Most likely, everyone reading this article has had a headache at one time or another. The American Headache Society reports that nearly 40% of the population suffers from episodic headaches each year while 3% have chronic tension-type headaches. The United States Department of Health and Human Services estimates that 29.5 million Americans experience migraines, but tension headaches are more common than migraines at a frequency of 5 to 1. Knowing the difference between the two is important, as the proper diagnosis can guide treatment in the right direction.
TENSION HEADACHES: These typically result in a steady ache and tightness located in the neck, particularly at the base of the skull, which can irritate the upper cervical nerve roots resulting in radiating pain and/or numbness into the head. At times, the pain can reach the eyes but often stops at the top of the head. Common triggers include stress, muscle strain, or anxiety.
MIGRAINE HEADACHES: Migraines are often much more intense, severe, and sometimes incapacitating. They usually remain on one side of the head and are associated with nausea and/or vomiting. An “aura”, or a pre-headache warning, often comes with symptoms such as a bright flashing light, ringing or noise in the ears, a visual floater, and more. For migraine headaches, there is often a strong family history, which indicates genetics may play a role in their origin.
There are many causes for headaches. Commonly, they include lack of sleep and/or stress and they can also result from a recent injury—such as a car accident, and/or a sports injury—especially when accompanied by a concussion.
Certain things can “trigger” a migraine including caffeine, chocolate, citrus fruits, cured meats, dehydration, depression, diet (skipping meals), dried fish, dried fruit, exercise (excessive), eyestrain, fatigue (extreme), food additives (nitrites, nitrates, MSG), lights (bright, flickering, glare), menstruation, some medications, noise, nuts, odors, onions, altered sleep, stress, watching TV, red wine/alcohol, weather, etc.
Posture is also a very important consideration. A forward head carriage is not only related to headaches, but also neck and back pain. We’ve previously pointed out that every inch (2.54 cm) the average 12 pound head (5.44 kg) shifts forwards adds an EXTRA ten pounds (4.5 kg) of load on the neck and upper back muscles to keep the head upright.
So, what can be done for people who suffer from headaches? First, research shows chiropractic care is highly effective for patients with both types of headaches. Spinal manipulation, deep tissue release techniques, and nutritional counseling are common approaches utilized by chiropractors. Patients are also advised to use some of these self-management strategies at home as part of their treatment plan: the use of ice, self-trigger point therapy, exercise (especially strengthening the deep neck flexors) and nutritional supplements.
Content Courtesy of Chiro-Trust.org.
All Rights Reserved
Many people seek chiropractic care when their back goes out or their neck tightens up. But how does this form of care actually work? What are the benefits of receiving chiropractic care for nerve dysfunction compared with other healthcare options? Let’s take a look!
First, let’s discuss how the nervous system “works.” We have three divisions of the nervous system: the central, peripheral, and autonomic nervous systems. The central nervous system (CNS) includes the brain and spinal cord, and it’s essentially the main processing portion of the nervous system. The spinal cord is like a multi-lane highway that brings information to the brain for processing (sensory division) and returns information back to the toes, feet, legs, and upper extremities from which the information originated (motor division). For example, hiking on a mountain trail or simply walking requires constant input to and from the CNS so we can adjust our balance accordingly and not fall. These “sensory-motor pathways” are essential and allow us to complete our daily tasks in an efficient, safe manner as information is constantly bouncing back and forth between the brain and the rest of the body.
The peripheral nervous system (PNS) includes a similar sensory/motor “two-way street” system relaying information back and forth from our toes/feet/legs and fingers/hands/arms to the spinal cord (CNS). And if this isn’t complicated enough, we also have “reflexes” that, for example, allow us to QUICKLY pull our hand away from a hot stove to minimize burning our fingers.
Reflexes allow the information to “skip” the brain’s processing part so quicker reactions can occur. The autonomic nervous system (ANS) includes the sympathetic and parasympathetic divisions that basically “run” our automatic (organ) functions like breathing, heart rate, digestion, hormonal output, and more. There is constant communication between the ANS, PNS, and CNS that allow us to function in a normal, balanced way… unless something disrupts them.
