Training for improved torsional control

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Torsion can play a big role in cLBP given the prevalence of disc ‘tears’. McGill points out torsion can be a distinct problem to many and training/exercise methods that utilize twisting motions can be more damaging than helpful. He decries the use of “torsion” based rotation machines. These machines are poor oblique trainers and impose high compression on the discs. Generating torque about the twist axis imposes 4Xs the compression as equal torque about the flexion/extension axis.  The exercise determined to impose the least compression but successfully train the “torsional moment generators” is the one-arm, supported dumbbell row. The exercise is performed by supporting the upper body in slight flexion with one-arm and rowing with a dumbbell while bracing the core. Other motions which impose greater loads such as cable “pulls” and “chopping” motions can come later when torsional control is optimized.

Dr. Kennedy comment: I have trained many patients using the one-arm, supported core-brace row and found it to be extremely important. It’s also simple and convenient for anyone to perform at home themselves. His core “brace techniques” should be a staple in any Chiropractic rehab regime.

“equine Chiropractic care is a rapidly emerging field among veterinarians due to increasing demand from horse owners for alternative therapies”.

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This magazine article in July’s The Horse continues a trend toward good press for the profession. Dr. Taryn Yates DVM begins: “equine Chiropractic care is a rapidly emerging field among veterinarians due to increasing demand from horse owners for alternative therapies”. “It is an art of healing that focuses on restoring the spinal column’s normal movement and function to promote healthy neurologic activity”. “Chiropractic can be very useful for alleviating pain in horses with chronic issues…its benefits are greatest when used in conjunction with traditional veterinary care to help keep a horse balanced and performing at his best”. “There are many circumstances where adding chiropractic to your horses’ health care routine would be appropriate, the most significant being signs of pain…behavior changes, abnormal posture, reduced performance sensitivity to touch or difficulty turning”.

 

Dr. Kennedy comment: I have attempted (using an Arthristim, not manipulation) to adjust my and others horses over the year. Never were there any adverse consequences and often very good results. More recently with our older horse we’ve been relying on Diowave 15 watt Laser treatments for a stifle issue. The medical director of Diowave is in fact a DVM and is always enthusiastic to recommend a series of Laser sessions.

 

horse chiropractic

Annals of rheumatic Diseases & American College of Rheumatology (2003)

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 “Steroid injections, though widely used in clinical practice for sciatic/HNP for over 50 years provide no additional benefit vs. saline solution. The natural history of sciatica is such that most patients improve over time, which may hide the treatment effect”.

The prevalence of prolapsed disc is 1%-3%. Sciatic due to herniation resolves within one month in up to 70% of patients and within one year in 90% according to these studies. Surgery should be reserved for the very small minority who do not show response within the expected parameters.

The widespread use and reliance on steroid injections shouldn’t be confused with the effectiveness of such injections. Cochrane reviews suggest a small-to-modest effect but as is noted the natural history vs. treatment effect is always difficulty to factor out (the so-called regressive analysis).

We all have sent patients to the pain management centers for fluoroscope injections and at times they clearly “appear” to work…and at other times the patient continues with our treatment.

Recent studies cast doubt on Medrol dose packs and these studies cast doubt on injections.

Laser, decompression, spinal adjusting and core-control are still the best, most advantageous approach for most patients.

“Back trouble” factoids….

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Inheritability of back pain may be as high as 68% with inheritable factors including disc degeneration (statistically accounting for up to 75%) and tendency toward psychological distress.  Four studies draw the conclusion muscle strength and general fitness appear to be of little significance and there is no persuasive evidence flexibility, gender or leg length inequality play a meaningful role. Taller men do have a higher prevalence of certain disc problems presumable due to the fact tall people lift weights at the end of longer lever arms. Several studies have concluded there is “moderate evidence” that lumbar flexibility, bodyweight and straight leg raise have no predictive value for future LBP. Additionally recent studies also show moderate evidence that general cardiorespiratory fitness has no predictive value for future LBP.  And has been mentioned in other blogs MRI and radiographs hold NO value in predicting future LBP.

A relatively recent systematic review (Pincus et al Spine 2002) of psychological factors as predictors of “unfavorable outcomes” concluded there is “good evidence” to implicate distress/depressive mood and somatization in development of chronicity.

And there is also “strong evidence” psychological factors play an important role in persisting symptoms. A workers’ belief regarding their work having caused their pain and their expectations of inability to return (‘yellow flags’) are of particular importance.

Revisiting MRI findings: circa 1990 (Bodon et al Mar J Bone Joint Surg)

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They found 1/3rd of asymptomatic individuals to have a “substantial abnormality”.
Those under 60; 25% had a HNP, over 60 nearly 60% showed abnormalities; 40% HNP and 25% stenosis. Degeneration and bulging was found in more than a 1/3rd of those under 40 and in everyone 60 and older.
In 1994 similar findings were demonstrated in a study in the New England Journal of Medicine.
MRI T2 weighted images reveal that degeneration may begin in the teens especially in athletic individuals.
Degenerated discs are ubiquitous and assumed a source of pain but how they are “turned on” remains elusive…however an untenable or uncontrolled torque is usually the mechanical act that may initiates the pain (dietary and psychological factors notwithstanding).
I will guess that eventually MR scans (or another technology) will become so detailed as to reveal the microscopic fibers and the “active tear” where the pain probably generates. Why the pain fails to disappear after months in 10-15% is also elusive but recurrent mechanical stress and inefficient systemic healing must play a role.