Suffering From Knee Pain? Your Chiropractor Is Your Best Choice

To Your Health
September, 2021 (Vol. 15, Issue 09)

By Editorial Staff

New research confirms what many doctors of chiropractic and their patients with patellofemoral pain syndrome (PFPS) – the most common cause of knee pain, characterized by cartilage damage under the kneecap due to overuse or injury – likely know already: spinal manipulation is more effective than local exercise therapy in reducing pain, improving function and other key outcome measures.

A randomized, controlled trial [Scafoglieri A, and colleagues; BMC Musculoskel Disord, 2021] assigned PFPS patients (ages 16 and older and experiencing anterior knee pain for at least three months) to a local exercise or spinal manual therapy group. For six weeks, patients received high-velocity, low-thrust manipulations of the thoracolumbar region, sacroiliac joint and/or hip (one session per week); or supervised training of the knee and hip muscles with mobilization of the patellofemoral joint (also one session per week). Patients in both groups also received instructions on home exercises that focused on mobilizing the thoracolumbar region.

Outcome measures included maximum, minimum and current pain; function; and maximum voluntary peak force (MVPF) of the quadriceps – all assessed at three points: before intervention, after six weeks of intervention and after six weeks of follow-up (week 12 of the study).

knee pain - Copyright – Stock Photo / Register Mark

In terms of improvement, significant between-group differences for both pain and functionality were noted, favoring the spinal manual therapy group. Significant between-group differences were not noted relative to improvement in quadriceps MVPF.

Per the study authors: “This is the first study supporting evidence that spinal manual therapy is more effective than local exercise therapy in patients with PFPS in the medium term. Compared to local exercise therapy, six sessions of manipulative therapy of the spine resulted in minimal clinically important differences in pain and functionality after 6 weeks of intervention and at 6 weeks of follow-up.”

All Activity Isn’t Healthy

To Your Health
May, 2021 (Vol. 15, Issue 05)

By Editorial Staff

Any physical activity is healthy activity, right? Not so fast. Where you do it might make a big difference. It could boil down to whether your activity is on or off the job.

Researchers tracked more than 100,000 men and women who completed questionnaires regarding their activity during leisure and work hours, categorizing participants into four activity groups for both leisure and employment activity: low, moderate, high or very high. After an average of 10 years of monitoring, death rates from any cause or a major (fatal or nonfatal) cardiovascular event during that time period were assessed.

Compared to men and women with low leisure activity levels, moderate, high and very high leisure-time activity levels decreased early death significantly – by 26 percent, 41 percent and 40 percent, respectively. However, compared to low job activity levels, high and very high job activity levels actually increased the risk of early death by 13 percent and 27 percent, respectively.

running late - Copyright – Stock Photo / Register Mark

The European Society of Cardiology, which published the findings in its journal, the European Heart Journal, emphasized, “[Leisure] time physical activity and occupational physical activity have opposite, and independent, associations with cardiovascular disease risk and longevity.” The society’s press release also quoted study author Prof. Andreas Holtermann, who explained why leisure-time vs. on-the-job activity may not be the same:

“A brisk 30-minute walk will benefit your health by raising your heart rate and improving your cardio-respiratory fitness, while work activity often does not sufficiently increase heart rate to improve fitness. In addition, work involving lifting for several hours a day increases blood pressure for many hours, which is linked with heart disease risk, while short bursts of intense physical activity during leisure raises blood pressure only briefly.”

Safer With Chiropractic

To Your Health
June, 2015 (Vol. 09, Issue 06)

By Editorial Staff

Whenever you visit a health care provider, safety is always a concern: How will that treatment (whether a drug, procedure, etc.) affect me? Those fears are magnified in elderly patients, who can generally handle less physical trauma than their younger counterparts.


