Traumatic brain injury (TBI) is an injury caused by a forceful bump, blow or jolt to the head or from an object that forcefully hits the head or pierces the skull. Certainly not all blows to the head result in a TBI, but many do and TBI can have various levels of severity. Those levels range in a wide spectrum from a mild concussion all the way to coma, loss of brain function and even death.

Military members in active combat, those returning home and Veterans are often thought about when considering a traumatic injury to the head caused by explosions, blasts or firearms. The condition commonly occurs in everyday life for civilians as well from things like slips and falls, blunt forces to the head, car accidents/whiplash, work injuries, assaults/violence or common incidents that occur during sports activities.

According to the Brain Trauma Foundation there are an estimated 2.5 million traumatic injuries each year in the U.S. According to a report from the CDC, about 190 Americans died from TBI-related injuries each day in 2021.

Blatant TBI injuries are fairly obvious and in most cases are immediately addressed medically. From a healthcare standpoint, another major concern is that mild TBIs may be easily overlooked and be more likely to go untreated. Such injuries may not have immediate symptoms or may have symptoms that take days to weeks to manifest. This can leave individuals in a very vulnerable position.

Early Intervention Promotes Safety and Healing

If a mild TBI or concussion goes without care and the patient gets hit in the head again, the result is injury on top of injury and the effects can be exponential and dangerous. Mild TBI and concussion may be present even if the event was perceived to be a low impact fall, fender-bender at low speed or a hit to the head during a sporting activity that they try to ‘shake off.’

According to the CDC, there is growing concern about the long-term effects on the brains of people who experience multiple or repeated head impacts. Repeated events that lead to a mild TBI or concussion, and also head impacts that do not cause the person to feel symptoms after a hit to the head are included. Collisions while playing sports is one common way a person may experience repeated impacts to the head.

The important take home point is that injury can exist even if there are no symptoms immediately after the event. Many concussion symptoms may take days or even weeks to appear which is why people should immediately take themselves out of the game and get assessed by a professional that understands concussion protocols.

Sports Correlations

According to TBI.com, the top sports related to the number of head injuries in 2019 were football, basketball, cycling and soccer. Whenever the head can be struck with force, it can result in concussion and repeated incidents are creating long-term ramifications for athletes. With football, a sport that requires helmets, approximately 300,000 concussions occur annually in the U.S.

Of special note is soccer. There are approximately 275 million soccer players in the world active in over 200 countries and territories and it is known as the world’s most popular sport. There are an estimated 128,983 players that are professional.

In soccer, there is a long tradition in the rules that allows players to use their head to strike the ball, called ‘heading,’ where a ball traveling at high velocity is met head on by the player to block its progress. It is one of the leading causes of concussion in the sport. So what may have begun as a single mild traumatic brain injury with little to no symptoms, can quickly become serious when it occurs repeatedly. As with any sport or risky situation, impacted individuals need to be removed from the game or activity, understand the risks and protect themselves from additional impacts that can bring severe complications.

Another sport to note is boxing. Though much smaller numbers participate worldwide, the CDC reported that chronic traumatic brain injury occurs in approximately 20% of professional boxers due to the number and magnitude of impacts over the course of their careers. These athletes have been known to present with varying degrees of motor, cognitive and behavioral impairments and in the most severe of cases, with dementia.

Care and Symptoms

Even if it seems minor at the time, or if no symptoms are currently present, anyone who has suffered an insult to the head from any source should seek an assessment with a professional that understands concussion protocols. 

In sports, commonly overlooked impacts could include helmets hitting, a ball or gloved fist to the head, falling off of a bike or any impact or motion that causes a jerking or ‘whipping’ of the neck (such as we see with whiplash injuries). Often such injuries will have a sprain/strain component in the soft tissues, joint dysfunction and in many cases a concussion.

The benefits of chiropractic care have long been acknowledged in professional athletics. Doctors of chiropractic (DCs) can be seen on the sidelines as crucial members of the medical staff for 90% of professional sports organizations including Major League Baseball (MLB), all of the National Hockey League (NHL) teams and all of the teams in the National Football League (NFL). Not only are DCs well-versed in injury care and management, they also work to prevent injuries and provide strategies for athletes to enhance performance.

Whether symptoms start immediately, are delayed or progress over time, red flags to watch for include but are not limited to the following examples:

Cognitive: confusion, concentration difficulty, trouble thinking or recognizing common items, difficulty creating new memories.

Behavioral: abnormal crying, laughing, aggression, irritability or persistent repetition of actions or words.

Whole body: fatigue, dizziness, fainting or blackouts.

Mood: anger, anxiety, loneliness or apathy towards things once cared about.

Eyes: dilated or unequal pupils, raccoon eyes

Gastrointestinal: nausea, vomiting.

Speech: difficulty speaking or slurred speech.

Visual: blurred vision, visual disturbance, and sensitivity to light.

Other: headaches, balance issues, loss of smell, loss of smell, ringing in the ears, sensitivity to sound, neuromusculoskeletal symptoms.

DCs understand injury assessment even in the absence of symptoms, and can help direct patients on what symptoms to watch for and how to manage their healing to prevent complications that could occur from multiple impacts. 

According to the International Association for the Study of Pain, low back pain (LBP) is recognized as the leading cause of disability worldwide with the global burden of LBP steadily increasing since 1990. In 2020, that translates to around 619 million people and that number is estimated by the World Health Organization to increase to 843 million by the year 2050.

Safe and effective ways to address low back pain are becoming more important for people of all ages and for society as a whole. One of the primary reasons for this is the crisis surrounding opioid use for pain. The heavy use of opioids as an intervention began in the 1990s and has transitioned through several waves of upsurgence since that time. The CDC has cited that the most common drugs involved in prescription opioid overdose deaths include methadone, oxycodone and hydrocodone. Prescription opioid overdose deaths also often involve benzodiazepines which are used to sedate, induce sleep and relieve anxiety. 

Opioids bring with them the serious risks of abuse, addiction and overdose. In addition, even when taken as directed, prescription opioids can have a number of additional side effects. Increased drug tolerance (meaning more medication is needed to provide the same pain relief), physical dependence, increased sensitivity to pain, nausea, depression, lower libido, dizziness or confusion to name a few.

Growing Trends in Natural Pain Relief

With the possible risks associated with opioid use, drug-free, first-line solutions for pain relief are more pertinent than ever. Recently, the Harris Poll has shown that younger Americans are opting to adopt more natural solutions at an increasingly higher rate.

According to the poll, more Americans age 54 and younger are choosing natural, drug-free chiropractic care to manage LBP. Many younger Americans grew up during the height of the opioid crisis and witnessed the dangers of prescription painkillers on the health of individuals, how opioid use could adversely affect families and the ways that the crisis negatively impacted communities and are seeking safe and effective alternatives.

This new poll also lends further credibility to in-depth health insurance claims research. In a 2022 pre-print study, researchers reviewed a database of more than 616,000 insured adults with LBP and found that doctors of chiropractic (DCs) were contacted as the desired first portal of care by 31% of patients. This was similar to the Harris Poll results and also showed that the numbers of individuals seeking chiropractic care first were very comparable to the 36% that opted to try medical allopathic or osteopathic treatment as their first stop.

Finding health care options is exceptionally important whether people have insurance or find themselves uninsured. The Harris Poll showed that 13% of uninsured poll respondents sought care from DCs at nearly the same rate as they did from other types of primary care doctors. The result indicates that when insurance coverage is removed from decision-making, that patients view chiropractic care as an effective and affordable way to manage their LBP.

