ARTICLE Table of Contents:
NECK PAIN
Can Chiropractic Really Help Neck Pain?
What Is This Pain In My Neck?
The Neck and Headache Connection
The Neck is Your Life Line
BACK PAIN
Low Back Pain, Why Is It So Common?
Low Back Pain; Where Is My Pain Coming From?
Low Back Pain & Balance Exercises
Does Chiropractic Work? What Do Insurance Companies Say?
Chiropractic Care For Low Back Pain-What Does The Research Say?
HEADACHES
Side Effects of Chiropractic vs. Medications for Headaches
Headaches-How Does Chiropractic Work?
Chiropractic Manipulation: A New Study Regarding Headaches
The Importance of Headache Diagnosis
Side Effects of Chiropractic vs. Medications for Headaches
CARPAL TUNNEL SYNDROME
Carpal Tunnel Syndrome-What Can You Do For It?
Do I Have To Have Surgery For Carpal Tunnel Syndrome?
Carpal Tunnel Syndrome (CTS)- What Does The Research Show?
Carpal Tunnel Synbdrome – Chiropractice vs. Medical Treatment
Carpal Tunnel: Results of a Clinical Trial of Two Treatments
FIBROMYALGIA
Fibromyalgia Facts
Fibromyalgia: I Have It…Now What?
Fibromyalgia & Chiropractic Care
Fibromyalgia-Can Chiropractic Help…Who Says?
Fibromyalgia And Your Upper Neck
WHIPLASH
Car Accidents and Mild Traumatic Brain Injuries
Whiplash Facts
What Really Causes Whiplash
Whiplash-What Is The Best Type of Treatment
Chiropractic-Only Proven Effective Treatment For Chronic Whiplash
CHIROPRACTIC
Chiropractic Education
Many Medical Doctors Recommending Chiropractic Care For Back Pain Relief
Physical Therapy Vs. Chiropractic
Is Chiropractic Dangerous?
The Difference in Effectiveness of Medical vs. Chiropractic In The Treatment of Acute and Chronic Back Pain
Neck Pain Articles
Neck Pain – Can Chiropractic Really Help?
Neck pain is a very common problem affecting up to 70% of the adult population at some point in life. Though there are specific causes of neck pain such as arising from a sports injury, a car accident or “sleeping crooked,” the vast majority of the time, no direct cause can be identified and thus the term nonspecific is applied. There are many symptoms associated with patients complaining of neck pain and many of these symptoms can be confused with other conditions. Wouldn’t it be nice to know what neck related symptoms are most likely to respond to chiropractic manipulation before the treatment has started? This issue has been investigated with very favorable results!
The ability to predict a favorable response to treatment has been termed, “clinical prediction rules” which in general, are usually made up of combinations of things the patient says and findings from exams. In a large study, data from about 20,000 patients receiving about 29,000 treatments, was collected and analyzed to find out what complaints responded well to chiropractic treatment. The results showed that the presence of any 4 of these 7 presenting complaints predicted an immediate improvement in 70-95% of the patients: 1. Neck pain; 2. Shoulder, arm pain; 3. Reduced neck, shoulder, arm movement; 4. Stiffness; 5. Headache; 6. Upper, mid back pain, and 7. None or one presenting symptom. Items not associated with a favorable immediate response included “numbness, tingling upper limbs,” and “fainting, dizziness and light-headedness in 4-12% of the patients. The “take-home” message here is that was far more common to see a favorable response (70-95%) of the patients compared to an unfavorable response (4-12%), supporting the observation that most patients with neck complaints will respond favorably to chiropractic treatment.
So, what do we do as chiropractors when a patient presents with neck pain? First, after gathering preliminary information such as name, address and insurance information, a history of the presenting complaint is taken. This consists of information including what started the neck complaint (if you know), when it started, what makes it worse, what makes it better, the quality of pain (aches, stiff, numb, etc.), the location and if there is radiating complaints, the severity (0-10 pain scale), timing (such as worse in the morning, evening, etc.), and if there have been prior episodes. Various questionnaires are included that are scored so improvement down the road can be tracked and a past history that includes a medication list, past injuries or illnesses, family history and a systems review are standard. The exam includes vital signs (BP, pulse, height, weight, temperature and respiration), palpation, range of motion, orthopedic and neurological examination. X-ray and/or other “special tests” may also be included, when needed. A review of all the findings are discussed and after permission to treat is granted, a chiropractic adjustment may then be rendered. A list treatment options may include:
1. Adjustments;
2. Soft tissue therapy (trigger point stimulation, myofascial release);
3. Physical therapy modalities;
4. Posture correction exercises and other exercises/home self-administered therapies;
5. Education about job modifications;
6. Co-management with other health care providers if/when needed.
What Is This Pain in My Neck!
“When I woke up this morning, I couldn’t move my neck! Every time I try to move it, I feel sharp pain on the left side of the neck shooting down into the shoulder blade. It just came out of nowhere!”
Chances are, you are suffering from a common condition called torticollis, which literally means, “twisted neck” after the Latin terms of “torti” (twisted) and “collis” (neck). The common name for this is “wry neck,” and it’s basically a painful muscle spasm, like a “Charlie-horse” but located in the neck muscles. Usually, a person wakes up in the morning with this and the cause is often related to sleeping with the window being open or a fan or air conditioner blowing on you. It can also relate to a “cold settling in the muscle” after a cold or flu virus. Trauma such as falling or a car accident can also cause torticollis. However, most of the time, patients with torticollis are not sure what caused the abrupt onset of symptoms.
Usually, torticollis will gradually improve over a 2 week time frame. However, it only takes a few days to a week (at the most) if you receive chiropractic adjustments. Most importantly, without treatments, the sharp pain can last a week and can severely limit your activity, often prohibiting work as well as your desired “fun” activities. Hence, most people prefer having this treated as opposed to “waiting it out.” In some cases, it can last longer than a month and in rare cases even longer, so getting this treated is highly recommended. Also, try to get in for a treatment immediately before the muscle spasm really sets up. We find this to be the most effective approach. Here are a list of symptoms and treatment suggestions for torticollis:
Acute Torticollis Symptoms
· Muscle spasms
· Neck and shoulder pain
· Neck and spine contortion (neck twisted to right or left side of body)
Pain Relief Treatments for Acute Torticollis
· Chiropractic neck and spinal adjustment
· Analgesics
· Heat packs
· Muscle relaxants
· Rubs and ointments (Icy Hot, BioFreeze)
· Massage with essential oils
· Reiki
· Sleep / Relax
· Supportive cervical collar
The Neck and Headache Connection
Patients with headaches also commonly complain of neck pain. This relationship is the rule, not the exception and therefore, treatment for headaches must include treatment of the neck to achieve optimum results. The term, “cervicogenic headaches” has been an accepted term because of the intimate connection between the neck and head for many years. There are many anatomical reasons why neck problems result in headaches. Some of these include:
· The first 3 nerves exiting the spine in the upper neck go directly into the head. They penetrate the muscles at the top of the neck near the attachments to the skull and therefore, any excess pressure on these nerves by the muscles or spinal joints will result in irritation and subsequent pain.
· The origin or nucleus of the 5th cranial nerve called the Trigeminal, innervates the sensation to the face and is located in the upper cervical region near the origin of the 2nd cervical spinal nerve, which innervates sensation to the back of the head up to the top. Therefore, problems located in the upper neck will often result in pain radiating up from the base of the skull/upper neck over the top of the skull to the eyes and /or face.
· The 11th cranial nerve that innervates the upper shoulders and muscles in the front of the neck arises from the top 5 to 7 spinal cord levels in the neck. Injury anywhere in the neck can result in spasm and pain in these large muscle groups.
· Other interconnections between the 2nd cervical nerve and trigeminal/5th cranial nerve include communication with the 7th cranial / facial nerve, the 9th cranial / glossopharyngeal nerve, and the 10th cranial / vagus nerve. These connections can affect facial muscle strength/movements, taste, tongue and throat movements, and stomach complaints such as nausea from these three cranial nerve interconnections, respectively.
When patients seek treatment for their headaches, a thorough examination of the neck, upper back, and cranial nerves is routinely performed for the above reasons. It is common to find upper cervical movement and vertebral alignment problems present in patients complaining of headaches. Tender points located between the shoulder blades, along the upper shoulders, on the sides of the neck and particularly, at the base of the skull are commonly found. Pain often radiates from the tender point over the top of the skull when pressure is applied in the upper neck/base of the skull area. Tenderness on the sides of the head, in the temples, over the eyes, and near the jaw joint are also common. Traction or pulling the head to stretch the neck is often quite pain relieving and this is often performed as part of the chiropractic visit and can also be applied at home with the use of a home cervical traction unit. Chiropractic adjustments applied to the fixated or misaligned vertebra in the upper neck often brings very satisfying relief to the headache sufferer. Exercises that promote movement in the neck, as well as strengthening exercises are also helpful in both reducing headache pain and in preventing occurrences, especially with stress or tension headaches.
The Neck is Your Life Line
The nervous system is the master control network for your body, directing virtually every function and action, from monitoring your life needs, to precisely responding to threats to your health.
Each system, from your heart and blood vessels, to your digestive and immune systems, is directed through nerve impulses originating in your brain or spinal cord that travel through its protective bony structure: the spinal column.
The neck region is the most vulnerable region of the spine to injury. Indeed, even death can be brought through significant trauma to the neck. When the trauma is not fatal, the consequences can still be severe, such as when paralysis strikes.
Most people will not experience these severe injuries, however sprains of the delicate ligaments with subluxation (misalignment) do commonly occur. Despite the injury being smaller, their location (the neck) makes their impact more profound. Functions throughout the body can be impaired when the nerves in the upper neck are compromised.
Within chiropractic, there are specialists who focus their entire care on the uppermost two vertebrae of the spine.
Because every nerve passes through the neck, if irritation or compression is present, virtually any system of the body can be affected. The point being is that a neck disorder will not necessarily just cause neck pain or headache. Dizziness, digestive problems, fatigue, high blood pressure and generally reduced quality of life are some of the symptoms patients commonly experience.
If you have suffered a severe whiplash, you may have noticed far more than a stiff neck. Indeed, recent research suggests whiplash needs to more thought of as a whole body disorder.
We take these injuries in our office and address them in both a specific and comprehensive manner. Most patients who have suffered a neck trauma will require x-rays to analyze the posture of their spine. X-rays may also need to be taken in motion to test the stability of your ligaments and to determine precise levels of impaired movements. Without this road map, it is difficult to determine how care should be directed and factors that could influence your long-term prognosis, such as degeneration.
Back Pain Articles
Low Back Pain: Why Is It So Common?
This question has plagued all of us, including researchers for a long time! Could it be because we’re all inherently lazy and don’t exercise enough? Or maybe it’s because we have a job that’s too demanding on our back? To properly address this question, here are some interesting facts:
1. The prevalence of low back pain (LBP) is common, as 70-85% of ALL PEOPLE have back pain that requires treatment of some sort at some time in life.
2. On a yearly basis, the annual prevalence of back pain averages 30% and once you have back pain, the likelihood of recurrence is high.
3. Back pain is the most common cause of activity limitation in people less than 45 years of age.
4. Back pain is the 2nd most frequent reason for physician visits, the 5th ranking reason for hospital admissions, and is the 3rd most common cause for surgical procedures.
5. About 2% of the US workforce receives compensation for back injuries annually.
6. Similar statistics exist for other countries, including the UK and Sweden.
So, what are the common links as to why back pain is so common? One reason has to do with the biomechanics of the biped – that is, the two legged animal. When compared to the 4-legged species, the vertically loaded spine carries more weight in the low back, shows disk and joint deterioration and/or arthritis much sooner, and we overload the back more frequently because, well, we can! We have 2 free arms to lift and carry items that often weigh way too much for our back to be able to safely handle. We also lift and carry using poor technique. Another reason is anatomical as the blood supply to our disks is poor at best, and becomes virtually non-existent after age 30. That makes healing of disk tears or cracks nearly impossible. Risk factors for increased back injury include heavy manual lifting requirements, poor or low control of the work environment, and prior incidence of low back pain.
Other risk factors include psychosocial issues such as fear of injury, beliefs that pain means one should not work, beliefs that treatment or time will not help resolve a back episode, the inability to control the condition, high anxiety and/or depression levels, and more. Because there are so many reasons back problems exist, since the early 1990’s, it has been strongly encouraged that we as health care providers utilize a “biopsychosocial model” of managing those suffering with low back pain, which requires not only treatment but proper patient education putting to rest unnecessary fears about back pain.
Low Back Pain: Where Is My Pain Coming From?
Low back pain can emanate from many anatomical locations (as well as a combination of locations), which always makes it interesting when a patient asks, “…doc, where in my back is my pain coming from?” In context of an office visit, we take an accurate history and perform our physical exam to try to reproduce symptoms to give us clues as to what tissue(s) may be the primary pain generators. In spite of our strong intent to be accurate, did you know, regardless of the doctor type, there is only about a 45% accuracy rate when making a low back pain diagnosis? This is partially because there are many tissues that can be damaged or injured that are innervated by the same nerve fibers and hence, clinically they look very similar to each other. In order to improve this rather sad statistic, in 1995 the Quebec Task Force published research reporting that accuracy could be improved to over 90% if we utilize a classification approach where low back conditions are divided into 1 of 3 broad categories:
1. Red flags – These include dangerous conditions such as cancer, infection, fracture, cauda equina syndrome (which is a severe neurological condition where bowel and bladder function is impaired). These conditions generally require emergency care due to the life threatening and/or surgical potential.
2. Mechanical back pain – These diagnoses include facet syndromes, ligament and joint capsule sprains, muscle strains, degenerative joint disease (also called osteoarthritis), and spondylolisthesis.
3. Nerve Root compression – These conditions include pinching of the nerve roots, most frequently from herniated disks. This category can include spinal stenosis (SS) or, combinations of both, but if severe enough where the spinal cord is compromised (more commonly in the neck), SS might then be placed in the 1st of the 3 categories described above.
The most common category is mechanical back pain of which “facet syndrome” is the most common condition. This is the classic patient who over did it (“The Weekend Warrior”) and can hardly get out of bed the next day. These conditions can include tearing or stretching of the capsule surrounding the facet joint due to performing too many bending, lifting, or twisting related activities. The back pain is usually localized to the area of injury but can radiate down into the buttocks or back of the thigh and can be mild to very severe.
Low Back Pain and Balance Exercises
You may recall last month, we talked about the relationship between low back pain and balance, particularly our unfortunate increased tendency to fall as we “mature.” This month, we’re going to look at ways to improve our balance by learning specific exercises that utilize the parts of our nervous system that regulate balance or, proprioception. Particularly, our cerebellum (back of the brain that regulates coordination), the vestibular system (the inner ear where the semi-circular canals are located), the ascending tracts in our spinal cord (the “highways” that bring information to the brain from our feet and the rest of our body), and the small “mechano-receptors” located in our joints that pick up our movements as we walk and run and sends that information through our nerves, up the spinal cord tracts to the brain. Here are some very practical exercises to do, “…for the rest of our lives.” Start with the easy ones!
1. Easy (Level 1): Standing eyes open/closed - Start with the feet shoulder width apart, look straight ahead to get your balance and then close the eyes and try not to sway counting to 30 by, “…one thousand one, one thousand two, one thousand three, etc.” Repeat this with your feet closer together until they touch each other. You can make this harder by standing on a pillow or cushion -- but don’t start that way!
2. Medium (Level 2): Lunges - from a similar starting position as #1, step forwards with one leg and squat slightly before returning back to the start position. Repeat this 5x with each foot/leg. As you progress, you can take a longer stride and/or squat down further with each repetition. You can even hold onto light dumbbells and/or close your eyes to make it more challenging.
3. Hard (Level 3): Rocker or wobble board exercises - use a platform that rocks back & forth or, wobbles in multiple directions. Rock back and forth, eyes open and then closed, once you get comfortable on the board. You can rotate your body on the board, standing straight ahead (12 o’clock) followed by 45 degree angles as you work your way around in a circle at 45 degree increments (12, 1:30, 3, 4:30, 6, 7:30, 9, 10:30 and back to noon). Repeat these eyes open and closed. The Wii Balance board is a fun way to exercise – check that out as well.
You can “improvise” and mix up different exercises and create your own routine. Just remember, stay safe, work slowly until you build up your confidence and keep challenging yourself.
Does Chiropractic Work? - What Do Insurance Companies Say?
If chiropractic care helps patients get better faster and costs the patient and/or insurance company less, shouldn’t EVERY low back pain patient FIRST see a chiropractor before any other type of doctor? That is in fact, what should be done, based on a recent report!
On October 20, 2009, a report was delivered on the impact on population, health and total health care spending. It was found the addition of chiropractic care for the treatment of neck and low back pain “…will likely increase value-for-dollar in US employer-sponsored health benefit plans.” Authored by an MD and an MD/PhD, and commissioned by the Foundation for Chiropractic Progress, the findings are clear; chiropractic care achieves higher satisfaction and superior outcomes for both neck and low back pain in a manner more cost effective than other commonly utilized approaches.
The study reviews the fact that low back and neck pain are extremely common conditions consuming large amounts of health care dollars. In 2002, 26% of surveyed US adults reported having back pain in the prior 3 months, 14% had neck pain and the lifetime prevalence of back pain was estimated at 85%. LBP accounts for 2% of all physician office visits where only routine examinations, hypertension, and diabetes result in more. Annual national spending is estimated at $85 billion in the US with an inflation-adjusted increase of 65% compared to 1997. Treatment options are diverse ranging from rest to surgery, including many various types of medications. Chiropractic care, including spinal manipulation and mobilization, is reportedly also widely utilized with almost half of all patients with persisting back pain seeking chiropractic treatment.
