More Information:
When it comes to professional chiropractic services, Latrobe Chiropractic Health Center has been serving the health care needs of the Latrobe Area for over 40 years.
The importance of "one-on-one service" is the trademark of Dr. Samuel H. Sarraf III and the staff of Latrobe Chiropractic Health Center.  Since 1984, "Doc Sam" has treated patient's with the respect and individualized treatment they have come to expect.  The exceptional service is one of the reasons our patients keep coming back time and time again for all their chiropractic, rehabilitative and nutritional needs.
In 2002, the Latrobe office, originally located on Lincoln Avenue, was moved to its' new home at 1901 Ligonier Street. This was the former CarQuest and Beacon Auto Parts store. This 6,000 sq. ft. building was transformed from warehouse space into professional offices. The building is now the home to four professional office suites ranging in size from 475 sq. ft. to 2,800 sq. ft.
In March of 2004 Dr. Sarraf was accepted into the HMO/PPO program for Highmark Blue Cross/Blue Shield. Dr. Sarraf is now participating in all the health care programs provided by Highmark. This participation will now allow patients to receive the expert, quality care, they have come to expect, at a reduced fee to them. Providing the best possible health care at the most affordable price is our goal.

News and Other Notables:

Study in Medical Journal Touts Effectiveness of Chiropractic Manipulation

A recent randomized, controlled trial conducted in Italy sheds new light on the use of spinal manipulation in the treatment of acute back pain and sciatica with disc protrusion. Results of the study, published in a recent issue of The Spine Journal, indicate that active spinal manipulation relieves pain more effectively than a sham simulation, leading to fewer days of localized pain and fewer days of radiating pain, and with no side-effects.

The study population consisted of 102 adults seen in two medical rehabilitation centers in Rome. All of the patients demonstrated the following characteristics: moderate to severe low back pain, moderate to severe radiating pain in one leg, and MRI evidence of disc protrusion in the spinal segments believed to be associated with the pain. Obese patients with acute LBP were excluded, as were patients with chronic LBP, disc protrusion with a ruptured annulus, and those who had already received spinal manipulation.

Upon admission to the study, each patient was interviewed and given a complete physical examination. During the interview, researchers collected detailed information on low back pain and leg pain (using a pair of visual analog scores), including the location of pain and the patient's overall quality of life with the pain.

Participants were randomized into two types of manipulation groups – active and simulated. Individuals in the active manipulation group received a maximum of 20 sessions over a 30-day period, with each session lasting five minutes. Active manipulation consisted of examining the range of motion in the patient's back, followed by soft-tissue manipulation and "brisk rotational thrusting away from the greatest restriction." The purpose of manipulation was to restore movement to the "physiological motor unit" (with each motor unit consisting of two vertebrae, disc and surrounding structures). Subjects in the simulated manipulation group received soft muscle pressing that was similar to manipulation, but did not follow any specific patterns or involve rapid thrusts. All manipulations were performed by two experienced chiropractors with similar formal training from a U.S. chiropractic college.

During the treatment period, patients in both groups were asked to track the number of days they were in pain, the number and type of nonsteroidal anti-inflammatory drugs (NSAIDs) they took, and the number of drug prescriptions. In addition, patients were assessed at 15, 30, 45, 90 and 180 days to document changes in pain.
Among the variables the researchers measured were the number of patients who were free of pain at the end of the study period, along with treatment failure (the number of patients who stopped receiving care because it failed to relieve the pain). Changes in visual analog scores at both anatomical locations and in the number of patients experiencing a reduction in disc protrusion (at 45 days) also were recorded.

Results
At the end of the follow-up period, the authors noted "a significant difference" in the percentage of patients between manipulation groups who were pain-free. Fifty-five percent of patients in the active treatment group were free of radiating pain, compared to only 20 percent of patients who received simulated manipulations. Moreover, 28 percent of the active manipulation patients were free of local pain, versus 6 percent of simulated manipulation patients.

In addition, there were significant differences between groups in terms of the number of days patients suffered pain. Active manipulation patients experienced an average of 23.6 days with pain (including 13.9 days experiencing moderate or severe pain). Among patients who received simulated manipulations, the average number of days with pain was higher (27.4), as was the number of days they experienced moderate or severe pain (17.9). Patients who received active manipulations also reported taking fewer NSAIDs and for fewer days than simulated-manipulation patients, although these results were considered nonsignificant. No adverse events were reported by patients.