Removing Roadblocks to Care

According to the Harris Poll, 21% of respondents said that they initially avoided chiropractic care due to the misconception that the treatment might hurt. In reality, chiropractic care offers gentle and varied approaches to optimize joint function in the spine. Chiropractic adjustments may occasionally elicit a ‘popping’ sound as is stereotyped in films and media. Formally termed ‘cavitation,’ the popping sound does not cause or indicate pain, it is simply a release of gasses within the joint capsule. Some adjustments elicit the noise, some do not, both are normal responses.

For those patients with financial or insurance roadblocks, many chiropractic clinics also offer reasonable payment plans or options that can help ease the burden of out-of-pocket care.

Consumers seeking care for their LBP, should consider a primary care provider such as a doctor of chiropractic to assist them with their neuromusculoskeletal conditions. This can potentially avoid the dangers and risks of prescription painkillers. If seeking care first from a primary medical provider, ask them about collaborating with a DC for optimized healing using a natural approach before drugs or surgery. 

As consumers (insured or uninsured) seek care for low back issues, there are a variety of resources available. To find a doctor, the Yellow Pages can still be a local resource. At a broader level, the Foundation for Chiropractic Progress (F4CP) also hosts a national database to find a DC near your zip code. Potential patients can search for chiropractors, call and ask questions, and if there are preferences between a male or female practitioner they can also filter their search to find specific practitioners.

Acetaminophen is a common medication used for relieving a variety of discomforts such as: back pain, mild to moderate pain from headaches, cramping from menstrual periods, muscle aches, arthritis, tendonitis, toothaches, colds, flu, sore throats and it can also be used to reduce fever. The product is readily available over-the-counter (OTC) and is also used in a variety of OTC and prescription strength ‘combination’ medicines. Combination products are consumables that contain more than one active ingredient to treat more than one symptom. For example, cold and flu remedies may contain multiple active ingredients to address aches, pains, cough and fever.

More than 600 common prescription and over-the-counter medications contain acetaminophen as an active ingredient. It has become so mainstream that many people don’t realize that acetaminophen is responsible for over 56,000 emergency department visits annually in the U.S. and is the most common cause of acute liver failure in the U.S., Europe and Australia. Toxicity caused by acetaminophen use is also the second most common cause of liver transplantation worldwide.

Roughly 8 in 10 Americans routinely reach for OTC pain pills for discomfort and most people are unaware that these medications can be just as dangerous as prescription drugs if used incorrectly.

Dangers in the Dose

Individuals occasionally utilizing OTC acetaminophen as directed for something like an infrequent headache or menstrual cramps is not the concern as long as consumption is kept at or below the recommended dosage for a very short period of time. Ongoing and multiple daily doses trying to mask acute or chronic pain bring much higher risks for overconsumption and damage.

With the wide availability of OTC medications, it can be easy for people to underestimate the dangers involved or to inadvertently ‘double dose’ and take too much, especially if they are taking multiple products that each contain acetaminophen and they don’t realize it. Further, more potent prescription medications already contain much higher concentrations of acetaminophen and many combine it with an ingredient like codeine (an opioid) which can cause additional layers of threat or abuse.

Some consumers may try to address their pain at home with a medication that they have generally perceived as safe and then if they feel more unwell, they may try to take even more of it for relief, not realizing the potential risks. More is not better.

Whether overdose is intentional, or unintentional, the toxic effects on the liver are the same. Even in therapeutic doses, studies have shown that ongoing use creates an elevation in liver enzymes. When cells of the liver become damaged and no longer can handle the amount of acetaminophen in the body, then toxic intermediate stages of drug breakdown do not get processed and can result in life-threatening damage.

It is important to note that acetaminophen toxicity is a common cause of acute liver failure in children and adolescents, perhaps because they don’t read the labels, understand combination products or because they don’t understand that even OTC medicines have dangers. Symptoms of acetaminophen toxicity may include outward signs such as: abdominal pain, irritability, general weakness, loss of appetite, irritability, diarrhea, nausea, vomiting, jaundice (yellow appearance of whites of eyes and skin), convulsions or coma.

Avoiding Acetaminophen Overload

With the harm and risks associated with prescription and OTC painkillers, finding drug-free natural solutions to address pain are more important than ever. Chiropractic care is working on the forefront of this issue and has had a long history of effective nonpharmacological care for back pain, headaches, sprain/strain injury and a variety of other conditions. Doctors of chiropractic (DCs) understand neuromusculoskeletal pain, optimizing the function of the joints and supporting the surrounding soft tissues with a natural approach to help patients minimize the need for harmful analgesics.

In the battle to educate the public about the proper use and dangers of acetaminophen, DCs can work to help educate patients and suggest public service websites such as www.catiescause.org that strive to bring more awareness to the importance of this issue. To learn more about Catie’s Cause, listen to the Adjusted Reality Podcast episode featuring the organization’s founder, Karen Smith.

When consumers do opt to reach for acetaminophen, the following tips are provided to help guide safe usage and avoid overdose or abuse:

• Always read and follow the labels. Never take more than directed (dose or frequency).
• Pay special attention to dose levels for age and body weight, particularly for children.
• Keep all medicines out of reach of children.
• Do not mix acetaminophen with alcohol.
• If you have to take medications for pain more than a few days, talk to your doctor about other alternatives so that pain medications don’t become an unhealthy habit.
• If taking more than one OTC or prescription medication, ensure that you aren’t getting more than one dose of acetaminophen. Pay special attention to combination medicines that have more than one active ingredient. (Eg. don’t take acetaminophen for headache and fever and then inadvertently take it again within a cold and flu combination product).
• When buying OTC products, get in the habit of telling the pharmacist what other medications you or your child are taking and ask if adding acetaminophen is safe.

If at any time you suspect that you or a family member may have taken too much acetaminophen, timing is a vital factor in the treatment for possible toxicity. Go to the Emergency Room or call 911 as soon as possible (ideally within 8 hours of ingestion or shorter time frame) to achieve the best possible outcome for the patient. 

According to the World Health Organization (WHO), headaches are reported to be one of the most common disorders of the nervous system. Globally, it is estimated that nearly everyone has an occasional headache and that over 50% of the world’s population are regularly plagued by them. For many sufferers, headaches are not just an occasional occurrence and may not even be reported to healthcare providers due to the sad, untrue perception that they should be a regular expectation of life.

Experts approximate that 15% of the world’s population is having some type of headache on any given day. It is also estimated that people suffering from headaches have increased compared to prior generations. 

Not only are headache disorders painful, but they are also disabling and contribute to substantial personal suffering, impaired quality of life and financial cost. WHO reported that the Global Burden of Disease Study ranked headache disorders as the third highest cause worldwide of years lost due to disability. Headaches should not be viewed as an expected part of life and should not be simply tolerated. Sufferers of headaches should be assessed with the goal of alleviation and prevention.

Types of Headaches

Headaches can be classified into two major categories, primary and secondary. 

• A primary headache has specific qualities but does not necessarily have an underlying cause that can be pinpointed. 
• A secondary headache is the result of another condition or specific action. For example, a sinus headache due to sinusitis/congestion would be a secondary headache. 

Though there are many different headache types, here we will focus on WHO’s top three: tension, migraine and medication overuse.

