Just scroll down this page to find the following topics:
Fibromyalgia
Gymnastics and Chiropractic
Hypopnea
Osteoporosis
Runners and Chiropractic
Shoes
Sleep Apnea
Sports and Chiropractic
The Sunshine State Games
From Chiro Corner, a Kelly Chiropractic, P.A. Blog 3/1/2010
Hi Everyone,
I see a fair number of fibromyalgia patients in my office. One patient has been bugging me for a couple of years to put some of this information on the internet. Well, here it is.
Since fibromyalgia is a symptom-based diagnosis, the treatment plan can vary a bit from person to person. Fibromyalgia is not diagnosed based on the cause of the symptoms, but rather on the symptoms themselves. This means that there could be several treatments that work for different people because the cause might not be the same. The cause is still debated in the health care world, but several sound theories are being looked into. Until the cause of fibromyalgia is defined more clearly, the treatment needs to be based on each individual.
I have read many studies on this problem, and today I found two studies I hadn’t read before. I was unable to find links to some of the other information I have come across in the past. Before I share the studies today, I’d like to share some more information.
Some possible causes of Fibromyalgia syndrome (FMS) or Fibromyalgia (FM) include stress, lack of certain vitamins and minerals, and a lack of or imbalance in some neurotransmitters (such as norepinephrine and serotonin). There are other ideas out there, these are just a few.
I like to start with lifestyle changes. Are you getting enough water, vitamins, and minerals? Are you exercising on a daily basis? Are you doing something every day to relax? All of these things can decrease symptoms of FM.
Heart and cardiovascular issues as well as sleep issues can also be a problem in people with FM. Dealing with these issues can also help symptoms. For some people a visit with a cardiologist or a sleep study might be helpful to rule out heart problems, sleep apnea, or hypopnea.
Digestive issues like IBS (irritable bowel syndrome) and other digestive problems are common in people who have FM. Allergies and food sensitivities can contribute to symptoms of FM. It is important to rule out any digestive abnormalities. Managing digestive problems will help with the FM symptoms.
Depression, anxiety, and other psychological issues are common in fibromyalgia patients. These issues, like cardiovascular, digestive, and sleep disorders, should be dealt with. Getting help from a psychologist is not something to be embarrassed about. Many people try to avoid the possibility that stress and other psychological influences could be affecting their physical pain. Finding out if some of the physical pain can be helped with stress reduction and counseling is an important part of care. There are very real physical results that manifest due to what we are thinking.
Chiropractic treatment, aerobic exercise, strength training, acupuncture, Qi Gong, and nutritional supplements (especially Magnesium, EPA, and DHA) can all be helpful in treating fibromyalgia. The difficulty is in finding the right combination of treatments to help each individual with fibromyalgia to feel better. Patients I have worked with have found that chiropractic care as well as massage, acupuncture, Pilates, yoga, tai chi/qi gong, ball rolling, aerobic exercise, relaxation, meditation, diet changes, and nutritional supplements all to be helpful. Not every patient does all of the above, but different combinations of the above. FM patients need to give their doctors enough time to run through trial treatments of various combinations of things that we know will help. Too often a patient gives up on care without trying all of the different combinations of treatments available, or don’t follow doctor’s instructions. Find a doctor you trust and stick with it. It takes time to find a treatment plan that works for any given person with FM.
There are also medications that can be helpful, but as a chiropractor those are out of my legal scope of practice.
http://www.chiroindex.org/?search_page=articles&action=&articleId=16610 –This study finds that chiropractic care can be helpful for fibromyalgia patients.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1779399/?tool=pmcentrez –This study is a medical study, and so it is heavy on the drug treatments. It didn’t look like it mentioned chiropractic. It did, however, find that exercise, acupuncture, nutrition, and Qi gong can be helpful.
In the past I have read that 20 min. of aerobic exercise (huff and puff you could talk but you don’t feel like it, exercise) daily, can significantly decrease symptoms of FM. The above study says 20 min. two times a week will do. The above study also mentions strength exercise is helpful as well.
Clearly, the best treatment for Fibromyalgia is a multi-level plan of care. It is my opinion that the best results come when the different health care specialties can work together to manage the problems that come with FM. Chiropractors usually have great results in treating FM symptoms.
Hope you all have a wonderful day!
Sincerely,
Dr. Gwen
(Gwendolyn E. Kelly-Kohnke, D.C.)
As a former gymnast, and former gymnastics coach, this sport will always hold a special place in my heart. Once a gymnast always a gymnast, or so they say. Are you tired of your health care providers not being able to understand you? I know how frustrating it is to first explain what an event in gymnastics is, and which one you were on when you got hurt. Then still needing to try to help them understand what the skill you were doing looks like. Here you can simply tell me what skill you were doing, or even what timers you were working on. I promise I won't ask if you can do a flip, because what is that really?
