Straight Talk About Foot Orthotics

Good spinal health is built from the ground up, starting with the feet.

For years medical researchers and healthcare providers have recognized that problems there can cause posture changes that eventually trigger a variety of musculoskeletal issues in other parts of the body (particularly the ankle, knee, hip and back).

Studies have also shown that even slight foot problems can negatively affect athletes’ performance and predispose them to a broad range of sports-related injuries.

What Are Orthotics and How Can They Help?

Orthotics are shoe inserts that are specially designed and manufactured to correct an abnormal or irregular walking pattern by promoting proper alignment and balance.  They’ve improved the quality of life for millions of people, and it’s become very common for physicians to recommend them to address many different patient needs:

• Reducing pain and/or fatigue
• Providing targeted foot support
• Relieving pressure or stress on an injured or sensitive area
• Preventing or limiting deformity
• Improving foot positioning and function
• Restoring balance

Reinforcing or supplementing other therapies (particularly chiropractic adjustments)

Foot orthotics are medical devices that can significantly change the way a person stands, walks and runs (and therefore the way his or her body absorbs and distributes related forces). For this reason, it’s important that the person wearing them clearly understand their benefits, risks and limitations.  It’s also important that the person use them correctly.

What Every Patient Should Know About Orthotics

There is no “one-size-fits-all” answer when it comes to orthotics. What works for another family member or neighbor will probably not work for you!

Getting the right prescription for your particular needs is all about working effectively with your healthcare provider to define your own goals and develop a complete understanding of your foot’s unique structure and function.

For instance, orthotics can be very sport-specific—the performance requirements of a hiker will not be the same as those of a skier or a football player.
 
 
Not all orthotics are created equal, and the differences matter. The prefabricated orthotics that can be purchased at shoe stores, pharmacies and sporting goods stores are not the same as the custom orthotics prescribed by a healthcare provider. Do not confuse them!

Mass-produced products are tailored for the “typical” foot and are unlikely to address problems specific to any one individual’s foot.

In some situations, such products can actually make a medical condition worse, cause new problems or increase the risk of injury. So while they’re usually less expensive than custom orthotics, they may not actually solve your particular problem.
     
Orthotics don’t actually correct foot or ankle problems. They are intended to realign the structures of the foot to improve function, reduce pain and decrease the risk of injury.
 
Needs can change over time and your orthotics should too. The structure and function of the foot can change as people age. So too can people’s lifestyle and priorities. Your healthcare provider can work with you to ensure that your prescription is still the right one for you.

Long-term use of orthotics may pose its own risks. Any time that you provide outside help to the structures normally responsible for supporting and moving parts of your body (casts or braces are good examples), you are essentially asking them to do less. And if you provide that help over a sufficiently extended period, you run the risk that your bones, muscles and connective tissues may become weaker as a result. The unintended consequence is that you may actually become less capable and more reliant on your devices to do the work your body used to do.

Your healthcare provider will talk with you about how to use your orthotics correctly and manage any long-term risk that he or she believes may exist.
      

Prescribing orthotics is arguably as much an art as a science. Don’t underestimate the role of professional judgment in prescribing orthotics. Experts acknowledge that there are few widely-accepted standards and that we can’t always predict successfully how an individual will respond to a particular prescription.

In fact, recent research has demonstrated that individuals with the same condition can respond very differently to identical orthotic therapy.

There’s even evidence that the same patient can respond to a prescription inconsistently or can respond just as favorably to two entirely different (even contrary) prescriptions. This means that some trial and error may be necessary to get the results both you and your healthcare provider are looking for and that good communication is critical. Without accurate and timely feedback from you about how well your orthotics are doing their job, it’s impossible for your healthcare provider to make the adjustments that will eventually lead to success.


How Your Chiropractor Can Help

There’s a close relationship between the way your feet work and the way the rest of your musculoskeletal system supports your body. So even if your feet themselves don’t actually hurt, they could be contributing to other health problems that you’re experiencing.

