WHAT IS A FACET JOINT ?

Spinal discs are getting the lion’s share of the attention when it comes to painful structures of the spine. I often see the proverbial “deer in the headlight” look on patient’s faces when we discuss their imaging and what we think is causing their problem

Each spinal segment, except for the very first one in the upper cervical spine, is composed of a disc and two facet joints, one on the right and one on the left. The discs and facets are vastly different in their anatomy and their function. The discs are meant to be the primary weight bearing structures while the facet joints are meant to guide fine movement in rotation and lateral bending, This often in distorted in pathological states , when the facets start bearing extra weight that the discs should be shouldering - often the case with states of “swayback” or hyperlordosis.

Facet joints can be the source of a lot of pain, In a way that is very different from a spinal disc. The pain tends to be more local . Facet joints are less likely to cause pain into the arm or leg unless they have significant osteoarthritis and cause spurring into the spinal nerve opening from the posterior aspect.

https://www.youtube.com/watch?v=CZ86VzZOrGw

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The Dark Side of Marijuana use for Chronic Pain and Psychiatric Management

https://www.ctvnews.ca/health/cannabis-use-impacts-cognitive-ability-beyond-intoxication-study-1.5747545#:~:text=The%20systematic%20review%20of%2010,making%2C%20suppressing%20inappropriate%20responses%2C%20and

This blog entry is only going to scratch the surface on what is ultimately a very complicated topic. But I felt compelled to put a few words out since I see a dangerous trend in this article gave legitimacy on a broader scale to my concerns.

The research on the medical use of whole plant marijuana including both CBD and THC is pretty robust, but with many caveats that are overlooked. It is pretty specific for certain conditions, and needs to be incredibly finely dosed. In the same way any other pharmaceutical would be used. It has indications, benefits, and side effects. And not everyone responds to it.

The research on the appropriate use of properly dosed medical cannabis has been hijacked by a whole subculture that has broadly applied the potential benefits to inappropriate uses. I see an alarming trend of many patients self directing the use of recreational grade cannabis for medical purposes. Because it's "natural" doesn't mean it's good or safe in all circumstances. Arsenic and poisonous mushrooms are very much naturally occurring substances as well. In the instances where I see self-directed cannabis use, there is no consistency of that dosage, no clear indication of what the purpose is, and no monitoring. And the side effects are overt and overlooked.

One of the most concerning side effects is the long-term cognitive impairment associated with daily cannabis use. This is a known fact even in medical prescriptions of whole plant marijuana, but in those circumstances the severity of the condition being treated warrants the potential side effect. The term "pothead" did not come out of a vacuum. It's a real documented phenomenon that appears to be irreversible in the long run.

I'm not trying to discount the very legitimate uses of medical cannabis that some of my patients are resorting to. It often is a better and safer alternative than some of the high grade pharmaceutical approaches they have tried as well. But it needs to be done with the same caution as one would use for any other pharmaceutical substances.

Cardio Workout from Home with a Twist (or two)

https://www.youtube.com/watch?v=fYQq4iyUYAM

I am continuously adding to the resource file of home workout videos that may be appropriate for our patients needs. While we have a robust selection in the area of no equipment weight training, strength, flexibility, yoga, and Pilates, I have had comparatively fewer offerings in the area of new equipment cardiovascular workouts.

This gap became more relevant to me a few weeks ago after our household added a wonderful 12 week old puppy, and I am in charge of the morning shift, which is historically when I get my exercise in. I have since then learn to do yoga with a tongue in my ear and a paw on my belly, but I have not been able to escape to my spin bike in the loft without enduring howls of desperate longing from the puppy a floor below.

