Author Archives Mark Croucher

How old is your brain?

Posted by Mark Croucher
on March 20, 2016
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How old is your brain?

Neurobiology of Aging Home

Differences between chronological and brain age are related to education and self-reported physical activity  April 2016 Volume 40


My take away from this study is pretty straight forward. It appears that if we continue to exercise routinely and focus on continued learning, we may be doing our future selves a great bit of benefit with regard to our brain function.  


Conclusions: These results demonstrate that higher levels of education and daily FOSC (flights of stairs climbed) are related to larger brain volume than predicted by CA (chronological age) which supports the utility of regional gray matter volume as a biomarker of healthy brain aging.

This study investigated the relationship between education and physical activity and the difference between a physiological prediction of age and chronological age (CA). Cortical and subcortical gray matter regional volumes were calculated from 331 healthy adults (range: 19–79 years). Multivariate analyses identified a covariance pattern of brain volumes best predicting CA (R2 = 47%). Individual expression of this brain pattern served as a physiologic measure of brain age (BA). The difference between CA and BA was predicted by education and self-report measures of physical activity. Education and the daily number of flights of stairs climbed (FOSC) were the only 2 significant predictors of decreased BA. Effect sizes demonstrated that BA decreased by 0.95 years for each year of education and by 0.58 years for 1 additional FOSC daily. Effects of education and FOSC on regional brain volume were largely driven by temporal and subcortical volumes.

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Spinal Stenosis

Posted by Mark Croucher
on March 15, 2016
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A recent paper in Pain Medicine spoke to the management of lumbar spinal stenosis.  The authors conclude that the condition is common among older adults with chronic lower back pain and that management can be accomplished without surgery.  There are a number of problems that accompany lumbar spinal stenosis. These may include:

  • chronic back pain
  • leg pain
  • leg weakness
  • leg numbess
  • the need to sit all the time
  • the need to bend forward
  • difficulty walking through a grocery store without a cart
  • difficulty with standing
  • exercise is difficult due to leg fatigue and back pain

Lumbar spinal stenosis exists not uncommonly in older adults with CLBP and management often can be accomplished without surgery. Treatment should address all conditions in addition to LSS contributing to pain and disability 1.

I believe that treatment focus should be on addressing improvements in spinal function, leg strength and endurance, cardiovascular health and reducing back pain.  A comprehensive chiropractic approach deals with these issues head on.

At our office we use a number of therapeutic interventions to deal with this issue. One of the therapies we use is lumbar flexion distraction.  This is another method of manual therapy, where the patient is lying in a comfortable face down position with the lumbar spine flexed, like when you bend over a little. Manual pressure is slowly applied to the spine, stretching the vertebra apart.  This technique is used to restore damaged spinal nerves and surrounding structures by reducing the stricture of the spinal ligaments, increasing the movement of metabolites in discs, reducing the stress and internal pressure imposed on the posterior discs through the opening of the spinal facet joints, and expansion intervertebral foramens 2.

In our clinic we find that combining flexion distraction with instrument assisted manipulation, targeted spinal exercise and recumbent bike training to be a very effective approach.

1. Deconstructing Chronic Low Back Pain in the Older Adult-Step by Step Evidence and Expert-Based Recommendations for Evaluation and Treatment. Part VI: Lumbar Spinal Stenosis. Fritz JM, et al. Pain Med. 2016.
2. Computed tomographic investigation of the effect of traction on lumbar disc herniations.   Onel D, Tuzlaci M, Sari H, Demir K  Spine (Phila Pa 1976). 1989 Jan; 14(1):82-90.
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25 years

Posted by Mark Croucher
on March 4, 2016
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Chiropactic Conference chiro conference









25 years!

25 years has passed and I’m still the best of friends with my compatriots from chiropractic school.  We had a great time together again at the National Chiropractic Leadership Conference in Washington DC.  Every year we get together to participate with the American Chiropractic Association.  We lobby congress on issues like increased chiropractic care in the V A for active and retired military folks.  We attend numerous continuing education seminars.  And…we have a great time together at our Nation’s Capital!

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High Heels Hurt

Posted by Mark Croucher
on March 4, 2016
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High-heeled shoes in adolescents can lead to the development of postural disorders, among which stands out the forward head posture, lumbar hyperlordosis, pelvic anteversion, and knee valgus. The height and width of the heels are characteristics that exert most influence in the emergence of postural changes and body imbalance.