Hypopnea is not well defined, and the definition may vary from study to study. Hypopnea is not strictly sleep apnea, it is a category made for people who exhibit mild signs and symptoms of sleep apnea but miss the cut off of the definition for sleep apnea. For example, hypopnea is a slowing of breathing rate and a decrease in breathing volume that causes decrease of oxygen in the blood. There is not necessarily a stop in breathing. Since hypopnea is almost sleep apnea, and has the same treatments, it is included in discussions as a form of sleep apnea.
See also Sleep Apnea further down this page.
Resources
Javaheri, S. (2003 June). Heart failure and sleep apnea: emphasis on practical therapeutic options. Clin Chest Med. 3(2):207-22. Retrieved from Pub Med http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?CMD=Display&DB=PubMed in September 2003. PMID 12800779 (PubMed-indexed for MEDLINE)
Meoli, Amy MD, et al. (2001). Hypopnea in Sleep-Disordered Breathing in Adults. Sleep, 24(4): 469-470.
The Merk Manual Seventeenth Edition (Centennial Edition). (1999). West Point, PA: Merk & Co.,Inc.
Osteoporosis is a loss of bone mass. It can be seen on x-rays if the loss is 30% or more. It is diagnosed by using a bone density test.
Facts
Risk Factors
Prevention/treatment
As we get older, our ability to absorb nutrients from the food we eat, decreases. In general, this makes using supplements important not just for prevention of osteoporosis, but for our general health. Ask your Doctor of Chiropractic for advice on the use of and proper combination of supplements. Supplements can cause problems if they are used improperly, they can interact with each other as well as other drugs or medications you may be taking. They may not work properly or optimally if they are not taken correctly. For example, some vitamins work as blood thinners, if you are already on high blood pressure medications you should not take a vitamin that "thins" the blood, because it could cause problems. In this section, I will give you some supplement recommendations. Please do not just start taking these supplements without having your diet analyzed first. Before taking supplements, you need to know how much of that supplement you are already getting. For example, if I am drinking 3 glasses of milk a day, I will need less calcium then if I am drinking 1 glass of milk a day. Too much of a supplement may be problematic, and too little may not be effective. So Please consult with your Doctor of Chiropractic before using any supplements. These recommendations are for informational purposes only.
-Calcium can prevent and treat osteoporosis. You (adult male or female) should be getting 1500mg/day (milligrams a day), this includes what you get from your supplements as well as your diet. 1glass/8oz. of milk or fortified orange juice has about 250mg of Ca++. So, you would need about 6 glasses a day. Other sources of calcium are yogurt, fortified rice or soy milk, and green leafy vegetables. Cheese is not a good source, it has a lot of calcium in it, but it is hard for your body to get the calcium from it (it isn't as bioavailable as other sources), especially if you are lactose intolerant or have food sensitivities to dairy. If supplementing Ca++, take the citrate malate form of calcium (in the top three most bioavailable forms of Ca++). The bicarbonate form of Ca++ is not very bioavailable and can cause constipation. Your body can only absorb 500mg of calcium at a time, so taking one tablet with your whole 1500mg of calcium is useless. You will only absorb about 500mg, so don't waste your money on a supplement with tablets that have more than 500mg each (Note: there are instances when taking more is helpful, so if your doctor recommends more, don't tell him/her that they are crazy). Calcium supplements are supplements that are highly likely to be contaminated, due to the source that the calcium is taken from. It is important that you are taking a high quality supplement if you are taking Ca++ supplements. Make sure it is a pharmaceutical grade supplement...most chiropractors can get these, as well as other health practitioners. There are many different ways to take Ca++ in order to increase the amount your body can absorb, or the effectiveness of the supplement. Taking Ca++ at night before you go to sleep without food, is best (remember you can't take all of your calcium at once, you will need to take it other times as well). Too much calcium can cause problems...calcium deposits in soft tissues, kidney stones, etc.
-Vitamin D is necessary to help get the calcium that you absorb from your food into your bones. We naturally make vit. D when the sun hits our skin. If we live in a northern state, however, there are only 2-3 months in the summer when the sun is strong enough for this to happen. Here in MN, we need to supplement vit. D in fall, winter, and spring. And supplementing all year is not a bad idea. To prevent osteoporosis, you should take vit. D 200-800 IU/day (International Units per day). Prevention with Vit. D should only be done in the northern states from Oct.-March and is best done if over 50 years of age. To treat osteoporosis vit. D should be taken 800-1600IU/day, this is for any state, time of year, or age of person who has osteoporosis. Vit. D is fat soluble, and you should not get too much...consult your doctor first.