There are obvious conditions that interfere with this communication process that include (but are not limited to) diabetes (with neuropathy), frost bitten or burned fingers, peripheral nerve damage from conditions like carpal/cubital tunnel syndromes, thoracic outlet syndrome, and/or pinched nerves in the neck, mid-back, low-back spinal regions, as well as conditions such as multiple sclerosis (MS), Guillain-Barre Syndrome, after a stroke (spinal cord or brain), and after trauma with resulting fractures where nerve, spinal cord, and/or brain damage can occur. These are “obvious” reasons for delayed or blocked neurotransmission.
There are many other less obvious injuries or conditions that can result in faulty neuromotor patterns and nerve transmission of which chiropractic services can benefit. The “subluxation complex” is a term some chiropractors use to describe the compromised nerve transmission that may occur if a nerve is compressed or irritated due to faulty bone or joint position along the nerve’s course. Reducing such nerve compression typically allows for a restoration of function. A good illustration of this is a patient who suffers from a herniated disk in the neck with numbness and tingling down the arm to the hand. The goal of treatment (for all healthcare professionals) is to remove the pinch of the nerve.
To realize this goal, doctors of chiropractic utilize spinal manipulation and mobilization in addition to other non-surgical, non-drug approaches that may include exercises, nutritional advice, home-care such as a cervical traction unit, and other anti-inflammatory measures (ice, modalities like low level and class IV laser, electric stimulation, pulsed magnetic field, and more). Given the minimal side-effect risks and well-reported benefits, it only makes sense to try chiropractic FIRST and if you’re not satisfied, your doctor will help you find the next level of care.
Management of ankle inversion sprains requires two steps; each is equally important.
STEP 1—Move for Pain Relief
Early return to activity for acute inversion sprains is supported by the literature. Exercises and treatments that promote joint motion and early return to weight bearing for acute ankle sprains have proven more effective than immobilization. While grade III sprains (ligament rupture) may require immobilization, grade I and II ankle sprains should forego complete immobilization and instead focus on regaining full range of motion. In fact, early rehab and return to weight bearing will increase ankle range of motion, decrease pain, and reduce swelling sooner than immobilization.
In a study by Linde et al., 150 patients with inversion ankle sprains were treated with early motion and weight bearing. After one month, 90% of the patients treated with early motion and weight bearing demonstrated pain-free gait and 97% had increased work ability. (3) Early mobility exercises would typically include:
These four exercises promote balance and range of motion – specifically dorsiflexion, which is a key contributor to ankle injury. Patients who have lost an average of 11 degrees of dorsiflexion are five times more likely to suffer lateral ankle sprains. (4)
In office care should also include mobilization and manipulation for restoring function. Joint mobilization has been shown to decrease pain, increase dorsiflexion, and improve ankle function. (5) IASTM or transverse friction massage to the affected ligament may help mobilize scar tissue and increase pliability. Myofascial release may help release tightness or adhesions in the gastroc and soleus.
Knowing when to treat and when to refer is critical. Whitman’s clinical prediction rule identifies four variables to predict the success of manipulation and exercise for the treatment of inversion ankle sprains. (6) The presence of three out of four of the following variables predict greater than a 95% success rate for manual therapy and exercise:
STEP 2- Prevent Re-injury
The second step is shorter and easier than the first. The most crucial variable in the successful prevention of future ankle sprains is improving BALANCE. Balance training reduces the incidence of ankle sprains and increases dynamic neuromuscular control, postural sway, and joint position sense in athletes. (7) A study by de Vasconcelos et al. (2018) found that balance training reduced the incidence of ankle sprains by 38% compared with the control group. (7)
Two of the most common exercises used for balance and proprioception include the single-leg stance exercise and Veles. A simple explanation stressing the importance of balance training may be necessary to promote patient compliance.
Finally, we encourage our patients to start walking “normal” as soon as possible. As evidence-based chiropractors, we need to return patients back to their normal gait as soon as tolerable. Patients with foot and ankle pain will often favor a supinated gait in order to unload the soft tissues of the foot and arch in favor of their bony architecture on the lateral foot. The lateral column of the foot affords stability but at the expense of a very inefficient gait. Over an extended period, these patients may develop a Tailor’s bunion, i.e. 5th metatarsal head bursitis. However, in the case of ankle sprains, a rapid increase in activity may overload the metatarsal fast enough to cause a Jones Fracture. Return to normal gait will minimize these compensations.
