Should you treat your aching back with a crack?

(CNN)Spinal manipulation might make a small difference in your lower-back pain, but it’s unlikely to have you doing backflips right away, according to an analysis published today in the Journal of the American Medical Association.

The research, which pooled 26 prior studies, found that spinal manipulation was linked to “modest improvements” in pain and function among people with short-term lower-back pain. Their pain improved an average of one point on a 10-point scale.
“For acute back pain, this is usually not considered a clinically meaningful improvement,” said Dr. Wolf Mehling, who practices at the Osher Center for Integrative Medicine at the University of California, San Francisco. Mehling was not involved in the JAMA study.
    The analysis did not include people with chronic low back pain, which lasts much longer. A 2011 Cochrane review failed to find good evidence that spinal manipulation was any better or worse than other treatments for chronic low back pain.
    Mehling is one of two doctors he knows at UCSF who practice spinal manipulation and other chiropractic therapies. He said the new study lumps together many people who may have differing causes for their back pain.
    For this reason, a lackluster average drop in pain may actually hide people who do see a noticeable benefit.
    “It’s not like everybody gets exactly a one-point benefit,” said Dr. Paul Shekelle, one of the authors of the study and a physician at the VA Medical Center in West Los Angeles. “Some people get zero, but some people get a lot more.”
    Previous research has suggested that some people are more likely to benefit from spinal manipulation than others: for example, those whose symptoms last fewer than 16 days, who have no pain below the knee and who are willing to remain active.
    Mehling, who trained in both Germany and the United States, said that most American doctors do not receive training in spinal manipulation, nor do they know how to test whether a patient might be a good candidate. Often, those who practice the technique may be chiropractors or physical therapists.
    “Physicians in the US are not trained to put their hands on patients,” he said. “In Germany, spinal manipulation … is part of normal care.”

    Pills and motions

    “We’re trying to take joints in your spine that have become too stiff and give them back their normal motion again,” said William Lauretti, a spokesman for the American Chiropractic Association and an associate professor at New York Chiropractic College.
    Lauretti, who did not participate in the study, said spinal manipulation can take different forms, but the most common involves someone lying on their side on a low bench while a chiropractor twists and moves each spinal joint through its normal range of motion.
    “There are people who respond very, very well to this,” he said.
    But some experts say that a sample of patients with acute low back pain is inherently skewed.
    “We know that the vast majority of these patients will spontaneously get better whether or not we do anything,” said Dr. Raj Rao, a spine specialist who has served on the American Academy of Orthopaedic Surgeons’ board of directors. Rao was not involved in the new analysis.
    Two of the studies in the analysis compared spinal manipulation to a fake, placebo version of the therapy, while additional studies compared it to other treatments. But Rao said that, because spinal manipulation is practiced in different ways by many types of practitioners — physical therapists, chiropractors and doctors included — it can be hard to standardize how the research is conducted.
    Experts say there is a need for well-designed studies that can prove or disprove the benefits of spinal manipulation and whom it is most likely to help. In their analysis, Shekelle and his co-authors rated the quality of each study they included; over half were classified as “low quality.”
    “It makes me a little cautious about my interpretation of any results of the study,” Rao said.

    No magic bullet

    “There’s no magic bullet out there, on average,” said Shekelle, the study author.
    About four out of five people will have lower-back pain at some point, according to the National Institute of Neurological Disorders and Stroke, making it a leading cause of missed work and disability.
    “Spinal manipulation is one of those therapies that on average has a small effect, and it’s in your doctor’s bag of things you can pull out and try,” Shekelle said.
    By coincidence, Shekelle found that the effect of spinal manipulation was about the same as anti-inflammatory drugs, such as Tylenol and Advil, according to a 2008 Cochrane review.
    “All of this manipulation didn’t change things that much but certainly adds to the cost of care,” Rao said.
    A first visit with a chiropractor, which typically includes an evaluation, may run between $75 and $200 depending on location and other factors, the ACA’s Lauretti estimated. Followup visits may cost between $30 and $70. He said many insurance plans cover some sort of chiropractic treatment, but policies and co-payments can vary.
    Over-the-counter pills, on the other hand, are cheaper and widely available, but come with potential side effects like stomach ulcers, Lauretti said. But side effects are more likely at high doses and over long periods, according to experts.
    On the other hand, no “serious” harms were reported in the low back pain studies that were analyzed, but minor aches and pains were plenty. About half to two-thirds of patients treated with spinal manipulation had temporarily increased pain, muscle stiffness and headache.
    Lauretti said, “This is similar to what you might get if you did a workout for the first time.”

