Author: Superadmin

Acute disc herniation is a common issue encountered by doctors and chiropractors alike. However, some studies have suggested that chiropractic care can actually increase the risk of complete disc herniation. To this end, a recent study by Hincapié et al. sought to elucidate the relationship between acute disc herniation and chiropractic care.

Acute disc herniation results from the collapse of the intervertebral disc. There are two primary causes of disc herniation. The first simply occurs over time, as aging leads to reduced proteoglycan production by disc fibrochondrocytes. In turn, the disc becomes dehydrated and more brittle, leading to strain on the annulus fibrosis, collapse of the disc, and herniation of the inner disc material.¹ On the other hand, biomechanical force can also lead to fissures in the annulus fibrosis and acute disc herniation in healthy, young or middle-aged individuals.¹ These types of acute disc herniations often occur in individuals who put immense strain on their back, such as athletes or individuals lifting heavy objects without protective form. The discs in the lumbar spine are most prone to herniation; however, injury-related disc herniation can also occur in the cervical or thoracic spine.²

Not only is acute disc herniation strongly associated with back pain, reduced mobility, and other adverse symptoms, but it is also notoriously difficult to treat. In fact, the primary recommendation for treatment is avoidance of motions which cause the patient pain.³ For this reason, it is best to simply avoid the risk factors for acute disc herniation in order to prevent the injury from occurring. While it is known that excessive strain and back injuries are associated with acute disc herniation, there has been debate as to whether chiropractic care increases risk of the injury occurring in the first place. Many people experience lower back pain as a prodromal symptom of acute disc herniation; as a result, a good proportion of these individuals seek chiropractic care, which is known to improve chronic low back pain. The relationship may be that people with lower back pain who are more likely to seek chiropractic care are separately at a heightened risk for developing acute disc herniation, or that chiropractic care itself increases the risk of acute disc herniation.

In order to answer this question, authors Hincapié et al. set out to evaluate chiropractic care and its relationship to acute lumbar disc herniation.⁴ The authors based their study in Ontario, Canada, where they used a self-controlled case series and population-based healthcare databases to investigate patients who made visits to the emergency department from April of 1994 to December of 2004. A total of 195 patient cases met the inclusion criteria, which was history of acute lumbar disc herniation and early surgical intervention. Using this data, the authors analyzed the association between chiropractic care and acute lumbar disc herniation requiring early surgery. They used patients who had visited their primary care physician for prodromal symptoms of lumbar disc herniation as a control.

First, the authors found significant positive associations between both previous chiropractic and primary care appointments and lumbar disc herniation requiring early surgery. This finding would suggest that patients typically seek care prior to complete herniation, whether that be chiropractic or medical. Notably, the frequency of acute lumbar disc herniations was comparable for patients who previously sought medical care and those who sought chiropractic care. Therefore, the authors reported that chiropractic care was equally likely to precede acute lumbar disc herniation as a visit to one’s primary care provider. In other words, there is little reason for concern that chiropractic care could disproportionately lead to acute lumbar disc herniation.

While the findings of Hincapié et al. are certainly reassuring, further investigation into the subject of acute disc herniation and chiropractic care might prove interesting. For example, do primary care visits or chiropractic appointments confer any preventative benefit when it comes to acute disc herniation? Do different chiropractic approaches to prodromal symptoms of acute disc herniation lead to varied outcomes? As studies reveal more about the relationship between acute disc herniation and chiropractic care, these questions will continue to be answered.

References 

¹ Schoenfeld, A. J., & Weiner, B. K. (2010). Treatment of lumbar disc herniation: Evidence-based practice. International journal of general medicine, 3, 209–214. https://doi.org/10.2147/ijgm.s12270 

² Herniated Disc. Retrieved from https://www.aans.org/en/Patients/Neurosurgical-Conditions-and-Treatments/Herniated-Disc 

³ Herniated disk. (2019, September 26). Retrieved from https://www.mayoclinic.org/diseases-conditions/herniated-disk/diagnosis-treatment/drc-20354101 

⁴ Hincapié, C. A., Tomlinson, G. A., Côté, P., Rampersaud, Y. R., Jadad, A. R., & Cassidy, J. D. (2018). Chiropractic care and risk for acute lumbar disc herniation: a population-based self-controlled case series study. European spine journal, 27(7), 1526–1537. https://doi.org/10.1007/s00586-017-5325-y 

Deficiencies in bone health are common among elderly populations [1]. Associated musculoskeletal conditions, particularly osteoporosis, can result in significant physical disability and psychological impacts [1]. Fortunately, following guidelines for physical activity, nutrition, and pharmacological therapies can promote bone health and avoid the musculoskeletal problems that have become characteristic of old age.

