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HEALTHBEAT SHOW NOTES .... Episode #88 - Recorded March 16, 2007

Hello and welcome to this week’s edition of HealthBeat, Chiropractic OnLine Today’s Health, News and informational Podcast.

In this week’s news:  We’ll Look At –  

• Obesity and Inflammation

• Iliotibial Band Syndrome

• Leg Length Evaluation via the Allis test

• Chronic LBP In Elderly

For HealthBeat, This is Dr. Todd Eglow.

Welcome to HealthBeat Podcast #88, recorded March 16, 2007.  HealthBeat is Chiropractic OnLine Today’s radio program, providing current news and commentary about Chiropractic and Health.

This week’s Episode is sponsored by DaVinci Laboratories.  Please surf to our web site at www.ChiropracticRadio.com and click on the DaVinci link for your Health and Nutritional needs.

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And Now for some news ….

Obesity and Inflammation

A common theme that links many diseases and chronic illness is uncontrolled cellular inflammation. It is a factor in diseases including cardiovascular disease, diabetes, cancer, arthritis and many autoimmune-related conditions.

Obesity has recently been added to this group of diseases as it is now known to present a low grade inflammatory response within many of the body’s tissues, which cause deleterious effects, often leading to the development of cardiovascular and metabolic disease. It is well known that being overweight is detrimental to one’s health, but until recently the known mechanisms were limited.

Scientists over the last decade have started to unravel the mystery of why obesity leads to premature death. Although there is still much to learn, it is valuable to comprehend the known effects of chronic inflammation, as the prevalence of obesity continues to be a rising problem among the American population, particularly in children.

Inflammation is, by design, a protective response leading to the repair of tissue. When inflammation becomes chronic, as is the case with obesity, chemical mediators, derived from different cellular activities, change in dynamics causing a progressive state of decline.

Fat cells are now considered an immune organ that secretes numerous immune modulating chemicals. Visceral fat, in particular, is associated with the low grade inflammation that seems to be a contributing pathologic feature for metabolic disease through insulin resistance and the promotion of atherosclerotic build-up in circulatory vessels.

When high levels of visceral fat are combined with physical inactivity, over-nutrition, and advancement in age, the effect becomes more pronounced. Visceral fat is highly metabolic and contributes to cytokine hyperactivity.

Adipokines secreted from fat tissue influence the metabolic process and contribute to proper function. The consequent low grade inflammation associated with obesity causes disturbance in the secretion and function of adipokines.

Research has identified changes in adiponectin, leptin, and resistin that exhibit harmful effects upon the body in obese individuals.

Adiponectin is an antiatherogenic agent, meaning it helps prevent the development of atheroschlerotic plaque in blood vessels and slows the progression of atherosclerosis in coronary vessels.

It does this by acting directly upon the vessel wall, inhibiting adhesive molecules from contributing to plaque formation and acts as a blocking agent to the formation of foam cells. In the skeletal muscle and the liver, adiponectin serves to promote insulin sensitivity and a positive blood lipid profile.

Visceral adiposity reduces adiponectin concentrations. Lowering the adiponectin concentrations lessens the cardio-protective effect, leading to increased cardiovascular risk.

Leptin regulates energy metabolism and balance in conjunction with the brain’s hypothalamus. Leptin is currently being touted as having cardio-protective benefits among its others roles in metabolism.

Leptin concentrations adjust in response to obesity and contribute to insulin resistance. The changes in leptin concentration have also been recognized as a risk factor for coronary heart disease.

Likewise increased resistin concentrations correlate with obesity related inflammation and may be associated with the initiation and progression of atherosclerotic lesions. Resistin also promotes insulin resistance, although the actual mechanism is not known. 

Insulin resistance due to adipokine dysfunction is further influenced by free fatty acids liberated directly into the liver from visceral fat tissue.

For individuals that are currently obese, there is still plenty of hope. Weight loss is related to reduction of oxidative stress and inflammation, and these beneficial effects likely translates into reduction of cardiovascular risk in obese individuals.

Likewise, exercise and dietary management, along with pharmacologic intervention can lead to atherosclerotic reversal in the earlier stages of CAD.

Individuals with central adiposity, poor blood lipid profiles, hypertension, and/or insulin resistance should seek immediate professional assistance to prevent further health detriment.

For a full discussion of this topic, surf to our Show Notes for a link to this article - http://www.ncsf.org/enew/articles/articles-ObesityandInflammation.aspx

Iliotibial Band Syndrome

Iliotibial Band Syndrome (ITBS) is generally regarded as an overuse injury that affects the lateral aspect of the thigh.

The condition commonly occurs in running and cycling due to the repetitive flexion of the knee at approximately 30 degrees. The Iliotibial Band extends from the tensor fascia latae distally in the lateral leg and inserts on the lateral aspect of the tibia.

