ADHD Helped With Chiropractic, A Case Study

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In the October 2004 issue of the peer-reviewed research publication, the Journal of Manipulative and Physiological Therapeutics (JMPT), comes a study of a child with ADHD (Attention Deficit/Hyperactivity Disorder), who was helped with chiropractic.

The case was pf a 5 year old boy who had been diagnosed with ADHD at age 2. The child's pediatrician prescribed methylphenidate (Ritalin), Adderall, and Haldol for the next 3 years. The combination of drugs was unsuccessful in helping the child. At age 5 the child was brought to a chiropractor to see if chiropractic would help. This history taken at that time noted that during the child's birth, there were complications during his delivery process. The results of this trauma and complications resulted in a 4-day stay in the neonatal intensive care unit. The child's mother reported no other incidence of trauma.

The chiropractic examination and x-rays showed noticeable spinal distortion including a reversal of the normal neck curve indicative of subluxations. Chiropractic care was begun and the child's progress was monitored. According to his mother, positive changes in her son's general behavior were noticed around the twelfth visit. By the 27th visit the patient had experience considerable improvement.

The child was brought by the mother to the medical doctor for a follow up visit and questioned the usage of Ritalin. The medical doctor reviewed and examined the child and based on that assessment and his clinical experience, the MD felt that the young boy was no longer exhibiting symptoms associated with ADHD. He then took the boy off the medications that he had been taking for 3 years.

The conclusion of the author of the JMPT case study noted, "The patient experienced significant reduction in symptoms. Additionally, the medical doctor concluded that the reduction in symptoms was significant enough to discontinue the medication"

How Do You Rate?

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In the field of statistics, a five-point rating scale is commonly used to evaluate all sorts of personal responses, feelings, and assessments. This frequently used tool is known as the Likert scale, and most people have completed such a rating device on numerous occasions, most typically in consumer after-sales surveys. The Likert scale asks a person to respond to a statement such as “I would recommend this restaurant to my friends”, choosing from the predetermined answers of “strongly disagree,” “disagree,” “neither agree nor disagree,” “agree,” and “strongly agree.” The Likert scale was developed in 1932 and has been consistently validated over many decades of use. We can effectively apply this rating system to our own state of health by answering the statement, “I enjoy high levels of health and well-being.” We can than employ our truthful answers to make sound decisions on our own behalf regarding future health-promoting activities.

If your truthful response is “strongly agree,” you probably have been engaged for a year or more in a regular, vigorous exercise program and consistently follow a nutritional healthy eating plan. You do at least 30 minutes of vigorous exercise five times a week, on most weeks. You are probably at or very near your target body weight (based on a calculation of your body mass index, readily done at numerous online resources) and consume an appropriate amount of calories on a daily basis. Overall, you feel fit. You sleep well and wake up refreshed. You have abundant energy to do all the things you need to do for yourself and your family, every day.

At the other end of the Likert rating system, if your truthful response is “strongly disagree,” you probably haven’t done any form of exercise for some time. Of course, such a circumstance might be the result of a serious illness. But if your lack of engagement in regular exercise and healthy eating is related to apathy or some other form of ennui, or in itself is a personal choice, it’s useful to consider the consequences of such inaction. Or, rather, it could be personally beneficial to consider the value in taking on new habits that result in your becoming a person who responds “strongly agree” to the statement, “I am healthy and well.”

How do you get to “strongly agree”? The solution is three-fold. The first part is to make a choice that you want to enjoy high levels of health and well-being. No one is ever going to make such a commitment because someone else told him or her they should, no matter whether that someone is a spouse, other family member, or a physician. The decision must be a personal choice. The second and third components are to begin an exercise program¹ and a healthy eating plan^2,3. Exercise needs to be vigorous (“vigorous” is relative, based on your age, overall health status, and other considerations) and done five times per week. Healthy eating encompasses a wide range of selections and options. One of the key elements is to consume at least five servings of fresh fruits and vegetable every day.

The good news is that every person who begins and stays with such a course of healthy living will soon reap the benefits. And not too long after that, you’ll find you’ve become a person who sleeps better, has more energy, and has, day by day, more fun in living. This is what healthy eating and exercise is really all about.