Exercise is one of the most impactful ways through which people can improve their bone health [1]. Optimally, exercise should occur frequently during maturation to ensure that young people reach their peak bone mass and, accordingly, prevent or delay osteoporosis later in life [1]. Although exercise earlier in life can be very beneficial, it is impactful during middle and older age as well [1]. While the optimal form of exercise to promote bone health is not known, researchers recommend high-impact exercises that involve dynamic movements such as hopping or jumping [1, 2]. Alternatively, odd- or high-impact movements paired with resistance training can also be beneficial [2]. People who cannot engage in high-impact activities may benefit from certain yoga postures, lower-impact resistance training, or even walking [2]. Research indicates that habitually engaging in these forms of exercise for at least two or four short (30 minute or less) sessions each week is a good guidelines for maintaining or improving bone health [2].

Better nutrition is another lifestyle change that people can adopt to promote their bone health. Multiple studies have pointed to protein as highly influential for bone health; however, protein can be either detrimental or beneficial, depending on several factors [3]. Protein source is one hypothesized factor. Shams-White and colleagues investigated the differential effects of animal-based protein versus plant-based protein [3]. Their primary outcomes included lumbar spine (LS), femoral neck (FN), and total body bone mineral density (BMD) biomarkers [3]. Despite the two sources’ dissimilar amino acid profiles, research did not show a difference in benefits [3]. Another study conducted by the same researchers found that higher protein intake was more beneficial than lower intake for LS BMD, but otherwise, the two levels of intake were comparable in terms of FN, total hip, and total body BMD markers [4]. On another note, dairy products are a greater source of bone-beneficial proteins than any other food characteristic of the adult diet [5]. Indeed, in certain populations, calcium from dairy products appears to increase bone mineral density and improve total body bone mineral content when consumed over the long term [5].

When bone conditions have already progressed significantly, doctors often need to turn to pharmacological interventions [1]. Medications for bone conditions tend to be effective, but their benefits are often short-lived and associated with rare but drastic side effects [1]. For example, treatments such as bisphosphonates are known for their high success rates in treating patients who suffer from glucocorticoid-induced osteoporosis [6]. Unfortunately, bisphosphonates may not serve as an optimal long-term solution for certain patients, in which case additional management is required [6].

Ultimately, bone health can perhaps best be achieved by regularly following guidelines that have been established by thorough research, including a high-intensity impact workout regimen and consuming bone-nutrient-rich foods, such as dairy. When bone diseases have already progressed, pharmacological treatments can be highly effective, but their success may be limited to the short term. Therefore, maintaining healthy nutritional and exercise habits is of the utmost importance to avoid persistent bone problems.

References 

[1] L. Santos, K. J. Elliott-Sale, and C. Sale, “Exercise and bone health across the lifespan,” Biogerontology, vol. 18, no. 6, p. 931-946, October 2017. [Online]. Available: https://doi.org/10.1007/s10522-017-9732-6. 

[2] K. L. Troy et al., “Exercise Early and Often: Effects of Physical Activity and Exercise on Women’s Bone Health,” International Journal of Environmental Research and Public Health, vol. 15, no. 5, p. 1-17, April 2018. [Online]. Available: https://doi.org/10.3390/ijerph15050878. 

[3] M. M. Shams-White et al., “Animal versus plant protein and adult bone health: A systematic review and meta-analysis from the National Osteoporosis Foundation,” PLoS One, vol. 13, no. 2, p. 1-24, February 2018. [Online]. Available: https://doi.org/10.1371/journal.pone.0192459. 

[4] M. M. Shams-White et al., “Dietary protein and bone health: a systematic review and meta-analysis from the National Osteoporosis Foundation,” The America Journal of Clinical Nutrition, vol. 105, no. 6, p. 1528-1543, June 2017. [Online]. Available: https://doi.org/10.3945/ajcn.116.145110. 

[5] E. G. H. M. van den Heuvel and J. M. J. M. Steijns, “Dairy products and bone health: how strong is the scientific evidence?,” Nutrition Research Reviews, vol. 31, p. 164-178, March 2018. [Online]. Available: https://doi.org/10.1017/S095442241800001X. 

[6] A. Caplan et al., “Prevention and management of glucocorticoid-induced side effects: A comprehensive review: A review of glucocorticoid pharmacology and bone health,” Journal of American Academy of Dermatology, vol. 76, no. 1, p. 1-9, January 2017. [Online]. Available: https://doi.org/10.1016/j.jaad.2016.01.062. 

