From: Journal of Human Hypertension (2007), 1–6

It is well known that achievement of blood pressure goals in more than 70% of hypertensive individuals requires two or more antihypertensive agents. Based on the most recent NHANES 1999– 2000 data, blood pressure control in the US has not improved significantly. Moreover, many people have searched for alternative methods for lowering arterial pressure.

Since the early 1940s, a small cadre of chiropractic specialists have foregone typical ‘full-spine manipulations’, limiting their practice to precise, delicate manual alignment of a single vertebra, C-1 or Atlas; these practitioners make up the National Upper- Cervical Chiropractic Association (NUCCA). Unlike other vertebrae, which interlock one to the next, the Atlas relies solely upon soft tissue (muscles and ligaments) to maintain alignment; therefore, the Atlas is uniquely vulnerable to displacement. Displacement of C-1 is pain free and thus, remains undiagnosed and untreated, whereas health-related consequences are attributed to other aetiologies.

Minor misalignment of the Atlas vertebra can potentially injure, impair, compress and/or compromise brainstem neural pathways. The relationship between hypertension and presence of circulatory abnormalities in the area around the Atlas vertebra and posterior fossa of the brain has been known for more than 40 years. Studies by Jannetta et al. note arterial compression of the left lateral medulla oblongata by looping arteries of the base of the brain in 51 of 53 hypertensive patients who underwent left retromastoid craniectomy and microvascular decompression for unrelated cranial nerve dysfunctions. Such compression was not present in normotensive patients. Treatment by vascular decompression of the medulla was performed in 42 of the 53 patients and amelioration of hypertension was noted in 76%.6 Moreover, studies to clarify the mechanism by which decompression of the left rostral ventrolateral medulla relieves neurogenic hypertension are summarized in a review. It is clear from these studies that a sub-population of hypertensive patients improved their blood pressure after microvascular decompression.

Changes in the anatomical position of the Atlas vertebra and resultant changes in the circulation of the vertebral artery lend itself to worsening of hypertension. Recent studies by Akimura et al. using magnetic resonance (MR) imaging examined hypertensive patients and compared them to controls, evaluating the relationships between the upper ventrolateral medulla and vertebral arteries and branches. They noted compression in 90.6% of 32 hypertensive cases, this was in contrast to controls and those with secondary hypertension who failed to demonstrate a significant incidence of compression. Furthermore, two other studies using MR imaging techniques also demonstrated a significant association between compression of the vertebral artery and changes in the posterior fossa of hypertensive but not normotensive individuals. Thus, alterations in Atlas anatomy can generate changes in the vertebral circulation that may be associated with elevated levels of blood pressure.

This pilot study examines the relationship between nonsurgical interventions to align the Atlas vertebra and long-term changes in blood pressure and heart rate. The criteria used in this study to establish efficacy of an antihypertensive effect are those defined by the Food and Drug Administration for approval of a new antihypertensive drug. Specifically, it would require a blinded design with a placebo-subtracted reduction in diastolic blood pressure of 5mm Hg or more and be free of serious side effects to be approvable.

The findings of this pilot study represent the first demonstration of a sustained blood pressure lowering effect associated with a procedure to correct the alignment of the Atlas vertebra. The improvement in blood pressure following the correction of Atlas misalignment is similar to that seen by giving two different antihypertensive agents simultaneously. Moreover, this reduction in blood pressure persisted at 8 weeks and was not associated with pain or pain relief or any other symptom that could be associated with a rise in blood pressure.

Other studies support the notion that changes in the cerebral circulation that is related to the position of the Atlas vertebra can affect blood pressure. Coffee et al. reviewed MR images and demonstrated a significant association between pulsatile arterial compression of the ventrolateral medulla and presence of hypertension. They concluded that subjects with hypertension should have an evaluation of their posterior fossa for evidence of anatomic abnormalities. In fact, data linking changes in Atlas anatomy and posterior fossa circulatory changes associated with hypertension date back more than 40 years and are reviewed by Reis.

The mechanism as to why this improvement in blood pressure occurs is unknown and cannot be determined by this study. What is clear is that a significant change in sympathetic tone is probably not a major contributing mechanism as heart rate was not significantly changed. The data presented, however, raises a number of important questions including: (a) how does misalignment of C1 affect hypertension? (b) If there is a cause and effect relationship between C1 misalignment and hypertension is malposition of C1 an additional risk factor for the development of hypertension?

