggestions to help prevent recurrence is to not do anything “stupid”. By that I mean that on most occasions when I have a returning disc bulge patient they relate to me that they had done something “stupid”. They were in a hurry, should have gotten some help or should have known better than to do the activity in the first place. Some commonsense can go a long way.

My next column will be on disc herniations or ruptures.

Dr. David D. Godwin
Chiropractic Physician
Salisbury Chiropractic
Salisbury, NC 704-633-9335
www.salisburychiropractic.us

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Who reads my CAT scan?

March 3, 2011 By

Your doctor orders a CT scan. You skip breakfast, you drink two large containers of bland-tasting white liquid, and you drive to the Imaging Center. After checking in at the front desk, a young lady (the technologist) escorts you to a room with a narrow padded bed. You sit on the bed, and the technologist asks you why you are there (“My doctor ordered this test because I have this pain in my belly.”) She asks if you are allergic to anything (“No”). She discusses the IV contrast (“dye”) and obtains your
permission. She explains that you will lie down on the bed, she will put an IV in your arm vein, and the bed will move until you are partly within the doughnut-shaped device at the end of the bed. She explains you may feel a cool sensation in your arm as the “dye” fluid is injected, or you may feel warmth in various parts of your body; and you should report to the technologist if you feel any burning or pain in your arm, any nausea, any itching or difficulty breathing or swallowing, or any other unusual sensations.

She explains that as the dye is injected, she will ask you to hold your breath, and the bed will steadily move through the doughnut while the “pictures” are taken.

All proceeds as expected. You had a brief generally flushed feeling that passed in less than a minute. The technologist comes in, looks at you, at your arm; then goes out
(“to check the pictures…”). She returns and says “The radiologist will look at your images and send a report to your doctor.”

You depart, relieved that the test is over; but wondering what the “pictures” showed.
After a few days, you have your follow-up appointment with your doctor who tells you, “Your Cat scan was normal except for a few cysts in your kidneys…”

What does it mean? What about my abdominal pain?
Well, most concerned physicians will take the time to explain the implications of the scan to you and then to address the possibilities that remain as a cause for your discomfort.
He or she may also then suggest the next step to elucidate the problem or suggest a
treatment if he or she has formulated a likely diagnosis from all the data (your history, your physical exam, your other lab tests).

So, who is this mysterious radiologist and what did he/ she really do for me?

A Diagnostic Radiologist is trained to interpret a variety of imaging studies – from the
simple radiograph (“xray or plain film”), like a chest xray – to the more complex CT or CAT scans, ultrasounds, MRI’s, mammograms and nuclear medicine studies. Some radiologists perform interventional procedures (eg., angiograms, biopsies) as well.

In the case of the CAT scan, there is usually a radiologist available at or near the facility where your study is performed to prescribe the study, monitor the study if needed, and to
be there in case you have a rare allergic reaction to the “dye” or contrast administered.

After the technologist prepares the final images for review, the radiologist views each of
the usually greater than 100 separate images per study to view the pertinent parts of the body in cross section. In many cases the images can be manipulated on computer to provide different views and different shades of gray to the tissues, to allow for the best evaluation.

After his or her review, the radiologist decides what structures are normal, what features are or may be abnormal, and ultimately tries to put the findings together to come to a conclusion. If the study is not in the normal range, the radiologist provides a “differential diagnosis.” That is, he or she offers a list of possible or likely causes for the findings that
have been observed. Since the radiologist is not fully aware of your history or physical exam or the results of your other lab tests, it is up to your clinical doctor to put all the
pieces of the puzzle together – which may lead your doctor towards or away from the
diagnosis (or diagnoses) offered by the radiologist.

Sometimes the radiologist will suggest additional tests to clarify findings noted on the original CT scan.

For instance, on your abdominal CT, the simple kidney cysts are almost always benign, and therefore almost always an incidental finding. They rarely require further testing.
On the other hand, the fact that the rest of the study was “negative” suggests that the diagnosis lies outside the realm of what CT can diagnose – such as some gastrointestinal problems that may not show up on CT — or the problem is too early in its development or too subtle to recognize at this time.

