Back in Shape and Pain Free

Exercises to Safeguard Your Back
Stretching and an active lifestyle are recommended by the American Chiropractic Association to help reduce back pain and speed the recovery process following an injury. Improving flexibility through stretching is also an excellent way to avoid future injuries.

Depending upon one’s individual injury and level of pain, the exercise and rehabilitation program may vary. Dr. Brenda Rooney agrees that the key is to start slowly and increase the repetitions as you feel stronger. Consult with your doctor of chiropractic prior to starting a new exercise program, especially when associated with low-back pain. An individualized program can be developed and instructions provided on proper stretching technique.

Passive Stretches
Passive stretches help facilitate movement in the affected muscle or joint. Stretches should be held for 15 to 30 seconds, allowing the muscles to gradually relax and lengthen. Stretches should never cause pain nor should you feel tingling in the extremities. Stop immediately if you experience any discomfort.

Hamstring Stretch
Lie on your back with both legs straight. Bend one leg at the knee and extend one leg straight up in the air. Loop a towel over the arch of the lifted foot, and gently pull on the towel as you push against it with your foot; you should feel a stretch in the back of the thigh. Hold 30 seconds. Relax. Repeat 3 times per leg. This stretch may be performed several times per day.

Piriformis Stretch
The piriformis muscle runs through the buttock and can contribute to back and leg pain. To stretch this muscle, lie on the back and cross one leg over the other; gently pull the knee toward the chest until a stretch is felt in the buttock area. Hold 30 seconds. Relax. Repeat 3 times. This stretch may be performed several times per day.

Back Stretch
Lie on your stomach. Use your arms to push your upper body off the floor. Hold for 30 seconds. Let your back relax and sag. Repeat. This stretch may be performed several times per day.

Active Stretches
Active stretches facilitate movement and improve strength. Stretches should never cause pain nor should you feel tingling in the extremities. Stop immediately if you experience any discomfort.

Leg Raises
Lie on your stomach. Tighten the muscles in one leg and raise it 1 to 2 inches from the floor. Return the raised leg to the floor. Do the same with the other leg. Repeat 20 times with each leg. This leg may be performed several times per day.

Bridges
Lie on your back with your knees flexed and your feet flat on the floor. Keep the knees together. Tighten the muscles of the lower abdomen and buttocks; slowly raise your hips up from the floor and then lower them back to the resting position. Repeat this exercise 20 times. This exercise may be performed several times per day.

The Pointer
Kneel on mat on hands and knees, with palms directly under shoulders and knees hip-width apart. Slowly raise your right arm, and extend it forward parallel the floor. (Balance by contracting your abdominal muscles.) Keep right palm parallel to the floor, then lift the left leg, and straighten it behind you. Hold opposing limbs off the ground for 30 to 60 seconds without arching your back. Switch sides. Repeat 3 to 6 times.

Stretching Tips
To get the maximum benefit from stretching, proper technique is essential. The American Chiropractic Association recommends the following tips:

• Warm up your muscles before stretching by walking or doing other gentle movements for 10 to 15 minutes.
• Slowly increase your stretch as you feel your muscles relax. Don't bounce.
• Stretch slowly and gently only to the point of mild tension, not to the point of pain.
• Don’t hold your breath. Inhale deeply before each stretch and exhale during the stretch.
· As your flexibility increases consider increasing the number of repetitions.
• Stop immediately if you feel any severe pain.

Designing an Anti-Inflammatory Diet

Help your patients prevent chronic disease by reducing inflammation risk factors.

By James Gerber, MS, DC.
Reproduced from the February 2010 issue of ACA News, a publication of the American Chiropractic Association.

The pathological process of inflammation has been understood for decades, but only recently health conditions not previously associated with inflammation, such as heart disease, cancer and degenerative brain disease, have been linked with this process. As a result, there has been an expansion of interest in discovering how anti-inflammatory interventions might help in the prevention or management of many diseases.

