Therapeutic Massage:

Not Just Decadent Anymore

     Therapeutic massage is the intentional and organized manipulation of the tissues in the body using touch and movement. Usually, this is done using hands and elbows but today some massage therapists incorporate mechanical tools as well to facilitate muscle relaxation. For decades, such experiences were seen as luxuries for professional athletes and the rich. Recently, the clinical research has begun to show the benefits of therapeutic massage for pain, aggression, neonatal patients, joint pain, post-traumatic stress disorder, range of motion improvement and more.[i]

·        What does the research say?  Over the past several years, studies made on the effects of massage on various health conditions have skyrocketed. Here are what some of the major studies have shown:

·        Massage can help with chronic back pain. Alternative therapies such as seeing a chiropractor in conjunction with a physical therapist have been shown to dramatically reduce chronic back pain when used in conjunction with therapeutic massage.[ii] Further, a study published in the Annals of Internal Medicine in 2011 found that either structural or relaxation massage can help reduce lower back pain for up to six months.[iii]

·        Massage can relieve symptoms of osteoarthritis: Osteoarthritis is a degeneration of the cartilage and underlying bone in joints such as knee, hip, elbows and thumbs. It is debilitating and painful. An article in the Wall Street Journal states: “Massage is already widely used to treat osteoarthritis, for which other treatments have concerning side effects. A study published in the Archives of Internal Medicine in 2006 showed that full-body Swedish massage greatly improved symptoms of osteoarthritis of the knee. Patients who had massages twice weekly for four weeks and once a week for an additional four weeks had less pain and stiffness and better range of motion than those who didn't get massages. They were also able to walk a 50-foot path more quickly.” [iv]

How Does It Work?:

     Massages should be provided by a certified massage therapist or physical therapist who is trained. The patient usually lies down on a massage table and the therapist provides the massage. There are several types of massage including Swedish, Reflexology, and Deep Tissue. Massage works by kneading and stroking muscles to relax them and uses friction to stimulate soft tissues.  This therapy can increase circulation while breaking up scar tissue between muscle fibers. Usually, massage sessions last about one hour and can be undergone once or twice a week. In some cases, a doctor may recommend more sessions, depending on the patient and the condition they are seeking to treat. A massage therapist and your physician can help you determine what kind of massage is appropriate for you.

What Does Therapeutic Massage Feel Like?

     Therapeutic massage usually feels good though the effects vary with each individual.  Clothing is optional but is often removed from just the area being treated, keeping patients warm, relaxed and comfortable.  A lubricating oil or lotion is used to reduce friction during the massage session. Some people find parts of the massage painful, especially Deep Tissue massage where knots in muscles are manipulated.

     There is little doubt anymore that therapeutic massage is useful for many people with many different conditions. Physical, mental and emotional disorders can be helped and managed with therapeutic massage.

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[i] National Center for Complementary and Alternative Medicine (2014) Massage therapy for health purposes: what you need to know. http://nccam.nih.gov/health/massage/massageintroduction.htm

[ii] Filler, Aaron G. (2004) Do You Really Need Back Surgery? A Surgeon’s Guide to Neck and Back Pain and How to Choose Your Treatment. Oxford University Press.

[iii] http://annals.org/article.aspx?articleid=747008

[iv] Peterson, A. (2011). Don’t call it pampering: Massage wants to be a medicine. http://online.wsj.com/news/articles/SB10001424052702304537904577277303049173934

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The Importance of Posture: Mood, flexibility and health

     [i]Our bodies can be seen as a creative act of our inner psyche. People who stand a certain way are perceived to be stronger, more confident and even more capable. Those who tend to slouch are seen in more negative ways, even though they are just as skilled as someone with “good” posture. For many years, people who have back problems have participated in Posture Corrective Exercises (PCE) to reduce pain. Studies have shown that working on improving posture has positive effects in many areas of our lives, not only in back pain relief. Activities like Yoga are becoming more popular because of its emphasis on positioning the body properly. It is one example of posture improvement and its positive effects in our lives.

·        Physical Activity and Body Image:  Stephano et al (2011) found that participating in physical activity where the participant paid close attention to body position and posture had a positive effect on one’s overall body image. This means that people who exercise  in this fashion tend to feel more content about how their body looks and feels, as well as feeling more positive  about how their body is perceived. Body image is a critical part of feeling healthy and happy in our daily lives. Good posture promotes a good body image. There is no doubt that many of us fight the deluge of media images for what a “body” should look like. It is important to remember that there are many ways a healthy body can look. Good posture helps us to be more in touch with how our own body can look its best.

