As Safe as Can Be

Some people refuse to go to a chiropractor because they fear suffering a stroke after neck manipulation. Recent media attention has focused on the claim of a cause-effect relationship between chiropractic and stroke, yet little evidence actually supports the hypothesis that neck manipulations can cause a stroke. A recent study in the Journal of Manipulative and Physiological Therapeutics makes this relationship seem even more implausible.

To determine the extent of strain on the vertebral artery of the neck during spinal manipulative therapy, six vertebral arteries were utilized from five cadaveric specimens, with only the necessary arterial loops exposed. Strains on the arteries were measured during range-of-motion tests, diagnostic tests and a number of manipulation procedures. Next, each artery was removed and strained until failure on a materials-testing machine, with the level of mechanical failure recorded.

Spinal manipulative therapy on the cervical spine caused an average strain of about 2-6% over resting artery length to the arterial loops, similar to strains measured during range-of-motion tests. The failure tests showed that the vertebral arteries could be stretched to 39-62% over resting length before causing mechanical failure, however. The strain required to damage the vertebral arteries was approximately nine times greater than strain actually produced by spinal manipulation.

The researchers who conducted this study concluded that in normal circumstances, typical chiropractic manipulations to the neck are highly unlikely to tear the vertebral artery, and that the strains measured on the arteries in this study were within the range of those generated during normal activities. In fact, the estimated occurrence of stroke following cervical manipulations is approximately one per 6 million manipulations; even in these cases, the manipulations aren't necessarily the cause of the strokes. By comparison, a person's odds of getting struck by lightning in his or her lifetime are much higher: about one in 3,000.

Reference: Symons BP, Leonard T, Herzog W. Internal forces sustained by the vertebral artery during spinal manipulative therapy. Journal of Manipulative and Physiological Therapeutics 2002:25(8), pp. 504-510.

To read about neck pain click here.

Strike While the Iron Is Hot

Iron-deficiency anemia in infants, a condition caused by inadequate levels of iron in the body, was recently covered in a review in the Canadian Medical Association Journal. Our bodies require iron to make hemoglobin, a part of the red blood cells that carry oxygen throughout the body. If iron levels get too low, an adult might experience fatigue; headaches; dizziness; concentration problems; a pale appearance; and brittle nails and cracked lips. Although few adults in developed nations suffer from this form of anemia, infants are more commonly affected.

In a healthy infant's first months outside the womb, breastfeeding does not provide adequate iron, so iron stored in the liver and bone marrow is utilized. However, by around six months of age, these stores are depleted. Premature birth; prolonged and excessive breastfeeding; providing the wrong types of complementary foods; and frequent infections can all lead to iron deficiency in infants. In children and adolescents, it usually occurs in females as the result of menstruation combined with restricted food intake.

In young children, iron deficiency is characterized by altered behavior, including excessive wariness, irritability and depression, and altered motor development, including a fear of leaving a parent's side. Adolescents and children who were anemic as infants may end up having lower grades and cognitive test scores; worse math scores; and reduced verbal learning and memory abilities.

It is crucial that babies and young children have enough iron while still developing and growing. Strike while the iron is still hot: Feed your kids red meat, poultry and fish - the best natural sources of dietary iron. Fortified breakfast-type cereals and infant formulas are also excellent sources. Infants 7-12 months old, children ages 4-8, and adolescents ages 14-18 require the most dietary iron. When detected, existing iron-deficiency anemia can be treated immediately with iron supplementation provided by a doctor.

Reference: Zlotkin S. Clinical nutrition:8. The role of nutrition in the prevention of iron deficiency anemia in infants, children and adolescents. Canadian Medical Association Journal 2003:168(1), pp. 59-63.

For a wealth of nutrition studies click here.

Don't Be a Dropout

When was the last time you exercised vigorously? For optimal health, you should be performing a strenuous workout, such as running or lifting weights, several times each week. Based on a recent Gallup Poll, however, the odds are that most people aren't getting nearly enough exercise.

In November 2002, the Gallup Organization conducted a Health and Healthcare Poll of over 1,000 American adults to find out how many are vigorously exercising (i.e., at least 20 minutes of exercise that causes large increases in heart rate and breathing) or performing other forms of physical activity, and how often they're doing it. Gallup then compared the results to a similar phone survey it completed in November 2001.

