Archive for June, 2012

Neck pain is one of the most common complaints for which patients present to chiropractic offices. Headaches are also another very common problem and often go hand-in-hand with the presence of neck pain. So, the question that is frequently asked is, “…why do headaches and neck pain often travel together?”

There are many types of headaches, some of which we have discussed previously with migraine and tension-type headaches being the most common. This month, the focus is on how headaches and the neck are related to each other and what YOU can do about it.

The relationship between neck pain and headaches is strong! In fact, in some cases, headaches will occur ONLY when the neck hurts. One reason is because the first three nerves that exit out from the top of the cervical spine (C1, 2 and 3) have to travel through the thick group of muscles that insert onto the back/base of the skull along the occipital rim. Because we carry a lot of stress in the neck muscles, when they tighten up, they squeeze or pinch those 3 nerves and pain then radiates into the back of the head and sometimes up and over the vertex to the eyes or behind the eyes. If you take your fingers or thumb and push firmly into those muscles at the very top of the neck or base of the skull, it often feels, “…like a good hurt.” This is because they are usually tight since most of us carry our head too far forwards and the muscles have to contract and constantly work to keep the head from gliding even further.

So, what can YOU do about it? Let’s talk about a few GREAT posture retraining exercises. Tuck in your chin to the point where the voice changes pitch (your voice will start to sound “funny”). At that point, release the chin slightly so the voice clears and stay in position! That is the posture or head position of choice. Initially, it will be very difficult to remember to hold that position very long because your muscles (and brain) aren’t used to it and, you’ll slip back into the old forward head carriage habit or chin poke position. So, be patient with yourself because it takes about 3 months of constant self-reminding to, “…keep that chin tucked,” before this new “habit pattern” is formed in the brain.

Another great exercise is an “offshoot” of this, where you tuck the chin in as far as you can (making a double or triple chin) holding that position for 3 seconds, and then tip the head back as far as you can without releasing the chin tuck and hold for another 3 seconds. Repeat this 2-3x / “set” and perform this multiple times per day.

A 3rd great exercise for improving the forward head carriage posture is performed by lying on your back on a bed so that the edge of the bed is at the middle of the neck and head is dangling off the bed. Take a tightly rolled up towel (a hand size towel works well) and place it under the neck so that is resting on the edge of the bed so that your head can fall back towards the floor. Take some deep breaths and concentrate on relaxing all your neck muscles. Periodically, slowly rotate your head left to right, right to left, and “feel” the different muscles stretch as you do this. If you can afford 15 minutes, that’s PERFECT! But, if you only have a few minutes it’s still GREAT!

Between maintaining a chin tuck upright posture and retraining the curve in your neck with the head hang off the bed exercise, you’ll feel (and look) much better!

We realize that you have a choice in where you choose your healthcare services. If you, a friend or family member requires care for neck pain, we sincerely appreciate the trust and confidence shown by choosing our services and look forward in serving you and your family presently and, in the future.

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Fibromyalgia (FM) is a very common cause of chronic pain and fatigue. It’s plagued with the combination of not knowing what causes it (in many cases) and, the fact that very few treatments seem to work. Also, patients often relay information about a “bad experience” with a doctor who down plays the diagnosis or worse, outwardly denies that it even exists! This makes it all the more challenging for the patient who is simply just trying to find answers as to how to manage living with this condition.

Chiropractic offers the patient a “quarterback” or, someone who can coordinate care (when needed) from different health care providers, as well as offer the patient a very effect treatment option. In one study, chiropractic spinal manipulation was used in conjunction with ischemic compression with results measured by tracking pain, fatigue levels and sleep quality by the use of validated questionnaires completed by the patient. In this 24 FM patient trial (members were recruited from a regional Fibromyalgia Association group), the subjects had symptoms for >3 months, and a total of 30 treatment were performed. After the first 15 treatments, about 2/3rds of the subjects reported significant improvement (questionnaire score improvements of at least 50%) in the pain, fatigue and sleep quality! Even better, after 30 treatments, there was a 77% reduction in pain intensity, 64% improvement in sleep quality, and 75% reduction in fatigue level scores. Moreover, these improvements were maintained even a month after treatment ended. Also, they found that subjects with less than 35% improvement after 15 treatments did not have a satisfactory response after the 30 treatments. A trend (though not statistically significant) suggested that older subjects with more severe symptoms and chronic pain tended to do have a greater number of tender points, and responded more poorly to treatment. The conclusion reported this favorable response deserves a larger scaled study.