Your doctor may discuss this with you. And, as the visibility of the practice of radiology evolves, there is an early but growing tendency for some patients to discuss findings with the radiologist.

Most radiologists today in the U.S. (especially if they are board-certified) have undergone
(after medical school) an internship (such as surgery or internal medicine or some combination), a residency (now 4 years) in Diagnostic Radiology, and in some cases
a year or more fellowship in a subspecialty (such as Chest Radiology). They are trained
to know what the best tests are for various diagnoses your doctor is considering, how
best to perform those tests, and how to interpret the tests. The radiologist usually communicates to the referring doctor by written report, but will often
call your doctor if the findings are unusual or urgent.

So, you see, the Radiologist is a Medical Doctor, just like your internist or surgeon; but
his or her training emphasizes imaging the body, and helping your doctor arrive at the
most likely diagnosis, so that the proper treatment can be implemented.

Today, there is an impetus to make the Radiologist more visible – to emerge from behind
the curtain – to allow you, the patient, to appreciate what really goes into (and comes out of) all those imaging procedures that you undergo. Take advantage of this opportunity, especially if you want more information about the studies than your referring physician can offer.

The final decisions and treatment plans offered to you still come from your primary or referring doctor, since he or she is generally better equipped than the radiologist to perform this function.

Malcolm Friedman, M.D.
Diagnostic Radiologist
Hamden, CT – malfmd@gmail.com

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Calluses, Corns and Ulcers

January 24, 2011 By

Understanding the relationship between friction and skin helps one understand how similar calluses, corns and ulcers are and what their relationships are to one another. To better understand this connection, one first has to understand the function of the human body’s largest organ – the integumentary system, a.k.a. your skin.

Depending on your source of information, the cellular turnover of the outermost layer of your body is between 40,000 cells an hour to well over a million. And irrespective of the precise number is the sense that this is an ongoing attempt to repair and renew our outermost armor.

To give a little more depth to our topic matter, I will include the dreaded blister. It may not be widely known but 15 minutes of sustained friction will most often result in a blister which is not only in acute form of a callus but at times its precursor. Take for instance the neophyte guitarist: after the first lesson, in an hour or two of practicing, the tips of her fingers become sore and after several days they form a blister. After long enough time at her craft, calluses will appear to replace the blisters.

Calluses are most often diffuse and located under softly rounded bones (think of a marble) and corns are often punctate and located over smaller bony projections (think coral reef). And soft corns are the same as ‘regular’ corns except they’re located between two contiguous bony projections, like toes and have an element of moisture.

In essence, the rate of cellular death or destruction should equal the rate of cellular birth. When there is an excess of friction sensed by your body, and overproduction of cells in the area of friction is a protective mechanism to prevent a wound from occurring. So stated another way a callus is the results of more cells being produced then being sloughed off in a very localized area.

A soft tissue ulcer is the results of a higher rate of cellular death than of its regeneration. While friction can create an area of ulceration, there are other common causes including but not limited to decreased blood supply, inadequate return and increased pressure over a bony or none bony area. And unlike most calluses or corns, ulcers are often painless. To diminish adequate perfusion of blood, which is required for normal cellular turnover, a combination of excessive pressure or inadequate blood supply can result in an ulceration just as easy as from chronic friction. Ulcers are graded, not only by their progression but by their depth.

To illustrate the influence and ease of compromised blood flow to a body part, press your index finger over an area for a few seconds and release. No matter what your blood flow or blood pressure to that body part, the pressure exerted by your finger will push all blood out of the area creating a white spot. When your finger is lifted, the blood quickly returns to the white area. This demonstrates capillary and sometimes arterial refill capability. If you were to keep your finger in place for a prolonged period of time, the area of tissue beneath your finger will be starved of blood supply and perhaps within several hours there may be signs of profound tissue death. This is what makes a tourniquet so valuable and so dangerous.