The percentage of Americans who engage in vigorous exercise dropped from 52% in 2001 to 45% in 2002. Moderate exercise, or activities that cause a slight increase in heart rate (e.g., gardening or walking), has pretty much remained constant. Around 80% of people engage in weekly moderate exercise, although the percentage of those who do also dropped slightly in the past year. At every frequency of exercise, there was evidence of a decline in participation, according to the poll. Also, only a quarter of Americans are weight training, despite numerous efforts by health professionals to encourage people to lift weights every week.

Based on Gallup's "overall exercise index," 54% of Americans are considered sedentary or having low activity levels. So, at the same time Americans are eating more food with higher fat content, they're also working out less and burning fewer calories. Don't be a dropout - if you used to exercise, start working out again. If you've never really worked out, there's never been a better time to start. There may be no better way to stay healthy.

Reference: Saad L. Fewer Americans feeling the burn: Dwindling number report vigorous exercise. Gallup News Service, Poll Analyses, Jan. 10, 2003.

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Fight Acid With Acid

Recently, a new and highly accurate predictor of declining health has emerged. The amino acid homocysteine, measured through blood serum concentration, is an accurate predictor of risk for stroke and heart disease. Whether homocysteine causes these conditions or is simply correlated has been uncertain, though.

Using 92 studies involving a total of over 20,000 adults, the authors of this study in the British Medical Journal evaluated the possible causation of stroke and heart disease due to high homocysteine levels in the blood. They found that for every unit increase in serum homocysteine, the odds were increased approximately one-and-a-half times for heart disease, deep vein thrombosis (major blood clotting) and stroke.

This adds to evidence suggesting the link between homocysteine and cardiovascular disease is a causal one. Lowering homocysteine concentrations in the blood by even less than one unit may significantly reduce the risk of heart disease, deep vein thrombosis and stroke.

So how can you lower your homocysteine levels? It's easier than you think. Homocysteine can be lowered through supplementation of another acid - folic acid. Also known as vitamin B9, folic acid can be obtained through foods including fortified cereals, peas and beans, spinach and whole wheat. To be sure you are getting enough, taking a multivitamin is your best bet. Folic acid also helps prevent birth defects (when taken by pregnant women), cancer, osteoporosis and depression.

Reference: Wald DS, Law M, Morris JK. Homocysteine and cardiovascular disease: Evidence on causality from a meta-analysis. British Medical Journal 2002:325, pp. 1202-1208.

Room to Move

What is it about chiropractic care that makes it so effective? Patients swear by the spinal adjustments they receive from their chiropractor, but often don't know how the manipulation is helping, other than a general knowledge that their backs have been "cracked." Adhesions in the hinge joints of the vertebrae, called the facet joints, may be one reason for back pain.

Adhesions, or joints being improperly stuck together, can be caused by reduced mobility from injury or inactivity. Chiropractic spinal manipulation theoretically separates the facet joints and increases the space between them, breaking adhesions and restoring motion. One of the most common spinal adjustments performed by chiropractors - the side-posture adjustment - involves positioning a patient on his or her side, then rotating the upper body using the shoulder and hip as levers. From here, an adjustment is made with a slight twisting of the spine.

In a study in the journal Spine, 64 men and women ages 22-30 without back pain were divided into four groups for varying treatment interventions, involving placing patients in side-posture position only (without performing an adjustment), providing actual side-posture spinal adjusting, or leaving patients in a neutral position. MRI scans were taken before and after interventions, in side-posture position or with people lying on their backs, and compared for each individual.

People given side-posture adjustments followed by MRI in side-posture position showed the greatest separation in the facet joints. Those in side-posture position alone, without adjustments, showed the second-greatest separation before and during MRI. Side-posture adjusting clearly created greater separation than no adjustments. The average difference in separation between neutral group subjects' facet joints and the group receiving side-posture adjustments was only a few millimeters, but the authors called this amount "not only significant," but also "clinically relevant."

Reference: Cramer GD, Gregerson DM, et al. The effects of side-posture positioning and spinal adjusting on the lumbar Z joints: A randomized controlled trial with sixty-four subjects. Spine 2002:27(22), pp. 2459-2466.

To read more studies on back pain treatment click here.

Deliver Yourself From Pelvic Pain

A Cesarean section is the surgical delivery of a baby through an incision made in the mother's abdomen. These surgeries, though sometimes the best option for delivery (e.g., when a very small woman is having a very large child), are increasingly being performed when unnecessary in the U.S., increasing risks for mother and child. Chronic pelvic pain, or persistent, long-term pain of the lower abdomen, is a condition that affects millions of women in their reproductive years and may be more prevalent in women who've had a C-section.