In review of the scientific literature, it is noted that 1) chiropractic care is at least as effective as other widely used therapies for low back pain; 2) Chiropractic care, when combined with other modalities such as exercise, appears to be more effective than other treatments for patients with neck pain. Other studies reviewed reported patients who had chiropractic coverage included in their insurance benefits found lower costs, reduced imaging studies, less hospitalizations, and surgical procedures compared to those with no chiropractic coverage. They then utilized a method to compare medical physician care, chiropractic physician care, physiotherapy-led exercise and, manipulation plus physiotherapy-led exercise for low back pain care. They found adding chiropractic physician care is associated with better outcomes at “…equivalent to an incremental cost-effectiveness ratio of $1837 per QALY (Quality-adjusted Life Year).”
When combined with exercise, chiropractic physician care was also found to be very cost-effective when compared to exercise alone. This combined approach would achieve improved health outcomes at a cost of $152 per patient, equivalent to an “incremental cost-effectiveness ratio of $4591 per QALY.” When comparing the cost effectiveness of chiropractic care with or without exercise even at 5 times the cost of the care they utilized in their analysis, it was still found to be “substantially more cost-effective” compared to the other approaches. It will be interesting given these findings if insurance companies and future treatment guidelines start to MANDATE the use of chiropractic FIRST – it would be in everyone’s best interest!
Chiropractic Care For Low Back Pain – What Does the Research Say?
There has been a debate for years regarding the use of spinal manipulation and its benefits in the treatment of low back pain. Since the founding of chiropractic in 1895, the initial reaction against the early pioneer chiropractors resulted in doctors of chiropractic (DC’s) being incarcerated for “…practicing medicine without a license.” But chiropractors kept forging ahead and because of obtaining good results and helping millions of people, by 1971, Medicare adopted coverage for chiropractic – a first in chiropractic’s history. In 1975, the US Department of Health, Education, and Welfare invited an international group of health care provider types (MD’s, DC’s, DO’s, etc.), to share with each other at the National Institute of Health, and determine what the “current” research status of spinal manipulative therapy was at that time. Recommendations for future needed research resulted and the proceedings were published in: The DHEW Publication No. (NIH) 76-998 “The Research Status of Spinal Manipulative Therapy.” That landmark gathering stimulated a plethora of research that was to follow over the course of the next 30+ years and continues today. Due to the overwhelming positive benefits of chiropractic published in many research studies, by the late 1980’s, most insurance companies included coverage for chiropractic care. Today, many chiropractors practice in multidiscipline health care centers that include DC’s, MD’s, and PT’s others. The following list of research studies has had a significant impact in vaulting chiropractic to its current accepted status in the health care system (the URL is included for further study):
1. Meade TW, Dyer S, Browne W, Townsend J, Frank AO. British Medical Journal 1990 (Jun 2); 300 (6737):1431-1437. http://www.chiro.org/LINKS/ABSTRACTS/LBP_of_Mechanical_Origin.shtml
2. Manga P, Angus DE, Papadopoulos C, Swan WR. A Study to Examine the Effectiveness and Cost-effectiveness of Chiropractic Management of Low-Back Pain. 8/1993; Ontario, Canada. http://www.chiro.org/LINKS/GUIDELINES/Manga_93.shtml
3. Bigos S, et. al., 1994, Agency for Health Care Policy and Research (AHCPR). http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=hstat6.chapter.25870
4. Meade TW, Dyer S, Browne W, Frank AO. Randomised Comparison of Chiropractic and Hospital Outpatient Management for Low Back Pain: Results from Extended Follow up. British Medical Journal 1995 (Aug 5); 311 (7001): 349–351 http://www.chiro.org/LINKS/ABSTRACTS/Chiropractic_and_Hospital_Outpatient.shtml
5. Luo X, Pietrobon R, Sun SX, Liu GG, Hey L. Estimates and Patterns of Direct Health Care Expenditures Among Individuals With Back Pain in the United States. Spine 2004 (Jan 1); 29 (1): 79–86. http://www.ncbi.nlm.nih.gov/pubmed/14699281
Headache Articles
Side Effects of Chiropractic vs. Medications for Headaches
Have you ever stopped and wondered, “…which type of doctor should I go to for treatment of my headaches?” In order to make an informed decision, it is appropriate to look at the side effects each treatment option carries and then consider the pros and cons of each treatment.
It has been reported that 45 million Americans suffer from headaches, many on a daily basis. Though some just put up with the pain, others become totally disabled during the headache. Most people initially turn to an over the counter drug such as a non-steroidal anti-inflammatory drug (NSAID) of which there are 3 types: 1) salicylates, such as aspirin; 2) traditional NSAIDs, such as Advil (ibuprofen), Aleve (naproxen); and, 3) COX-2 selective inhibitors, such as Celebrex.
According to the medical review board of About.com, complications of NSAID drugs include stomach irritation (gastritis, ulcer), bleeding tendencies, kidney failure, and liver dysfunction. Some NSAIDs (particularly indomethacin) can interfere with other medications used to control high blood pressure and cardiac failure and long term use of NSAIDs may actually hasten joint cartilage loss, leading to premature arthritis. Another over the counter commonly used drug is Tylenol (Acetaminophen) in which liver toxicity can be a potential side effect (particularly with long term use).
Here’s the kicker – only about 60% of patients respond to a 3 week trial of an NSAID, NSAIDs can mask signs and symptoms of infection, it cannot be predicted which NSAID will work best, and no single NSAID has been proven to be superior over others for pain relief. Moreover, estimates of death associated with NSAID (mostly gastrointestinal causes) range between 3200 on the low side to higher than 16,500 deaths per year in the United States. Another BIG concern is that low daily doses of aspirin, “…clearly have the potential to cause GI injury as 10mg of aspirin daily causes gastric ulcers.”
Others may turn to prescription medication for hopeful pain relief. One of the more frequently prescribed medications for headaches is amitriptyline (commonly known as Elavil, Endep, or Amitrol). This is actually an antidepressant but was found to work quite well for some headache sufferers. The potential side effects include blurred vision, change in sexual desire or ability, constipation or diarrhea, dizziness, drowsiness, dry mouth, headache (ironically), appetite loss, nausea, tiredness, trouble sleeping, tremors and weakness. Allergic reactions such as rash, hives, itching, difficulty breathing, tightness in the chest, swelling of the mouth, face, lips or tongue, chest pain, rapid and/or irregular heart rate, confusion, delusions, suicidal thoughts or actions AND MORE are reported.
The pros and cons of chiropractic include a report on children under 3 years of age, where only one reaction for every 749 adjustments (manipulations) occurred (it was crying, NO serious side effects were reported). In adults, transient soreness may occur. Though stroke has been reported as a cause of headache, it was concluded that stroke “…is a very rare event…”, and that, “…we found no evidence of excess risk of VBA stroke associated chiropractic care compared to primary care.” Another convincing study reported that chiropractic was 57% more effective than drug therapy in reducing headache and migraine pain! They concluded – chiropractic first, drugs second and surgery last.
Headaches – How Does Chiropractic Work?
Headaches are a common complaint at chiropractic clinics. There are many causes of headaches, some of which are “idiopathic” or, unknown. Some headaches arise from “vascular” (blood vessels) causes such as migraine and cluster headaches. These often include nausea and/or vomiting and can be quite disabling and require rest in a dark, quiet place sometimes for a half or a whole day. Another type of headaches can be categorized as “tension” headaches. These usually result from tightness in the muscles in the neck and upper back caused from stress, work, lack of sleep, sinusitis, trauma such as whiplash, and others.
So “how does chiropractic work?” To answer this, let’s first discuss what we do when the headache patient comes in. First, the history is very important! Here, we’ll ask “how/when did the headaches start. This may glean the actual cause of headaches such as a car accident or injury of some sort.
Next, we’ll ask about activities that increase or create the headache, which gives us ideas of how we might help manage the headache patient. For example, when certain activities precipitate the onset of a headache, we will modify the work station and/or give specific exercises on a regular schedule to keep the neck tension under control. When information gathered about what decreases or helps the neck pain and headaches, we will recommend treatments often that can be done at home such as a home traction unit. This would be suggested if we are told that “…pulling on my neck feels great!” The quality of pain (throbbing = vascular, ache and tightness = neck), intensity of pain (0-10 pain scale), and timing (worse in the morning vs. evening) help us track change after treatment is rendered, usually gathered once a month.
The examination includes blood pressure which can in itself create headaches when high, looking in the eyes to view the blood vessels in the back of the eye to make sure there is no evidence of increased pressure against the brain, ears – to see if there is an infection or wax blockage. This can help if there is dizziness and/or balance loss. We will sometimes listen to the throat as well as the heart to see if there may be a blockage, a valve problem, or other issues. Neck muscle tightness (spasm) will be evaluated along with the range of motion, paying particular attention to the positions/directions that increases and decreases pain, especially those that decrease pain. Nerve function by checking reflexes, sensation and muscle strength as well as correlating information like positions that decrease arm or leg pain will be included as any position that reduces pain in the arm or leg must be incorporated into an exercise. X-rays may include bending “stress” views so that ligaments (that hold bones together) can be evaluated for “laxity” (torn and unstable). When this is found, we avoid adjustments to these vertebrae.
As you can see, if is very important do a thorough evaluation so headache patients can be properly managed. Treatment approaches include: 1. Adjustments; 2. Soft tissue therapy (trigger point stimulation, myofascial release); 3. Posture correction exercises and other exercises; 4. Education about job modifications; 5. Co-management with other health care providers, if medication or injection therapy is needed.
Chiropractic Manipulation: A New Study Regarding Headaches
Headaches are a common complaint in patients presenting for professional care, including chiropractic management. Patients with headaches seek chiropractic care because they find manipulation or adjustments applied to the cervical spine and upper back region are highly effective in reducing the intensity, frequency and duration of the headache pain. This is because the cervical spine / neck, is often the origin of the headache as the three nerves in the upper neck (C1, 2 and 3) pass through the thick, overly taught neck muscles in route to the scalp / head. When the muscles of the neck are in spasm, the nerves get “pinched” or squeezed by the overly tight muscles resulting in headache pain. Each nerve runs to a different part of the head and therefore, pain may be described as “…radiating over the top of head (sometimes into the forehead and eyes),” or, into the head and over the ear, sometimes reaching the temple. Also, an area located in the back and side of the head is the area where the C1 nerve innervates, so pain may also be reported in that location. When more than one of the C1-3 nerves is pinched, the whole side to the top of the head may be involved.
In the October 2009 issue of The Spine Journal, Western States Chiropractic College, Center for Outcomes Studies, reported benefits are obtained with the utilization of spinal manipulation in the treatment of chronic cervicogenic headaches. The word “chronic” means at least 3 months of headache pain has been present. This new study compared 2 different doses of therapy using several outcome measures including the pain grade, the number of headaches in the last 4 weeks and the amount of medication utilized. Data was collected every 4 weeks for a 24 week period and patients were treated 1-2 times/week and separated into either an 8 or a 16 treatment session with half the group receiving either spinal manipulative therapy or a minimal light massage (LM) control group.
The results of the study revealed the spinal manipulation group obtained better results than the control group at all time intervals. There was a small benefit in the group that received the greater number of treatments with the mean number of cervicogenic headaches reduced by 50% in both pain intensity and headache frequency.
The importance of this study is significant as there are many side effects to medications frequently utilized in the treatment of headaches. Many patients prefer not taking medications for this reason and spinal manipulation therapy (SMT) offers a perfect remedy for these patients. Couple SMT with dietary management, lifestyle modifications, stress management, and a natural, vitamin/herbal anti-inflammatory (such as ginger, turmeric, boswellia) when needed, a natural, holistic approach to the management of chronic headaches is accomplished.
The Importance of Headache Diagnosis
All good doctors know the importance of getting an accurate diagnosis of a patient's problem. But why is this so important? It's important because without knowing what is the disease or injury, the treatment cannot be directed to the actual problem.
Unfortunately, when it comes to headaches, many patients do not receive an accurate diagnosis. If a patient were to see a doctor with a pain in the head and the doctor were to conclude that you have a pain in your head (headache), this tells little about the actual problem. In headache patients, we've become very good at labeling problems-giving them a name. If the headache comes and goes we call it episodic. If it occurs suddenly we call it acute, and if it occurs over many years we say it is chronic. But are these labels really helpful?
The reality is everyday people show up in doctors offices, obtain cursory examinations and walk out with a prescription for their head pain. Not all doctors do this, of course, but with the time constraints of managed care and the insurance company oversight, a doctor's visit is just not what it used to be. When was the last time you had a house call from a doctor? Of course, the worst case is when a patient acts as their own doctor, sees an advertisement for a pill and does the diagnosing himself or herself!
In chiropractic, we may also label your headache as tension-type, migraine or chronic, but a good chiropractor will not stop there. The label does not give much of an indication of what needs to be done, and more importantly we still do not know the CAUSE of the pain. Clinical experience and research over many decades has shown that many headaches are actually caused by injuries to the neck and spine. But if a doctor does not examine the neck, they may not discover these hidden injuries. Sometimes an astute doctor will take a history and it may be discovered you had a whiplash or other neck trauma, months or even years earlier. This is important information to get at the cause.
We take a comprehensive approach to headache patients at our clinic. A detailed history about the location, duration, and quality of pain is followed up by a thorough physical examination, especially of your spinal column. We may also order imaging tests such as x-rays to see the positions of the individual vertebrae in your neck.
The normal neck has a forward curve or arch, which keeps your head upright and directly above your shoulders. When this curve is lost, the patient's head is thrust forward in the classic "bad posture" stance. Making sure your neck is both flexible, and in good postural alignment, is critical to maintaining good health.
Side Effects of Chiropractic vs. Medications for Headaches
Have you ever stopped and wondered, “…which type of doctor should I go to for treatment of my headaches?” In order to make an informed decision, it is appropriate to look at the side effects each treatment option carries and then consider the pros and cons of each treatment.
It has been reported that 45 million Americans suffer from headaches, many on a daily basis. Though some just put up with the pain, others become totally disabled during the headache. Most people initially turn to an over the counter drug such as a non-steroidal anti-inflammatory drug (NSAID) of which there are 3 types: 1) salicylates, such as aspirin; 2) traditional NSAIDs, such as Advil (ibuprofen), Aleve (naproxen); and, 3) COX-2 selective inhibitors, such as Celebrex.
According to the medical review board of About.com, complications of NSAID drugs include stomach irritation (gastritis, ulcer), bleeding tendencies, kidney failure, and liver dysfunction. Some NSAIDs (particularly indomethacin) can interfere with other medications used to control high blood pressure and cardiac failure and long term use of NSAIDs may actually hasten joint cartilage loss, leading to premature arthritis. Another over the counter commonly used drug is Tylenol (Acetaminophen) in which liver toxicity can be a potential side effect (particularly with long term use).
Here’s the kicker – only about 60% of patients respond to a 3 week trial of an NSAID, NSAIDs can mask signs and symptoms of infection, it cannot be predicted which NSAID will work best, and no single NSAID has been proven to be superior over others for pain relief. Moreover, estimates of death associated with NSAID (mostly gastrointestinal causes) range between 3200 on the low side to higher than 16,500 deaths per year in the United States. Another BIG concern is that low daily doses of aspirin, “…clearly have the potential to cause GI injury as 10mg of aspirin daily causes gastric ulcers.”
Others may turn to prescription medication for hopeful pain relief. One of the more frequently prescribed medications for headaches is amitriptyline (commonly known as Elavil, Endep, or Amitrol). This is actually an antidepressant but was found to work quite well for some headache sufferers. The potential side effects include blurred vision, change in sexual desire or ability, constipation or diarrhea, dizziness, drowsiness, dry mouth, headache (ironically), appetite loss, nausea, tiredness, trouble sleeping, tremors and weakness. Allergic reactions such as rash, hives, itching, difficulty breathing, tightness in the chest, swelling of the mouth, face, lips or tongue, chest pain, rapid and/or irregular heart rate, confusion, delusions, suicidal thoughts or actions AND MORE are reported.
The pros and cons of chiropractic include a report on children under 3 years of age, where only one reaction for every 749 adjustments (manipulations) occurred (it was crying, NO serious side effects were reported). In adults, transient soreness may occur. Though stroke has been reported as a cause of headache, it was concluded that stroke “…is a very rare event…”, and that, “…we found no evidence of excess risk of VBA stroke associated chiropractic care compared to primary care.” Another convincing study reported that chiropractic was 57% more effective than drug therapy in reducing headache and migraine pain! They concluded – chiropractic first, drugs second and surgery last.
Carpal Tunnel Articles
Carpal Tunnel Syndrome - What Can You Do For It?
Carpal tunnel syndrome or, CTS, is a common condition that drives many patients to chiropractic clinics asking, “…what can chiropractic do for CTS?” As an overview, the following is a list of what you might expect when you visit a Doctor of Chiropractic for a condition like CTS:
1. A thorough history is VITALLY important as your doctor can ask about job related stressors, hobby related causes (such as carpentry or playing musical instruments), telephone work, or factory work – especially if it’s fast and repetitive. Your doctor will also need to learn about your “co-morbidities” or, other conditions that can directly or indirectly cause CTS such as diabetes, thyroid disease, certain types of arthritis, certain medication side effects, and others.
2. A Physical Exam to determine the area(s) of nerve compression degree of severity. This may include ordering special tests such as EMG/NCV, if necessary.
3. Treatment can include manipulation, soft tissue release, PT modalities (eg., electric stim., ultrasound).
4. Home Therapies are the main topic for this Health Update. What can YOU do for CTS?
Here are some of the things that you, the CTS sufferer can self-manage:
A Carpal tunnel splint is primarily worn at night, keeping your wrist in a neutral or straight position. This position places the least amount of stretch on the nerves and muscle tendons that travel through the carpal tunnel at the wrist.
