Nykwest Chiropractic

Armonk, NY 914-273-5505

In This Issue:
Can Herinated Discs Reduce in Size or Resorb?
Chiropractic: The First-line Treatment for Disc-Related Low Back Pain
Some Headaches Linked to Upper Cervical Spine
Pacifiers Cause Breastfeeding Problems
Poor Cycling Technique and Low Back Pain
Mass Media and Dangerous Female Self-Image
Regular House Cleaning Can Protect Toddlers from Lead Poisoning
Carbohydrates Can Cause Overeating!
 

Can Herinated Discs Reduce in Size or Resorb?
In the past, it was believed that once a patient acquired a herniated disc, it was permanent. However, recent research with MRI and CT outcome studies has documented that this is fallacy. Herniated discs in the cervical and lumbar spine have been shown to not only reduce in size after a period of conservative care, but in many cases regress and disappear upon reimaging. Numerous medical studies and some chiropractic studies have been performed and published. In recent studies by Mochida et al., both cervical (CDH) and lumbar (LDH) disc herniations were studied in pre- and post-MR imaging conditions. In CDH cases, they demonstrated that in 40% of the time, there was a reduction in size or regression. In LDH cases, they demonstrated about a 60% reduction or regression in the size of the herniation. They also found that the larger the extrusion or sequestration, the better the rate of regression. They concluded that disc regression or resorption depended upon size, location and the phase of the injury. Discs tended to reduce in size early on after onset, and more so in the lateral or sequestered type of herniation than smaller or subligamentous herniations. It is interesting to note that most patients in Mochida's study did well clinically with conservative care regardless of the MRI outcome.

In a different study, Mochida found that there is a large percentage of macrophages in excised herniated disc material, as well as evidence of neovascularization. As such, the reduction in size is most likely due to phagocytic or macrophagic digestion, since the body attacks the disc fragment as a foreign protein, much like any other antigen. Immunohistochemistry studies are being conducted at this time to elucidate the pathophysiology of disc herniation and regression.

In a similar study of LDH outcome by Bozzao et al., 63% of the patients treated nonsurgically with epidurals, medication, etc., demonstrated disc resorption upon repeat imaging. In a prospective study of patients with LDH, Ellenberg et al. documented that patients with CT evidence of herniated discs and EMG evidence of radiculopathy had a 78% rate of disc reduction. Matsubara found in a similar study that medical care involving medication, physiotherapy, traction and epidural steroid injections resulted in disc regression in 60% of the cases. In another prospective study, Bush et al. showed disc regression in 12 of the 13 cases studied. The period of care averaged six months, with a range of 2-12 months for good clinical and anatomical MRI outcome.

In one of the few chiropractic care MRI studies published a prospective case series of 27 patients with either CDH or LDH. Pre- and post-chiropractic care MRIs were obtained. Iy was found that in 63% of the cases, there was either a reduction in size, or the disc herniation resorbed completely. It was also found that 80% of the cases had good clinical outcomes, and 78% of the patients returned to their preinjury occupations. Chiropractic care was shown to be amenable to the clinical management of the disc herniation not only on a clinical level, but on an anatomical level as well. In a study by Cassidy et al. on the effects of side posture manipulation on CT-documented herniated discs, the authors found that 13 of 14 patients had good clinical results. Of those, about half had a decrease in the size of the herniation on repeat CT follow-ups.

References
1. BenEliyahu DJ. MRI and clinical followup study of 27 patients receiving chiropractic care for cervical and lumbar disc herniation. JMPT 1996;19(9):597-606.
2. Bush K. Pathomorphologic changes that accompany the resolution of cervical radiculopathy. Spine 1997;22(2):183-187.
3. Matsubara Y. Serial changes on MRI in lumbar disc herniations. Neuroradiology 1995;37:378-383.
4. Komori H. Natural history of herniated nucleus pulposus with radiculopathy. Spine 1996;21(2):225-229.
5. Saal J. Nonoperative management of cervical herniated disc with radiculopathy. Spine 1996;21(16):1877-83.
6. Mochida K. Regression of cervical disc herniation observed on MRI. Spine 1998;23(9):990-997.
7. Ellenberg MR. Prospective evaluation of the course of disc herniations in patients with radiculopathy. Arch Phys Med Rehab 74; Jan 1993, p. 3.
8. Bozzao A. Lumbar disc herniation: MR imaging assessment of natural history in patients treated without surgery. Radiology 1992;185:135-141.
9. Maigne JY. CT followup study of 21 cases of nonoperatively treated cervical soft disc herniation. Spine 1994;19(2):189-191.

