Public release date: 28-Dec-2011

CORVALLIS, Ore. – New research has found that elderly people with higher levels of several vitamins and omega 3 fatty acids in their blood had better performance on mental acuity tests and less of the brain shrinkage typical of Alzheimer's disease – while "junk food" diets produced just the opposite result.

The study was among the first of its type to specifically measure a wide range of blood nutrient levels instead of basing findings on less precise data such as food questionnaires, and found positive effects of high levels of vitamins B, C, D, E and the healthy oils most commonly found in fish.

The research was done by scientists from the Oregon Health and Science University in Portland, Ore., and the Linus Pauling Institute at Oregon State University. It was published today in Neurology, the medical journal of the American Academy of Neurology.

"This approach clearly shows the biological and neurological activity that's associated with actual nutrient levels, both good and bad," said Maret Traber, a principal investigator with the Linus Pauling Institute and co-author on the study.

"The vitamins and nutrients you get from eating a wide range of fruits, vegetables and fish can be measured in blood biomarkers," Traber said. "I'm a firm believer these nutrients have strong potential to protect your brain and make it work better."

The study was done with 104 people, at an average age of 87, with no special risk factors for memory or mental acuity. It tested 30 different nutrient biomarkers in their blood, and 42 participants also had MRI scans to measure their brain volume.

"These findings are based on average people eating average American diets," Traber said. "If anyone right now is considering a New Year's resolution to improve their diet, this would certainly give them another reason to eat more fruits and vegetables."

Among the findings and observations:

• The most favorable cognitive outcomes and brain size measurements were associated with two dietary patterns – high levels of marine fatty acids, and high levels of vitamins B, C, D and E.
• Consistently worse cognitive performance was associated with a higher intake of the type of trans-fats found in baked and fried foods, margarine, fast food and other less-healthy dietary choices.
• The range of demographic and lifestyle habits examined included age, gender, education, smoking, drinking, blood pressure, body mass index and many others.
• The use of blood analysis helped to eliminate issues such as people's flawed recollection of what they ate, and personal variability in nutrients absorbed.
• Much of the variation in mental performance depended on factors such as age or education, but nutrient status accounted for 17 percent of thinking and memory scores and 37 percent of the variation in brain size.
• Cognitive changes related to different diets may be due both to impacts on brain size and cardiovascular function.

The epidemiology of Alzheimer's disease has suggested a role for nutrition, the researchers said in their study, but previous research using conventional analysis, and looking in isolation at single nutrients or small groups, have been disappointing. The study of 30 different blood nutrient levels done in this research reflects a wider range of nutrients and adds specificity to the findings.

The study needs to be confirmed with further research and other variables tested, the scientists said.

This work was supported by the National Institutes of Health.

Contact: Maret Traber
maret.traber@oregonstate.edu
541-737-7977
Oregon State University

Save Your Vision Month: Healthy Vision at the Computer

• Computer Vision Syndrome Fact Sheet
• More on Computer Vision Syndrome
• News Release

Computer Vision Syndrome

These symptoms contribute to computer vision syndrome, which the American Optometric Association defines as "the complex of eye and vision problems related to near work that are experienced during or related to computer use."

Sitting at a computer generally causes a person to look straight ahead for long stretches, work in a dry office or home environment, and to blink less often. These factors can lead to vision problems. Additionally, computer use requires specific vision skills, which add further demands to the visual system and contribute to eye and vision discomfort. These skills include:

• Ocular motility — the ability of the eyes to move in various positions.
• Accommodation — the ability of the eyes to focus clearly at various distances.
• Vergence — The ability to move the eyes in (convergence) or out (divergence). 

Effects of Working Environment

Computer work places various demands on the visual system. Each of these factors can play a part in computer vision syndrome.

