Wednesday, June 20, 2012

Getting Treatment for Your Neck

Many medical procedures carry risk.  We’ve all seen the drug commercials on TV with long, speedy disclaimers that the drug might make you wet yourself or stop your heart or something.  We do these things to ourselves because the benefits are greater than the risks involved.  For example, the risks of taking Plavix (fatigue, easy bruising) seem pretty small compared to the benefit of preventing stokes.  In medical areas, good science means taking a look at various treatments and deciding whether the benefits are greater than the risks. 

My neurologist told me some time ago that there is growing evidence that chiropractic adjustments to the neck are linked to strokes and arterial damage. A lot of medical treatments have risks, so that doesn’t bother me too much.  Because I am inclined to follow the evidence, I want to know:

1.       Is it true that neck manipulations are connected to strokes and arterial damage?
2.       If it is true, do the benefits outweigh the risks?

The British Journal of Medicine (BMJ) publish an article on June 7th 2012 asking these very questions.  The researchers did a systematic review of this area, which means they gathered all the data points they could get, to see if any indicators could be found or conclusions drawn.

Problems
Nobody has done a randomized, double-blind study to see if people who get chiropractic neck treatment have stokes.  That would be a fast way to be charged with ethical violations.

The next problem is that when someone has a stroke, most of the time nobody is going to ask them if they have been seeing a chiropractor.  For that reason, the number of strokes related to neck manipulations is highly likely to be underreported. 

On the other hand, just because two things seem correlated, does not mean one is causing the other.  As the JREF article (below) points out, some chiropractors counter that people had arterial damage and neck pain already; that’s why they came for treatment.  That sounds like baloney to me.  If they know someone has arterial damage why in the world are they doing neck adjustments on them!?

Are Neck Manipulations Linked to Strokes and Damage?
The answer is: yep!  It turns out that jerking the neck around has been correlated with arterial damage and strokes.  According to the BMJ article, the rate of damage to the artery from these neck adjustments is between 1 in 400k to 5.8 million manipulations.  Compared to other medical treatments, this doesn’t seem like a big risk.  On the other hand, death from stroke is a pretty bad outcome if you are only seeing a chiropractor for headaches or a sore neck.  So overall, I would consider the riskiness pretty high: even though the absolute risk is low the severity is high.

Do Benefits Outweigh the Risks?
Basically, studies have shown that there is no measurable benefit to neck manipulation (PubMed 1-4).  Other studies have shown that getting your neck cracked by a chiro was no better than applying tape to the neck (PubMed 5 below).  I should point out that there was no placebo in that study, so just remember that they were comparing two treatments – they weren’t actually testing if the treatments work.  Neck adjustments work as much as tape.  And what is the downside to taping your neck?  None.  Well, maybe some skin irritation.

 There Are Other Risks
According to the Guardian, not very long ago, 1 in 4 chiropractors in Britain were under investigation for making false claims of chiropractic services helping various conditions (like bed wetting!).  The British Chiropractic Association has fired back with an exhaustive (chuckle) list of studies supporting chiro.  There were 29 studies on the list.  10 of them had nothing to do with chiropractic and some of them weren’t actually studies at all.  The list also ignored large, high quality studies that showed no benefit to chiropractic treatment.  The bottom line is that your chiropractor may actually be making false claims about what symptoms they can help with.  So you should be careful.

 What’s the point?
The benefits of getting your neck adjusted (same benefit as taping) are MUCH smaller than the risk of injury or death.  For this reason, the British Medical Journal recommends we abandon chiropractic neck adjustments for safer and more beneficial treatments.  No matter how persuasive your chiropractor or neighbors may be, a scientific review of the evidence says that the benefits of neck adjustments do not outweigh the risks.

 Scientific support for chiropractic treatments as a whole is iffy.  In fact, even the concepts behind chiropractic are fairly iffy.  Overtime, scientific evidence will continue to collect, but for now the best we can do is follow the evidence.


Monday, June 4, 2012

Apps for your health


Below is a list of some apps I've tried out, or thought people may be interested in.  Links are provided below for itunes, but many of these apps are also available for android phones. There are a zillion health apps out there and a lot are low quality, so do some reading before you throw your money around.

Your mental and physical health is an important part of your life, so be willing to spend a few bucks on it.  This list is just a handful of apps that I have found helpful. 

Of course, if you want a great app for your health, take a look at twitter!  There are a ton of people getting healthy that would love to tell you all about it!  Check out our wellness twitter account: @hbmwellness

THI Trainer - $2.99
This is a comprehensive program for building, recording and personalizing workouts.
Pros:  You tell it what muscles you want to work and you can see a list of exercises and even watch videos on how to do the exercise properly.  You can follow their pre-made workouts or build one of your own.  You can also see graphs of how your strength/endurance have improved over time.  There is a free version if you want to try it out.
Cons:  It's a big app and you can get a little lost if you are new to exercise.  The app is geared towards weight lifting, which may not fit your goals.

This app has nutritional information for over 30,000 foods at more than 200 restaurants!  This is really useful when you are traveling for work.  Just because work makes us travel doesn’t mean we have to get fat while we do it.  It’s not perfect, but it’s pretty helpful.
Pros:  It’s pretty straight forward to use, and it’s free!
Cons:  The ads can be annoying and it doesn’t have all menu items for the restaurants.


