Whiplash

The term "whiplash" was first used in 1928 to define an injury mechanism of sudden hyperextension followed by an immediate hyperflexion of the neck that results in damage to the muscles, ligaments and tendons – especially those that support the head. Today, we know that whiplash injuries frequently do not result from hyperextension or hyperflexion (extension and flexion beyond normal physiological limits), but rather an extremely rapid extension and flexion that causes injuries.


Due to their complicated nature and profound impact on peoples lives, few topics in health care generate as much controversy as whiplash injuries. Unlike a broken bone where a simple x-ray can validate the presence of the fracture and standards of care can direct a health care professional as to the best way in which to handle the injury, whiplash injuries involve an unpredictable combination of nervous system, muscles joints and connective tissue disruption that is not simple to diagnose and can be even more of a challenge to treat. In order to help you understand the nature of whiplash injuries and how they should be treated, it is necessary to spend a bit of time discussing the mechanics of how whiplash injuries occur.

The Four Phases of a Whiplash Injury

During a rear-end automobile collision, your body goes through an extremely rapid and intense acceleration and deceleration. In fact, all four phases of a whiplash injury occur in less than one-half of a second! At each phase, there is a different force acting on the body that contributes to the overall injury, and with such a sudden and forceful movement, damage to the vertebrae, nerves, discs, muscles, and ligaments of your neck and spine can be substantial.

Phase 1

During this first phase, your car begins to be pushed out from under you, causing your mid-back to be flattened against the back of your seat. This results in an upward force in your cervical spine, compressing your discs and joints. As your seat back begins to accelerate your torso forward, your head moves backward, creating a shearing force in your neck. If your head restraint is properly adjusted, the distance your head travels backward is limited. However, most of the damage to the spine will occur before your head reaches your head restraint. Studies have shown that head restraints only reduce the risk of injury by 11-20%.

Phase 2

During phase two, your torso has reached peak acceleration - 1.5 to 2 times that of your vehicle itself - but your head has not yet begun to accelerate forward and continues to move rearward. An abnormal S-curve develops in your cervical spine as your seat back recoils forward, much like a springboard, adding to the forward acceleration of the torso. Unfortunately, this forward seat back recoil occurs while your head is still moving backward, resulting in a shearing force in the neck that is one of the more damaging aspects of a whiplash injury. Many of the bone, joint, nerve, disc and TMJ injuries that I see clinically occur during this phase.

Phase 3

During the third phase, your torso is now descending back down in your seat and your head and neck are at their peak forward acceleration. At the same time, your car is slowing down. If you released the pressure on your brake pedal during the first phases of the collision, it will likely be reapplied during this phase. Reapplication of the brake causes your car to slow down even quicker and increases the severity of the flexion injury of your neck. As you move forward in your seat, any slack in your seat belt and shoulder harness is taken up.

Phase 4

This is probably the most damaging phase of the whiplash phenomenon. In this fourth phase, your torso is stopped by your seat belt and shoulder restraint and your head is free to move forward unimpeded. This results in a violent forward-bending motion of your neck, straining the muscles and ligaments, tearing fibers in the spinal discs, and forcing vertebrae out of their normal position. Your spinal cord and nerve roots get stretched and irritated, and your brain can strike the inside of your skull causing a mild to moderate brain injury. If you are not properly restrained by your seat harness, you may suffer a concussion, or more severe brain injury, from striking the steering wheel or windshield.

Injuries Resulting from Whiplash Trauma

As we discussed briefly in the introduction, whiplash injuries can manifest in a wide variety of ways, including neck pain, headaches, fatigue, upper back and shoulder pain, cognitive changes and low back pain. Due to the fact that numerous factors play into the overall whiplash trauma, such as direction of impact, speed of the vehicles involved, as well as sex, age and physical condition, it is impossible to predict the pattern of symptoms that each individual will suffer. Additionally, whiplash symptoms commonly have a delayed onset, often taking weeks or months to present. There are, however, a number of conditions that are very common among those who have suffered from whiplash trauma.