After your chiropractor has examined you carefully and talked with you about your situation, he or she can help you decide whether foot orthotics should be part of your broader treatment plan. Call Dr. Wintermute at our office today to learn more - (949) 559-7999.

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References and Resources
 
Gina Kolata, Close Look at Orthotics Raises a Welter of Doubts.  Orthotic Shoe Inserts May Work, but It’s Not Clear Why.  New York Times Fitness and Nutrition.  January 17, 2011.  Accessed August 2011.
http://www.nytimes.com/2011/01/18/health/nutrition/18best.html?pagewanted=all

Nigg, BM et. al., Effect of Shoe Inserts on Kinematics, Center of Pressure, and Leg Joint Movements During Running.  Medicine & Science in Sports & Exercise.  February 2003.  Accessed August 2011.
http://journals.lww.com/acsm-msse/Abstract/2003/02000/Effect_of_Shoe_Inserts_on_Kinematics,_Center_of.21.aspx

Best Foot Forward with Chiropractic.  Journal of the American Chiropractic Association.  January 2001.  Accessed August 2011.
http://www.acatoday.org/pdf/focus_january2001.pdf

Reliable Information on Nutritional Supplements

Great Source for Reliable Information on Nutritional Supplements

Have you ever found yourself tuning out information about nutritional supplements because it all seems confusing and contradictory? If yes, you are not alone.

One headline says 'get more X' the next headline says 'be careful about too much X' and another says 'X supplementation not necessary at all'. Headlines are meant to sell newspaper and magazines.

They report on what's new not necessarily what is backed by the most evidence. And, the stories are often selected based on findings that are contrarian or against conventional wisdom. After all, who is going to buy a magazine with the headline, "No change in guidelines – eating more plant-based foods is still good for you."

Consumers really need a reliable source of evidence-based recommendations for nutritional supplements. Since these are not regulated by the FDA, there isn't a government run website that you can count on to be unbiased. There are several private companies, non-profits and even individuals that claim to offer comprehensive unbiased information on nutritional supplements, but who has the time to sift through all of these to figure out whose information is the best?

At the risk of offending a number of other great sources, this article is a plug for the Linus Pauling Micronutrient Information Center at Oregon State University at http://lpi.oregonstate.edu/infocenter. Chances are this is a source you've never heard of or looked at, but you should.

The website describes the Linus Pauling Institute as a “source for scientifically accurate information regarding the roles of vitamins, minerals, other nutrients, dietary phytochemicals and some foods in preventing disease and promoting health”.

As you can see from the description, their mission extends beyond nutritional supplements to also include whole foods. This is critically important because sometimes nutrients are more potent together (as in a food) than they are separately.

When you visit the website, you'll have a chance to subscribe to the newsletter near the top of the page. Do it. This isn't another email newsletter but rather a printed, bound newsletter sent to your house containing all of the Institute's latest research.

The folks at OSU are doing excellent work to bring us all trustworthy, evidence based recommendations on the tens of thousands of nutrients in our foods. Take some time to look at their website, bookmark it and share it with others. If there are concepts or terms you don't understand, feel free to ask us during your next appointment or send us an email.

Are Chiropractic X-Rays Safe?

How Safe are Chiropractic X-Rays?

Patients occasionally ask whether chiropractic x-rays are safe, so we wanted to summarize the current FDA statements on x-ray safety and give you a couple credible resources where you can learn more. Read the full article if you want the complete story, but if you are looking for a quick answer, the FDA estimates that the radiation exposure from a chest ray is roughly equivalent to the background radiation you are exposed to in 10 ordinary days on planet Earth.

The FDA states on its website "Don't refuse an X-ray. The risk of not having a needed X-ray is greater than the small risk of radiation."

First of all, there is no difference between a chiropractic x-ray and any other type of x-ray. While x-ray equipment does vary slightly by manufacturer, what really matters is the body part being imaged. Different body tissues absorb radiation in different ways.