    Back pain: Now what?

    So what to do about short-term back pain? Shekelle said that if something is safe and has worked for patients in the past, he doesn’t mess with a good thing.
    He may ask his patients to start by applying heat and trying over-the-counter meds and said he generally follows the advice of the American College of Physicians.
    In February, that group published its own recommendations for treating low back pain, suggesting starting with noninvasive remedies like superficial heat, massage, acupuncture or spinal manipulation. They also listed NSAIDs and muscle relaxants, if people prefer to take medicines.
    “Physicians should avoid prescribing unnecessary tests and costly and potentially harmful drugs, especially narcotics, for these patients,” Dr. Nitin Damle, the organization’s president, said in a statement.
    The group’s review said that spinal manipulation was backed by “low-quality evidence,” as well. Although the technique appeared to slightly improve function for short periods, there wasn’t enough evidence to say that it had any impact on the back pain itself.
    No matter which path people take, Shekelle said several things are key: reassurance that “the sky is not falling,” that most patients get better no matter what and that it is important to remain active.

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    “When I first started out 30 years ago, we put everybody to bed for a week and told them to rest their back. It turns out we were probably causing more harm than good,” Shekelle said, adding that the Department of Veterans Affairs, which requested the study, has integrated chiropractic care for years.
    Rao said that anecdotally, some patients do well with chiropractic therapies, which may be appropriate for short-term pain.
    “If you go to a chiropractor (one or two times) and it makes a difference, I’m all for it,” he said. “What I think I’m a little bit more cautious about … is prolonged chiropractic care.
    “When any of us is in pain,” he added, “we’re willing to do almost anything to get relief.”

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    Missing hiker, dog detected safe in California woods

    A woman and her dog were found dehydrated but alive by searchers Saturday, two days after they disappeared while hiking in Northern California.

    Bethnee Haury, 56, had stumbled into a deep ravine while hiking with her Australian shepherd, Camaro, near the community of Kings Mountain, the San Mateo County Sheriff’s Office told.

    Haury’s family told KTVU that the woman suffers from dementia and is dependent on insulin. Haury was airlifted to a hospital to be treated for dehydration and minor injuries after she had constructed her route into a canyon, which had about a 200 -foot drop. Searchers observed her about 600 yards from a road.

    “There were so many things that could have gone wrong, you know, the weather, her health, the terrain, ” San Mateo County Sheriff’s Detective Salvador Zuno. “There were so many things that could have gone wrong but they didn’t.”

    Haury was visiting a bed and breakfast in Woodside with her husband and son when she went on a hike in the timbers with the dog Thursday afternoon. Her husband reported her missing that evening when she did not return.

    In all, Zuno said that a team of 230 rescuers from 13 bureaux looked for Haury.

    “That( number) does not include search puppies, ponies, off-road vehicles, the sheriff’s air squadron or the Cal Fire helicopter that also participated, ” he said.

    The Associated Press contributed to this report .

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    Everything You Suppose You Knew About Curry Is Likely Wrong

    If you’re a curry fan, you may have noticed the word “curry” refers to a great many ranges of foodstuffs. It can get very confusing.

    There are curry foliages. Then there’s curry, the famous spice. And then curry is also the general name of a type of stewed dish.

    So before you enjoy another bowl of Thai curry soup or use another teaspoon of curry powder, it’s time you know what’s what when it comes to all things curry. We’re going to start with the basics: the leaves.

    What are curry foliages?

    bdspn via Getty Images A bunch of fresh curry leaves from the curry leaf tree.

    Curry leaves are an herb cultivated from the curry foliage tree( Murraya koenigii) and are largely used in South Indian cuisine. Do not confuse them with curry powder, which is a mixture of ground spices that may or may not contain ground curry leaves. And do not confuse the curry leaf tree with the curry plant.( The curry plant might induce you think of curry, but it is in fact not edible .)

    Curry leaves belong to the citrus fruit family. The foliages are glossy green and have a very powerful fragrance. There’s a citrus quality to them, naturally, but also something else that’s both bitter and sweet. There are many ways to cook with curry leaves, but they are often used in a similar fashion to bay foliages — though they’re often first fried in oil to release their flavor.