So, what you can expect when you arrive for treatment? The first “order of business” is to obtain your health history, paying particular attention to your specific treatment goals. This is also the time when we review your daily activities and quantify your activity tolerance so we can properly compare your current (baseline) level of function to future re-evaluations. Part of the assessment may include measuring your physical performance, although that entirely depends on your level of function at the time of the initial examination. Usually, after 2-3 treatments and after reviewing your response to the treatments, we will begin incorporating home-based exercises or if you’re already exercising, augment your current program. These exercises may include stretching, core stabilizing strengthening exercises, balance training, aerobic exercises, and others. Depending on your confidence with exercise and, of course, your goals, other forms of exercise may also be recommended such as yoga, Palates, water exercises, health club programs, and/or others. We may recommend various modalities such as electric stimulation, ultrasound, pulsed magnetic stimulation, low level laser therapy, class IV laser therapy, and/or others. A massage therapist may also be considered as part of your “management team.” Coordination of care with your primary care physician is also important. Nutritional counseling can also be highly effective and may include an anti-inflammatory diet such as a low gluten diet, and specific vitamin recommendations may include a multiple vitamin mineral, magnesium, calcium, omega 3 fatty acids, vitamin D, and/or CoQ10 (anti-oxidant). Most important is that we can facilitate as a “quarterback” with your other personal management strategies.

If you, a friend or family member requires care for FM, we sincerely appreciate the trust and confidence shown by choosing our services!

In many cases, Carpal Tunnel Syndrome (CTS) results strictly from overuse activities though, as we have discussed previously, other conditions such as hypothyroid, taking birth control pills, pregnancy, diabetes, obesity, certain types of arthritis, etc. can also be involved as a contributor and / or the sole cause. When these conditions are present, they must be properly treated to achieve a favorable result. However, the majority of cases are the result of a repetitive motion injury. So, the question remains: What is the role of the patient regarding activity modification during the treatment process of CTS? How important is it?

To answer this question, let’s look at a fairly common type of CTS case. In our hypothetical case, the patient is female, 52 years old, moderately obese (Body Mass Index 35 where the normal is 19-25), and works for a local cookie packing company. Her job is to stand on a line where cookies are traveling down a conveyor belt after being baked and cooled. She reaches forwards with both arms and grasps the cookies, sometimes several at a time, and places them into plastic packaging which are then wrapped and finally removed from the belt and placed into boxes located at the end of the line. Each worker rotates positions every 30 minutes. A problem can occur when other workers fall behind or when there aren’t enough workers on the line, at which time the speed required to complete the job increases.

So now, let’s discuss the “pathology” behind CTS. The cause of CTS is the pinching of the median nerve inside the carpal tunnel, located on the palm side of the wrist. The tunnel is made up of 2 rows of 4 carpal bones that form top of the tunnel while a ligament stretches across, making up the tunnel’s floor. There are 9 tendons that travel through the tunnel and “during rush hour” (or, when the worker is REALLY moving fast, trying to keep up with production), the friction created between the tendons, their sheaths (covering) and surrounding synovial lining (a lubricating membrane that covers the tendons sheaths), results in inflammation or swelling. When this happens, there just isn’t enough room inside the tunnel for the additional swelling and everything gets compressed. The inflamed contents inside the tunnel push the median nerve (that also travels through the tunnel) against the ligament and pinched nerve symptoms occur (numbness, tingling, and loss of the grip strength). The worker notices significant problems at night when her hands interrupt her sleep and she has to shake and flick her fingers to try to get them to “wake up.” She notices that only the index to the 3rd and thumb half of the 4th finger are numb, primarily on the palm side.

