Scientific Studies Interpreted

Journal of Manipulative and Physiological Therapeutics

Since the dawn of modern science answers to life’s questions have been sought through studies.  I highly recommend research and physicians using research to the advantage of their patients.  I encourage patients to stay informed through reading research.  In life, online, and even the media you hear things like, “oh it’s true, they’ve done studies.”  I’m not sure who “they” are and whatever study is being referred to probably didn’t mean what you thought it did.

American Chiropractic Association

Chiropractic, for good or bad, has been forced into research by the well-meaning movement of evidence based medicine.  This movement, as with most things, falls short when strictly applied to every scenario.  There are always too many exceptions.  One of the most well-known, and a great read, is a farcical review article discussing, “parachute use to prevent death and major trauma related to gravitational challenge.”  This article was actually published in the British Medical Journal in 2003.  It inferred that because there was no research studies to show the efficacy of parachute use that their use should be discontinued as a preventative health care measure.

Index to Chiropractic Literature

The truth is that most studies are either to vague or to specific or too something to be applied directly in real life situations.  They all have flaws and weaknesses.  Even the gold standard Double Blind Randomized Controlled Trial is not perfect.  Most of the good studies admit and disclose their bias so that readers can take that into consideration when determining usefulness.  If you don’t understand research bias don’t worry there are entire college courses dedicated to the topic, if you want to learn more you can begin here  Google results: research bias.

To make things simple for you, there is no perfect study because people are not perfect.   This principle becomes utterly clear in online debates that usually end in name calling and any truth lost to both parties.

The Chiropractic Resource Organization

I often cite research on my blog, and sometimes people agree and sometimes they disagree with the research.  You are welcome to do so.  I highly recommend reading research for truth.  The best RCT can be useless and the anectdotal single case study may hold the answer to the problem you face.  Don’t discount evidence of any kind.  Read it for truth and accept the research for what it is, one possible view of a whole situation.

Is Popping Your Knuckles/Back/Joints Bad For You (Part II)?

My prior post on this topic had so many comments that it had become bloated and difficult to follow. I will attempt here to summarize the answers to those comments and also add new insights that I have gained in the years since that prior post.

Joint motion is good.  Here is an excellent summary quote from The Mayfield Clinic for Brain and Spine: “Good joint motion is essential for the health and nutrition of the discs and joints because it permits the exchange of nutrients, fluids, and waste. Good motion helps reduce pain, muscle spasms or imbalance, and improves nervous system function and overall health. Without movement, discs and joints may degenerate more quickly than normal. Motion also reduces the formation of scar tissue, which can lead to stiffness and degeneration.”

The issue is simple sometimes our joints make noise when they move.  Noises are OK.  The old wives tale that popping your knuckles will give you arthritis is just that, a tale.  With that said, knuckle cracking is not a good habit.  There are 4 major noises that joints make and the general rule for all of those noises is, that if it doesn’t hurt, it is probably fine.  Here they are…

The Break – This one hurts and is therefore bad. When bones break they make a noise.

The Thunk – This one can go either way. The best example I can come up with is a dislocated shoulder. It thunks going out and then thunks coming back in, but one hurts and one makes it feel better.

The Twang – It’s like strumming a guitar string. You’ve seen people with their ankles or wrists popping over and over. It doesn’t hurt, but the ligaments or tendons are being strummed or popped over a bump or restriction of some sort.

The Pop – This is the one that the most people refer to with chiropractors. The popping is not perfectly understood.  The current thinking is that it is a cavitation. The pressure increases in the joint space causing the nitrogen or other gases to be “popped” from the liquid to gaseous form. It takes a refractory period before this can happen again. That’s why you can’t pop your knuckles immediately after doing it, but have to wait for a time before they will pop again

Popping your knuckles or any joint is not bad for you – Anything to excess is bad. You should not be popping any joint, all the time. I’ve seen people who every 30 minutes or so will take their head and twist it “crackle”. Every time you take your joints that far it puts stress on the joint capsule.  Stress by its self is not bad as with exercise it can lead to improvement, but if it is over done you can hurt yourself.

Let me address popping your own joints as a form of treatment.  A Chiropractor will assess specific joints, find restrictions and adjust them sometimes getting a pop.  If you try to adjust yourself you will likely end up getting some popping sounds somewhere, but you will probably only get temporary relief, if any at all.  You can also make things worse by producing a hypermobility around the area that is stuck.  

I encourage you to stretch and take your body through all of the ranges of motion that you can.  That will often solve your problem.  If stretching does help, that is great. If range of motion exercise does not solve your problem then seek chiropractic help.

Here are some of the most common questions asked in the past and their answers.

Q: How much is too much popping.

A: There is no answer for everyone.  If you think you do it too much, you probably do.  Track your symptoms. Make a little list of each that you are concerned with.  Write down what the symptoms are, when/how often they happen and anything that you do on your own that makes them feel better or worse.  You might find the cause and be able to make a change that resolves the symptoms on your own or you might be the best informed patient your doctor has seen in weeks.

Q: What should I do if I pop my knuckles/back/joints too much?

A: First see a chiropractor to see if there is something wrong that you should address physically.  If you can remove the cause then you won’t have to worry about popping.

If this popping has become habitual or obsessive for you and is not due to some underlying condition then you can try behavior modification.  Habits are always easier to break with support, and professional help may be useful to you.

Q: Can you tell me what’s wrong with my popping knuckles?

A: It’s very difficult and illegal to diagnose over the internet and without an examination.  I provide this information as educational.  It should not be a substitute for seeing your chiropractor.