In review, a blister is an acute lesion caused by excessive friction in a short span of time. A callus is an area of an excessive amount of skin cells laid down as a result of a low-level but chronic friction mechanism most often over a diffuse area. A corn results from the same mechanism of injury but occurs over a sharp bony prominence. And finally, an ulcer occurs when more cells die than are renewed thus creating a soft tissue defect.
01.15.11
Dr. Andrew E. Schwartz
Medical/Surgical Podiatry
51 Hospital Hill Road
Sharon, CT 06069
860.364.5944

88 Elm Street
Winsted, CT 06098
860.379.3100

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So You Have a Disc Problem

January 13, 2011 By

Problems with the intervertebral discs of the spinal column can be in many forms. These can range from thinning or deterioration to herniating or rupturing. As the discussion of the various forms of disc problems is somewhat lengthy I am going to cover them in separate columns. This column will focus on disc deterioration or “degenerative disc disease”. One thing I want to put to rest right away is the term “slipped disc”. This is a very commonly used inaccurate term to describe disc problems. There is no such thing as a slipped disc. The discs are firmly attached to the vertebrae and are surrounded by ligaments and muscle. There really is no room for discs to slip or move so the term slipped disc is not an accurate one. Now, before going into what disc deterioration/degeneration is lets talk about what a normal healthy disc looks like and its function.

Spinal discs are supple cartilage pads that are tightly fixed between the vertebrae. Each disc is a flat, circular capsule about one-quarter inch thick and contain about 80% water when we are young. They have a tough, fibrous, outer membrane called the annulus fibrosus and an elastic gel-like core called the nucleus pulposus. A disc serves as a spacer or cushion between the vertebrae and allows for movement to occur between them. It also helps to absorb shock as our bodies move.

One of the most common disc problems that is going to essentially affect all of us at some point in our lives is degeneration also known as “degenerative disc disease” or “DDD”. This is an unfortunate term as it contains the word “disease” which makes a somewhat normal process sound scary. I can’t tell you the number of times a patient has related to me that their doctor told them they had DDD but didn’t bother to explain to them that is a common and somewhat normal process that accompanies aging. (This is also why we get shorter as we get older as the discs make up for one quarter of the height of the spine) Unfortunately, DDD can lead to “DJD” or “degenerative joint disease” otherwise known as arthritis. These arthritic changes are your body’s way of stabilizing the spinal segment. As the disc deteriorates or thins the vertebrae come closer together making the segment somewhat loose or unstable. This could lead to the vertebrae shifting and possibly hitting on the spinal cord. Thus arthritis is a necessary evil. Even though arthritis, as many of you are aware, can be painful; most of us have arthritic changes in our spines and aren’t even aware that it’s there. One reason for this is that the process of degeneration of the disc is very slow and occurs over years of time with the subsequent formation of arthritic changes also being a very slow process. This allows us to gradually get used to these changes over time with the effect being that we don’t even realize we have any discomfort or stiffness. Many times people are shocked when I review their x-rays with them and they see the disc degeneration and arthritic changes that are there and relate that they never felt it. Should you experience a trauma such as a fall or an auto accident however these underlying changes can be brought to the surface. This can account for why a rather mild fall or accident can result in a lot more pain than you would have thought.

Another problem that can result from DDD and subsequent DJD is that the resultant arthritic changes can take the form of boney spurs. These spurs can grow into the openings on each side of the vertebrae where the nerves exit off the spinal cord or into the spinal canal itself where the cord traverses through the spine. This causes narrowing or stenosis of these openings and thus compressing on and irritating these structures. This can give pain into the arms or legs.

As stated earlier, when we are young our discs contain about 80% water. As we age this water content decreases thus allowing the thinning and degeneration to begin. Trauma to the discs in the form of falls or accidents can also damage the disc beginning the process. Discs have no real direct blood supply. They get their nutrients and get rid of their waste products through a process called imbibation. It works a bit like a sponge. When the joint space opens up on movement the pressure is taken off the disc and it absorbs fluid and nutrients, when the space is compressed it pushes out waste products. (When you wake up in the morning you are taller than you were when you went to bed; this is due to the pressure being off the discs while your lying down thus allowing them to absorb fluid and become thicker) When the disc is damaged from a trauma it has a harder time repairing than other blood rich tissues and thus the deterioration process is easily started.