Chiropractic: The First-line Treatment for Disc-Related Low Back Pain
With low back pain being the burden that it is to both patients and the health care system, patients and health care practitioners regularly must decide if surgery or more conservative management is the best option.

This review of the literature distills and synthesizes previously published research. The article lists various causes of low back pain, noting what findings in patient histories, physical examinations, and diagnostic imaging represent "red flags" that indicate the need for referral to a specialist for surgical intervention.

After patients are screened for red flags, conservative treatment should be the first line of treatment for patients without absolute signs for surgical intervention. The authors concluded: Of the available conservative treatments, chiropractic management has been shown through multiple studies to be safe, clinically effective, cost-effective, and to provide a high degree of patient satisfaction. As a result, in patients . . . for whom the surgical indications are not absolute, a minimum of 2 or 3 months of chiropractic management is indicated.
Troyanovich SJ, Harrison DD, Harrison DE. Low back pain and the lumbar intervertebral disk:
Clinical consideration for the doctor of chiropractic. Journal of Manipulative and Physiological Therapeutics, Feb. 1999; vol. 22, no. 2, pp96-104.

Some Headaches Linked to Upper Cervical Spine
There is a common structural variation of the atlas vertebra at the top of the spine. It is called ponticulus posticus (also known as foramen arcuale or "Kimmerle's anomaly"). Investigators studied the relationship between this condition and headache symptoms in 895 first-time chiropractic patients. The patients" complaints included migraine with aura (classical migraine), migraine without aura (common migraine), cervicogenic headache, neck pain only, and other problems. They were examined for the presence or absence of partial or complete ponticulus posticus.

The authors found a significant correlation of ponticulus posticus with migraine without aura. They explain that because the ponticulus posticus is intimately attached to the atlanto-occipital membrane (where the spine and skull meet) and this membrane, in turn, is attached to the dura (the outermost covering of the brain and spinal cord), small tensions exerted on the dura may result in excruciating head pain of a type experienced in migraine. The beneficial results of chiropractic treatment for migraine and cervicogenic headache are probably related to the nature of the structures connecting the upper spine to the skull.
Wight S, Osborne N, Breen AC. Incidence of ponticulus posterior of the atlas in migraine and cervicogenic headache. Journal of Manipulative and Physiological Therapeutics, Jan. 1999; vol. 22, no. 1, pp15-20.

Pacifiers Cause Breastfeeding Problems
Because many of the infant health benefits attributable to breastfeeding depend on the duration of full breastfeeding, this study sought to determine if infrequent and shortened-duration breastfeeding is associated with pacifier use.

The subjects were breastfeeding mothers and their infants. Results showed that 68% of the mothers began using pacifiers before 6 weeks. Pacifier introduction this early significantly increased the chances for a shortened duration of full breastfeeding. Mothers who introduced pacifiers tended to breastfeed less frequently and they experienced breastfeeding problems consistent with infrequent infant feeding.
Howard CR, Howard FM, Lanphear EAD, et al breastfeeding. The effects of early pacifier use on breastfeeding duration. Pediatrics, Mar. 1999; vol. 103, no. 3, p. e33.

Poor Cycling Technique and Low Back Pain
This study was inspired by a 24-year-old male chiropractic patient's report that he was experiencing numbness and tickling in a small region of his upper right buttock. His chiropractor noted that the condition had developed in the few days since the man's most recent bimonthly adjustment. A physical exam and close scrutiny of the patient's history revealed that the complaint was probably gluteus medius syndrome (GMS) resulting from the man's activities as an amateur cyclist.