1. Tension: Tension-type headaches are the most common type of primary headache disorder and affect over one-third of all men and over one-half of women. Statistics show that up to one in 20 adults actually deal with a tension headache nearly every single day. They are often described as a feeling of ‘pressure’ or ‘tightness’ in the shape of a band around the top of the head. For many, it spreads from, or to, the cervical spine (neck). They can last from hours to days.  
2. Migraine: Migraines are a specific primary headache disorder with special qualities (eg. not every bad headache can be classified as a migraine). One in seven adults are affected regularly by migraine headaches. Once they begin, these headaches are often a life-long affliction characterized by recurring attacks that could occur in varied frequency ranging from one or more a week, month or year. They are thought to be hormonally influenced but no specific cause has been found. They tend to be located on one side of the head with an extreme pulsating quality and moderate to severe intensity. Attacks can last hours or days and are often accompanied by other symptoms: prodromal vision of flashing light (scintillating scotoma), sensitivity to light and sound, fatigue, nausea and even vomiting. 
3. Medication Overuse: Chronic and excessive use of medications to treat headache or other chronic pain conditions can, ironically, lead to medication-overuse headaches (MOH). Also called ‘analgesic rebound headaches’ these are one of the most recognized secondary headache disorders. They are rated by WHO as being one of the top three headache types with public health importance since they are responsible for ill-health and disability in high numbers of the population. According to Cleveland Clinic, these are a vicious cycle of having headaches, taking more and more pain medications in an effort to relieve them, but only inciting the result of daily or nearly daily headaches where the drugs being taken become less and less effective. These headaches are said to be indistinguishable from the original headache that they were taken to relieve. This can lead to overuse and a feeling of helplessness. MOH typically occurs in patients with a background of primary headaches like migraine or tension. However, it may also occur when analgesics are used for other chronic pain conditions such as low back pain or fibromyalgia. 

Adverse Effects of Pain Medications

Many individuals strive to get through ongoing headaches with the help of painkillers. Pain medications that are only taken occasionally and at recommended doses typically do not pose an issue. However, more than 30 million Americans misuse over-the-counter (OTC) pain medications on a daily basis. Overuse is a significant problem. The most common type of OTC painkillers are non-steroidal anti-inflammatory drugs (NSAIDs). Commonly referred to as ‘aspirin’ or ‘ibuprofen’ products, they are often used to relieve symptoms for conditions such as: headaches, menstrual pain, sprain/strain injuries, arthritis or back pain.

Just as with certain prescription drugs, OTC pain reducers can pose significant health issues if misused or overused. Long-term use of NSAIDs may cause numerous adverse effects that include but are not limited to gastrointestinal, cardiovascular and renal (kidney) risks. A majority of peptic ulcers and hospitalizations (that are not caused by a direct bacterial infection of Helicobater pylori), are from chronic NSAID use. One study showed that endoscopy procedures in up to 30% of arthritis patients demonstrated the development of significant GI complications, like ulcers, after NSAID consumption.

Even other common OTC pain medications, such as acetaminophen (which is not an NSAID), pose potential long-term harm to the kidneys and GI system and both ibuprofen and acetaminophen also have potential short term side effects that can affect quality of life such as: upset stomach, nausea, vomiting, headache, diarrhea, constipation, dizziness or drowsiness. Consumers need to be aware that products with these ingredients come under different brand names and that there may also be ‘combination products’ which contain multiple types of analgesics. Reading all labels carefully will help people to not inadvertently take more than is recommended.

Managing Headaches Naturally

Many common headaches can be addressed naturally and help patients reduce their consumption of potentially harmful OTC and prescription medications. Medication overuse headaches are common and regarded as a major cause of disability in adults under 50 years of age. 

Lifestyle changes are extremely beneficial and include a variety of areas that patients can address on their own.

• Reducing stress: stress can contribute to muscle tension which then in turn can contribute to joint pain and headache. Finding time for meditation, yoga or other activities that will help you decompress mentally will also help your physical state.
• Dietary mindfulness: watch your food and drink carefully for elements that may trigger your headache. Some chemical additives/preservatives, for example MSG, have been linked to triggering migraines in susceptible people.
• Sleep: too much or little sleep has long been correlated with headache symptoms. Strive for regular sleep patterns and ample quality hours of sleep each night.
• Exercise/Stretching: staying strong and flexible can help diminish the muscular component of headaches. Work to create balance in the flexor and extensor muscles and stretch to help alleviate spasms that can lead to a cycle of affected joints and tension-type headaches.
• Posture/Ergonomics: Foundational causes of stress in the muscles and joints can often be related to posture and the hours of ill-positioning that can occur at a workstation that is not set up to compliment your body dimensions ergonomically.

In addition to personal changes, chiropractic care has also been shown to be beneficial. Headache patients actually make up a substantial proportion of the caseload in chiropractic offices. Evidence from the Journal of Manipulative Physiological Therapeutics suggests that chiropractic care improves cervicogenic headaches (coming from the neck) as well as migraine. The anatomy of the head and neck and imbalances due to posture or ergonomics are all significant contributors to headaches. Tension headaches in particular have components in the musculature of the mid-back, shoulders and all the way through the neck and muscles of the head. This type of extreme muscular tension may also disrupt the joints of the spine where they attach to. Much like a chicken and egg loop, posturing and joint dysfunction can lead to muscle tension and muscle tension can reduce the stability and alignment of the spinal joints cumulatively resulting in headache cycles.

Doctors of chiropractic (DCs) have expertise in neuromusculoskeletal anatomy to naturally affect the root cause of many headache types and work to help prevent relapses. Cervicogenic headaches, migraines and secondary headaches such as those experienced after whiplash injury, slips/falls and poor posturing all have potential to respond extremely well to conservative care and lifestyle changes.

Youth sports in the United States is a $19.2 billion dollar market, a size that rivals even the National Football League. According to the CDC, organized sports participation in the U.S. among children aged 6-17 years was at 54.1% in 2020. That translates to approximately 60 million youth taking part in sports activities.

Involvement in team activities provides a variety of benefits for growing bodies and minds. In addition to needed physical activity, for many kids, participation provides an important social outlet and support network that can reduce stress as well. Many athletes may also do better academically as sporting activities require skill sets that include discipline, repetition and memorization that can translate to work in the classroom. Involvement in sports also requires teamwork, communication, problem-solving skills, goal-setting and determination that can all be applied throughout life.

The benefits of chiropractic care have long been acknowledged in professional athletics. Doctors of chiropractic (DCs) can be seen on the sidelines as crucial members of the medical staff for 90% of professional sports organizations including Major League Baseball, all of the National Hockey League teams and all of the teams in the NFL. Not only are DCs well-versed in injury care and management, they also work to prevent injuries and provide strategies for athletes to enhance performance. For our younger developing athletes, DCs offer similar benefits.

The Chiropractic Edge

Chiropractors work with patients of all ages and understand the complexities of how the bones and soft tissues of the body develop throughout childhood and adolescence. DCs strive to support younger athletes to encourage optimal health both on and off of the playing field.

Exams: Chiropractors offer sports physicals and spinal screenings to help protect kids as they develop. Physicals for sports are imperative and are typically required for all athletics in U.S. school systems.  These exams help provide a baseline for overall health and detect potential underlying conditions, such as Marfan’s Syndrome, heart issues or joint problems that could lead to complications or injury during play. Though cardiac arrest in young athletes is rare (about 1 in 50,000) heart abnormalities in young athletes can include structural or electrical issues. A family history taken during the process can also provide vital information for potential conditions that may be inherited. DCs collaborate care with other specialists whenever necessary to support the best interests of athletes’ health and safety. Atypical heart findings, such as an arrhythmia (irregular rhythm) found during a sports physical, for example, would prompt the DC to refer the athlete for further analysis or testing with a pediatric cardiologist.