What can be done for DDD/DJD? As a chiropractor I physically work with these joints. One of the problems that results from DDD/DJD is a loss of normal movement in these spinal segments. This loss of motion is irritating to the interlocking joints of the spine. One of the biggest things a chiropractor does is to restore mobility to these stuck or fixated joints through manipulation. Spinal manipulation is a safe and proven method of treating this problem and relieving its painful effects. Manipulation helps to restore movement allowing for increased imbibation and making the remaining disc material healthier and more functional. As I tell my patient’s-“ I’m going to take your lemons and try to make some lemonade.” Can I make the deteriorated discs brand new again, no. Can I make the spinal segments affected by the degeneration function better and feel better, yes. Along these same lines exercise and movement are good for your spine and helps to keep it mobile. One of the better exercises to do is yoga as it puts all of the joints of your body through their full range of motion. Another great exercise, and simple to do, is walking. Grab your spouse or a friend and get in the habit of doing a daily walking routine.

Another possible help for disc degeneration are the nutritional supplements glucosamine sulfate and MSM (methyl sulfonyl methane). If you look these two up you will find studies that support them and vice versa. I opt on the side of recommending them to my patients but I tell them to look them up online and to make the ultimate decision for themselves.

One last bit of advice on trying to preserve your disc health is to stop smoking. Smoking and its effects are damaging to the discs. Much along the same process that a smoker develops facial wrinkles their discs are also affected.

In my next column I will discuss “disc bulging”. Stay tuned!

Dr. David D. Godwin
Salisbury Chiropractic
Salisbury, NC
www.salisburychiropractic.us

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Avoiding whiplash and how to treat it

October 26, 2010 By

Last week I almost hit three deer on two different occasions while driving to work. I have also driven through torrential rain and witnessed a van hitting and cracking a telephone pole.

Accidents happen all the time and while modern cars can often withstand quite a bit of “injury”, the human body often can not.

Your head weighs 8 to 10 pounds; if your seat belt is fastened, the force of a collision can cause your head to whip forward and back or side to side. Accidents are at times unavoidable, but there are things you can do to decrease the chance of sustaining a whiplash injury.

  • Always fasten your seat belt.
  • Position your head rest to “catch” your head, which means it should be right in the center of your head. Positioning it too high or too low can actually cause or worsen a whiplash injury.
  • Position your seat properly. You should be sitting up straight and the seat should be as close to your head as possible to lessen the distance between your head and the seat upon impact.
  • Be aware of your surroundings — which means no calling, texting, eating, putting on makeup, etc.

If you do sustain a whiplash injury, get checked out by a medical professional. Some of the symptoms of whiplash: blurred vision, dizziness, jaw, shoulder or neck pain, headaches, vertigo, memory loss, irritability, sleeplessness, fatigue.

Most pain associated with whiplash is caused by tense muscles. When the neck is forced back and forth in a jarring motion, such as the type caused by a car accident, muscles and ligaments in the area are stretched beyond their normal limits. In severe instances, the supportive muscles of the spine are torn. Muscles in the surrounding area then tighten to try and support the injured tissues. This limits range of motion and causes strain on those muscles which are not being used to bearing the extra load. This causes more pain.

Muscle pain is your chiropractor’s specialty, so get checked out. And be careful out there.

Monica S. Nowak, DC
The Chiropractic Center of Canaan
176 Ashley Falls Road
Canaan, CT 06018
860-824-0748

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Back Talk – Acute Injuries

October 8, 2010 By

Last weekend my husband, my brother, his children and a few friends and I went to Pulaski, N.Y. to see the salmon run. My brother rolled his ankle while walking down to the river. His ankle swelled to the size of a melon which got me thinking: Do people know the best way to care for an injury like that?

