Below is an article from the New York Times. This provides good reassurance to what we have known for a long time; that chiropractic is extremely helpful for neck pain. The interesting thing is that the study only compared chiropractic alone and it separated exercise. Now if you combined both chiropractic and exercise you would really have a winning combination.
Here's the article:
Seeing a chiropractor or engaging in light exercise relieves neck pain more effectively than relying on pain medication, new research shows.
The new study is one of the few head-to-head comparisons of various treatments for neck pain, a problem that affects three quarters of Americans at some point in their lives but has no proven, first-line treatment. While many people seek out spinal manipulation by chiropractors, the evidence supporting its usefulness has been limited at best.
But the new research, published in The Annals of Internal Medicine, found that chiropractic care or simple exercises done at home were better at reducing pain than taking medications like aspirin, ibuprofen or narcotics.
“These changes were diminished over time, but they were still present,” said Dr. Gert Bronfort, an author of the study and research professor at Northwestern Health Sciences University in Minnesota. “Even a year later, there were differences between the spinal manipulation and medication groups.”
Moderate and acute neck pain is one of the most frequent reasons for trips to primary care doctors, prompting millions of visits every year. For patients, it can be a difficult problem to navigate. In some cases the pain and stiffness crop up without explanation, and treatment options are varied. Physical therapy, pain medication and spinal manipulation are popular options, but Dr. Bronfort was inspired to carry out an analysis because so little research exists.
“There was a void in the scientific literature in terms of what the most helpful treatments are,” he said.
To find out, Dr. Bronfort and his colleagues recruited a large group of adults with neck pain that had no known specific cause. The subjects, 272 in all, were mostly recruited from a large HMO and through advertisements. The researchers then split them into three groups and followed them for about three months.
One group was assigned to visit a chiropractor for roughly 20-minute sessions throughout the course of the study, making an average of 15 visits. A second group was assigned to take common pain relievers like acetaminophen and — in some cases, at the discretion of a doctor — stronger drugs like narcotics and muscle relaxants. The third group met on two occasions with physical therapists who gave them instructions on simple, gentle exercises for the neck that they could do at home. They were encouraged to do 5 to 10 repetitions of each exercise up to eight times a day. (A demonstration of the exercises can be found at www.annals.org).
After 12 weeks, the people in the non-medication groups did significantly better than those taking the drugs. About 57 percent of those who met with chiropractors and 48 percent who did the exercises reported at least a 75 percent reduction in pain, compared to 33 percent of the people in the medication group.
A year later, when the researchers checked back in, 53 percent of the subjects who had received spinal manipulation still reported at least a 75 percent reduction in pain, similar to the exercise group. That compared to just a 38 percent pain reduction among those who had been taking medication.
Dr. Bronfort said it was a “big surprise” to see that the home exercises were about as effective as the chiropractic sessions. “We hadn’t expected that they would be that close,” he said. “But I guess that’s good news for patients.”
In addition to their limited pain relief, the medications had at least one other downside: people kept taking them. “The people in the medication group kept on using a higher amount of medication more frequently throughout the follow-up period, up to a year later,” Dr. Bronfort said. “If you’re taking medication over a long time, then we’re running into more systemic side effects like gastrointestinal problems.”
He also expressed concern that those on medications were not as empowered or active in their own care as those in the other groups. “We think it’s important that patients are enabled to deal with as much control over their own condition as possible,” he said. “This study shows that they can play a large role in their own care.”
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Alternative Med
Wednesday, January 11, 2012
Monday, March 21, 2011
AAP: Toddlers in rear-facing seat until 2
Well, I haven't written in quite awhile, but I have quite a bit of experience treating injuries related to motor vehicle accidents and want to emphasize the importance of safety restraints for both children and adults. This article (http://www.cnn.com/2011/HEALTH/03/21/car.seat.guidelines.parenting/index.html?eref=mrss_igoogle_cnn) came out today saying that children should remain in a rear facing seat until they are at least 2 years old or until they exceed the height or weight limit for the car seat, which can be found on the back of the seat.
As a parent, I recognize the convenience of being able to see your child when he/she is facing forward, but the recommendation to keep them facing to the back really makes sense. Toddler's relative large head size related to the relatively little strength of their neck muscles puts them at a greater risk for injury when they face forward. This means that even very minor accidents can cause injuries. Unfortunately, kids this age aren't really capable of communicating their injuries to parents or doctors so they often get left untreated. Typically signs of injury other than pain and lack of range of motion are a sudden change in behavior, like being more irritable, sleeping more or less than usual or clinging to mom or dad more than usual. If you see any of these symptoms in your child after an accident please get them checked out by a qualified practitioner. Fortunately, children respond really well to conservative care.
Please take the advice of the experts in this article and keep your child in a rear facing seat as long as possible.
As a parent, I recognize the convenience of being able to see your child when he/she is facing forward, but the recommendation to keep them facing to the back really makes sense. Toddler's relative large head size related to the relatively little strength of their neck muscles puts them at a greater risk for injury when they face forward. This means that even very minor accidents can cause injuries. Unfortunately, kids this age aren't really capable of communicating their injuries to parents or doctors so they often get left untreated. Typically signs of injury other than pain and lack of range of motion are a sudden change in behavior, like being more irritable, sleeping more or less than usual or clinging to mom or dad more than usual. If you see any of these symptoms in your child after an accident please get them checked out by a qualified practitioner. Fortunately, children respond really well to conservative care.
Please take the advice of the experts in this article and keep your child in a rear facing seat as long as possible.