·        [ii] Emotional Lift and Improved Appearance:  Being aware of one’s posture has been shown to provide an increase feeling of happiness and control over one’s life. Poor posture has been compared to holding a bowling ball in front of you for hours and days one end. You can imagine how it changes the body (Krucoff, 2008). The other positive effect of better posture is “instant weight loss”. Yes, it is true that standing properly with shoulders back and head balanced gives the sense that one has lost about 5 pounds. As it is, our bodies do not have the best design as a biped (quadrupeds are more agile and have fewer back issues). There is already much stress on the spine and back muscles. If improving posture can help so many areas, who would not want to focus on this relatively simple task?

·        [iii]Flexibility and Range of Motion:   Posture is also closely linked with stretching. It is not possible to stretch muscles when the body is hunched over or pulled too far forward. Thus people who stretch every day (either before an exercise or as an activity in itself) are improving their posture and range of motion. When muscles are stretched, they maintain flexibility. Remember that muscles do not age, and it is never too late to build strength, range of motion, better posture and flexibility.

     The evidence that good posture has nothing but good effects on our lives is overwhelming. From reducing pain, to making us look thinner, to more flexibility, to more happiness, there is no reason not to focus on having better posture.

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[i]  Stefano Scarpa et al., "Does Women's Attitudinal State Body Image Improve after One Session of Posture Correction Exercises?," Social Behavior and Personality: An International Journal39, no. 8 (2011), http://www.questia.com/read/1G1-268602637.

[ii]  Carol Krucoff, "Get out of Your Slump: Proper Posture Can Relieve Pain and Enhance Appearance," The Saturday Evening Post, September-October 2008, 14, http://www.questia.com/read/1G1-184287302.

[iii] It's a STRETCH Warming Up Can Increase Flexibility, Range of Motion," Daily Herald (Arlington Heights, IL), January 9, 2012, http://www.questia.com/read/1G1-276667749.

   

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Celebrities Flock to Chiropractic Care;

Should you?

     Chiropractors have a polarized image; either people love them or hate them. Some say they are quacks while others swear by the services they provide. But the truth is in the behavior of people whose careers depend on performance and image. Who better to trust than professional athletes and celebrities? If celebrities and professional athletes take advantage of chiropractic services, there has to be some benefit. It seems safe to trust in what the rich do to care for themselves. Here are the primary reasons celebrities use a chiropractor:

·        Hurry Up and Wait: This is the cliché Hollywood phrase that causes actors and support personnel to sit around for hours and hours. Sitting, and not being able to leave long enough to stretch your legs or get some exercise, tends to cause alignment problems. This is probably the one aspect of Hollywood that makes celebrities seek relief from a chiropractor. If you have a job that requires that you sit all day, you experience the same issue. Going to a chiropractor will likely help you.

·        Muscle and Joint Pain:  Professional NFL football players describe playing one game as equivalent to being in 30 to 40 car accidents[1]. Muscle and joint pain severely impact a player’s ability. Other professionals such as body builders, cyclists, and golfers also see chiropractors to ensure their form. A crooked golf swing or a cyclist who cannot keep their line will not last long in their job! Most ordinary people have lower back pain. This causes us not to walk straight or to favor one side over the other. These issues affect our performance to in terms of low production or missed days at work.

·        Being Lopsided:  Actors are paid to look good. Depending on the role they are playing, the character may or may not have certain ailments. But in general, celebrities are expected to wear designer labels, make appearances at events and look fabulous. This is difficult to do if one shoulder is higher than the other, or the hem of their dress is uneven. So, celebrities see a chiropractor. Even ordinary people want to look good on the job. Having your head directly over your shoulders and weight evenly distributed will only make you look better and feel more confident.

·        Injury treatment and prevention: Professional athletes and celebrities who do a lot of their own stunt work see chiropractors as part of a general wellness plan. Regular chiropractic adjustments before and injury are just as important as having them after an injury. Celebrities need to be sure their bodies are in top form. This allows for better and safer performances. When your body is aligned and all joints are working properly, you are less likely to suffer injury or to heal faster from one.

     Professional Athletes and celebrities have the means to do whatever they need to do to perform well. They all work in a very competitive environment. If celebrities and professional athletes experience a benefit from seeing a chiropractor, the odds are extremely high that consulting one is a good thing to do. Celebrities have nothing but great things to say about their chiropractor. Click here to read what they say and here to understand why so many athletes have their own chiropractor that travels with them. If you are still skeptical about seeing a chiropractor, you can see one yourself and decide if they can help. But if so many people like celebrities whose livelihood depends on their bodies working perfectly use a chiropractor,  that is the best recommendation one can have.