Well, the statistics don’t lie: A recent study in the peer-reviewed journal Spine compared two groups of elderly patients’ experiences with chiropractic and medical care, respectively, arriving at an interesting conclusion: Chiropractic is the safer of the two options in terms of the elderly patient’s likelihood of suffering an injury within seven days of an office visit.

safty first - Copyright – Stock Photo / Register Mark

The study evaluated the risk of injury to the head, neck or trunk after an office visit for chiropractic spinal manipulation or evaluation by a primary care physician. The cumulative probability of injury in the chiropractic group: 40 injury incidents per 100,000 subjects; in the primary care group: 153 incidents per 100,000 subjects.

The study authors’ conclusion makes their findings crystal clear: “Among Medicare beneficiaries aged 66 to 99 years with an office visit for a neuromusculoskeletal problem, risk of injury to the head, neck, or trunk within 7 days was 76% lower among subjects with a chiropractic office visit than among those who saw a primary care physician.”

The Last Profession Standing for Low Back Pain: Chiropractic

To Your Health
April, 2021 (Vol. 15, Issue 04)

By Donald M. Petersen Jr., BS, HCD(hc), FICC(h)

In the research world, low back pain has become the benchmark for effectiveness, as there are significantly more studies on LBP than any other musculoskeletal ailment. The studies we have seen over the past several years read like the makings of a great detective novel.

But instead of trying to discover “who done it,” science has been eliminating the usual suspects in an effort to unveil “who should do it.”

Ruling Out PTs or DOs

A study published last August eliminated two professions from the lineup. The randomized, controlled trial revealed that “[neither] spinal manipulation nor mobilization appeared to be an effective intervention for young adults with mild to moderate chronic low back pain.” While this may be unsettling on its face, it should be noted that “all treatments” were provided by “either a doctor of osteopathic medicine or physical therapist.”1

It’s Not MDs, Either

The most recent study narrows down the virtual last profession standing. In their efforts to better understand the risks associated with patients’ transition from acute to chronic LBP, a research team at the University of Pittsburgh discovered that almost half (48 percent) of medical patients received “nonconcordant care” or care not consistent with established guidelines. The researchers’ work demonstrated that “exposure to nonconcordant care was associated with increased odds of developing chronic LBP.”2

lbp - Copyright – Stock Photo / Register Mark

In essence, the nonconcordant care provided by the medical physicians during the first 21 days of care increased the patient’s chances of transitioning from acute to chronic. Not surprisingly, the most common form of nonconcordant care involved drugs. Almost a third, (30 percent) “received prescriptions for nonrecommended medications,” of which almost two-thirds (65 percent) received opioids.

Health Payers Are Noticing

The above is not lost on health payers, who enjoy the ability to analyze large data to better understand what works. Two years ago, David Elton, DC, senior VP of clinical programs at OptumHealth, gave a powerful presentation in which he outlined the most effective care for their insureds. Dr. Elton noted, “The pathway that’s most aligned with all prevailing guidelines [is] when patients start with chiro / PT / acupuncture. … You receive the services you should, you avoid the services you shouldn’t, imaging is aligned, total episode cost is lowest. … The actuaries have done the work, it’s presented at the actuarial conference, the net of the increased conservative care will take out about 230 million in annual medical expenditures and reduce opiate prescribing for back pain by 25-26 percent.”3

The Last Profession Standing: Chiropractic

So, what’s the problem? Why aren’t almost all acute spine cases seen by doctors of chiropractic? (Not that this is the only benefit to chiropractic care.)

More than 30 years ago, United States District Judge Susan Getzendanner held that “the conduct of the [American Medical Association] and its members constituted a conspiracy in restraint of trade based on the following facts: the purpose of the boycott was to eliminate chiropractic; chiropractors are in competition with some medical physicians; the boycott had substantial anti-competitive effects; there were no pro-competitive effects of the boycott; and the plaintiffs (chiropractors) were injured as a result of the conduct.” Old prejudices die hard. I believe the impact of this effort is still influencing referral decisions today.