Two limitations were noted by the study authors: the lack of an exit interview (which precluded the researchers from ascertaining whether the patients were truly "blinded" with regard to treatment) and the specificity of the condition being treated (pain with disc protrusion). Because of these limits, the authors stated that their study "needs to be replicated in other settings to verify its findings."

Limitations aside, active chiropractic manipulation appeared to have a greater effect on overall pain relief than simulated chiropractic manipulation, with secondary benefits such as reduced use of pain medication, and without causing any adverse effects. As the researchers noted in the study's conclusion: "Patients receiving active manipulations enjoyed significantly greater relief of local and radiating acute LBP, spent fewer days with moderate-to-severe pain, and consumed fewer drugs for the control of pain. Thus, manipulations may relieve acute back pain and sciatica with disc protrusion, although the results of subgroup analyses must be interpreted with caution."

Reference
Santilli V, Beghi E, Finucci S. Chiropractic manipulation in the treatment of acute back pain and sciatica with disc protrusion: a randomized double-blind clinical trial of active and simulated spinal manipulations. The Spine Journal 2006; in press, published online Feb. 3, 2006.

Written by Michael Devitt

High Levels of Omega-3 Fatty Acids Improve Mood, Behavior Levels

In 2000, the American Heart Association revised its Dietary Guidelines to recommend that people eat at least two servings of fatty fish per week as a means of reducing the risk of cardiovascular disease. While the cardioprotective effects of omega-3 fatty acids are well-established, other studies have demonstrated that omega-3 fatty acids may be linked to a variety of psychological conditions, including major depression and bipolar disorder. Research presented at a recent meeting of the American Psychosomatic Society has strengthened this link, with the results of small trial suggesting that low blood levels of omega-3s may have a negative impact on a person's mood and behavior.

In the study, researchers collected blood samples of 106 hypercholesterolemic people who had no history of depression or any other diagnosed mood disorder, and did not take fish oil supplements or psychotropic drugs. In addition to blood tests, all subjects completed a series of tests designed to measure mood, personality and levels of impulsive behavior.

Participants with low blood levels docosahexaeonic acid (DCA) were 42 percent more likely to report symptoms of mild to moderate depression, while patients with low levels of eicosapentaenoic acid (EPA) were more likely to be in a negative mood, and were associated with high neuroticism scores. Low levels of alpha-linolenic acid (ALA) were associated with higher levels of impulsive behavior.

"In conjunction with published research, these data suggest that dietary intake of omega-3 fatty acids may be a determinant of normative variability in affect regulation, impulse control and personality," the authors wrote in their conclusion. They added, "This study opens the door for future research looking at what effect increasing omega-3 intake - whether by eating omega-3-rich foods like salmon or taking fish oil supplements - has on people's moods."

Conklin S, Harris JI, Manuck SB, et al. Plasma fatty acids are associated with normative variation in mood, personality and behavior. Abstract #1411. Presented at the 64th Annual Scientific Meeting of the American Psychosomatic Society, Denver, CO, March 1-4, 2006.

For more information go to:
http://www.chiropracticresearchreview.com/crr/sub_topic.php?id=67


Pain Management of Musculoskeletal Disorders

U.K. Health and Safety Executive Releases New Report

The Health and Safety Executive (HSE), a division of the United Kingdom's Department of Health, has published a new report, Improved Pain Management for Musculoskeletal Disorders, co-authored by Alan Breen, DC, PhD, and other researchers from the Anglo-European College of Chiropractic. The report, which presents the latest evidence on the usefulness of early secondary-intervention pain management techniques that can be used to help people return to work or continue working, includes a series of "care pathways" consistent with the latest evidence and relevant to doctors of chiropractic and other providers involved in the early management of musculoskeletal disorders.

According to the HSE, musculoskeletal disorders and stress are the most commonly reported types of work-related illness in the U.K. In 2001-2002, an estimated 1.1 million people in the U.K. suffered a musculoskeletal disorder they thought was caused or made worse by their current or past employment. While the total number of musculoskeletal disorders appears to have decreased, their prevalence has not; according to the HSE, approximately three-quarters of all work-related illness are attributed to a combination of musculoskeletal disorders, stress or both.