¹ Chilton WL, et al: Acute Exercise Leads to Regulation of Telomere-Associated Genes and MicroRNA Expression in Immune Cells. PLoS One 2014 Apr 21;9(4):e92088. doi: 10.1371/journal.pone.0092088. eCollection 2014

² Michas G, et al: Dietary fats and cardiovascular disease: Putting together the pieces of a complicated puzzle. Atherosclerosis 2014 Mar 27;234(2):320-328. doi: 10.1016/j.atherosclerosis.2014.03.013. [Epub ahead of print]

³ Yoon U, et al: Efficacy of lifestyle interventions in reducing diabetes incidence in patients with impaired glucose tolerance: a systematic review of randomized controlled trials. Metabolism 62(2):303-314, 2013

Inside Out Vs. Outside In

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If a patient has high blood pressure, a standard medical approach would be to choose a drug that lowers blood pressure, and ask the patient to take the drug. This may serve to lower the blood pressure, but ignores the underlying cause that is making the blood pressure high, and runs the risk of side effects complicating the person's recovery. Whether it's a nutritional issue, faulty control by the nerve system or a manifestation of stress, the medication could decrease the blood pressure, leaving the problem causing the symptom of high blood pressure unaddressed.

The Wellness Approach

Wellness is a state of optimal conditions for normal function...and then some. The wellness approach is to look for underlying causes of any disturbance or disruption (which may or may not be causing symptoms at the time) and make whatever interventions and lifestyle adjustments would optimize the conditions for no
rmal function. That environment encourages natural healing, and minimizes the need for invasive treatment, which should be administered only when absolutely necessary. When the body is working properly, it tends to heal effectively, then there is another level of health that goes beyond "aymptomatic" or "pain-free" which reveals an open-ended opportunity for vitality, vibrant health, and an enhanced experience of life. This is true for mental and physical health. Which some people may suffer psychological disorders, creating an atomosphere of mental and emotional wellness will address all but the most serious problems.

Repairing an Injured Rotator Cuff

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As we get older, rotator cuff injuries become more common, a result of the natural aging process. A similar mechanism operates in the discs separating the vertebrae in your lower back. These cartilaginous structures lose water over time, becoming less flexible and more brittle as the decades roll by. In the case of the shoulder, the rotator cuff tendon is pulleyed to and fro as the arm swings forward and back and up and down. As the years pass, this constant motion may cause fraying in the rotator cuff tendon and inflammation in the muscles that comprise the rotator cuff. Eventually, partial or full thickness tears may develop in one or more of these musculotendinous units, causing pain and some loss of function. Importantly, conservative care may be all that’s needed to reduce pain and restore needed motion.

The shoulder joint is beautifully designed and a marvel of engineering. Its construction makes possible a full 360-degree arc of motion in both the sagittal and frontal planes. In other words, you can swing your arm in a complete circle from front-to-back and to-the-side-and-up-and-around. In the third, horizontal, plane, 180 degrees of motion is available. The overall combination of movements in three-dimensional space makes the shoulder joint the most freely movable joint in your body. However, as with all freedoms we enjoy in this life, there is a price. The shoulder joint’s great mobility is countered by its very limited stability.

The shoulder’s lack of stability needn't concern us in our average day-to-day tasks. Protection to the joint is built-in by way of the rotator cuff muscles, which form a strong hood that envelops the intersection of the arm bone and shoulder blade. Falling on an outstretched arm may result in a dislocated shoulder, so we need to have some care in this regard.

If you’re a young athlete and have suffered a rotator cuff tear, surgery may be an appropriate option.¹ But for the vast majority of people, especially for those over age 40, most rotator cuff injuries are chronic rather than acute and can be treated with rest and rehabilitative exercise. Again, if you’re a 60-year-old skier who has torn his or her rotator cuff in a downhill accident, surgery could be indicated. For the rest of us, rehabilitative exercise is the key.^2,3

Four or five primary strength training exercises are involved in shoulder or rotator cuff rehabilitation. The three basic shoulder exercises are (1) seated overhead press, which trains all the shoulder girdle muscles simultaneously; (2) standing side [lateral] raise; and (3) seated or standing bent-over raise. The lateral raise specifically trains the middle deltoid muscle and the bent-over raise specifically trains the posterior deltoid muscle. Specific rotator cuff strength training exercises include internal rotation and external rotation on a flat bench using very light dumbbells. More painful injuries with greater loss of mobility may require (1) Codman pendulum exercises and (2) finger-walking (up a wall) to the front and to the side.