Until she becomes old enough to do vigorous outdoor walking as an alternative, I've been looking for home cardiovascular videos I can do in the smaller space of my living room. And while I appreciate the walking videos from Leslie Sansone, about which I blogged a little while ago, I was looking for something a little more entertaining. I have always been curious about doing Zumba class but have felt many of the videos to be a little bit too complicated unless you have a good repertoire of their dance moves. I came across this particular channel that has several really good beginner Zumba videos. They range in length from 20 to 30 minutes which is ideal for a morning workout or after work workout. These may be a great alternative for people who are dog walkers on rainy days as well.

You have to remember that dancing has a lot of well documented scientific benefits beyond just cardiovascular endurance, including agility, long-term cognitive decline prevention, and general creativity.

And while my puppy has been wholly unimpressed by my dance moves, she has been agreeable to chase around the living room without howling while I attempt to mimic Zumba Zulu.

What is the Difference Between Standard and Custom Insoles ?

As the old saying goes, a picture is worth a thousand words. Customs orthotics are sometimes recommended as part of a treatment plan. Not always because of foot, ankle, or knee pain, but also in some lumbar and sacroiliac pain patterns that are aggravated by ligament laxity of the ankle leading to pronation.

Some patients will do really well with standard appliances: patients with low normal stable arches in particular. There are several good over the counter brand that we can direct patients to buy on their own. But in some patients, the anatomy and shape of their particular foot is just not going to be met with a standard appliance and they will need a custom orthotic to get results. This is often the case with patients who have a normally high tented arch and a short foot.

Below is a picture of two orthotics for the same patient. The bronze colored orthotics is a standard over the counter insole, the black custom made.

The Silent Epidemic of Unrecognized Mild Head Injuries in Car Accidents

https://www.sciencedirect.com/science/article/abs/pii/S0003999313010605

I recall hearing this statistic at a conference a few months ago. It sobered me but did not surprise me. 1/4th of all motor vehicle accidents, even “minor” ones, is an awful lot of people walking around with some persistent mild head injury symptoms 12 months later. Chiropractic, nutrition, and some brain exercises, especially visual, is what it often takes to clear them up.

Pain and Statin Medication

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2517983/#:~:text=Overall%2C%2022.0%25%20(95%25,did%20not%20use%20a%20statin.

This blog came on the heels of several patients reporting a common problem in the same week: Intense persistent pain in their legs and quads from taking statin medications. The problem is well known, but often underreported by patients and not always recognized by the prescribing physician. Differential diagnosis of neuro-musculoskeletal pain can be challenging in the population most often taking statins. But in the context of our chiropractic practices, we always need to take statin side effect as a possible reason for persistent pain, especially in the lower extremity. This can mimic or compound pain from other areas (hip and knee arthritis, bursitis, lumbar nerve pinching) and limit how much a patient can recover.

The solution can be just as complex as isolating the problem. Patients needs to inform themselves on risk benefit ratios of any medications and non pharmacological approaches to improving abnormal lipid profile.

What is Spinal Stenosis and Can Chiropractic Help ?

I often get patients presenting to an appointment with a stack of medical records and imaging, stating that their problem is caused by spinal stenosis. It becomes very apparent to me that while those patients can correctly articulate the word stenosis, most are at a complete loss to describe really what it is, much less what it means clinically.

The word stenosis basically means “narrowing”. In the context of the spine, the term stenosis is used to describe the narrowing of a bony passage for important neurological structures. Lateral stenosis describes the narrowing of the passageway of the spinal nerves during their exit from the spinal cord into a limb, and central canal stenosis describes the narrowing of the conduit for the spinal cord behind the vertebra, prior to the point where it sends it to the spinal nerves.

Stenosis is often a degenerative anatomical constant, meaning it is an unchanging narrow space from narrowing of the spinal disc and other overgrowth of other spinal structures. Patients with stenosis however can have significant fluctuation of pain while the stenosis is constant. The explanation is that other, intermittent and modifiable factors will make it better or worse: spine/pelvis/leg alignment, posture shifting, and muscular core deconditioning. This explains why many patients with diagnosed stenosis on an MRI can still report quite a bit of relief from chiropractic care.