Reprinted via permission from ChiroUp
A new review of more than 50 prior research studies concluded: “manipulation and mobilization are likely to reduce pain and improve function for patients with chronic low back pain. The researchers also found that “(Chiropractic) manipulation appears to produce a larger effect than (physical therapy) mobilization.”
We Provide Affordable, Short Term Care For The Relief Of Your Neck and Lower Back Pain.
Between 80% and 90% of the general population will experience an episode of lower back pain (LBP) at least once during their lives. When it affects the young to middle-aged, we often use the term “non-specific LBP” to describe the condition. The geriatric population suffers from the “aging effects” of the spine—things like degenerative joint disease, degenerative disk disease, and spinal stenosis. Fractures caused by osteoporosis can also result in back pain.
The “good news” is that there are rare times when your doctor must consider a serious cause of LBP. That’s why he or she will ask about or check the following during your initial consultation: 1) Have you had bowel or bladder control problems? (This is to make sure a patient doesn’t have “cauda equina syndrome”—a very severely pinched nerve.) 2) Take a patient’s temperature and ask about any recent urinary or respiratory tract infections to rule out spinal infections. 3) To rule out cancer, a doctor may ask about a family or personal history of cancer, recent unexplained weight loss, LBP that won’t go away with time, or sleep interruptions that are out of the ordinary. 4) To rule out fractures, a doctor may also take x-rays if a patient is over age 70 regardless of trauma due to osteoporosis, over age 50 with minor trauma, and at any age with major trauma.
Once a doctor of chiropractic can rule out the “dangerous” causes of LBP, the “KEY” form of treatment is giving reassurance that LBP is manageable and advise LBP sufferers of ALL ages (especially the elderly) to KEEP MOVING! Of course, the speed at which we move depends on many things—first is safety, but perhaps more importantly is to NOT BECOME AFRAID to do things! As we age, we gradually fall out of shape and end up blaming our age for the inability to do simple normal activities. Regardless of age, we must GRADUALLY increase our activities to avoid the trap of sedentary habits resulting in deconditioning followed “fear avoidant behavior!”
Here are a few “surprising” reasons your back may be “killing you”: 1) You’re feeling down – That’s right, having “the blues” and more serious mood disorders, like depression, can make it more difficult to cope with pain. Also, depression often reduces the drive to exercise, may disturb sleep, and can affect dietary decisions—all of which are LBP contributors. 2) Your phone – Poor posture caused by holding a phone between your bent head and shoulder (get a headset!) or prolonged mobile phone use can increase your risk for spinal pain. 3) Your feet hurt, which makes you walk with an altered gait pattern, forcing compensatory movements up the “kinetic chain” leading to LBP. 4) Core muscle weakness, especially if you add to that a “pendulous abdomen” from being overweight—this is a recipe for disaster for LBP. 5) Tight short muscles such as hamstrings, hip rotator muscles, and/or tight hip joint capsules are common problems that contribute to LBP. Stretching exercises can REALLY help!
Review the latest news: Manipulation for headaches and lateral elbow pain
KinesioTape for carpal tunnel syndrome
Epidural steroid injections increase the risk of fracture
How common are rotator cuff tears?
1. A Spine Journal study found that in patients suffering from cervicogenic headache, spinal manipulation cuts the number of symptomatic days in half:
“256 adults with chronic cervicogenic headache (CGH) were randomized to four dose levels of chiropractic SMT: 0, 6, 12, or 18 sessions. Participants were treated three times per week for 6 weeks and received a focused light-massage control at sessions when SMT was not assigned. A linear dose-response was observed for all follow-ups, a reduction of approximately 1 CGH day/month for each additional 6 SMT visits. Cervicogenic headache days/month were reduced from about 16 to 8 for the highest and most effective dose of 18 SMT visits. Cervicogenic headache intensity showed no important improvement nor differed by dose.”
Incidentally, SMT proved to be more effective than massage for CGH.