The research was conducted in the Scopus, SciELO and PubMed databases between 1980 and 2011, searching for articles written in English and Portuguese with the following key-words: “posture”, “center of gravity”, and “high-heeled shoes”. Among 55 retrieved articles, 20 were analyzed regarding posture of the spine and lower limbs, the center of gravity, and the effects of high-heeled shoes in the musculoskeletal system in adolescents.

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Okay…it’s a rat study but still.

Posted by Mark Croucher
on February 24, 2016
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Chronic post surgical pain – Neuropathy.

Possibly great news for patients who continue to suffer with post-opperative pain and/or what is called neuropathic pain.  With neuropathic pain, the nerve fibers in the area of pain may be damaged or injured. They simply function badly.  These damaged nerve fibers send incorrect signals to the brain.  A recent study in the Journal of Manipulative and Physiological Therapeutics demonstrated that repetitive instrument delivered spinal manipulation therapy had a substantial effect on the simulated neuropathic pain and postoperative pain and the therapy increased anti-inflammatory response in the subject!  Mind you…the study was on rats.  But the little guys felt better!

These findings show that spinal manipulation may activate the endogenous anti-inflammatory cytokine IL-10 in the spinal cord and thus has the potential to alleviate neuropathic and postoperative pain.

Seriously though…we see this type of result in practice with several different types of manual therapies.  There are unfortunately, not any long term studies on neuropathic pain in humans that demonstrate the positive results.  As we say in our line of work;  A lack of evidence in the literature, does not equate to a lack of effectiveness in practice.  More study is needed for sure.

Attenuation Effect of Spinal Manipulation on Neuropathic and Postoperative Pain Through Activating Endogenous Anti-Inflammatory Cytokine Interleukin 10 in Rat Spinal Cord.  January 2016

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Notes from Dr. Daniel Carlson

Posted by Mark Croucher
on February 24, 2016
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By Dr. Daniel Carlson



sneakersIt’s been known for several years that people who are aerobically fit have less mechanical back pain so as soon as our patients are able we remind them to resume their walking, biking or running program.


For those who haven’t been doing aerobic exercise we try to motivate them to start by pointing out that as little as a 30 minute session 5 days a week is associated with less heart disease, fewer strokes, reduced colon and breast cancer and better insulin sensitivity.  We determine their age-related target heart range and teach them to take their own pulse if necessary.


We may be able to add building more brain cells to the list of aerobic benefits.  An upcoming study to be published in the Journal of Physiology compared aerobic with high intensity interval and resistance training in laboratory rats.  The animals doing voluntary running had 2 to 3 times more hippocampal neurons at the end of the experiment than the other two groups.  This was observed after 6 to 8 weeks of exercise.


The hippocampus is a part of the brain associated with learning and the formation of new memories and is severely shrunken in Alzheimer’s disease patients.


Anyone concerned with this devastating disease (is there anyone who isn’t?) should be aware of this Alzheimer’s-hippocampus relationship and the impact that a minor amount of regular aerobic exercise has.

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What about PT for back pain

Posted by Mark Croucher
on February 22, 2016
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A recent study was published including of 4597 patients who underwent physical therapy for back pain. The findings showed that a significant percentage of patients did NOT improve to minimal clinical standards.  How Effective is Physical Therapy for Common Low Back Pain Diagnoses? A Multivariate Analysis of 4597 Patients.      Spine: February 15, 2016

Prior studies have also shown that spinal manipulation/mobilization (chiropractic care) showed significantly greater improvement than exercise therapy in patients with chronic low back pain. The effects were reflected on all outcome measures, both on short and long-term follow-up.  Manual Therapy and Exercise Therapy in Patients With Chronic Low Back Pain: A Randomized, Controlled Trial With 1-Year Follow-up Spine:  15 March 2003 – Volume 28 – Issue 6 – pp 525-531

Meanwhile a number of studies have indicated that chiropractic treatment combined with exercise can work better than either individually for treatment of chronic neck pain.


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Coffee for muscle recovery!

Posted by Mark Croucher
on February 21, 2016
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coffeeThe benefits of coffee on skeletal muscle

In our chiropractic clinic we focus on a number of things to help our patients live healthier lives.  Diet and nutrition are paramount issues with regard to health.  We’re often asked about coffee and if its good or bad for you.