As part of an effort to reduce the number of days lost due to workplace injuries and work-related ill health by 2009-2010, the HSE established a musculoskeletal disorders priority program. One component of that program was the development of a research agenda designed to "understand how best to develop a culture of good practice including use of collaboration and partnership working to ensure continuous improvement in tackling musculoskeletal disorders."

Improved Pain Management for Musculoskeletal Disorders, which was prepared for the HSE by the Institute for Musculoskeletal Research and Clinical Implementation, explores pain management from a variety of perspectives. While interested parties are encouraged to read the report in its entirety to fully appreciate the implications it holds for the role of chiropractic in the treatment of musculoskeletal disorders, the following is a brief synopsis of the report's major sections:

Rationale for Early Intervention
Whether early intervention produces better outcomes has been difficult to ascertain. Based on the available evidence, however, the authors of the report believe that "return to work is much less likely if longer-term absence has already occurred" and that "changes related to determinants of disability, quality of life and chronic disability can appear by 14 days" after the onset of a musculoskeletal disorder.

In the past, early intervention has been considered an appropriate measure when musculoskeletal problems occur. According to the authors, however, "there is a considerable body of expert opinion, with continuing support from recent research, that successful early intervention does not necessarily depend on treatment." Rehabilitation should no longer focus on the medical aspects of treatment, but also "the use of practical considerations and personal emotional, societal and work-related factors to promote recovery from injury."

The Influence of Job Culture, Ethnicity and Gender on Pain
According to the report, one of the main considerations to early pain management is the control of pain while avoiding withdrawal and inactivity. Ethnicity and gender-related cultural issues may be important factors; however, overall, job culture appears to play a larger role in this consideration than ethnicity or gender.

Pain Physiology
This section of the report introduces the neuromatrix theory of pain, which is based on the premise that pain is multidimensional. In the neuromatrix theory, various body systems, such as the sensory nervous system, the cognitive and affective functions of the brain, its neural modulating and inhibiting systems, and endocrine and other chemical effects, along with genetic characteristics, combine to influence recovery from painful experiences.
In relation to the management of musculoskeletal disorders, the neuromatrix theory posits that "there is a synergy between musculoskeletal pain and emotional stress that can work against recovery," which supports the rationale for the reduction of stress and anxiety as a vital component of rehabilitation. Negative neurophysiological interactions between pain and stress, therefore, promote an environment that sustains disability and absence from work, while positive interactions, along with activity and involvement, oppose such an environment.

Predictors of Outcome
While recent evidence has demonstrated consistent themes about the prediction of poor outcomes from work-related musculoskeletal disorders, none of these themes has been associated with specific conditions. The majority of published studies have focused on back pain; evidence is less clear for musculoskeletal disorders related to the neck and upper limbs.

Improved early pain management should take account of the natural progression of musculoskeletal disorders and their relation to a particular job. Health care providers should also be aware of, and responsive to, psychosocial factors associated with the management of musculoskeletal disorders.

Current Guidelines, Subsequent Reviews and Research
This section summarizes guidelines, reviews and research for general musculoskeletal disorders, back pain, neck pain, upper limb disorders, knee pain, and ankle and heel disorders. Of particular interest to the chiropractic profession is the subsection on back pain, which states, in part: "There is strong consensus in the latest evidence-based guidelines that absence from work because of non-specific back pain is likely to delay, rather than hasten recovery. However, failure to manage the episode optimally in its early stages by, if necessary, controlling pain, modifying activities, acting on worsening symptoms or inappropriately using bed rest, may inhibit recovery." The report adds, "When treatment is needed, there is also a growing level of support for multi-modal evidence-based interventions, combining the interventions recommended in current major guidelines."

Prospects for Improved Care
For patients who require clinical assessment and care of a musculoskeletal disorder, the conventional medical system appears to be of little use. Despite the publication of national guidelines that have focused on preventing acute back pain patients from becoming chronic back pain patients, the authors note that "inappropriate referral to secondary care for musculoskeletal disorders in general seems to persist," and that "assessment of non-medical obstacles to recovery is problematical and frustrating for health care traditionalists." Furthermore, evidence suggests many health care providers are not confident about their ability to provide appropriate care: "GPs' confidence in their own abilities to assess patients and supply evidence-based care generally and for back pain in particular is lacking."