Exercises (Dose: 5-10 second holds, 5-10 repetitions, multiple times / day) such as: A. The “Bear claw” (keep the big knuckles of the hand straight but bend the 2 smaller joints of the fingers and thumb and alternate with opening wide the hand) B. Tight Fist / open hand (fully open – spread and extend the fingers and then make a fist, with the hand). C. The upside down palm on wall wrist and forearm stretch (stand facing a wall; with the elbow straight, place the palm of your hand on the wall, fingers pointing down towards the floor. Try to bend the wrist to 90 degrees keeping the palm flat on the wall. Feel the stretch in the forearm – hold for 5-10 seconds. Reach across with the other hand and gently pull back on the thumb for an added stretch! D. Wrist range of motion (dorsiflexion/palmar flexion) – Place forearm on a table with wrist off the edge, palm down. Bend hand downward as far as possible, then upward. Repeat 5 or 10 times. E. Wrist range of motion (pronation/supination) – Place forearm and whole hand on table-- elbow bent 90°, palm flat on tabletop. Rotate the wrist and forearm so the back of hand is now flat on tabletop. Repeat 5 or 10 times. F. Neck Stretch. Sit or stand with head facing forward. Side bend as far to the right as possible (approximate the right ear to right shoulder) and hold for 5 seconds. Reach over with the right hand to the left side of the head and gently pull further to the right to increase the stretch. Reverse instructions for the other side. Repeat 3 to 5 times. Consider other neck exercises if needed. G. Shoulder shrug and rotation. Stand with arms at the sides. Shrug the shoulders up toward the ears, then squeeze the shoulder blades back, then downwards and then roll them forward. Do the whole rotation slowly and reverse the direction. Repeat 3 to 5 times. If you cannot comfortably do the whole rotation, just shrug the shoulders up and down. H. Pectoral stretch. Stand in a doorway (or a corner of a room). Rest your forearms, including your elbows, on the doorframe, keeping your shoulders at a 90-degree angle. Lean forward until a stretch is felt in the chest muscles. Do not arch your back. Hold 20 seconds; repeat 5 times.
Job modifications are also VERY important but unfortunately, a topic for another time! In short, rotate job tasks (if possible), take mini-breaks, and use tools with handles that fit easily into the hands. Have a job station analysis completed if the above are not enough.
Do I Have to Have Surgery For Carpal Tunnel Syndrome?
“For the last few months, I’ve been waking up at night with numbness and tingling in my hand. Lately, I’ve been waking up more often, 3-4 times a night and I’m having a hard time falling back to sleep. When I drive, my hands fall asleep within a few minutes and I have to shake my hand and fingers to wake them up. This has gotten to the point where I have to do something but I really don’t want surgery. What are my non-surgical options?”
CTS or, carpal tunnel syndrome is a condition where a nerve (called the median nerve) that travels down from the neck into the arm and through the wrist becomes pinched and inflamed. Common symptoms include numbness, tingling, dexterity problems (such as difficulty buttoning shirts), and opening jars due to weakness in grip and pinch strength. Sleep interruptions and loss of many daily activities, including work, occur because of CTS.
There are many non-surgical approaches to the treatment of CTS that should be utilized before surgery is considered, according to the American Academy of Neurology. In one study, 40% of neurologist polled recommended non-surgical care due to the potential side effects of surgery, some of which being severe, resulting in lengthy work loss post-surgically. A partial list of non-surgical care options include:
Carpal Tunnel Syndrome (CTS) – What Does Research Show?
So often we hear, “…well if it’s so good, show me the proof!” Chiropractic case management of CTS has been well established for many years. And yet, we still hear skepticism from patients, MD’s, insurers, employers, and others about the benefits of chiropractic management of CTS. If we can, “show them the data” regarding the effectiveness of chiropractic for CTS patients, we will finally be able to help more people with this potentially disabling condition.
So, let’s take a look at the evidence that supports the benefits of chiropractic for CTS:
1) Davis PT, Hulbert JR, Kassak KM, et al. “Comparative efficacy of conservative medical and chiropractic treatments for carpal tunnel syndrome: a randomized clinical trial”
J Manipulative Physiol Ther. 21.5 (June 1997): 317-326.
The most important finding reported in this 91 patient study was that chiropractic treatment was equally effective in reducing CTS symptoms as medical treatment. The chiropractic care included ultrasound, nighttime wrist supports and manipulation of the wrist, arm and spine. Medical care included ibuprofen (800 mg, 3x/day for 1 wk, 800 mg, 2x’day for 1 wk, & 800 mg as needed for 7 wks) plus a night wrist splint. Both groups did equally well but given the side-effect potential of ibuprofen on the stomach, liver, and kidneys, a strong argument for the non-drug, chiropractic approach can be made.
2) Bonebrake AR, Fernandez JE, Marley RJ et al. “A treatment for carpal tunnel syndrome: evaluation of objective and subjective measures” J Manipulative Physiol Ther. 13.9 (Nov-Dec 1990): 507-520
CTS sufferers (n=38) received chiropractic spinal manipulation and extremity adjusting. Also, soft tissue therapy, dietary modifications or supplements (B6) and daily exercises were prescribed. After treatment, results showed improvement in all strength and range of motion measures. Also, a significant reduction in pain and distress ratings was reported.
3) Mariano KA, McDougle MA, Tanksley GW “Double crush syndrome: chiropractic care of an entrapment neuropathy” J Manipulative Physiol Ther. 14.4 (May 1991):262-5
In 1973, Upton and McComas first proposed the presence of the "double crush syndrome." Their hypothesis was that when a nerve is pinched anywhere along its route, it makes the rest of the nerve more sensitive to otherwise “normal” stimulation. A case report of a man with both cervical radiculopathy and carpal tunnel syndrome, i.e., "double crush syndrome" was presented. Chiropractic management consisted of chiropractic manipulative therapy as well as ultrasound, electrical nerve stimulation, traction and a wrist splint. The experimental basis, clinical evidence, etiology, symptomatology and findings of this condition are discussed. The Double Crush Syndrome helps explain why cervical/neck manipulation helps many CTS patients.
Carpal Tunnel Syndrome – Chiropractic vs. Medical Treatment
There are many patients who suffer from Carpal Tunnel Syndrome (CTS). In fact, CTS is one of the most common work related injuries. In spite of multiple studies that show the benefits of chiropractic treatment with patients suffering from CTS, many medical doctors are unaware of the studies and still tell their patients that chiropractic treatment is either ineffective, or may actually harm them. This unsupported ill advice can easily result in the patient not even considering chiropractic care as a potential effective form of treatment. This can be especially damaging to a patient who cannot tolerate anti-inflammatory medications such as Ibuprofen, Aleve, or aspirin. In fact, side effects secondary to stomach pain (gastritis and/or ulcer) can be quite common, especially at the recommended dose of 2400 mg / day. Moreover, if poor tolerance to these medications exists and a unsatisfying response to conservative medical treatment occurs, the “next step” offered to the patient may be surgery. Surgery that may have been avoidable had chiropractic treatment been considered on an equal par to non-surgical medical care.
There are several studies available that will enlighten those who simply are not aware of the effectiveness of chiropractic care in the treatment of CTS. In 1998, a 91 patient group was divided in half and treated for 9 weeks by either a non-surgical medical approach or by a chiropractic treatment approach. The medical approach included the use of 800 mg of Ibuprofen, 3x/day for 1 week, 2x/day for 1 week, and 800mg as needed to a maximum of 2400 mg/day dose for 7 weeks, as well as the use of a nighttime wrist splint. The chiropractic group utilized manipulation of the bony joints and soft tissues of the spine and upper extremity for 3x/week for 2 weeks, 2x/week for 3 weeks, and 1x/week for 4 weeks, in addition to ultrasound over the carpal tunnel and a wrist splint at night. It was reported that BOTH the medical and the chiropractic patient groups did equally well stating, “significant improvement in perceived comfort and function, nerve conduction and finger sensation.”
In 2007, two different chiropractic approaches were compared and found to both be equally effective in improving nerve conduction, wrist strength, and wrist motion as well as patient satisfaction and daily activity function. These improvements were maintained for 3 months in both groups equally as well. Another study reported significant improvements in strength, range of motion, and pain after chiropractic treatment was given to 25 patients diagnosed with CTS. The majority of the patients reported continued improvements for 6 months or more. There are other studies but I think the point is obvious – chiropractic treatment helps patients with CTS.
The type of treatment that one may receive when being treated by a chiropractor includes manipulation of the bony joints of the neck and upper extremity. The objective of this is to improve the mobility of the joints and loosen the muscles through which the nerves pass, particularly, the median nerve that runs through the carpal tunnel and innervates the 2nd to 4th fingers. There are several exercises of both stretching and strengthening types that strive for similar goals. Physical therapy modalities such as low-level laser therapy have reported beneficial results. Other modalities such as ultrasound, interferential current (IFC), ice massage/cupping over the tunnel, and others may also be utilized. Nighttime wrist splints or braces also help to keep the wrist straight so that prolonged bending of the wrist at night is not possible. There may be other treatment approaches that your chiropractic physician may suggest on an individual case basis.
Carpal Tunnel: Results of a Clinical trial of Two Treatments
Carpal tunnel syndrome occurs when the median nerve, which starts at the neck and runs from the forearm into the hand, becomes compressed or squeezed at the wrist. In some cases there may also be compression at the spine.
The median nerve controls sensations to the palm side of the thumb and fingers (but not the little finger), as well as impulses to some small muscles in the hand that allow the thumb and fingers to move.
A recent study in the Journal of Manipulative and Physiological Therapeutics compared two different conservative treatments for patients with mild to moderate carpal tunnel symptoms. One treatment was the Graston technique, which uses an instrument to rub the forearm, wrist and hand areas to breakdown scar tissue and adhesions. In the other treatment a chiropractor applied deep pressure by hand to the same areas. These treatments are thought to release tight muscles and myofascial restrictions.
The patients got the treatments twice each week for four weeks followed by one treatment a week for two additional weeks. The patients also did at-home stretching exercises. They did not use common conservative treatments such as wrist splints and anti-inflammatory medications.
After both interventions, there were objective improvements to nerve conduction latencies (nerve function), wrist strength, and wrist motion. The patient symptoms of pain also improved, and both groups reported high satisfaction with the care they received.
Despite surgery being in widespread use in the US for carpal tunnel syndrome, it is important for conservative treatments to be tried prior to an invasive operation.
The surgical complication rates are low but when they do occur, can be devastating. In addition to direct surgery costs, one has to also consider disability payments (not working), and rehabilitation that may take several weeks. These costs can be substantial. For this reason, many medical doctors recommend conservative treatments first.
Of all the conservative options, manual therapy by a chiropractor is an excellent choice. It comes without the side effects associated with long-term use of medications.
A comprehensive examination by a Doctor of Chiropractic can determine if your carpal tunnel symptoms are likely to respond to care. He or she can also advise on at-home stretching exercises that can be done to help recovery. In some cases, hidden spinal and neck problems can influence carpal tunnel symptoms, and be the key to treating the cause vs. the symptom.
Fibromyalgia Articles
Fibromyalgia Facts
Fibromyalgia (FM) is a condition that is characterized by widespread, generalized pain “all over” the body that does not follow any specific anatomical pathway like the course of a nerve, muscle, or blood vessel. It is often diagnosed only after all other conditions have been eliminated by using various testing approaches such as blood tests, x-ray, CT or MRI Scans, and others. Controversy exists between health care providers (HCP’s) as some believe that FM either doesn’t exist at all or if it does, it’s grossly over diagnosed while others feel most patients have some form or degree of FM. Because of this common split in beliefs, patients may be treated poorly by those non-believing HCP’s, which often alienates them from seeking further care for FM.
Recent literature suggests FM is disorder of “central pain processing” or, a specific situation where the pain threshold (the point where pain is felt) is reached sooner than what is normal. Fibromyalgia has been classified into 2 separate groups – primary and secondary FM. Primary FM is diagnosed when no known cause can be identified while secondary FM is related to a specific cause such as a disease or condition. Conditions that have been reportedly associated with FM include irritable bowel syndrome (IBS), TMJ (jaw disorders), chronic low back pain, and headaches. There are genetic as well as environmental factors associated with FM. Researchers have found that there is a strong familial component with 1st degree relatives where an 8 fold greater risk of developing FM compared to the general population exists. These people are also more likely to have one of the other associated conditions previously mentioned (IBS, TMJ, headaches). Environmental factors can lead to FM in 5-10% of the cases. Some of these include physical trauma such as car accidents, following infections such as parvovirus, Epstein-Barr virus, and Lyme disease. Psychological stress, hormonal alterations such as hypothyroid, drug side effects, vaccination reactions and certain catastrophic events such as war are included in the “environmental factors” category. Gender differences include woman being 2-3 times more likely to suffer from FM than men.
So, what are the treatment options for FM? Typically, if you go to a medical doctor, you can expect various forms of drug therapy – possibilities include anti-depressants, anti-anxiety meds, and sleep aids but with these, watch out for grogginess, side effects and some habit forming/dependency problems. Pain killers or analgesics – opioides are NOT appropriate but often prescribed and narcotics can also be habit forming. Tylenol is perhaps the safest but is not very effective. Anti-inflammatory include aspirin, ibuprofen but watch for stomach irritation and blood thinning problems. Dr. Christopher Morris, MD reports that drug treatments for FM have, “…very limited success in providing significant improvement in most patients.” He recommends behavior modification for sleep improvement, exercise (walking, water exercises, strength training, yoga, tai chi, Qi Gong), as well as cognitive behavioral therapy, massage therapy, chiropractic, acupuncture, biofeedback, hypnosis, and dietary modification. Examples of dietary changes include avoiding foods with certain additives including MSG (monosodium glutamate) and aspartame where in one study, “complete resolution” of FM symptoms was reported.
Patients with FM NEED a “quarterback” to guide them in their management of FM and chiropractic is the PERFECT choice as many of these holistic approaches are utilized or can be coordinated through our office.
Fibromyalgia: I Have It… Now What?
“…I was told by my doctor that I have fibromyalgia and I don’t know what to do. I’ve noticed that over the last couple of years that I’ve been having a progressively harder time doing simple tasks that I used to take for granted like folding laundry, ironing, cooking, cutting up vegetables, sewing, driving a car, holding a book, and even sleeping has become very challenging. I have to take many breaks while I’m doing these tasks and even take a nap in the middle of the day. I never used to have to do that! My family doctor initially seemed interested in helping me. He listened to me, took some blood, took some x-rays, and then said ‘….everything looks fine.’ His conclusion was that I must have fibromyalgia – I’ve never even heard of that! He prescribed many different drugs. One was to help me sleep but all it did was knock me out to the point where I couldn’t get up in the morning and felt so groggy that I couldn’t function. Then, he tried this other one and I felt like I wanted to crawl out of my skin! I’ve tried 3 or 4 different drugs and the side effects were all worse than what I’m dealing with, without the drugs. He finally concluded, ‘…you’ll just have to learn how to live with it.’ Well, thank you very much, doctor! Tell me HOW to do that?”
That feeling of helplessness and not knowing what to do next is a common complaint among fibromyalgia (FM) sufferers and the fact is, many patients with FM simply CAN’T just “…learn to live with it,” and need guidance.
One such patient recently presented in such situation. After a detailed history, the chiropractor checked her vital signs, performed a physical exam that included observation, palpation, range of motion, physical performance testing, orthopedic and neurological tests and then sat down to discuss the findings and what specific things chiropractic could offer her. The chiropractor laid out a treatment that consisted of the following:
· Leg length correction: she had a 12mm short right leg, a tipped pelvis with a compensatory curve in the low back. Heel lifts were recommended.
· Foot orthotics: she had flat feet and rolled in ankles that were altering her gait pattern.
· Exercises: she was quite deconditioned (out of shape) and needed help with flexibility, strength and endurance, balance/coordination, and aerobic function.
· Spinal manipulation: She had areas in her spine that were not properly moving and she had to compensate and use other parts too much, setting up faulty movement habits.
· Nutritional counseling: She was consuming too many glutens (wheat, oats, barley, rice) which can make you feel tire/fatigued/”wiped out” all the time. She was placed on a strict gluten-free diet and encouraged to use of several nutrients.
· They discussed “realistic goals.” This was probably the MOST important part for her. She was told NOT to expect a “cure” but rather, a means of “controlling” FM. It was emphasized that expecting “too much” will set her up for disappointment and treatment failure. They discussed ways she could control or minimize the symptoms of FM and what the role of chiropractic played in that management process. They also discussed finding a family doctor who was willing to work with her chiropractor.
Her doctor reports she is doing very well, independent of regular doctor visits, and is for the first time in a long time, happy with her ability to control her FM condition.
Fibromyalgia & Chiropractic Care
Do you wake up feeling tired, washed out, and dragged down? Do you have generalized pain throughout your body that doesn’t seem to respond to anything you’ve tried? Do you wake up multiple times a night and fight getting back to sleep? These are classic symptoms of fibromyalgia (FM). However, when caught early and treated appropriately, FM can resolve or at least be controlled. Chiropractic care and management of FM is very effective and is becoming increasingly popular among FM sufferers. The goal of managing FM is to return you to a productive, enjoyable lifestyle allowing you to function and perform all of your desired activities.
Chiropractic care is the most popular and sought after form of alternative care or complementary medicine as 20% of American men and women utilize chiropractic care at some point in their lives. Of all the health care options, few have been found to be as satisfying to their patients as chiropractic with 80% of those seeking chiropractic treatment reporting significant pain relief, better functioning and an increased sense of wellbeing. Still, many ask questions such as, what is the science behind chiropractic and, what exactly does a chiropractor do?
The original hypothesis or theory of chiropractic that led to its founding in 1895 is that skeletal or bone misalignments cause nerve interference resulting in pain, loss of function, and a host of other symptoms related to the nervous system. The entire body is connected through bones, joints, muscles, ligaments, tendons, with their supporting circulatory or blood flow system and nervous system. When the skeletal structure is in good alignment, the body can handle the many stresses and challenges we all face on a daily basis. When there is a breakdown in this system, symptoms manifest and when left untreated, these symptoms can develop into chronic pain, including conditions such as fibromyalgia. Chiropractors focus to reduce pain and the many other symptoms by correcting the imbalances in the skeletal system with the objective of reducing nervous system dysfunction. Many of the techniques utilized in chiropractic care include manipulation of not only the bony structures, but also the muscles, tendons, and ligaments through various forms of manual or hands-on therapy, stretching, posture correction methods, exercise, lifestyle modification recommendations including diet and nutritional management, and activity modifications. Chiropractic care also includes discussions and instructions for modifying methods of performing tasks including bending, lifting, pulling, pushing in both at work and home activities. Work station modifications are also thoroughly investigated, especially when symptoms are consistently worse after the work day.