    You can find curry leaves at Indian and Asian food markets. Fresh leaves can be stored in the freezer, too. Just know: once “youre starting” cooking with curry foliages, you’ll never look back. And they are not a substitute for curry powder. Which leaves us with another question…

    What is curry powder?

    vikif via Getty Images A bright yellow heap of curry powder.

    Curry powder can be a lot of different things. Actually, that’s exactly what it is: curry powder is a combination of a bunch of spices. A quick search for curry powder will result in pages of recipes for how to build your own. It can range from five ingredients to more than 10, and it can include spices such as: cumin, coriander, turmeric, ginger, dry mustard, fenugreek and black pepper.

    The idea of ” curry powder” is a British one.( It resembles the North Indian spice mix garam masala, but it isn’t a spice mixture most Indian cooks would recognize .) British manufacturers came up with curry powder in an attempt to create a ready-made flavor that could recreate the flavors of South India that British colonists came to love.

    In fact, the word curry for Indian cook is also British in origin — they lumped all the savory, spiced Indian dishes into one category called curries. You can’t go to India and order a curry — it merely doesn’t exist. The British term curry was likely derived from the word Kari, which is the word for sauce in Tamil, a South Indian speech.

    So, what are “curries?”

    Curries are what happened when the Brits devised the word and introduced it to the rest of the world. It was first used to refer to a meat or vegetable dish cooked in a spiced gravy and served with rice. As an expression of the results of trade this dish was introduced to the rest of the world and each country that adopted it made it their own.

    In Japan, a curry is often a mild, sweet dish of meat, vegetables and gravy served with rice. In Thailand, curry has incorporated many of the nation’s regional ingredients — such as fiery chiles and coconut milk — and it is more soup-like. In Jamaica, they’re most well known for their goat curry that uses allspice and pimento. And in India, curries don’t exist.( But if you were to order a Malai Kofta, Matar Paneer, or Dum Aloo, you’d get what you probably think of as a curry .)

    This Is What A Happy Meal Looks Like Six Years After It Was Bought

    McDonald’s Happy Meals- a staple part of many a childhood treat and many an adult hangover when bite sized snacks are all your stomach can manage .

    Plus the little toy is a welcome distraction from how rough “youre feeling”, right?

    But after ensure just how … intact a Happy Meal appear a whopping SIX years after it was bought might put you off ever feeing one again? One woman, Jennifer Lovdahl- who frankly has a strange, yet innovative, savour in experimentations- decided to leave a Happy Meal in her office for six years to prove to her patients just how unhealthy the little box of wonder is…

    Jennifer who runs a Chiropractic clinic in Anchorage, Alaska, posted the photo on Facebook saying 😛 TAGEND

    “It’s been 6 years since I bought this “Happy Meal” at McDonald’s. It’s been sitting at our office this whole time and has not rotted, molded, or decomposed at all !!! It reeks only of cardboard. We did this experiment to reveal our patients how unhealthy this “food” is.”

    I mean, she has kind of got a point.

    Has this put you off McNuggets for life? Or has it just made you strangely hungry ?

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    10 Style To Trick People Into Thinking You’re Not The Slob You Truly Are

    Getting in shape is hard. It’s time devouring. It’s uncomfortable. You sweat. It’s, like, a whole thing.

    And like you, I don’t feel like doing it. My schedule is very inundated between bingeing on “Top Chef, ” profoundly investigating my hairline and thinking about starting a blog.

    Unfortunately, there is a widely spread andpopular opinion that, as humen, we should always be striving to better ourselves, and one thing we can do to live longer and happier lives is get in shape.

    But Jamie, this runs exactly against what we just “was talkin about a”, ” you might tell. “And I don’t wishes to. And I might start a blog soon.

    I know. Fear not. I’ve put together a list of tips-off and tricks that make it looklike you’re get into shape, when truly, you don’t have to change a damn thing about your awesome, perfect, lazy routine.

    1. Sports bra+ pony tale+ sneakers= instant SoulCycle instructor.

    Dressing the part of someone who is in shape is literally 90 percent of being shape. The other 10 percent is side planks from what we can tell.

    2. Get a spray tan.

    Contouring your newborn rolls builds them go from flab to fab-ish.