Haas M. et al. Dose-response and efficacy of spinal manipulation for care of cervicogenic headache: a dual-center randomized controlled trial. Spine J. 2018 Feb 23. [Epub ahead of print]
2. Archive of Physical Medicine & Rehabilitation: “For patients with neurogenic claudication due to lumbar spine stenosis, a comprehensive conservative program demonstrated superior, large and sustained improvements in walking ability and can be a safe non-surgical treatment option.”
Ammendolia C, et al. Comprehensive non-surgical treatment versus self-directed care to improve walking ability in lumbar spinal stenosis: A randomized trial. Arch Phys Med Rehabil. 2018.
3. As many as 96% of persons over age 50 years may have shoulder abnormalities involving the rotator cuff. Many of these individuals remain asymptomatic. Now a new study has found the incidence and prevalence of subclinical supraspinatus pathology in young subjects may be significantly greater than expected:
“Forty-six subjects, having no shoulder pain or known functional impairment were assessed using physical screening and musculoskeletal sonography. Results showed that 24% of these asymptomatic shoulders demonstrated degenerative changes.”
Guffey JS, et al. Degenerative Changes in Asymptomatic Subjects: A Descriptive Study Examining the Using Musculoskeletal Sonography in a Young Population. J Allied Health. 2018.
4. A study in Spine Journal found that sheep that underwent L3/4 spinal fusion experienced significant degenerative changes:
“(In fused specimens) The MRI and histologic analysis demonstrated significant disc degeneration. The mechanical environment set up by immobilization alone is capable of inducing lumbar disc degeneration.”
Wang T et. al. A novel in vivo large animal model of lumbar spinal joint degeneration. Spine J. 2018 May 22. [Epub ahead of print]
5. A study in the Journal of Bone & Joint Surgery found that lumbar epidural steroid injections increase the risk of osteoporotic vertebral compression fracture by 21%, per injection:
“Each successive injection increased the risk of fracture by a factor of 1.21. The findings suggest that Lumbar epidural steroid injections, like other forms of exogenous steroid administration, may lead to increased bone fragility.”
Mandel S. et al. A Retrospective Analysis of Vertebral Body Fractures Following Epidural Steroid Injections. The Journal of Bone & Joint Surgery. 95(11):961–964, JUN 2013
6. A study of over 32,000 people found that overweight people have a 21% increased risk of LBP, while obesity increases one’s risk by 55%.
Peng, Trent et al. The Association Among Overweight, Obesity, and Low Back Pain in U.S. Adults: A Cross-Sectional Study of the 2015 National Health Interview Survey. Journal of Manipulative & Physiological Therapeutics , Volume 41 , Issue 4 , 294 – 303
7. Individuals who received mobilization and expressed a positive perception of effect exhibited significantly greater changes in neurodynamic mobility than those without a positive perception.
Hartstein, Aaron J. et al. Immediate Effects of Thoracic Spine Thrust Manipulation on Neurodynamic Mobility. Journal of Manipulative & Physiological Therapeutics , Volume 41 , Issue 4 , 332 – 341
8. A systematic review in the Journal of Hand Therapy has shown “compelling evidence” that joint mobilization and manipulation improve pain, grip strength, and functional outcomes in patients with tennis elbow.
Lucado AM. et. al. Do joint mobilizations assist in the recovery of lateral elbow tendinopathy? A systematic review and meta-analysis. J. Hand Therapy 2018 Apr 25. [Epub ahead of print]
9. A randomized clinical trial compared the effectiveness of a splint vs. KinesioTape (KT) for the management of carpal tunnel syndrome:
“A significant improvement was observed in the KT group compared to the splint group in terms of electrophysiological changes, provocative test responses, symptom severity, and functional status scores. KT may help prevent the disease from progressing further in mild and moderate idiopathic CTS when applied in time using the appropriate technique and be a good alternative to neutral splinting in terms of patient compliance.”
Akturk S. et. al. Comparison of splinting and Kinesio taping in the treatment of carpal tunnel syndrome: a prospective randomized study.Clin Rheumatol. 2018 Jun 15. [Epub ahead of print]
10. NEJM: “A staggering 36,000 randomized controlled trials (RCTs) are published each year, on average, and it typically takes about 17 years for findings to reach clinical practice.”
Kanter MH et. al. A Model for Implementing Evidence-Based Practices More Quickly. NEJM Catalyst. February 5, 2017
Headaches can arise from many different causes. A partial list includes stress, lack of sleep, allergies, neck trauma (particularly sports injuries and car accidents), and more. In some cases, the cause may be unknown.