The etiology of ITBS may be due to an independent variable, but in most cases the condition is brought on by overstraining and multifactorial events such as biomechanical errors, improper footwear and variations in plantar surface angles, functional overpronation (malalignment) and/or inflexibility of the ITB and abductor/adductor muscle imbalances which may all lead to dysfunction.

The condition is often exacerbated with continued participation in repetitive activities that employ limited knee flexion such as jogging. In order to adapt to the painful condition, individuals with ITB Syndrome will often externally rotate their hip, internally rotate their lower leg, and pronate their foot.

This present’s additional concern as gait disturbance can corrupt the kinetic chain leading to inflammation in other regions.

No matter what the actual cause the first step to treating the syndrome is removing the stimulus of irritation, which is most often repetitive leg movement at 30 degrees of flexion.

Return to repetitive activities can occur once cleared by the appropriate healthcare professional. As mentioned earlier, overstraining/training are associated with IT band syndrome, so the exercise prescription should be reviewed to assess volume and intensity changes that may be a contributing cause.

In most cases, IT band syndrome can be managed in a relatively short period of time with routinely applied therapeutic modalities.

For a full discussion of this topic, surf to our Show Notes for a link to this article - http://www.ncsf.org/enew/articles/articles-IliotibialBandSyndrome.aspx

http://www.wheelessonline.com/ortho/tensor_fascia_lata_iliotibial_band

Leg Length Evaluation via the Allis test

A study in the online journal www.ChiroandOsteo.com investigated a leg length evaluation via the Allis test.  Chiropractors use a variety of supine and prone leg checking procedures. Some, including the Allis test, purport to distinguish anatomic from functional leg length inequality.

Although the reliability and to a lesser extent the validity of some leg checking procedures has been assessed, little is known on the Allis test. The present study mathematically models the test under a variety of hypothetical clinical conditions. In the author's search for historical and clinical information on the Allis test, nomenclatural and procedural issues became apparent.

The test is performed with the subject carefully positioned in the supine position, with the head, pelvis, and feet centered on the table. After an assessment for anatomic leg length inequality, the knees are flexed to approximately 90°.

The examiner then sights the short leg side knee sequentially from both the foot and side of the table, noting its relative locations: both its height from the table and Y axis position. The traditional interpretation of the Allis test is that a low knee identifies a short tibia and a cephalad knee a short femur.

The study concluded that the original Allis (aka Galeazzi) test was developed to identify gross hip deformity in pediatric patients. The extension of this test to adults suspected of having anatomical leg length inequality is problematic, and needs refinement at the least. The authors' modeling, questions whether this test can accurately identify anatomical leg length inequality, let alone distinguish a short tibia from a short femur.

For more information about this study, surf to our Show Notes - http://www.chiroandosteo.com/content/15/1/3

Chronic LBP In Elderly

Chronic low back pain (CLBP) is a common and debilitating problem in older adults. Little exists in the literature about primary care physicians' (PCPs') knowledge of and confidence in managing this problem.

A self-administered survey was mailed to PCPs in western Pennsylvania to measure knowledge of the evaluation and treatment of common contributors to CLBP in older adults, confidence in diagnosing these contributors through physical examination, and the association between confidence levels and knowledge.

The survey combined items with an ordinal scale on which PCPs ranked their confidence in detecting various contributors to CLBP (e.g., fibromyalgia) using physical examination and patient vignettes followed by multiple choice questions designed to assess knowledge. One hundred fifty-three of 634 surveys were returned (24.1%). Overall, the majority of PCPs did not feel "very confident" in their ability to diagnose any of the contributors of CLBP listed (most items <40%).

PCPs felt most confident in detecting scoliosis and least confident detecting myofascial pain of the piriformis muscle. There was a wide range in the number of respondents answering all questions related to a particular topic correctly (3.9% for sacroiliac joint syndrome to 70.4% for hip osteoarthritis).

There was no relationship between knowledge scores and confidence ratings (P>.05 for all comparisons). The results point to a need for more PCP education about CLBP in older adults. It also suggests that accurate needs assessment should not rely on physician confidence ratings alone.

For more information about this study published in the Journal of the American Geriatrics Society, surf to our Show Notes for a link - http://www.blackwell-synergy.com/doi/abs/10.1111/j.1532-5415.2006.00883.x

As always, please surf to our Podcast Show Notes at ChiropractiRadio.com for a full listing of web references mentioned in today’s show.

And remember - COT’s Healthbeat always recommends discussing any nutritional or exercise lifestyle modifications with a qualified healthcare professional.

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– Emily Dickinson

For Chiropractic OnLine Today’s HealthBeat, This is Dr. Todd Eglow.

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