Wednesday, June 23, 2010
The Upper Back
THE THORACIC SPINE:
Overlooked and Undertreated
By
Dr. Nicholas Studholme, DC, CCSP, CCEP, FAFS
To say one area of the spine is more important than another would be unfair to the rest of the spine; however, it is clear that when we closely inspect the thoracic spine, it is profoundly different than the cervical or lumbar spine. It typically has twelve segments, many more than the other spinal regions, and it has a ribcage attached to it, providing significant stability and support. It also is located between the cervical and lumbar regions so any bottom‐up or top‐down movements will be forced to go through the thoracic spine.
One of the most important principles of Applied Functional Science (AFS) is gravity, and in our daily lives, the thoracic spine is constantly fighting this tremendous force. Generally, all daily movements require that we have our hands pronated, thereby constantly shortening our pecs and lats, and also create a stretch and inhibition of our scapular stabilizers (traps, rhomboids, serrratus anterior, etc.). As a result, we tend to hunch forward and yet because we have to see the horizon, we look up, thus creating anterior head carriage. This can result in significant sub‐occipital and cerico‐thoracic pain as these areas are now taking on excessive load to compensate for the rounded thoracic spine.
If we understand the mechanics of the thoracic spine, then we can use the principles of AFS to assist our patients in creating meaningful, sustainable changes. First, we must understand coupled motion, which requires nothing more than the knowledge that any movement of the spine in one plane is normally accompanied by a compatible spinal movement in another plane. A common example used is that spinal lateral flexion is always accompanied by spinal rotation. In other words, two types of motions are "coupled" together. Type 2 Motion is defined by the joints rotating and laterally flexing the same direction; Type 1 Motion is defined by the joints rotating and laterally flexing in opposite directions). The thoracic spine tends to exhibit Type 2 Motion from T1‐T5 and Type 1 from T6‐T‐12. It is theorized that when a spinal section (or an individual vertebral segment) moves in two directions that are not the expected coupled movements, then this is considered to be uncoupled mechanics. Uncoupled mechanics in spinal sections or in a vertebral segment can lead to abnormal ranges of motion, recurrent joint dysfunction, joint degeneration, inflammation, and pain.
However, when we look at many athletic endeavors, we realize that both coupled and uncoupled motions occur all the time. Therefore, we need to assess, mobilize, and train our patients and clients to be successful in all motions to avoid injury and enhance performance. When treating the thoracic spine, I always use the AFS principle of starting with success and building on success. For a majority of thoracic spine conditions, success is typically that our patients have great movement into flexion and dysfunctional extension. If we understand that all movements are three‐dimensional and understand the concept of relative joint motion, then we can create a strategy that drives motion that encourages flexion with side bending and rotation, and as we return from flexion to our starting position, we remarkably are creating thoracic joint extension. Again, keeping the patient in a successful movement pattern allows for chasing the endgame of better extension.
A great case example is the nursing mother patient who presents significant neck and upper thoracic and rib pain, who has to constantly hold her newborn, and who additionally has an increase in breast tissue due to nursing. This patient is permanently in an anterior head carriage neck position, has rounded shoulders, and has a more anterior center of mass. What this patient does not know is that her pain is rarely due to the neck and more often due to the thoracic spine. A typical progression in my office is to manually work tissue, then mobilize through adjustment(s) and Functional Manual Reaction (FMR), and to stabilize with matrices (three‐dimensional, logical movement patterns). For this example, I would use manual adjustments, combined with FMR in Type 1 Motion and Type 2 Motion of the thoracic spine with the pelvis in and out of synch with relationship to the shoulders (in the TrueStretch™). This would then be followed by the patient performing anterior lunges (beginning with both arms extended in front of his/her body at shoulder height) and reaching both hands in front of the lunging knee (or even in front of the lunging foot at ground height). This drives flexion of the thoracic spine as the patient lunges and creates extension of the thoracic spine as the patient returns from the lunge. If this is successful, we then go to three‐dimensional waist to shoulder dumbbell press, and then to a three‐dimensional shoulder to overhead press. Finally, if we are having success, we will ultimately finish with a Thoracic Spine Matrix.
Please review FMR of the Thoracic Spine (Functional Video Digest Series v3.10) and Thoracic Spine (Functional Video Digest Series v1.8) for more specifics pertaining to Dr. Studholme’s explanation of treatment.
Overlooked and Undertreated
By
Dr. Nicholas Studholme, DC, CCSP, CCEP, FAFS
To say one area of the spine is more important than another would be unfair to the rest of the spine; however, it is clear that when we closely inspect the thoracic spine, it is profoundly different than the cervical or lumbar spine. It typically has twelve segments, many more than the other spinal regions, and it has a ribcage attached to it, providing significant stability and support. It also is located between the cervical and lumbar regions so any bottom‐up or top‐down movements will be forced to go through the thoracic spine.
One of the most important principles of Applied Functional Science (AFS) is gravity, and in our daily lives, the thoracic spine is constantly fighting this tremendous force. Generally, all daily movements require that we have our hands pronated, thereby constantly shortening our pecs and lats, and also create a stretch and inhibition of our scapular stabilizers (traps, rhomboids, serrratus anterior, etc.). As a result, we tend to hunch forward and yet because we have to see the horizon, we look up, thus creating anterior head carriage. This can result in significant sub‐occipital and cerico‐thoracic pain as these areas are now taking on excessive load to compensate for the rounded thoracic spine.
If we understand the mechanics of the thoracic spine, then we can use the principles of AFS to assist our patients in creating meaningful, sustainable changes. First, we must understand coupled motion, which requires nothing more than the knowledge that any movement of the spine in one plane is normally accompanied by a compatible spinal movement in another plane. A common example used is that spinal lateral flexion is always accompanied by spinal rotation. In other words, two types of motions are "coupled" together. Type 2 Motion is defined by the joints rotating and laterally flexing the same direction; Type 1 Motion is defined by the joints rotating and laterally flexing in opposite directions). The thoracic spine tends to exhibit Type 2 Motion from T1‐T5 and Type 1 from T6‐T‐12. It is theorized that when a spinal section (or an individual vertebral segment) moves in two directions that are not the expected coupled movements, then this is considered to be uncoupled mechanics. Uncoupled mechanics in spinal sections or in a vertebral segment can lead to abnormal ranges of motion, recurrent joint dysfunction, joint degeneration, inflammation, and pain.