A unique common denominator of headaches has to do with cervical spine anatomy, in particular the upper part of the neck. There are seven cervical vertebrae, and the top three (C1-3) give rise to three nerves that travel into the head. These nerves also share a pain nucleus with the trigeminal nerve (cranial nerve V), which can route pain signals to the brain.
Depending on which nerve is most irritated, the location of the headache can vary. For example, C2—the greater occipital nerve—travels up the back of the head to the top. From there, it can communicate with another nerve (cranial nerve V or the trigeminal nerve), which can refer pain to the forehead and/or behind the eye.
When C1—the lesser occipital nerve—is irritated, pain travels to the back of the head, while irritation to C3—the greater auricular nerve—results in pain to an area just above the ear. When a nerve is pinched, the altered sensation can include pain, numbness, tingling, burning, itching, aching, or a combination of these sensations.
These are classified as cervicogenic headaches (CGH), and as the name implies, the origin of pain/altered sensation arises from the neck.
A 2013 study reviewing the literature on CGH found that manipulation and mobilization improved pain, disability, and function. The most effective approach included manipulation combined with neck-upper back strengthening exercises.
But what about migraine headaches? Migraines are vascular headaches, and some (but not all) are preceded by an aura or a pre-headache warning that may include blurry vision, tingling, strange olfactory sensations, etc. One study of 127 migraine sufferers reported fewer attacks and less medication required by those who received chiropractic care.
The good news is that spinal manipulation is very safe, and a trial is often very rewarding for many types of headaches.
Content Courtesy of Chiro-Trust.org. All Rights Reserved.
Low back pain (LBP) is one of the most common ailments that chiropractors treat. That’s probably because MOST of us will suffer from low back pain that requires outside help at some point in our lives! Posture has long been studied as a potential cause of low back pain, and this month’s topic will take a closer look at some recent research discussing this issue.
A December 2014 study looked at low back posture in two groups of LBP patients and its relationship with problems associated with intervertebral disk diseases. Looking at a person from the side, have you noticed that the low back area has an arched or inward curve? This is called the “lumbar lordosis” (or, the “sway back” area), and this can be highly variable in terms of the angle or amount of arch. It normally differs between males and females. Degenerative disk disease (DDD) is a common condition affecting virtually all of us at some point in time. DDD results in narrowing of the disk spaces, which there are five total in the lumbar spine (twelve in the thoracic spine/mid-back, and six in the cervical spine/neck). One particular study evaluated a group of 50 patients with long-term intractable (chronic) low back pain with intervertebral disk disease and a group of 50 chronic LBP patients without DDD that served as a “control group.” Researchers measured the degrees of lordosis, or amount of curve (lumbar lordosis), by looking at the person from the side using two different methods in the two patient groups and compared the data. The group with degenerative disk disease had an overall reduction in the lumbar lordosis curve (less arched) using both methods of measuring. The authors concluded that the patients with intervertebral disk lesions had a straighter, or more flat curve (less sway back), when compared to those without disk degeneration. What they were unable to determine was which came first, the disk degeneration or the reduction in the lumbar lordosis?
This study points out several important points. When treating patients with low back pain, some patients feel better when placed in a bent forwards position, or they favor a flat low back curve. Others have the opposite response, or their position of preference favors a more curved (arched) lower spine. The reason for this difference is that LBP is generated from different tissues in the low back, and some tissues favor or feel better in one position and typically feels worse in the opposite direction when injured. The intervertebral disks in the spine lie between the vertebral bodies and serve as “shock absorbers” for the spine and trunk. The center, or “nucleus,” of the disk is liquid-like and is usually well contained inside the disk, held by a tough, outer fibrocartilage material (the “annulus”). The disk is approximately 80% water, and as we age, the water content gradually reduces and the disk spaces narrow, thus limiting the mobility of that part of the spine. More importantly, DDD usually narrows the size of the canals through which the spinal cord and nerve roots travel. When we bend forward, these canals open up wider placing less pressure on the nerves and/or spinal cord. This is why we often see elderly people leaning on grocery carts when shopping, as it hurts less and they can walk longer / farther. Those with herniated disks tend to be the opposite, as they favor bending backwards as this position shifts the nucleus or liquid center forwards and away from the nerve root thus reducing the pinched nerve resulting in less or complete elimination of radiating leg pain.