Patients with fibromyalgia classically have generalized pain and tender spots throughout their body and often present with back pain, neck pain, headaches, as well as arm and/or leg pain. Chiropractic care can effectively reduce the pain associated with FM by reducing bony misalignments, restoring muscle tone, and improving posture. Proper exercise training has been found to be very important in maintaining long-term control of FM and is included in the management of FM. Diet and nutritional counseling may also be beneficial. Research has been very supportive of chiropractic care for patients suffering from FM.
Fibromyalgia – Can Chiropractic Help… Who Says?
Fibromyalgia (FM) is one of the most commonly diagnosed soft tissue conditions in most branches of health care, including chiropractic. A paper was recently published with the primary purpose to review the existing literature / published research to determine what aspects of chiropractic treatment are the most commonly used and, to determine the quality of those treatment approaches. The emphasis of the study was to look at non-drug, conservative forms of therapy, rather than medication based approaches.
Commonly utilized chiropractic treatment options found to be beneficial include massage, muscle strengthening exercises, acupuncture, spinal manipulation, movement/body awareness, vitamins, herbs, and dietary modification. Cognitive behavioral therapy, not typically a chiropractic specific form of care, was also reported to be of significant benefit, as well as aerobic exercise. This study places chiropractic in a very favorable position in the management of FM.
Chiropractic is unique in that it encompasses many non-drug, non-surgical forms of treatment, making it appealing to many who do not want to risk the chances of drug related side effects and post-surgical complications. Patients with FM require a multi-dimensional treatment approach and a health care provider versed in whole-body, holistic concepts is in the best position to help this population.
Fibromyalgia can be primary where the specific cause is not well understood or secondary to an underlying injury or condition. Sometimes, it is difficult to determine the exact cause as other conditions can be present and/or arise simultaneously with FM making it difficult to differentiate between primary and secondary. When other conditions are present, sometimes attending those specific conditions will improve the status of FM and focus on treatments that address all of the patient’s physical and emotional health issues yields the most patient satisfying results.
Fibromyalgia And Your Upper Neck
How can a spinal problem possibly contribute to your fibromyalgia symptoms? As with many disorders, especially pain, the nervous system is involved. The nervous system can get affected thorough structural changes in the spinal column. The classic one is the disk bulge producing a painful sciatic nerve. But, there are also other ways to interfere with the function of nervous system.
When viewing the neck from the side, there should be a forward curve with your head above your shoulders, not in front of them. When forward head carriage is present or when there is a reduction in this forward arch, this may cause additional strain to the upper cervical spine or spinal cord, allowing delicate nerves to be compromised. Chiropractic care should improve your posture if this forward head carriage is present.
The upper neck can also be influenced by malalignment/subluxation of the upper vertebrae, such as the atlas. This small bone supports the weight of the skull and is necessary for the great rotational range of motion of the neck.
During neck trauma, the head and neck can be put through a violent range of motion that causes the soft tissues (muscles and ligaments) to tear. Blows to the head, childhood or sports injuries and even poor sleeping posture, can cause the upper neck vertebrae to displace, injuring the soft tissues of the joint. Swelling and inflammation can also be a source of irritation to the nervous system. Scar tissue can develop after trauma, which may affect the precise movements of the upper neck.
The atlas surrounds the spinal cord and as it displaces, it can also pull or tether the spinal cord through attachments of delicate ligaments (dentate). This could cause irritation to the nervous system.
The disorders of poor posture and displaced vertebrae can be assessed through x-rays. Range of motion tests are necessary to see how your function may be affected. In some patients, fibromyalgia symptoms can improve substantially. However, most people will need a comprehensive approach that also incorporates an exercise program and nutritional or weight loss support. Chiropractic care is a natural alternative for those who wish a drug-free and non-invasive approach. It carries few risks of side effects and is balanced by the potential to help patients who also have spinal disorders contributing to their poor health.
Whiplash Articles
Car Accidents and Mild Traumatic Brain Injury
When you woke up today, you thought this was like any other Friday. You’re on your way to work, and traffic is flowing smoother than normal. Suddenly, someone crashes into the back end of your car and you feel your head extend back over the headrest and then rebound forwards, almost hitting the steering with your forehead. It all happened so fast. After a few minutes, you notice your neck and head starting to hurt in a way you’ve not previously felt. When the police arrive and start asking questions about what had happened, you try to piece together what happened but you’re not quite sure of the sequence of events. Your memory just isn’t that clear. Within the first few days, in addition to significant neck and headache pain, you notice your memory seems fuzzy, and you easily lose your train of thought. Everything seems like an effort and you notice you’re quite irritable. When your chiropractor asks you if you’ve felt any of these symptoms, you look at them and say, "…how did you know? I just thought I was having a bad day – I didn’t know whiplash could cause these symptoms!"
Because these symptoms are often subtle and non-specific, it’s quite normal for patients not to complain about them. In fact, we almost always have to describe the symptoms and ask if any of these symptoms “sound familiar” to the patient.
As pointed out above, patients with Mild Traumatic Brain Injury (MTBI) don’t mention any of the previously described symptoms and in fact, may be embarrassed to discuss these symptoms with their chiropractor or physician when they first present after a car crash. This is because the symptoms are vague and hard to describe and, many feel the symptoms are caused by simply being tired or perhaps upset about the accident. When directly asked if any of these symptoms exist, the patient is often surprised there is an actual reason for feeling this way.
The cause of MTBI is due to the brain actually bouncing or rebounding off the inner walls of the bony skull during the “whiplash” process, when the head is forced back and forth after the impact. During that process, the brain which is suspended inside our skull, is forced forwards and literally ricochets off the skull and damages some of the nerve cells most commonly of either the brain stem (the part connected to the spinal cord), the frontal lobe (the part behind the forehead) and/or the temporal lobe (the part of the brain located on the side of the head). Depending on the direction and degree of force generated by the collision (front end, side impact or rear end collision), the area of the brain that may be damaged varies as it could be the area closest to initial impact or, the area on the opposite side, due to the rebound effect. Depending on which part of the brain is injured, the physical findings may include problems with walking, balance, coordination, strength/endurance, as well as difficulties with communicating (“cognitive deficits”), processing information, memory, and altered psychological functions.
The good news is that most of these injuries will recover within 3-12 months but unfortunately, not all do and in these cases, the term, “post-concussive syndrome” is sometimes used.
Whiplash Facts
Whiplash is a fairly common condition that occurs when the neck is suddenly forced forwards and backwards, usually from motor vehicle collisions. Before 1928, whiplash was sometimes called “railway spine” as it was used to describe injuries that occurred to people involved in train accidents. Since 1928, much has been studied and reported about this condition and in 1995, the term, “whiplash associated disorders” or WAD, was introduced. The WAD classification of whiplash patients includes 3 main category (WAD I, II and III) and a few years later, WAD II was broken into 2 sub-categories (WAD I, IIa, IIb, III). This occurred because some patients in WAD II took a longer time to heal than others. Here are the basic definitions of WAD I, II, III:
We have discussed the cause of whiplash in previous articles and what happens when we are hit from behind unexpectedly. In essence, we cannot guard against the abnormal forces that occur in the neck as it all happens faster than we can voluntarily contract our muscles. Also, the myth about no car damage = no injury is just that – a myth! In fact, in low speed impacts, less damage to the car transfers greater forces to the contents inside because the energy of the force is not absorbed by crushing metal (elastic vs. plastic deformity).
Symptoms of whiplash vary widely. Most common symptoms include neck pain and stiffness, headache, shoulder pain/stiffness, dizziness, fatigue, jaw pain, arm pain, arm weakness, visual disturbances, ringing ear noises, and sometimes back pain. If symptoms continue and chronic WAD occurs, depression, anger, frustration, anxiety, stress, drug dependency, post-traumatic stress syndrome, sleep disturbance, and social isolation can occur.
Diagnosis is based on the history, physical exam, x-ray, MRI, and if nerve damage occurs (WAD III), an EMG. Treatment includes rest, ice and later heat, exercise, pain management and avoiding prolonged use of a collar. Chiropractic includes all of these as well as manipulation, mobilization, muscle release methods, and patient education. Prompt return to normal activity including work is important to avoid the negative spiral into long term disability.
What Really Causes Whiplash?
Whiplash is a non-medical term for a condition that occurs when the neck and head move rapidly forwards and backwards or, sideways, at a speed so fast our neck muscles are unable to stop the movement from happening. This sudden force results in the normal range of motion being exceeded and causes injury to the soft tissues (muscles, tendons and ligaments) of the neck. Classically, whiplash is associated with car accidents or, motor vehicle collisions (MVCs) but can also be caused by other injuries such as a fall on the ice and banging the head, sports injuries, as well as being assaulted, including “shaken baby syndrome.”
The History Of Whiplash. The term “Whiplash” was first coined in 1928 when pilots were injured by landing airplanes on air craft carriers in the ocean. Their heads were snapped forwards and back as they came to a sudden stop. There are many synonyms for the term “whiplash” including, but not limited to, cervical hyperextension injury, acceleration-deceleration syndrome, cervical sprain (meaning ligament injury) and cervical strain (meaning muscle / tendon injury). In spite of this, the term “whiplash” has continued to be used usually in reference to MVCs.
Why Whiplash Occurs. As noted previously, we cannot voluntarily stop our head from moving beyond the normal range of motion as it takes only about 500 milliseconds for whiplash to occur during a MVC, and we cannot voluntarily contract our neck muscles in less than 800-1000 msec. The confusing part about whiplash is that it can occur in low speed collisions such as 5-10 mph, sometimes more often than at speeds of 20 mph or more. The reason for this has to do with the vehicle absorbing the energy of the collision. At lower speeds, there is less crushing of the metal (less damage to the vehicle) and therefore, less of the energy from the collision is absorbed. The energy from the impact is then transferred to the contents inside the vehicle (that is, you)! This is technically called elastic deformity – when there is less damage to the car, more energy is transferred to the contents inside the car. When metal crushes, energy is absorbed and less energy affects the vehicle's contents (technically called plastic deformity). This is exemplified by race cars. When they crash, they are made to break apart so the contents (the driver) is less jostled by the force of the collision. Sometimes, all that is left after the collision is the cage surrounding the driver.
Whiplash Symptoms. Symptoms can occur immediately or within minutes to hours after the initial injury. Also, less injured areas may be overshadowed initially by more seriously injured areas and may only “surface” after the more serious injured areas improve. The most common symptoms include neck pain, headaches, and limited neck movement (stiffness). Neck pain may radiate into the middle back area and/or down an arm. If arm pain is present, a pinched nerve is a distinct possibility. Also, mild brain injury can occur even when the head is not bumped or hit. These symptoms include difficulty staying on task, losing your place in the middle of thought or sentences and tireness/fatigue. These symptoms often resolve within 6 weeks with a 40% chance of still hurting after 3 months, and 18% chance after 2 years. There is no reliable method to predict the outcome. Studies have shown that early mobilization and manipulation results in a better outcome than waiting for weeks or months to seek chiropractic treatment. The best results are found by obtaining prompt chiropractic care.
Whiplash – What is the Best Type of Treatment?
Whiplash usually occurs when the head is suddenly whipped or snapped due to a sudden jolt, usually involving a motor vehicle collision. However, it can also occur from a slip and fall injury. So the question on deck is, which of the health care services best addresses the injured whiplash patient?
This question was investigated in a published study titled, A symptomatic classification of whiplash injury and the implications for treatment (Journal of Orthopaedic Medicine 1999;21(1):22-25). The authors state conventional [medical] treatment utilized in whiplash care, "is disappointing." The authors’ reference a study that demonstrated chiropractic treatment benefited 26 of 28 patients with chronic whiplash syndrome. The objective of their study was to determine which type of chronic whiplash patient would benefit the most from chiropractic treatment. They separated patients into one of 3 groups: Group 1: patients with "neck pain radiating in a 'coat hanger' distribution, associated with restricted range of neck movement but with no neurological deficit"; Group 2: patients with "neurological symptoms, signs or both in association with neck pain and a restricted range of neck movement"; Group 3: patients who described "severe neck pain but all of whom had a full range of motion and no neurological symptoms or signs distributed over specific myotomes or dermatomes." These patients also "described an unusual complex of symptoms," including "blackouts, visual disturbances, nausea, vomiting and chest pain, along with a nondermatomal distribution of pain."
The patients underwent an average of 19.3 adjustments over the course of 4.1 months (mean). The patients were then surveyed and their improvement was reported:
These findings show the best chiropractic treatment results occur in patients with mechanical neck pain (group 1) and / or those with neurological losses (group 2). The exaggerated group (group 3) was the most challenging and, the only group where a small percentage worsened. The good news is, the number of cases that responded well to chiropractic treatment (groups 1 & 2) far out number those that don’t (group 3). Hence, most patients with whiplash injuries should consider chiropractic as their first choice of health care provision.
“The Only Proven Effective Treatment” for Chronic Whiplash?
You may have wondered, “If I get hurt in a car accident, who should I go to for treatment of my whiplash problem?” This can be quite a challenge as you have many choices available in the healthcare system ranging from drug-related approaches from anti-inflammatory over-the-counter types all the way to potentially addicting narcotic medications. On the other side of the fence, there are nutritional based products such as vitamins and herbs as well as “alternative” or “complementary” forms of treatment such as chiropractic, exercise, and meditation, with many others in between. Trying to figure out which approach or perhaps combined approaches would best serve your needs is truly challenging. To help answer this question, one study reported the superiority of chiropractic management for patients with chronic whiplash, as well as which type of chronic whiplash patients responded best to the care. The research paper begins with the comment from a leading orthopedic medical journal stating, “Conventional [meaning medical] treatment of patients with whiplash symptoms is disappointing.” In the study, 93 patients were divided into three groups consisting of:
Here are the results:
Chiropractic Articles
Chiropractic Education
Many people seem surprised to find out that the chiropractic education process is so extensive. I usually reply, "...whether you're planning to become a chiropractor, medical doctor, or dentist, it takes four years of college followed by and additional 4-5 years of additional education (med school, dental school, chiropractic college) simply because there is that much to learn about the body to become a competent health care provider. "
Hence, depending on the area of interest a person has in the health care industry, it takes a similar amount of time to complete the educational program.
DID YOU KNOW...
· The initial step is completing a typical "pre-med" undergraduate or college degree.
· Courses including biology, inorganic and organic chemistry, physics, psychology, various science labs, as well as all the liberal art requirements needed to graduate are included in the undergraduate education process.
· Many states now require 4 years of college in addition to the 4 to 5 academic years of chiropractic education to practice in their particular state.
· Once entering a chiropractic university, the same format exists as most health care disciplines.
· The basic sciences are covered in the first half of the educational process after which time successful completion of the National Boards Part I examination is required to move into the second half - the clinical sciences.
· From there, internships, residency programs, preceptorship programs become available to the chiropractic student.
· Once graduated, residence programs including (but not limited to) orthopedics, neurology, pediatrics, radiology, sports medicine, rehabilitation, internal medicine, and others are options. Many various Masters and doctorate programs in specialty areas are also available.
This chart shows the similarities between three health care delivery approaches, DC, MD, and DPT (doctor of physiotherapy). Curriculum Requirements For the Doctor of Chiropractic Degree (DC) in comparison to the Doctor of Medicine Degree (MD) and the Doctor of Physical Therapy Degree (DPT): *Does not include hours attributed to post-graduation residency programs.
AS YOU CAN SEE, THE ACTUAL NUMBER OF AVERAGE CLASSROOM AND CLINICAL STUDY HOURS PRIOR TO GRADUATION IS EVEN HIGHER FOR CHIROPRACTIC COMPARED TO THE MD AND DPT CURRICULUM.
It should be noted that this does not include additional educational training associated with residency programs, which are available in the three disciplines compared here.
At one of the chiropractic colleges, the academic core program or Clinical Practice Curriculum consists of 308 credit hours of course study and includes 4,620 contact hours of lecture, laboratory and clinical education.
There are 10 trimesters of education arranged in a prerequisite sequence.
The degree of Doctor of Chiropractic (D.C.) is awarded upon successful completion of the required course of study.
In order to receive a degree, a student must have satisfied all academic and clinical requirements and must have earned no less than the final 25 percent of the total credits required for the D.C. degree, allowing up to 75 percent of the total credits through advanced standing.
The academic program may be completed in three and one-third calendar years of continuous residency. Graduation, however, is contingent upon completion of the program in accordance with the standards of the College, which meet or exceed those of its accrediting agencies.
In addition to courses included in the core curriculum, a variety of procedure electives are available to the students. These electives are designed to complement the study of adjustive procedures included and facilitate investigation of specialized techniques.
As a doctor of chiropractic, we are committed to providing the highest quality care available to our patients. We coordinate care with other doctors when appropriate in quest of reaching the goal of our helping our patients in the most efficient, economic, and evidence-based approach possible.
Many Medical Doctors Recommending Chiropractic Care For Back Pain Relief
Harvard Study: Low Back Pain Patients Significantly More Satisfied With Chiropractic Than Conventional Medical Care.
At the 17th annual North American Spine Society meeting, three medical doctors defended Chiropractic by citing a Harvard study that found low back pain patients were significantly more satisfied with Chiropractic treatments compared to conventional medical care.
After researching "myths," Co-author , Dr. Zigler, MD found Chiropractic education is more similar to medical education than it is dissimilar.
Dr. Zigler had integrated Chiropractors into his multi-disciplinary spine center where the Chiropractors screen patients for surgical versus non-surgical care.
Another co-author, Dr. Cole, MD, stated, "overall, manipulation* has the advantage of reducing pain, decreasing medication, rapidly advancing physical therapy and requiring fewer passive modalities." (*Manipulation is one of the primary treatment techniques used by Doctors of Chiropractic.)
