Improving mobility in ankylosing spondylitis patients

Most patients who are given the diagnosis of ankylosing spondylitis have no idea what the disease is all about. Essentially, ankylosing spondylitis is a form of inflammatory arthritis that localizes in the spine. Because it is an auto-immune disease, the body attacks the facet joints between the vertebra, resulting in fusion and the hallmark forward stooping posture. It is difficult to diagnose and patients can live with it for years undetected. Arthritis is generally thought to be an old person’s disease, however, ankylosing spondylitis is most commonly seen in individuals between 17 and 35 years of age.A new class of drugs called biologics have revolutionized the treatment of auto-immune diseases and many patients are able to improve their quality of life as a result. Dr. Carlo Ammendolia at the University of Toronto says that the use of these drugs actually control the inflammatory process and are life changing for those struggling with the pain ankylosing spondylitis, however, they do not address the fusion of the joints that can impair mobility. Since most people are young when they receive their diagnosis, the thought of not being able to enjoy all of life’s activities because of spinal fusion can be devastating. Through his research, Dr. Ammendolia is working with patients to develop management approaches to help minimize or slow the fusion process.Dr. Ammendolia has identified several tailored exercises that when combined with the drugs can help improve or slow the fusion process. “The exercise program is really geared towards lifestyle and self management where patients are doing things sitting, standing, walking and sleeping in a posture that mitigates that risk to fuse in that posture.” The goal is to improve the muscles around the joints so that optimal posture is maintained. Chiropractic care also plays a role, with carefully considered treatments known as “adjustments” adding to the overall treatment plan to help maintain mobility. Push/relax techniques are used to help regain neck flexibility. In cases where joints are already fused together, adjustment or manual manipulation is not performed.As much as we hate to admit it, most health care, especially disease management, requires commitment from the patient to improve or maintain their wellness. That is of course what Empowered Health is all about, right? With these protocols, Dr. Ammendolia hopes that individuals suffering from ankylosing spondylitis will be “kick started” into self management of the condition. Next steps include developing tools and resources that will help patients track and monitor their progress. For more information, be sure to consult your family chiropractic doctor.

Can’t Sleep? It may not be your bed’s fault.

Approximately 14% of Canadians suffer from insomnia. It’s safe to assume that a significant number of these individuals are having trouble sleeping because of chronic pain. Just because you hurt after laying in your bed all night, doesn’t necessarily mean it’s time to trade in your mattress. It’s important to look at all of the different variables in your life before jumping to any conclusions.Consider this: If you’ve been sleeping on the same mattress for over a year and your pain developed suddenly, there is a good chance your bed hasn’t changed all that much and that some other factor is causing your discomfort. Did you load any boxes, luggage or groceries from you car recently? Do you perform duties at work that may bring on a repetitive stress injury? Have you been in a car accident? Have you changed your diet or do you still have that extra holiday weight? Maybe you overdid it at the gym or went a little further on your daily walk? There are countless sources of injury and it is very common for the pain to manifest in the morning after a period of inactivity (laying in your bed all night in this case).Poor sleeping posture can often magnify pre-existing spine conditions. Some of the best positions for sleeping are laying flat on your back and laying on your side with a pillow between your legs to keep your hips and spine in line. Pillows are also very important when it comes to sleep. Make sure your pillow isn’t too high, but does provide ample support for the curve in your neck. If you need advice on how to improve your sleeping posture, your family chiropractor’s office is a great place to start.In some cases, your bed may be responsible for your pain. The ideal sleeping surface is one that is firm with some give in the top to support the natural curvature of the spine. If your mattress has lost its shape, it wouldn’t be a bad idea to consider an upgrade. Many mattress retailers even provide a trial period for you to test your new bed.The moral of the story? It can be difficult to pinpoint the cause of your pain and it is extremely frustrating when it interferes with your sleep. Don’t wait another night in pain. Talk to your family chiropractor and together you can answer the question of whether or not to a new mattress is in your future.

What does excessive weight really mean to your joints?

It is common knowledge that being overweight is associated with many negative health outcomes.  Heart disease, diabetes and cancer are linked to obesity and are usually the diseases we jump to first.  There are also other very real dangers to our muscles and joints that often present before these diseases manifest as a result of the extra weight.For those who are overweight, there is significantly more stress on the musculoskeletal system.  The demand on the muscles, joints and bones increases exponentially as body mass increases.  In one example, Dr. Michael Lyon, MD, who is actively involved in research around diet, nutrition and weight loss, suggests that every extra 10 pounds contributes to at least 40 pounds of added stress per knee.  Consider that your spine is made up of 24 bone and their related joints.  This extra weight is amplified throughout each of these joints, causing severe strain on your muscles, facets, vertebral discs and nerves which could result in arthritis, stenosis or other mobility issues.Extra weight also throws off your centre of gravity due to far from optimal body mechanics.  Your spine, joints and muscles need to adjust to this change that impacts balance and mobility.  Simply bending down to lift a box is much harder than it once was and puts overweight individuals at a higher risk of injury.The second factor working against your joints and muscles is the activation of the body’s inflammatory response.  This is a biochemical reaction involving the vascular and immune systems that is triggered when the body senses injury or infection.  Essentially, the body believes it is in a diseased state.  Inflammation around the joints contributes to pain, swelling and loss of mobility and is ultimately a precursor to very serious conditions like heart disease and diabetes.Once your vascular system is impaired, blood has a difficult time supplying the tissues of the body with the oxygen and nutrients they need.  Nerve, muscle and other body systems suffer as a result of poor circulation.  Your muscles may feel more tired, you will most likely grow physically weaker and breathing with be more of a chore.Of course, most people do understand the risks and negative aspects of being overweight.  The difficult part is overcoming and maintaining a healthy body weight after suffering from obesity.  Statistics from 2011 suggest that approximately 1/2 of the adult Canadian population self reported as being overweight or obese.  Plus, our country is on track to see these numbers skyrocket in the near future.  It’s a huge problem that most people struggle to overcome.  Dr. Michael Lyon is featured on the Empowered Health show (Mondays at 8:30pm and Thursdays at 4pm on ChekTV or check local listings)  in a two part series highlighting the challenges we encounter when trying to lose weight and more importantly, keep it off.  He offers several suggestions on how to work with your body, rather than against it.

