The Power of Positive Feedback and Motivation

Previously published studies have shown that regular exercise can help people who suffer from chronic low back pain (LBP). Unfortunately, however, many LBP sufferers do not follow through and complete their recommended exercise program. Part of the reason, some scientists believe, is that these people do not receive enough motivation from their doctor to complete the program.

In this study, researchers looked at the effect motivation and positive feedback could have on people with chronic low back pain. Ninety-three patients were randomized into two groups and followed at different intervals for 5 years. The first group participated in a series of 10 25-minute training sessions an average of 2.3 times per week, with gradual increases in exercise over time. The second group engaged in the same series of exercises, but also received other interventions, such as counseling, problem-solving strategies, positive feedback from practitioners, and the signing a "contract" in which the patient agreed to stay on the exercise program.

While patients in both groups showed significant improvements in disability scores, "the cumulative effect in the motivational group across all points of assessment was more than twice that in the control group." In addition, only patients who received motivation and positive feedback showed a significant increase in the ability to return to their original level of work activity. The authors concluded that "the combined exercise and motivation program was superior to the standard exercise program" for patients with chronic low back pain.

Exercise is an important tool that can be used to treat low back pain, but it is by no means the only one. Receiving encouragement and support from others, along with a balanced diet, are just as important. Using these therapies together will help relieve your back pain - and make you a happier, healthier person.

Friedrich M, Gittler G, Arendasy M, Friedrich KM. Long-term effect of a combined exercise and motivational program on the level of disability of patients with chronic low back pain. Spine, 2005;30(9):995-1000.

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Want to Lose Weight? Try Catching Some Zzzzs

Are you struggling to shed some pounds or working hard to maintain your current weight? The answer may be as easy as making some slight adjustments to your sleep patterns. A recent study showed that sleep deprivation may be linked to the hormones responsible for controlling hunger.
Researchers studied 12 healthy men for two consecutive nights in which sleep was limited to four hours and two consecutive nights in which participants were allowed to sleep for 10 hours. Volunteers reported feeling hungrier after sleeping for only four hours compared to sleeping for 10 hours.

Researchers believe the connection is related to leptin and ghrelin, two hormones responsible for regulating appetite. Leptin signals the brain that the body is full, while ghrelin triggers feelings of hunger. Following the four-hour nights, participants showed an 18 percent decrease in leptin and a 28 percent increase in ghrelin. Although the authors acknowledge study limitations, namely the sample size, they do note that "Additional studies should examine the possible role of chronic sleep curtailment as a previously unrecognized risk factor for obesity."

Clearly, a good night's sleep is important whether you're trying to lose weight or simply want to take better care of yourself. Experts suggest no fewer than seven hours a night.

Reference: Spiegel K, Tasali E, Penev P, Van Cauter E. Sleep duration and levels of hormones that influence hunger. Annals of Internal Medicine 2004; 141:846-50.


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Bed Rest: Still Unadvisable for LBP

Considerable evidence in the past decade shows that bed rest has not been beneficial to patients suffering from low back pain (LBP). A recent review by the Cochrane Collaboration Back Review Group analyzed all randomized studies up to March 2003, yielding two new trials comparing advice to rest in bed with advice to stay active for patients with LBP. In total, six trials compared bed rest with staying active for the management of LBP.

Results found that advice to rest in bed was clearly less effective than advice to stay active for patients with acute simple LBP. High-quality evidence shows small but consistent differences in favor of staying active for pain and functional status at 3-4 weeks and 12 weeks follow-up, respectively. Additionally, in patients with acute simple LBP, evidence shows that bed rest will increase length of sick leave in the first 12 weeks, compared to advice to stay active. For patients with sciatica, evidence shows that bed rest has little or no effect on pain and functional status, compared to staying active at 3-4 weeks and 12 weeks.

All in all, it appears that LBP sufferers should not count on bedrest to help decrease their recovery time or stave off pain. If you suffer from LBP, talk to your Doctor of Chiropractic about an appropriate treatment plan to include staying active.

Reference: Hagen KB, Jamtvedt G, Hilde G, Winnem MF. The updated Cochrane Review of bed rest for low back pain and sciatica. Spine, March 1, 2005;30(5):542-46.