Based on these and multiple earlier studies, chiropractic is the only profession left standing for effective LBP care, both acute and chronic. And while this distinction minimizes the impact chiropractic care has on the rest of the spine, the entire musculoskeletal system and ultimately, total wellness, it does present providers and payers with a clear choice.

But as this most recent study demonstrates, many providers, particularly medical doctors, are still choosing nonconcordant care in place of guideline-directed chiropractic care. You can change all that – by visiting your doctor of chiropractic regularly for low back pain; and always requesting you see a chiropractor if your medical doctor suggests otherwise.


  1. Thomas JS, Clark BC, Russ DW, et al. Effect of spinal manipulative and mobilization therapies in young adults with mild to moderate chronic low back pain: a randomized clinical trial. JAMA Netw Open, 2020;3(8):e2012589.
  2. Stevans JM, Delitto A, Khoja SS, et al. Risk factors associated with transition from acute to chronic low back pain in US patients seeking primary care. JAMA Netw Open, 2021;4(2):e2037371.
  3. The Role of Nonpharmacological Approaches to Pain Management: Proceedings of a Workshop. National Academies of Sciences, Engineering and Medicine, 2019.

Donald Petersen Jr. is the president and publisher of MPA Media, which produces To Your Health and a variety of other media resources on natural health and wellness, including trade publications for the chiropractic and acupuncture professions.

Exercising for Heart Health: The More the Better

To Your Health
March, 2021 (Vol. 15, Issue 03)

By Editorial Staff

If you’ve ever heard the story of the avid jogger who dropped dead of a heart attack, or the extreme marathon runner who still got cardiovascular disease, you may have wondered: Is there a limit to how much exercise I should do? The short answer, according to new research, is no. Certainly even the fittest of the fit can experience a heart issue, but this study involving more than 90,000 adults found that over a five-year period, the people who engaged in the most vigorous-intensity exercise (top 25 percent) reduced their heart disease risk by 54-63 percent.

And the risk reductions don’t apply just to vigorous exercise: People in the top 25 percent in terms of all intensities of exercise (moderate to vigorous) also reduced their risk by 48-57 percent. Study findings appear in the journal PLOS Medicine.

heart health - Copyright – Stock Photo / Register Mark

Now you may be wondering, But those people are also healthier in general, right? True, but the researchers accounted for this, adjusting for factors that could influence heart disease risk, such as whether participants smoked, were overweight or obese, and drank more than moderate amounts of alcohol. Higher levels of exercise still correlated with lower rates of heart disease.

Your doctor can tell you more about the health benefits of consistent exercise and help outline a program suitable to your goals and health needs.

Start Pain Relief Early With Chiropractic

To Your Health
April, 2019 (Vol. 13, Issue 04)

By Editorial Staff

When it comes to spinal pain, it’s a big mistake to limit the conversation to adults. In fact, anyone at any age can suffer spinal pain, which makes chiropractic care essential for people of all ages. What’s more, research shows that even in adolescent, teen and young adult populations, chiropractic is effective at relieving pain.

Case in point: a study published in Complementary Therapies in Clinical Practice that evaluated chiropractic management of younger people (ages 10-24) with spinal pain. All study participants had spinal pain in one or more of the four regions of the spine (cervical – neck; thoracic – upper- / mid-back; lumbar – low back; and sacral – bottom of the spine / tailbone).

start - Copyright – Stock Photo / Register Mark

Patients showed “statistically and clinically significant improvement on the numeric rating scale (NRS) in all four spinal regions following chiropractic management,” which included spinal manipulation and other techniques commonly performed by chiropractors under their scope of practice, including mobilization, soft-tissue therapy and other modalities. Simply put, chiropractic relieved some or all of their pain.

By the way, while this study evaluated children as young as age 10, research also suggests chiropractic care is effective – and necessary – for children at any age, including infants. Birth / delivery trauma, childhood falls, poor posture, excessive sitting / slumping and a variety of other life events can cause spinal pain. Talk to your doctor to learn more about how anyone can benefit from the power of chiropractic!