• Screen resolution — Better resolution offers greater clarity and usually leads to improved comfort. Adjust the resolution to the highest resolution your monitor will support. If the increased screen resolution makes items too small, try increasing the font size (DPI) to compensate.
• Screen contrast — Adjust the contrast between the characters on the monitor and the background so the letters are easily read. Adjust the brightness of the monitor to an intensity that is comfortable to your eyes--not too bright and not too dim. Adjust both brightness and contrast for the best clarity.
• Screen glare and reflections — Minimize reflected glare on your monitor by using window treatments, dimmer switches on lights and glare reduction filters. Look for glare reduction filters that have received the American Optometric Association Seal of Acceptance. Proper adjustment should eliminate any reflected images from the monitor screen. To reduce glare, eliminate bright light sources from your peripheral vision and position your monitor perpendicular to windows or other bright light sources.
• Image refresh rates and flicker — A higher refresh rate for your monitor is best. The image on the screen should not flicker at all. (This is not a concern with LCDs.)
• Working distances and angles — It is important to work at a distance that is comfortable for you and where the image on the screen is clear. Having to move your head to an awkward angle to see the screen clearly suggests that your prescription may need adjustment.
• General eyeglass prescription may not be adequate — Computers are usually further and higher than a typical reading task. Glasses for most people wearing bifocals are not adjusted for this new distance or angle and therefore often are not adequate for using the computer.
• Repetitive and stressful tasks — Difficult tasks are challenging. Don't forget to take occasional breaks and let the eyes look far away while resting.

Tips for Healthy, Comfortable Vision at the Computer

While decreasing time spent at a computer may not be an option, there are ways to maximize healthy vision for comfortable use of the computer.

• Have a regular comprehensive eye exam to ensure your eyes are healthy and that you have the correct eyeglass or contact lens prescription (if necessary). Be certain to tell your optometrist about the computer work you do.
• Wear glasses that are specifically designed to function comfortably at the computer. The lenses you wear for day-to-day activities may not be the best for working at the computer.
  • Rest the eyes
  • Blink forcefully
  • Use a humidifier
  • Instill artificial tears

After you have had a comprehensive eye examination, there are a number of things that you can do to arrange and use the elements of your workstation to eliminate or minimize discomfort.

Workstation Setup for Comfortable Computer Use

Is Your Work Station Properly Arranged?

Healthy Computer Use

Although the visual system faces considerable challenges when using a computer, most issues can be solved. Remember that problems with the use of the computer cause needless discomfort and may rob productivity. Heeding the suggestions made here along with those made by your doctor of optometry, will enable you to use your computer comfortably and productively.

• Feet should be flat on the floor (or on a slightly angled foot rest) with knees bent close to or greater than 90 degrees.
• Chair seat should support the legs without excessive pressure on the back of the thighs.
• The back should be snug against the seat to fit your spinal contour. Thigh-to-trunk angle should be 90 degrees or greater.
• Wrists and hands should extend nearly straight from the elbow to the home row of the keyboard.
• A commonly preferred work surface height for keyboard use is about 26" as opposed to the conventional 29" of most tables or desks.
• Place the monitor 20"-26" from your eyes, depending on the size of the monitor and individual vision conditions.
• The monitor and keyboard should be straight ahead.
• The top of the monitor should be slightly below horizontal eye level. Tilt the top of the monitor away from you at a 10 degree to 20 degree angle. The center of the monitor should be 10 degrees to 20 degrees below your eyes. This is 4?-9? below your eyes at a distance of 24"
• Keep the monitor free of fingerprints and dust. Both can reduce clarity.
• Place document holders close to the screen within the same viewing distance. Keep the keyboard and monitor in line.
• Adjust the keyboard tilt angle so that wrists are straight.

You may have heard the saying, "the eyes are the window to the soul." There is another saying in the world of chiropractic, "your spine is the window to your health." How can the condition of your spine divulge so much information about overall health? Your spine is the central support column of your body and its primary role is to protect your spinal cord. Think of it like the foundational frame of a house holding everything together. If the frame becomes dysfunctional many problems will begin to manifest themselves. The house begins to develop cracks, shifts, and structural problems. When your spinal foundation becomes dysfunctional you develop aches, pains, injuries, and other health related issues. The good news is you can do a simple spinal health checklist to determine if you may benefit from the expert intervention of a chiropractor or other healthcare professional. Becoming familiar with simple spinal anatomy, structure and function will help empower you to take control of your health.