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Caffeine Increases Risk for Chronic Daily Headache

Before your reach for your next "cup-o'-jo," consider the consequences of excessive caffeine consumption. Caffeine has been shown to cause withdrawal headache, which may contribute to the development of chronic daily headache (CDH), or headache occurring at least 15 days per month.

To confirm such a hypothesis, researchers recruited population-cases and control subjects from three U.S. metropolitan areas as part of a study designed to address caffeine's potential involvement in CDH. Control subjects reported two to 104 headache days annually (average: 30 days), while population-cases reported 180 or more headache days per year (average: 260 days). Current and past caffeine consumption was assessed by way of self-report.

Results: High caffeine exposure, defined as being in the upper quartile of dietary consumption or using a caffeine-containing over-the-counter medication as a headache treatment, was associated with onset of CDH. Approximately one-fourth of case subjects reported taking pain medication of any type daily for headache in the previous three months.

According to the authors, "High medicinal or dietary caffeine consumption at the time of CDH onset (e.g., pre-CDH consumption) was a modest risk factor for CDH onset. Secondary analyses revealed that pre-CDH caffeine consumption might be an initiating factor in a subset of CDH sufferers, with the high-risk groups being women and those younger than age 40."

Still need a "pick-me-up" in the morning, but want to wean off caffeine? Try drinking green tea instead, which contains substantially less caffeine than coffee and has been shown to have a host of health benefits, including antioxidant and anti-cancer properties.

Reference: Scher AI, Stewart WF, Lipton RB. Caffeine as a risk factor for chronic daily headache. A population-based study. Neurology, Dec. 14, 2004;63(11):2022-27

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The Graston Technique:
A New Way to Decrease Pain and Improve Function

We have recently added a new technique called the Graston Technique to the health care services we offer our patients. This remarkable procedure allows us to detect and treat areas of "scar tissue" or adhesions in muscles, tendons and ligaments that can lead to pain and dysfunction.

In the healing process our body attempts to repair muscles, tendons and ligaments with "scar tissue", much like the scar that forms on the skin when you have scraped or banged your knee. As you can imagine, that scar tissue is not as strong and flexible as normal, healthy, undamaged tissue. Over time we can have a build up of this fibrous scar tissue, particularly in the muscles, tendons and ligaments that get a lot of use. This can lead to pain and dysfunction because this replacement tissue lacks the strength and flexibility of healthy tissue (in some areas it may even mat down and entrap a nerve).

The Graston Technique allows us to better detect and treat these areas because it uses a stainless steel instrument that glides along a patient's muscle, tendons or ligaments and acts like a "scar tissue" stethoscope. When knots or bands of scar tissue are encountered, both the doctor and the patient sense a restriction or a granular feeling. The instrument can then be used to "break up" this restriction or adhesion. Stretching exercises are then used to promote realignment of the fibers so that they behave more like normal, healthy tissue.

The benefit of the Graston Technique is not only in detection of restrictions or adhesions, but also in the amount of improvement that takes place in a short amount of time. Unfortunately, the unaided hand is hard pressed to detect and break up as much scar tissue as the stainless steel instruments can.

When the Graston Technique is coupled with the necessary strengthening and stretching exercises, it provides a great aid to the chiropractic adjustment and the patient gets better much quicker and more completely.

The Graston Technique is not appropriate for every patient condition. It is, however, very helpful for people with the most common conditions we treat in this office. If you have not experienced the Graston Technique and you still have lingering discomfort or stiffness, please ask us whether you may be helped by this effective new treatment. If you would like more information on the Graston technique visit the website at www.grastontechnique.com.

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Grapefruit: More Than Just a Tangy Treat?

Grapefruit is a good source of vitamin C, potassium, and dietary fiber, and it's a good way to get your recommended five daily servings of fruit and vegetables. Recently, researchers added diabetes protection to the potential list of benefits associated with regular grapefruit consumption.

Researchers surveyed 100 overweight volunteers who were on varying diets: One group ate half a grapefruit three times a day; another group drank a glass of grapefruit juice prior to every meal; while group did not consume any grapefruit. After 12 weeks, grapefruit eaters had shed an average of 3.6 pounds - with some losing as much as 10 pounds. Juice drinkers lost an average of 3.3 pounds, and those without grapefruit in the diet lost only 0.5 pounds apiece.