Neck pain
It is the single most common complaint in whiplash trauma, being reported by over 90% of patients. Often this pain radiates across the shoulders, up into the head, and down between the shoulder blades. Whiplash injuries tend to affect all of the tissues in the neck, including the facet joints and discs between the vertebrae, as well as all of the muscles, ligaments and nerves.

Facet joint pain is the most common cause of neck pain following a car accident. Facet joint pain is usually felt on the back of the neck, just to the right or left of center, and is usually tender to the touch. Facet joint pain cannot be visualized on x-rays or MRIs. It can only be diagnosed by physical palpation of the area.

Disc injury is also a common cause of neck pain; especially chronic pain. The outer wall of the disc (called the anulus) is made up of bundles of fibers that can be torn during a whiplash trauma. These tears, then, can lead to disc degeneration or herniation, resulting in irritation or compression of the nerves running through the area. This compression or irritation commonly leads to radiating pain into the arms, shoulders and upper back, and may result in muscle weakness.

Damage to the muscles and ligaments in the neck and upper back are the major cause of the pain experienced in the first few weeks following a whiplash injury, and is the main reason why you experience stiffness and restricted range of motion. But as the muscles have a chance to heal, they typically don’t cause as much actual pain as they contribute to abnormal movement. Damage to the ligaments often results in abnormal movement and instability.

Headaches
After neck pain, headaches are the most prevalent complaint among those suffering from whiplash injury, affecting more than 80% of all people. While some headaches are actually the result of direct brain injury, most are related to injury of the muscles, ligaments and facet joints of the cervical spine, which refer pain to the head. Because of this, it is important to treat the supporting structures of your neck in order to help alleviate your headaches.

TMJ problems
A less common, but very debilitating disorder that results from whiplash is temporomandibular joint dysfunction (TMJ). TMJ usually begins as pain, clicking and popping noises in the jaw during movement. If not properly evaluated and treated, TMJ problems can continue to worsen and lead to headaches, facial pain, ear pain and difficulty eating. Many chiropractors are specially trained to treat TMJ problems, or can refer you to a TMJ specialist.

Brain injury
Believe it or not, mild to moderate brain injury is common following a whiplash injury, due to the forces on the brain during the four phases mentioned earlier. The human brain is a very soft structure, suspended in a watery fluid called cerebrospinal fluid. When the brain is forced forward and backward in the skull, the brain bounces off the inside of the skull, leading to bruising or bleeding in the brain itself. In some cases, patients temporarily lose consciousness and have symptoms of a mild concussion. More often, there is no loss of consciousness, but patients complain of mild confusion or disorientation just after the crash. The long-term consequences of a mild brain injury can include mild confusion, difficulty concentrating, sleep disturbances, irritability, forgetfulness, loss of sex drive, depression and emotional instability. Although less common, the nerves responsible for your sense of smell, taste and even your vision may be affected as well, resulting in a muted sense of taste, changes in your sensation of smell and visual disturbances.

Dizziness
Dizziness following a whiplash injury usually results from injury to the facet joints of the cervical spine, although in some cases injury to the brain or brain stem may be a factor as well. Typically, this dizziness is very temporary improves significantly with chiropractic treatment.

Low back pain
Although most people consider whiplash to be an injury of the neck, the low back is also commonly injured as well. In fact, low back pain is found in more than half of rear impact-collisions in which injury was reported, and almost three-quarters of all side-impact crashes. This is mostly due to the fact that the low back still experiences a tremendous compression during the first two phases of a whiplash injury, even though it does not have the degree of flexion-extension injury experienced in the neck.

Recovery from Whiplash
With proper care, many mild whiplash injuries heal within six to nine months. However, more than 20% of those who suffer from whiplash injuries continue to suffer from pain, weakness or restricted movement two years after their accident. Unfortunately, the vast majority of these people will continue to suffer from some level of disability or pain for many years after that, if not for the rest of their lives.