However, when we look at many athletic endeavors, we realize that both coupled and uncoupled motions occur all the time. Therefore, we need to assess, mobilize, and train our patients and clients to be successful in all motions to avoid injury and enhance performance. When treating the thoracic spine, I always use the AFS principle of starting with success and building on success. For a majority of thoracic spine conditions, success is typically that our patients have great movement into flexion and dysfunctional extension. If we understand that all movements are three‐dimensional and understand the concept of relative joint motion, then we can create a strategy that drives motion that encourages flexion with side bending and rotation, and as we return from flexion to our starting position, we remarkably are creating thoracic joint extension. Again, keeping the patient in a successful movement pattern allows for chasing the endgame of better extension.
A great case example is the nursing mother patient who presents significant neck and upper thoracic and rib pain, who has to constantly hold her newborn, and who additionally has an increase in breast tissue due to nursing. This patient is permanently in an anterior head carriage neck position, has rounded shoulders, and has a more anterior center of mass. What this patient does not know is that her pain is rarely due to the neck and more often due to the thoracic spine. A typical progression in my office is to manually work tissue, then mobilize through adjustment(s) and Functional Manual Reaction (FMR), and to stabilize with matrices (three‐dimensional, logical movement patterns). For this example, I would use manual adjustments, combined with FMR in Type 1 Motion and Type 2 Motion of the thoracic spine with the pelvis in and out of synch with relationship to the shoulders (in the TrueStretch™). This would then be followed by the patient performing anterior lunges (beginning with both arms extended in front of his/her body at shoulder height) and reaching both hands in front of the lunging knee (or even in front of the lunging foot at ground height). This drives flexion of the thoracic spine as the patient lunges and creates extension of the thoracic spine as the patient returns from the lunge. If this is successful, we then go to three‐dimensional waist to shoulder dumbbell press, and then to a three‐dimensional shoulder to overhead press. Finally, if we are having success, we will ultimately finish with a Thoracic Spine Matrix.
Please review FMR of the Thoracic Spine (Functional Video Digest Series v3.10) and Thoracic Spine (Functional Video Digest Series v1.8) for more specifics pertaining to Dr. Studholme’s explanation of treatment.
Wednesday, May 12, 2010
Functional Flexibility
FUNCTIONAL FLEXIBILITY: Complex Made Simple
by
Lenny Parracino PT, FAFS
Whether training for golf, football, baseball, or any sport, most athletes realize the benefits from a strength training program, yet rarely recognize the importance of a flexibility program. Flexibility is the foundation of what we do! In fact, without flexibility the body will not exhibit optimal levels of power, strength, cardiovascular fitness, or muscle endurance. Flexibility is the cornerstone of rehab, performance, and preventing injuries. However, flexibility programs seem to be less popular, most likely for a variety of reasons – one being research shows mixed reviews which often leads to confusion.1 When reviewing the principles (or lack thereof) behind most research it is easy to understand why the mixed reviews exist. As professionals, it is important that our decisions on what technique to choose be determined by a principle-based approach that is specific to each person’s intended need, not an arbitrarily designed guideline. To assist in determining what technique to choose, we will first explore three primary principles that should be considered, followed by a strategy to assess and address your patient’s / client’s functional flexibility.
Three Primary Principles of Functional Flexibility:
1. Individual and Task Dependent
2. Three-Dimensional
3. Mobility / Stability System
Functional flexibility is flexibility that allows us to function better. It allows one to perform tasks optimally and efficiently.2 The exact function is individual and taskdependent. 3 Therefore, general stretching techniques designed for muscle origininsertion will not provide us with an optimal functional outcome. Instead, the practitioner must appreciate the function of the muscles during the task. In other words, what a muscle does is task driven not textbook driven. This doesn’t make the textbook authors wrong, their right relative to the position, motion in which they concluded function at that time. When the body changes angles, positions, etc., its function changes; this is why for flexibility to be functional the techniques must look like the intended function. Therefore, we need to understand how the muscles, fascia, tendons, ligaments, nerves, joint capsules, and joints are moving three-dimensionally during the exact task; not only how much motion but also how well. This is the principle of mobility-stability, the right amount of motion with the right amount of stability in all three planes specific to the individual (not textbook) and intended task (all tasks require different levels of motion-stability).
To help simplify this complexity, we would like to share a practical strategy applying our three principles. This strategy can be used practically during your next assessment / evaluation…
First and foremost, understand each unique individual and task. Once you understand the individual’s current condition, limitations, concerns, and what they want to do, assess the intended task with as much authentic function as possible. The key is in understanding what they want / need to do and what they currently can do successfully. From here build a strategy to lead them in the right direction as quickly and safely as possible. For example, start with level one and only move to level two and three as needed per individual, per task.
Level One: Task specific. Assess the ability to perform the exact task. For example, walking, lunging, squatting, pivoting, stepping, reaching, running, balancing, picking up a specific object, sitting while reaching with right hand, etc. If this produces pain, discomfort, and/or lack of confidence, create authentic support to assist in the task. For example, one may reach forward at knee height from a split standing stance and feel low back stress. What if you changed the height of the reach to waist height? Same discomfort or less? If less, is it the back or the hips inability to allow the back to be successful from the range first assessed? Become a detective by changing body angles, positions, heights, drivers, ranges, etc. before leaving the intended task. Figure out a way to gain success in what they want/need to do. If this fails, progress to level two (although level two will look like level one).