Screenings:  During development, scoliosis screenings are also important for all children to ensure potential cases are caught early, monitored and managed appropriately. DCs are often called into schools to provide this service but also include screenings in their offices during sports physicals and as part of office visits with children and adolescents.

Doctors of chiropractic routinely analyze posture and recommend ways to correct any imbalances found. Tech Neck is currently a very concerning issue amongst youth worldwide and the altered posture and symptoms that come with it can affect the health of youth, set them up for injury and influence sports performance. DCs offer a variety of interventions to correct the unhealthy posture of Tech Neck and help kids lay a foundation to support future spinal health and avoid premature joint degeneration and deformity.

Performance Enhancement: Agility is a main factor when enhancing performance. This can sometimes be a challenge for kids undergoing growth spurts and having to periodically re-learn how to coordinate a taller, larger body. Chiropractic care can help developing athletes with strategies to maintain balance, stability and flexibility so they keep their game strong:

Balance: Enables the athlete to be agile and exert their body with greater strength, speed and precision. Imbalance can inhibit performance or contribute to situations that can result in injury. DCs work with muscular imbalances between flexor and extensor muscle groups and provide exercises for athletes to gain and maintain stability and increase proprioceptive skills which allow for the body’s ability to inherently sense movement, action and location.

Stability: Allows the body to quickly return to a state of equilibrium after it is disrupted (eg. from a sudden movement or quick turn.) Stability directly affects an athlete’s resilience and allows for a strong solid foundation on which to be grounded or defend from opponents. Chiropractic care can help stabilize skeletal inequities through spinal adjustments, restore optimal alignment and address issues such as gait issues, uneven shoulders or hips that can affect both balance and stability.

Flexibility: Provides optimum range of motion (ROM) that is needed to maximize speed, strength and overall performance. In track, for example, increased flexibility in the hip and muscles of the leg can allow for a longer stride or ability to position the legs for a hurdle. Flexibility also plays a role in injury prevention; rigidity in tissues that require a specific ROM can more easily lead to sprain/strain injuries.

Injury Recovery: Two of the most common injuries that arise from participation in sports include head injury (concussion) and sprain/strain of the spine and/or the extremity joints. DCs on the sidelines are trained to assess injuries when they occur and provide early interventions for healing. In the case of head injuries, DCs understand current concussion guidelines and how to assess for brain injury, communicate with emergency services, determine a need for imaging studies and safely stabilize the head and neck to minimize further damage or complications.

A concussion is a type of traumatic brain injury, not unlike what is experienced with whiplash. A bump, blow or jolt to the body causes the head to move rapidly back and forth affecting the brain within the skull. After any type of injury, care should be sought out as soon as possible to mitigate complications and facilitate healing. Though most mild concussions are not usually life threatening, they should be closely monitored. The tissues need time to heal and symptoms can be significant. Athletes and their parents should realize that a concussion is a “traumatically induced transient disturbance of brain function.”

DCs are trained to assess concussion injury and monitor symptoms that may include:

• Affective/emotional function such as mood changes or irritability
• Cognitive functions such as confusion, disorientation, amnesia, mental fog or difficulty concentrating
• Physical symptoms like headache, dizziness, balance issues and visual changes
• Sleep issues such as drowsiness, sleeping more or less or difficulty falling asleep

In sports, as in car accidents, this type of injury is most often accompanied with injury (sprain/strain) to the cervical spine (neck). Sprain/strains also occur in sports in other parts of the spine, shoulder and extremities such as the wrist or ankle. DCs work to keep optimum motion in the affected joints, facilitate healing in the soft tissues and mitigate symptoms to promote complete healing and faster healing times.

Pain Relief and Beyond

As young athletes heal from injury, they often are more focused on getting back in the game as quickly as possible. For parents and guardians, a main concern includes the dangers of painkillers and the possibility that their child will mask the pain with pills and potentially cause more injury.

Chiropractic care is not only drug-free, but is also highly effective for managing both acute and chronic neuromusculoskeletal pain. DCs work to keep optimum motion in the involved joints, provide physiotherapy modalities when indicated, offer exercises to strengthen and stabilize injured muscles and joints, address muscle spasms and recommend nutrition or supplements that can work to reduce inflammation in the body. All of these strategies maximize the healing process to safely get young athletes back to the sport they love.

Whether in sports arenas, on a school team or at a park near home, DCs are a vital part of the healthcare team for athletes. Starting with exams and screenings, doctors of chiropractic work to keep young athletes safe and healthy. DCs provide pain relief and injury recovery and then go beyond those basics to focus on prevention and remain injury free. By adjusting the joints of the spine and extremities to optimize function, offering nutritional and lifestyle recommendations and providing strategies to improve balance, stability and flexibility, DCs provide a competitive edge as they strive to improve the overall performance and resilience of student athletes of all ages.

According to the National Safety Council, “Falls are one of the leading causes of unintentional injuries in the U.S.”  In 2020 over 42,000 people died in falls at home and at work and more than 6.8 million people were treated in emergency rooms for fall-related injuries. 

Slips, trips and fall accidents can happen at any stage of life. For babies and toddlers, it may be a tumble from a crib or from learning to walk; for children, it may be from roughhousing on the playground or falling from a bicycle. Sports are a common field for falls for people of all ages and we also find slips and falls a common cause of personal injuries at home and in public domains.

During our careers (and depending on vocation), workplace slips and falls are common cause of injury, lost work time and workers’ compensation issues. In the golden years, fall risks become even more significant. For senior citizens, (those 65 and older), fall risks increase substantially and can pose much higher risks of morbidity and mortality as a result. It is estimated that millions (one in four) of older individuals will suffer a fall each year. Out of those that fall, it is sadly reported that less than half will even tell their doctor.

Many falls that people endure are ‘light’ and do not cause significant injuries, however, one of every five falls is said to cause a serious injury such as harm to the head or a broken bone. A big danger lies in-between these extremes in that injury may exist but symptoms from a fall injury or mild concussion may not manifest right away. These types of ‘temporarily hidden’ injuries are a cause for concern. Don’t wait for a deep bruise or dizziness to manifest days after injury to realize you were hurt. Because concussion and musculoskeletal symptoms may show up later, it is extremely pertinent that people seek care and monitoring after any slip and fall incident to avoid complications and optimize a swift and safe healing process.

When preparing for an assessment it is very helpful to try to remember the mechanism of the fall and your positioning such as: ‘What caused it?,’ ‘How did you land?,’ ‘Did you hit your head?,’ ‘Did any joints of the back or extremities bend abnormally?,’ ‘What type of surface did you land on?,’ ‘Were there any abrasions or bleeding?’ These types of details provide many important clues about the injuries that you may have sustained.

A Dangerous Reality

In the case of severe falls, 911 and emergency care should happen immediately. For other falls, it’s still critical to seek consultation and care as soon after a fall as possible. It is imperative to understand that individuals may or may not feel the effects right away. For some people pain, strain/sprain, lack of motion, bleeding, a bump on the head, blurred vision or other telltale signs of injury will be present. For others, the effects and symptoms may be delayed many days after the fact.