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[1] http://yourchiropracticwellness.com/tag/celebrity-testimonials-chiropractic/

   

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Why Use a TENS Unit?

The uses and benefits

     Transcutaneous electric nerve stimulation or TENS is a way to treat back pain. It is best used in conjunction with other pain alleviating treatments[1]. A TENS unit, as it is called, is a battery operated durable medical device that is relatively small and portable. While the research about TENS unit use on back pain is inconclusive, it also appears that the research conducted has had so many different control and sample group types, it can be difficult to say that TENS treatment is NOT helpful. Many people have described relief, and many others have not. The good news is that TENS treatment is relatively safe when used properly. Here are some things you should know before using a TENS durable medical equipment:

·        Uses: TENS is used for the treatment of acute lower back pain (such as that experienced after back surgery) as well as to control labor pain during childbirth. Generally, TENS is NOT USED FOR CHRONIC BACK PAIN LASTING LESS THAN ONE YEAR. The idea for TENS use in childbirth is to use it instead of other pain killing techniques than may harm mother, child or both. It is also used to promote wound healing and neuropathic pain, a complex condition of the soma sensory system.  Neuropathic pain can result from chemotherapy, shingles, multiple sclerosis, alcoholism and many other situations.

·        How Does TENS Work? The basic idea around TENS is to stimulate nerves in such a way as to alleviate pain. This is based on what is called the Gate Theory which surmises that stimulating larger nerve fibers will block out the pain felt from activity in the smaller nerve fibers. Ironically, it is the small nerve fibers that are the culprit in pain. By stimulating nerves in this way, the “gateway” to the brain in the spinal cord could be blocked so pain is not felt. This is not a new theory, and has been around since around 1965.[2]

·        How Long Does TENS Treatment Last?  Pain relief can last anywhere from a few minutes to 18 hours. If a high frequency electric pulse is used, pain relief is usually instant, but ceases when the electrodes are turned off. Using a lower frequency takes longer to work, but the effects tend to last several hours. It is important that you talk to your doctor about which frequencies are safe for you to use. Obvious concerns are things like pacemakers and pregnancy, but there are other considerations that your doctor can identify for your situation.

·        How do I get TENS Treatment? The first step is to see your Chiropractor to determine if you are a candidate for TENS. If you are, and your doctor prescribes it, you will then most likely see a Chiropractor to show you how to use the machine. You will learn where to place the electrodes and the settings that will best treat your condition. There is a learning curve for TENS units and safety precautions must be taken, TENS treatment is not to be taken lightly[3].

     Although the evidence about the usefulness of a TENS treatment is varied, enough evidence shows that there is reason to believe that it can be useful in managing long lasting (over one year) chronic or acute pain. Probably the most important finding of research is that TENS treatment does not seem to be effective as the ONLY treatment for pain. But, when it is used in conjunction with other pain relieving therapies, it seems to be more helpful. Adding TENS therapy to your pain management regimen may serve you well and it is worth investigating.

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[1] http://www.nursingtimes.net/exploring-the-evidence-for-using-tens-to-relieve-pain/5042395.article

[2] http://www.nursingtimes.net/exploring-the-evidence-for-using-tens-to-relieve-pain/5042395.article

[3] http://www.webmd.com/back-pain/guide/tens-for-back-pain

                           

WHAT YOU NEED TO KNOW ABOUT CALIFORNIA TRAFFIC ACCIDENTS

What you need to know about California Traffic Accidents

     Driving is part of our culture here in CA, especially in Los Angeles. There is really no other viable option for most people. So being sure you understand what risks you are taking when you drive to work every day is important, as well as how to lower your risk of an accident or serious injury. The facts show that overall CA is a safer place to drive than the USA overall, but this does not mean there are not serious trends that we need to be aware of. Here are some things you need to know.

Staggering Facts

·        In 2011, there were 2,791 fatalities in CA from traffic accidents. This is up 2.6% from the previous year. Many of these were the result of distracted driving; i.e cell phone use or texting etc. That is a lot of people who died; about 54 people per week! Yikes!

·         More than 50,000 people experienced injuries from auto accidents in Los Angeles County alone in 2011. These are not fatalities, but just injuries. That is about 962 people per week who are injured in auto accidents!

·        Texting convictions increased 42 percent from 14,866 in 2011 to 21,059 in 2012. (DMV). Too many people still think they have time to text while at a light. Don’t do it!