Level Two: Task with outside support. Subtly add outside support or points of stability to the intended function. Using our example, simply add outside support such as in a True Stretch or a doorway. The outside support will allow you to position your patient / client in a specific range or zone to then apply authentic drivers. As their driving motion, use your palpation skills to assess the entire chain reaction searching for the “weak-link.” This is the application of the motion-stability principle. Then the body perceives stability it will exhibit mobility, providing it’s there. If one suspects the mobility is not there and desires to assess structural tissue texture, tension level three can provide information regarding the suspected structure (not exact function).
Level Three: Structure specific. Provides an environment for a structural assessment such as a plinth or table. This deviation from the exact functional task must be understood as a deviation and the results then correlated and integrated back into function, if function is the desired outcome.
Traditionally many techniques have been taught to start from the symptom or structural tightness to level three eventually getting to level one. In this paradigm shift, we allow the exact function to dictate how far away from function and into isolated structure we go. This strategy saves time but most importantly gives hope to your patient / client – function feeds function. Although function is complex due to its always changing nature, we can simplify function by simply following function. Use what your patient / client is saying, what they have experienced, and how they are moving as your guide to improving their wellbeing. When we apply the principles of Applied Functional Science (convergence of physical, biological, and behavioral science), flexibility takes on a new meaning. Functional flexibility recognizes the individual as a whole. Once you understand the dynamics of the whole, you derive, at least in principle, the properties and patterns of interactions of the parts.
1 Journal of Bodywork and Movement Therapies (2003) 7(1),1
2 Gray G: Functional Video Digest. Functional Flexibility Enhancing Life. V2.11
3 Gray G: Fast Function. Flexibility, Mobility. 2006
by
Lenny Parracino PT, FAFS
Whether training for golf, football, baseball, or any sport, most athletes realize the benefits from a strength training program, yet rarely recognize the importance of a flexibility program. Flexibility is the foundation of what we do! In fact, without flexibility the body will not exhibit optimal levels of power, strength, cardiovascular fitness, or muscle endurance. Flexibility is the cornerstone of rehab, performance, and preventing injuries. However, flexibility programs seem to be less popular, most likely for a variety of reasons – one being research shows mixed reviews which often leads to confusion.1 When reviewing the principles (or lack thereof) behind most research it is easy to understand why the mixed reviews exist. As professionals, it is important that our decisions on what technique to choose be determined by a principle-based approach that is specific to each person’s intended need, not an arbitrarily designed guideline. To assist in determining what technique to choose, we will first explore three primary principles that should be considered, followed by a strategy to assess and address your patient’s / client’s functional flexibility.
Three Primary Principles of Functional Flexibility:
1. Individual and Task Dependent
2. Three-Dimensional
3. Mobility / Stability System
Functional flexibility is flexibility that allows us to function better. It allows one to perform tasks optimally and efficiently.2 The exact function is individual and taskdependent. 3 Therefore, general stretching techniques designed for muscle origininsertion will not provide us with an optimal functional outcome. Instead, the practitioner must appreciate the function of the muscles during the task. In other words, what a muscle does is task driven not textbook driven. This doesn’t make the textbook authors wrong, their right relative to the position, motion in which they concluded function at that time. When the body changes angles, positions, etc., its function changes; this is why for flexibility to be functional the techniques must look like the intended function. Therefore, we need to understand how the muscles, fascia, tendons, ligaments, nerves, joint capsules, and joints are moving three-dimensionally during the exact task; not only how much motion but also how well. This is the principle of mobility-stability, the right amount of motion with the right amount of stability in all three planes specific to the individual (not textbook) and intended task (all tasks require different levels of motion-stability).
To help simplify this complexity, we would like to share a practical strategy applying our three principles. This strategy can be used practically during your next assessment / evaluation…
First and foremost, understand each unique individual and task. Once you understand the individual’s current condition, limitations, concerns, and what they want to do, assess the intended task with as much authentic function as possible. The key is in understanding what they want / need to do and what they currently can do successfully. From here build a strategy to lead them in the right direction as quickly and safely as possible. For example, start with level one and only move to level two and three as needed per individual, per task.
Level One: Task specific. Assess the ability to perform the exact task. For example, walking, lunging, squatting, pivoting, stepping, reaching, running, balancing, picking up a specific object, sitting while reaching with right hand, etc. If this produces pain, discomfort, and/or lack of confidence, create authentic support to assist in the task. For example, one may reach forward at knee height from a split standing stance and feel low back stress. What if you changed the height of the reach to waist height? Same discomfort or less? If less, is it the back or the hips inability to allow the back to be successful from the range first assessed? Become a detective by changing body angles, positions, heights, drivers, ranges, etc. before leaving the intended task. Figure out a way to gain success in what they want/need to do. If this fails, progress to level two (although level two will look like level one).
Level Two: Task with outside support. Subtly add outside support or points of stability to the intended function. Using our example, simply add outside support such as in a True Stretch or a doorway. The outside support will allow you to position your patient / client in a specific range or zone to then apply authentic drivers. As their driving motion, use your palpation skills to assess the entire chain reaction searching for the “weak-link.” This is the application of the motion-stability principle. Then the body perceives stability it will exhibit mobility, providing it’s there. If one suspects the mobility is not there and desires to assess structural tissue texture, tension level three can provide information regarding the suspected structure (not exact function).
Level Three: Structure specific. Provides an environment for a structural assessment such as a plinth or table. This deviation from the exact functional task must be understood as a deviation and the results then correlated and integrated back into function, if function is the desired outcome.