Neglecting timely management can prolong the inflammatory process and healing time which in turn can cause people to unwittingly cause further injury. A delayed response to seeking evaluation after a fall can lead to complications. Concussion is one of the most serious. If the fall causes a jerk or hitting of the head, the effect can be like that of a whiplash injury and a concussion may be present along with injury to the cervical spine (neck). 

If symptoms show up later, the dangerous reality is that people may not realize that they suffered a concussion. Healing and rest is needed for the brain. When an individual opts to jump back into activities or sports it can create risk for a potential second incident that could cause much more significant harm. After a fall, and especially if you jerk or hit your head, have your doctor of chiropractic (DC) evaluate you right away.

No matter when they occur, symptoms such as passing out, blurred or tunnel vision, nausea/vomiting dizziness, amnesia, fluid drainage from the nose or ears, ongoing paleness, slurred speech, weakness in the arms or legs, seizures, inability to balance and walk would all warrant an immediate assessment.

Latent symptoms

Mild concussions may have symptoms that manifest later. Neck stiffness with injury to soft tissues, headache, dizziness, abnormal sensations or paresthesias (burning, prickling or numbness), shoulder or back pain, extremity pain or loss of motion, memory loss, concentration issues, nervousness, irritability, sleep disturbances, fatigue or depression should all be watched for after a fall. New headaches that do not remit or get worse over time should be paid special attention to as they may represent a building of pressure in the brain and would require immediate attention.

In the case of neuromusculoskeletal injuries, like sprain/strain, pain symptoms, limited motion and outward signs like bruising may take time to appear. Waiting days for symptoms to arrive is losing precious time to optimize joint function, care for inflammation and support the healing process. Having an assessment right after a fall occurs allows your DC to examine the involved joints and maximize your healing process. 

After a fall the individual should cease activity and engage in R.I.C.E. protocols to minimize inflammation. Rest-Ice-Compression-Elevation takes the pressure off of the joints, works to control inflammation and start the healing process in a healthy way.

Without management of the injury site, some patients, for example, may opt to use a heating pad because it sounds relaxing. In reality, they will be increasing inflammation in the joints that can swiftly lead to more pain and disrupt the body’s healing process.

Prompt chiropractic care also decreases the risks of doing something too quickly that will result in further harm to the area of injury (like a heating pad or initiating exercise prematurely), DCs deliver care that includes:

• Utilizing protocols for monitoring concussion.
• Stabilizing the spine or joints when needed with braces or splints.
• Managing acute injuries with R.I.C.E and changing protocols as healing occurs.
• Restricting the movement of joints that need to rest to heal.
• Recognizing the risk of mini-fractures that may not show up on X-rays right away. If fractures are not obvious and go untreated they may become unstable when people try to use the injured area normally. A care team will watch for fractures that may appear later and ensure they have time to heal effectively and not become worse.
• Adjusting all affected joints to maximize function and alignment that help ensure that surrounding soft tissues will heal in balance with the attached bones.

Doctors of chiropractic (DCs) are an invaluable part of the health care team for slips and falls and may be a more accessible option for those cases that don’t require immediate emergency services. DCs are trained to examine the spine and extremities after injuries and are well-versed in the guidelines for concussion and management. Many offices also are equipped with X-ray capabilities for diagnosis and physiotherapy modalities that can be incorporated in recovery plans.

Chiropractic care is a family affair. From birth to the golden years, doctors of chiropractic (DCs) offer natural solutions for pain relief, provide strategies to support optimal health and lay a strong foundation in the prevention of future health issues. 

Not only can DCs offer targeted strategies that maximize joint function and deliver injury care for neuromusculoskeletal issues, they also provide consultation on other health topics like nutrition, exercise, posture and ergonomics so that family members of all ages can enjoy better health and well-being. For the young, the young at heart and all the steps in between, the benefits of chiropractic care can be found at every stage of life.

Fertility, Pregnant Moms and New Babies

As stated by The American Pregnancy Association, ‘Investing in the fertility and pregnancy wellness of women who are pregnant or trying to conceive is a routine matter for most chiropractors.’

From fertility, preparing the body for a healthy conception and pregnancy, to encouraging a healthy birth process, chiropractic care is uniquely positioned to offer safe, gentle approaches to support mothers and developing babies.

Studies in the Journal of Manipulative Physiologic Therapeutics (JMPT) and Obstetrics Gynecology respectively, have reported that nearly 50% of all pregnant women experience back pain during their pregnancy and up to 75% of women have back pain during labor.  

DCs understand how variations in hormones can affect the synovial joints and soft tissues in pregnant women. Chiropractic works to optimize joint function and provide stability as the biomechanics of expectant mothers change during gestation. Positive effects of chiropractic on the neuromusculoskeletal system helps many women to:

• Maintain a healthier pregnancy and posture
• Improve sleep
• Control symptoms of nausea.
• Reduce labor and delivery time.
• Relieve back, neck or joint pain.
• Promote an uncomplicated delivery

The birth process itself can be a stressful event for babies. Their small bodies must respond to strong uterine contractions and travel through the birth canal. In situations of cesarean section, breech birth, shortened or wrapped umbilical cord, an unnatural rotation or pulling on the head, surgery or the use of tools like forceps, the trauma can be compounded. It’s an issue that has long been recognized.

The Journal of the American Osteopathic Association featured a ground-breaking article in 1966 by Dr. Viola Frymann that helped the world understand the problem. It stated that 90% of babies were born with some type of injury as a result of the birth process. Of those, 10% were born with profound injuries that could be readily observed even by an untrained eye. Only 10% of babies were born without any trauma. These statistics imply that 80% of newborn babies have suffered some sort of insult that may not be easily recognized and go unattended.

Examining babies from the cranium to the pelvis and optimizing joint function can help facilitate the best possible start in life. Maximizing neuromusculoskeletal dynamics not only helps with restricted motion or pain, it can also often benefit other underlying issues such as colic, sleep difficulties, feeding problems and more.

Children and Adolescents

As babies grow into children, a number of developmental events take place including rapid growth of the skeleton, brain development, fusing of the cranial bones, hormonal changes and so much more.  

From toddlers to school-age, children are developing and increasingly engaged in a variety of activities that can affect the neuromusculoskeletal system. Learning to walk, riding a bike, growing pains, tumbles and falls, rough-housing during play, heavy backpacks and school sports can all contribute to creating imbalance or inciting injury. 

These formative years of growth are also the peak time to watch for signs of scoliosis. As spine experts, DCs are often invited into schools for professional scoliosis screenings or to discuss backpack safety. Chiropractors are also on the front line in the battle against ‘tech neck.’ Also called ‘text neck syndrome,’ the condition is becoming a worldwide 21st-century issue for children and adolescents. This syndrome refers to the abnormal straightening or reversal of the spinal curve that comes with an abnormal forward lean of the cervical spine. It can lead to pain, headaches, muscle spasm, a change in the natural curve of the spine, premature degeneration of the spinal joints and ultimate deformity. 

Young people are spending excessive hours a day on mobile devices texting friends, playing games, surfing the internet or watching videos. The resulting abnormal posture and joint damage is an issue of epidemic proportions for children and teens and may also be linked to other developmental, medical, psychological and social complications.