He also recommends spine surgeons refer their patients to Chiropractors.
Physical Therapy Vs. Chiropractic
The most obvious difference between doctors of chiropractic (DC's) and physical therapists (PT's) is virtually all DC's utilize some form of manipulation to restore joint function, whereas only a very small percentage of PT's utilize manipulation and virtually none of them have nearly as much experience "adjusting" patients or, the training to determine how and when to adjust for ultimate results go beyond just pain relief. Another very important difference is the education curriculum of chiropractors includes many class hours in physiology, pathology, clinical examination, radiology, laboratory testing and interpretation and diagnosis - these are not included in the PT educational process.
Perhaps even more important, chiropractors are accessible to the general public - that is, a referral from a medical doctor is not required. This is not the case for physical therapy as a medical referral is required and, the medical doctor can limit the amount of care rendered. This is an area that the physical therapy groups are currently working hard to change with many debated issues being presented. There are now some states that allow direct access of patients to doctors of physical therapy (DPT's), a new program created to improve the limited accessibility to PT's.
With the debate raging on about health care reform, a pilot study indicating chiropractic care and other physical medicine approaches may reduce costs is VERY TIMELY!
In 2008, Welllmark Blue Cross and Blue Shield conducted a 1-year pilot program designed to study the patient quality of care. The researchers concluded that the use of chiropractic and other physical medicine services significantly improved clinical outcomes and reduced health care costs. The 2008 Iowa and South Dakota pilot study included 238 chiropractors, physical therapists and occupational therapists that provided care to 5500 Wellmark patients with musculoskeletal disorders. They reported 89% of all patients receiving physical mediclne services improved at least 30% within 30 days. These statistics were so impressive that they decided to continue the program.
Supporters of chiropractic treatment praised the findings, saying that the cost-effectiveness of the method has been documented in several studies.
The president of the American Chiropractic Association, Glenn Manceaux, referred to a 2005 study published in the Journal of Manipulative and Physiological Therapeutics that found chiropractic and medical care have comparable costs for treating chronic low-back pain, with chiropractic care producing significantly better outcomes. Similarly, a study published in a 2003 edition of Spine medical journal found that manual manipulation provides better short-term relief of chronic spinal pain than a variety of medications, he said - "Especially during the health care reform debate, it's important that chiropractic and other conservative care methods are taken into serious consideration as a cost-effective alternative to the utilization of expensive surgery and hospital-based care."
Is Chiropractic Dangerous?
The mission of chiropractic is to help sick people get well, as well as to help healthy people function better in the absence of drugs or surgery.
When people are asked, "...what do chiropractors do?" the frequent response is, "...they crack your neck and/or back."
Chiropractic spinal manipulation (frequently called an adjustment), often produces an audible popping or cracking noise.
This sound is known as joint cavitation and it is reported to be caused by the release of pressure created by gases (nitrogen, oxygen, and carbon dioxide) within the joint.
It is the same noise produced when one cracks their knuckles. One common myth is that cracking or cavitating a joint will produce arthritis in the joint - this is simply not true.
Several scientific studies of joint cavitation dispel this old wives tale. In fact, studies demonstrated that joint manipulation actually benefits patients with arthritis of the spine.
There have been a number of studies published on the topic of unwanted reactions to spinal manipulation.
In general, side effects, if any, are mild and transient.
When they do occur, they typically happen shortly after the first or second session of spinal manipulation, similar to the post-exercise soreness that occurs when first introducing a new sport or activity.
Unpleasant side effects may occur in between 10% and 30% of patients. They occur more often in women than men, and as previously stated, they seem to occur more often after the first session of spinal manipulation.
The most commonly reported unpleasant reaction is temporary and transient increased pain or stiffness. This reaction usually resolves in 24 hours or less. More rare reports of tiredness, light headedness, and occasional nausea have been infrequently reported.
The type and nature of these reactions may be associated with the severity and nature of the condition being treated.
It seems self evident that more severe problems have the potential to produce short term increases in symptoms. The use of ice, ultrasound and or other modalities can help to minimize any irritation that may occur due to spinal manipulative treatment.
SPINAL MANIPULATION HAS BEEN FOUND TO BE SAFE AND EFFECTIVE FOR UNCOMPLICATED SPINAL PAIN SYNDROMES. MORE IMPORTANTLY, IT MAY ALSO BE A VIABLE ALTERNATIVE TO SURGERY FOR LUMBAR OR CERVICAL DISK HERNIATIONS.
There are many reports on both sides of this subject, with some stating spinal manipulation can increase compression of the spinal nerves in patients with disk herniations as well as the opposite - that it reduces nerve root pressure.
The good news is that the rate of occurrence is only about 1 in 1- 3 million cases, making spinal manipulation for disk problems an extremely safe treatment option for patient with herniated disks.
Chiropractors will often use low-force manipulation methods for treating herniated disks that do not require a standard type of manipulation thrust.
These spinal methods are sometimes preferred over traditional manipulative techniques for the treatment of herniated spinal disks, but this is case dependent.
To make an educated decision about any type of care you may be considering, you must consider "relative risks". Simply put, relative risks compare the risk of one procedure with the risk of a second procedure for the same condition.
For example, if you are taking medications to relieve your pain, how do the risks of the medications compare with the risks of an alternative treatment, like chiropractic care?
An example is chiropractic treatment versus drugs known as non-steroidal anti-inflammatory drugs (NSAIDs), which include aspirin, Aleve and Advil (TM).
THE RISK FOR SERIOUS SIDE EFFECTS FROM ANTI-INFLAMMATORY DRUG IS FROM 6000-9000 TIMES GREATER THAN THE RISK FOR SERIOUS SIDE EFFECTS FROM SPINAL MANIPULATION, MEANING THAT CHIROPRACTIC CARE IS A MUCH SAFER ALTERNATIVE THAN ASPIRIN OR OTHER NSAID DRUGS FOR TREATING INFLAMMATORY BACK OR NECK PAIN.
Further, there is no significant increased risk to add chiropractic care to an existing regime of NSAIDs, thus treating the condition with two different strategies.
Interestingly, studies have reported that patients receiving chiropractic care were able to reduce their intake of drugs, thus, reducing the risks of drug reactions/interactions.
If you are trying to avoid surgery for a spine related problem, your condition is more serious and potential side effects of surgery should be compared with chiropractic.
You should understand any patient who is a potential candidate for spine surgery has a serious medical condition. There is pressure on a nerve and the potential for permanent damage to that nerve exists.
Studies show that chiropractic care often can reduce the pressure on a compressed nerve in the lower back or neck, without surgery.
The Difference in Effectiveness of Medical vs. Chiropractic
In The Treatment of Acute and Chronic Back Pain
Have you ever considered who is the best suited to treat back pain? Since there are so many treatment options available today, it is quite challenging to make this decision without a little help.
To facilitate, a study looking at this very question compared the effectiveness between medical and chiropractic intervention. Over a 4-year time frame, 2780 patients were followed with questionnaires. Low Back Pain patients were treated using conventional approaches by both MDs (Medical Doctors) and DCs (Doctors of Chiropractic).
Chiropractic treatments included spinal manipulation, physical therapy, an exercise plan, and self-care education. Medical therapies included prescription drugs, an exercise plan, self-care advice and about 25% of the patients received physical therapy.
The study focused on present pain severity and functional disability (activity interference) measured by questionnaires mailed to the patients. It was reported that chiropractic was favored over medical treatment in the following areas:
· Pain relief in the first 12 months (more evident in the chronic patients)
· When LBP pain radiated below the knee (more evident in the chronic patients)
· Chronic LBP patients with no leg pain (during the first 3 months)
Similar trends favoring chiropractic were seen for disability but were of smaller magnitude. All patient groups saw significant improvement in both pain and disability over the four year study period.
Acute patients saw the greatest degree of improvement with many achieving symptom relief after 3 months of care.
This study also found early intervention reduced chronic pain and, at year 3, those acute LBP patients who received early intervention reported fewer days of LBP than those who waited longer for treatment.
While both MDs and DCs treatment approaches helped, it's quite clear from the information reported that chiropractic should be utilized first.
These findings support the importance of early intervention by chiropractic physicians and make the most sense for those of you struggling with the question of who to see for your LBP.
NECK PAIN
Can Chiropractic Really Help Neck Pain?
What Is This Pain In My Neck?
The Neck and Headache Connection
The Neck is Your Life Line
BACK PAIN
Low Back Pain, Why Is It So Common?
Low Back Pain; Where Is My Pain Coming From?
Low Back Pain & Balance Exercises
Does Chiropractic Work? What Do Insurance Companies Say?
Chiropractic Care For Low Back Pain-What Does The Research Say?
HEADACHES
Side Effects of Chiropractic vs. Medications for Headaches
Headaches-How Does Chiropractic Work?
Chiropractic Manipulation: A New Study Regarding Headaches
The Importance of Headache Diagnosis
Side Effects of Chiropractic vs. Medications for Headaches
CARPAL TUNNEL SYNDROME
Carpal Tunnel Syndrome-What Can You Do For It?
Do I Have To Have Surgery For Carpal Tunnel Syndrome?
Carpal Tunnel Syndrome (CTS)- What Does The Research Show?
Carpal Tunnel Synbdrome – Chiropractice vs. Medical Treatment
Carpal Tunnel: Results of a Clinical Trial of Two Treatments
FIBROMYALGIA
Fibromyalgia Facts
Fibromyalgia: I Have It…Now What?
Fibromyalgia & Chiropractic Care
Fibromyalgia-Can Chiropractic Help…Who Says?
Fibromyalgia And Your Upper Neck
WHIPLASH
Car Accidents and Mild Traumatic Brain Injuries
Whiplash Facts
What Really Causes Whiplash
Whiplash-What Is The Best Type of Treatment
Chiropractic-Only Proven Effective Treatment For Chronic Whiplash
CHIROPRACTIC
Chiropractic Education
Many Medical Doctors Recommending Chiropractic Care For Back Pain Relief
Physical Therapy Vs. Chiropractic
Is Chiropractic Dangerous?
The Difference in Effectiveness of Medical vs. Chiropractic In The Treatment of Acute and Chronic Back Pain
Neck Pain Articles
Neck Pain – Can Chiropractic Really Help?
Neck pain is a very common problem affecting up to 70% of the adult population at some point in life. Though there are specific causes of neck pain such as arising from a sports injury, a car accident or “sleeping crooked,” the vast majority of the time, no direct cause can be identified and thus the term nonspecific is applied. There are many symptoms associated with patients complaining of neck pain and many of these symptoms can be confused with other conditions. Wouldn’t it be nice to know what neck related symptoms are most likely to respond to chiropractic manipulation before the treatment has started? This issue has been investigated with very favorable results!
The ability to predict a favorable response to treatment has been termed, “clinical prediction rules” which in general, are usually made up of combinations of things the patient says and findings from exams. In a large study, data from about 20,000 patients receiving about 29,000 treatments, was collected and analyzed to find out what complaints responded well to chiropractic treatment. The results showed that the presence of any 4 of these 7 presenting complaints predicted an immediate improvement in 70-95% of the patients: 1. Neck pain; 2. Shoulder, arm pain; 3. Reduced neck, shoulder, arm movement; 4. Stiffness; 5. Headache; 6. Upper, mid back pain, and 7. None or one presenting symptom. Items not associated with a favorable immediate response included “numbness, tingling upper limbs,” and “fainting, dizziness and light-headedness in 4-12% of the patients. The “take-home” message here is that was far more common to see a favorable response (70-95%) of the patients compared to an unfavorable response (4-12%), supporting the observation that most patients with neck complaints will respond favorably to chiropractic treatment.
So, what do we do as chiropractors when a patient presents with neck pain? First, after gathering preliminary information such as name, address and insurance information, a history of the presenting complaint is taken. This consists of information including what started the neck complaint (if you know), when it started, what makes it worse, what makes it better, the quality of pain (aches, stiff, numb, etc.), the location and if there is radiating complaints, the severity (0-10 pain scale), timing (such as worse in the morning, evening, etc.), and if there have been prior episodes. Various questionnaires are included that are scored so improvement down the road can be tracked and a past history that includes a medication list, past injuries or illnesses, family history and a systems review are standard. The exam includes vital signs (BP, pulse, height, weight, temperature and respiration), palpation, range of motion, orthopedic and neurological examination. X-ray and/or other “special tests” may also be included, when needed. A review of all the findings are discussed and after permission to treat is granted, a chiropractic adjustment may then be rendered. A list treatment options may include:
1. Adjustments;
2. Soft tissue therapy (trigger point stimulation, myofascial release);
3. Physical therapy modalities;
4. Posture correction exercises and other exercises/home self-administered therapies;
5. Education about job modifications;
6. Co-management with other health care providers if/when needed.
What Is This Pain in My Neck!
“When I woke up this morning, I couldn’t move my neck! Every time I try to move it, I feel sharp pain on the left side of the neck shooting down into the shoulder blade. It just came out of nowhere!”
Chances are, you are suffering from a common condition called torticollis, which literally means, “twisted neck” after the Latin terms of “torti” (twisted) and “collis” (neck). The common name for this is “wry neck,” and it’s basically a painful muscle spasm, like a “Charlie-horse” but located in the neck muscles. Usually, a person wakes up in the morning with this and the cause is often related to sleeping with the window being open or a fan or air conditioner blowing on you. It can also relate to a “cold settling in the muscle” after a cold or flu virus. Trauma such as falling or a car accident can also cause torticollis. However, most of the time, patients with torticollis are not sure what caused the abrupt onset of symptoms.
Usually, torticollis will gradually improve over a 2 week time frame. However, it only takes a few days to a week (at the most) if you receive chiropractic adjustments. Most importantly, without treatments, the sharp pain can last a week and can severely limit your activity, often prohibiting work as well as your desired “fun” activities. Hence, most people prefer having this treated as opposed to “waiting it out.” In some cases, it can last longer than a month and in rare cases even longer, so getting this treated is highly recommended. Also, try to get in for a treatment immediately before the muscle spasm really sets up. We find this to be the most effective approach. Here are a list of symptoms and treatment suggestions for torticollis:
Acute Torticollis Symptoms
· Muscle spasms
· Neck and shoulder pain
· Neck and spine contortion (neck twisted to right or left side of body)
Pain Relief Treatments for Acute Torticollis
· Chiropractic neck and spinal adjustment
· Analgesics
· Heat packs
· Muscle relaxants
· Rubs and ointments (Icy Hot, BioFreeze)
· Massage with essential oils
· Reiki
· Sleep / Relax
· Supportive cervical collar
The Neck and Headache Connection
Patients with headaches also commonly complain of neck pain. This relationship is the rule, not the exception and therefore, treatment for headaches must include treatment of the neck to achieve optimum results. The term, “cervicogenic headaches” has been an accepted term because of the intimate connection between the neck and head for many years. There are many anatomical reasons why neck problems result in headaches. Some of these include:
· The first 3 nerves exiting the spine in the upper neck go directly into the head. They penetrate the muscles at the top of the neck near the attachments to the skull and therefore, any excess pressure on these nerves by the muscles or spinal joints will result in irritation and subsequent pain.
· The origin or nucleus of the 5th cranial nerve called the Trigeminal, innervates the sensation to the face and is located in the upper cervical region near the origin of the 2nd cervical spinal nerve, which innervates sensation to the back of the head up to the top. Therefore, problems located in the upper neck will often result in pain radiating up from the base of the skull/upper neck over the top of the skull to the eyes and /or face.
· The 11th cranial nerve that innervates the upper shoulders and muscles in the front of the neck arises from the top 5 to 7 spinal cord levels in the neck. Injury anywhere in the neck can result in spasm and pain in these large muscle groups.
· Other interconnections between the 2nd cervical nerve and trigeminal/5th cranial nerve include communication with the 7th cranial / facial nerve, the 9th cranial / glossopharyngeal nerve, and the 10th cranial / vagus nerve. These connections can affect facial muscle strength/movements, taste, tongue and throat movements, and stomach complaints such as nausea from these three cranial nerve interconnections, respectively.
When patients seek treatment for their headaches, a thorough examination of the neck, upper back, and cranial nerves is routinely performed for the above reasons. It is common to find upper cervical movement and vertebral alignment problems present in patients complaining of headaches. Tender points located between the shoulder blades, along the upper shoulders, on the sides of the neck and particularly, at the base of the skull are commonly found. Pain often radiates from the tender point over the top of the skull when pressure is applied in the upper neck/base of the skull area. Tenderness on the sides of the head, in the temples, over the eyes, and near the jaw joint are also common. Traction or pulling the head to stretch the neck is often quite pain relieving and this is often performed as part of the chiropractic visit and can also be applied at home with the use of a home cervical traction unit. Chiropractic adjustments applied to the fixated or misaligned vertebra in the upper neck often brings very satisfying relief to the headache sufferer. Exercises that promote movement in the neck, as well as strengthening exercises are also helpful in both reducing headache pain and in preventing occurrences, especially with stress or tension headaches.
The Neck is Your Life Line
The nervous system is the master control network for your body, directing virtually every function and action, from monitoring your life needs, to precisely responding to threats to your health.
Each system, from your heart and blood vessels, to your digestive and immune systems, is directed through nerve impulses originating in your brain or spinal cord that travel through its protective bony structure: the spinal column.
The neck region is the most vulnerable region of the spine to injury. Indeed, even death can be brought through significant trauma to the neck. When the trauma is not fatal, the consequences can still be severe, such as when paralysis strikes.
Most people will not experience these severe injuries, however sprains of the delicate ligaments with subluxation (misalignment) do commonly occur. Despite the injury being smaller, their location (the neck) makes their impact more profound. Functions throughout the body can be impaired when the nerves in the upper neck are compromised.
Within chiropractic, there are specialists who focus their entire care on the uppermost two vertebrae of the spine.
Because every nerve passes through the neck, if irritation or compression is present, virtually any system of the body can be affected. The point being is that a neck disorder will not necessarily just cause neck pain or headache. Dizziness, digestive problems, fatigue, high blood pressure and generally reduced quality of life are some of the symptoms patients commonly experience.