Your spine is composed of 24 bones (vertebrae); 7 in the neck (cervical spine), 12 in the middle back (thoracic spine), 5 in the lower back (lumbar spine) and the base tailbone (sacrum). Your soft spinal cord is encased inside these 24 moveable hard vertebrae to protect it from injury. Your spinal column has three natural curvatures making it much stronger and more resilient than a straight design. There are cervical, thoracic, and lumbar curves designed with precise angles for optimum function. However, these curves are different than the abnormal curves associated with scoliosis and postural distortions. You may remember getting screened in school or your doctor for scoliosis when they had you bend over and touch your toes. This was an early checklist for spinal abnormalities. Through life's stresses, genetics, trauma, injuries, and neglect the spine can develop dysfunctions in these curvatures and the body must compensate by changing posture as a protective mechanism.

What are some of the compensations your body develops and what can they tell you about spinal health?

We all want to look young and beautiful, no matter what our age, and keeping your skin in good condition goes a long way toward that goal. There are a number of things you can do to keep your skin looking supple and glowing that don’t involve expensive treatments or surgery!

• Drink more water­– This may be the number one tip in achieving healthy-looking skin. Controlled climates such as homes and offices with heat and air conditioning tend to be very drying to the skin. Most people are actually chronically dehydrated, and this leads to an increased in lines and wrinkles, much as a grape becomes a raisin! Optimally, you should drink between 2 and 3 liters of water every day, which will make your tissues more plump and resilient, reducing fine lines and wrinkles. If you can’t stomach that much water, other beverages are fine, but beware of any that contain lots of sugar or caffeine, as an excess of these substances is not good for your health.

• Cleanse and exfoliate – At the end of the day, after being subjected to the elements, including sun, wind, climate, etc. (not to mention makeup), you need to give your skin a good cleanse. Dead cells can accumulate on the skin’s surface, making it look dull and lifeless. Start by removing all makeup with a gentle cleanser, such as a little plain yogurt on a cotton ball, which removes makeup without the use of harsh chemicals. Then treat it to a light apricot kernel scrub, which can remove those dead cells and expose the fresh ones underneath.

• Eat healthy – A diet high in fruits and vegetables, particularly the ones with high amounts of antioxidants such as Vitamin C, and low in sugar, unhealthy fats and processed foods, has been shown to promote younger looking skin. Red peppers, strawberries and avocados are among the foods highest in antioxidants and healthy fats.

• Wear protective clothing – We all know that too much sun exposure is bad, exposing our skin to damage from free radicals. Chemicals in some commercial sunscreens can be almost as bad for you as too much sun and keep you from getting an adequate amount of vitamin D to boot! The best option is to wear protective clothing as much as possible. This includes long-sleeved shirts and hats with wide brims.

• Moisturize – One way to keep your skin from drying out is to apply a good moisturizer once in the morning and again before bed, after your cleansing routine. Look for a moisturizer that does not contain any SLS (sodium lauryl/lauryth sulfate) or parabens, neither of which are good for you. The best are those containing olive oil, aloe or vitamin E.

• Quit Smoking – The increased number of wrinkles that appear on the faces of smokers is yet another reason to quit. Smoking constricts the tiny blood vessels that supply oxygen and important nutrients that nourish the skin. It also damages the collagen and elastin that keep skin strong and elastic. 

As autumn turns to winter and the days become shorter, do you find yourself suffering from symptoms of depression that mysteriously seem to disappear once the days have become longer? Do you feel like you would just like to hibernate until spring? If so, you may have Seasonal Affective Disorder (SAD), which is estimated to affect around seven percent of the population, though the number can be higher, particularly among those who live greater than 30 degrees north or south of the equator.