Whiplash is a unique condition that requires the expertise of a skilled health professional specially trained to work with these types of injuries. The most effective treatment for whiplash injuries is a combination of chiropractic care, rehabilitation of the soft tissues and taking care of yourself at home.

Chiropractic Care
Chiropractic care utilizes manual manipulation of the spine to restore the normal movement and position of the spinal vertebrae. It is by far the single-most effective treatment for minimizing the long-term impact of whiplash injuries, especially when coupled with massage therapy, trigger point therapy, exercise rehabilitation and other soft tissue rehabilitation modalities.

Soft Tissue Rehabilitation
The term ‘soft tissue’ simply refers to anything that is not bone, such as your muscles, ligaments, tendons, nervous system, spinal discs and internal organs. During a whiplash injury, the tissues that are affected most are the soft tissues, the muscles, ligaments and discs in particular. In order to minimize permanent impairment and disability, it is important to use therapies that stimulate the soft tissues to heal correctly. These include massage therapy, electro-stimulation, trigger point therapy, stretching and specific strength and range of motion exercises.

Home Care
The most effective chiropractic care and soft tissue rehabilitation will be limited in its benefit if what you do at home or at work stresses or re-injures you on a daily basis. For this reason, it is important that your plan of care extend into the hours and days between your clinic visits to help speed your recovery. Some of the more common home care therapies are the application of ice packs, limitations on work or daily activities, specific stretches and exercises, taking nutritional supplements and getting plenty of rest.

Medical Intervention
In some severe cases of whiplash, it may be necessary to have some medical care as part of your overall treatment plan. The most common medical treatments include the use of anti-inflammatory medications, muscle relaxants, trigger point injections and, in some cases, epidural spinal injections. These therapies should be used for short-term relief of pain, if necessary, and not be the focus of treatment. After all, a drug cannot restore normal joint movement and stimulate healthy muscle repair. Fortunately, surgery is only needed in some cases of herniated discs, when the disc is pressing on the spinal cord, and in some cases of spine fractures.

Dr Wade is certified in Spinal Trauma and in Sport Injury and Rehabilitation. He actively treats hundreds of people with auto accidents every year since 1984.  For more information go to http://www.wadechiropractic.com/. You can ask Dr Wade a question by email drwade@wadechiropractic.com, or call the office at 256-237-9423.

Is surgery overdone?

A silent scandal simmers untended in American medicine. Every year surgeons perform thousands upon thousands of questionable or unnecessary procedures on unwitting patients. The complications can be deadly, and the costs potentially add up to billions of dollars. In some cases the surgery itself is of doubtful value. In others the operation works just fine, but drugs or other nonsurgical remedies may be safer or cheaper.

This epidemic of uncertain care is an unintended outgrowth of a decades-long boom in elective surgery. Despite managed care's unceasing attempts to restrain the costs of health care, aging baby boomers are rushing to repair their creaky joints, valves and tendons in record numbers. Nationally, 72 million operations are performed a year, with most of the growth in the mushrooming ambulatory care market. The most popular orthopedic procedures, including back, knee and rotator-cuff surgery, are growing at 10% a year or more.

Researchers have barely begun trying to assess what portion of all this care is wasted. At issue are some of the most commonly performed operations in the nation, including arthroscopic surgery to clean up arthritic cartilage in the knee; a much-debated procedure to ease lower-back pain by fusing vertebrae in the spine; carotid endarterectomy to prevent stroke; and hysterectomy, the removal of the uterus. Little if any definitive data exist on how often unnecessary surgery occurs, but some evidence suggests the problem is bigger than surgeons like to admit. Studies conducted in the early 1990s by Rand Corp. found that 10% to 30% of many common operations were inappropriate or questionable. If these rates hold true across the board, it would mean 7 million to 20 million questionable operations each year, possibly wasting tens of billions that might be put to better use.

Adding to the doubts; your chances of undergoing a particular operation can vary vastly from one zip code to another, fluctuating by as much as tenfold. This owes to more than just income levels and age distributions--it also can be shaped by how many specialists operate in your hometown. It may well be that "we are making a lot of scars that aren't necessary," says Dartmouth University orthopedic surgeon James Weinstein.