-Magnesium (Mg) does not help prevent osteoporosis but can be helpful if you have osteoporosis already. 350-400mg/day of Mg to treat osteoporosis. If you get too much Magnesium, it can cause Diarrhea. Starting with a lower dose even 50-100mg is not a bad idea. It is possible to then gradually increase the dose as needed from there.
-Protein is helpful, 1-2 servings of protein drink a day, or 30-60 g. (grams) protein a day. Too much animal protein can increase calcium loss in the urine. In the United States most of us get too much protein as it is and most of it is animal protein. If supplementing protein for osteoporosis I recommend soy protein drinks. Make sure it has soy isoflavones. Soy isoflavones are helpful in osteoporosis, and menopause. Soy isoflavones can be found in other foods and supplements as well. Soy isoflavones should not be used if you have a personal or family history of estrogen-based cancer.
-Hormone Replacement Therapy (HRT) is a popular treatment and prevention for osteoporosis. HRT can prevent osteoporosis after menopause/hysterectomy. It only brings you back to a normal level of bone loss (i.e. from 3.5% loss per year to 1.2% loss per year). This means that for the first 5 years after menopause it is extremely helpful in treatment/prevention of osteoporosis, but after that, it doesn't help much. (see Facts above). HRT is most helpful in osteoporosis for the first 5-7 years after menopause. HRT does not prevent heart disease as once thought. Estrogen based HRT does increase your risk for estrogen-based cancer i.e. breast cancer. Please talk to your Medical Doctor about your options. Chiropractors do not work with medications.
-Vit K is helpful, but there are only a few studies, too much vit. K is bad, and the wrong kind of vit. K can cause jaundice.
-We need 25g. (grams) of fiber a day. But too much fiber will decrease calcium absorption.
-Too much salt, animal protein, or caffeine will increase calcium loss in the urine.
-Phosphorus will increase fecal calcium loss, but decrease calcium loss in urine.
-Exercise is important. You need weight bearing exercise (exercise with resistance) in order to get the absorbed calcium into your bones. If you have severe osteoporosis (2 STD's or standard deviations, from the mean) exercise could be problematic and you should consult your doctor before starting an exercise program.
Chiropractic Care
Chiropractic care is beneficial for everyone. In treatment of people with osteoporosis, there are several adjusting techniques that can be used. These techniques are gentler than other adjustment techniques and are used to avoid putting too much pressure on the bones so that risk of fracture is decreased. This allows chiropractors to treat people with mild to moderate osteoporosis.
Chiropractors are also well trained in nutrition. Your chiropractor can analyze your diet and recommend the supplements you need to prevent and treat osteoporosis. Your chiropractor can also help you get on an exercise program that is necessary to build and maintain strong bones. Exercise and nutrition are extremely important in the prevention and treatment of osteoporosis. Remember prevention starts with moms getting enough nutrients to us as babies, and needs to be done throughout our whole lives, but it is never too late to start now.
References
Lecture notes Joel J. Pins, MPH, LN. Clinical Nutrition II, fall 2000.
As an ultra-runner myself, I tend to see a lot of runners at my office. Are you just starting out with running? Have you never run before, but would love to learn? Do you love nothing more than to spend days out on the trails? Maybe your jam is something in between. I can help you navigate through training, get yourself to the start line to crush your goals, and have the time of your life on race day. Having goals is optional, having fun is mandatory!
I do love to look at shoes. As a chiropractor I see shoes not only as a fashion statement, but as a way to assess spinal health, and to point out any biomechanical issues throughout the body. The shoes you wear can affect the health of the joints, muscles, and nervous system in your legs and back. I look at factors such as how your laces are tied, how many miles your shoes have gone, how the soles on the shoes are wearing, and others, when I want to find out more about the problems causing you pain or preventing optimal sports performance. What your old shoes look like can also give me clues as to what kind of shoes and orthotics may work best for you in the future. If you want me to check your shoes, all it takes is a few extra minutes during your regular appointment. Just give me a call.
Sincerely,
Dr. Gwendolyn E. Kelly-Kohnke, DC
(Blog entry from MySpace Oct. 2008)
Sleep Apnea is defined in The Merk Manual Seventeenth Edition Centennial Edition as:
"A group of disorders in which breathing during sleep stops for more than or equal to 10 seconds, usually more than 20 times per hour, causing measurable blood deoxygenation."
Basically, sleep apnea is a sleeping disorder in which breathing stops several times an hour, for 10 seconds or more. In order for these breaks in breathing to be call sleep apnea, they also have to cause a decrease of oxygen in the blood ("blood deoxygenation") that is significant and that can be measured.
There are several different types of Sleep Apnea. The different types include central sleep apnea, obstructive sleep apnea, hypopnea (see also Hypopnea above), and combinations of these. Central Sleep Apnea (CSA) is due to a decrease in respiration (breathing), due to problems in the central nervous system (CNS- specifically the respiratory center has decreased output) or brain stem. Obstructive Sleep Apnea (OSA) is caused by an obstruction of the airway, usually in the upper airway or at the beginning of the airway.
