Chiropractic + Naturopathic Doctor • May 2017 • Roundup

Music therapy decreases pain in patients recovering from spine surgery, compared to a control group of patients who received standard postoperative care alone, according to results of a new study.

The study, published in the American Journal of Orthopedics, included a team of researchers from The Louis Armstrong Center for Music and Medicine and the Mount Sinai Department of Orthopaedics. About 70 per cent of people in the United States experience at least one episode of back pain in their lifetime, and more than five million are temporarily or permanently disabled by spinal disorders.

“This study is unique in its quest to integrate music therapy in medicine to treat postsurgical pain,” said John Mondanaro, the study’s lead author and clinical director of The Louis Armstrong Department of Music Therapy. “Postoperative spine patients are at major risk for pain management challenges.”

Visual analog scale (VAS) pain ratings were collected before and after music therapy in the experimental group and within the same time period in the control group. In the control group, VAS pain levels increased slightly, from 5.20 to 5.87. In the experimental group, however, VAS pain levels decreased by more than one point, from 6.20 to 5.09.

“The degree of change in the music group is notable for having been achieved by non-pharmacologic means with little chance of adverse effects,” said Joanne Loewy, co-author of the study and director of The Louis Armstrong Center for Music and Medicine. “Pain is subjective and personal, and warrants an individualized approach to care. Certified, licensed music therapists are able to tailor treatment to each patient’s musical preferences and meet their pain level.”

Music therapists from the Louis Armstrong Center provided treatment options to each patient, including patient-preferred, live music that supported tension release/ relaxation and joint singing and/or rhythmic drumming. Breath work and visualization techniques were also offered.

Postoperative pain treatment, which is primarily pharmacologic, is a critical component of recovery, particularly during the immediate postoperative period, when pain and anxiety are prominently increased.

For this study, researchers provided 30 spine surgery patients with a 30-minute music therapy session within 72 hours after surgery in addition to standard care. Another 30 spine surgery patients received standard postoperative care without music therapy. The 60 patients ranged in age from 40 to 55 years and underwent anterior, posterior, or anterior- posterior spinal fusion.

Ice fishing might seem like a benign sport for everyone – except the fish. Sitting in a cozy shanty waiting for a bite, what could go wrong? A lot, Mayo Clinic surgeons have found. The ice fishing injuries they have chronicled seem more like a casualty list from an extreme sport: burns, broken bones, concussions and more. The findings are published in the American Journal of Emergency Medicine.

The study team analyzed data on emergency department visits between 2009 and 2014 obtained from the National Electronic Injury Surveillance System – All Injury Program and found 85 patients hurt while ice fishing. There may be more cases than they could find; the researchers had to search case narratives to identify ice fishing injuries.

Most of the 85 patients were treated and released. Roughly 11 per cent were injured so severely they had to be admitted to the hospital.

“Falling through the ice is the most feared risk of ice fishing,” says lead author Dr. Cornelius Thiels, a surgical resident at Mayo Clinic. “However, it turns out that burns are just as common, but rarely discussed. Ice fishing huts often contain rudimentary heating systems, and we have seen injuries from fires and carbon monoxide inhalation. We hope this research will bring awareness to the safety issues that surround this pastime and help prevent similar incidents.

“Nearly half of the injuries were orthopedic or musculo-skeletal: broken bones, sprains and strains. Just over one-third involved minor trauma, such as cuts, abrasions, punctures and fishing hook injuries. There were five cases of major trauma, a category that includes concussions, loss of an appendage and organ injuries.”

Four anglers were injured falling into cold water: two in December and two in March. Four were burned, likely due to the heating systems they were using, the study found.

The researchers also looked for differences between injured ice anglers and people hurt while fishing on open water. Intoxication was likelier to be reported with ice fishing injuries. Those harmed while ice fishing were likelier to have injuries to the torso or lower half of the body, and to have more serious injuries. Both groups were similar in age and gender: Most injured anglers were men under 40.

“Ice fishing has become more popular in the last few years and, with this, we have seen an increase in ice fishing- related injuries,” Thiels says.