The first thing to know is that there are two basic types of injury — acute and chronic. An acute injury is defined as one that has rapid or sudden onset. The pain is typically short-lived. A chronic injury is one that develops over time and is long-lasting.

When treating an acute injury, you use cold; when treating a chronic injury, you use heat.

Acute injuries are often accompanied by swelling and inflammation; the application of ice will help reduce those symptoms and the pain. You can usually ice an injury as often as you like but here is the key: only apply the ice for 15 minutes at a time; then allow the skin to warm up in between applications. And do not place the ice directly on your skin; the best thing to do is wrap it in a towel.

If you apply ice for longer than 15 minutes, your body’s natural defenses will kick in and try to warm the area by bringing more blood there. At that point, the ice pack will do the opposite of what you want it to do. It will cause more swelling.

Chronic injuries are often accompanied by sore, still muscles or joint pain. This type of pain can be relieved by warming the injury to increase elasticity of the joint connective tissues and to stimulate blood flow. Heat can be applied for 15 to 20 minutes at a time.

And, of course, sports injuries and the pain that accompanies them can also be treated by a chiropractor.

Monica S. Nowak, D.C.
Chiropractic Center of Canaan
176 Ashley Falls Road
Canaan, CT 06018
860 824-0748

Reprinted with permission from the writer.

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Getting backpacks right

September 9, 2010 By

Quite literally, we are talking about backs in this Back Talk column – specifically about children’s backs and their school backpacks.

The backpack might seem like the least important thing for a parent to worry about in the hectic days before school starts, but keep in mind that even very young children wear their packs every day, nine months a year.

And, when those backpacks fit incorrectly, it can add pressure to a child’s neck, shoulders and back.

Here are some tips to prevent neck and back pain/strain.

* Choose a lightweight material. You might have to replace it sooner but it won’t add to your child’s already heavy load.

* Wide padded shoulder straps help distribute the weight of the pack more evenly.

* Children should carry no more than 10 to 20 percent of their body weight. Their bodies are still developing muscles, bones and their attachments are only equipped to support a small amount of weight without taxing them. Would you be comfortable carrying an 80 pound briefcase to work? For many children, this means working with a parent to figure out which one can remain on campus, in a desk or locket.

* Show them how to pack their bags ergonomically. Heavy items should be closest to their back. Use multiple compartments so that the load doesn’t sway from side to side.

* Make sure your children are wearing their backpacks correctly. They should be worn over both shoulders, high on the back (2 inches above the waistline) and have them buckle the waist strap if their pack has one.

No one is saying that backpacks are going to cause major illnesses or dysfunction in a child. But, packs can contribute to future neck and back problems.

So, check in with your children, ask them if they have any pain and/or numbness in their neck, shoulders, arms, back and/or legs. Children should not have any pain at any age, it’s just not normal.

If they are experiencing pain, try a natural alternative: chiropractic. It can help them adjust their spine and skeleton before any problems become permanent.

Monica S. Nowak, DC
The Chiropractic Center of Canaan
176 Ashley Falls Road
Canaan, CT 06018
860 824-0748

Reprinted with permission

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No pain, better game

August 17, 2010 By

My father has become an avid golfer. He plays every Tuesday — and then comes to see me, suffering from back and joint pain.

When I ask him if he warmed up before playing, he demonstrates his stretching routine by whipping his upper body back and forth. Clearly, this routine isn’t working.

Golfers exert a huge amount of effort, repetitively pounding on specific joints (usually on one side of the body). Among other ailments, this can lead to “golfer’s elbow.”

Warming up your joints is essential. Slow stretching lubricates the joints and warms the muscles surrounding them, to prevent tearing of ligaments, tendons, and other soft tissues.

To prevent injury, golfers should do exercises to strengthen the muscles supporting the joints used in golfing. That means they should do exercises to strengthen their shoulders, arms, wrists, legs, knees, ankles, abdominals and low back.

Many of our clients are golfers who compete in weekend tournaments without any preparation — and then wonder why, at the end of two grueling days, they are so sore they can barely move.