The cumulative risks are enormous. Spinal fusion surgery has a 17% complication rate, including infections and, in rare cases, nerve damage. Hysterectomy takes women out of commission for weeks, and up to 9% of the women who get one, or 60,000 patients, encounter complications. Carotid endarterectomy has a 2% mortality rate. "My belief is that if you are talking about patient safety, this is the number one problem in medicine," says Dr. Robert Brook, a UCLA professor and director of health sciences for Rand. "It wastes money and kills people." More disturbing, some observers attribute part of the problem to greed. Unneeded surgery "is an enormous scandal, white-coat crime as far as I am concerned, and it is just being ignored," says Charles Inlander of the consumer group People's Medical Society.

Patients assume doctors base their decision to operate on hard data, but some surgeons still operate based on conviction rather than solid evidence. "They believe they can look at an MRI and, like Carnac from Johnny Carson, say, ‘This is the disc that is causing pain and I will fuse it,'" says University of Pennsylvania physiatrist Curtis Slipman, who treats pain without surgery. New drugs are subjected to rigorous trials comparing them with existing treatments or placebos before they are allowed on the market. But surgery sometimes goes mainstream without ever being evaluated in a randomized, controlled trial. One problem is that surgery can have an enormous placebo effect, masking a reality of meager benefits in exchange for the risk and cost it entails. "There is the potential that the majority of surgery we do for symptom relief is only effective because of the placebo effect--with significant potential of harming the patient," says Dr. Nelda Wray, research chief at the U.S. Department of Veterans Affairs.

But surgeons have largely escaped scrutiny. They believe in what they do and reign as the main arbiters of whether an operation should be performed--and insurers pay per procedure. Their complicit partners: hospitals, insurers and patients themselves. Hospitals reap ancillary charges related to a procedure. Insurers are reluctant to second-guess. Patients are eager for a quick fix; some refuse to take no for an answer.

Now some researchers, abetted by federal officials tired of paying the bill for questionable procedures, are pushing for more rigorous tests of new operations. The Veterans Administration, one of the biggest health care providers in the nation, is targeting up to six common surgeries for clinical trials, likely including back surgery and non-urgent gall bladder surgery. Dartmouth's James Weinstein is leading a 2,500-person, $14 million study comparing surgery with non-surgical treatment for back pain.

The push already is yielding results. A study last year found that one of the most common operations for arthritis of the knee, performed for decades, was actually no better than a placebo. A 1,218-person study this spring found that lung-volume-reduction surgery for emphysema, touted as a breakthrough in the early 1990s, failed to significantly boost exercise capacity for 84% of the patients who received the procedure, while some high-risk patients died sooner. While all of the following procedures are beneficial for some patients, controversy surrounds how often they should be done and on whom they should be performed.

A Trick Knee
Each year hundreds of thousands of arthritic Americans undergo arthroscopies in which surgeons shave away rough cartilage from the knee joints, at a cost of $5,000 per procedure. It turns out the procedure is no better than fake surgery in alleviating arthritis pain. That is the conclusion of an innovative study published last summer in the New England Journal of Medicine. Dr. Wray and others at the VA Medical Center in Houston randomly assigned 180 arthritis patients to get one of two arthroscopic procedures or a fake surgery. In the sham operation patients were wheeled into the operating room, sedated and cut just enough to give them a convincing scar. (All patients consented in advance.)

The fake surgery was so controversial that it took ten years to plan and complete the trial. The results are unambiguous. At no point in two years of follow-up was the real surgery better than the fake one. Six patients who got the fake operation liked it so much that they came back to have it on their other knee.