“What is even more concerning is that ice fishing injuries tend to be more severe than injuries associated with traditional fishing.” – Newswise

Health Canada has launched a second set of public consultations about a controversial plan to revamp regulations governing self-care products such as natural health remedies and over-the-counter medications.

Public meetings to gather consumer and industry input about the proposed changes began April 4th in Saskatoon and continue in cities across the country for the next three months, said Manon Bombardier, director-general of the department’s Natural and Non- Prescription Health Products Directorate.

The Canada-wide consultation process follows a web-based gathering of opinion last fall that heard from more than 3,500 respondents, including consumers, industry representatives, health providers and public interest groups.

Much of the feedback was negative – with proponents of natural health products, in particular, expressing concerns over the suggested retooling – prompting Health Canada to develop “refined” proposals and take the consultation initiative on the road.

The proposed framework is meant to modernize the way self-care products and non-prescription drugs are regulated, Bombardier said, noting that some of the rules were first enacted decades ago.

“We want to ensure that Canadians continue to have access to a wide range of products that are safe and effective and can enter the market on a timely basis,” Bombardier said.

Self-care products considered moderate- or high-risk – such as a new, non-prescription painkiller – would require a government review, based on science-based evidence that supports the manufacturer’s health claims.

Lower-risk products – including vitamins, homeopathic remedies and herbal medicines with a long history of use – would not be reviewed by Health Canada.However, they would no longer be able to make claims about prevention or treatment of a particular health condition, such as “relieves back pain.”

“Health Canada is of the view that self-care products in general are lower risk and therefore will not be treated (like) prescription drugs,” Bombardier said.

The overhaul of self-care product regulations, put forward last fall, was met with opposition from many consumers, producers and retailers of natural health products, among them the Canadian Health Food Association.

The trade association, which represents manufacturers, distributors and retailers of natural and organic health products, expressed concern that if adopted, the proposed changes would limit government oversight for some natural health products, reduce information on their labels and boost their cost. Some products might disappear from the market, while development of new products could be curtailed, the organization argued.

The foot and tibial angles of a rearfoot strike runner do not correlate well with loading impact rates, according to research presented at this year’s Association of Academic Physiatrists Annual Meeting in Las Vegas.

Despite numerous health advantages, running injuries are common with incidence rates ranging from 19.4 to 79.3 per cent.

Foot strike patterns have been a topic of debate with regards to injury risk in runners. Foot strike patterns are typically separated into three categories: rearfoot strike, where the runner’s heel hits the ground first; midfoot strike, where the runner’s foot lands flat; and forefoot strike, where the runner’s ball of the foot lands on the ground first.

Runners with a rearfoot strike make up 69 to 95 per cent of modern competitive and recreational endurance runners. A rearfoot strike is associated with an abrupt impact and increased force applied to the runner’s leg and foot (called a load rate), which can lead to injury.

Forefoot runners have been reported to sustain less injury than rearfoot runners. Rather than transitioning to a forefoot running pattern, which takes time to adjust to, it has been suggested that landing with a less dorsiflexed foot and a more vertical tibia (or, shinbone, as it is commonly called) is a way to lower impact on the leg and foot. In other words, landing with a near flat foot onto the ground.

To address this, researchers recently studied the relationship between foot angle (angle formed between the ground and foot on initial contact with the ground) & tibial angle (angle of the tibia from perpendicular landing) with vertical average load rate as well as vertical instantaneous load rates. These load rates are a subset of values involved in ground reaction forces. A ground reaction force is the force exerted by the ground onto the body at the time when the body comes into contact with the ground.

“In runners, the association of higher impact loading rates and injury risk has been demonstrated in previous studies,” said Dr. Robert Diaz, resident physician at Spaulding Rehabilitation Hospital/ Harvard Medical School and lead investigator in the study.

“To obtain this valuable information, a clinic would need to utilize expensive equipment such as an instrumented treadmill lab with motion capture cameras and computer software to analyze 3D models and force data.

“Our team wanted to identify a proxy for loading impact rates to attempt to use this information in a typical musculoskeletal or sports medicine clinic without the expensive equipment. The proxies we chose included the foot and tibial angle values on footstrike that were obtained using a digital camera that any clinic would have access to. We hypothesized that those rearfoot strike runners that had higher foot and tibial angles would have higher impact loading rates, and therefore would have a higher risk of a running injury.”