Researchers attributed the grapefruit-mediated weight loss to the burning of sugar, facilitated by insulin and indicated by lowered glucose levels, which could be good news to the estimated 18.2 million people in the US that have diabetes. Moreover, this study paves the way for further research on a larger scale, researchers said.

Get a jump-start on the next round of results by consuming grapefruit (and a regular supply of fruits and vegetables) to maintain health, and if for nothing else - the taste.

References: A full copy of the article is available from the SCI press office. Email: press@soci.org.

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Low Back Pain: Not Just for Adults Anymore

Although back pain is usually thought of as an "adult" problem (research shows that up to 80 percent of all adults worldwide will suffer low back pain at least once in their lifetime) new evidence suggests that back pain is becoming an increasing problem for children and teenagers, and that a variety of factors can lead to this condition.

Researchers questioned more than 10,000 Israeli schoolchildren in 1st through 6th grade regarding their average weight, average weight of backpacks, if there were on-campus facilities to store backpacks, the height of chairs and desks in relation to student height, seating arrangements, and physical activity during recess.

Results: Between 30 percent and 54 percent of the students carried bags containing 15 percent or more of their body weight; almost 15 percent of the 1st graders and 20 percent of 6th graders sat in chairs of "inappropriate" height; in 74 percent of the classes, students sat with their sides facing the instructor and in another 35 percent, students sat with their backs to the teacher; 30 percent of the schools did not have storage facilities for backpacks; in 48 percent of the schools, there was no organized play activity during recess and in another 6 percent there was no provision for any type of physical activity during recess.

Parents, your children may be at risk of developing low back pain. Fortunately, you can take several steps to maintain your child's health: Monitor your child's backpack for weight; talk to the school about repositioning desks and physical activity; and of course, have your child examined regularly by a doctor of chiropractic - it could prevent years of unwanted back pain.

Reference: Limon S, Valinsky LJ, Ben-Shalom Y. Children at risk. Risk factors for low back pain in the elementary school environment. Spine, March 15, 2004;29(6):697-702.

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Maintaining Musculoskeletal Health With Vitamin D

Stunt doubles in the motion picture industry make a living out of falling off buildings, out of windows -- you name it. For the elderly, however, a fall isn't something you see in the movies; it's a serious matter with serious consequences.

Previous research indicates that up to one-third of all people age 65 and older - and up to half of those over age 80 - suffer injuries from falls.

Researchers examined the role vitamin D plays in reducing the risk of falls in the elderly. The analysis reviewed five studies involving more than 1,200 patients in which patients took a certain amount of vitamin D per day, usually with calcium.

After adjusting for study differences, researchers concluded that vitamin D intake reduced the odds of falling by 22 percent, compared with patients who received either calcium or placebo. Patients who took higher doses of vitamin D (700 to 800 international units daily) seemed to fare better than patients receiving 400 IU per day. In at least one study, vitamin D appeared to reduce the risk of falls.

Talk to your doctor of chiropractic about other forms of nutritional and structural support for your bones and muscles, and how to maintain a healthy musculoskeletal system.

Reference: Bischoff-Ferrari H, Dawson-Hughes B, Willett W, et al. Effect of vitamin D on falls. A meta-analysis. Journal of the American Medical Association, April 28, 2004;291:1999-2006.

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Eating Vegetable Protein May Spare Gallbladder

NEW YORK (Reuters Health) - Women who get a lot of their dietary protein from vegetables are at reduced risk for having their gallbladder removed, which is usually performed for gallstones and related problems, new research suggests.

"In animals, vegetable protein can inhibit gallstone formation," Dr. Chung-Jyi Tsai, from the Harvard School of Public Health in Boston, and colleagues note.

However, few studies have looked at this association in humans.

As reported in the American Journal of Epidemiology, the researchers studied data from some 121,000 women participating in the Nurses' Health Study. Over 20 years of follow-up, 7831 women underwent gallbladder removal, also called cholecystectomy.

Total protein intake and animal protein intake had no effect on the risk of cholecystectomy. For vegetable protein, however, the risk of cholecystectomy dropped as intake increased.

"These results suggest that increased consumption of vegetable protein in the context of an energy-balanced diet can reduce the risk of cholecystectomy in women," the authors conclude.

SOURCE: American Journal of Epidemiology, July 15, 2004.

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