A Fitter You = A Better Fighter Against COVID-19 Complications

To Your Health
February, 2021 (Vol. 15, Issue 02)

By Editorial Staff

While vaccine seems destined to remain the buzzword when it comes to COVID, let’s not forget about natural options that, while they may not prevent COVID-19 infection, appear to reduce the chances you’ll suffer serious consequences if you do end up contracting the virus.

The researchers’ conclusion, published along with their findings in Mayo Clinic Proceedings, makes the value of these study results clear: “Maximal exercise capacity is independently and inversely associated with the likelihood of hospitalization due to COVID-19. These data further support the important relationship between cardiorespiratory fitness and health outcomes.”

respiratory infection - Copyright – Stock Photo / Register Mark

It’s Time for Better Sleep

To Your Health
May, 2020 (Vol. 14, Issue 05)

By Editorial Staff

OK, quick quiz: How much has your sleep been affected during the coronavirus pandemic? We’re not just talking about the amount of sleep; after all, some people may actually be getting more sleep than usual if they’ve been out of work, restricted in where they can go, etc.

Then again, losing your job or spending more time glued to the COVID-19 updates on TV or your cellphone probably isn’t helping your stress levels, which isn’t helping you sleep, either.

Here’s question #2: How well are you sleeping? Sleeping for eight hours a night and sleeping well for eight hours are two entirely different things. You can hit the bed at 10 p.m. and roll out of bed at 6 a.m., but those eight hours may have been filled with tossing, turning, stressing, thinking and never getting to the deep, restorative sleep your body and brain need.

If any of the above applies to you, and we’re certain it applies to literally millions of people these days, it’s time to do something about it. It’s time for better sleep. Here’s a simple three-step plan to do it:

1. Tune It Out: We know this can be easier said than done, but we all need to try. Particularly in today’s social-media-driven world, it’s far too easy to get news, opinions, and conversations at your fingertips, 24/7. The more we tune in, the more we take in, obsess about, reflect upon; and all that information stays in our brains, even as we try to get to sleep. Tips: Pick a few times during the day to review the latest news, check your social media, etc. Ignore the rest. Most of all, don’t tune in right before bed, or you’ll be up all night thinking, instead of resting.

bad sleep - Copyright – Stock Photo / Register Mark

2. Block It Out: We live in a fashion-over-function world, and our homes are a great example. We’re inundated with home renovation shows that teach us to crave a certain “look,” even if that look doesn’t deliver the function we need. Does your bedding look amazing … but keep you hot (or cold) all night? Do your window treatments keep your bedroom dark – we mean really dark – all night? Do you have a high-tech flat-screen TV mounted on your bedroom wall … that you tend to watch into the wee hours? Tips: If you’re going to achieve quality sleep, your bedroom has to be a help, not a hindrance. Fashion without function in your bedroom equals restless nights that will compromise your health.

3. Calm It Down: We’ve already told you to tune it out a few hours before bedtime; but you have to take it a big step beyond TV and technology. Much like a car, your body has trouble going from 100 miles an hour to a complete stop; it needs a slow, gradual deceleration. Unfortunately, when it comes to eating and exercise habits, too many people make a similar mistake. Eating or exercising right before bed essentially puts your body into overdrive, rather than slowing it down.

In the case of exercise, your muscles are initiating the repair process, rather than resting. In the case of food, your body is starting the digestion process. Either way, it’s a poor way to wind down. Tips: Try to exercise / eat your last meal of the day at least 2-3 hours before bedtime. Also keep in mind that if your last meal is particularly greasy, fatty, sugary or fibrous, it could compromise sleep before it even gets started.

Sleep is rapidly being recognized as a major factor in overall health and wellness, with chronic poor sleep linked to a higher risk of numerous health issues. But don’t take our word for it; just reflect on how your body feels after a poor night’s sleep. Now extrapolate that to weeks, months or even years of inadequate, poor-quality sleep. Talk to your doctor for more information.