Natural approaches to achieving anti-inflammatory effects through the diet typically include: 1) an attempt to shift dietary fatty acid intake to reduce pro-inflammatory products of fatty acid metabolism, 2) an increased intake of plant-based foods that are naturally high in antioxidants and other anti-inflammatory phytonutrients and 3) a search for potentially allergenic foods, which, when eliminated, may lower systemic immune responses that promote inflammation. Let’s consider each of these strategies, the evidence supporting their rationale and the steps needed to implement them.

The Complexity of Fatty Acids
Fatty acids, specifically certain members of the omega-6 and omega-3 polyunsaturated families, are precursors of eicosanoids such as prostaglandins that have many influences on local tissues, including the mediation of inflammatory mechanisms. One of the omega-6 family, arachidonic acid, can be converted to a variety of powerful promoters of inflammation, while conversion of gamma-linolenic acid (GLA, another omega-6 fatty acid) and eicosapentaenoic acid (EPA, a long-chain omega-3 fatty acid) does not help promote inflammation to any considerable degree.

Since these precursors compete with each other for conversion to their respective eicosanoid products, a relative anti-inflammatory balance would be achieved by minimizing arachidonic acid and/or maximizing GLA and EPA in the diet. This is the rationale for modifying fatty acid intake in the anti-inflammatory diet, as well as for the use of anti-inflammatory fatty acids, such as fish oils, as supplements.

Popular anti-inflammatory diets often oversimplify the relative contribution of different omega-6 and omega-3 fatty acids to the inflammatory response. Since arachidonic acid can be produced in the body from other omega-6 precursors, a broad recommendation is typically made to limit omega-6 intake from all sources, even though some omega-6 precursors, such as GLA, are anti-inflammatory. Similarly, since EPA can be produced from other omega-3 precursors, a broad recommendation to increase intake in general from all omega-3 sources is common, even though short-chain omega-3s are converted to EPA to a limited degree only.

Clinical studies have shown the most promise for increasing food and supplemental sources of EPA and other long-chain omega-3s, beginning at about 500 mg/day for heart disease prevention and up to 3,000 mg/day for clinical anti-inflammatory effects. Reducing dietary sources of arachidonic acid by minimizing animal fats and flesh has some support, as well. GLA has shown promise as a supplement in amounts beginning at about 1,000 mg/day, but it is not present in edible foods. Flaxseed and its oil are rich in short-chain omega-3 and have some
healthful properties, but flaxseed oil was ineffective in the only clinical trial to date that investigated effects on a chronic inflammatory disease.

Clearly, the best evidence for designing the fatty acid contribution of an anti-inflammatory diet is to increase EPA intake from marine sources such as oily fish (salmon, sardines, herring, trout, black cod) and oysters, aiming for consuming these foods several times a week, and to reduce dietary sources of arachidonic acid (meat, high-fat milk and cheese products, eggs) as much as possible. This was demonstrated well in a randomized controlled trial in rheumatoid arthritis patients that found benefits from either a diet low in arachidonic acid or supplementation with fish oils—but an even larger clinical effect when both strategies were combined.

Switching to Plants
Plant-based foods are the richest dietary sources of substances known to affect the biology of inflammation, such as antioxidants and phenolics, which include the flavonoid family. The Mediterranean diet, with its emphasis on unprocessed plant-based foods and phenolic-rich olive oil, as well as recommending seafood as a preferred source of animal protein and fat, has emerged as a healthful anti-inflammatory diet. (To view Mediterranean Diet Food Pyramid, go to www.mediterraneandiet.com/tag/new-mediterranean-pyramid/.)

This diet has not only been found helpful for the prevention of heart disease through anti-inflammatory and other mechanisms, but has even helped reduce symptoms and disease activity in patients with rheumatoid arthritis. The Mediterranean diet and probably other, similar plant-based diets are certainly legitimate models for an anti-inflammatory diet.