Traditionally many techniques have been taught to start from the symptom or structural tightness to level three eventually getting to level one. In this paradigm shift, we allow the exact function to dictate how far away from function and into isolated structure we go. This strategy saves time but most importantly gives hope to your patient / client – function feeds function. Although function is complex due to its always changing nature, we can simplify function by simply following function. Use what your patient / client is saying, what they have experienced, and how they are moving as your guide to improving their wellbeing. When we apply the principles of Applied Functional Science (convergence of physical, biological, and behavioral science), flexibility takes on a new meaning. Functional flexibility recognizes the individual as a whole. Once you understand the dynamics of the whole, you derive, at least in principle, the properties and patterns of interactions of the parts.
1 Journal of Bodywork and Movement Therapies (2003) 7(1),1
2 Gray G: Functional Video Digest. Functional Flexibility Enhancing Life. V2.11
3 Gray G: Fast Function. Flexibility, Mobility. 2006
Thursday, December 3, 2009
Vit D and pregnancy
Five million dollar randomized controlled trial sponsored by Thrasher Research Fund and NIH
Scientists around the world presented their work at the recent Vitamin D conference in Brugge, Belgium. Many, but not all, of the scientists opined that we have to wait for randomized controlled trials (RCT) before recommending Vitamin D. In a future newsletter, I will review many of these presentations.
However, one was extraordinary. Professor Bruce Hollis presented findings from his and Carol Wagner’s five million dollar Thrasher Research Fund and NIH sponsored randomized controlled trials of about 500 pregnant women. Bruce and Carol’s discoveries are vital for every pregnant woman. Their studies had three arms: 400, 2,000, and 4,000 IU/day.
1. 4,000 IU/day during pregnancy was safe (not a single adverse event) but only resulted in a mean Vitamin D blood level of 27 ng/ml in the newborn infants, indicating to me that 4,000 IU per day during pregnancy is not enough.
2. During pregnancy, 25(OH)D (Vitamin D) levels had a direct influence on activated Vitamin D levels in the mother’s blood, with a minimum Vitamin D level of 40 ng/ml needed for mothers to obtain maximum activated vitamin D levels. (As most pregnant women have Vitamin D levels less than 40 ng/ml, this implies most pregnant women suffer from chronic substrate starvation and cannot make as much activated Vitamin D as their placenta wants to make.)
3. Complications of pregnancy, such as preterm labor, preterm birth, and infection were lowest in women taking 4,000 IU/day, Women taking 2,000 IU per day had more infections than women taking 4,000 IU/day. Women taking 400 IU/day, as exists in prenatal vitamins, had double the pregnancy complications of the women taking 4,000 IU/day.
What does this huge randomized controlled trial mean?
We have long known that blood levels of activated Vitamin D usually rise during very early pregnancy, and some of it crosses the placenta to bathe the fetus, especially the developing fetal brain, in activated vitamin D, before the fetus can make its own. However, we have never known why some pregnant women have much higher activated Vitamin D levels than other women. Now we know; many, in fact most, pregnant women just don’t have enough substrate, the 25(OH)D building block, to make all the activated Vitamin D that their placenta wants to make.
Of course fetal tissues, at some time in their development, acquire the ability to make and regulate their own activated Vitamin D. However, mom’s activated Vitamin D goes up very quickly after conception and supplies it to baby, during that critical window when fetal development is occurring but the baby has yet to acquire the metabolic machinery needed to make its own activated Vitamin D.
The other possibility, that this is too much activated Vitamin D for pregnancy, cannot stand careful scrutiny. First, the amount of activated vitamin D made during pregnancy does not rise after the mother’s 25(OH)D reaches a mean of 40 ng/ml, so the metabolism is controlled. Second, levels above 40 ng/ml are natural, routinely obtained by mothers only a few short decades ago, such as President Barack Obama’s mom probably did, before the sun scare. (President Obama was born in Hawaii in late August before the sun-scare to a mother with little melanin in her skin) Third, higher blood levels of Vitamin D during pregnancy reduce risk of infection and other pregnancy complications, the opposite may be expected if 25(OH)D levels above 40 ng/ml constituted harm.
It is heartening to see the Thrasher Research Fund and NIH support such a large randomized controlled trial. In fact the Thrasher Research Fund has already funded a three year follow up and the NIH request for a follow up grant is pending. Nevertheless, a large number of medical scientists keep saying, “We need even more science before recommending Vitamin D.” What are they really saying?
First they said we need randomized controlled trials (RCT) before we do anything. Well here is a big one. Then they say, as they did in Brugge, “We don’t believe this RCT, we need more money for more RCTs.” If you think about it, they are saying pregnant women should remain Vitamin D deficient until scientists get all the money for all the RCTs they want, which may take another ten years. How many children will be forever damaged in that ten years?
Amazing study just presented at American Heart Association meeting
Dr. Tami Bair and Dr. Heidi May, of the Intermountain Medical Center in Utah, report yet another study showing that your risk of heart attack, stroke, congestive heart failure and death are dramatically increased by Vitamin D deficiency. In a presentation at the American heart Association meeting, they found that people with low levels (< 15 ng/ml) had a 45% increased risk for cardiovascular disease, 78% greater risk of stroke and double the risk for congestive heart failure, not to mention a 77% increased risk of death, compared to people with Vitamin D levels > 30 ng/ml. All that disease and death occurred in only 13 months of follow up for the 27,000 people in the study.
New York Times: Vitamin D Shows Heart Benefits in Study
So how many Americans died this last year from Vitamin D deficiency? Ten thousand? A hundred thousand? More? How many will die next year? Someone is responsible. Medical scientists who want more money before recommending that Vitamin D deficiency be treated have to assume responsibility. I am all for more studies but we have to act now, like we did with cigarettes. Remember, no human randomized controlled trials exist showing cigarettes are dangerous, so we have much more and better science than we did when we warned about smoking. If we fail to act on the dangers of Vitamin D deficiency, someone will end up with blood on their hands.