To provide consumers with a way of monitoring radiation exposure across multiple sources, the FDA uses an effective dosage scale. Each type of x-ray has an effective dosage associated with it measured in millisieverts (mSv). Since millisieverts isn't a unit of measure most people are familiar with (like a mile or a teaspoon), having a reference value helps put the numbers in context.

The FDA estimates that the average person is exposed to 3.0 millisieverts of radiation per year from naturally occurring radioactive materials and cosmic rays. That's what allows them to state that a 0.1 millisievert dosage from a chest x-ray is equivalent to about 10 days of background radiation exposure.

Compared to a chest x-ray, x-rays of the extremities (arms and legs) have a much lower effective dosage and x-rays of the lower torso have a higher effective dosage. Recall that the effective dosage comes mainly from the body part being imaged not the intensity or duration of the x-ray machine pulse. Here's a summary of effective dosages and background radiation equivalents for the various types of x-rays a chiropractor is likely to recommend:

• Extremities - 0.001 mSv – similar to 3 hours background radiation
• Chest - 0.1 mSv - similar to 10 days background radiation
• Spine - 1.5 mSv - similar to 6 months background radiation

The FDA website and the excellent radiologyinfo.org website from the American College of Radiology and the Radiological Society of North America both point out that disease risks from radiation exposure are cumulative across time and that patients play a critical role in tracking their own exposure levels.

Since you may be working with multiple health care providers in different specialty areas, you should keep a log of your exposures. Here is a link to a site where you can download a personal Patient Medical Imaging Record: http://imagewisely.org/Patients.aspx

Note that this article refers to effective exposures and recommendations for adults. If you are pregnant or looking for x-ray safety information for children, visit imagegently.org


Bibliography
Consumer Updates Reducing Radiation from Medical X rays. (n.d.). Retrieved 8 29, 2011, from FDA.gov: http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm095505.htm

Patient Safety X ray and CT. (n.d.). Retrieved 8 29, 2011, from Radiologyinfo.org: http://www.radiologyinfo.org/en/safety/index.cfm?pg=sfty_xray

Radiology Risks Benefits for Patients Image Wisely Image Wisely. (n.d.). Retrieved 8 29, 2011, from ImageWisely.org: http://imagewisely.org/Patients.aspx

Back Pain during Pregnancy

Does Chiropractic Help Back Pain Associated with Pregnancy?

If you are pregnant and suffering from low back pain, a neighbor or a friend has probably suggested you visit a chiropractor because a chiropractor was able to help them during their pregnancy.

The discussion probably left you curious, is that good advice or just a single success story?

Additionally, you may be wondering whether chiropractic is safe during pregnancy and how much low back pain improvement the average pregnant woman can expect to get.

After looking at several scientific publications on these exact topics, the appropriate conclusion seems to be that “chiropractic evaluation and treatment during pregnancy may be considered a safe and effective means of treating common musculoskeletal symptoms that affect pregnant patients. The scarcity of published literature warrants further research.” (Borggren, 2007)

So basically the answers are:

• Yes, chiropractic is safe during pregnancy.
• Yes, chiropractic helps common musculoskelatal probelms during pregnancy  (including back pain).
• Your friends experience isn’t just one woman’s story. Many women are finding relief and the results are being sporadically published in medical journals too.
• More research under more controlled conditions is needed for the purposes of educating primary care physicians and obstetricians about chiropractic care during pregnancy.

Here are a few additional details about the prevalence of low back pain during pregnancy and the number of women being referred for treatment.

• 57 – 69% of women complain of low back pain during pregnancy
• Only about 32% of women report these symptoms to their primary doctor
• Only about 25% of primary doctors recommend seeking treatment for the pain.

Clearly this is a big problem with 2 in 3 having pregnancy-related back pain. Also a big problem is that they are generally not talking to their obstetricians and primary care physicians about it and that these professionals are not referring them to effective treatment options.

Chiropractic treatments can be quite effective for pregnancy-related back pain with just a few visits for the majority of women seeking help. In a small study of 17 women:

• Sixteen of 17 (94%) saw clinically important improvements in low back pain with chiropractic care.
• The average pain rating went down from 5.9 to 1.5 (on a scale of 0 to 10).
• It took an average of 1.8 visits and 4.5 days to get clinically important pain relief.