We realize you have a choice in whom 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 requires care for back pain, we would be honored to render our services.
Chiropractic methods are traditionally sought after for pain relief for neuromusculoskeletal conditions or from pain arising from the nervous and musculoskeletal systems. But in the tradition of chiropractic, the WHOLE PERSON is cared for, not just a select region of pain. For example, when a low back pain patient first comes to the office, their history form includes detailed information about their overall health, not just their chief complaint (eg. “low back pain”). A thorough case history form will ask about past accident history, past hospitalizations, current medication list, family and social histories, occupational history, habit history, and a review of all the body’s systems (cardiovascular, respiratory, endocrine, EENT, genitourinary, skin, digestive, blood/lymphatic, and more). Doctors of chiropractic treat the WHOLE person so when obesity is present in a patients, they see treating it as part of the healing process. Granted, the main focus is usually given to the primary or chief complaint, but we must look at all the reasons as to why the low back hurts, especially since, in MOST cases, the cause of low back pain (LBP) is multimodal (there is more than one single cause), though the LAST activity prior the back “…going out,” typically gets the blame. Also, most of us who have had LBP have had it more than once. In fact, most studies report that if you’ve had LBP in the past, you can EXPECT to have it again. That is why you your doctor to examine and identify ALL the possible reasons as to why the back was injured and manage everything they can.
In addition to all the historical information gathered, a family history of obesity is very relevant in these cases. Also, thyroid deficiency can make weight loss next to impossible since it regulates our metabolic rate and when sluggish, we simply can’t break down fat efficiently and fluid is usually retained (another cause for weight gain). Your doctor of chiropractic may ask what you and your family typically eat. Is it “fast food” or does it consist of whole foods in a well-balanced diet? How about snacking habits? These can “undo” a lot of good if there are abuses in that department. Chiropractors will often integrate exercises into the treatment plan as regaining flexibility, strength, stamina, and coordination ALL help, not only the LBP, but also allows for aerobic activity to be better tolerated and enjoyed. If you experience pain every time you get up to walk, you will react by modifying or stopping that activity.
To continue the example above, doctors of chiropractic will look at all possible causes for low back pain and address things like a short leg, flat/pronated feet, knee, hip, and pelvic issues as all of these can affect the frequency, intensity, and duration of LBP. These possible issues can also impede one’s efforts to exercise, and in fact, may worsen every time they try. Your doctor must FIRST reduce the “cause” of the LBP by decreasing inflammation (“RICE”: rest, ice, compress, elevate). He or she will manipulate within the patient’s tolerance to restore spinal and extremity joint function so exercises do NOT hurt. They can then guide the patient in the process of integrating exercises into their lifestyle GRADUALLY so he or she can identify any exercise that may be too much for them at that particular time. Of course, nutritional consulting with diets that may include calorie counting / restriction diets, the “Paleo” or caveman diet, low carbohydrate diet, and many other options will be considered. Discussing what the patients has tried in the past that seemed to work, as well as those approaches that failed, is important so they don’t waste time.
Chiropractors WANT to help patients find ways that can be continued for the long-term that they like, that make sense, and that work. THEN, the patient can be in control of their weight, their low back pain, and their lives.
Have you ever had neck or back pain and considered Chiropractic but feared you’d be required to commit to a long term plan?
You are not alone.
Even though there is plenty of research backing up Chiropractic, some patients just can’t afford the time or expense of long-term, corrective care.
That is why we now offer “pay per visit” Chiropractic for your neck pain or back pain.
This means you can call and come in on the same day and provided that there are no contraindications, get exactly what you want; an adjustment without pressure to keep coming back over and over again.
As a matter of fact, this mainstream approach is featured on www.Chiro-Trust.org… one of the most visited online back pain information websites in the country.
So, if you, your spouse, or a friend is complaining of aches and pains, rest assured that you can come in and get the care you want and can afford.
Give us a call at 772-286-5277. We’ll take good care of you.
Cliff Atwell, B.S., D.C.