The subject's chiropractor learned that the ailing cyclist had just begun riding a new bicycle. Because the new bike had different gearing than his previous bicycle, by continuing to use his customary riding technique, the patient was fatiguing and straining himself, as he hadn't done before getting the new bike. The patient's cycling technique was modified to accommodate the changed gearing of the new machine. After only 2 days, the GMS symptoms resolved and did not return-results attributable to altering a cycling technique that was damaging him and interfering with his favorite pastime.
Green B, Johnson C, Maloney A. Effects of Altering Cycling Technique on Gluteus Medius Syndrome. Journal of Manipulative and Physiological Therapeutics, Feb. 1999; vol. 22, no. 2, pp108-13.

 

Mass Media and Dangerous Female Self-Image
The subjects of this study were 548 fifth- through twelfth-grade girls in a working-class suburb in the northeastern United States. The objective was to assess the influence of the media on girls' weight concerns, weight control/loss behaviors, and perceptions of body weight and shape.

The study found that "the majority of preadolescent and adolescent girls . . . were unhappy with their body weight and shape. This discontent was related strongly to the frequency of reading fashion magazines, which was reported to influence their idea of the perfect body shape by 69% of the girls." It also obtained data showing that frequent readers of fashion magazines were significantly more likely to diet and exercise to lose weight and to get their image of ideal body shape from the pictures of grossly underweight models.

There is a substantial health risk associated with being overweight, and in the past 2 decades the prevalence has increased sharply among children and adolescents. The authors concluded: "It is not prudent to suggest that overweight girls should accept their body shape and not be encouraged to lose weight. However, aspiring to look like underweight models may have deleterious psychological consequences."
Field AE, Cheung L, Wolf AM, et al. Exposure to the mass media and weight concerns among girls. Pediatrics, Mar. 1999; vol. 103, no. 3, p. e36.

 

Regular House Cleaning Can Protect Toddlers from Lead Poisoning
Household dust may be a major source of exposure for children with elevated blood lead levels. This randomized trial was designed to test the hypothesis that regular vigorous household cleaning could reduce exposure to lead and blood lead levels. All mothers in the study were educated on the importance of adequate housecleaning and biweekly assistance with household cleaning. Two trained lay workers did the cleaning, focusing on wet mopping floors, damp-sponging walls and horizontal surfaces, and vacuuming with a high-efficiency particle-accumulating vacuum. Household dust lead levels, blood lead levels of the children, and maternal knowledge of lead poisoning were measured before and after the study.

Results after a year of follow-up: "Blood lead fell 17% in the intervention group and did not change among controls. Household dust and dust lead measures also fell significantly in the intervention group. Children in homes cleaned 20 or more times throughout the year had an average blood lead reduction of 34%."

Conclusion: The utility of regular home cleaning, accompanied by maternal education, is "a safe and partially effective intervention that should be recommended for the large majority of lead-exposed children for whom, unfortunately, removal to lead-safe housing is not an option."
Rhoads GC, Ettinger AS, Weisel CP, et al. The effect of dust lead control on blood lead in toddlers: A randomized trial. Pediatrics, Mar. 1999; vol. 103, no. 3, pp551-55.

Carbohydrates Can Cause Overeating!
Carbohydrate-containing foods that are rapidly digested and absorbed or transformed into glucose have a high glycemic index (GI). Starchy foods such as refined grain products and potatoes have a GI that is higher than table sugar by some 50%. Vegetables, legumes, and fruits tend to have a low GI.

The objective of this study was to test the hypothesis that consumption of high dietary GI foods induces a sequence of hormonal changes that lead to decreased availability of metabolic fuels, excessive hunger, and overeating in obese individuals.

The subjects of this study were 12 boys (mean age 15.7) who were more than 120% of ideal body weight. They were given identical test meals at breakfast and lunch that had a low, medium, or high GI. The results showed that energy intake after a high-GI meal was 53% greater than after a medium-GI meal and 81% greater than after a low-GI meal. Insulin levels were also elevated.

The investigators concluded: "Rapid absorption of glucose after consumption of high-GI meals induces a sequence of hormonal and metabolic changes that promote excessive food intake in obese subjects." Excessive fat consumption should not remain the prime focus of what causes and maintains obesity. Eating food with a high-GI should be considered a factor in obesity and the risk of diabetes.
Ludwig DS, Majzoub JA, Al-Zahrani A, et al. High glycemic index foods, overeating, and obesity. Pediatrics, Mar. 1999; vol. 103, no. 3, p. e26.