Golfers should straighten up, too. Good posture is key to achieving a great golf swing, and it is important to spinal health.

Golf also requires spinal flexibility, so try some yoga. You might be surprised at the improvements they bring to your game.

And if you still have pain after you play, visit a chiropractor. Chiropractors have extensive training in the biomechanics of human movement, so if after playing you feel pain in specific joints or muscles, you probably need those joints adjusted.

People don’t normally think of chiropractic for elbows and knees, but chiropractic is very effective in mobilizing smaller joints and relieving pain.

Your chiropractor can not only treat those repetitive stress injuries but can possibly redirect your swing pattern, improving your game while getting you out of pain.

Monica S. Nowak, DC
The Chiropractic Center of Canaan
Monica Nowak, DC and Peter Markowicz, DC
176 Ashley Falls Road
Canaan, CT 06018
860-824-0748

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FIBROMYALGIA and CHIROPRACTIC

August 2, 2010 By

Over the past 25 years that I have been in practice there has been a slow but steady increase in the number of patients that upon entering my office relate that they have fibromyalgia also known as fibromyalgia syndrome or FMS. Some of these patients have been diagnosed by a healthcare professional and some have relied on self-diagnosis, which can be dangerous as I will discuss below. There has been a lot of controversy over FMS from is it a real entity, what exactly is wrong, how to diagnose it and to how to treat it. As a chiropractic physician the question put to me is “how can chiropractic help me with my fibromyalgia?”

Let’s first discuss a bit about what FMS is considered to be. FMS was first recognized by the American Medical Association as a diagnosis in 1987 even though it has been around for much longer than that. The name “fibromyalgia” implies pain and inflammation of the muscles and connective tissues of the body but this is an inaccurate label because there aren’t any actual problems in these particular structures, they just happen to be where the patient “feels” the pain and discomfort. On biopsy of these tissues in a patient considered to have FMS they do not show any inflammatory changes. Also, FMS symptoms do not respond well to anti-inflammatories e.g. prednisone as again these structures are themselves not inflamed. Much like having a pinched nerve in the neck or lower back that sends the pain down the arm or leg; the pain is only felt there, the problem is in the spine itself. The “problem” in FMS appears to be in the central nervous system. The problem in the central nervous system is in the area that controls the bodies sensitivity to pain. The ability to filter or dampen the nerve impulses for pain is impaired and thus stimuli that would not normally be interpreted by the body as painful are. No one knows for sure why this breakdown occurs but it is thought that this part of the central nervous system becomes “burned out” from the body dealing with significant stressful situations. This can be in the form of physical and/or emotional stress. Physical traumas such as auto accidents, which have seemingly been the trigger for some of my patients, or having to deal with stressful family or personal situations over a long period of time can be the underlying cause of this “burn out” situation in the central nervous system. Thus, FMS can be considered to be a post traumatic stress disorder or PTSD.

Patients that have FMS usually have a wide range of symptoms the most common of which are- hurt all over, insomnia, fatigue, depression and anxiety. Many also complain of difficulties with concentration and memory and may experience what many refer to as “fibrofog”. The list of symptoms that have been associated with FMS can be quite lengthy and can almost seem like any symptom you have can be attributed to FMS. Herein lies the biggest problem with a fibromyalgia diagnosis. Because that list of symptoms is so wide ranging someone who has been labeled as having FMS will just assume that any symptom they have is due to it. This can be dangerous as those symptoms may well be from some other underlying illness that is now going to be ignored as the patient assumes that they already know the reason for it. Even the more common symptoms associated with FMS may well be from some other illness or condition. Thus a diagnosis of FMS is usually arrived at through the process of elimination of all other possible causes of the patient’s problems. Other conditions that could give similar symptoms include- hypothyroidism, anemia, Lyme disease, rheumatoid arthritis, hormonal imbalances, allergies as well as numerous other illnesses. That is why it is extremely important to rule out other conditions first as they may be treatable and would therefore go untreated ultimately leading to other health problems if it is just lumped in as a “fibro” symptom. Thus, the person who self diagnoses as having FMS, is doing the worst injustice to themselves as they may have some other treatable condition that is just going to worsen over time. Once all other possible causes are eliminated then a diagnosis of FMS can be considered. The standard accepted criteria for diagnosing FMS, after the elimination process, is having widespread pain in all four quadrants of the body for a minimum of three months and must also have pain in at least 11 of 18 tender points in specific body locations on the application of pressure.