Symptoms appear slowly as the autumn begins, and build up as the winter progresses. These symptoms include:

• Low energy
• Tiredness
• Trouble getting up in the morning
• Difficulty concentrating
• Increased appetite, particularly for carbohydrates
• Increased weight gain
• Increased feelings of depression
• Decreased sex drive

The more darkness the brain’s pineal gland receives, the more the hormone melatonin is produced. Melatonin is responsible for helping regulate the body’s hormones and maintaining its circadian rhythm. It particularly affects hormones produced by the pituitary gland, which is the main regulator of the entire endocrine system, including the thyroid gland, the gland responsible for producing the energy regulating hormones cortisol and adrenaline.

Melatonin is called the “sleep hormone,” as the pineal gland produces it when it gets dark to lower our body temperature and induce us to sleep, but as soon as sunlight hits our eyes in the morning the melatonin switch is turned off and is replaced by a surge in serotonin, which wakes us up and provides us with feelings of happiness and calm.

Though SAD can mimic the symptoms of depression, they are two different things. The symptoms of depression usually include insomnia and decreased appetite, while the opposite is the case in those with SAD. SAD also tends to occur primarily in the autumn and winter, whereas depression is experienced year-round.

If you have SAD, there are a number of treatments that can help ease your symptoms. These include light therapy, medication and/or timed melatonin supplementation.

Light therapy involves regular sessions of sitting before a bright white “full-spectrum” lightbox from 30 to 60 minutes. Studies have shown that 92 percent of those suffering from SAD experienced relief from their symptoms after this therapy.

The administration of selective serotonin reuptake inhibitors (SSRIs) has also proved to be helpful to some, with an effectiveness rate of 67 percent.

Supplementation with melatonin, administered at particular times of day, has also been shown to be effective in some cases, as it re-synchronizes the person’s circadian rhythms, affecting the timely release of the body’s other metabolic hormones.

So don’t suffer in silence! Consult with your health care provider if you feel you have symptoms of SAD, as effective treatment is easily available.

Chiropractic/Manipulation Therapy for Shoulder Pain

Shoulder pain is a common complaint that patients present with to both primary care physicians and chiropractic practitioners. There are several underlying conditions that may cause discomfort in this area, many of which may be assisted by chiropractic treatment and manipulation. A proper diagnosis is important in order to determine what kind of treatment is indicated in each case.

What are Spinal Pelvic Stabilizers?

Spinal pelvic stabilizers are specially designed orthotics that help stabilize and balance your feet. They can have a significant effect on your entire body’s performance and efficiency, reduce pain, and contribute to an overall sense of well-being.

How can something made just for your feet accomplish all this?

Our feet form the foundation of our entire body. They provide support for walking, standing, running, jumping, and reaching. In addition, your feet help protect your bones, spine and tissues from stress while moving around. It seems quite logical that your feet can perform these tasks better when their bones, muscles, and arches are in their proper, stable positions. For example, neck pain could be the result of a spinal misalignment that is caused by an imbalance in your feet. Your body’s joints and muscles work most efficiently when they are in balance, and balanced feet provide the foundational balance needed to support many of our daily activities.

Your feet contain three arches that support the weight of your entire body. If one arch is compromised, the other arches try to compensate. This results in additional stress, leading to pain, discomfort, and further compromise. Another common foot problem is flattening of the arches, which is known as pronation, which leads to rotation of the legs.

Spinal pelvic stabilizers balance the foundation of the pelvis and spine and help address structural problems of the feet. If they are properly fitted they can control pronation and supination. In this way they reduce unnatural stress and abnormal forces, and promote healthy functional and structural relationships between your feet and the rest of your body.

These devices also provide improved shock absorption. This reduces repetitive stress on your muscles and joints, allows better function, and reduces arthritic symptoms as well.

Pelvic stabilizers are a cost effective and long-term intervention for many kinds of foot and posture problems. They are worn inside your shoes, and they guide your feet into a more normal pattern as they are used for moving around.

Your chiropractor will use impression images of your feet to create custom-made flexible spinal pelvic 

stabilizers for your feet and your feet alone. You may wish to ask your chiropractor about the flexibility of the stabilizers that will be created for you. Some technologies use more rigid materials to force the foot into a supposedly ideal position, while most people prefer some flexibility for comfort, controlled support, and better movement from the feet on up through the body.