    Everyone knows pale, pasty wintertime scalp is a super common for someone who doesn’t work on themselves. Tan pudge is like the cool, older sister to pale pudge.It wears lots of eye shadow and smokes cigarettes by the motorcycle rack, if you know what we’re saying.

    Plus, it’s like, if no one is there to see you do the crunches, then did the crunches evenexist?

    3. Carry around a very expensive water bottle.

    No one buys expensive water bottles if they don’t have something to prove on the elliptical.Stocking up on cool, pricey gear sends out a message to everyone that you invest in your personal fitness journey.

    You wouldn’t expend $35 on a glass water bottle decked out with LED lighting, rearview mirrors and batteries included if you didn’t mean business on a stationary bike, am I right?

    4. Get a haircut.

    This maintains people guessing what’s different about you.Distract distract distract.

    If you are able to, get one of those infuriating haircuts that looks like maybe nothing happened to your head, but something definitely didhappen to your head. Then, when people ask what’s different about you, you are able to casually state that you’ve lost 15 pounds and gained half an inch of muscle around your biceps.

    They’llbe none the wiser.

    5. Leave supplements around your apartment.

    Having a giant bathtub of protein on top of your fridge can only mean one thing.

    Stocking up on and displaying fitness foods and supplements is a telltale symptom of a gym rat. If you want to be like a gym rat, you have to stagelike a gym rat.

    6. Whenever possible, run bananas into the conversation.

    Exclusive fitness tip: Bananas help the body avoid cramping. Drop that little truth bomb into a convo and watch people lose their minds.

    People LOVE fitness facts, and this one is particularly good because if they google it, it’s true. This constructs you the health whisperer of happy hour.

    7. Up your social media game. #bodygoals #fitness #ripped #lululemon

    Reshare, tag and post any and all images you insure considering health, fitness, the gym or yoga lots and lots of yoga.

    In fact, simply post pictures of people doing yoga in nature, and people will believe you fabricated the damn thing. It’s a natural phenomenon. We don’t know why it runs. It just does. #namaste #zen

    8. Fake an injury.

    Having a cast is a perfect reason to not show up to the gym.

    Use the guide below based on your personal fake sportspreferences to find your personal fake trauma 😛 TAGEND

    If you’re a fake tennis player or baseball player, your fake trauma is torn rotator cuff
    If you’re a fake football player, football player or basketball player, your fake trauma is torn achilles tendon
    If you’re a fake dancer or yogi, your fake injury is busted knee
    If you’re a fake runner, your fake trauma is shin splints
    If none of the above applies to your fake fitness activity of selection, just say you threw out your back and enjoy three months on your couch being left alone

    9. Wear a giant, oversized coat at all times.

    No one can argue you have a disgusting, unhealthy body if they can’t see your disgusting unhealthy body.

    10. Take a year to backpack around Europe.

    Give everyone some time to forget what you really look like.

    Once you’re back from a truly enlightening, life-changing experience, your inner spirit will glow so bright that the general public will be blinded looking at you and never recognize your totally normal, very average, just fine papa bod or mom butt. It’s what’s on the inside that counts .*

    * Unless you are a celebrity, politician or actual fitness teacher. In this case, we recommend eating right and regular exert, because candidly, you’re sort of eternally doomed to a life of judgment, inspection and outrageous criteria. Sorry.

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    Why John Kelly may be destined to recur history

    ( CNN) President Donald Trump, who is always looking for a quick fix, can only hope John Kelly, his new joint chiefs of staff, will be the magic bullet.

    But it won’t work. Kelly will find himself exceedingly frustrated, and there will be limits to the kind of “order” he will achieve. He is working for a chairperson who will continue to act in the same destructive way. Unless there is a wholesale purge, Trump will still be surrounded by some calculating and strong-headed figures like Steve Bannon, Kellyanne Conway, Sebastian Gorka, Jared Kushner and Anthony Scaramucci, who will not concede ground very easily.

    Kelly also faces a political environment that is even more difficult than before. Republican on Capitol Hill are angry and frustrated, while special advise Robert Mueller is conducting an investigation that could prove damaging. The trifecta of the Russian sanctions legislation, the defeat of health care and the backlash against the idea of removing Jeff Sessions as us attorney general suggests the Republican firewall on Capitol Hill is starting to weaken.