The Great Disappearing Act
We are currently witnessing one of the great mysteries of the natural world. The H1N1 outbreak is rapidly disappearing, despite a wealth of potential victims without antibodies to the virus, and yes, in spite of plummeting Vitamin D levels. In several weeks, the CDC will announce that perhaps one-third of Americans were infected in the last nine months and now have Swine flu antibodies, leaving the majority of the population still susceptible.
But this H1N1 virus is rapidly refusing the invitation to infect the two-third of Americans who are mostly immunological virgins and will soon recede until the next widespread outbreak, which may come this spring or next fall and winter. When H1N1 returns again, I predict it will cause more illness and death than it did this fall despite the fact it will attack a population with more H1N1 specific antibodies. Measles, another virus thought to transmit via respiratory secretions, would never forego the opportunity to infect so many virgins.
Influenzologists have no idea why this Disappearing Act happens. Dr. Edgar Hope-Simpson believed the reason lay in the mode of transmission; the current outbreak is ending despite a wealth of potential victims because the people transmitting the flu are suddenly no longer contagious. I recommend Hope-Simpson’s book:
The Transmission of Epidemic Influenza (The Language of Science).
I also believe that only a small population was transmitting, not all those infected. If these good transmitters – and not all the sick – usually spread the virus, and their transmission period is limited, the epidemic would end shortly after the good transmitters lose their infectivity. Why they lose their infectivity is yet another mystery, but a mystery that fits the epidemiology of influenza.
Cannell JJ, Zasloff M, Garland CF, Scragg R, Giovannucci E. On the epidemiology of influenza. Virol J. 2008 Feb 25;5:29. Review.
Another incredible Disappearing Act, one that usually follows the introduction of a pandemic virus, is the rapid and usually complete replacement of seasonal flu with the pandemic one. It is as if the pandemic virus murders the seasonal flu. We will have to wait to see if that happens worldwide with this pandemic, but in the USA it has already happened. Last week the CDC reported that more than 99% of all influenza viruses identified in the USA were Swine flu. Only 1 of 1,874 influenza A viruses identified last week was seasonal flu. Where did the seasonal flu virus go?
John Cannell, MD
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The Vitamin D Council
585 Leff Street
San Luis Obispo, CA 93422
Scientists around the world presented their work at the recent Vitamin D conference in Brugge, Belgium. Many, but not all, of the scientists opined that we have to wait for randomized controlled trials (RCT) before recommending Vitamin D. In a future newsletter, I will review many of these presentations.
However, one was extraordinary. Professor Bruce Hollis presented findings from his and Carol Wagner’s five million dollar Thrasher Research Fund and NIH sponsored randomized controlled trials of about 500 pregnant women. Bruce and Carol’s discoveries are vital for every pregnant woman. Their studies had three arms: 400, 2,000, and 4,000 IU/day.
1. 4,000 IU/day during pregnancy was safe (not a single adverse event) but only resulted in a mean Vitamin D blood level of 27 ng/ml in the newborn infants, indicating to me that 4,000 IU per day during pregnancy is not enough.
2. During pregnancy, 25(OH)D (Vitamin D) levels had a direct influence on activated Vitamin D levels in the mother’s blood, with a minimum Vitamin D level of 40 ng/ml needed for mothers to obtain maximum activated vitamin D levels. (As most pregnant women have Vitamin D levels less than 40 ng/ml, this implies most pregnant women suffer from chronic substrate starvation and cannot make as much activated Vitamin D as their placenta wants to make.)
3. Complications of pregnancy, such as preterm labor, preterm birth, and infection were lowest in women taking 4,000 IU/day, Women taking 2,000 IU per day had more infections than women taking 4,000 IU/day. Women taking 400 IU/day, as exists in prenatal vitamins, had double the pregnancy complications of the women taking 4,000 IU/day.
What does this huge randomized controlled trial mean?
We have long known that blood levels of activated Vitamin D usually rise during very early pregnancy, and some of it crosses the placenta to bathe the fetus, especially the developing fetal brain, in activated vitamin D, before the fetus can make its own. However, we have never known why some pregnant women have much higher activated Vitamin D levels than other women. Now we know; many, in fact most, pregnant women just don’t have enough substrate, the 25(OH)D building block, to make all the activated Vitamin D that their placenta wants to make.
Of course fetal tissues, at some time in their development, acquire the ability to make and regulate their own activated Vitamin D. However, mom’s activated Vitamin D goes up very quickly after conception and supplies it to baby, during that critical window when fetal development is occurring but the baby has yet to acquire the metabolic machinery needed to make its own activated Vitamin D.
The other possibility, that this is too much activated Vitamin D for pregnancy, cannot stand careful scrutiny. First, the amount of activated vitamin D made during pregnancy does not rise after the mother’s 25(OH)D reaches a mean of 40 ng/ml, so the metabolism is controlled. Second, levels above 40 ng/ml are natural, routinely obtained by mothers only a few short decades ago, such as President Barack Obama’s mom probably did, before the sun scare. (President Obama was born in Hawaii in late August before the sun-scare to a mother with little melanin in her skin) Third, higher blood levels of Vitamin D during pregnancy reduce risk of infection and other pregnancy complications, the opposite may be expected if 25(OH)D levels above 40 ng/ml constituted harm.
It is heartening to see the Thrasher Research Fund and NIH support such a large randomized controlled trial. In fact the Thrasher Research Fund has already funded a three year follow up and the NIH request for a follow up grant is pending. Nevertheless, a large number of medical scientists keep saying, “We need even more science before recommending Vitamin D.” What are they really saying?