Medicare now proposes to stop reimbursement for arthroscopies for arthritis pain. Surgeons who favor the procedure are fighting back, arguing it helps ease popping and other "mechanical" symptoms. But that view is nonsense, says Bruce Moseley, the surgeon who did all 180 procedures in the study. "It's desperate people trying to discredit the study. They are looking for a loophole," says Moseley, from the Baylor College of Medicine. The VA study does not call into question arthroscopy for major cartilage tears and acute injuries. But even here, unscrupulous doctors sometimes perform unneeded arthroscopies for minor injuries that will heal on their own, says Ronald Grelsamer, a knee surgeon at Maimonides Medical Center in Brooklyn. Go to some hospitals and you'll find "a doctor who does ten a week[of which] nine are unnecessary," he says.

Spine Spin Some 125,000 times a year neurosurgeons perform spinal fusion surgery, using a bone graft or metal implant rods or plates to fuse together two vertebrae in an attempt to relieve lower-back pain from degenerated discs, the spongy shock absorbers between vertebrae. Patient traffic has quadrupled in a decade, and fusion now costs about $30,000. Surgeons who perform these operations rake in a median salary of $545,000 a year, almost double what most specialists earn, says the Medical Group Management Association.

Fusion caught on decades ago as a well-accepted treatment for deformities, fractures and dislocations, but surgeons later expanded it to treat back pain as well. The evidence that fusion works well for regional back pain is "essentially nonexistent," says University of North Carolina rheumatologist Nortin Halder. "If this were a pill and I used it, I would probably lose my license and go to jail."

University of Washington internist and fusion skeptic Richard Deyo MD, working under a government grant for the U.S. Agency for Health Care Policy & Research to help devise guidelines for back-pain surgery, surveyed the literature in 1992 and found a dearth of random, controlled trials, wildly varying success rates and unreliable data. When the resulting guidelines concluded there was little evidence that fusion for lower-back pain works, some outraged surgeons tried (unsuccessfully) to get Congress to kill the agency that sponsored the study. They did however, successfully remove the funding to the agency, and required the agency to stop putting out policy guidelines.
The U.S. Agency for Health Care Policy & Research concluded that the best outcome for back pain treatment was from manipulation and exercise, along with stress management. (Isn’t it great Wade & Associated Chiropractic provides you with this type treatment.)

One of the few controlled studies since then, a Swedish trial of 294 back patients, found 63% of patients who got the operation reported some improvement, versus 29% who didn't get operated on. Surgeons say it is unfair for critics to demand spectacular results, given that the operation is performed as a last-resort for severe cases. But Deyo says the Swedish study is flawed because it didn't offer much new treatment to the non-surgery group. He points to a new 64-patient Norwegian study that compared spinal fusion surgery for back pain with a vigorous program of psychological and exercise therapy. The non-surgical regimen was about as effective as surgery, caused no complications and cost a fraction what surgery costs, says study leader Jens Ivar Brox at Oslo's National Hospital.

Some doctors, such as University of Michigan physical medicine specialist Andrew Haig, spend a lot of time seeing failed fusion patients. One of Haig's patients is 65-year-old minister Melvin Harrell, who has suffered unrelenting back pain since falling down the stairs in the 1960s. Harrell has undergone three spinal fusion operations involving five vertebrae; none slashed his pain. "When the orthopedist says you need surgery and you are in terrible pain, you assume he is right," Harrell explains. He plans to stick with Haig's non-surgical program and advises others considering fusions: "Think long and hard."

Unsure Shoulders
Another hot operation is arthroscopic surgery to relieve shoulder tendonitis caused by rubbing of the rotator cuff tendons against the shoulder blade. Surgeons disagree on when this operation is needed. The theory behind the surgery, developed in the 1970s, is that too much rubbing, or impingement, causes the rotator cuff to fray and eventually tear. In a procedure called acromioplasty, surgeons shave away some of the bone to make more room for the rotator cuff, in hopes of alleviating pain and preventing tears. The surgery can be done on an outpatient basis. "You can do a lot of these in a short period of time," says Dr. Brox of Oslo. "It's an easy way to make money, even in Norway."

In the early 1990s Brox conducted one of the few controlled studies of this procedure, comparing surgery with physical therapy in 125 patients with chronic shoulder pain. He found that the surgery was not significantly better than physical therapy in relieving pain, and only 22% of those in the physical therapy group needed surgery two and a half years later. But he says his result has been ignored by "snobbish" surgeons in the U.S.