If you have suffered a severe whiplash, you may have noticed far more than a stiff neck. Indeed, recent research suggests whiplash needs to more thought of as a whole body disorder.
We take these injuries in our office and address them in both a specific and comprehensive manner. Most patients who have suffered a neck trauma will require x-rays to analyze the posture of their spine. X-rays may also need to be taken in motion to test the stability of your ligaments and to determine precise levels of impaired movements. Without this road map, it is difficult to determine how care should be directed and factors that could influence your long-term prognosis, such as degeneration.
Back Pain Articles
Low Back Pain: Why Is It So Common?
This question has plagued all of us, including researchers for a long time! Could it be because we’re all inherently lazy and don’t exercise enough? Or maybe it’s because we have a job that’s too demanding on our back? To properly address this question, here are some interesting facts:
1. The prevalence of low back pain (LBP) is common, as 70-85% of ALL PEOPLE have back pain that requires treatment of some sort at some time in life.
2. On a yearly basis, the annual prevalence of back pain averages 30% and once you have back pain, the likelihood of recurrence is high.
3. Back pain is the most common cause of activity limitation in people less than 45 years of age.
4. Back pain is the 2nd most frequent reason for physician visits, the 5th ranking reason for hospital admissions, and is the 3rd most common cause for surgical procedures.
5. About 2% of the US workforce receives compensation for back injuries annually.
6. Similar statistics exist for other countries, including the UK and Sweden.
So, what are the common links as to why back pain is so common? One reason has to do with the biomechanics of the biped – that is, the two legged animal. When compared to the 4-legged species, the vertically loaded spine carries more weight in the low back, shows disk and joint deterioration and/or arthritis much sooner, and we overload the back more frequently because, well, we can! We have 2 free arms to lift and carry items that often weigh way too much for our back to be able to safely handle. We also lift and carry using poor technique. Another reason is anatomical as the blood supply to our disks is poor at best, and becomes virtually non-existent after age 30. That makes healing of disk tears or cracks nearly impossible. Risk factors for increased back injury include heavy manual lifting requirements, poor or low control of the work environment, and prior incidence of low back pain.
Other risk factors include psychosocial issues such as fear of injury, beliefs that pain means one should not work, beliefs that treatment or time will not help resolve a back episode, the inability to control the condition, high anxiety and/or depression levels, and more. Because there are so many reasons back problems exist, since the early 1990’s, it has been strongly encouraged that we as health care providers utilize a “biopsychosocial model” of managing those suffering with low back pain, which requires not only treatment but proper patient education putting to rest unnecessary fears about back pain.
Low Back Pain: Where Is My Pain Coming From?
Low back pain can emanate from many anatomical locations (as well as a combination of locations), which always makes it interesting when a patient asks, “…doc, where in my back is my pain coming from?” In context of an office visit, we take an accurate history and perform our physical exam to try to reproduce symptoms to give us clues as to what tissue(s) may be the primary pain generators. In spite of our strong intent to be accurate, did you know, regardless of the doctor type, there is only about a 45% accuracy rate when making a low back pain diagnosis? This is partially because there are many tissues that can be damaged or injured that are innervated by the same nerve fibers and hence, clinically they look very similar to each other. In order to improve this rather sad statistic, in 1995 the Quebec Task Force published research reporting that accuracy could be improved to over 90% if we utilize a classification approach where low back conditions are divided into 1 of 3 broad categories:
1. Red flags – These include dangerous conditions such as cancer, infection, fracture, cauda equina syndrome (which is a severe neurological condition where bowel and bladder function is impaired). These conditions generally require emergency care due to the life threatening and/or surgical potential.
2. Mechanical back pain – These diagnoses include facet syndromes, ligament and joint capsule sprains, muscle strains, degenerative joint disease (also called osteoarthritis), and spondylolisthesis.
3. Nerve Root compression – These conditions include pinching of the nerve roots, most frequently from herniated disks. This category can include spinal stenosis (SS) or, combinations of both, but if severe enough where the spinal cord is compromised (more commonly in the neck), SS might then be placed in the 1st of the 3 categories described above.
The most common category is mechanical back pain of which “facet syndrome” is the most common condition. This is the classic patient who over did it (“The Weekend Warrior”) and can hardly get out of bed the next day. These conditions can include tearing or stretching of the capsule surrounding the facet joint due to performing too many bending, lifting, or twisting related activities. The back pain is usually localized to the area of injury but can radiate down into the buttocks or back of the thigh and can be mild to very severe.
Low Back Pain and Balance Exercises
You may recall last month, we talked about the relationship between low back pain and balance, particularly our unfortunate increased tendency to fall as we “mature.” This month, we’re going to look at ways to improve our balance by learning specific exercises that utilize the parts of our nervous system that regulate balance or, proprioception. Particularly, our cerebellum (back of the brain that regulates coordination), the vestibular system (the inner ear where the semi-circular canals are located), the ascending tracts in our spinal cord (the “highways” that bring information to the brain from our feet and the rest of our body), and the small “mechano-receptors” located in our joints that pick up our movements as we walk and run and sends that information through our nerves, up the spinal cord tracts to the brain. Here are some very practical exercises to do, “…for the rest of our lives.” Start with the easy ones!
1. Easy (Level 1): Standing eyes open/closed - Start with the feet shoulder width apart, look straight ahead to get your balance and then close the eyes and try not to sway counting to 30 by, “…one thousand one, one thousand two, one thousand three, etc.” Repeat this with your feet closer together until they touch each other. You can make this harder by standing on a pillow or cushion -- but don’t start that way!
2. Medium (Level 2): Lunges - from a similar starting position as #1, step forwards with one leg and squat slightly before returning back to the start position. Repeat this 5x with each foot/leg. As you progress, you can take a longer stride and/or squat down further with each repetition. You can even hold onto light dumbbells and/or close your eyes to make it more challenging.
3. Hard (Level 3): Rocker or wobble board exercises - use a platform that rocks back & forth or, wobbles in multiple directions. Rock back and forth, eyes open and then closed, once you get comfortable on the board. You can rotate your body on the board, standing straight ahead (12 o’clock) followed by 45 degree angles as you work your way around in a circle at 45 degree increments (12, 1:30, 3, 4:30, 6, 7:30, 9, 10:30 and back to noon). Repeat these eyes open and closed. The Wii Balance board is a fun way to exercise – check that out as well.
You can “improvise” and mix up different exercises and create your own routine. Just remember, stay safe, work slowly until you build up your confidence and keep challenging yourself.
Does Chiropractic Work? - What Do Insurance Companies Say?
If chiropractic care helps patients get better faster and costs the patient and/or insurance company less, shouldn’t EVERY low back pain patient FIRST see a chiropractor before any other type of doctor? That is in fact, what should be done, based on a recent report!
On October 20, 2009, a report was delivered on the impact on population, health and total health care spending. It was found the addition of chiropractic care for the treatment of neck and low back pain “…will likely increase value-for-dollar in US employer-sponsored health benefit plans.” Authored by an MD and an MD/PhD, and commissioned by the Foundation for Chiropractic Progress, the findings are clear; chiropractic care achieves higher satisfaction and superior outcomes for both neck and low back pain in a manner more cost effective than other commonly utilized approaches.
The study reviews the fact that low back and neck pain are extremely common conditions consuming large amounts of health care dollars. In 2002, 26% of surveyed US adults reported having back pain in the prior 3 months, 14% had neck pain and the lifetime prevalence of back pain was estimated at 85%. LBP accounts for 2% of all physician office visits where only routine examinations, hypertension, and diabetes result in more. Annual national spending is estimated at $85 billion in the US with an inflation-adjusted increase of 65% compared to 1997. Treatment options are diverse ranging from rest to surgery, including many various types of medications. Chiropractic care, including spinal manipulation and mobilization, is reportedly also widely utilized with almost half of all patients with persisting back pain seeking chiropractic treatment.
In review of the scientific literature, it is noted that 1) chiropractic care is at least as effective as other widely used therapies for low back pain; 2) Chiropractic care, when combined with other modalities such as exercise, appears to be more effective than other treatments for patients with neck pain. Other studies reviewed reported patients who had chiropractic coverage included in their insurance benefits found lower costs, reduced imaging studies, less hospitalizations, and surgical procedures compared to those with no chiropractic coverage. They then utilized a method to compare medical physician care, chiropractic physician care, physiotherapy-led exercise and, manipulation plus physiotherapy-led exercise for low back pain care. They found adding chiropractic physician care is associated with better outcomes at “…equivalent to an incremental cost-effectiveness ratio of $1837 per QALY (Quality-adjusted Life Year).”
When combined with exercise, chiropractic physician care was also found to be very cost-effective when compared to exercise alone. This combined approach would achieve improved health outcomes at a cost of $152 per patient, equivalent to an “incremental cost-effectiveness ratio of $4591 per QALY.” When comparing the cost effectiveness of chiropractic care with or without exercise even at 5 times the cost of the care they utilized in their analysis, it was still found to be “substantially more cost-effective” compared to the other approaches. It will be interesting given these findings if insurance companies and future treatment guidelines start to MANDATE the use of chiropractic FIRST – it would be in everyone’s best interest!
Chiropractic Care For Low Back Pain – What Does the Research Say?
There has been a debate for years regarding the use of spinal manipulation and its benefits in the treatment of low back pain. Since the founding of chiropractic in 1895, the initial reaction against the early pioneer chiropractors resulted in doctors of chiropractic (DC’s) being incarcerated for “…practicing medicine without a license.” But chiropractors kept forging ahead and because of obtaining good results and helping millions of people, by 1971, Medicare adopted coverage for chiropractic – a first in chiropractic’s history. In 1975, the US Department of Health, Education, and Welfare invited an international group of health care provider types (MD’s, DC’s, DO’s, etc.), to share with each other at the National Institute of Health, and determine what the “current” research status of spinal manipulative therapy was at that time. Recommendations for future needed research resulted and the proceedings were published in: The DHEW Publication No. (NIH) 76-998 “The Research Status of Spinal Manipulative Therapy.” That landmark gathering stimulated a plethora of research that was to follow over the course of the next 30+ years and continues today. Due to the overwhelming positive benefits of chiropractic published in many research studies, by the late 1980’s, most insurance companies included coverage for chiropractic care. Today, many chiropractors practice in multidiscipline health care centers that include DC’s, MD’s, and PT’s others. The following list of research studies has had a significant impact in vaulting chiropractic to its current accepted status in the health care system (the URL is included for further study):
1. Meade TW, Dyer S, Browne W, Townsend J, Frank AO. British Medical Journal 1990 (Jun 2); 300 (6737):1431-1437. http://www.chiro.org/LINKS/ABSTRACTS/LBP_of_Mechanical_Origin.shtml
2. Manga P, Angus DE, Papadopoulos C, Swan WR. A Study to Examine the Effectiveness and Cost-effectiveness of Chiropractic Management of Low-Back Pain. 8/1993; Ontario, Canada. http://www.chiro.org/LINKS/GUIDELINES/Manga_93.shtml
3. Bigos S, et. al., 1994, Agency for Health Care Policy and Research (AHCPR). http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=hstat6.chapter.25870
4. Meade TW, Dyer S, Browne W, Frank AO. Randomised Comparison of Chiropractic and Hospital Outpatient Management for Low Back Pain: Results from Extended Follow up. British Medical Journal 1995 (Aug 5); 311 (7001): 349–351 http://www.chiro.org/LINKS/ABSTRACTS/Chiropractic_and_Hospital_Outpatient.shtml
5. Luo X, Pietrobon R, Sun SX, Liu GG, Hey L. Estimates and Patterns of Direct Health Care Expenditures Among Individuals With Back Pain in the United States. Spine 2004 (Jan 1); 29 (1): 79–86. http://www.ncbi.nlm.nih.gov/pubmed/14699281
Headache Articles
Side Effects of Chiropractic vs. Medications for Headaches
Have you ever stopped and wondered, “…which type of doctor should I go to for treatment of my headaches?” In order to make an informed decision, it is appropriate to look at the side effects each treatment option carries and then consider the pros and cons of each treatment.
It has been reported that 45 million Americans suffer from headaches, many on a daily basis. Though some just put up with the pain, others become totally disabled during the headache. Most people initially turn to an over the counter drug such as a non-steroidal anti-inflammatory drug (NSAID) of which there are 3 types: 1) salicylates, such as aspirin; 2) traditional NSAIDs, such as Advil (ibuprofen), Aleve (naproxen); and, 3) COX-2 selective inhibitors, such as Celebrex.
According to the medical review board of About.com, complications of NSAID drugs include stomach irritation (gastritis, ulcer), bleeding tendencies, kidney failure, and liver dysfunction. Some NSAIDs (particularly indomethacin) can interfere with other medications used to control high blood pressure and cardiac failure and long term use of NSAIDs may actually hasten joint cartilage loss, leading to premature arthritis. Another over the counter commonly used drug is Tylenol (Acetaminophen) in which liver toxicity can be a potential side effect (particularly with long term use).
Here’s the kicker – only about 60% of patients respond to a 3 week trial of an NSAID, NSAIDs can mask signs and symptoms of infection, it cannot be predicted which NSAID will work best, and no single NSAID has been proven to be superior over others for pain relief. Moreover, estimates of death associated with NSAID (mostly gastrointestinal causes) range between 3200 on the low side to higher than 16,500 deaths per year in the United States. Another BIG concern is that low daily doses of aspirin, “…clearly have the potential to cause GI injury as 10mg of aspirin daily causes gastric ulcers.”
Others may turn to prescription medication for hopeful pain relief. One of the more frequently prescribed medications for headaches is amitriptyline (commonly known as Elavil, Endep, or Amitrol). This is actually an antidepressant but was found to work quite well for some headache sufferers. The potential side effects include blurred vision, change in sexual desire or ability, constipation or diarrhea, dizziness, drowsiness, dry mouth, headache (ironically), appetite loss, nausea, tiredness, trouble sleeping, tremors and weakness. Allergic reactions such as rash, hives, itching, difficulty breathing, tightness in the chest, swelling of the mouth, face, lips or tongue, chest pain, rapid and/or irregular heart rate, confusion, delusions, suicidal thoughts or actions AND MORE are reported.
The pros and cons of chiropractic include a report on children under 3 years of age, where only one reaction for every 749 adjustments (manipulations) occurred (it was crying, NO serious side effects were reported). In adults, transient soreness may occur. Though stroke has been reported as a cause of headache, it was concluded that stroke “…is a very rare event…”, and that, “…we found no evidence of excess risk of VBA stroke associated chiropractic care compared to primary care.” Another convincing study reported that chiropractic was 57% more effective than drug therapy in reducing headache and migraine pain! They concluded – chiropractic first, drugs second and surgery last.
Headaches – How Does Chiropractic Work?
Headaches are a common complaint at chiropractic clinics. There are many causes of headaches, some of which are “idiopathic” or, unknown. Some headaches arise from “vascular” (blood vessels) causes such as migraine and cluster headaches. These often include nausea and/or vomiting and can be quite disabling and require rest in a dark, quiet place sometimes for a half or a whole day. Another type of headaches can be categorized as “tension” headaches. These usually result from tightness in the muscles in the neck and upper back caused from stress, work, lack of sleep, sinusitis, trauma such as whiplash, and others.
So “how does chiropractic work?” To answer this, let’s first discuss what we do when the headache patient comes in. First, the history is very important! Here, we’ll ask “how/when did the headaches start. This may glean the actual cause of headaches such as a car accident or injury of some sort.
Next, we’ll ask about activities that increase or create the headache, which gives us ideas of how we might help manage the headache patient. For example, when certain activities precipitate the onset of a headache, we will modify the work station and/or give specific exercises on a regular schedule to keep the neck tension under control. When information gathered about what decreases or helps the neck pain and headaches, we will recommend treatments often that can be done at home such as a home traction unit. This would be suggested if we are told that “…pulling on my neck feels great!” The quality of pain (throbbing = vascular, ache and tightness = neck), intensity of pain (0-10 pain scale), and timing (worse in the morning vs. evening) help us track change after treatment is rendered, usually gathered once a month.
The examination includes blood pressure which can in itself create headaches when high, looking in the eyes to view the blood vessels in the back of the eye to make sure there is no evidence of increased pressure against the brain, ears – to see if there is an infection or wax blockage. This can help if there is dizziness and/or balance loss. We will sometimes listen to the throat as well as the heart to see if there may be a blockage, a valve problem, or other issues. Neck muscle tightness (spasm) will be evaluated along with the range of motion, paying particular attention to the positions/directions that increases and decreases pain, especially those that decrease pain. Nerve function by checking reflexes, sensation and muscle strength as well as correlating information like positions that decrease arm or leg pain will be included as any position that reduces pain in the arm or leg must be incorporated into an exercise. X-rays may include bending “stress” views so that ligaments (that hold bones together) can be evaluated for “laxity” (torn and unstable). When this is found, we avoid adjustments to these vertebrae.
As you can see, if is very important do a thorough evaluation so headache patients can be properly managed. Treatment approaches include: 1. Adjustments; 2. Soft tissue therapy (trigger point stimulation, myofascial release); 3. Posture correction exercises and other exercises; 4. Education about job modifications; 5. Co-management with other health care providers, if medication or injection therapy is needed.
Chiropractic Manipulation: A New Study Regarding Headaches
Headaches are a common complaint in patients presenting for professional care, including chiropractic management. Patients with headaches seek chiropractic care because they find manipulation or adjustments applied to the cervical spine and upper back region are highly effective in reducing the intensity, frequency and duration of the headache pain. This is because the cervical spine / neck, is often the origin of the headache as the three nerves in the upper neck (C1, 2 and 3) pass through the thick, overly taught neck muscles in route to the scalp / head. When the muscles of the neck are in spasm, the nerves get “pinched” or squeezed by the overly tight muscles resulting in headache pain. Each nerve runs to a different part of the head and therefore, pain may be described as “…radiating over the top of head (sometimes into the forehead and eyes),” or, into the head and over the ear, sometimes reaching the temple. Also, an area located in the back and side of the head is the area where the C1 nerve innervates, so pain may also be reported in that location. When more than one of the C1-3 nerves is pinched, the whole side to the top of the head may be involved.