First they said we need randomized controlled trials (RCT) before we do anything. Well here is a big one. Then they say, as they did in Brugge, “We don’t believe this RCT, we need more money for more RCTs.” If you think about it, they are saying pregnant women should remain Vitamin D deficient until scientists get all the money for all the RCTs they want, which may take another ten years. How many children will be forever damaged in that ten years?
Amazing study just presented at American Heart Association meeting
Dr. Tami Bair and Dr. Heidi May, of the Intermountain Medical Center in Utah, report yet another study showing that your risk of heart attack, stroke, congestive heart failure and death are dramatically increased by Vitamin D deficiency. In a presentation at the American heart Association meeting, they found that people with low levels (< 15 ng/ml) had a 45% increased risk for cardiovascular disease, 78% greater risk of stroke and double the risk for congestive heart failure, not to mention a 77% increased risk of death, compared to people with Vitamin D levels > 30 ng/ml. All that disease and death occurred in only 13 months of follow up for the 27,000 people in the study.
New York Times: Vitamin D Shows Heart Benefits in Study
So how many Americans died this last year from Vitamin D deficiency? Ten thousand? A hundred thousand? More? How many will die next year? Someone is responsible. Medical scientists who want more money before recommending that Vitamin D deficiency be treated have to assume responsibility. I am all for more studies but we have to act now, like we did with cigarettes. Remember, no human randomized controlled trials exist showing cigarettes are dangerous, so we have much more and better science than we did when we warned about smoking. If we fail to act on the dangers of Vitamin D deficiency, someone will end up with blood on their hands.
The Great Disappearing Act
We are currently witnessing one of the great mysteries of the natural world. The H1N1 outbreak is rapidly disappearing, despite a wealth of potential victims without antibodies to the virus, and yes, in spite of plummeting Vitamin D levels. In several weeks, the CDC will announce that perhaps one-third of Americans were infected in the last nine months and now have Swine flu antibodies, leaving the majority of the population still susceptible.
But this H1N1 virus is rapidly refusing the invitation to infect the two-third of Americans who are mostly immunological virgins and will soon recede until the next widespread outbreak, which may come this spring or next fall and winter. When H1N1 returns again, I predict it will cause more illness and death than it did this fall despite the fact it will attack a population with more H1N1 specific antibodies. Measles, another virus thought to transmit via respiratory secretions, would never forego the opportunity to infect so many virgins.
Influenzologists have no idea why this Disappearing Act happens. Dr. Edgar Hope-Simpson believed the reason lay in the mode of transmission; the current outbreak is ending despite a wealth of potential victims because the people transmitting the flu are suddenly no longer contagious. I recommend Hope-Simpson’s book:
The Transmission of Epidemic Influenza (The Language of Science).
I also believe that only a small population was transmitting, not all those infected. If these good transmitters – and not all the sick – usually spread the virus, and their transmission period is limited, the epidemic would end shortly after the good transmitters lose their infectivity. Why they lose their infectivity is yet another mystery, but a mystery that fits the epidemiology of influenza.
Cannell JJ, Zasloff M, Garland CF, Scragg R, Giovannucci E. On the epidemiology of influenza. Virol J. 2008 Feb 25;5:29. Review.
Another incredible Disappearing Act, one that usually follows the introduction of a pandemic virus, is the rapid and usually complete replacement of seasonal flu with the pandemic one. It is as if the pandemic virus murders the seasonal flu. We will have to wait to see if that happens worldwide with this pandemic, but in the USA it has already happened. Last week the CDC reported that more than 99% of all influenza viruses identified in the USA were Swine flu. Only 1 of 1,874 influenza A viruses identified last week was seasonal flu. Where did the seasonal flu virus go?
John Cannell, MD
This newsletter may be reproduced as long as you properly and prominently attribute it source. Please reproduce it, post it on Internet sites, and forward it to your friends.
Remember, we are a non-profit and rely on your donations to publish our newsletter, maintain our website, and pursue our objectives. Send your tax-deductible contributions to:
The Vitamin D Council
585 Leff Street
San Luis Obispo, CA 93422
Monday, October 12, 2009
More good news about Vit D supplementation
Older adults with insufficient levels of vitamin D die from heart disease and all-cause death at greater rates than those with adequate levels of the vitamin, according to a recent study.
Also according to a new study, many pregnant women who are supplementing with vitamin D are still presenting as vitamin D deficient. This suggests that current recommendations for D supplementation may be still too low. Vitamin D insufficiency during pregnancy is associated with childhood rickets and longer-term problems including schizophrenia and type 1 diabetes.
And finally, patients on atorvastatin, a drug used to lower cholesterol, who were simultaneously supplemented with vitamin D, demonstrated lower blood serum levels of the drug and its metabolites and yet LDL and total cholesterol levels were also decreased.
Sources:
1. Prospective Study of Serum 25-Hydroxyvitamin D Level, Cardiovascular Disease Mortality, and All-Cause Mortality in Older U.S. Adults
2. Vitamin D deficiency and insufficiency in pregnant women: a longitudinal study
3. Statins and Vitamin D–Conflict or Concord? Prospective Study of Serum 25-Hydroxyvitamin D Level, Cardiovascular Disease Mortality, and All-Cause Mortality in Older U.S. Adults
Also according to a new study, many pregnant women who are supplementing with vitamin D are still presenting as vitamin D deficient. This suggests that current recommendations for D supplementation may be still too low. Vitamin D insufficiency during pregnancy is associated with childhood rickets and longer-term problems including schizophrenia and type 1 diabetes.
And finally, patients on atorvastatin, a drug used to lower cholesterol, who were simultaneously supplemented with vitamin D, demonstrated lower blood serum levels of the drug and its metabolites and yet LDL and total cholesterol levels were also decreased.