What is clear is that misalignment of the Atlas vertebra can be determined by assessment of the alignment of the pelvic crests. This should be considered in those who have a history of hypertension and require multiple medications for treatment. Additionally, it should be considered in those with refractory hypertension and a history of neck injuries, independent of the presence of pain. Note that pain was not present in any of the patients randomized in this study.

From: Otolaryngology Head and Neck Surgery 2008 Apr;138(4):479-85

Present experience in diagnosis and treatment for referred otalgia secondary to cervical spine degenerative disease.

A study of 123 patients with ear pain. All patients had a normal otologic examination and diagnosed with unspecified otalgia. The causes for referred otalgia were categorized into Group I: otalgia from non-cervical spine disease (n = 72), and Group II: cervical spine disease-referred otalgia (n = 51). Pain relief following cervical spine physical therapy was assessed.

The most common cause for referred otalgia in Group I was Temporomandibular joint (TMJ) dysfunction (46%); most common cervical spine finding in Group II was cervical spine degenerative disease (88%). Cervical spine physical therapy in those documented patients all reported subjective pain relief.

As the population in America ages, cervical spine degenerative disease in the elderly will begin to emerge as a major etiologic source for referred otalgia. With a targeted medical history and physical examination one can use directed studies to diagnose cervical spine degenerative disease-referred otalgia, and this pain can be alleviated with cervical spine physical therapy.

From: Journal of Athletic Training. 2004 Jul–Sep; 39(3): 278–279

Based on the available evidence, cryotherapy seems to be effective in decreasing pain. In comparison with other rehabilitation techniques, the efficacy of cryotherapy has been questioned. The exact effect of cryotherapy on more frequently treated acute injuries (eg, muscle strains and contusions) has not been fully elucidated. Additionally, the low methodologic quality of the available evidence is of concern. Many more high-quality studies are required to create evidence-based guidelines on the use of cryotherapy. These must focus on developing modes, durations, and frequencies of ice application that will optimize outcomes after injury.

We often recommend ice for neck pain relief, usually for whiplash injuries, however, I find many patients do not tolerate cryotherapy on the neck well, especially in colder climates. It would be interesting to see some actual studies comparing cryotherapy to a more traditional martial arts approach using a properly designed liniment with light massage on recovery from soft tissue injuries.

The effects of ice have been demonstrated in numerous animal models and human studies. Ice reduces tissue temperature, blood flow, pain, and metabolism. However, and possibly more important, is the question, “Does ice application improve the treatment outcomes?” Does treatment facilitate achievement of goals related to functional limitations and sudden transient disability after injury or surgery? Bleakley et al reported that cold seemed to be more effective in limiting swelling and decreasing pain in the short term (immediately after application to 1 week postinjury). However, the long-term effects of cryotherapy and the effect on the tissue repair are not known. Only 1 group examined the effect of cryotherapy at 4 weeks postinjury. Additionally, evidence is limited that cryotherapy hastens return to participation.

Currently, only 4 groups have examined the effect of cryotherapy on return to participation. The 4 groups addressed return to sport or work after ankle sprain and scored 2–4 on the PEDro scale (maximum = 10 points). Cryotherapy was applied immediately after injury. Two of the four reports suggested that cryotherapy speeds return to full activity. However, the results of the outcome measures were not fully documented. A confounding factor of compression as part of the treatment prevents interpretation of the effects of cryotherapy in one of the articles. Therefore, whether cryotherapy facilitates return to participation is still unclear.

Ice does not seem to be more effective than compression after surgery. Only 2 of the 8 groups reported significant differences in favor of ice and compression. However, in all 8 studies, postsurgical dressings or socks were used to separate the injured area of the body and the cooling agent. Such barriers may have mitigated the cooling effect of the cold compress. Further research comparing ice with compression is required in subjects with acute injuries.

Currently, no authors have assessed the efficacy of ice in the treatment of muscle contusions or strains. Considering that most injuries are muscle strains and contusions, this is a large void in the literature. Most cryotherapy studies have focused on postsurgical anterior cruciate ligament repairs and knee and hip replacements. The results of these studies cannot be generalized to muscle strains and contusions.

The Bleakley et al study has several limitations. In the 12 treatment comparisons made by Bleakley et al, only 1 or 2 articles were examined in some instances. It is difficult to generalize results based on only 1 or 2 studies. Additionally, the authors did not separate cryotherapy for acute immediate care from that for rehabilitation. The goals for each may be different and a potential reason for the lack of efficacy of cryotherapy.