In the October 2009 issue of The Spine Journal, Western States Chiropractic College, Center for Outcomes Studies, reported benefits are obtained with the utilization of spinal manipulation in the treatment of chronic cervicogenic headaches. The word “chronic” means at least 3 months of headache pain has been present. This new study compared 2 different doses of therapy using several outcome measures including the pain grade, the number of headaches in the last 4 weeks and the amount of medication utilized. Data was collected every 4 weeks for a 24 week period and patients were treated 1-2 times/week and separated into either an 8 or a 16 treatment session with half the group receiving either spinal manipulative therapy or a minimal light massage (LM) control group.
The results of the study revealed the spinal manipulation group obtained better results than the control group at all time intervals. There was a small benefit in the group that received the greater number of treatments with the mean number of cervicogenic headaches reduced by 50% in both pain intensity and headache frequency.
The importance of this study is significant as there are many side effects to medications frequently utilized in the treatment of headaches. Many patients prefer not taking medications for this reason and spinal manipulation therapy (SMT) offers a perfect remedy for these patients. Couple SMT with dietary management, lifestyle modifications, stress management, and a natural, vitamin/herbal anti-inflammatory (such as ginger, turmeric, boswellia) when needed, a natural, holistic approach to the management of chronic headaches is accomplished.
The Importance of Headache Diagnosis
All good doctors know the importance of getting an accurate diagnosis of a patient's problem. But why is this so important? It's important because without knowing what is the disease or injury, the treatment cannot be directed to the actual problem.
Unfortunately, when it comes to headaches, many patients do not receive an accurate diagnosis. If a patient were to see a doctor with a pain in the head and the doctor were to conclude that you have a pain in your head (headache), this tells little about the actual problem. In headache patients, we've become very good at labeling problems-giving them a name. If the headache comes and goes we call it episodic. If it occurs suddenly we call it acute, and if it occurs over many years we say it is chronic. But are these labels really helpful?
The reality is everyday people show up in doctors offices, obtain cursory examinations and walk out with a prescription for their head pain. Not all doctors do this, of course, but with the time constraints of managed care and the insurance company oversight, a doctor's visit is just not what it used to be. When was the last time you had a house call from a doctor? Of course, the worst case is when a patient acts as their own doctor, sees an advertisement for a pill and does the diagnosing himself or herself!
In chiropractic, we may also label your headache as tension-type, migraine or chronic, but a good chiropractor will not stop there. The label does not give much of an indication of what needs to be done, and more importantly we still do not know the CAUSE of the pain. Clinical experience and research over many decades has shown that many headaches are actually caused by injuries to the neck and spine. But if a doctor does not examine the neck, they may not discover these hidden injuries. Sometimes an astute doctor will take a history and it may be discovered you had a whiplash or other neck trauma, months or even years earlier. This is important information to get at the cause.
We take a comprehensive approach to headache patients at our clinic. A detailed history about the location, duration, and quality of pain is followed up by a thorough physical examination, especially of your spinal column. We may also order imaging tests such as x-rays to see the positions of the individual vertebrae in your neck.
The normal neck has a forward curve or arch, which keeps your head upright and directly above your shoulders. When this curve is lost, the patient's head is thrust forward in the classic "bad posture" stance. Making sure your neck is both flexible, and in good postural alignment, is critical to maintaining good health.
Side Effects of Chiropractic vs. Medications for Headaches
Have you ever stopped and wondered, “…which type of doctor should I go to for treatment of my headaches?” In order to make an informed decision, it is appropriate to look at the side effects each treatment option carries and then consider the pros and cons of each treatment.
It has been reported that 45 million Americans suffer from headaches, many on a daily basis. Though some just put up with the pain, others become totally disabled during the headache. Most people initially turn to an over the counter drug such as a non-steroidal anti-inflammatory drug (NSAID) of which there are 3 types: 1) salicylates, such as aspirin; 2) traditional NSAIDs, such as Advil (ibuprofen), Aleve (naproxen); and, 3) COX-2 selective inhibitors, such as Celebrex.
According to the medical review board of About.com, complications of NSAID drugs include stomach irritation (gastritis, ulcer), bleeding tendencies, kidney failure, and liver dysfunction. Some NSAIDs (particularly indomethacin) can interfere with other medications used to control high blood pressure and cardiac failure and long term use of NSAIDs may actually hasten joint cartilage loss, leading to premature arthritis. Another over the counter commonly used drug is Tylenol (Acetaminophen) in which liver toxicity can be a potential side effect (particularly with long term use).
Here’s the kicker – only about 60% of patients respond to a 3 week trial of an NSAID, NSAIDs can mask signs and symptoms of infection, it cannot be predicted which NSAID will work best, and no single NSAID has been proven to be superior over others for pain relief. Moreover, estimates of death associated with NSAID (mostly gastrointestinal causes) range between 3200 on the low side to higher than 16,500 deaths per year in the United States. Another BIG concern is that low daily doses of aspirin, “…clearly have the potential to cause GI injury as 10mg of aspirin daily causes gastric ulcers.”
Others may turn to prescription medication for hopeful pain relief. One of the more frequently prescribed medications for headaches is amitriptyline (commonly known as Elavil, Endep, or Amitrol). This is actually an antidepressant but was found to work quite well for some headache sufferers. The potential side effects include blurred vision, change in sexual desire or ability, constipation or diarrhea, dizziness, drowsiness, dry mouth, headache (ironically), appetite loss, nausea, tiredness, trouble sleeping, tremors and weakness. Allergic reactions such as rash, hives, itching, difficulty breathing, tightness in the chest, swelling of the mouth, face, lips or tongue, chest pain, rapid and/or irregular heart rate, confusion, delusions, suicidal thoughts or actions AND MORE are reported.
The pros and cons of chiropractic include a report on children under 3 years of age, where only one reaction for every 749 adjustments (manipulations) occurred (it was crying, NO serious side effects were reported). In adults, transient soreness may occur. Though stroke has been reported as a cause of headache, it was concluded that stroke “…is a very rare event…”, and that, “…we found no evidence of excess risk of VBA stroke associated chiropractic care compared to primary care.” Another convincing study reported that chiropractic was 57% more effective than drug therapy in reducing headache and migraine pain! They concluded – chiropractic first, drugs second and surgery last.
Carpal Tunnel Articles
Carpal Tunnel Syndrome - What Can You Do For It?
Carpal tunnel syndrome or, CTS, is a common condition that drives many patients to chiropractic clinics asking, “…what can chiropractic do for CTS?” As an overview, the following is a list of what you might expect when you visit a Doctor of Chiropractic for a condition like CTS:
1. A thorough history is VITALLY important as your doctor can ask about job related stressors, hobby related causes (such as carpentry or playing musical instruments), telephone work, or factory work – especially if it’s fast and repetitive. Your doctor will also need to learn about your “co-morbidities” or, other conditions that can directly or indirectly cause CTS such as diabetes, thyroid disease, certain types of arthritis, certain medication side effects, and others.
2. A Physical Exam to determine the area(s) of nerve compression degree of severity. This may include ordering special tests such as EMG/NCV, if necessary.
3. Treatment can include manipulation, soft tissue release, PT modalities (eg., electric stim., ultrasound).
4. Home Therapies are the main topic for this Health Update. What can YOU do for CTS?
Here are some of the things that you, the CTS sufferer can self-manage:
A Carpal tunnel splint is primarily worn at night, keeping your wrist in a neutral or straight position. This position places the least amount of stretch on the nerves and muscle tendons that travel through the carpal tunnel at the wrist.
Exercises (Dose: 5-10 second holds, 5-10 repetitions, multiple times / day) such as: A. The “Bear claw” (keep the big knuckles of the hand straight but bend the 2 smaller joints of the fingers and thumb and alternate with opening wide the hand) B. Tight Fist / open hand (fully open – spread and extend the fingers and then make a fist, with the hand). C. The upside down palm on wall wrist and forearm stretch (stand facing a wall; with the elbow straight, place the palm of your hand on the wall, fingers pointing down towards the floor. Try to bend the wrist to 90 degrees keeping the palm flat on the wall. Feel the stretch in the forearm – hold for 5-10 seconds. Reach across with the other hand and gently pull back on the thumb for an added stretch! D. Wrist range of motion (dorsiflexion/palmar flexion) – Place forearm on a table with wrist off the edge, palm down. Bend hand downward as far as possible, then upward. Repeat 5 or 10 times. E. Wrist range of motion (pronation/supination) – Place forearm and whole hand on table-- elbow bent 90°, palm flat on tabletop. Rotate the wrist and forearm so the back of hand is now flat on tabletop. Repeat 5 or 10 times. F. Neck Stretch. Sit or stand with head facing forward. Side bend as far to the right as possible (approximate the right ear to right shoulder) and hold for 5 seconds. Reach over with the right hand to the left side of the head and gently pull further to the right to increase the stretch. Reverse instructions for the other side. Repeat 3 to 5 times. Consider other neck exercises if needed. G. Shoulder shrug and rotation. Stand with arms at the sides. Shrug the shoulders up toward the ears, then squeeze the shoulder blades back, then downwards and then roll them forward. Do the whole rotation slowly and reverse the direction. Repeat 3 to 5 times. If you cannot comfortably do the whole rotation, just shrug the shoulders up and down. H. Pectoral stretch. Stand in a doorway (or a corner of a room). Rest your forearms, including your elbows, on the doorframe, keeping your shoulders at a 90-degree angle. Lean forward until a stretch is felt in the chest muscles. Do not arch your back. Hold 20 seconds; repeat 5 times.
Job modifications are also VERY important but unfortunately, a topic for another time! In short, rotate job tasks (if possible), take mini-breaks, and use tools with handles that fit easily into the hands. Have a job station analysis completed if the above are not enough.
Do I Have to Have Surgery For Carpal Tunnel Syndrome?
“For the last few months, I’ve been waking up at night with numbness and tingling in my hand. Lately, I’ve been waking up more often, 3-4 times a night and I’m having a hard time falling back to sleep. When I drive, my hands fall asleep within a few minutes and I have to shake my hand and fingers to wake them up. This has gotten to the point where I have to do something but I really don’t want surgery. What are my non-surgical options?”
CTS or, carpal tunnel syndrome is a condition where a nerve (called the median nerve) that travels down from the neck into the arm and through the wrist becomes pinched and inflamed. Common symptoms include numbness, tingling, dexterity problems (such as difficulty buttoning shirts), and opening jars due to weakness in grip and pinch strength. Sleep interruptions and loss of many daily activities, including work, occur because of CTS.
There are many non-surgical approaches to the treatment of CTS that should be utilized before surgery is considered, according to the American Academy of Neurology. In one study, 40% of neurologist polled recommended non-surgical care due to the potential side effects of surgery, some of which being severe, resulting in lengthy work loss post-surgically. A partial list of non-surgical care options include:
- Rest – Giving the inflamed CTS time to heal is therapeutic but not always an option.
- Activity/job modifications – Avoiding certain activities or modifying them by taking breaks during the work day, slowing down the pace of the job, altering the position of the job task, such as propping up a part so that the wrists do not have to bend to the extremes, or when necessary, complete avoidance of the job task.
- Wrist Splint – This is a brace that maintains the wrist in a neutral position so it cannot easily bend. When the wrist flexes or extends, the pressure inside the carpal tunnel (on the palm side of the wrist) increases significantly, placing additional pressure on the already pinched median nerve. Wrist splints are especially useful at night.
- Nerve Gliding Exercises – These are exercises that stretch the wrist joint and muscle tendons (as well as the median nerve inside the carpal tunnel), with the objective of breaking adhesions that limit the normal glide or movement of the nerve in the forearm and wrist.
- Manual therapy techniques – These include manipulation of the arm including the forearm, wrist, and hand and sometimes the neck and shoulder, when needed. The objective is to improve the range of motion of the joints and soft tissues that may be participating in the process of median nerve pinching.
- Anti-inflammatory medication / nutrients – Medications include aspirin, ibuprofen, naproxen and similar prescription drugs. Nutritional options including herbs (such as ginger, turmeric, boswellia), digestive enzymes, and Vitamin B6 may also help. Ice is also anti-inflammatory and direct, on-the-skin ice massage is quite effective.
Carpal Tunnel Syndrome (CTS) – What Does Research Show?
So often we hear, “…well if it’s so good, show me the proof!” Chiropractic case management of CTS has been well established for many years. And yet, we still hear skepticism from patients, MD’s, insurers, employers, and others about the benefits of chiropractic management of CTS. If we can, “show them the data” regarding the effectiveness of chiropractic for CTS patients, we will finally be able to help more people with this potentially disabling condition.
So, let’s take a look at the evidence that supports the benefits of chiropractic for CTS:
1) Davis PT, Hulbert JR, Kassak KM, et al. “Comparative efficacy of conservative medical and chiropractic treatments for carpal tunnel syndrome: a randomized clinical trial”
J Manipulative Physiol Ther. 21.5 (June 1997): 317-326.
The most important finding reported in this 91 patient study was that chiropractic treatment was equally effective in reducing CTS symptoms as medical treatment. The chiropractic care included ultrasound, nighttime wrist supports and manipulation of the wrist, arm and spine. Medical care included ibuprofen (800 mg, 3x/day for 1 wk, 800 mg, 2x’day for 1 wk, & 800 mg as needed for 7 wks) plus a night wrist splint. Both groups did equally well but given the side-effect potential of ibuprofen on the stomach, liver, and kidneys, a strong argument for the non-drug, chiropractic approach can be made.
2) Bonebrake AR, Fernandez JE, Marley RJ et al. “A treatment for carpal tunnel syndrome: evaluation of objective and subjective measures” J Manipulative Physiol Ther. 13.9 (Nov-Dec 1990): 507-520
CTS sufferers (n=38) received chiropractic spinal manipulation and extremity adjusting. Also, soft tissue therapy, dietary modifications or supplements (B6) and daily exercises were prescribed. After treatment, results showed improvement in all strength and range of motion measures. Also, a significant reduction in pain and distress ratings was reported.
3) Mariano KA, McDougle MA, Tanksley GW “Double crush syndrome: chiropractic care of an entrapment neuropathy” J Manipulative Physiol Ther. 14.4 (May 1991):262-5
In 1973, Upton and McComas first proposed the presence of the "double crush syndrome." Their hypothesis was that when a nerve is pinched anywhere along its route, it makes the rest of the nerve more sensitive to otherwise “normal” stimulation. A case report of a man with both cervical radiculopathy and carpal tunnel syndrome, i.e., "double crush syndrome" was presented. Chiropractic management consisted of chiropractic manipulative therapy as well as ultrasound, electrical nerve stimulation, traction and a wrist splint. The experimental basis, clinical evidence, etiology, symptomatology and findings of this condition are discussed. The Double Crush Syndrome helps explain why cervical/neck manipulation helps many CTS patients.
Carpal Tunnel Syndrome – Chiropractic vs. Medical Treatment
There are many patients who suffer from Carpal Tunnel Syndrome (CTS). In fact, CTS is one of the most common work related injuries. In spite of multiple studies that show the benefits of chiropractic treatment with patients suffering from CTS, many medical doctors are unaware of the studies and still tell their patients that chiropractic treatment is either ineffective, or may actually harm them. This unsupported ill advice can easily result in the patient not even considering chiropractic care as a potential effective form of treatment. This can be especially damaging to a patient who cannot tolerate anti-inflammatory medications such as Ibuprofen, Aleve, or aspirin. In fact, side effects secondary to stomach pain (gastritis and/or ulcer) can be quite common, especially at the recommended dose of 2400 mg / day. Moreover, if poor tolerance to these medications exists and a unsatisfying response to conservative medical treatment occurs, the “next step” offered to the patient may be surgery. Surgery that may have been avoidable had chiropractic treatment been considered on an equal par to non-surgical medical care.
There are several studies available that will enlighten those who simply are not aware of the effectiveness of chiropractic care in the treatment of CTS. In 1998, a 91 patient group was divided in half and treated for 9 weeks by either a non-surgical medical approach or by a chiropractic treatment approach. The medical approach included the use of 800 mg of Ibuprofen, 3x/day for 1 week, 2x/day for 1 week, and 800mg as needed to a maximum of 2400 mg/day dose for 7 weeks, as well as the use of a nighttime wrist splint. The chiropractic group utilized manipulation of the bony joints and soft tissues of the spine and upper extremity for 3x/week for 2 weeks, 2x/week for 3 weeks, and 1x/week for 4 weeks, in addition to ultrasound over the carpal tunnel and a wrist splint at night. It was reported that BOTH the medical and the chiropractic patient groups did equally well stating, “significant improvement in perceived comfort and function, nerve conduction and finger sensation.”
In 2007, two different chiropractic approaches were compared and found to both be equally effective in improving nerve conduction, wrist strength, and wrist motion as well as patient satisfaction and daily activity function. These improvements were maintained for 3 months in both groups equally as well. Another study reported significant improvements in strength, range of motion, and pain after chiropractic treatment was given to 25 patients diagnosed with CTS. The majority of the patients reported continued improvements for 6 months or more. There are other studies but I think the point is obvious – chiropractic treatment helps patients with CTS.
The type of treatment that one may receive when being treated by a chiropractor includes manipulation of the bony joints of the neck and upper extremity. The objective of this is to improve the mobility of the joints and loosen the muscles through which the nerves pass, particularly, the median nerve that runs through the carpal tunnel and innervates the 2nd to 4th fingers. There are several exercises of both stretching and strengthening types that strive for similar goals. Physical therapy modalities such as low-level laser therapy have reported beneficial results. Other modalities such as ultrasound, interferential current (IFC), ice massage/cupping over the tunnel, and others may also be utilized. Nighttime wrist splints or braces also help to keep the wrist straight so that prolonged bending of the wrist at night is not possible. There may be other treatment approaches that your chiropractic physician may suggest on an individual case basis.