Sources:
1. Prospective Study of Serum 25-Hydroxyvitamin D Level, Cardiovascular Disease Mortality, and All-Cause Mortality in Older U.S. Adults
2. Vitamin D deficiency and insufficiency in pregnant women: a longitudinal study
3. Statins and Vitamin D–Conflict or Concord? Prospective Study of Serum 25-Hydroxyvitamin D Level, Cardiovascular Disease Mortality, and All-Cause Mortality in Older U.S. Adults
Tuesday, September 29, 2009
Chronic Pain and the often overlooked glut muscles
Chronic Pain and the Often Overlooked Glut Muscles
Most people look at the abdominal wall when they have chronic low back or pelvic problems. They do endless amounts of crunches and Pilates type movements to strengthen their core. While this does build strength, it doesn’t address an often overlooked group of muscles which includes the external rotators of the hip and the gluteus muscles. For ease, I’ll call them the butt muscles.
When the butt muscles are weak (inhibited) they can cause multiple problems for the musculoskeletal system. Let’s look at the gluteus maximus as an example. This muscle attaches to the outside of your upper leg to a thick band called the iliotibial band. Its other attachment is at the top of your pelvis and to the small pie shaped bone at the base of your spine that forms the foundation of your spine, called the sacrum. It crosses the sacroiliac joint and the hip joint. It’s nearly always involved in sacroiliac pain, lumbar spine pain and hip pain.
You can notice the gluteus maximus muscle working when you walk with a long stride. If you place your hands over the lower portion of your buttocks and walk with a short stride, you will feel very little muscle contraction. Now lengthen your stride and you will feel the muscle contract when you toe off and when your heel strikes the ground. This is actually a good way to keep the muscle strong. Walking in heels prevents long strides and contributes to inhibited butt muscles.
Getting out of a chair or car and climbing stairs are other common uses of the butt muscles. When they are weak, you have to lean forward to shift your weight more over your knees in order to get up.
Why is the strength in these muscles important?
When these muscles are weak there will be a slow lengthening of the sacroiliac ligaments which causes pain and pelvic imbalances that become chronic. If this occurs, there will usually be muscle tightness running up your back even up to the neck muscles.
What are the symptoms of weakness of the butt muscles?
1. Chronic pelvic problems
2. Chronic knee pain
3. Stiffness to the lower back
4. Restriction in neck rotation
5. Difficulty sitting for long periods of time
6. Difficulty getting out of a car or up from a low chair
What can you do about this?
First you have to have your pelvis, hip, foot and thoracic spine tested for any structural imbalance. Then the muscle needs to be tested for its proper function and corrected if it cannot contract properly. Once the muscle is able to function properly, simply walking with long strides may be enough to keep the muscle contracting properly. If this is not enough, then specific exercises can be prescribed to help allow for proper biomechanics of the butt muscles. Unfortunately, all of the machines at the gym don’t take into account the way the butt muscles actually function when walking and they often work the hamstring and low back muscles more than the buttock muscles which leads to further imbalance.
If you have chronic problems or know someone with this type of problem, please talk to me about it. Often treating this group of muscles helps with many problems at once, from the foot to the neck.
As always, your referral is my greatest compliment.
Kevin Colling, D.C. 503-808-9145
¬¬
Most people look at the abdominal wall when they have chronic low back or pelvic problems. They do endless amounts of crunches and Pilates type movements to strengthen their core. While this does build strength, it doesn’t address an often overlooked group of muscles which includes the external rotators of the hip and the gluteus muscles. For ease, I’ll call them the butt muscles.
When the butt muscles are weak (inhibited) they can cause multiple problems for the musculoskeletal system. Let’s look at the gluteus maximus as an example. This muscle attaches to the outside of your upper leg to a thick band called the iliotibial band. Its other attachment is at the top of your pelvis and to the small pie shaped bone at the base of your spine that forms the foundation of your spine, called the sacrum. It crosses the sacroiliac joint and the hip joint. It’s nearly always involved in sacroiliac pain, lumbar spine pain and hip pain.
You can notice the gluteus maximus muscle working when you walk with a long stride. If you place your hands over the lower portion of your buttocks and walk with a short stride, you will feel very little muscle contraction. Now lengthen your stride and you will feel the muscle contract when you toe off and when your heel strikes the ground. This is actually a good way to keep the muscle strong. Walking in heels prevents long strides and contributes to inhibited butt muscles.
Getting out of a chair or car and climbing stairs are other common uses of the butt muscles. When they are weak, you have to lean forward to shift your weight more over your knees in order to get up.
Why is the strength in these muscles important?
When these muscles are weak there will be a slow lengthening of the sacroiliac ligaments which causes pain and pelvic imbalances that become chronic. If this occurs, there will usually be muscle tightness running up your back even up to the neck muscles.
What are the symptoms of weakness of the butt muscles?
1. Chronic pelvic problems
2. Chronic knee pain
3. Stiffness to the lower back
4. Restriction in neck rotation
5. Difficulty sitting for long periods of time
6. Difficulty getting out of a car or up from a low chair
What can you do about this?
First you have to have your pelvis, hip, foot and thoracic spine tested for any structural imbalance. Then the muscle needs to be tested for its proper function and corrected if it cannot contract properly. Once the muscle is able to function properly, simply walking with long strides may be enough to keep the muscle contracting properly. If this is not enough, then specific exercises can be prescribed to help allow for proper biomechanics of the butt muscles. Unfortunately, all of the machines at the gym don’t take into account the way the butt muscles actually function when walking and they often work the hamstring and low back muscles more than the buttock muscles which leads to further imbalance.
If you have chronic problems or know someone with this type of problem, please talk to me about it. Often treating this group of muscles helps with many problems at once, from the foot to the neck.
As always, your referral is my greatest compliment.
Kevin Colling, D.C. 503-808-9145
¬¬
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