UPDATE: Scientific American presents an interesting article reviews some of the research on the topic of knuckle cracking.

Menier’s Disease: New Research

Patients doing their own research on conditions occationally bring me something that they find interesting to get my opinion.  This recently happened with an article on MÉNIÈRE’S DISEASE AND JOINT INJURY.  The full title is “The Potential Role of Joint Injury and Eustachian Tube Dysfunction in the Genesis of Secondary Ménière’s Disease” I thought I’d just share that review with you.

Meniere’s Disease is a disorder of the inner ear causing many different symptoms from vertigo to ringing in the ears to hearing loss.  The article really seems to be just an idea that the authors have been pondering and sought to find evidence to back up their idea.  Not very scientific in my opinion.  What they’ve really done is see if there is any validity to their hypothesis so that they can do further studies.

The ear has 3 sections, inner, middle, and outer.  The inner ear is sealed off and in your skull and is what does all of the work you might associate with the ear, hearing and balance.  The middle ear is simply a cavity with facilities to allow the outer ear to “talk” to the inner ear and is drained by the eustachian tube into the back of your throat.  The middle ear is usually where ear “infections” occur.  The eustation tube becomes blocked and can’t drain the middle ear so fluid builds up or an infection may grow.  If this occurs frequently, medical doctors sometimes, (instead of fixing the tube that your body has) insert additional tubes that drain to your outer ear.

The bones in your neck join the skull right behind your ear.  If you put your finger right there you feel a soft spot between the bump of your skull your jaw and your ear.  Those are the joints that the article talks about, the upper cervical spine and the TMJ.  The close proximity has always caused people to justify a relationship between those joints and the ear. Neurologically there has been no direct connection found that I’m aware of. These authors are proposing an indirect nerve connection in order to explain why TMJ or neck injuries can lead to Menier’s disease. 

From a chiropractic perspective their hypothesis also implies the reverse, that patients with Menier’s Disease might benefit from chiropractic management.  To be determined…

Help for Weak Posture

I was recently listening to a podcast from a fellow chiropractor, Dr. Kinsler, which discussed posture as a unifying tool for chiropractic as a profession.  Now I’m not entirely convinced that this profession can unite around a public identity as the posture doctors, but one thing in the discussion did strike me. 

Dr. Steven Weiniger, who was being interviewed, discussed posture as weak vs strong and not bad vs good.  Many times patients come to me and know that the reason their back hurts is because they, “have bad posture.”  They report this to me as though they have a diabetes or cancer, or some disease that they have little control over. 

Using the term weak posture instead of bad posture implies the ability to strengthen.  I have taken to using the term weak posture and strong posture with my patients and they have seemed to get the idea.  Instead of assuming that they should just sit up straight which they can’t do they have begun to ask me what they can do to strengthen their posture. 

The biggest mistake people make when trying to improve thier posture is forgetting to strengthen postural muscles.  They just sit up straight then after about 20 min they’re back to slouching because their muscles cannot maintain it.  I have some exercises that I’ve used for years to strengthen posture.  Here are two simple ones, give them a try and see how your posture improves.

Shoulder Wall Slides (Muscle group: Lower Traps, Rhomboids, Scapular and Thoracic Spine Stabilizers)

  

1. Stand with your back to a wall
2. Bend your elbows 90 degrees and raise them out to the sides so your hands (palms facing out) are at shoulder height.
3. Keeping your arms pressed into the wall, lower your elbows as far as possible. Hold for a second, squeezing your shoulder blades together.
4. Slide your arms up the wall as high as they will go without losing contact with the wall.
5. When you start to lose contact, bring your arms back to the starting position.

Superman (Muscle group: Erector Spinae)

1. Lie face down with your arms stretched above your head (like superman)
2. STEP -1 Raise your arms and upper body off the ground (5-10 seconds)
3. Repeat
4. STEP -2 Raise your upper body and legs off the ground (5-10 seconds)
5. Repeat

 These exercises are for informational purposes and are not intended to be a substitute for examination, diagnosis and treatment by your physician chiropractic or otherwise.

Fast Food Can Change

My daughters don’t like fast food.  I think we scared them enough, and we don’t generally take them to fast food places.  Once or twice a year is about our average.  My oldest daughter told me that when she grew up she wanted to have a restaraunt that served good healthy food fast.  She went on to describe how fast she can make a healthy meal.  This daughter is only 10.  Will we have to wait until she grows up to see healthy options in fast food?  Can fast food even be healthy?

I recently got a letter from McDonalds (R) to healthcare professionals touting the changes that they plan to make.  They have heard the desire of the public and the government threats and decided to show that fast food can be healthy.  Here is the public press release.  I’ve also seen many fast food places or special menus with fresh or healthy names begin to pop up.  The changes seem to just be in the name.  The quality of the food is still up for debate. 

I know that if you have the right supplies and are working at it you can produce healthy food for large numbers of people relatively quickly.  I don’t see most fast food places tossing salad in the back or cutting up a fresh avocado.  Anytime you mass produce, corners are cut to be more efficient.  Those corners in food services are usually nutrition. 

Fast food has come a long way.  Apparently some places now serve oatmeal for breakfast and have fruit and yogurt.  That oatmeal is the stripped down instant oatmeal with almost no fiber left in it and I highly doubt the yogurt is cultured, but it’s better than the grease that was their only option before.  Many places have decent salads now.  And one thing I would always recommend is to, special order healthy.  When you change something the preparers have to pay attention to what they are doing and you make the choice to order something in a more healthy way than it usually is.  Fast Food obviously can change.  The question remains, will there ever really be healthy fast food?