Infant torticollis manifests when the sternocleidomastoid muscle, connecting the breastbone and collarbone to the skull, is shortened as a result of musculoskeletal or non-musculoskeletal factors ¹, either at birth in the form of congenital torticollis, or later on in development in the form of acquired torticollis. The worldwide incidence of congenital torticollis varies from 0.3% to 1.9 %, with some studies pointing to a prevalence of 1 in 250 newborns, representing the third most frequent congenital orthopedic anomaly ². An early diagnosis of newborn torticollis facilitates its swift noninvasive correction, such as through chiropractic care, minimizing any long-term complications. With proper treatment, 90% to 95% of children improve during their first year of life, and 97% of patients improve if treatment is begun prior to six months of age ³.

There are several methods of treating congenital torticollis. Physical and chiropractic therapy and repositioning are recommended as a first line treatment option. Such initial treatment focuses on passive range stretching and thorough patient follow ups, including manual flexion, extension, and lateral rotation stretches. Good stabilization and correct hand positioning are key, although stretching methods and positions are highly patient-centric ⁴.

A 2015 case study demonstrated that chiropractic management of infantile torticollis fully resolved the torticollis and associated abnormal fixation of the right eye ⁵. Chiropractic treatment consisted of cervical spine manipulative therapy alongside neck muscle massage and stretching; all symptoms resolved within 4 weeks.

Since, chiropractic manipulation under anesthesia has been developed as a novel therapeutic method. In a 2018 retrospective case series, 6 infants aged 4.5- to 15-months-old previously diagnosed with newborn torticollis, after failing to respond to conservative therapy options, were treated by a chiropractic doctor. All 6 infants, who were found to have arthrogenic newborn torticollis, responded well to manipulation under anesthesia ⁶, experiencing a significantly improved cervical range of motion. Manipulation under anesthesia may represent a therapeutic option for complex arthrogenic torticollis cases failing to respond to other adjunctive therapies.

Most recently, a 2020 case report documented the full resolution of an infant’s congenital torticollis using a multidisciplinary chiropractic approach. The treatment consisted of a gentle manipulation of the occipito-atlantal spinal region, soft tissue therapy of the sternocleidomastoid muscle, and cranial manipulation alongside a number of home exercises and a referral to a physiotherapist ⁷. Since, a 2020 systematic review assessing the effectiveness and safety of conservative interventions for torticollis at all ages corroborated that practitioner-led stretching and repositioning practices represented low risk, inexpensive interventions with tremendous potential for treating newborn torticollis ⁸. Finally, alongside these interventions, both Kinesio Taping and helmet therapy, primarily for infants with moderate to severe and persisting asymmetry, provide additional chiropractic care tools for the treatment of newborn torticollis ⁴. 

Research has highlighted the positive outcomes of a multidisciplinary approach to correcting pediatric torticollis. Parents should remain well-educated as regards the condition and its prognosis, alongside proactively participating in its management. In concert, healthcare providers should remain aware of the association between congenital torticollis and its impact on a child’s gross motor developmental milestones. In the end, prompt, patient-adapted therapy from a collaborative team will remain key to sustainable clinical outcomes ³.  

References

1.        Haugen, E. B., Benth, J. Š. & Nakstad, B. Manual therapy in infantile torticollis: A randomized, controlled pilot study. Acta Paediatr. Int. J. Paediatr. (2011). doi:10.1111/j.1651-2227.2011.02145.x

2.        Congenital torticollis – Physiopedia. Available at: https://www.physio-pedia.com/Congenital_torticollis.

3.        Gundrathi, J., Cunha, B. & Mendez, M. D. Congenital Torticollis. Anaesthesia, Pain Intensive Care 20, 376 (2021).

4.        Öhman, A. M. The Immediate Effect of Kinesiology Taping on Muscular Imbalance for Infants With Congenital Muscular Torticollis. PM R (2012). doi:10.1016/j.pmrj.2012.04.006

5.        Hobaek Siegenthaler, M. Chiropractic management of infantile torticollis with associated abnormal fixation of one eye: A case report. J. Chiropr. Med. (2015). doi:10.1016/j.jcm.2014.12.003

6.        Paravicini, I. Manipulation Under Anesthesia in Infants With Arthrogenic Newborn Torticollis: A Retrospective Case Series. J. Chiropr. Med. (2018). doi:10.1016/j.jcm.2018.04.004

7.        Lacerte, F. D. D. Positive outcome from a chiropractic multidisciplinary approach for congenital torticollis in an infant three-weeks of age: A case report. J. Clin. Chiropr. Pediatr. (2020).