Care Pathways and Clinical Management
Four "care pathways" are listed in the report: a genetic care pathway, which sets out a common sequence of events, along with individual pathways for employers, employees and health professionals. The pathways are designed to apply to any episode of musculoskeletal pain that interferes with work; lasts more than a day or two (if severe); or lasts up to a week (if not severe).

All four pathways operate in two stages in time and are intended to help prevent musculoskeletal disorders from becoming chronic or recurrent. For the generic, employer and employee pathways, stages occur within one week from when the problem began, with a follow-up within two weeks. The first stage of the health professional pathway occurs at the employee's first appointment, with the second stage occurring four weeks later. A copy of the generic care pathway is reproduced above; diagrams of all four pathways are included in the full report.

Early Interventions by Musculoskeletal Practitioners
While chiropractors, osteopaths and some physiotherapists offer a full array of manual therapies, there has been some confusion over terminology and the use of these therapies by different practitioners. Typical early interventions include analgesics, X-rays, soft-tissue techniques, articulatory techniques (or "mobilizations"), and manipulation of the central lumbar or sacroiliac joints. The authors note, "There is some evidence that high-velocity thrust manipulation is more effective than other types when compared to exercise or other physical therapies." They add, "Perhaps the strongest recommendations in evidence-based guidelines are for acute back pain and are in terms of advice to: give adequate information and reassure the patient; do not prescribe bed rest as a treatment; advise patients to stay active and continue normal daily activities including work if possible."

Summary Points and General Recommendations
The report concludes with recommendations for employers, employees and health professionals. Employers are asked to examine their policies regarding the early management of musculoskeletal disorders and what types of questions should be asked if a person reports a musculoskeletal disorder at work. Employees, meanwhile, are given advice on what to do if they are suffering from a musculoskeletal problem that is not resolving. Health professionals are given a list of 10 recommendations on providing optimal patient care.

The incidence of musculoskeletal disorders in the United Kingdom and other developed nations continues to increase at an alarming rate. As such, effective management of these conditions, especially in their early stages, is of significant importance to all parties involved. By working together, employees, businesses and health care providers can create effective methods of care and support to ensure that the pain workers suffer from is kept to a minimum, and that they can continue working or return to work as soon as possible. As the authors of the report conclude: "Latest evidence and current thinking supports the use of biopsychosocial assessment and intervention in close proximity to work for improved early management of musculoskeletal disorders. The employer and employee have the main roles in this, and musculoskeletal practitioners (chiropractors, osteopaths and musculoskeletal physiotherapists) are the most accessible qualified health professionals to support them."
The complete draft of Improved Pain Management for Musculoskeletal Disorders can be accessed at www.hse.gov.uk/research/rrhtm. The report's identification number is #RR399.

Written by Michael Devitt


A Hectic Lifestyle Doesn't Have to Be an Unhealthy One

A recent study published in Food Technology reports that Americans are too busy to make time for nutrition. The irony is that the busiest bodies absolutely need proper nutrition to maintain their on-the-go lifestyles. Between work, school, doctor's appointments, basketball practice, ballet, guitar lessons, and other various activities, Americans ate a cooked meal at home only 4.9 times per week in 2005. When eating out, they were more likely to take out food from a restaurant than to eat the purchased meal on site. Moreover, 22 percent of restaurant meals, which most often consisted of hamburgers and French fries, according to the study, were purchased from a car in 2005 – up from 14 percent in 1998. And coffee was the top breakfast food last year!1

With statistics like these, it's difficult to believe that Americans are receiving adequate nutrition in their daily diets. America is certainly a busy place, but those who must resort to a take-out menu more often than they would like don't have to sacrifice their health and nutrition for mere convenience.

Among the excuses Americans give for neglecting their health and opting for faster food options, the one that tops the list has to be, "I don't have time to eat well." When Nancy Clark, MS, RD, an international sports nutritionist and nutrition author, hears this from patients, she such as work, study or exercise instead of eat [well]."2 Clark doesn't urge patients to choose their health and the care of their bodies over work, study or exercise; instead, the idea is that proper nutrition is more than worthy of their time. After all, without a healthy body, no one can keep up with the daily hustle and bustle for long.