Doctors disagree on what constitutes impingement and whether it is always the culprit in shoulder pain. One doubter, University of Washington surgeon Frederick Matsen, frequently sees patients who have been told they need impingement surgery but in reality simply have stiff shoulders. He sends them home to try a six-week regimen of shoulder stretches. Few come back.

Most surgeons are still believers in the operation and cite good results in 90% of patients. "Impingement is probably overdiagnosed and operations are done that shouldn't be, but to say impingement doesn't exist is insanity," says Columbia University shoulder surgeon Louis Bigliani. One way to resolve the debate is a trial comparing real surgery with fake surgery in people with shoulder pain. .Says Matsen: "It could be the best thing ever, or it could be no better than placebo, and until we do the study we will never know."

Dousing Heartburn
Despite the spread of powerful heartburn drugs like Prilosec, surgery to stop acid reflux has surged in recent years. An estimated 65,000 surgeries are performed annually at a cost of $10,000 each, up almost sixfold in 15 years. By fixing the faulty valve that lets stomach acid seep back into the esophagus, surgeons seek to cure reflux and eliminate the need for popping pills. The operation also may help prevent esophageal cancer, a possible reflux complication.

Both claims are controversial. Stuart Jon Spechler, a gastroenterologist at the VA Medical Center in Dallas, has conducted one of the few trials comparing surgery and drug therapy, looking at 247 patients with severe reflux. When the study began in the 1980s drugs like Prilosec weren't available and surgery was more effective. But in 2001 Spechler decided to go back and examine how the original patients were doing.

He found that 62% of 37 surgery patients remaining alive after ten years still needed drugs to control their heartburn, according to results published in the Journal of the American Medical Association. The surgery patients had no better quality of life than 92 drug-only patients, nor did they have fewer reflux complications such as cancer. Mysteriously, surgery patients were slightly more likely to die of heart disease. Dr. Spechler theorizes that the surgical repair breaks down after several years. "When you look at the data it is hard not to be biased against surgery," he says.

NOTE: The nerves which control the esophagus and upper stomach also control the heart! If the roots of the tree are cut, the tree dies. Similar results will occur if the spine is pinching the nerves to the esophagus or heart. Surgery may remove the dead fruit, but eventually the tree dies.

Surgeons disagree. "The comment I most often get from patients is, ‘Why did I wait so long?'" says University of Southern California heartburn surgeon Steven DeMeester. DeMeester says that gastroenterologists like Dr. Spechler are biased because they see only the handful of surgery patients with complications, not the vast majority who are cured. Various studies show that 90% or more of surgery patients are satisfied with the result.

Similarly, the debate over whether surgery slashes cancer risk is so heated that "You get guys in fistfights up on the dais at national meetings," says West Virginia University surgeon David McFadden. Surgeons cite early studies hinting at reduced risk, but none are definitive. Meanwhile, the odds of dying from heartburn surgery, according to a University of Washington study, are about 1 in 125, although risks are lower with veteran surgeons.

The Expendable Uterus
The quintessential example of an overused operation is hysterectomy, or removal of the uterus. While hysterectomy can be lifesaving for women with cancer, most patients get it for quality-of-life problems, such as pain or bleeding caused by benign fibroids. Studies have long found the operation is often performed on women who don't need it. Yet hysterectomy rates remain stubbornly high, with 650,000 done every year. "The quality of care women get around hysterectomy has been really poor in this country for 50 years," says gynecologist Michael Broder, who has studied hysterectomy overuse.

He and a Rand research team surveyed almost 500 women who had undergone hysterectomies at several California managed care organizations. They found that 70% of the surgeries had been done without first conducting adequate diagnostic tests to ensure the surgery was appropriate. Some 14% of the women shouldn't have gotten a hysterectomy under any circumstances; 21% of 340 patients with fibroids had surgery without first trying drugs or other treatments that might have curbed their symptoms. "The medical establishment puts no value on having a uterus if a woman is no longer having babies," Broder says.