We hope this article gave you hope that many pregnant women do get significant, rapid relief from low back pain.

If you are currently pregnant with low back pain, you probably have many questions not answered by this article. Perhaps you’ve never had chiropractic care before or you want to know how we adjust our techniques to work with pregnant patients.

The best way to get answers to your questions is with an initial consultation. The only way for us to know whether you are a good candidate is for you to come see us, so call Dr. Wintermute at (949) 559-7999 for an initial appointment today.

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Bibliography
 
Borggren, C. L. (2007, Spring). Pregnancy and chiropractic: a narrative review of the literature. J Chiropr Med, 6(2), 70-74.

Khorsan, R., Hawk, C., Lisi, A., & Kizhakkeveettil, A. (2009, Jun). Manipulative therapy for pregnancy and related conditions: a systematic review. Obstet Gynecol Surv, 64(6), 416-27.

Lisi, A. (2006, Jan-Feb). Chiropractic spinal manipulation for low back pain of pregnancy: a retrospective case series. J Midwifery Womens Health, 51(1), 7-10.

Stuber, K., & Smith, D. (2008, ul-Aug). Chiropractic treatment of pregnancy-related low back pain: a systematic review of the evidence. J Manipulative Physiol Ther., 31(6), 447-54.

What Exactly Are the B Complex Vitamins?

The B group of vitamins is probably the most commonly misunderstood of the vitamins, simply because the B vitamins are several distinct vitamins lumped together.

Additionally, the fact that the vitamins in this group are known by both letter, number and name is confusing to many people. Here is a quick list of the B vitamins found in the Vitamin B complex group.

• B1 is also thiamin
• B2 is also riboflavin
• B3 is also niacin
• B5 is also pantothenic acid
• B6 is also pyridoxine
• B7 is also biotin
• B9 is also folic acid
• B12 is also cobalamin

You should note that there are four additional substances in the B complex group, though they are not known as vitamins. They are choline, lipoic acid, PABA and inositol. When you purchase B complex vitamins, these four will not be included.

Furthermore, one or two of the recognized B vitamins may also be omitted. B5 and B7 are so widely available in food that most people get plenty of these vitamins even if they aren’t eating a healthy diet.

There are gaps in the numbers of the B vitamins because our understanding of them has evolved over time. Initially there was only a single B vitamin.

Later it was recognized that what had been referred to as a single vitamin, actually had many components. These component parts where numbered 1,2,3,4, etc… Even later it was determine that some of these components (such as B4) did not meet the criteria of being a vitamin and they were dropped. That’s how we ended up with 8 B-vitamins with non-sequential numbers.

One thing that all the B vitamins share is that they are water soluble. Any excess vitamin B is not stored, but rather is excreted in the urine. That means that all the B vitamins need to be constantly replenished from our diets.

B vitamins are found in whole unprocessed foods including grains, meats and vegetables. In general, the more processed that food is, the lower the content of all the B vitamins.

A daily multi-vitamin is a great way to ensure that you are getting all the B complex Vitamins your body needs on a daily basis.

One of the most commonly recognized uses of the B vitamins is an energy booster. Many popular energy drinks that claim a natural boost of energy without sugar or caffeine are high in B vitamin complex.

There are too many components in the Vitamin B complex to discuss the health benefits, deficiencies and Recommended Daily Allowance for the whole group in a single article. Look for future articles about each of these important nutrients.

If you have questions about your current nutrition and supplement plan, just ask Dr. Wintermute. She is here to help!

Bibliography
B Vitamins MedlinePlus. (n.d.). Retrieved 8 10, 2011, from National Institutes of Health: http://www.nlm.nih.gov/medlineplus/bvitamins.html

Micronutrient Information Center. (n.d.). Retrieved 8 11, 2011, from Linus Pauling Institute at Oregon State University: http://lpi.oregonstate.edu/infocenter/vitamins.html