·        Based on data from the National Highway Traffic Safety Administration, 30.4 percent of all drivers who were killed in motor vehicle crashes in California in 2011 tested positive for legal and/or illegal drugs, a percentage that has been increasing since 2006. Marijuana was by far the most common drug found in drivers who tested positive for drugs - 25.3 percent of those drivers who tested positive for drugs.[1]

Common Types of Injuries in Traffic Accidents

·        Previous studies have shown that lower extremity injuries account for a significant portion of the injuries sustained by passenger vehicle drivers in frontal crashes, and this pattern continues to hold for newer model year vehicles.[2] Lower extremity injuries include leg and knee injuries such as bruises and broken bones. Tearing of knee cartilage is also a common injury.

·        Nearly 150,000 people were injured in 2009 just by closing the car door. They were not even on the road or highway. This is an amazing statistic.  They either fell while getting out of the car, or broke a bone slamming the door on their hand.

·        Older drivers and passengers are more vulnerable in a crash. At crash speeds of just over 31 mph (50 kph), the risk of sustaining a serious injury increases dramatically. A 50-year-old female has about a 10-percent risk of a serious injury in a frontal crash, but an 80-year-old female has about a 40-percent risk. [3]

·        A closed head injury (a concussion or a traumatic brain injury) is one of the most common injuries sustained. Often, there are not immediate signs of trauma.  Because the brain is likely to be moved around in the skill during impact, the signs may take a few hours or days to show themselves.[4] Always see a doctor even if you think you are fine. 

·        Whiplash is a very common neck injury, but there is also neck strain and serious injuries to the discs in the neck. The pain from these injuries may not be felt right away either.

·        Common back injuries include sprain or strain, fracture, disc injury, thoracic spine injury, lumbar radiculopathy, and lumbar spine injury. It is not unusual for the effects of a bad back injuries to not show up for hours or weeks. Back injuries often cause long term problems for victims.

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[1] http://www.ots.ca.gov/OTS_and_Traffic_Safety/Score_Card.asp

[2] Austin, R. A. (2012, March). Lower Extremity Injuries and Intrusion in Frontal Crashes. (Report No. DOT HS 811 578). Washington, DC: National Highway Traffic Safety Administration.

[3] www.ircobi.org/downloads/irc12/ pdf_files/14.pdf

[4] http://www.all-about-car-accidents.com/car-accident-injuries.html

NERVE CONDUCTION VELOCITY TESTING AND DIAGNOSTIC ULTRASOUND TESTING

Nerve Conduction Velocity and Diagnostic Ultrasound Testing

Nerve Conduction Velocity (NCV)

Nerve conduction velocity study (NCV) measures basic parameters of the nerve function – strength and speed of how an electrical signal (action potential) spreads through the nerve. This data complements electromyography (EMG) in making the diagnosis.

Both nerves and muscles produce electrical signals called action potentials which are detected and measured during NCV. A nerve is actually a bundle of axons - long twigs of nerve cells conducting electrical signals from one end of the nerve to another. An NCV machine is capable of detecting and analyzing these tiny electrical signals coming from active neurons.

In motor nerves, these electrical signals travel toward the muscle causing muscle contraction.

In sensory nerves, these electrical signals are travelled toward the spinal cord, bringing signals from skin and other tissues which we feel as different sensations like temperature, pain, pressure and others.

NCV and Axons

NCV measures different characteristics of action potentials traveling along the axons, and is not significant for diagnosing diseases that primarily affect nerve function. NCV uses electrodes similar to those used in electrocardiograms placed on the skin over a nerve. Ction potential is generated by giving a mild electrical shock which is then recorded by other electrodes as it travels through the nerve.

The speed of nerve conduction is influenced by a coating around axons, called myelin sheath. Myelin sheath insulates each axon and forces action potentials to "jump" quickly along the axon. Speed of action potential is slowed down when myelin sheath is damaged. Healthy axons provide a strong action potential. If axons degenerate the action potential becomes weaker.

Different diseases preferentially either affect myelin sheathing or damage axons. This is why the type of nerve damage detected by NCV is so important in making the right diagnosis.

Though some people may find the electric shocks of the NCV or the needle pricks of the EMG uncomfortable, these methods do not leave any permanent damage and are quite tolerable. NCV and EMG have remained for decades as the gold standard test for evaluating the nerve and muscle function. Considering that there are more than two hundred different diseases affecting nerves and muscles NCV and EMG are very important and valuable tools in gathering data on the type, distribution and severity of damage. This data is useful in making an accurate diagnosis and starting an appropriate treatment earlier. Patients usually understand that EMG is a valuable tool and that the benefit of precise diagnosis outweighs discomfort of the procedure.