Conducted in Brazil, another nation where rates of Cesarean sections are rising, a study appearing in the International Journal of Gynecology and Obstetrics focused on about 200 patients averaging approximately 35 years old. The women provided detailed pain histories and information on previous deliveries. The mothers also underwent complete gynecological and abdominal examinations, including laparoscopy - a procedure that involves using a viewing instrument inserted through an incision in the navel to examine a woman's reproductive organs.

Women with chronic pelvic pain were significantly more likely to have undergone a C-section than women without pain. C-sections had been performed on over two-thirds of women with the condition, as opposed to just over one-third of women without chronic pelvic pain. Women with endometriosis, a condition characterized by uterine lining abnormally forming outside the uterus, were also at a high risk for the condition (nearly nine times more likely).

Chronic pelvic pain can be caused by other factors, such as depression or sexual trauma. The important point to consider from this study is that unlike endometriosis, C-sections are optional in many cases. Mothers-to-be can often choose to avoid this procedure, which may reduce their risk for chronic pelvic pain, as well as infection, blood loss and scarring.

Reference: Almeida ECS, Nogueira AA, et al. Cesarean section as a cause of chronic pelvic pain. International Journal of Gynecology and Obstetrics 2002:79, pp. 101-104.

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Hip-Hip-Hooray!

A hip fracture, generally caused by a fall, is one of the most serious injuries elderly people face. Nursing home residents have a particularly high risk for these fractures, which often lead to extreme immobility and even death, despite corrective surgery for most sufferers. Wearing external hip protectors can reduce the impact of a fall, significantly lowering the odds for a hip fracture - but regular use of hip protectors is low.

To evaluate hip-protector usage following an educational intervention, almost 1,000 nursing home residents 70 or more years old and at a high risk for falling participated in a recent study published in the British Medical Journal. Staff at selected nursing homes in Hamburg, Germany, were educated about hip protector use in a single class, then instructed the residents and supplied them with hip protectors. Elderly patients provided with standard care were examined for comparison.

Over 18 months, the risk for hip fracture was reduced by 43% in seniors given free hip protectors and education about their usage, compared to their peers. Of those seniors who suffered a fall, hip protectors were used by 15% of people receiving standard care, versus 68% in the group given hip protectors and education.

This study may be cause for celebration. Some consider external hip protectors cumbersome and unsightly, but if you're a likely candidate for a hip fracture, they provide a safe, easy means of avoiding what can be a severe injury. Seniors who should consider wearing hip protectors are those with any of the following criteria: female gender; slight build; osteoporosis; poor balance or coordination; vision problems; general disorientation; or medication use that leads to dizziness or a weakened condition.

Reference: Meyer G, Warnke A, et al. Effect on hip fractures of increased use of hip protectors in nursing homes: Cluster randomized controlled trial. British Medical Journal 2003:326, pp. 76-80.

For more information about senior health issues click here.

Better Ways to Fight a Cold?

The herb echinacea, utilized by Native Americans for centuries, is a popular remedy for preventing or reducing the severity of the common cold. Hundreds of studies, primarily conducted in Germany, have provided information on the herb's chemical and pharmacological characteristics, yet few studies have actually proven its ability to reduce cold severity.

To evaluate the effectiveness of dried, whole-plant echinacea capsules for early treatment of the common cold, approximately 150 students in the early stages of a cold were divided to take either a placebo or echinacea. The echinacea group took an encapsulated mixture of unrefined echinacea root and herbs in one-gram doses, six times on the first day of illness and three times per day on subsequent days, for up to 10 days. The placebo group took capsules containing alfalfa, which has no proven ability to boost the immune system, at the same frequency.

No difference was observed between the echinacea and placebo groups for any cold symptoms, including cough, sore throat, runny/stuffy nose or headaches. Average duration of the cold was approximately six days in both groups. Also, cold severity measures were "nearly identical" in those taking echinacea or placebo pills.

Although this is certainly not the last word on echinacea, since some previous research contradicts this study, it shows that otherwise healthy people might not obtain as much benefit from the herb as older adults who have frequent colds or viral illnesses. The best advice is to reduce your chances of getting a cold in the first place: wash your hands frequently with soap and water, and boost your immune system by eating lots of fruits and vegetables and getting plenty of sleep. Your doctor of chiropractic can outline specific steps toward optimal health.

Reference: Barrett BP, Brown RL, et al. Treatment of the common cold with unrefined echinacea: A randomized, double-blind, placebo-controlled trial. Annals of Internal Medicine 2002:137(12), pp. 939-946.

To read more about herbs and their potential health benefits click here.