Based on this review by Bleakley et al and a similar review by Hubbard et al, the methodologic quality of clinical trials of cryotherapy is poor. Most of the studies were conducted years ago. Additionally, with cryotherapy research, it is not possible to blind subjects to the exposure to cold and thus score 10 on the PEDro scale. However, scores higher then 5 should be achieved. Assessing the quality of the randomized, controlled clinical trials is important because of evidence that low-quality studies provide biased estimates of treatment effectiveness. Despite the general acceptance of cryotherapy as an effective intervention, evidence on which to base these conclusions is limited. Only with strong randomized, controlled clinical trials will we know the true efficacy of cryotherapy.

Specific search criteria identified 55 articles for review, of which 22 were eligible randomized, controlled clinical trials. The articles’ scores on the PEDro scale were low, ranging from 1 to 5, with an average score of 3.4. Five studies provided adequate information on the subjects’ baseline data, and only 3 studies concealed allocation during subject recruitment. No studies blinded their therapist’s administration of therapy, and just 1 study blinded subjects. Only 1 study included an intention-to-treat analysis. The average number of subjects in the studies was 66.7; however, only 1 group undertook a power analysis. The types of injuries varied widely (eg, acute or surgical). No authors investigated subjects with muscle contusions or strains, and only 5 groups studied subjects with acute ligament sprains. The remaining 17 groups examined patients recovering from operative procedures (anterior cruciate ligament repair, knee arthroscopy, lateral retinacular release, total knee and hip arthroplasties, and carpal tunnel release). Additionally, the mode of cryotherapy varied widely, as did the duration and frequency of cryotherapy application. The time period when cryotherapy was applied after injury ranged from immediately after injury to 1 to 3 days postinjury. Adequate information on the actual surface temperature of the cooling device was not provided in the selected studies. Most authors recorded outcome variables over short periods (1 week), with the longest reporting follow-ups of pain, swelling, and range of motion recorded at 4 weeks postinjury. Data in that study were insufficient to calculate effect size. Nine studies did not provide data of the key outcome measures, so individual study effect estimates could not be calculated. A total of 12 treatment comparisons were made. Ice submersion with simultaneous exercises was significantly more effective than heat and contrast therapy plus simultaneous exercises at reducing swelling. Ice was reported to be no different from ice and low-frequency or high-frequency electric stimulation in effect on swelling, pain, and range of motion. Ice alone seemed to be more effective than applying no form of cryotherapy after minor knee surgery in terms of pain, but no differences were reported for range of motion and girth. Continuous cryotherapy was associated with a significantly greater decrease in pain and wrist circumference after surgery than intermittent cryotherapy. Evidence was marginal that a single simultaneous treatment with ice and compression is no more effective than no cryotherapy after an ankle sprain. The authors reported ice to be no more effective than rehabilitation only with regard to pain, swelling, and range of motion. Ice and compression seemed to be significantly more effective than ice alone in terms of decreasing pain. Additionally, ice, compression, and a placebo injection reduced pain more than a placebo injection alone. Lastly, in 8 studies, there seemed to be little difference in the effectiveness of ice and compression compared with compression alone. Only 2 of the 8 groups reported significant differences in favor of ice and compression.

FDA informed healthcare professionals and patients of the Agency’s investigation of the possible association between the use of Singulair and behavior/mood changes, suicidality (suicidal thinking and behavior) and suicide. Singulair is a leukotriene receptor antagonist used to treat asthma and the symptoms of allergic rhinitis, and to prevent exercise-induced asthma. Patients should not stop taking Singulair before talking to their doctor if they have questions about the new information. Healthcare professionals and caregivers should monitor patients taking Singulair for suicidality (suicidal thinking and behavior) and changes in behavior and mood.

This early communication is in keeping with FDA’s commitment to inform the public about its ongoing safety reviews of drugs. Due to the complexity of the analyses, FDA anticipates that it may take up to 9 months to complete the ongoing evaluations. As soon as this review is complete, FDA will communicate the conclusions and recommendations to the public.

From Pain Medicine Published article online: 11-Mar-2008

Objective. Chronic pain is a common reason for seeking medical care. We estimated the prevalence of chronic regional and widespread pain in the United States population overall, and by age, sex, and race/ethnicity.