Bypassing Obesity
So-called gastric bypass operations are on the rise, thanks to a new, less invasive technique that gets patients out of the hospital quickly. This operation unquestionably works: Patients can lose 100 pounds or more. The International Bariatric Surgery Registry pegs the 30-day mortality rate at a reassuring 1 in 300. But the real mortality rate may be far higher than that--almost one death in 50 cases, close to the death rate from coronary surgery.

That finding emerges from David Flum, a University of Washington gastrointestinal surgeon who surveyed a representative sample of several thousand patients who underwent gastric bypasses, by which a surgeon reduces the stomach to a fraction of its normal size to render overeating impossible. Flum attributes the high complication rate, in part, to inexperienced surgeons rushing to offer a lucrative but technically demanding plumbing job. "You have lots of obese patients, insurers willing to pay and doctors just learning the operation. It is the perfect storm for bad outcomes," he says. The operation can work wonders, Flum says, "but patients need to go in with their eyes open."

Physician Payday

Median salaries for several types of doctors.

Spine surgeons: $545,000

General orthopedic surgeons: $364,000

All specialists: $275,000

General surgeons: $255,000

All primary care docs: $153,000

Source: Medical Group Management Association.

How can I prevent obesity?

To keep from becoming overweight or obese, you need to maintain a balance between the calories you take in, and those you burn off. In order to maintain your weight, your caloric intake should mirror the following rough estimates:
Consume 10 calories per pound of desirable body weight if you are sedentary (very low activity level).
Consume 13 calories per pound of desirable body weight if your activity level is low, or if you are over age 55.
Consume 15 calories per pound of desirable body weight if you regularly do moderate activity.
Consume 18 calories per pound of desirable body weight if you regularly do strenuous activity.

A great way to maintain a healthy weight and to improve overall health is to consume a healthy balanced diet. This includes avoiding foods that are low in overall nutrients (such as candy and soda pop) and limiting intake of trans and saturated fats, cholesterol, sodium, and foods with a high glycemic index. The following are some general guidelines for a balanced diet:
Do not eat meat more than once a day - fish and poultry are preferred over other meats.
Avoid fried foods, which have high fat content from the oil they are cooked in; bake or broil food instead.
Limit your intake of salt and monosodium glutamate (MSG).
Eat plenty of fiber.
Do not eat more than 4 eggs per week; eggs are very high in cholesterol.
Limit desserts and other high-calorie foods that have little nutritive value.
Avoid alcohol, or drink in moderation.
Eat from all the food groups; eating too much of anything means you are missing out on the nutrients found in other foods.

For overall health, the American Heart Association recommends that the average person get at least 30 minutes of moderate exercise five times per week or 20 minutes of vigorous exercise three times per week. Moderate activity means participating in activities such as jogging, fast walking, or even things like raking leaves or washing windows and floors. Vigorous activities include things like playing basketball, aerobics, swimming laps, or even shoveling snow. For more information on maintaining a healthy weight, see the Healia Weight Management Health Guide.

Article from www.healia.com

If you are looking for assistance with a weight loss program go to www.wadechiropractic.com.

Q&A on Chiropractic

The primary goal of care is to reduce or eliminate the damaging effects of abnormal posture on the body. By improving the patients posture and spinal biomechanics (spinal position) the stress and strain upon the nervous system is minimized and the body has the greatest opportunity to heal. Only those techniques which have been validated clinically or through research are employed in working with the patient.

Research has proven that in order to change posture, many different techniques need to be appropriately applied;

"Because mechanical loading of the neuromusculoskeletal tissues plays a vital role in influencing proper growth and repair, chiropractic rehabilitative care should focus on the normalization/minimization of aberrant stresses and strains acting on spinal tissues.

Manipulation alone cannot restore body postures or improve an altered sagittal spinal curve.

Therefore, postural chiropractic adjustments, active exercises and stretches, resting spinal blocking procedures, extension traction and ergonomic education are deemed necessary for maximal spinal rehabilitation.