The most common, and the most studied form of sleep apnea is obstructive (OSA). OSA has many causes including obesity, alcoholism, excess skin, developmental or congenital abnormalities (genetics), sleeping position, medications, and others. If the cause is obesity, weight loss can often be the cure. Likewise, if alcoholism is the cause, cessation of drinking can often be the cure.
Diagnosis is best done at a sleep clinic. If you feel that you are having trouble sleeping, if your partner says you are having trouble sleeping (i.e.-they are awake because you are snoring), or if you sleep all night and still feel unrested in the mourning, a sleep clinic is the place for you. Snoring and difficulties sleeping do not mean you have sleep apnea, but a sleep clinic could tell you what your difficulties are from, and if they are indeed from sleep apnea.
Note: snoring does not mean you have sleep apnea. You can snore and not have sleeping difficulties. However, people with sleep apnea tend to have a higher tendency to snore, than the average person.
Treatment of sleep apnea is not usually difficult. Some people get results simply from not sleeping on their backs (sleeping on your side is best), decreasing weight, having their MD change their medications, or avoiding alcohol. Sometimes a simple mouth guard will do. The most common treatment, and the treatment that works on most forms of sleep apnea is a CPAP (Continuous Positive Airway Pressure) or other similar machines. This is a machine that has a mask you wear to bed. It makes sure you have enough air going into the airway to keep it open at all times. Most people get used to it quickly and find that they sleep better and feel more rested (this also helps their partners as well). Occasionally surgery has been used, but it is not usually recommended.
Chiropractic care as a treatment for sleep apnea has not yet been studied (I hope that changes). There are techniques used to open the airway by stimulation of the sympathetic nervous system (percussion temporarily helpful in asthma, emphysema, and some other lung diseases). We also know that chiropractic can influence the nervous system in a beneficial way. I hope that in the future, chiropractors will find a way to study the question...Can chiropractic help in the treatment of sleep apnea? I think it may be possible, but that is currently one of many questions left to be discovered by science.
Heart disease is associated with sleep apnea. People with heart disease have an increased likelihood of developing/having sleep apnea. And people with sleep apnea tend to have a higher risk of heart disease. The more severe the case of sleep apnea, the higher the risk of heart disease. These risks, however, are associated with untreated sleep apnea. It appears that treatment of sleep apnea will prevent the associated heart risks.
Resources
Javaheri, S. (2003 June). Heart failure and sleep apnea: emphasis on practical therapeutic options. Clin Chest Med. 3(2):207-22. Retrieved from Pub Med http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?CMD=Display&DB=PubMed in September 2003. PMID 12800779 (PubMed-indexed for MEDLINE)
Meoli, Amy MD, et al. (2001). Hypopnea in Sleep-Disordered Breathing in Adults. Sleep, 24(4):469-470.
The Merk Manual Seventeenth Edition (Centennial Edition). (1999). West Point, PA: Merk & Co., Inc.
As a former gymnast and current ultra runner, I love helping athletes. I understand what it means to love life through sports. The heart of what I do is helping people reach their goals in health, sports, activities, and in life. Many professional athletes have done testimonials on how they feel chiropractic has improved their performance in their sports. I help athletes from all sorts of sports, some of them a little more obscure than others. A few of the sports my patients play include golf, hockey, basketball, broomball, softball, volleyball, rugby, gymnastics, running (track, cross country, road, trail, ultra), football, soccer, cheerleading, wrestling, WWE style wrestling, MMA, Karate, Kung Fu, Tae Kwon Do, and others.
I understand that martial arts are not sports, but I felt this was a good place to include it here. Also, circus performers are welcome here... they too are not a sport, but an art... a performance! I hear you!
The Sunshine State Games is a sporting event in Florida with over 24 sports and 7,000 athletes.
I recently got back from working at the sunshine state games as a medic this June. I met a lot of dedicated chiropractors down there. It was a great experience!
There were many athletes there needing help to continue in their sports. I was part of a team of chiropractors, medical doctors, and students that were supplying first aid, taping, and stretching for athletes trying to heal from and prevent further injuries.
I found that the athletes in Florida are just as dedicated as the athletes we have here in Minnesota. They were definitely out there playing hard and doing their best. The athletes and coaches were wonderful to work with, and made the whole experience fun, and well worth my time.
From June 2008 newsletter. Written by Dr. Gwendolyn E. Kelly-Kohnke, DC
Kelly Chiropractic, P.A.
600 Twelve Oaks Center Drive, Suite 642B Wayzata, Minnesota 55391, United States
We use cookies to analyze website traffic and optimize your website experience. By accepting our use of cookies, your data will be aggregated with all other user data.