Patient attitudes influence recovery outcome

Why do some patients recovery quickly while others are slow to improve? This question reminds me of that children’s game where “one of these things is not like the other” except in the case with patients who have similar injuries and treatment plans, spotting the differences are much more difficult. Dr. Jason Busse, chiropractic researcher at McMaster University is conducting studies that aim to better identify these variables so that it is easier to distinguish patients who are at risk of a longer recovery from those who require less intervention.Dr. Busse’s initial findings uncovered approximately 100 studies identifying dozens of varying factors that play into a patient’s recovery. These factors ranged from things such as age, patient’s education, coping mechanisms and confidence in the healthcare provider. Thirty factors from the studies consistently predicted recovery, 25 factors showed no association to recovery and 60 factors proved inconsistent or lacked evidence to support recovery prediction.Many of the factors that predict recovery were influenced by patient attitudes. The findings suggest that patient beliefs and confidence in their health play a bigger role in recovery than we initially thought. As Dr. Busse puts it “there is a real potential there is seems for the provider by how they convey their impressions to actually influence [the patient’s] prognosis.”The team at McMaster wanted to evaluate the role of patient beliefs and attitudes as a predictor to recovery outcome. A research trial followed a group of patients who required surgery to repair a broken leg, all who received standardized care. Patients were asked to complete a survey one month after surgery about their beliefs and attitudes with recovery and were followed for one year. “What we found was there were 27 items in our survey that separated out the group that had recovered and gone back to work versus the group that has not recovered” reports Dr. Busse, “and all of these variables were potentially modifiable.”This reinforces the importance of the doctor’s role in health as they have the potential to influence the attitudes and behaviours of their patients which could ultimately result in a more favourable patient recovery and sooner return to work. Theoretically, the survey could be given to patients to help gauge their risks and needs. Knowing about these factors can assist health care providers in identifying patients who may require more support with recovery than others. Early intervention with patients who are “high-risk” could ensure a more appropriate course and frequency of treatment. Care could also be better tailored for all patients, depending on their needs detected by the factors.Ultimately, a survey cannot determine how well you will recover; however, it does provide a meaningful tool to help steer health providers in the correct direction. The key is in the doctor’s interpretation of the factors and their delivery of the information to the patient. Dr. Busse’s research is yet another example of the significance of the doctor/patient relationship.

Narrowing the evidence-practice gap

Healthcare research is conducted daily around the world and we often see headlines published on a single topic in newspapers or broadcast on the news. Some of these findings are nothing short of amazing, disc regeneration for example, but most studies provide small steps forward to improve prevention opportunities and recovery time. While most research papers do not garner airtime due to the volume of research, this should not dismiss their significance. But how do we get the attention of the public, or more importantly, the health professional when it comes to these types of studies?Dr. André Bussières DC, PhD holds the CCRF Professorship in Rehabilitation Epidemiology at McGill University. His goal is to develop methods and resources to narrow what some call the evidence-practice gap. This “gap” refers to published comprehensive research and what is practiced by the healthcare provider in the clinic setting. Dr. Bussières says that 30-40% of patients do not receive the best care as a result of this “gap”, so patients aren’t receiving care that is reflective of the latest research. Knowledge transfer is an extremely tricky process and it usually takes a long time to convey the latest best practices to clinicians.One of the reasons why communication is so difficult is because the research is scattered throughout many different journals and publications. To help centralize the information, Dr. Bussières and his team at McGill plan to look at all of the evidence and research available for a given condition or therapy. Once the review is complete and the research is scrutinized, qualifying studies are synthesized into one comprehensive document (also known as a Clinical Practice Guideline or CPG) that explains the research resources and demonstrates best practices supported by the research at that time. This creates somewhat of a road map that the health professional can use to assist with diagnosis and treatment. In addition, CPGs can reinforce a doctor’s experience with patients in practice (practice based evidence) through evidence-based research (what is learnt in the lab).Comprehensive CPGs can be very useful in the transfer of knowledge and support best practices in the clinic setting. These resources are also valuable when discussing expected outcomes and recovery times with insurance providers or patients themselves. The public is more informed about their health now than ever before so it is plausible that patients will have questions and ask for reassurance when receiving a diagnosis and recommended care.