Setting. We examined the data from 10,291 respondents who participated in the 1999–2002 NHANES (National Health and Nutrition Examination Survey) and completed a pain questionnaire. Items allowed classification of chronic (≥3 months) pain as regional or widespread. We used regression models to test the association of sex and race/ethnicity with each pain outcome, adjusting for age.

Results. Chronic pain prevalence estimates were 10.1% for back pain, 7.1% for pain in the legs/feet, 4.1% for pain in the arms/hands, and 3.5% for headache. Chronic regional and widespread pain were reported by 11.0% and 3.6% of respondents, respectively. Women had higher odds than men for headache, abdominal pain, and chronic widespread pain. Mexican-Americans had lower odds compared with non-Hispanic whites and blacks for chronic back pain, legs/feet pain, arms/hands pain, and regional and widespread pain.

Conclusion. The population prevalence of chronic pain in the United States was lower than previously reported, with smaller sex-related differences and some variation by race/ethnicity.

From: American Academy of Pain Medicine 24th Annual Meeting: Abstract 105.

Introduction: A frequent co-morbid condition of chronic pain is profound physical deconditioning that results from inactivity. Objective assessment of physical conditioning in patients with chronic pain has been impeded by several factors that this study attempted to overcome. Of primary importance is verifying the efficacy of a physical reconditioning program. Further, decreases in pain, depression, and anxiety following treatment in a pain rehabilitation program have been well documented; however, no study has determined the immediate effects of brief exercise on these factors. The purposes of this study are a) to determine the effect of a 3 week aerobic training program on physical conditioning, and b) to assess the acute effects of a brief (10 minute) exercise protocol on pain, mood, and perceived exertion.

Conclusion: This research suggests that relatively modest exercise leads to improved mood and physical capacity, which has further implications for mortality risk. Further, it suggests that brief exercise is a safe, cost-free, nonpharmacologic strategy for immediately reducing depression and anxiety.

Chattem Issues URGENT Voluntary Nationwide Recall of Icy Hot Heat Therapy Products (Feb. 8)

Indoor allergy sufferers will often wheeze, sneeze, cough and hack their way through the winter months, thinking they have a chronic cold. In actuality, they are probably reacting to indoor allergens. Some symptoms between a cold and allergies are similar, such as sneezing and a stuffy or runny nose. But, if your symptoms are also accompanied with a fever, sore throat, colored nasal discharge, and aches and pains, then you probably have a cold. With allergies, there is never a fever, the nasal discharge is clear, and eyes may become red and itchy. Furthermore, while a cold usually lasts about a week, allergies can last all year.

Prevention of common indoor allergens

The key is to focus on sites where allergens accumulate. The term “allergen” refers to any substance that can trigger an allergic response. First, you must know which allergens or irritants in your home provoke your symptoms.

Common allergens and some ways to prevent them include:

Dust mites:

These thrive in house dust, which is composed of plant and animal material. Their droppings are the most common trigger of perennial allergy and asthma symptoms.

• Change and clean cooling and heating system filters once a month.
• Have your home, car and office vacuumed and dusted frequently.
• Wash blankets and bedspreads weekly and sheets and pillowcases more often. Be sure that the water is above 130 degrees.
• Try to regularly wash your curtains and throw rugs.

Molds:

These are microscopic fungi. Their spores float in the air like pollen and are present throughout the year in many states. Molds can be found indoors in attics, basements, bathrooms, refrigerators and other food storage areas, garbage containers, carpets and upholstery.

• Keep bathroom and kitchen surfaces dry, fix leaky plumbing and seal cracks where water can seep in to avoid mold buildup.
• Never put carpeting on concrete or damp floors, and avoid storing clothes, papers or other items in damp areas.
• Reduce humidity in damp areas by using a dehumidifier. Clean dehumidifiers once a week.
• All rooms, especially basements, bathrooms and kitchens, require ventilation and consistent cleaning to deter mold and mildew growth. Use a cleaning solution containing 5% bleach and a small amount of detergent.

Pets:

People are not allergic to their pets’ hair, but to a protein found in the saliva, dander (dead skin flakes) or urine of an animal with fur. These proteins are carried in the air on small, invisible particles and can trigger allergy symptoms.

• If you have a cat or dog, it might help reduce household allergens by washing your pet once a week.
• Do not sleep with your pet. Sleeping with your pet, long or short-haired, greatly increases the amount of contact with unwanted allergens.
• Vacuum and mop your floors regularly to remove excess animal dander.