DCs understand the complexities of neuromusculoskeletal growth in children and how to minimize damage from strain on the spine caused by using mobile devices. Chiropractic care provides exams and adjustments to optimize joint function in the spine and extremities to help keep kids running at their full potential. DCs also offer exercises and techniques to maintain proper posture, provide guidance for ergonomic positioning and counsel families about tech time limits to help young people find a healthy balance with technology use.

Early Adulthood

As we traverse into adulthood in our 20s and 30s, entering the full-time workforce can usher in major changes in lifestyle and posture. If standing for repetitive work on an assembly line for eight hours a day, you may find yourself prone to a specific set of neuromusculoskeletal issues due to overuse. If sitting sedentary at a computer desk, a different but just as important set of concerns will arise.

DCs are advocates and valued partners for a variety of wellness initiatives focused on health and prevention in the workplace. Not only do they offer spinal and extremity adjustments to support healthy joint function, they can also recommend on-the-job workstation ergonomics, posture techniques, exercise and muscle balance strategies to naturally keep the spine healthy for years to come and help you keep your youthful edge.

Early to middle adulthood is also a time where many people may become ‘weekend warriors’ and physically ‘over-do’ it when there is time away from the job. This is often a time when people choose to have children too. As dads and moms are becoming sports stars on the weekends and trying to keep up with lifting, carrying, running and jumping with little ones it also becomes a time for inadvertent joint strains. Prompt care after a strain injury will help you heal faster and get back into the action.

Very important in this stage of life it is encouraged to be mindful about future bone health and conditions like osteoporosis and arthritis. A 2017 study in the European Journal of Rheumatology reported that worldwide, it is estimated that the number of patients with hip fractures stemming from osteoporotic bone fragility is more than 200 million. This is significant as hip fractures are associated with morbidity, mortality, loss of independence and financial burden later in life. 

Though it may seem early to think about it, osteoporosis is called a ‘silent disease’ process. This means it often isn’t detected until the damage is done and there is no cure. Early detection and preventative measures are paramount and it is never too early to emphasize joint health and start regimens to keep bones strong as we age.

Middle Age

As individuals enter middle age, chiropractors can help with the new sets of concerns that come with it. Changes in hormones and lifestyles in mid-life are a main focus as bone and joint health comes to center stage along with weight gain and other symptoms.

Some women may enter the preliminary hormonal changes of perimenopause as early as their 30s. Others may not go through the change and ultimate cessation of menses until their late 40s and early 50s. As symptoms of menopause occur such as irregular periods, hot flashes, mood changes and muscle mass changes, it is important to realize that bone density has a higher risk of depletion as your hormones deplete.

For men, a change of hormones also occurs, though differently than in women. Women’s hormones plummet during the relatively short period going through menopause. In men, the production of testosterone and other hormones declines steadily over a span of many more years. Low levels of testosterone in older men may often go unnoticed, but they can be detected by a blood test. Symptoms of declining hormones in men may include but not be limited to concerns such as: height loss, low bone mineral density, sweats, ‘man breasts,’ low libido, mood changes, reduced muscle bulk, reduced strength and an increase in body fat.

With the natural progression of these changes in hormones, musculoskeletal pain and arthritis are recognized as being increasingly common after you pass the age of 50. In addition to neuromusculoskeletal care to reduce pain and maximize joint function, a      DC can help individuals analyze their specific risk factors for osteoporosis and the possible need for a bone screening study. Your DC can also recommend nutritional foods and supplements targeted to support the metabolic needs of your bones, as well as help you devise a plan of specific weight-bearing exercise to help maintain healthy bones and strength over time.  

The Golden Years

In our golden years (generally considered around age 65 and beyond) chiropractic care strives to enhance quality of life and promote independence by helping patients maintain optimum mobility and stability in the joints.  As our bodies age we find that joints stiffen and balance naturally declines. These factors increase the risk of falling and make the possibility of suffering an injury more common. Older adults are also particularly vulnerable to back pain.  A 2016 study in the journal Clinical Interventions in Aging listed back pain as one of the top two reasons that elderly patients visit a doctor’s office. 

DCs continue to increase in popularity with older adults as they utilize gentle low impact techniques that are safe and effective to maximize joint function which can significantly reduce pain and reduce the need for surgery or drugs that could have potentially dangerous side effects. DCs also can provide recommendations for nutritional foods and supplements targeted to support the metabolic needs of older bones, offer solutions for tight muscles, as well as help you devise a plan of specific weight bearing exercise to help maintain strong bone health and enhance balance and stability to reduce fall risk.

Natural Care for the Entire Family

Doctors of chiropractic are primary care neuromusculoskeletal specialists with extensive diagnostic skills and are well-trained to offer a drug-free hands-on approach to healthcare that includes patient assessment, ordering special studies, diagnosis, management and referral or co-management when indicated. DCs are specialized to:

• Analyze and adjust the joints of the spine and extremities to optimize function
• Recommend therapeutic and rehabilitative exercises
• Recommend or apply a wide-range of soft tissue mobilization techniques
• Recommend or apply physical modalities such as heat, laser, ultrasound,      electrotherapies, traction
• Provide nutritional, ergonomic and lifestyle recommendations

Chiropractic care works toward short and long-term goals to go beyond pain relief to promote prevention and enhance quality of life. Ask your DC to develop a comprehensive care plan tailored for each member of your family to provide a safe gentle approach to optimize health at every stage of life. 

According to data from the UN’s International Telecommunication Union and the World Bank, within the last decade, the number of active cell phone subscriptions on the planet grew larger than the population of actual people living here. Compared to the estimated 8 billion people currently comprising the populace, and with many people having more than one subscription, in 2021 there were nearly 15 billion mobile devices being used worldwide and that number is projected to reach in excess of 18 billion by the year 2025.

Though the utilization of cellular data is now considered a common necessity in the modern world, it is also creating epidemic-level health concerns that are becoming more and more commonplace. 

What is Tech Neck?

Tech neck, also commonly called ‘text neck syndrome,’ is not just caused by texting. It is a condition that exemplifies the price our bodies are paying due to the upsurge of technology use as a whole and is swiftly being considered a 21^st century health issue. The unnatural positioning of the body while using phones, tablets, computers and other devices is creating undue stress on the involved joints and soft tissues of the body such as joint capsules, muscles, ligaments, tendons and nerves.  

The syndrome comprises a complex cluster of clinical symptoms that can result in strain on the cervical spine (neck), cervical degeneration, deformity and other developmental, medical, psychological and social complications. Basic symptoms may include but not be limited to: headaches, pain, stiffness, neck spasms, back pain, numbness, tingling or even weakness in one or both arms. Tech neck may also cause sharp, sudden pain in the neck when users look down at their phone or other devices.

Understanding the Physiology

Ideal spinal anatomy consists of spinal curves that create an ‘S’ shape from head to tailbone. These arcs include lordotic (forward) curves in the neck and low back, and a slight kyphotic (backward curve) in the thoracic region. At proper angles, these curves serve to allow movement, support the head on a strong secure ‘pillar’ and stabilize the spine.

Tech neck correlates with a very specific abnormal posture that is hallmarked by anterior weight-bearing of the head. Anterior weight-bearing means that the head is unnaturally hanging forward, away from the body and away from the supportive column of the spine. This can create immense pressure on the joints and soft tissues of the spine and lead to straightening or even reverse the normal curve of the neck which predisposes people to joint damage in the neck and spine, a dowager hump, other health complications and future deformities.  