8.        Ellwood, J., Draper-Rodi, J., Carnes, D. & Carnes, D. The effectiveness and safety of conservative interventions for positional plagiocephaly and congenital muscular torticollis: A synthesis of systematic reviews and guidance. Chiropractic and Manual Therapies (2020). doi:10.1186/s12998-020-00321-w

In light of an increasingly sedentary society, back pain is growing increasingly common among the general population (1), resulting from a number of ailments – of which bulging or herniated discs are quite frequent.

A bulging disc is formed when the soft cushion of tissue between vertebrae pushes outward, resulting in consistent pressure. In contrast, a herniated disc is formed when the outer covering of the disc is torn, causing the innermost nucleus pulposus to leak into the spinal canal. Both bulging and herniated discs result in significant pain and tenderness, although bulging discs tend to generate a radiating sensation of dull pain. In more severe cases, bulging or herniated discs may impinge traversing nerves as these exit the neural foramen, causing nerve pain, or even directly compress the spinal cord contained within the spinal canal. Both most frequently affect the cervical and thoracic spinal regions (2).

Clinically considered degenerative, a bulging disc presents as a progressive, gradual onset of symptoms. Symptoms can include pain in the buttocks, legs, or back, preventing a patient from walking smoothly. Bulging discs tend to affect multiple discs and may generate other disc degeneration-related issues, such as lumbar stenosis, or a narrowing of the spinal canal (3). Short-term treatment includes the administration of anti-inflammatory medications, especially during acute flare-ups. Steroids may also be administered in the case of significant nerve pain. Thereafter, long-term treatment involves a self-directed exercise program which is begun with a physical therapist prior to being continued at home. In the case of lumber stenosis, lumbar decompression surgery – decompressing the spinal canal such that the nerves are no longer compressed to alleviate the pain – may be warranted.

Herniated discs generally occur abruptly, as a result of an acute injury, and affect only one individual nerve root (3). If symptoms have lasted less than 6 weeks and patients have not experienced any nerve damage, anti-inflammatory medications, physical therapy or chiropractic treatment, and steroid injections can help address symptoms over a 6- to 12-week period. Most modern chiropractors use a variety of effective treatment approaches, including gentle soft tissue therapies, graded mobilization, and intermittent traction. If these less invasive forms of treatment are not sufficiently effective, an outpatient surgery in the form of a microdiscectomy may quickly alleviate the pain by relieving the pressure on the affected nerve root. Certain extreme cases of disc herniation require tailored treatment. For example, lumber disc herniation into the dural space, a rare phenomenon associated with degenerative lumbar lesions among the elderly, requires immediate surgery, yielding generally positive outcomes (4). It should not go unnoticed that, interestingly, a recent study showed that common terms used in lumbar spine imaging reports are poorly understood by the general population and may contribute to the burden of lower back pain (5).

Overall, non-surgical treatments such as chiropractic care are effective and are the preferred first line treatment for a bulging or herniated disc. Alongside lucid and thorough patient education, patient-tailored treatments of varying degrees of invasiveness help patients rapidly resume their normal activities in a safe and sustainable fashion.

References 

1. Hanna, F. et al. The relationship between sedentary behavior, back pain, and psychosocial correlates among university employees. Front. Public Heal. (2019). doi:10.3389/fpubh.2019.00080 

2. Bulging Discs vs. Herniated Discs: Understanding the Difference – Chiropractic BioPhysics. Available at: https://idealspine.com/bulging-discs-vs-herniated-discs-understanding-the-difference/. 

3. Bulging Disc Vs. Herniated Disc: What’s The Difference? – Penn Medicine. Available at: https://www.pennmedicine.org/updates/blogs/musculoskeletal-and-rheumatology/2018/november/bulging-disc-vs-herniated-disc. 

4. Ge, C. Y. et al. Intradural lumbar disc herniation: A case report and literature review. Clin. Interv. Aging (2019). doi:10.2147/CIA.S228717 

5. Farmer, C. et al. 53 Consumer understanding of terms used in imaging reports requested for low back pain. in (2019). doi:10.1136/bmjebm-2019-pod.66 

            Kinesiotaping is a popular therapeutic approach in the overlap between physical therapy, sports medicine, and chiropractic care. Flexible pieces of kinesiotape are placed strategically around the affected area in order to guide muscular movement, improve circulation, and relieve pain. The tape is both waterproof and durable; it can therefore be worn during intense physical exercise as well as during rest. Often, tape does not need to be replaced by a practitioner for several days.

            Given the flexibility of its applications as well as its multidimensional benefits, kinesiotaping has shown particular promise for the adjustment of posture and alignment during motion, particularly when it comes to foot pronation. Indeed, several studies have suggested that kinesiotaping may be a promising treatment for excessive pronation.^1,2,3 In order to verify these findings, a 2020 study by physical therapists Senem Guner and Serap Alsancak aimed to characterize the benefits of kinesiotaping as a therapeutic intervention for foot pronation.⁴ A total of twenty participants (split equally by gender) with a current diagnosis of foot pronation were included in the study.