Start Simple
When we're hungry, we eat. The equation seems simple enough, but unfortunately, Americans don't exist in a vacuum. In this country, where a new fad diet is born each week and new potential causes of cancer, heart disease, and diabetes are uncovered every day, the simplicity that once was becomes cluttered with variables that make the pursuit of health and wellness as complex as quantum physics. If dwelled upon, these variables tend to polarize attitudes toward foods, creating categories of "good" and "bad" that then go on to affect how people feel about certain foods.3

"Twenty-two percent of restaurant meals, which most often consisted of hamburgers and French fries were purchased from a car in 2005. And coffee was the top breakfast food! With statistics like these, it's difficult to believe that Americans are receiving adequate nutrition in their daily diets."

If Americans claim they "don't have time" to choose fresh foods over fried, for example, they certainly don't have time to consider all the clutter in their lives. And the truth is, the equation really is simple: Hunger is a signal that the body needs nutrients,3 not an annoyance to be ignored or lessened with whatever pre-made, processed items are nearby. An infant's cry is an indication of an unarticulated need. Parents don't use earplugs or cover the child's mouth to lessen the noise; they see to it that the child's needs – whether food, drink or sleep – are met. Adults ought to view their nutritional needs in the same way.

Dietary Guidelines
Last year, the U.S. Department of Agriculture (USDA), together with the U.S. Department of Health and Human Services, updated and reissued the Dietary Guidelines for Americans and food pyramid to help consumers choose adequate nutrients within their caloric or energy needs. The USDA offers a user-friendly, interactive Web site, www.mypyramid.gov, that includes a breakdown of the new dietary guidelines and food pyramid, tips and resources, and even "MyPyramid Tracker," which illustrates a link between good nutrition and regular physical activity by calculating a person's energy expended through exercise, and the energy taken in from food.4 Americans can take comfort in the fact that following the guidelines is different from diving into the next fad diet, because the guidelines emphasize consumption of appropriate foods and nutrients, instead of deprivation or avoidance of particular foods or food groups. The guidelines promote health consciousness, rather than obsession. Once your patients are informed about the recommended foods and nutrients, here are a few thoughts to pass along that will make their healthy food choices more gratifying.

Take Time to Taste Food and Feel Full
The rich tastes and smells of so many nutrient-rich foods offer ample reward for a person's health-driven efforts. However, without slowing down long enough to really taste a meal, it's impossible to enjoy it. Linda Feingold, MEd, MS, RD, a nutritionist and exercise physiologist in New York, urges her patients to sit down, make each mealtime a dining experience, and savor each bite of food.5 It makes nutrition, which might otherwise seem tedious, much more exciting.

Feingold also stresses the importance of taking at least 20 minutes to enjoy food, which helps her patients avoid overeating. "It takes about [20 minutes] for your brain to receive signals from the stomach that you have ingested a sufficient amount of energy and nutrition, and are no longer hungry. Taking fewer than 20 minutes to eat may make you feel pressured to inhale anything and everything you can."5 And because today's food portions are so large, the likelihood that rushed eaters will take in more than they can comfortably digest is quite high.

Armor for the Drive-Thru
Despite a fresh perspective and a plan to slow down for nutrition, the fact remains: Americans are still busy people. No one, not even the USDA, can expect those who follow the new dietary guidelines to abstain from fast food altogether – nor does anyone have to. It is possible to make nutrition a priority when dining out. Again, time is key! Taking time to look over a menu, skipping "the usual" for healthier fare, and adding variety to daily meals can help keep your patients on track nutritionally. It seems America is already making wiser decisions at the drive-thru. In 2004, diet soft drinks, main-dish salads, bottled water, milk, and fruit made the top 10 list of restaurants' fastest-growing orders, joining burgers, fries, coffee and chicken sandwiches. In 2005, main and side-dish salads were among the top 10 foods ordered by men, women and young adults.1 Feingold encourages her patients to start the day with meals in mind, "If you don't plan out when and what you'll be eating throughout the day, you are setting yourself up for disaster."5