At this stage, the worker often waits to see if this is just a temporary problem that will go away on its own and if not, she’ll make an appointment for a consultation, often at her family doctor (since many patients don’t realize chiropractic treatments REALLY HELP this condition). In an “ideal world,” the primary care doctor first refers the patient to the chiropractor for non-surgical management. Other treatment elements include the use of a night wrist splint, ice massage over the tunnel, and possibly modality treatments such as low level laser therapy and (one of the MOST IMPORTANT) “ergonomic management.” That means work station modifications, which may include slowing down the line, the addition 1 or 2 workers, and reducing the reach requirement by adding a “rake” that pushes the cookies towards the worker/s. Strict home instructions to allow for proper rest and managing home repetitive tasks are also very important. Between all these approaches, chiropractic is HIGHLY SUCCESSFUL in managing the CTS patient, but it may require a workstation analysis.

We realize you have a choice in who you consider for your health care provision and we sincerely appreciate your trust in choosing our service for those needs. If you, a friend or family member require care for CTS, we would be honored to render our services.

Low back pain (LBP) can have many causes. The primary goal of the chiropractic physician is to identify the main pain generator(s) and manage the patient accordingly. This requires a careful history, examination, and often, a low back/pelvic x-ray. So, how does this work?

When first presenting for care, the patient tells us about their complaint in the history portion of our evaluation. Here, we not only ask about the main reason for their appointment or, what’s bothering them now but also their past history. We also discuss old injuries such as slips and falls, sports injuries that date back to high school, motor vehicle induced injuries, as well as family history (we ask if family members have or have had low back trouble since it’s been reported that there is a genetic link identified for osteoarthritis). We also inquire about the patient’s current activity level and how well those activates are tolerated, often using tools completed by the patient that can be scored and compared periodically during care to track the benefits of treatment. When we finally return to the primary complaint history, we ask about the location, mechanism of injury, notable changes in the course of the condition, the onset date, pain related activities that increase or decrease pain, the quality of pain, radiation patterns, severity levels (such as a 0-10 scale), and timing issues such as, worse in the mornings vs. evenings.

When patients say, “…I have low back pain,” they may point to anywhere between the lower rib cage and their hip area. In other words, everyone interprets where their low back is located differently. So, when differentiating between low back pain and hip pain, one would think that the patient would either point to their low back or their hip, right? Well, where does hip osteoarthritis usually hurt? That’s what makes it so hard! The pain location can vary and move around in the same patient anywhere in the pelvic region including the groin (which is common), to the side of the pelvis, to the buttocks, the sacrum and in the low back. To make it even more challenging, degenerative or injured disks in the lower lumbar spine can refer pain directly into the hip area and also create localized low back pain. In fact, patients often have BOTH conditions simultaneously! Usually, during examination, we move the hip in the socket and feel for reduced motion and watch for pain patterns in certain positions. When comparing the two sides, we both can feel, “…a difference between the two.” The osteoarthritic (OA) hip is comparably more tight and painful with rotation movements. For example, the patient is seated with their leg crossed, trying to touch their knee to their opposite shoulder. In the OA hip patient, they may only be able to get it half way there compared to the other side and often complain of groin pain. The “ultimate test” is the x-ray that reveals the loss of the joint space – the “cartilage interval” – which narrows on the OA hip side.

How often is hip OA found? In a recent article, after reviewing 2000 patient files and 1000 x-rays of patients 40 years or older, 19% (~1 out of 5) demonstrated x-ray findings of hip OA. THAT’S A LOT! Chiropractic management of hip OA includes mobilization, manipulation, stretching the muscles surrounding the hip joint, leg length correction (sometimes requiring heel lifts in the short leg shoe), foot orthotics if the ankles roll in too far as that causes the knees knock and hips move inwards (like a card table with the legs partially folded, making the table top – or pelvis unstable), PT modalities (like ultrasound or electric stim), exercise/stretch instruction, nutritional strategies and others. If/when the time comes, we will help set up a referral to the orthopedic surgeon for joint replacement, as any “quarterback” of your care should.

We realize you have a choice in who you choose to provide your healthcare services. If you, a friend or family member requires care for low back pain, we sincerely appreciate the trust and confidence shown by choosing our services and look forward in serving you and your family presently and, in the future.