Diaz’s team studied 110 runners who typically run barefoot. Sixty-nine of these runners were being treated for a running injury at the time of the study, and 41 of the runners were healthy. The group, which was evenly split between men and women, had an average age of 36, an average BMI of 23, and were rearfoot.

The participants each ran on a treadmill while a high-speed camera recorded 10 consecutive left foot strikes. Diaz’s team used the video footage to calculate average foot and tibial angles as well as vertical average load rates and vertical instantaneous load rates in each participant.

In the group of injured runners, Diaz’s team found no association between foot angles and tibial angles and vertical average load rates or vertical instantaneous load rates. The average foot angle was similar between the group of injured runners and the group of healthy runners, but the tibial angles were increased in healthy runners. The significance of this finding is unclear.

Finally, both vertical average and instantaneous load rates were higher in injured runners than in healthy runners consistent with prior literature.

“Based on our team’s study, unfortunately a rearfoot strike runner’s foot and tibial angles do not correlate well with loading impact rates,” Diaz notes of the findings.

“We recommend to our colleagues not to use these angles as surrogates for estimating impact loading in runners. Our data suggests that there are other contributors, besides foot and tibial angles, that are important to determine impact loading values. For those runners who are interested in lowering their impact loading and injury risk, we recommend evaluation in a running lab.” – Newswise

Insufficient sleep, a common problem that has been linked to chronic disease risk, might also be an unrecognized risk factor for bone loss. Results of a new study were presented March 31st at the Endocrine Society’s 99th annual meeting in Orlando.

The study investigators found that healthy men had reduced levels of a marker of bone formation in their blood after three weeks of cumulative sleep restriction and circadian disruption, similar to that seen in jet lag or shift work, while a biological marker of bone resorption, or breakdown, was unchanged.

“This altered bone balance creates a potential bone loss window that could lead to osteoporosis and bone fractures,” lead investigator Dr. Christine Swanson, an assistant professor at the University of Colorado in Aurora, Colo., said. Swanson completed the research while she was a fellow at Oregon Health & Science University in Portland, Ore., with Drs. Eric Orwoll and Steven Shea.

“If chronic sleep disturbance is identified as a new risk factor for osteoporosis, it could help explain why there is no clear cause for osteoporosis in the approximately 50 per cent of the estimated 54 million Americans with low bone mass or osteoporosis,” Swanson said.

Inadequate sleep is also prevalent, affecting more than 25 per cent of the U.S. population occasionally and 10 per cent frequently, the U. S. Centers for Disease Control and Prevention report.

The 10 men in this study were part of a larger study that some of Swanson’s co-authors conducted in 2012 at Brigham and Women’s Hospital in Boston, Mass. That study evaluated health consequences of sleep restriction combined with circadian disruption. Swanson defined circadian disruption as “a mismatch between your internal body clock and the environment caused by living on a shorter or longer day than 24 hours.” Study subjects stayed in a lab, where for three weeks they went to sleep each day four hours later than the prior day, resulting in a 28- hour “day.” Swanson likened this change to “flying four time zones west every day for three weeks.” The men were allowed to sleep only 5. 6 hours per 24-hour period, since short sleep is also common for night and shift workers. While awake, the men ate the same amounts of calories and nutrients throughout the study. Blood samples were obtained at baseline and again after the three weeks of sleep manipulation for measurement of bone biomarkers. Six of the men were ages 20 to 27, and the other four were ages 55 to 65. Limited funding prevented the examination of serum from the women in this study initially, but the group plans to investigate sex differences in the sleep-bone relationship in subsequent studies.

After three weeks, all men had significantly reduced levels of a bone formation marker called P1NP compared with baseline, the researchers reported. This decline was greater for the younger men than the older men: a 27 per cent versus 18 per cent decrease. She added that levels of the bone resorption marker CTX remained unchanged, an indication that old bone could break down without new bone being formed.

“These data suggest that sleep disruption may be most detrimental to bone metabolism earlier in life, when bone growth and accrual are crucial for longterm skeletal health,” she said. “Further studies are needed to confirm these findings and to explore if there are differences in women.”