            In order to optimize kinesiotape efficacy, the authors projected a laser line onto each participant as they stood, barefoot, with one foot on a force plate, thus illuminating the joint load carrying line. A practitioner then applied kinesiotape in a corrective fashion. Assessment of the joint load carrying line was done prior to kinesiotape application, immediately after, and then at 24-48 hours following application. A ruler was placed at the level of the joint line tangentially to the patella and ankle joint in order to quantify deviation of the joint load carrying line.

            Interestingly, Guner and Alsancak found that kinesiotape corrected neither the weight bearing nor the joint load carrying line in any significant way. While improvement was noted in lateral knee joint movement at the time of application of the kinesiotape, this change did not persist into the 24-48-hour mark. This finding suggests that kinesiotape may experience waning efficacy with continued wear, perhaps due to stretching and/or loosened adhesion, and that the tape should be reapplied more frequently to maximize effectiveness.

            While these findings are somewhat contradictory to those of previous studies, it is important to note a few pertinent factors which may have contributed. Firstly, the authors’ sample size was small and not particularly diverse in age (average age 19.7 ± 1.2 years); there is therefore ample opportunity for future studies to both replicate and expand on these findings. Moreover, other pertinent values which were assessed in other similar studies – such as changes in peak plantar pressure – were not assessed by Guner and Alsancak. A more multidimensional study may have revealed a more nuanced effect.

The authors do note that kinesiotaping still may be useful for amplifying sensory input and reduction of perceived discomfort. Furthermore, short-term use of kinesiotape may also prove more effective when paired with orthotic footwear. However, the authors findings do indicate the need for continued research.

References

1. Franettovich, M. M., Murley, G. S., David, B. S., & Bird, A. R. (2012). A comparison of augmented low-Dye taping and ankle bracing on lower limb muscle activity during walking in adults with flat-arched foot posture. Journal of science and medicine in sport, 15(1), 8–13. https://doi.org/10.1016/j.jsams.2011.05.009

2. Franettovich, M., Chapman, A., & Vicenzino, B. (2008). Tape that increases medial longitudinal arch height also reduces leg muscle activity: a preliminary study. Medicine and science in sports and exercise, 40(4), 593–600. https://doi.org/10.1249/MSS.0b013e318162134f

3. Lange, B., Chipchase, L., & Evans, A. (2004). The effect of low-Dye taping on plantar pressures, during gait, in subjects with navicular drop exceeding 10 mm. The Journal of orthopaedic and sports physical therapy, 34(4), 201–209. https://doi.org/10.2519/jospt.2004.34.4.201

4. Guner, S., & Alsancak, S. (2020). Kinesiotaping Techniques to Alter Static Load in Patients With Foot Pronation. Journal of chiropractic medicine, 19(3), 175–180. https://doi.org/10.1016/j.jcm.2019.12.004

In the United States, falls and fall-related injuries occur frequently [1]. Among the population aged 65 years and older, about 25% of people experience a fall annually [1]. While these falls do not always result in serious injury or fatality, they are still incredibly costly and risky overall [1]. Each year, falls and related injuries account for at least $50 billion in medical costs, 2.8 million visits to emergency departments, and 27,000 deaths [1]. Falls are also a major contributor to hospital readmission rate [2]. Considering that fewer than 25% of fall-related injuries are accurately reported, these numbers are likely an underestimate [3]. Accordingly, it is essential to know the risk factors associated with fall injuries, as well as the ideal prevention techniques necessary to reduce the ubiquity of this occurrence, especially among older adults.

The risk factors for fall injuries are manifold. They include environmental factors, such as uneven floors, missing hand-rails, and poor lighting [4]. Chronic conditions that affect mobility and/or cognition, such as Parkinson’s Disease, stroke, diabetes, and arthritis, can increase an older adult’s likelihood experiencing a fall and subsequent injuries [5]. Additionally, acute illnesses like pneumonia and urinary tract infections augment the likelihood that a person will fall [5]. Physiologically, visual and hearing impairments, sarcopenia, low body mass index, and postural hypertension can also heighten the risk of falling among older adults [5].

Over recent years, further research has revealed more unintuitive risk factors. For instance, Lohman, Fairchild, and Merchant identified a possible association between antidepressant medication use and falls and fall injuries [1]. In their study of 3,565 community-dwelling older adults (aged 65 years or older), antidepressant medication accounted for about 19% and 18% of the association between major depressive disorder and falls and fall injuries respectively [1]. Other psychoactive medications have also been associated with greater fall risk [5].