Here is a fun study from Life Sciences.  From their description, this journal is an international journal publishing articles that emphasize the molecular, cellular, and functional basis of therapy. The journal emphasizes the understanding of mechanism that is relevant to all aspects of human disease and translation to patients. All articles are rigorously reviewed.

“Coffee is consumed worldwide with greater than a billion cups of coffee ingested every day. Epidemiological studies have revealed an association of coffee consumption with reduced incidence of a variety of chronic diseases as well as all-cause mortality. Current research has primarily focused on the effects of coffee or its components on various organ systems such as the cardiovascular system, with relatively little attention on skeletal muscle. Summary of current literature suggests that coffee has beneficial effects on skeletal muscle. Coffee has been shown to induce autophagy, improve insulin sensitivity, stimulate glucose uptake, slow the progression of sarcopenia, and promote the regeneration of injured muscle. Much more research is needed to reveal the full scope of benefits that coffee consumption may exert on skeletal muscle structure and function.”

So there you have it!  A little coffee may be a really good thing.

Life Sci. 2015 Dec 15;143:182-6. doi: 10.1016/j.lfs.2015.11.005. Epub 2015 Nov 10.

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The ankle bone is connected to the…

Posted by Mark Croucher
on February 16, 2016
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deep thoughtsPatients routinely ask us why we are evaluating the function of their hips, knees and ankles when they present to us with lower back problems.  The reason is they’re related and our job is to improve your function.  Evaluate the spine and then evaluate everything that may be related.  That way you can help the patient to heal.  I like to use the old kid’s song DRY BONES.

The toe bone connected to the heel bone,
The heel bone connected to the foot bone,
The foot bone connected to the leg bone,
The leg bone connected to the knee bone,
The knee bone connected to the thigh bone,
The thigh bone connected to the back bone,
The back bone connected to the neck bone,

Research on the lumbar spine has shown a relationship to wear down of the lower back spinal discs (degenerative disc disease) and areas of arthritis in the hip and knee.  A recent study in The American Journal of Orthopedics focused how degenerative damage in the lumbar spine (lower back) may be strongly related to ankle arthritis as well.

In this study there was found to be a considerable association of ankle arthritis and subsequent alteration in walking (gait) when patients had levels of lower back spinal disc damage (degeneration).  When there were multiple levels of disc degeneration there was found to be even higher odds of the development of severe ankle arthritis.

Furthermore, the presence of severe lumbar degeneration significantly predisposes individuals to the development of severe ankle arthritis.  Gait changes resulting from disc degeneration or neural compression in the lumbar spine may play a role in ankle osteoarthritis development. This association must be considered when treating patients with lumbar disc degeneration and leg pain.

In an effort to substantially and holistically address a patients problem we try to like to look at the bigger picture.  If pain relief is the only issue, there are a lot of drugs that work just fine.

Am J Orthop (Belle Mead NJ). 2015 Apr;44(4):E100-5.  Lumbar degenerative disc disease and tibiotalar joint arthritis: a 710-specimen postmortem study.

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Chiropractic in Williamsburg VA

Posted by Mark Croucher
on February 15, 2016
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considering  surgeryChronic back pain

Degenerative Disc Disease  

Sciatica – Spinal Stenosis  

Post-Surgical Back & Neck Pain

Does this sound like you?


Susan from Williamsburg says: “I have never had a Doctor as careful about listening to me and explaining the diagnosis and how to treat it, as Dr. Croucher.  He did not sugar-coat anything.  He was conservative in his outlook and delivered incremental, perceivable results.”

“My pain management doctor referred me to Dr. Carlson for lower back and right leg pain which was reduced immediately. He showed me a number of exercises to help build muscles and diet for weight control. Dr. Carlson is very knowledgeable and has a wonderful bedside manner that takes time to talk and listen to his patients.”  Tom Grummell, Newport News, VA (retired)

At The Spine Center of Williamsburg, our doctors of chiropractic have over 20 years’ experience in dealing with chronic spinal pain, spinal stenosis, disc herniation and degenerative spinal disorders.  With today’s technology, chiropractic treatment can be delivered in a number of comfortable ways without any of the “cracking and popping” that many people associate with chiropractic adjustments.  Combining these spinal treatments with the right spinal rehabilitative exercise can provide great success.  Our office participates fully with Medicare and many other insurance plans.  If you would like to see if our office has a solution for you, give us a call.

The Spine Center of Williamsburg

A Modern Chiropractic Practice






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