The head is like a 10-12 pound bowling ball that sits atop the strong pillar of the spine. As shown in the image, “The Weight of Strain,” in an ideal posture, the head is positioned over the pillar of the spine and is held even with the shoulders. This natural position would only exert pressure that would simply equal the weight of one’s head. As the head incrementally comes forward (away from the support pillar) from looking at devices, the pounds of pressure created increases detrimentally and correlates with the angle of the neck and head. The joints of the spine and soft tissues of the head, neck and back can be subjected to an additional 27-60+ pounds of pressure with technology use. When you think about this happening for many hours each day, every day, it ultimately alters posture and leads to degeneration, deformity and symptoms (not necessarily in that order).

In general, people are overusing devices every single day to text, stream, surf the web, answer emails, etc. and it is altering normal posture. After consistently looking downward with the head hanging forward throughout the bulk of the day (while using devices) the problems compound. 

Children and youth, starting with the use of devices so young, are especially at risk for problems earlier in life, even before being fully grown. Having forethought about what postures can affect future health is pertinent for technology users of every age. Young people in particular could be setting themselves up for a variety of imminent health issues and even a shortened life expectancy.

Tech Neck in Children and Youth

For those of us that adopted technology use later in life, and in moderation, it may not seem like such an issue. However, for children and adolescents, the use of tech is ingrained in daily life and most spend a median of 5-7 hours a day on their smartphones and handheld devices. This comes with an extensive positioning of their heads and necks flexed forward to text and watch their screens. 

The excess stress from these abnormal postures is alarming and can involve the musculoskeletal system, eyes, heart, lungs, head and mental health. In the past, children would go outside to play and interact with other people. Kids of the 21^st century are more sedentary and spend more time alone in their rooms staring at their phones. They may have more ‘friends’ on social media, but they are lacking face to face meaningful relationships and the physical activity required for optimal childhood growth and development.

In a recent study of 207 children and adolescents with nonspecific neck pain, 180 were diagnosed with musculoskeletal findings and muscle spasm. Of the 180, 100% reported flawed flexion of their back and neck while studying and/or using devices. Also, 21% had eye symptoms and 82% of the parents of participants reported a change in the social and psychological behavior of their children.

Chiropractic Care on the Front Line

Doctors of chiropractic (DCs) have a long-standing history of whole body health and prevention. As musculoskeletal experts, DCs can examine and evaluate children’s spines and postures, adjust affected joints and recommend changes and exercises for spinal alignment.

DCs can also advise on ergonomic positioning when using devices and help guide parents through the process of creating limited screen time for their kids to promote physical and social activity to benefit healthy well-rounded development.

Beginning a successful exercise regimen requires an understanding of how to avoid injury and ensure you are properly prepared for the increased stress that this will play on your body. To take the stress out of your work out, this article will showcase why the engines of locomotion are firmly planted on the ground and why they are so important. 

Foot and Ankle Anatomy 

The human foot is a complex machine consisting of a flexible network of structures including: bones, joints, muscles, tendons and ligaments. Each foot consists of 26 bones, 30 joints and more than 100 muscles/tendons/ligaments all of which work together to provide support, balance and mobility. Sections of the foot are divided into three recognized areas:

• The Forefoot: includes the bones of your toes (phalanges) and the five longer bones that attach to them, called metatarsals.
• The Midfoot: consists of a puzzle-like pyramid of bones that contribute to the arches of the feet. These include three cuneiform bones (meaning wedge-shaped), the cuboid bone (square) and the navicular bone which gets its name from being boat-shaped.
• The Hindfoot: contains structures to form the heel and ankle. The talus bone supports the bones of the lower leg (fibula and tibia) to create the ankle. The calcaneus (heel bone) is the largest bone in the foot.

What many people don’t realize is that each foot also contains three arches, not just one. When functioning properly, they work the same way as a spring, allowing the feet to bear the weight of the body and absorb the shock produced during activities like walking, running and jumping.

• The Medial Longitudinal Arch: Stretches from the ball of the foot (under the big toe) to the heel. This is what most people think of when discussing ‘the arch of the foot’ because it is the highest and most noticeable arch.
• The Lateral Longitudinal Arch: Spans from the ‘ball’ under the pinky toe to the heel. Note that what we think of as the balls of our feet are actually the heads of the metatarsal long bones where they meet the toes. 
• The Anterior Transverse Arch: Crosses the width of the foot from the ball of the foot under the big toe to the ‘ball’ under the pinky toe and represents the arc of the metatarsal heads.

All of these structures form an association of moveable parts that work synergistically. As experts in optimizing joint function and alignment, doctors of chiropractic (DCs) not only address joints in the spine, they also work with the many joints of the upper and lower extremities and have a detailed understanding of the complexities of the foot and its many supporting structures.

Understanding the Kinetic Chain

Feet are the body’s foundation. Our feet provide the groundwork for our upright weight-bearing posture. This makes them a primary influence when we talk about the kinetic chain in the body. ‘Kinetic chain’ is actually an engineering concept used to describe human movement. It refers to the interconnectedness of the body and how our body areas work together, compensate for or affect one another to perform movements. When choosing footwear, the importance of having proper support to promote functional stability for the many joints and arches of the feet cannot be undervalued. 

It has been estimated that every pound of body weight exerts up to three pounds of force that the feet have to absorb when walking. If a person weighs 200 lbs., the force on the feet will be up to 600 lbs. When running, that number grows exponentially with up to seven pounds of force per pound of body weight being exerted which would translate to 1,400 pounds of pressure per footfall for our 200 lb. example. 

Foot and ankle biomechanics influence motion and function throughout our skeletal structure. Improper gait, foot strike or subtle differences in functionality from one foot to the other can all translate stresses up through the knees and into the hips, pelvis and spine. Anyone who has ever broken a toe, been in a leg cast or sprained an ankle will inherently relate to this concept of how a change in gait can cause pain in other areas. However, an injury does not have to be the primary cause of compensatory pain. Pain can also manifest simply from the way you are walking.

Watching your Step

Over-pronation, for example, is a very common finding in patients. It means you are walking more on the inside arch of your foot. Walking this way actually creates an unnatural internal rotation in the lower leg, which when combined with typical joint positions needed to simply walk, translates to stress in the knee joint and has been shown to increase the risk for knee injuries and back pain.

Internal rotation of the lower leg from over-pronation has also been correlated with an increased Q-angle (Q for quadriceps). The Q-angle is a valuable indicator when evaluating biomechanical function in the lower extremity. The assessment of it provides useful information about the alignment of the hips, pelvis, leg and foot. Increased Q-angle measurements have been associated with higher incidence of ACL injuries.

As we continue up the body, we find multiple studies have also linked over-pronation in the foot to unspecified low back pain. In 2017, a randomized controlled trial was published in the journal Archives of Physical Medicine and Rehabilitation which concluded that over 40% of patient participants had a significant reduction in low back pain and an increase in function with a combination of custom foot orthotics and chiropractic care. This exemplifies how much impact a well-functioning foundation can have on our musculoskeletal system as a whole.

Optimum Foot Strike and Support

The way you walk contributes to significant outcomes. Years of improper walking can lead to joint stress, pain, degeneration, spurs, fallen arches, and in the shorter term, can translate to compensation and resulting pain in your ankles, knees, hips and spine. 

Most people will demonstrate a better foot strike when barefoot. This is because the nerves in your feet can feel the ground and adjust the way your steps hit the floor. Being barefoot on the beach isn’t just a daydream, it also takes more effort than walking on a hard surface and strengthens your foot and ankle while you burn more calories!