3 Reasons to See Your Chiropractor (Now More Than Ever)

To Your Health
May, 2020 (Vol. 14, Issue 05)

By Editorial Staff

Here are three reasons why you should be making an appointment (either in person or via telemedicine, depending on what’s available right now in your area) with your chiropractor today:

1. You’ve been ignoring pain: And you’re not the only one. With stay-at-home orders in place for the past few months, most health care facilities have closed their doors to all but emergency cases. Unfortunately, pain isn’t generally regarded as an emergency, particularly not things like back pain, neck pain, headaches, etc. At the same time pain services have been limited, more people have likely experienced pain, and for several reasons: stress, inactivity, improper remote work set-up, etc. That means many people have been putting up with pain – or popping pills for temporary relief that doesn’t address the underlying cause.

If you haven’t experienced any pain, you should still make an appointment with your chiropractor, especially if you have a history of back pain. That’s because research suggests maintenance care – periodic visits to your chiropractor, even when you aren’t experiencing pain –  reduces the number of days you’ll be bothered by the pain: nearly 13 fewer days a year.

doctor's appointment - Copyright – Stock Photo / Register Mark

2. Immune support matters: COVID-19 is opening people’s eyes to a few realities. First, your immune system is pretty powerful. In fact, it’s constantly defending the body against attack by all sorts of viruses and other invaders. Most of the time, it’s very good at its job. But if you’re old, sick or otherwise immunocompromised, you risk experiencing complications from viral invasion — as we’ve seen during the pandemic, and as we see with other viruses, such as the flu.

You Can’t Beat a Strong Immune System

By Editorial Staff

To Your Health
March, 2020 (Vol. 14, Issue 03)

There’s a great deal we don’t know about the novel coronavirus (COVID-19), but we do know if you’re a senior or someone with a significant health condition, you’re at greater risk for complications. What’s the common denominator in people who seem to have major problems with COVID-19: a weakened immune system – either weakened naturally by age or weakened because of a disease-compromised immune system.

Now here’s what we know in general about the human immune system: It responds quite favorably to certain nutrients available either in the diet and/or via supplementation. In other words, the immune system can get stronger. And people with stronger immune systems tend to fight back powerfully against the flu virus; so why not coronavirus? Here are some of the key micronutrients that can help boost your immune system, courtesy of longtime nutrition contributor and doctor of chiropractic, Dr. James Meschino. Always make sure to talk to your doctor before taking any supplements.

Immune cells have a high requirement for antioxidants – especially vitamins C and E, and beta-carotene. Many immune cells (i.e. , neutrophils) use these antioxidants to generate reactive oxygen species (ROS) or free radicals to kill viruses and other microbes. Immune cells also require antioxidants to protect themselves against the ROS they produce. With suboptimal antioxidant status, immune cells cannot kill viruses as effectively and they cannot protect themselves from the ROS they generate. The high ROS levels, in turn, damage immune cells and they become less effective or immunosuppressed.

Vitamin C

virus protection - Copyright – Stock Photo / Register Mark

As an example, a 2017 study reviewed all the available studies looking at the role of vitamin C on the immune system. The researchers cited the research showing that the ingestion of 250 mg per day of vitamin C in otherwise healthy people helps to enhance many important aspects of immune function. As we get older and immune function declines, some studies suggest that the combination of 1,000 mg of vitamin C per day and 200 IU of vitamin E per day improves immune function in people over 60. Thus, higher doses are required as we age.