This study received funding from the National Institute of Arthritis and Musculoskeletal and Skin Diseases, the National Institute on Aging and the Medical Research Foundation of Oregon.

A new study in the Journal of the American Medical Association (JAMA) adds to a growing body of research supporting spinal manipulative therapy (SMT) as a first-line treatment for acute low back pain, according to the American Chiropractic Association (ACA).

The review examined randomized controlled trials, systematic reviews and other published research since 2011 to determine the effectiveness and safety of SMT for low back pain patients. Researchers found that spinal manipulation was associated with statistically significant improvements in pain and function for up to six weeks with no serious adverse side effects.

“As the nation struggles to overcome the opioid crisis, research supporting non-drug treatments for pain should give patients and health-care providers confidence that there are options that help avoid the risks and dependency associated with prescription medications,” said ACA president Dr. David Herd.

Commenting on the report, the British Columbia Chiropractic Association (BCCA) said the JAMA review provides the “needed evidence to support what patients and practitioners are seeing in practice.” Approximately a million people utilize chiropractic in B.C. each year.

“We are hoping that endorsements and studies such as this will help our stakeholders and governments improve their positions toward chiropractic involvement in health care,” BCCA president Jay Robinson and communications manager Angie Knott said in a statement.

Benjamin De Villena, a second year student at Canadian Memorial Chiropractic College, has won the Canadian Chiropractic Guideline Initiative’s new student award for knowledge translation and/or implementation research in the area of musculoskeletal disorders. This makes De Villena the first winner of the $500 award, which the CCGI launched in late 2016. De Villena’s submission was on “the development of patient versions of clinical practice guidelines, as well as barriers and facilitators to, and strategies for effective implementation.” De Villena is the vice-president of the Interprofessional Education Council and president of the Business Club at the CMCC.

The American Chiropractic Association (ACA) has honoured Canadianborn Dr. Scott Haldeman (right) with its Humanitarian of the Year Award for the work he has done with World Spine Care (WSC), a notfor- profit organization that Haldeman founded in 2008. WSC’s goal is to bring sustainable, integrated, evidence-based spinal care to poor, underserved communities across the globe. Haldeman is a chiropractor, a neurologist and clinical professor in the Department of Neurology at the University of California-Irvine. The WSC aims to create a world in which everyone has access to the highest quality spine care possible. The ACA handed out the award during its annual House of Delegates meeting in Washington, D.C., last March. ACA president Dr. David Herd (left) handed out the award.

Dr. Dirk Keenan of Ottawa is the Ontario Chiropractic Association’s Chiropractor of the Year. Keenan has been in practice for 30 years and helped launch one of the first volunteer chiropractic clinics in Canada that is operating within a community health centre. “From 1997 to 2004, Dr. Keenan worked countless hours to get the clinic off the ground and to staff and manage the program without compensation,” the OCA said in the Spring 2017 issue of ON Chiropractic. Through his career, Keenan has advocated for the chiropractic profession in both the provincial and national levels.

The Alberta College and Association of Chiropractors (ACAC) is celebrating its centennial year and asking chiropractic patients to share stories of healing and their experiences with chiropractic. As part of the group’s centennial celebration, it is encouraging the public to send in their chiropractic stories for a chance to win some great prizes, including a grand prize package valued at $350. “The story of chiropractic does not only belong to chiropractors; it belongs to every Albertan positively impacted by chiropractic,” the ACAC said in a statement. Stories can be submitted through the ACAC centennial celebration web page. Also part of this year’s celebration is the ACAC Centennial Gala Dinner and Dance, held Saturday, May 13th, at the Calgary Commonwealth Centre in Calgary.

More than 400 chiropractors, chiropractic assistants, students and guests attended the 2017 Life Vision Seminar in Montreal, March 31 to April 1st. The event was held at the Hotel Bonaventure and featured more than a dozen speakers from Canada and the U.S. Life Vision is a two-day shot of high-energy, high-impact, inspirational and educational moments designed to bring current and future chiropractic leaders of all perspectives together to connect and recharge, organizers say. Life Vision is hosted by Life University in Atlanta.