With shoes, people are more prone to developing bad walking habits such as dragging the feet, heavy impact steps and limiting natural movement in the joints of the foot. Most of us, however, need to wear shoes the majority of our waking hours. Watch the soles of your shoes, if the outer sole wears down unevenly it can be a strong clue that you need to adjust your foot strike/gait. 

To best support your feet, keep the following considerations in mind to help optimize the way that you walk:

• Proper Posture: Stand up straight/shoulders back/head supported by your spine. Do not look down (such as at your feet or your phone), look forward. Feet should be shoulder width apart/chest forward and abdominals/core muscles engaged.
• Foot Strike: Should begin with the heel landing squarely on the floor. As you roll onto the entire ball of your foot the heel should begin to slightly lift and toes should be flexed. The step should spread to each toe, beginning with the small toe hitting the floor and lifting up off the ground as you complete the step. Mindfully watch to see if your step has you rolling inward or outward.
• Gait: Ensure your toes face forward to keep the ankles in a neutral position. If toes are in a ‘V’ outward or inward it creates strain on soft tissues of the ankle and heel.
• Shoe Fit: Ensure that your shoes are supportive for all areas of the foot and that they are flexible and provide ample width. Also note if they are causing blisters. Custom orthotics may be indicated for many patients that require extra support to ensure that foot strike is optimized. 

Urban exercise myths like ‘no pain, no gain’ certainly do not apply to the foot. Your feet should not feel pain during normal walking or with exercise activities. In the chiropractic office, DCs can analyze and advise on your foot strike/gait, evaluate the complexities of the foot and kinetic chain, adjust affected areas to optimize joint function and mobility, offer strengthening exercises and many offices are also equipped to take foot molds and have custom orthotics created for patients that need to augment foot support. 

For more information on the benefits of walking and running read the Next Step Walking Guide and tune into our ‘Adjusted Reality’ podcast interview with elite endurance athlete, author and adventurer, Colin O’Brady, as he discusses the benefits of walking and how shifts in mindset can enhance our time on the trail.      

Embracing a Menopause Mindset

Every single day, millions of women all around the world are experiencing a natural mid-life progression called menopause. Mindsets about it, however, can be very different. In the Western world, for example, the menopause event seems to carry with it a lot of stigma and may be viewed negatively with aspects of aging. Loss of menses and mid-life hormonal changes are treated as a medical event vs. a natural conversion that our bodies were made to undertake. 

In China, the process of menopause is much different, described as a ‘rebirth’; a time when energy that was once used for fertility/child-bearing and rearing can be saved and repurposed. Many other cultures see the process as one of liberation and ‘being set free.’ In Japan, menopause is viewed as an expected stage of life and the term for it, konenki, actually means renewal, season and energy. For many cultures, the time of menopause is one for celebration and postmenopausal women are revered in the community as mentors with experience and wisdom. Embrace menopause with a positive mindset.

Defining the Process

Menopause is a term loosely used to describe the cessation of menses. Though it sounds like a simple instant change, it is actually a multi-stage process. These stages include:

• Perimenopause: The time (often years) leading up to menopause. During this time hormones change/decline and menstrual cycles may become inconsistent. Women may begin to feel side effects of these subtle hormonal shifts such as hot flashes, vaginal dryness, mood changes, sleep issues and menstrual irregularity. 
• Menopause: The body stops producing the hormones that cause your menstrual period. After going without a period for 12 consecutive months, you are medically considered to be in menopause. If you go without a period and after 10 months you get one, it is not official and you begin the count again. After the 12 consecutive month benchmark, you enter postmenopause.
• Postmenopause: Once menopause has occurred, women are in a postmenopausal state for the rest of their lives.

It is important to note that the process of menopause should not be associated with a specific age. It is a change in physiology, and for some women, perimenopause can begin as early as in their 30s. Other women don’t go through the change until their late 40s or 50s. The menopausal experience is a process specific to each individual. Some women breeze through the progression and others may experience symptoms such as: hot flashes, mood issues, urinary/bladder symptoms, vaginal dryness or sleep disruption. Musculoskeletal and joint pain are also correlated with age and hormonal changes.

Doctors of chiropractic (DCs) provide care to support women throughout their lifecycle, from the onset of menses, through child-bearing years and as they work through the natural and expected process of menopause.      

21^st Century Considerations

A core contributor to increased symptoms for menses and menopause is stress.  Stress has been well-documented to worsen menstrual symptoms, to affect fertility during childbearing years, and to contribute to menopausal symptoms. Stress is also a growing concern in our modern world. In the body, it is our adrenal glands that respond to stress. These walnut-sized glands that sit on top of our kidneys are also responsible for producing the precursors for our sex hormones including: estrogens, testosterone (androgens and DHEA) and progesterone. This means that high stress can affect all of these other hormones. Optimal adrenal gland function is needed for a smooth menopausal transition and stress reduction is paramount.

Talking to family members (grandmothers, mother and aunts) can help you get a feel for what your menopausal experience may be like. However, if a 21^st century woman is under significantly higher stress than her relatives (or vice-versa), that could change family correlations.

Common medical interventions for menopausal symptoms, such as Hormone Replacement Therapy (HRT), can include significant risks including: breast cancer, endometrial cancer, blood clots in the legs and lungs, heart disease, strokes and an increased risk of dementia and gallbladder problems. For that reason, women all over the world are opting for more natural approaches to address symptoms.

Reducing stress should be at the top of the list. Chiropractic care has a long history of aiding in the alleviation of many of the symptoms of stress. It been demonstrated that as chiropractic optimizes joint function, it contributes to muscle relaxation and pain relief. Studies have also specifically shown that menstrual pain associated with primary dysmenorrhea may be alleviated through lumbosacral joint care. 

Preventing Conditions of Change

Beyond basic symptoms of hormonal change, it is important for women to take a preventative approach to the more critical conditions associated with aging and preventative actions are the best way to combat those conditions.

Osteoporosis is a primary concern after menopause. This is because women lose bone more rapidly due to decreased hormone levels. Research indicates that up to 20% of bone loss can happen during these stages. More than one in ten women over the age of 60 are affected by osteoporosis worldwide. Bone loss increases the risk of developing osteoporosis and bone fractures. The bones of the hip, wrist and spine are most commonly affected.

Cardiovascular disease is another major concern. Decreased hormones make women more prone to cardiovascular disease complications including heart disease, stroke and heart attack. After menopause, many women also become more sedentary which can lead to higher cholesterol levels and ultimately high blood pressure. 

Your Partner on the Menopause Path

Your doctor of chiropractic (DC) can help you navigate a positive path through menopause by helping you monitor osteoporosis and osteopenia (a precursor to osteoporosis) through a referral for bone mineral testing. DCs can also design a program of specific weight-bearing exercises to help keep bones strong, and recommend nutrition (such as calcium and vitamin D3 which supports the absorption of calcium) that will help promote the foundational needs of bone tissue.

Chiropractic care can also help you get moving with exercise plans, promote healthy eating habits, and aid in smoking cessation (if needed) which are all paramount to preventing heart disease. 

On the symptomatic level, chiropractic can offer relief from joint aches and pains by promoting optimal joint function, provide recommendations for stress reduction techniques and advise on nutrition to support adrenal function and hormonal balance to give you the smoothest menopausal experience possible so that you can enjoy the newfound freedom that comes with the season of postmenopause.