Here is a quote from the research paper itself regarding lung infections, pneumonia and vitamin C: “Beneficial effects of vitamin C on recovery have been noted in pneumonia. In elderly people hospitalized because of pneumonia, who were determined to have very low vitamin C levels, administration of vitamin C reduced the respiratory symptom score in the more severe patients. In other pneumonia patients, low-dose vitamin C (250 – 800 mg/day) reduced the hospital stay by 19% compared with no vitamin C supplementation, whereas the higher-dose group (500 – 1600 mg/day) reduced the duration (hospital stay) by 36%. Vitamin C supplementation also showed a positive effect on the normalization of chest X-ray, temperature, and erythrocyte sedimentation rate (a marker of inflammation and infection). Since prophylactic vitamin C administration also appears to decrease the risk of developing more serious respiratory infections, such as pneumonia, it is likely that the low vitamin C levels observed during respiratory infections are both a cause and a consequence of the disease.”

Editor’s Note: Interestingly, preliminary reports out of Wuhan, China, the reported site of the first COVID-19 outbreak, suggest high-dose vitamin C is being used effectively to treat patients with coronavirus.

Vitamin D

An excellent review of how vitamin D works to strengthen the immune system against acute respiratory tract infections was published in the Journal of Infectious Diseases in 2010. These researchers performed a placebo-controlled, double-blind study involving 164 young men (18-24 years of age) undergoing compulsory periodic military training. Men given 400 IU of vitamin D per day during the six-month training period had significantly fewer respiratory tract infections and related fewer days of absenteeism from training compared to the recruits who ingested the placebo.

In this published paper, the researchers explained a novel way in which vitamin D affects immunity with respect to the prevention of respiratory tract infections. They explain that immune cells that line the respiratory tract have vitamin D receptors, which allows vitamin D to enter these immune cells. Once inside the immune cell vitamin D is converted to a more potent form of vitamin D, which is then transported to the nucleus of the cell.

Within the cell nucleus, vitamin D modulates specific genes involved in immunity. One of the gene effects is that vitamin D increases the secretion of a virus-killing molecule known as cathelicidin. As immune cells interact with various microbes, including viruses, in the respiratory tract, cathelicidin punctures a hole in the viral and/or bacterial cell membrane, destroying the invader and thus, preventing infection.

As such, lower vitamin D blood levels result in lower secretions of cathelicidin with resulting reduced anti-viral fighting abilities of the immune cells that line the respiratory tract.

Note: Some people need to be extra cautious with vitamin D supplements. These individuals include those with active tuberculosis, individuals with sarcoidosis (an autoimmune condition), lymphoma, and primary hyperparathyroidism. In each of these cases the body is often synthesizing very high amounts of vitamin D as a result of the disease. Taking additional vitamin D can easily cause vitamin D toxicity in these cases.

Editor’s Note: Former CDC Director  Dr. Tom Frieden recently suggested vitamin D could help boost the immune system as part of the discussion about potentially preventing and/or treating COVID-19.

Other Micronutrients of Importance

Other antioxidants have also been shown to be critical to immune function. For example, supplementation of healthy individuals over age 60 with 200 IU vitamin E per day improved many aspects of immune function and reversed some key age-related features of immune system decline.  In short, they had more youthful immune function with vitamin E supplementation.

Supplementation with other nutrients has also shown improved immune function in human subjects, including zinc and beta-carotene.  As well, animal studies show the importance of selenium to immune function.

Various researchers have conducted research providing healthy elderly individuals with supplement combinations such as vitamin A, vitamin C and vitamin E, or with a multiple vitamin/trace mineral supplement.  In many of these studies, the participants ingesting the supplements showed improved function of many immune parameters compared to their baseline values and compared to those who ingested the placebo.

Moreover, human and animal studies have proven that even marginal deficiencies of certain vitamins and minerals cause a significant decline in immune function or immunocompetence. These nutrients include vitamin A, beta-carotene, folic acid, vitamin B6, vitamin B12, vitamin C, vitamin E, riboflavin, iron, zinc, and selenium. The National Health and Nutrition Examination Surveys (NHANES) show that many people are walking around with marginal deficiencies of some of these nutrients unless they are taking a well formulated multiple vitamin and mineral supplement.