(J Manipulative Physiol Ther 1998; 21:37Ñ50).

Therefore, all of these procedures are routinely used to assist the patient in regaining and then maintaining their normal structure and ultimately their function.

Q: What kinds of things does a chiropractor treat?

A: In my office, patients present with a variety of conditions ranging from lower back pain, to childhood ear infections. Regardless of the type of condition presented by the patient, the spinal analysis is the same. I am concerned about how your spinal and postural structure is affecting your nervous system, your muscles, joints and ligaments. The greater majority of the times, structural problems are the cause of musculoskeletal pain, and often, the root cause of other problems as well. By finding the cause of your problem, I am able to assist your own body in healing itself.

That said, the most common types of problems I see are; neck pain, back pain, headache, problems associated with automobile, work or athletic accidents or injuries.

In addition, there are patients who are looking for a conservative approach to an athletic injury or extremity problem.

There are also more and more people who present for examination simply because they have learned that in order to be as healthy as possible, they must have normal structure. Therefore, they want their spine and posture checked and corrected if it is found to be out of alignment from normal.

Q: Does chiropractic treatment hurt?

A: No, not generally. There are certainly times when correction of a posture is uncomfortable, much like working out, or performing a strenuous task of which you are unaccustomed. However every effort is made to work within your tolerance, to make as much change as possible, in as short a time as possible, with minimal discomfort. Many times, patients have had an abnormal posture for many years. When this is the case, the muscles, ligaments, and joints are accustomed to their current position. Changing that position is important, and at times uncomfortable. However again I stress, never in such a way as to be intolerable to the patient.

Q: Why should I care about my posture?

A: Your posture is an outward representation of how your spine is built. Research into what makes a body healthy has demonstrated without a doubt that normal posture is essential for your body to function optimally. The majority of the afflictions which plague mankind have as their root, abnormal structure. That little ditty we all learned as children "the foot bone is connected to the leg bone is connected to the thigh bone, is connected to the pelvic bone..." is ever so true. By making certain your posture is as good as possible, you ultimately enable your body to be as healthy as possible, and even avoid many if not all of the problems associated with an aging spine.

Q: When should someone have their spine examined?

A: I am asked this question quite often by patients who attend my Spinal Care Class. The answer is quite simple. As soon as possible, after birth.

This answer occasionally startles people because they think if they do not have pain, why should they be examined?

If this philosophy was applied to dental evaluations and treatment, the condition of your teeth would be quite nasty. You could have multiple cavities, and possibly gum disease before you ever had any symptoms. What a shame! Why not be proactive and find out early if you have a spinal problem, and then correct it or improve it as much as possible. You then have the option of maintaining a better quality of life, and enjoying optimum health.

Q: Why do some people go to chiropractors over and over again? I have heard once you go, you have to go forever.

A: Ultimately, your health is your own business. Many people in the last 10-15 years have discovered that ultimately, your health is your responsibility, and no one else's. Therefore, by learning the fundamental truth that "structure determines function" they desire to have their structure as normal and healthy as possible. Once your posture is corrected, you may require (and often do) occasional check ups to insure you remain aligned normally. This is not such a foreign concept. Think of those folks you know who have had their teeth aligned. More often than not, a "retainer" is required to maintain the new and healthy position of the teeth.

Ultimately, you decide what you want out of chiropractic care in my office. If you simply want to get rid of your pain without drugs or surgery, and as soon as you feel better, be done with your care, you may certainly choose this option (called "Patch Care"). However if you want to be as structurally sound as possible, you may choose to correct or improve your spine as much as is possible ("Fix Care") and then periodically be checked to be sure you are as good as can be ("Wellness or Maintenance Care").

Once corrected, many patients choose to continue supporting their health with periodic spinal adjustments. However, this choice is due to understanding the relationship between structure function, and optimal health.

If you or a loved one has been struggling with aches and pains with nothing seeming to work.

Call and set up your appointment with us today.

Wade & Associates Chiropractic

256-237-9423