Reducing Allergic Response
The role of food allergy in inflammatory disease has primarily focused on disorders of joints, such as rheumatoid arthritis; of the intestine, such as Crohn’s disease; and of the skin, as in atopic dermatitis. While benefits from food allergy identification and avoidance have been frequently demonstrated in individual cases and some clinical trials, controversy persists due to lack of double-blind challenges to confirm true sensitivities in most research. Of course, most dietary interventions cannot easily be concealed from subjects in a clinical trial, so placebo effects could explain the positive results on symptoms reported in these studies. Nonetheless, at least one rheumatoid arthritis trial has demonstrated persistent benefits of a low-allergen diet for up to one year.

A Combined Approach
Clinical benefits of anti-inflammatory diets may be due to a combination of the above mechanisms. Researchers in Sweden and other countries have shown that a “vegan diet free of gluten” has positive effects on symptoms and clinical signs of inflammatory diseases in trials lasting as long as one year. Such a diet would be void of arachidonic acid; free of potentially allergenic wheat, dairy and egg products; and high in plant-based antioxidants and other potentially anti-inflammatory phytonutrients. Similarly, the Mediterranean diet will typically have a more favorable omega-3/omega-6 fatty acid balance and might significantly limit potential allergens from animal-based foods. Clearly, there is more than one way to design an anti-inflammatory diet or to explain the benefits of such an approach.

Dr. Gerber is associate professor of clinical sciences at Western States Chiropractic College (WSCC) and is the lead instructor for WSCC nutrition courses. He has authored conservative care pathway protocols for treating dyslipidemia and obesity, as well as for using specialized supplements for treating joint disorders and musculoskeletal trauma. Dr. Gerber can be reached at jgerber@wschiro.edu.

Sources
1. Adam O, Beringer C, Kless T, et al. Anti-inflammatory effects of a low arachidonic acid diet and fish oil in patients with rheumatoid arthritis. Rheumatol Int 2003 Jan;23(1):27-36.
2. Gamlin L, Brostoff J. Food sensitivity and rheumatoid arthritis. Env Toxicol Pharmacol 1997;4:43-49.
3. Harris WS, Mozaffarian D, Rimm E, et al. Omega-6 fatty acids and risk for cardiovascular disease: a science advisory from the American Heart Association Nutrition Subcommittee of the Council on Nutrition, Physical Activity, and Metabolism; Council on Cardiovascular Nursing; and Council on Epidemiology and Prevention. Circulation 2009 Feb 17;119(6):902-7.
4. Hafström I, Ringertz B, Spångberg A, et al. A vegan diet free of gluten improves the signs and symptoms of rheumatoid arthritis: the effects on arthritis correlate with a reduction in antibodies to food antigens. Rheumatology (Oxford) 2001 Oct;40(10):1175-9.
5. Kapoor R, Huang YS. Gamma linolenic acid: an antiinflammatory omega-6 fatty acid. Curr Pharm Biotechnol 2006 Dec;7(6):531-4.
6. Pischon T, Hankinson SE, Hotamisligil GS, Rifai N, Willett WC, Rimm EB. Habitual dietary intake of n-3 and n-6 fatty acids in relation to inflammatory markers among US men and women. Circulation 2003 Jul 15;108(2):155-60.
7. Skoldstam L, Hagfors L, Johansson G. An experimental study of a Mediterranean diet intervention for patients with rheumatoid arthritis. Ann Rheum Dis 2003;62:208-14.

Patients in Medicare Demonstration Project Give Chiropractors High Marks

A Press Release from the American Chiropractic Association

According to long-awaited results from a congressionally mandated pilot project testing the feasibility of expanding chiropractic services in the Medicare program, patients have a high rate of satisfaction with the care they receive from Doctors of Chiropractic.

When asked to rate their satisfaction on a 10-point scale, 87 percent of patients in the study gave their Doctor of Chiropractic a level of 8 or higher. What’s more, 56 percent of those patients rated their chiropractor with a perfect 10.