Fall prevention is an essential element in the care of older adults, particularly those with several risk factors. However, it can be difficult to successfully navigate, with patients, payers, providers, and the overall health care system often impairing the quality of care available to older adults. Furthermore, strategies that appear as though they would be beneficial can fail to reduce fall rates. One such example is multifactorial interventions, such as the one studied by Bhasin in 2020 [6]. Despite providing patients with individualized plans and risk assessments, all administered by specialized nurses, the rate of fall injury did not diminish compared to standard care [6].

This is not to say that all multi-pronged approaches are unsuccessful: Kruschke and Butcher recommended an evidence-based ten-step protocol including fall, gait, and balance screening [4]. Unfortunately, those experimenters did not provide data on the success of their protocol [4]. However, other studies indicate that some multifactorial intervention programs can reduce the rate at which older adults fall [5]. Along with incorporating various screenings and risk factor-specific guidelines, medical practitioners should also advise their patients to regularly engage in physical activities, such as Tai Chi [5]. As seen with antidepressants, doctors should prescribe psychoactive medications with potential effects on fall risk in mind.

Because of the multitude of factors that can influence patients’ likelihood of falling, fall prevention is difficult to navigate. Regardless, analyzing risk factors, adjusting medications, screening appropriately, and promoting regular exercise can help reduce fall risk and rate.

References 

[1] M. C. Lohman, A. J. Fairchild, and A. T. Merchant, “Antidepressant Use Partially Mediates the Association Between Depression and Risk of Falls and Fall Injuries Among Older Adults,” The Journals of Gerontology: Series A, vol. 76, no. 9, p. e171-e178, October 2020. [Online]. Available: https://doi.org/10.1093/gerona/glaa253.  

[2] G. J. Hoffman et al., “Posthospital Fall Injuries and 30-Day Readmissions in Adults 65 Years and Older,” JAMA Network Open, vol. 2, no. 5, p. 1-12, May 2019. [Online]. Available: https://doi.org/10.1001/jamanetworkopen.2019.4276. 

[3] G. J. Hoffman et al., “Underreporting of Fall Injuries of Older Adults: Implications for Wellness Visit Fall Risk Screening,” Journal of the American Geriatrics Society, vol. 66, no. 6, p. 1195-1200, April 2018. [Online]. Available: https://doi.org/10.1111/jgs.15360. 

[4] C. Kruschke and H. K. Butcher, “Evidence-Based Practice Guideline: Fall Prevention for Older Adults,” Journal of Gerontological Nursing, vol. 43, no. 11, p. 15-21, October 2017. [Online]. Available: https://doi.org/10.3928/00989134-20171016-01. 

[5] R. E. Taylor-Piliae and R. Peterson, “Clinical and Community Strategies to Prevent Falls and Fall-Related Injuries Among Community-Dwelling Older Adults,” Nursing Clinics, vol. 52, no. 3, p. 489-497, September 2017. [Online]. Available: https://doi.org/10.1016/j.cnur.2017.04.004. 

[6] S. Bhasin, “A Randomized Trial of a Multifactorial Strategy to Prevent Serious Fall Injuries,” The New England Journal of Medicine, vol. 383, p. 129-140, July 2020. [Online]. Available: https://doi.org/10.1093/gerona/glaa253.  

Iron is a metallic element that participates in chemical reactions important for biological processes. The physiological role of iron is as a component of heme and in other protein functional groups (Dev and Babitt, 2017). It is generally found in two different ionic forms: Fe²⁺, the reduced form and Fe³⁺, the oxidized form (Dev and Babitt, 2017). In excess, iron in the Fe²⁺ form can lead to the production of toxic free radicals that can damage cell structures; it is thus highly regulated in the body (Vogt et al, 2021).

Iron is brought into the body through the diet. The estimated average requirement for iron intake is 5 to 11.4 mg/day (Lim et al, 2013). Meat, seafood, legumes and fortified cereals are all significant dietary sources of iron (Lim et al, 2013). Although plant-derived foods contain slightly more iron on average than animal-derived foods, iron from heme in animal tissues is more bioavailable — more able to be absorbed and requiring less energy to be useful in its physiological role (Lim et al, 2013). Phytates (a form of phosphate storage in seeds and grains) and polyphenols (antioxidants found in tea and coffee) reduce the bioavailability of iron. Vitamin C, on the other hand, increases bioavailability (Lim et al, 2013).