Lose It! – FREE!
This is a fantastic app to anchor your health goals.  There are a lot of apps like this, but I think this is one of the easier apps to use.  It tracks your food, exercise, weight, and all sorts of stuff. 
Pros:   It has a ginormous database of foods built in and it’s pretty easy to add your own foods.  You can also add friends to help you stay on track with your goals.  It also roughly estimates the calories you burn doing various exercises, and can provide all sorts of helpful graphs.
Cons:  It’s a inaccurate on calculating how many calories you should be eating, so you’ll have to manually adjust the numbers periodically.

HeartWise  - $.99
A simple little app for tracking your blood pressure and resting heart rate.  I like to measure how I am benefitting from my exercise and resting heart rate is one factor I look at.
Pros:  It’s a no frills stat tracker that docs love cuz it tracks your blood pressure history for you.  It even has an area for comments on the days stats (if you need it).
Cons:  It’s boring, but it does the job.


Pushup Fu - $.99
Train to do 100 pushups in a single sitting!  Challenge friends and move up the ranks.  If you don’t know how to do pushups at all, this app will teach you how it’s done PROPERLY and then give you a pre-test to see where you should begin.  You can start at 0 pushups and work all the way up to 200.
Pros:  Unlike some other pushup programs, the graduated workouts increase in difficulty slowly so I was less likely to give up.  Also, the ipod/iphone will tell you if you are doing the pushups too slow or fast, so it’s a good trainer.  The battle mode is pretty fun because you can challenge people who are at your own level.  I got a lot more out of my workouts when I was competing with someone.
Cons:  You’ll need a good armband for your ipod/iphone since this runs on an accelerometer.

CrunchFu - $.99
This is the same as Pushup Fu, but it trains you on doing up to 200 crunches!

Squatfu - $.99
This is the same as Pushup Fu, but it trains you on doing up to 200 Squats!
Cons:  The accelerometer is tricky on this one.  It takes some getting used to.

FitFu - $5.99
FitFu is like the facebook of exercise.  It is the big brother of the other 'FU' apps. It allows you to earn points for exercising and helping your friends to exercise.  If you are starting out with exercise and need to start small, this is a good way to do it.
Pros:  I like this app because it’s a motivating way to keep people exercising when there isn’t a gym around.  It's fun.  The app tracks your personal best in all the exercises.  It’s got a good interface and connects with facebook and twitter.  It will also TEACH you to do all sorts of exercises. 
Cons:  Aside from being expensive, the success of the app relies on social pressure to keep you exercising  You need people who are going to do it with you.

BodyShot - $2.99
This is a great app that I own.  If you are working on losing a significant amount of weight or want to put on a lot of muscle, this is an important app.  Not all progress gets reflected in your weight!  This app also tracks your body fat %  and all sorts of measurements.  Best of all it lets you take pictures of yourself so that you can see the slow changes you are making over time.  The pics came be stored privately so you don't have to worry about them being accessible to others.
Pros:  This app can help keep you motivated when your progress is slow.  You can always go back and look at the pics of how fat and sloppy you used to be.
Cons:  The app doesn't lie.  You can't keep lying to yourself about the condition of your body and the app will show you the truth.  (It's kind of a pro, right?)

Fat2Fit - Free
This is my go to app for health.  It will help you find a healthy goal weight, determine your basal metabolic rate and do other important calculations. Best of all, their numbers are based on real science.  They will help you get healthy in a reasonable way without starving yourself or going on dangerous diets. The makers of the app also have a pretty good podcast that I listen to occasionally to keep my motivation up.
Pros:  Good science, reasonable goals
Cons: none!


Pranayama - $4.99 or FREE
This is a breathing app that will help you relax your mind and body.  It tells you when to breathe in and out and has numerous levels of difficulty that you can work towards.  The time you spend in the breathing app is very customizable and quiet relaxing.
Pros:  The free version will work for most people.  If you want some of the benefits of meditation in an easy format this is for you.
Cons: I eventually realized that actual meditation provided more benefits and moved on to other apps.  I would use the free version for a few weeks before spending the money.

Meditator - $2.99
There are a bunch of free meditation timers out there.  I paid for this one because it is pretty customizable and has some built in sounds.  Chimes, fountains, etc.  There are a fair number of options to customize your meditation experience.
Pros:  This is one of the better of meditation apps.  
Cons:  There are other apps that are better at sounds.  I use another app if I want white noise.  Also, there are plenty of free meditation timer apps.  Don't pay money for a meditation app until AFTER you decide you are gonna be using it long term.

Last I checked this was only available for android.  Sorry!  This is a great app if you want to gain the health and mental refreshment that comes from meditation - but in an easier way.  This apps give you quotes and principles to ponder during your mediation time.  The quotes are designed to help you be more aware of your life and the state of your own mind.  Although the principles are based on Buddhism, no particular religiosity is needed.

Ambience - $2.99
This is the King Kong of white noise apps.  I use it for mediation and relaxation, but the possible uses of this app are endless.  It is easily worth 3 bucks.  It has high quality sounds in numerous areas.  For any kind of sound you want to hear, someone has a recording of it. Buying the app gives you access to a huge online library of all kinds of soundscapes.  The app also includes a timer and an alarm.
 Pros:  Awesomeness, great sound library
Cons: Kind of expensive, but well worth it.