When Chris Drake, 39, first started having issues with his back in his late twenties, it sidelined his much-loved golf habit. Diagnosed with type 1 diabetes at the age of nine, Drake, an entrepreneur, had played golf competitively and continued to play multiple times a week, often with business clients. Although he was in good shape and controlled his diabetes fairly well, his back pain continued off and on. If he played a lot, it would flare up and he’d have to rest. But he never recovered to the point where he could swing a golf club properly and be confident it wouldn’t hurt his back.
“I know people with diabetes have a higher incidence of low back pain,” says Drake, who sees an endocrinologist every six months. “With type 1 diabetes, musculoskeletal issues are complications that are somewhat under-recorded because they’re not as well known as kidney damage, stroke or retinal eye issues. People with diabetes often have trouble with their hands and feet from the degeneration of the nerves, plus there are vascular issues. Their blood flow can become impeded over time, which makes it harder to heal because that flow is needed.”
His endocrinologist suggested seeing a chiropractor, and a neighbour recommended Dr. Alex Pessoa, a sports-focused chiropractor who runs Peak Performance Health Centre in Cambridge, Ont.
“Knowing that I wanted to continue golfing, Dr. Pessoa put me through an intensive exercise routine to strengthen my core to try to prevent a reoccurrence of injury,” says Drake. “He also had me getting into position with a golf club to show me what to modify to avoid strain on my lower back. It got me playing again.”
Drake recently moved from Kitchener to Santa Barbara, Calif., after his wife, Kelly, accepted a job there, so now he can golf year round. “When I play a lot, I make sure I’m hammering those exercises to keep my core strong and ready to play,” he says. “You’ve got to stick to it.”
Musculoskeletal (MSK) conditions such as back pain, limited joint mobility or neck and shoulder disorders can often prevent people living with diabetes from exercising. That lack of exercise, complicated by trouble with weight management, negatively impacts their ability to control blood sugar levels. While research is ongoing, it does show MSK conditions and diabetes are often interrelated.
With diabetes, there can be issues of nerve damage that affect patients’ walking and balance, explains Dr. Nadira Husein, an endocrinologist in Waterloo, Ont., who specializes in diabetes treatment and internal medicine. She says patients who have type 1 diabetes, which is an autoimmune disease, are also at risk of having other autoimmune MSK diseases such as rheumatoid arthritis.
“Diabetes is like a malignant disease,” says Dr. Husein. “Like cancer, it can hit you from head to toe. When there are mobility issues, it’s hard for patients to exercise. There are exercises available from the Canadian Diabetes Association that some patients can do. Obviously walking is good. You do what your body can do.”
Trina Fitter, a registered dietitian and diabetes educator at Groves Memorial Community Hospital in Fergus, Ont., regularly sees diabetes patients with mobility issues. Depending on their level of pain, she says the pain response and the hormonal response to it can make it harder to control blood sugars, so people may feel defeated because they see higher numbers even though they’re trying to exercise and watch what they eat. Additionally, the demands of managing a chronic disease can impact mental health, whether it’s mood, motivation or energy level. “What we can do is offer support and try to come up with an individualized plan of care to help them combat whatever their obstacles are,” Fitter says. “Helping them have better blood sugar control will lower their risk of diabetes complications.”
She says the biggest risk factors are related to lifestyle, so the goal is to keep people active and eating healthy because so many different diseases stem from their diabetes, whether cardiovascular or joint-related. “It’s a long haul for people to make a change in their ingrained habits,” she says. “We pick away at small changes and celebrate the successes. For some people, the goal may just be not gaining more weight.”
For patients with diabetes, Dr. Pessoa says the most common problems he sees are low back, foot and hip pain. Exercise depends on the patient’s degree of mobility, but he says people with diabetes seem to go downhill fast when you add obesity. Although his clinic specializes in athletes, he treats a lot of patients with diabetes referred to him by family doctors in his building.
“We have the same goals to increase their mobility and decrease their pain,” says Dr. Pessoa. “As long as the patient allows, we try to share information with the dietitian, medical doctor and other professionals caring for the patient. You need a team of people to manage diabetes.”
Debbie Hollahan, director of Waterloo Wellington Diabetes, a diabetes resource centre in Cambridge, Ont., agrees it takes a multidisciplinary team with good communication to manage the disease. While she says most diabetes education programs consist of a nurse and a dietitian, sometimes they include a social worker, a kinesiologist or chiropodist and, increasingly, a chiropractor.
“We don’t typically think of chiropractors when we’re caring for people with diabetes, but more and more we’re realizing that’s another group we need to pull into the circle of care,” Hollahan says. “They’re important because they’re seeing many patients with back pain and neuropathic pain that may be a result of diabetes. It’s another opportunity to link everyone together.”
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