Cockroaches:

These live in warm, tropical climates, but various species dwell in the offices and homes of humans living in various climates. A protein found in their droppings can trigger allergy and asthma symptoms.

• Frequently remove all household food wastes, including garbage and recyclables. Food should be stored in sealed containers.
• Wash dishes immediately after use in hot, soapy water, and clean under stoves, refrigerators or toasters where loose crumbs can accumulate. Wipe off the stove top and clean other kitchen surfaces and cupboards regularly.
• Consider a professional exterminator to eliminate cockroaches.
• Thoroughly and frequently clean to remove dust and cockroach byproducts.

When should you see an allergist/immunologist?

By conducting a thorough history of your health and performing allergy tests, if needed, an allergist/immunologist can help you determine which indoor allergens provoke your symptoms. Environmental control measures differ for dust mites, animal allergens, cockroaches and molds, but your allergist/immunologist can help you determine ways to reduce your exposure to these allergens. To relieve your symptoms, your allergist/immunologist may also prescribe appropriate medications, such as antihistamines, decongestants or asthma medications and allergy vaccine therapy (immunotherapy). Visit http://www.aaaai.org for more information on indoor allergies.

]]> http://necksolutions.com/pain/general-health/indoor-allergies/feed/ http://necksolutions.com/pain/general-health/olivier-parmesan-and-asiago-garlic-and-basil-dip-warning/ http://necksolutions.com/pain/general-health/olivier-parmesan-and-asiago-garlic-and-basil-dip-warning/#comments Mon, 04 Feb 2008 19:39:25 +0000 Administrator General Health http://necksolutions.com/pain/general-health/olivier-parmesan-and-asiago-garlic-and-basil-dip-warning/ Olivier brand Parmesan and Asiago Dip with Garlic and Basil

Dr. Mark Horton, Director of the California Department of Public Health (CDPH), today warned consumers not to eat Olivier brand Parmesan and Asiago Dip with Garlic and Basil, because of the possibility of contamination with Clostridium botulinum. The product was distributed to William-Sonoma retail stores nationwide and to Olivier Napa Valley retail stores located in Truckee and St. Helena, California.

]]> http://necksolutions.com/pain/general-health/olivier-parmesan-and-asiago-garlic-and-basil-dip-warning/feed/ http://necksolutions.com/pain/general-health/aging-and-physical-activity/ http://necksolutions.com/pain/general-health/aging-and-physical-activity/#comments Sat, 02 Feb 2008 20:49:09 +0000 Administrator General Health http://necksolutions.com/pain/general-health/aging-and-physical-activity/ The Association Between Physical Activity in Leisure Time and Leukocyte Telomere Length

From: Arch Intern Med. 2008;168(2):154-158

Background Physical inactivity is an important risk factor for many aging related diseases. Leukocyte telomere dynamics (telomere length and age-dependent attrition rate) are ostensibly a biological indicator of human aging. We therefore tested the hypothesis that physical activity level in leisure time (over the past 12 months) is associated with leukocyte telomere length (LTL) in normal healthy volunteers.

Methods We studied 2401 white twin volunteers, comprising 2152 women and 249 men, with questionnaires on physical activity level, smoking status, and socioeconomic status. Leukocyte telomere length was derived from the mean terminal restriction fragment length and adjusted for age and other potential confounders.

Results Leukocyte telomere length was positively associated with increasing physical activity level in leisure time; this association remained significant after adjustment for age, sex, body mass index, smoking, socioeconomic status, and physical activity at work. The LTLs of the most active subjects were 200 nucleotides longer than those of the least active subjects. This finding was confirmed in a small group of twin pairs discordant for physical activity level (on average, the LTL of more active twins was 88 nucleotides longer than that of less active twins).

Conclusions A sedentary lifestyle (in addition to smoking, high body mass index, and low socioeconomic status) has an effect on LTL and may accelerate the aging process. This provides a powerful message that could be used by clinicians to promote the potentially antiaging effect of regular exercise.

A sedentary lifestyle increases the propensity to aging related disease and premature death.

Inactivity may diminish life expectancy not only by predisposing to aging-related diseases but also because it may influence the aging process itself.

The U.S. guidelines recommend that 30 minutes of moderate intensity physical activity at least five days a week can have significant health benefits.

Our results underscore the vital importance of these guidelines. They show that adults who partake in regular physical activity are biologically younger than sedentary individuals. This conclusion provides a powerful message that could be used by clinicians to promote the potential anti aging effect of regular exercise.

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