The goals of rotator cuff rehabilitation, as for any mechanical injury, include decreased inflammation, decreased pain, return to more full active range of motion, return to more full muscular strength, and restoration of function.

¹ Plate JF, et al: Rotator cuff injuries in professional and recreational athletes. J Surg Orthop Adv 22(2):134-142, 2013

² Escalmilla RF, et al: Optimal management of shoulder impingement syndrome. Open Access J Sports Med 5:13-24, 2014

³ McMahon PJ, et al: What Is the Prevalence of Senior-athlete Rotator Cuff Injuries and Are They Associated With Pain and Dysfunction? Clin Orthop Relat Res 2014 Mar 12. [Epub ahead of 

Checkmate

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In chess, checkmate occurs when a player’s king is under attack and has no safe place to go. The king is threatened and every possible escape route is blocked. Such an existential condition, an allegorical “no exit,” is known as checkmate.

In life, a person may be similarly threatened by a serious illness. For example, a person may receive a diagnosis for which there is no effective long-term treatment. Short-term, temporary solutions may be available, but these usually require enormous expenditures of resources, both financial and personal. Most often, when the temporary fix has run its course, the illness persists and the long-term outlook remains the same. Optimally, we would prefer to avoid such medical “checks” and avoid being faced with an untimely “checkmate.” As in chess, obtaining success with respect to our health and well being depends in large part on having a sound strategy in place.

Successful chess players think several moves ahead. High-level chess players such as grand masters have the ability to envision combinations involving ten or more future moves. Fortunately, being successful at the game of promoting personal health and well being is much less complicated. There are only a few elements involved in developing a strategy that works.

These elements are well known and include (1) regular, vigorous exercise; (2) a healthy diet¹; (3) sufficient rest; and (4) a positive mental attitude. But despite being well known, only the minority of people actually implements these critical “moves.” The evidence for such lack of action may be seen in the United States, for example, where one-third of Americans are overweight and additional one-third are obese. Merely knowing something is not sufficient to obtain a result.

What is required is actual action.² In terms of exercise, evidence-based guidelines agree that 30 minutes of vigorous exercise, done five days a week, will provide a sound foundation for health. Optimally, such exercise consists of both cardiovascular and strength training sessions, but the most important point is to do five 30-minute sessions per week. With respect to diet, all the evidence affirms that men, women, and children should follow specific calorie-intake guidelines.³ For example, a moderately active man, aged 31-50, should consume, on average, 2500 calories per day. A moderately active woman, aged 31-50, should consume, on average, 2000 calories per day. A man intending to lose weight, and then maintain an ideal weight, should take in about 1800 calories per day. A woman intending to lose weight, and then maintain an ideal weight, should consume about 1600 calories per day. Regarding daily food intake, the most important rule to follow is to consume at least five portions of fresh fruits and vegetables per day. It is also important, on a daily basis, to eat foods from all the major food groups. In terms of rest, most people require seven to eight hours of sleep a night. This may not be possible every night, of course, but over time people need to obtain the right amount of rest for them. The criterion is simple: if you do not feel rested after a night’s sleep, then you did not obtain sufficient sleep. Obtaining sufficient rest is an often-neglected component of a well-rounded health and wellness strategy.

Our strategy for helping ensure our long-term health and wellness contains only a few components, and involves many less moves than does a winning chess strategy. It should be easy to put such a strategy into place. What is required is a commitment and dedication to ourselves, our families, and our loved ones.