 

In the Sept. 27, 2011 posting of the Biomedical Central Journal: Family Practice, R.J. Adams and colleagues commented on concerns raised by the common prescribing of nonsteroidal anti-inflammatory medications, particularly with respect to their important and sometimes fatal adverse side effects. They state, "Non-steroidal anti-inflammation drugs (NSAIDs) are one of the most common causes of reported serious adverse reactions to drugs, with those involving the upper gastrointestinal tract (GIT), the cardiovascular system and the kidneys being the most common. Much of the focus on NSAID adverse effects has been on GIT consequences, with good reason. A U.S. study found the rate of deaths from NSAID-related GIT adverse effects is higher than that found from cervical cancer, asthma or malignant melanoma."1 They also point out that frequent use of NSAIDs increases risk for high blood pressure, chronic heart failure, as well as serious cardiovascular events (with certain NSAIDs).

Studies show that the risk of suffering these adverse side effects is increasing among the elderly and those with co-morbidities. The researchers cite recent evidence suggesting that the burden of illness resulting from NSAID-related chronic heart failuremay exceed that resulting from GIT damage.1

Adams, et al., also cite evidence from a recent Danish population study, which suggests increased cardiovascular mortality among people without a prior history of heart disease, but who frequently useNSAIDs. This seems to be particularly true for diclofenac and ibuprofen. However, the baseline cardiovascular risk of people in this study was not reported. The researchers also note that NSAIDs promote the rapid deterioration of renal function. As such, national medical guidelines recommend avoidance of nephrotoxic drugs, including NSAIDs, in people with chronic kidney disease.1

Acetaminophen

It's not only NSAID medications, such as drugs containing aspirin, ibuprofen, indomethacin, diclofenac, COX-2 inhibitors, that raise concerns regarding frequent and significant side effects, but also foracetaminophen-containing medications. The National Kidney & Urologic Diseases Information Clearinghouse (a service of the National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health) posted the following precautionary notes about acetaminophen on its Web site:

"Kidney Disease From Acetaminophen and NSAIDs - A form of kidney damage, called analgesic nephropathy, can result from taking painkillers every day for several years. Analgesic nephropathy is achronic kidney disease that over years gradually leads to irreversible kidney failure and the permanent need for dialysis or a kidney transplant to restore kidney function. Researchers estimate that four out of 100,000 people will develop analgesic nephropathy. It is most common in women over 30.2

A review article in Life Extension provides scientific references outlining the dangers of acetaminophen use over long periods. The authors state, "Acetaminophen is a leading cause of liver failure in the Western world and the leading cause of drug-induced liver failure in the United States (Bartlett D, 2004). People who have liver disorders or who consume large amounts of alcohol are advised to avoid acetaminophen, which can damage both the kidneys and the liver, even at therapeutic doses (Bromer MQ, et al., 2003). People who use acetaminophen on a regular basis double their risk of kidney cancer (Kaye JA, et al., 2001; Gago-Dominguez M, et al., 1999; Derby LE, et al., 1996). Most cases of acetaminophen poisoning occur because people take smaller doses over a long period of time. In this setting, doses of 4000 mg daily can be toxic."3

Drugs for Autoimmune Patients

Many people with autoimmune diseases also have inflammation of joints and other tissues. Some novel medications have been developed to inhibit the overstimulation of tumor necrosis factor (TNF) on target tissues in these cases, as well as anti-metabolite medications, such methotrexate and purine inhibitors, which decrease proliferation of the immune cells involved in the inflammatory and hyperproliferative signalling cascade.