Contributing to that satisfaction was the attention given to patients’ needs and the accessibility of chiropractic care. Patients reported that doctors of chiropractic listened to them carefully and spent sufficient time with them. Some 95 percent said they had to wait no longer than one week for appointments.

“Doctors of Chiropractic everywhere should feel pride in these patient satisfaction results and in being part of a profession that still sees the great need for spending time with patients and truly listening to them,” said Dr. Rick McMichael, president of the American Chiropractic Association (ACA). “It’s clear that patients deeply value the time their chiropractic providers spend with them and the expert care that Doctors of Chiropractic offer.” ACA is the largest chiropractic organization in the United States, representing more than 15,000 Doctors of Chiropractic and students.

The pilot, known as a “demonstration project” in Congress, was conducted from April 2005 to March 2007 throughout the states of Maine and New Mexico, and also in Scott County, Iowa, 26 counties comprising the Chicago metropolitan area, and 17 counties in central Virginia.

Current chiropractic coverage under Medicare is limited to spinal manipulation. Under the demonstration project, however, chiropractic care was expanded to include diagnostic and other services, such as X-rays, examinations, physical therapy and rehabilitation services.

The final report to Congress also includes information on the costs of expanding chiropractic services in the demonstration sites. The report indicates that in all but one of the demonstration sites, patients’ health care costs were not significantly changed by expanding coverage of chiropractic services. In contrast, a cost increase was found in the Chicago metropolitan area. Further research into the reasons why the results in Chicago differ from the rest of the demonstration project sites is needed to better understand these findings.

“We already know that Medicare costs in general tend to be higher in Chicago than other similar areas of the country. We must find the underlying cause of the cost difference found in the chiropractic demonstration project and determine whether it had anything at all to do with the expansion of chiropractic services,” Dr. McMichael noted.

To further analyze the results of the demonstration project, ACA is creating a taskforce of Medicare experts and researchers who will review the report and develop a response for the Centers of Medicare and Medicaid Services.

To view the report online, visit www.acatoday.org/pdf/demo_report.pdf.

The American Heart Association’s Go Red For Women Movement Continues in 2010

Heart disease is the No. 1 killer of women in America. In fact, more women die of cardiovascular disease than the next 5 causes of death combined. That’s including cancer! But there’s something women can do. They can choose to speak up and fight the statistics by supporting the American Heart Association’s (AHA) Go Red For Women movement.

There are many ways that a woman can become an advocate of women’s heart health. The first priority is to take care of herself. She can get empowered with the facts, find a community of support, make healthy changes to her diet and exercise. She can start with a heart check-up and then speak to her doctor about a lipid blood screen that will determine her cholesterol, triglycerides and phospholipids levels. By going to the American Heart Association’s website for Go Red for Women at www.goredforwomen.org, women can connect and share their heart experiences and be empowered with the support of other pro-active, positive women. By speaking up and spreading the word, together, they can help save lives.

Dr. Brenda Rooney’s goal is to utilize therapies which will provide her patients with the most efficient and expeditious recovery. Dr. Rooney conducts thorough physical examinations and reevaluations which include heart rate and blood pressure assessments. If any symptoms of heart disease or hypertension are present, she will put you in touch with a heart specialist. She is a member of the American Chiropractors Association and the Association of New Jersey Chiropractors. Dr. Rooney advocates a healthy diet appropriate for each individual and counsels patients how the nervous system controls heart rate and respiration. Chiropractic subluxations have assisted many patients with hypertension.

National Wear Red Day is Friday, February 5, 2010. The red dress pin is the American Heart Association’s symbol of women’s fight against heart disease. By joining the Go Red For Women movement, you become part of the fight against heart disease. A woman who Goes Red eats healthier, exercises more and loves her heart.

Dr. Rooney is a participant in the Go Red for Women movement.