Popular Fast-Food Items Ordered in 2005
McDonald's Carl's Jr. Jack in the Box Pizza Hut
Big Mac® French Fries (lg.) Super Star® w/cheese CrissCut Fries® (lg.) Jumbo Jack® w/ cheese Seasoned Curly Fries (lg.) Pepperoni Lover's® Pizza (2 slices) Meat Lover's® Pizza (2 slices)
Calories 560 520 920 410 686 550 560 560
Fat (g) 30 25 57 24 41 31 26 26
Fiber (g) 3 7 3 4 2 6 4 4
Protein (g) 25 6 48 5 23 8 28 28


Healthier Options Available on the Same Menus
McDonald's Carl's Jr. Jack in the Box Pizza Hut
Grilled Chicken Classic Sandwich Cobb Salad w/ Grilled Chicken* Charbroiled BBQ Chicken Sandwich Charbroiled Chicken Salad-To-Go* Chicken Fajita Pita Asian Chicken Salad* Fit n' Delicious Veggie Pizza (2 slices) Spaghetti w/ Marinara Sauce
Calories 420 280 370 330 300 140 260 490
Fat (g) 9 11 4 7 10 1 7 8
Fiber (g) 3 4 4 5 3 5 2 10
Protein (g) 32 35 35 34 23 14 10 14
*Nutritional data is for a salad without any dressing. (Low-fat and nonfat dressings are available for all salads listed.)


For mealtime guidance, The Mississippi Department of Health Web site offers a fairly exhaustive list of tips to help fast-food frequenters make wise food choices away from home. A few hints for those in a hurry include:
•   Order the regular or kid-sized portion. Mega-sized servings are more than anyone needs.
•   Boost the nutrients in all kinds of sandwiches by adding tomato, peppers and other vegetables.
•   Go easy on condiments, special sauces and dressings on sandwiches and salads. Ask for mustard, catsup, salsa, or low-fat spreads and dressings.
•   A baked potato offers more fiber and fewer calories than French fries; just tell your patients to go easy on the sour cream and butter. The potato can be topped with broccoli, a small amount of cheese, or salsa.

Making Progress
Despite many startling statistics, the January 2006 Food Technology report did include some admittedly encouraging details. After a 14-year slump, fresh fruit consumption has risen by 4 percent since 2002, with young adults ages 18-37 and those with children under age 6 posting the largest gains in fruit intake last year.1 And apparently, Americans are paying more attention to portion control: 61 percent say simply that they are motivated to cut back on the amount of food they eat, and 62 percent of consumers feel that there are not enough small portions in restaurants. Moreover, full-service and fast-casual restaurants have seen a continual drop in appetizer and dessert sales over the past four years.

Many popular fast-food restaurants are getting wise to these healthy trends. The same menus that offer double cheeseburgers, deep fried chicken nuggets, and pepperoni pizza, also include more nutritional meal-time options – if you choose to look for them. At the risk of frightening patients, it's important that they know what they are putting in their bodies. The truth might even provide a little motivation.

Often, healthy menu options are far less aggressively marketed than the fat-laden favorites. The healthy menu items contain less fat and fewer calories, are packed with protein, and share the same menu with some of the "old standbys." Compare the charts above.

More extensive nutritional information for these and other menu items are readily available on the listed restaurants' Web sites. Your patients can better plan the meals they will be eating throughout the day if they are familiar with their options before visiting their favorite or most-frequented restaurants. Clearly, America isn't slowing down, and the days aren't getting any longer. But with education and increased awareness, there's no excuse for your patients and their families not making time for nutrition.
Written by Julie Engebretson

References
Sloan, Elizabeth A. What, when, and where America eats. Food Technology, Jan. 6, 2006.
Clark, Nancy. Take time for a good lunch. The Physician and Sports Medicine, March 1997;25(3).
Brown University Department of Health Services: Health Education. www.brown.edu/Student_Services/Health_Services/Health_Education/ nutrition/weightconcerns.htm#8.
U.S. Department of Agriculture food pyramid. www.mypyramid.gov.
Feingold, Linda. Slow Down, You Chew Too Fast! www.spineuniverse.com/displayarticle.php/article2378.html. Published online Sept. 13, 2003.