The potential side effects of TNF-inhibitors such as infliximab (Remicade), adalimumab (Humira), certolizumab pegol (Cimzia), or etanercept (Enbrel), include lymphoma, infections, congestive heart failure, demyelinating disease, a lupus-like syndrome, induction of auto-antibodies, injection-site reactions, systemic side effects and opportunistic infections.4 The most common side effects of methotrexate include acne, chills and fever, dizziness, flushing, general body discomfort, hair loss, headache,infertility, irregular periods, itching, loss of appetite, lowered resistance to infection, miscarriage, nausea, sensitivity to sunlight, sore throat, speech impairment, stomach pain, swelling of the breast, unusual tiredness, vaginal discharge, and vomiting.5

Common side effects of purine-synthesis inhibitors include increased risk of infection, nausea, fatigue, hair loss, and rash. Azothioprine has been listed as a human carcinogen by the U.S. Department of Health and Human Services in its 11th Report on Carcinogens.6

Corticosteroids (e.g., Prednisone)

Long-term use of corticosteroid drugs, such as prednisone and dethamexasome, are known to cause weight gain – with redistribution of body fat to the upper back and neck (Buffalo hump), glucose intolerance, hypertension, increased susceptibility to infections and cancer from immune suppression, osteoporosis from demineralization, easy bruising, mood swings, insomnia, depression upon withdrawal, avascular necrosis of bone, abdominal striae, cataracts and acne.7

Realistic Options

It's not realistic to eliminate all anti-inflammatory drugs from the market due to the risk of serious adverse side effects. In some cases, these drugs are life-saving (e.g., acute flare-ups of lupus and other autoimmune diseases), or have been shown to improve the management of various inflammatory conditions and improve quality of life for certain patients when no other forms of therapy or treatment have been useful. However, there are a number of dietary and supplementation practices that should also be implemented in these cases. (I have described these practices in detail in "Nutrition and Supplementation Management in Autoimmune Diseases," "The Clinical Use of Natural Anti-inflammatory Herbs and Supplements" and "The Research Status of Glucosamine Sulfate.")

The problem is that most medical doctors fail to teach patients who suffer from joint inflammatory diseases how important it is for them to follow an anti-inflammatory diet and to use natural supplements that have proven anti-inflammatory and analgesic effects to help manage their condition (as well as the use of glucosamine sulfate to support joint cartilage in osteoarthritis and cartilage injury management). These dietary practices and ingestion of anti-inflammatory and cartilage-supporting supplements can be taken concurrently with anti-inflammatory, analgesic and autoimmune medications. Their inclusion in the comprehensive management of these conditions can reduce the patient's need and dependency on synthetic medications, and thus reduce the risk of significant side effects over the patient's lifetime.

The responsibility to educate patients on this subject often falls to doctors of chiropractic and other evidence-based holistic practitioners. Chiropractors are aware that many patients with inflammatory joint conditions respond well to chiropractic care, in addition to exercise and various ancillary modalities. Educating patients on the value of an anti-inflammatory diet and anti-inflammatory supplements as part of the scope of management of these cases can further help to reduce the patient's dependency on NSAIDs and other anti-inflammatory, analgesic and autoimmune medications. These measures are an important step in reducing the patient's risk of serious drug-related adverse side effects and organ damage over their lifetime.

References

1. Adams J, et al. Cause for concern in the use of non-steroidal anti-inflammatory medications in the community - a population-based study. BMC Family Practice, 2011;12:70.
2. Analgesic Nephropathy (Painkillers and the Kidneys). National Kidney & Urologic Diseases Information Clearinghouse.
3. "Acetaminophen and NSAID Toxicity." Life Extension magazine: www.lef.org/protocols/appendix/otc_toxicity_01.htm
4. Antoni C, Braun J. Side effects of anti-TNF therapy: current knowledge. Clin Exp Rheumatol, 2002;20(Suppl. 28):S152-S157.
5. Methotrexate. U.S. National Library of Medicine, National Institutes of Health. MedlinePlus: www.nlm.nih.gov/medlineplus/druginfo/meds/a682019.html
6. Azathioprine. Medpedia: http://wiki.medpedia.com/Azathioprine
7. "Prednisone and other corticosteroids: Balance the risks and benefits." The Mayo Clinic: www.mayoclinic.com/health/steroids/HQ01431

Click here for more information about James P. Meschino, DC, MS.

Study: Spinal manipulation and exercise are more effective than OTC pain relievers, narcotics and muscle relaxants.