Now, lets get back to the original question, “how can chiropractic help me with my fibromyalgia?” First of all, as stated above, a patient should not just assume that any symptom they have is due to FMS. I have many patients say “there is nothing you can do for me my pain is from fibromyalgia”. Even though you may have FMS you are still entitled to good old-fashioned neck and back pain that may be from sprain/strains, disc related problems or even arthritis. All of which have nothing to do with FMS and can most certainly be treated in my office. They may also have an underlying carpal tunnel syndrome, tennis elbow, bursitis, and many other pain producing conditions not related to FMS that also respond well to chiropractic care. If it is determined that the problems with which the patient presents are indeed related to fibromyalgia and not from other causes then here is what I can do to help them. First of all, as a chiropractor, my number one form of treatment is spinal or extremity manipulation. Manipulations help to restore mobility to joints that may have been lost or reduced due to the tightness of the surrounding muscles as a response to the underlying pain feelings that the patient has. All joints are designed to move and to lose even some of that mobility can cause them to experience discomfort which just adds to that experienced from FMS. I usually also recommend 5-Hydroxytryptophan to help with sleep. Loss of sleep from FMS is the proverbial chicken or the egg scenario. It’s not really known if the lack of good sleep is a trigger for FMS or if having FMS affects the patient’s sleep. Regardless of which comes first to help the patient to have improved restorative sleep is certainly a plus. Also, along the lines of nutrition I recommend taking Magnesium and Malic acid as well as Omega-3 fatty acids all of which has shown some promise for relieving FMS symptoms. Further, a change in diet shifting from processed foods to eating whole foods and preferably organic (without additives, pesticides, hormones or antibiotics) is helpful not only for FMS but for your general overall health. Exercise is also important. Typically, a lot of physical exercise can be aggravating to a FMS patient so I usually recommend low impact type exercises e.g. water exercises, Pilates or especially Yoga which is very good for helping the joints of the body to keep mobile.

In summary, you always want to make sure that you have eliminated all other possible causes of your symptoms before accepting a diagnosis of FMS. Then, once it is established that you have true fibromyalgia, then it would behoove you to seek out natural treatment alternatives such as chiropractic. All you really have to lose is your pain.

David D. Godwin, D.C.
Salisbury Chiropractic
www.salisburychiropractic.us
Salisbury, NC
704-633-9335

Filed Under: Guest Column Tagged With: , ,

Back Talk

July 27, 2010 By

Summer fun is here and so is summer yard work. Be kind to your spine and take the proper precautions when working hard in your back yard.

First, hydrate. Your body is 70% water and your nervous system is 90% water. Water feeds your body, discs, ligaments and joints.

Position yourself properly. Being bent over, kneeling for long periods of time or lifting and hauling heavy objects can put a strain on your back, shoulders and neck. Bend your knees when lifting; use a kneeling board or stool; and get help with the big stuff.

Rest. Take breaks. Stretch before any strenuous activity and in-between doing them. Warming up your muscles can significantly reduce your chance of injuring yourself. The job may take you a little longer, but your back will thank you in the lung run.

And, finally — get adjusted. Visit your local chiropractor to realign your spine and get that much-needed muscle work done to balance out all that summer “fun”.

People too often put more care and attention into their cars and homes than their own bodies. We only have one and if you take care of yours, it will take care of you.

Monica S. Nowak, DC
Chiropractic Center of Canaan
176 Ashley Falls Road
Canaan, CT 06018
860 824-0748
www.PeterMarkowiczDC.com

Above article reprinted with permission from Monica S. Nowak, DC

Filed Under: Guest Column Tagged With: ,
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