¹Voeghtly LM, et al: Cardiometabolic risk reduction in an intensive cardiovascular health program. Nutr Metab Cardiovasc Dis 23(7):662-669, 2013
²Carson V, et al: A cross-sectional study of the environment, physical activity, and screen time among young children and their parents. BMC Public Health 2014 Jan 21;14:61. doi: 10.1186/1471-2458-14-61
³Wang YC, et al: Reaching the healthy people goals for reducing childhood obesity: closing the energy gap. Am J Prev Med 42(5):437-444, 2012

Entropy, the Gym, and You

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Let’s say you've been taking some time off from the gym. Maybe you reached the end of your 12-week training cycle and you’re taking a week off. It’s possible that one week turns into two or even three or four weeks. Life happens, you need to attend to some pressing matters, and going to the gym starts to take a back seat. Before you know it, two or three months have passed by. Suddenly, you’re no longer a person who goes to the gym, but a person who needs to figure out a way to get back to the gym on a regular basis. “What happened to me?” you wonder. “Where did the time go?” Now you have to actually exert effort to fit “workout time” into your schedule. You scratch your head and ponder. “I thought I had this all covered,” you think, not for the first time.

What happened to you and your well-made plans was entropy, that insidious force in the universe that turns order into disorder. The basic rule is that any organized system, left unattended, will immediately begin to break down. As a mundane example, those piles of papers on your desk keep reaccumulating as a result of entropy. The weeds in your garden? Entropy. The dust bunnies in your attic and basement? Entropy. The collapse of your plan for doing regular workouts? Entropy.

What’s worse, entropy takes a serious toll on your physical fitness.^1,2 If you miss enough time from the gym, all your fitness gains begin to melt away. First, your muscles begin to lose their stores of energy. Glycogen, the complex sugar that supplies energy for muscle work, is broken down for use elsewhere. Arterioles and capillaries, small blood vessels that were needed to supply nutrients to your growing muscles, are no longer required and rapidly disappear. Muscle fibers that were continually added to support your exercise activities are cannibalized, so that their constituent parts may be used for other physiological processes. Entropy launches a process of randomization that breaks down your carefully built-up muscular structure. Your body, being very smart, metaphorically swoops in and moves all those metabolic components to other structures and systems for more efficient use.

The superficial result is loss of muscle definition. The deeper result is loss of muscle tone.³ Your cardiorespiratory system (heart and lungs), digestive system, and metabolism are all affected, as these physiologic systems are no longer required to be functioning at peak to support a regular vigorous exercise program. Entropy sets in to all these systems, as well. The overall result is a profound impact on your health and well-being.

The good news is we can help keep entropy at bay. But doing so requires attention and determination. We want to attend to our bodies as carefully and regularly as we attend to the environment of our home, office, and garden. Just as our cars, motorcycles, and bicycles require periodic maintenance, our bodies require much more frequent care, care on a daily and weekly basis. It’s fine to occasionally skip a week or two, or even a month if needed, of exercise. But we must make sure we get right back on schedule to ensure benefits to our short-term and long-term health.

¹Barwais FA, et al: Physical activity, sedentary behavior and total wellness changes among sedentary adults: a 4-week randomized controlled trial. Health Qual Life Outcomes 2013 Oct 29;11:183. doi: 10.1186/1477-7525-11-183

²Loprinzi PD, Lee H: Rationale for promoting physical activity among cancer survivors: literature review and epidemiologic examination. Oncol Nurs Forum 2014 Mar 1;41(2):117-25. doi: 10.1188/14.ONF.117-125.

³Ricci-VItor AL, et al: Influence of the resistance training on heart rate variability, functional capacity and muscle strength in the chronic obstructive pulmonary disease. Eur J Phys Rehabil Med 49(6):793-801, 2013

Chiropractic Care, Your Nerve System, and Pain

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The experience of pain causes all sorts of unpleasant physical reactions. Tight muscles are one such response, and muscular tightness may progress to localized knots, known as trigger points, and even muscle spasm. These responses are never a good thing, and usually result in more widespread and more intense pain.

The solution to most types of musculoskeletal pain involves getting at the underlying cause of the problem. Often, the underlying cause is biomechanical. Neck pain or low back pain, for example, frequently results from a lack of full mobility of spinal vertebra's and the resulting irritation and inflammation of spinal muscles and spinal ligaments. Bigger problems may ensue when this irritation and inflammation begins to affect spinal nerves. Nerve inflammation may then involve other tissues and organs, with subsequent development of various symptoms and disorders.

By addressing the underlying cause of biomechanical pain, regular chiropractic care helps restore maximum function to both your spinal column and your spinal nerves. The long-term result is enhanced health and well being for you and your family.