A study published in the Jan. 3, 2012 issue of the Annals of Internal Medicine and widely reported by mainstream media suggests conservative care consisting of either spinal manipulation or home exercise is more effective than over-the-counter and prescription medication for relieving acute and subacute neck pain. Spinal manipulative therapy was more effective than medication in both the short and long term, as was home exercise in the form of self-mobilization of the neck and shoulder joints – a point media outlets were quick to emphasize in a classic attempt to downplay the value of the chiropractic intervention.

The study involved 272 adults ages 18-65 with nonspecific mechanical neck pain of two to 12 weeks' duration. Participants were recruited from a university research center and a pain management clinic in Minnesota. Other inclusion criteria included pain equivalent to grade I or grade II according to the Bone and Joint Decade's Task Force on Neck Pain and Its Associated Disorders; and neck pain score of 3 or greater on a 0-10 scale. Exclusion criteria included cervical spine instability, fracture, neck painreferred from peripheral joints or viscera, progressive neurologic deficits, diffuse idiopathic hyperostosis, inflammatory or destructive changes of the cervical spine, previous cervical spine surgery, and blood-clotting disorders, among other criteria.

Subjects were randomized at their second baseline appointment to one of three groups for 12 weeks:

• A spinal manipulative therapy group, which received "manipulation of areas of the spine with segmental hypomobility by using diversified techniques, including low-amplitude spinal adjustments ... and mobilization." According to the study, six chiropractors, each with at least five years' experience, provided treatment, with the specific spinal level to be treated and the number of treatments rendered left to the discretion of the individual chiropractor.
• A home exercise advice group, "with advice provided [by six therapists] in two 1-hour sessions one to two weeks apart. Recommended mobilization exercises included "neck retraction, extension, flexion, rotation, lateral bending motions, and scapular retraction, with no resistance." Participants received a booklet and laminated cards of prescribed exercises, and were advised to perform 5-10 repetitions of each exercise six to eight times daily.
• A medication group monitored by a licensed medical physician, with nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, or both serving as the first line of pharmacological therapy. With patients who did not respond to or could not tolerate these drugs, narcotic medications and muscle relaxants were prescribed. With each patient, the MD determined the type of medication administered and the number of patient visits.

Self-reported outcomes, including pain, were measured six times during the 12-week treatment period in all three groups: at both baseline appointments; two, four, eight and 12 weeks after randomization; and on two occasions post-treatment (weeks 26 and 52). Objective measures of cervical spine motion were measured at four and 12 weeks by seven trained examiners blinded to treatment assignment.

Of the 272 participants, essentially equally assigned to the three treatment groups (91 SMT, 91 home exercise and 90 medication), "improvement in participant-rated pain significantly differed with SMT compared with medication at 12 weeks ... and in longitudinal analyses that incorporated pain ratings every two weeks from baseline to 12 weeks. At 12 weeks, a significantly higher proportion of the SMT group experienced reductions of pain of at least 50% [compared to the medication group]. Differences in participant-related pain improvement between the SMT and [home exercise] groups were smaller and not statistically significant."

Specifically, at week 12, more than 82 percent of the SMT group reported a 50 percent or greater reduction in pain; 57 percent reported at least a 75 percent reduction and 32 percent reported a 100 percent reduction. By comparison, the home exercise group reported pain reductions of 77 percent, 48 percent and 30 percent, respectively, while the medication group reported reductions of only 69 percent, 33 percent and 13 percent.

In terms of long-term improvement, 75 percent of the SMT group reported at least a 50 percent reduction in pain after 26 weeks, while nearly 81 percent reported at least a 50 percent reduction at 52 weeks. At 26 and 52 weeks, 71 percent and 69 percent of the home exercise group, respectively, reported at least a 50 percent reduction in pain. In long-term follow-up, the medication group's improvement fluctuated from 59 percent reporting pain reduction of 50 percent or more at 26 weeks to 69 percent reporting the same reduction at 52 weeks.

"Spinal manipulation therapy and [home exercise advice] led to similar short- and long-term outcomes," stated the authors, "but participants who received medication seemed to fare worse, with a consistently higher use of pain medications for neck painthroughout the trial's observational period."