Ultrasound

Sonography was performed by a musculoskeletal radiologist who was blinded to the subject’s symptoms, signs, and the results of NCS, using a 12–5 MHz linear array transducer (HDI 5000; Phillips Ultrasound, Bothell, WA). Subjects sat down with the arm on a table in a position of supinated forearm, neutral-positioned wrist, and semi-flexed fingers. After identifying the ulnar artery, flexor retinaculum, and median nerve, transverse images of the median nerve were scanned at 2 levels: the carpal tunnel inlet (at the level of pisiform) and the carpal tunnel outlet (at the level of the hook of hamate) (Fig. 1A). The cross-sectional area (CSA) of the median nerve at each level was measured by directly tracing with an electronic caliper around the margin of the median nerve. The margin of the median nerve was defined as the margin outside the hypoechoic nerve fascicles and inside the hyperechoic nerve sheath (Fig. 1B).16 each measurement was performed 5 times; the highest and lowest values were eliminated, and the remaining 3 measurements were averaged.

Sonographic examination of the median nerve has been suggested as a useful alternative to electrophysiologic study in the diagnosis of carpal tunnel syndrome. To determine its usefulness and the best diagnostic criterion, sonograms of patients with the disease were compared with sonograms of healthy subjects in a case–control study.

How the Test Is Performed

An ultrasound machine creates images that allow various organs in the body to be examined. The machine sends out high-frequency sound waves, which reflect off body structures. A computer is used to receive these reflected waves which use them to create a picture.
The test is done in the ultrasound or radiology department. You will be lying down for the procedure. A clear, water-based conducting gel is applied to the skin over the area being examined to help with the transmission of the sound waves. A handheld probe called a transducer is moved over the area being examined. The radiologist may ask you to change your position so that other areas can be examined.
For specific information about ultrasound examinations, please refer to the following topics:

• Abdominal ultrasound
• Breast ultrasound
• Doppler ultrasound of an arm or a leg
• Doppler/ultrasound of the heart (echocardiogram)
• Duplex ultrasound
• Pregnancy ultrasound
• Testicle ultrasound
• Thyroid ultrasound
• Transvaginal ultrasound
• Vascular ultrasound

Preparation for the procedure will depend on the body region being examined.

How the Test Will Feel

There is generally little discomfort with ultrasound procedures. The conducting gel may feel slightly cold and wet.
The reason for the examination will depend on your symptoms.

Normal Results

Results are considered normal if the organs and structures in the region being examined are normal in appearance.

What Abnormal Results Mean

The significance of abnormal results will depend on the body region being examined and the nature of the problem. Consult your health care provider with any questions and concerns.
References

• Caliandro P, La Torre G, Aprile I, Pazzaglia C, Commodari I, Tonali P, et al. Distribution of paresthesias in carpal tunnel syndrome reflects the degree of nerve damage at wrist. Clin Neurophysiol 2006; 117: 228–31.
• Zanette G, Marani S, Tamburin S. Extra-median spread of sensory symptoms in carpal tunnel syndrome suggests the presence of pain-related mechanisms. Pain 2006; 122: 264–70.
• Nathan PA, Keniston RC, Meadows KD, Lockwood RS. Predictive value of nerve conduction measurements at the carpal tunnel. Muscle Nerve 1993; 16: 1377–82.
• Atroshi I, Gummesson C, Johnsson R, Ornstein E. Diagnostic properties of nerve conduction tests in population-based carpal tunnel syndrome. BMC Musculoskelet Disord 2003; 4: 9.
• Lew HL, Date ES, Pan SS, Wu P, Ware PF, Kingery WS. Sensitivity, specificity, and variability of nerve conduction velocity measurements in carpal tunnel syndrome. Arch Phys Med Rehabil 2005; 86: 12–6.
• Beekman R, Visser LH. Sonography in the diagnosis of carpal tunnel syndrome: a critical review of the literature. Muscle Nerve 2003; 27: 26–33
• Uchiyama S, Itsubo T, Yasutomi T, Nakagawa H, Kamimura M, Kato H. Quantitative MRI of the wrist and nerve conduction studies in patients with idiopathic carpal tunnel syndrome. J Neurol Neurosurg Psychiatry 2005; 76: 1103–8.
• American Academy of Neurology. Practice parameter for carpal tunnel syndrome (summary statement): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 1993; 43: 2406–9.
• Cosgrove DO, Meire HB, Lim A, Eckersley RJ. Ultrasound: general principles. In: Adam A, Dixon AK, eds. Grainger & Allison's Diagnostic Radiology: A Textbook of Medical Imaging . 5th ed. New York, NY: Churchill Livingstone; 2008:chap 3.