In the digestive tract, iron is taken up by the cells of the duodenum. It must be in the Fe²⁺ form for this to happen, so iron that is in the Fe³⁺ form is converted by the cytochrome DCYTB (Vogt et al, 2021). Fe²⁺ ions enter duodenal cells through the transport protein DMT1. The iron can then be sent to the bloodstream by the transport protein ferroportin on the other side of the cell. It is immediately converted back to Fe³⁺ by the proteins ceruloplasmin and hephaestin and binds to transferrin, a carrier protein in the bloodstream (Vogt et al, 2021).

The most common physiological role of iron in the body is for hemoglobin in red blood cells, also known as erythrocytes (Vogt et al, 2021). Erythroid precursor cells have transferrin receptor 1. When transferrin binds to the receptor, the complex is internalized by the cell. The Fe³⁺ that was bound to the transferrin is released and is turned back into Fe²⁺ by protein STEAP3. The iron is finally available to be incorporated into heme (Vogt et al, 2021). A similar process occurs in the muscle cells for the production of myoglobin, which allows muscles to maintain their own small stores of oxygen. Cells can also store iron that they intake with the intracellular protein ferritin. Cells are able to regulate their iron storage through how many ferritin proteins and transferrin receptors they make (Vogt et al, 2021).

Systemically, iron levels are regulated by the liver. The liver produces the hormone hepcidin, which causes ferroportin to be destroyed. Doing this prevents excess iron from entering circulation (Dev and Babitt, 2017). Additionally, immune system macrophages contribute to iron regulation by recycling iron stores. Once the macrophages have cleaned up an old or damaged red blood cell, they can remove the iron from the hemoglobin and use ferroportin to transport it back into the bloodstream (Dev and Babitt, 2017).

Problems with iron homeostasis can lead to health complications. One example is anemia, which is a problem with red blood cells’ ability to carry oxygen. Iron deficiency anemia can occur when there is not enough dietary iron available; excessive iron loss, such as bleeding or chronic kidney disease; genetic issues with any of the proteins mentioned previously; or chronic immune conditions that cause an overproduction of hepcidin (Dev and Babitt, 2017). On the other hand, iron overload can cause highly reactive forms of iron to be taken up by organs such as the heart, liver and endocrine tissues and cause lasting damage and dysfunction (Dev and Babitt, 2017).

References

Dev S, Babitt JL. Overview of iron metabolism in health and disease. Hemodial Int. 2017;21 Suppl 1(Suppl 1):S6-S20. doi:10.1111/hdi.12542

Lim KH, Riddell LJ, Nowson CA, Booth AO, Szymlek-Gay EA. Iron and zinc nutrition in the economically-developed world: a review. Nutrients. 2013;5(8):3184-3211. Published 2013 Aug 13. doi:10.3390/nu5083184

Vogt AS, Arsiwala T, Mohsen M, Vogel M, Manolova V, Bachmann MF. On Iron Metabolism and Its Regulation. Int J Mol Sci. 2021;22(9):4591. Published 2021 Apr 27. doi:10.3390/ijms22094591

Omega-3 fatty acids are unsaturated fatty acids found in foods such as fish and flaxseed and in dietary supplements such as fish oil.[i] They are an essential nutrient, meaning that the body cannot synthesize them naturally but must derive them from food.[ii] Omega-3 fatty acids play an important role in many physiological functions, including joint health.

The three main omega-3 fatty acids are alpha-linolenic acid (ALA), eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA); while EPA and DHA can be synthesized from ALA, the conversion efficiency is low and thus all three are considered “essential.”[iii] Omega-3 fats are involved in several important cellular processes, including the production of hormones that regulate blood clotting and inflammation and the formation of cell membranes.²      

Omega-3 fatty acids have long been highlighted by the American Heart Association for their ability to reduce the incidence of cardiovascular events like heart attack and stroke.[iv] They are also integral for the function of the nervous system and the retina.[v] Many of these health benefits first came to light in the 1980s, when studies showed that the Greenland Inuit, whose diets are rich in seafood, have a dramatically lower incidence of cardiac and other health disorders than Western Europeans.[vi]

Additionally, omega-3 fatty acids have been shown to be an effective addition to boost joint health in treatment regimens for musculoskeletal disorders, particularly rheumatoid arthritis (RA). This is primarily due to the anti-inflammatory action of omega-3 fatty acids. RA occurs when the immune system attacks healthy cells in the joints, causing pain and inflammation.[vii] Many studies have used fish oil to demonstrate the anti-inflammatory effects of omega-3 fatty acids. For example, Espersen et al. showed that the blood plasma level of interleukin-1 beta, an inflammatory cytokine, decreases after fish oil consumption.[viii] Other mechanisms of action for the anti-inflammatory properties of omega-3 fatty acids may include the inhibition of T-cell proliferation and the reduction of antigen presentation.[ix]

