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IN THIS ISSUE

 Massive Disc Herniation

 Salt and Blood Pressure
 Flaxseed and Blood Pressure

 Tennis Elbow and Cortisone

 Size Matters

 David Lee Roth

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February 2013

As I write this, the snow is falling and it appears that we will not get through this winter unscathed.  I’m often asked if I see more back injuries in the winter due to snow shoveling. I’ll see a few, but what causes the most are slips and falls on ice.  So be careful out there!

Update: Well we finally dug out and while my back and shoulders feel tired, my hands are aching from shoveling and gripping the snow blower.  Oh the irony of a chiropractor with sore hands.  Not good!

Massive Disc Herniations: Conservative Care 

In my experience, patients are understandably worried when, based on exam and MRI findings, I diagnose a disc herniation in the lower back.  I always try to keep things in perspective and reassure that surgery is not a given.  The natural history of a lumbar disc herniations is not fully known and several studies have shown that the largest discs appear to have the greatest tendency to resolve with conservative care.  Here is a study that investigated whether massive prolapsed discs can be safely managed conservatively once clinical improvement has occurred.

The results found it safe to adopt a ‘wait-and-watch’ policy for cases of massive disc herniation if there is any early sign of clinical improvement.  Where clinical progress is evident, 83% of cases of massive disc herniation will have sustained improvement.  Only 17% of cases will have recurring crises of back pain and sciatica.  If there is evidence of clinical improvement, massive disc prolapses do not appear to carry a risk of major nerve damage.  Massive disc herniations usually reduce in volume and by 6 months most are only a third of their original size. Study

Scant Evidence that Salt Raises Blood Pressure

Ready to slay some sacred cows?  It has long been taken as fact that salt intake is a major cause of high blood pressure. Recent reviews of the medical literature have raised the question; is salt restriction for high BP effective?  Well it seems that the connection is rather weak.  Many studies have failed to demonstrate a benefit and the researchers in this article  noted a disservice to patients when outdated guidelines are not regularly challenged and adapted when the evidence contradicts conventional wisdom.  

By far the major source of sodium in our diets is from processed foods.  Interestingly, those new to low carb diets who avoid processed foods,  may even develop muscle cramps due to lack of sodium.  The reality is that fear of salt is not justified. Read more

Impressive Lowering of Blood Pressure with Flaxseed 

Adding flaxseed to the diets of patients with peripheral arterial disease resulted in large drops in blood pressure of around 10 mm Hg systolic and 7 mm Hg diastolic after six months, according to the results of a double-blind, placebo-controlled study.

“This reduction after administration of dietary flaxseed is the largest decrease in BP ever shown by any dietary intervention,” said Dr Delfin Rodriguez (University Hospital Holguin, Cuba) speaking at the American Heart Association 2012 Scientific Sessions. Such reductions would be expected to result in around a 50% fall in the incidence of stroke and a 30% reduction in heart attack.

The researchers chose to study flaxseed because animal studies have shown it has antiatherogenic, anti-inflammatory, and antiarrhythmic effects and may reduce circulating cholesterol and trans-fatty acid levels.

They randomized 110 patients to milled flaxseed (30 g/day) in the form of bagels, muffins, and buns (n=58) or placebo products (n=52), made from wheat with a similar flavor.

The results out to one year are in the process of being analyzed and will be presented at a future date.  Stay tuned.

Tennis Elbow Therapies Fail in Trial

One of the more difficult injuries I treat is lateral epicondylitis, or tennis elbow.  From the outset I prepare patients for the inordinate amount of time and treatment that’s typically required for a relatively  benign injury.  So what about steroid injections?

The conclusion was that the use of corticosteroid injection versus placebo injection resulted in worse clinical outcomes after 1 year, and physiotherapy did not result in any significant differences. Read the article here: Elbow Shot?  

Size Matters!

David Lee Roth

I’m a fan of Diamond Dave and I cannot help but smile when I click all over here.  Thanks to Mat O.