A 2013 study published in the British Journal of Clinical Pharmacology argues convincingly for anti-inflammatory effects of omega-3 fatty acids. The paper[x] touches on the effect omega-3 fatty acids have on the chemotaxis, or movement, of white blood cells, which contribute to the development of arthritis when they attack the lining of the joint capsule.[xi] White blood cells are attracted to inflammatory sites by “chemo-attractants” such as the chemical LTB4.¹⁰ The author cites several studies which support the notion that fish oil supplements, and ultimately, the omega-3 fatty acids they contain, can restrict the chemotaxis of white blood cells toward chemoattractants. The mechanism of action has not yet been deduced, but the paper hypothesizes that it may involve the antagonism of receptors for chemo-attractants. The review also discusses the amount of omega-3 fatty acids needed to elicit their anti-inflammatory effects. It notes that typical consumption of “marine” omega-3 fatty acids (those coming from fish or seafood) is in the tens or low hundreds of milligrams per day.[xii] However, as Calder points out, multiple studies show that much larger amounts of omega-3 fatty acids are needed to reduce inflammation in those with chronic conditions: a study of rheumatoid arthritis showed 3.5g of EPA to be necessary to significantly reduce inflammation.[xiii] The review therefore suggests that those with inflammatory conditions take omega-3 supplements that far surpass what one would receive from a natural diet.

References

[i] “Office of Dietary Supplements – Omega-3 Fatty Acids.” NIH Office of Dietary Supplements, U.S. Department of Health and Human Services, 4 Aug. 2021, ods.od.nih.gov/factsheets/Omega3FattyAcids-Consumer/.

[ii] “Omega-3 Fatty Acids: An Essential Contribution.” The Nutrition Source, Harvard T.H. Chan School of Public Health, 22 May 2019, www.hsph.harvard.edu/nutritionsource/what-should-you-eat/fats-and-cholesterol/types-of-fat/omega-3-fats/.

[iii] “Essential Fatty Acids.” Linus Pauling Institute, Oregon State University, 1 Jan. 2021, lpi.oregonstate.edu/mic/other-nutrients/essential-fatty-acids.

[iv] “Fish and Omega-3 Fatty Acids.” www.heart.org, American Heart Association, www.heart.org/en/healthy-living/healthy-eating/eat-smart/fats/fish-and-omega-3-fatty-acids.

[v] Querques, G., et al. “Retina and Omega-3.” Journal of Nutrition and Metabolism, vol. 2011, 2011, pp. 1–12., doi:10.1155/2011/748361.

[vi] Kromann, N., and A. Green. “Epidemiological Studies in The Upernavik District, Greenland.” Acta Medica Scandinavica, vol. 208, no. 1-6, 2009, pp. 401–406., doi:10.1111/j.0954-6820.1980.tb01221.x.

[vii] “Rheumatoid Arthritis (Ra).” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 27 July 2020, www.cdc.gov/arthritis/basics/rheumatoid-arthritis.html.

[viii] Espersen, G. T., et al. “Decreased Interleukin-1 Beta Levels in Plasma from Rheumatoid Arthritis Patients after Dietary Supplementation with n-3 Polyunsaturated Fatty Acids.” Clinical Rheumatology, vol. 11, no. 3, 1992, pp. 393–395., doi:10.1007/bf02207200.

[ix] Kostoglou-Athanassiou, I., et al. “The Effect of Omega-3 Fatty Acids On Rheumatoid Arthritis.” Mediterranean Journal of Rheumatology, vol. 31, no. 2, 2020, p. 190., doi:10.31138/mjr.31.2.190.

[x] Calder, P. C. “Omega-3 Polyunsaturated Fatty Acids and Inflammatory Processes: Nutrition or Pharmacology?” British Journal of Clinical Pharmacology, vol. 75, no. 3, 2013, pp. 645–662., doi:10.1111/j.1365-2125.2012.04374.x.

[xi] “Arthritis.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 19 July 2019, www.mayoclinic.org/diseases-conditions/arthritis/symptoms-causes/syc-20350772.

[xii] Meyer, B. J., et al. “Dietary Intakes and Food Sources of Omega-6 and Omega-3 Polyunsaturated Fatty Acids.” Lipids, vol. 38, no. 4, 2003, pp. 391–398., doi:10.1007/s11745-003-1074-0.

[xiii] Calder, P. C. “Session 3: JOINT Nutrition Society and IRISH Nutrition and Dietetic Institute Symposium ON ‘Nutrition and Autoimmune Disease’ Pufa, Inflammatory Processes and Rheumatoid Arthritis.” Proceedings of the Nutrition Society, vol. 67, no. 4, 2008, pp. 409–418., doi:10.1017/s0029665108008690.