Carpal Tunnel: Results of a Clinical trial of Two Treatments
Carpal tunnel syndrome occurs when the median nerve, which starts at the neck and runs from the forearm into the hand, becomes compressed or squeezed at the wrist. In some cases there may also be compression at the spine.
The median nerve controls sensations to the palm side of the thumb and fingers (but not the little finger), as well as impulses to some small muscles in the hand that allow the thumb and fingers to move.
A recent study in the Journal of Manipulative and Physiological Therapeutics compared two different conservative treatments for patients with mild to moderate carpal tunnel symptoms. One treatment was the Graston technique, which uses an instrument to rub the forearm, wrist and hand areas to breakdown scar tissue and adhesions. In the other treatment a chiropractor applied deep pressure by hand to the same areas. These treatments are thought to release tight muscles and myofascial restrictions.
The patients got the treatments twice each week for four weeks followed by one treatment a week for two additional weeks. The patients also did at-home stretching exercises. They did not use common conservative treatments such as wrist splints and anti-inflammatory medications.
After both interventions, there were objective improvements to nerve conduction latencies (nerve function), wrist strength, and wrist motion. The patient symptoms of pain also improved, and both groups reported high satisfaction with the care they received.
Despite surgery being in widespread use in the US for carpal tunnel syndrome, it is important for conservative treatments to be tried prior to an invasive operation.
The surgical complication rates are low but when they do occur, can be devastating. In addition to direct surgery costs, one has to also consider disability payments (not working), and rehabilitation that may take several weeks. These costs can be substantial. For this reason, many medical doctors recommend conservative treatments first.
Of all the conservative options, manual therapy by a chiropractor is an excellent choice. It comes without the side effects associated with long-term use of medications.
A comprehensive examination by a Doctor of Chiropractic can determine if your carpal tunnel symptoms are likely to respond to care. He or she can also advise on at-home stretching exercises that can be done to help recovery. In some cases, hidden spinal and neck problems can influence carpal tunnel symptoms, and be the key to treating the cause vs. the symptom.
Fibromyalgia Articles
Fibromyalgia Facts
Fibromyalgia (FM) is a condition that is characterized by widespread, generalized pain “all over” the body that does not follow any specific anatomical pathway like the course of a nerve, muscle, or blood vessel. It is often diagnosed only after all other conditions have been eliminated by using various testing approaches such as blood tests, x-ray, CT or MRI Scans, and others. Controversy exists between health care providers (HCP’s) as some believe that FM either doesn’t exist at all or if it does, it’s grossly over diagnosed while others feel most patients have some form or degree of FM. Because of this common split in beliefs, patients may be treated poorly by those non-believing HCP’s, which often alienates them from seeking further care for FM.
Recent literature suggests FM is disorder of “central pain processing” or, a specific situation where the pain threshold (the point where pain is felt) is reached sooner than what is normal. Fibromyalgia has been classified into 2 separate groups – primary and secondary FM. Primary FM is diagnosed when no known cause can be identified while secondary FM is related to a specific cause such as a disease or condition. Conditions that have been reportedly associated with FM include irritable bowel syndrome (IBS), TMJ (jaw disorders), chronic low back pain, and headaches. There are genetic as well as environmental factors associated with FM. Researchers have found that there is a strong familial component with 1st degree relatives where an 8 fold greater risk of developing FM compared to the general population exists. These people are also more likely to have one of the other associated conditions previously mentioned (IBS, TMJ, headaches). Environmental factors can lead to FM in 5-10% of the cases. Some of these include physical trauma such as car accidents, following infections such as parvovirus, Epstein-Barr virus, and Lyme disease. Psychological stress, hormonal alterations such as hypothyroid, drug side effects, vaccination reactions and certain catastrophic events such as war are included in the “environmental factors” category. Gender differences include woman being 2-3 times more likely to suffer from FM than men.
So, what are the treatment options for FM? Typically, if you go to a medical doctor, you can expect various forms of drug therapy – possibilities include anti-depressants, anti-anxiety meds, and sleep aids but with these, watch out for grogginess, side effects and some habit forming/dependency problems. Pain killers or analgesics – opioides are NOT appropriate but often prescribed and narcotics can also be habit forming. Tylenol is perhaps the safest but is not very effective. Anti-inflammatory include aspirin, ibuprofen but watch for stomach irritation and blood thinning problems. Dr. Christopher Morris, MD reports that drug treatments for FM have, “…very limited success in providing significant improvement in most patients.” He recommends behavior modification for sleep improvement, exercise (walking, water exercises, strength training, yoga, tai chi, Qi Gong), as well as cognitive behavioral therapy, massage therapy, chiropractic, acupuncture, biofeedback, hypnosis, and dietary modification. Examples of dietary changes include avoiding foods with certain additives including MSG (monosodium glutamate) and aspartame where in one study, “complete resolution” of FM symptoms was reported.
Patients with FM NEED a “quarterback” to guide them in their management of FM and chiropractic is the PERFECT choice as many of these holistic approaches are utilized or can be coordinated through our office.
Fibromyalgia: I Have It… Now What?
“…I was told by my doctor that I have fibromyalgia and I don’t know what to do. I’ve noticed that over the last couple of years that I’ve been having a progressively harder time doing simple tasks that I used to take for granted like folding laundry, ironing, cooking, cutting up vegetables, sewing, driving a car, holding a book, and even sleeping has become very challenging. I have to take many breaks while I’m doing these tasks and even take a nap in the middle of the day. I never used to have to do that! My family doctor initially seemed interested in helping me. He listened to me, took some blood, took some x-rays, and then said ‘….everything looks fine.’ His conclusion was that I must have fibromyalgia – I’ve never even heard of that! He prescribed many different drugs. One was to help me sleep but all it did was knock me out to the point where I couldn’t get up in the morning and felt so groggy that I couldn’t function. Then, he tried this other one and I felt like I wanted to crawl out of my skin! I’ve tried 3 or 4 different drugs and the side effects were all worse than what I’m dealing with, without the drugs. He finally concluded, ‘…you’ll just have to learn how to live with it.’ Well, thank you very much, doctor! Tell me HOW to do that?”
That feeling of helplessness and not knowing what to do next is a common complaint among fibromyalgia (FM) sufferers and the fact is, many patients with FM simply CAN’T just “…learn to live with it,” and need guidance.
One such patient recently presented in such situation. After a detailed history, the chiropractor checked her vital signs, performed a physical exam that included observation, palpation, range of motion, physical performance testing, orthopedic and neurological tests and then sat down to discuss the findings and what specific things chiropractic could offer her. The chiropractor laid out a treatment that consisted of the following:
· Leg length correction: she had a 12mm short right leg, a tipped pelvis with a compensatory curve in the low back. Heel lifts were recommended.
· Foot orthotics: she had flat feet and rolled in ankles that were altering her gait pattern.
· Exercises: she was quite deconditioned (out of shape) and needed help with flexibility, strength and endurance, balance/coordination, and aerobic function.
· Spinal manipulation: She had areas in her spine that were not properly moving and she had to compensate and use other parts too much, setting up faulty movement habits.
· Nutritional counseling: She was consuming too many glutens (wheat, oats, barley, rice) which can make you feel tire/fatigued/”wiped out” all the time. She was placed on a strict gluten-free diet and encouraged to use of several nutrients.
· They discussed “realistic goals.” This was probably the MOST important part for her. She was told NOT to expect a “cure” but rather, a means of “controlling” FM. It was emphasized that expecting “too much” will set her up for disappointment and treatment failure. They discussed ways she could control or minimize the symptoms of FM and what the role of chiropractic played in that management process. They also discussed finding a family doctor who was willing to work with her chiropractor.
Her doctor reports she is doing very well, independent of regular doctor visits, and is for the first time in a long time, happy with her ability to control her FM condition.
Fibromyalgia & Chiropractic Care
Do you wake up feeling tired, washed out, and dragged down? Do you have generalized pain throughout your body that doesn’t seem to respond to anything you’ve tried? Do you wake up multiple times a night and fight getting back to sleep? These are classic symptoms of fibromyalgia (FM). However, when caught early and treated appropriately, FM can resolve or at least be controlled. Chiropractic care and management of FM is very effective and is becoming increasingly popular among FM sufferers. The goal of managing FM is to return you to a productive, enjoyable lifestyle allowing you to function and perform all of your desired activities.
Chiropractic care is the most popular and sought after form of alternative care or complementary medicine as 20% of American men and women utilize chiropractic care at some point in their lives. Of all the health care options, few have been found to be as satisfying to their patients as chiropractic with 80% of those seeking chiropractic treatment reporting significant pain relief, better functioning and an increased sense of wellbeing. Still, many ask questions such as, what is the science behind chiropractic and, what exactly does a chiropractor do?
The original hypothesis or theory of chiropractic that led to its founding in 1895 is that skeletal or bone misalignments cause nerve interference resulting in pain, loss of function, and a host of other symptoms related to the nervous system. The entire body is connected through bones, joints, muscles, ligaments, tendons, with their supporting circulatory or blood flow system and nervous system. When the skeletal structure is in good alignment, the body can handle the many stresses and challenges we all face on a daily basis. When there is a breakdown in this system, symptoms manifest and when left untreated, these symptoms can develop into chronic pain, including conditions such as fibromyalgia. Chiropractors focus to reduce pain and the many other symptoms by correcting the imbalances in the skeletal system with the objective of reducing nervous system dysfunction. Many of the techniques utilized in chiropractic care include manipulation of not only the bony structures, but also the muscles, tendons, and ligaments through various forms of manual or hands-on therapy, stretching, posture correction methods, exercise, lifestyle modification recommendations including diet and nutritional management, and activity modifications. Chiropractic care also includes discussions and instructions for modifying methods of performing tasks including bending, lifting, pulling, pushing in both at work and home activities. Work station modifications are also thoroughly investigated, especially when symptoms are consistently worse after the work day.
Patients with fibromyalgia classically have generalized pain and tender spots throughout their body and often present with back pain, neck pain, headaches, as well as arm and/or leg pain. Chiropractic care can effectively reduce the pain associated with FM by reducing bony misalignments, restoring muscle tone, and improving posture. Proper exercise training has been found to be very important in maintaining long-term control of FM and is included in the management of FM. Diet and nutritional counseling may also be beneficial. Research has been very supportive of chiropractic care for patients suffering from FM.
Fibromyalgia – Can Chiropractic Help… Who Says?
Fibromyalgia (FM) is one of the most commonly diagnosed soft tissue conditions in most branches of health care, including chiropractic. A paper was recently published with the primary purpose to review the existing literature / published research to determine what aspects of chiropractic treatment are the most commonly used and, to determine the quality of those treatment approaches. The emphasis of the study was to look at non-drug, conservative forms of therapy, rather than medication based approaches.
Commonly utilized chiropractic treatment options found to be beneficial include massage, muscle strengthening exercises, acupuncture, spinal manipulation, movement/body awareness, vitamins, herbs, and dietary modification. Cognitive behavioral therapy, not typically a chiropractic specific form of care, was also reported to be of significant benefit, as well as aerobic exercise. This study places chiropractic in a very favorable position in the management of FM.
Chiropractic is unique in that it encompasses many non-drug, non-surgical forms of treatment, making it appealing to many who do not want to risk the chances of drug related side effects and post-surgical complications. Patients with FM require a multi-dimensional treatment approach and a health care provider versed in whole-body, holistic concepts is in the best position to help this population.
Fibromyalgia can be primary where the specific cause is not well understood or secondary to an underlying injury or condition. Sometimes, it is difficult to determine the exact cause as other conditions can be present and/or arise simultaneously with FM making it difficult to differentiate between primary and secondary. When other conditions are present, sometimes attending those specific conditions will improve the status of FM and focus on treatments that address all of the patient’s physical and emotional health issues yields the most patient satisfying results.
Fibromyalgia And Your Upper Neck
How can a spinal problem possibly contribute to your fibromyalgia symptoms? As with many disorders, especially pain, the nervous system is involved. The nervous system can get affected thorough structural changes in the spinal column. The classic one is the disk bulge producing a painful sciatic nerve. But, there are also other ways to interfere with the function of nervous system.
When viewing the neck from the side, there should be a forward curve with your head above your shoulders, not in front of them. When forward head carriage is present or when there is a reduction in this forward arch, this may cause additional strain to the upper cervical spine or spinal cord, allowing delicate nerves to be compromised. Chiropractic care should improve your posture if this forward head carriage is present.
The upper neck can also be influenced by malalignment/subluxation of the upper vertebrae, such as the atlas. This small bone supports the weight of the skull and is necessary for the great rotational range of motion of the neck.
During neck trauma, the head and neck can be put through a violent range of motion that causes the soft tissues (muscles and ligaments) to tear. Blows to the head, childhood or sports injuries and even poor sleeping posture, can cause the upper neck vertebrae to displace, injuring the soft tissues of the joint. Swelling and inflammation can also be a source of irritation to the nervous system. Scar tissue can develop after trauma, which may affect the precise movements of the upper neck.
The atlas surrounds the spinal cord and as it displaces, it can also pull or tether the spinal cord through attachments of delicate ligaments (dentate). This could cause irritation to the nervous system.
The disorders of poor posture and displaced vertebrae can be assessed through x-rays. Range of motion tests are necessary to see how your function may be affected. In some patients, fibromyalgia symptoms can improve substantially. However, most people will need a comprehensive approach that also incorporates an exercise program and nutritional or weight loss support. Chiropractic care is a natural alternative for those who wish a drug-free and non-invasive approach. It carries few risks of side effects and is balanced by the potential to help patients who also have spinal disorders contributing to their poor health.
Whiplash Articles
Car Accidents and Mild Traumatic Brain Injury
When you woke up today, you thought this was like any other Friday. You’re on your way to work, and traffic is flowing smoother than normal. Suddenly, someone crashes into the back end of your car and you feel your head extend back over the headrest and then rebound forwards, almost hitting the steering with your forehead. It all happened so fast. After a few minutes, you notice your neck and head starting to hurt in a way you’ve not previously felt. When the police arrive and start asking questions about what had happened, you try to piece together what happened but you’re not quite sure of the sequence of events. Your memory just isn’t that clear. Within the first few days, in addition to significant neck and headache pain, you notice your memory seems fuzzy, and you easily lose your train of thought. Everything seems like an effort and you notice you’re quite irritable. When your chiropractor asks you if you’ve felt any of these symptoms, you look at them and say, "…how did you know? I just thought I was having a bad day – I didn’t know whiplash could cause these symptoms!"
Because these symptoms are often subtle and non-specific, it’s quite normal for patients not to complain about them. In fact, we almost always have to describe the symptoms and ask if any of these symptoms “sound familiar” to the patient.
As pointed out above, patients with Mild Traumatic Brain Injury (MTBI) don’t mention any of the previously described symptoms and in fact, may be embarrassed to discuss these symptoms with their chiropractor or physician when they first present after a car crash. This is because the symptoms are vague and hard to describe and, many feel the symptoms are caused by simply being tired or perhaps upset about the accident. When directly asked if any of these symptoms exist, the patient is often surprised there is an actual reason for feeling this way.
The cause of MTBI is due to the brain actually bouncing or rebounding off the inner walls of the bony skull during the “whiplash” process, when the head is forced back and forth after the impact. During that process, the brain which is suspended inside our skull, is forced forwards and literally ricochets off the skull and damages some of the nerve cells most commonly of either the brain stem (the part connected to the spinal cord), the frontal lobe (the part behind the forehead) and/or the temporal lobe (the part of the brain located on the side of the head). Depending on the direction and degree of force generated by the collision (front end, side impact or rear end collision), the area of the brain that may be damaged varies as it could be the area closest to initial impact or, the area on the opposite side, due to the rebound effect. Depending on which part of the brain is injured, the physical findings may include problems with walking, balance, coordination, strength/endurance, as well as difficulties with communicating (“cognitive deficits”), processing information, memory, and altered psychological functions.
The good news is that most of these injuries will recover within 3-12 months but unfortunately, not all do and in these cases, the term, “post-concussive syndrome” is sometimes used.
Whiplash Facts
Whiplash is a fairly common condition that occurs when the neck is suddenly forced forwards and backwards, usually from motor vehicle collisions. Before 1928, whiplash was sometimes called “railway spine” as it was used to describe injuries that occurred to people involved in train accidents. Since 1928, much has been studied and reported about this condition and in 1995, the term, “whiplash associated disorders” or WAD, was introduced. The WAD classification of whiplash patients includes 3 main category (WAD I, II and III) and a few years later, WAD II was broken into 2 sub-categories (WAD I, IIa, IIb, III). This occurred because some patients in WAD II took a longer time to heal than others. Here are the basic definitions of WAD I, II, III:
- WAD I: Patients have complaints but no objective findings meaning we cannot reproduce your pain during our examinations
- WAD IIa: Patients have complaints with objective findings but a normal range of movement of the neck and no neurological findings (normal strength and sensation ability)
- WAD IIb: Same as WAD IIa except here, neck movements are decreased
- WAD III: Here, neurological abnormal findings (weakness and/or sensation) are present.
- WAD IV: Includes fractures and dislocations. Because of this unique difference, this category is often left out of the research that uses this category system to determine prognosis of the WAD case.
We have discussed the cause of whiplash in previous articles and what happens when we are hit from behind unexpectedly. In essence, we cannot guard against the abnormal forces that occur in the neck as it all happens faster than we can voluntarily contract our muscles. Also, the myth about no car damage = no injury is just that – a myth! In fact, in low speed impacts, less damage to the car transfers greater forces to the contents inside because the energy of the force is not absorbed by crushing metal (elastic vs. plastic deformity).
Symptoms of whiplash vary widely. Most common symptoms include neck pain and stiffness, headache, shoulder pain/stiffness, dizziness, fatigue, jaw pain, arm pain, arm weakness, visual disturbances, ringing ear noises, and sometimes back pain. If symptoms continue and chronic WAD occurs, depression, anger, frustration, anxiety, stress, drug dependency, post-traumatic stress syndrome, sleep disturbance, and social isolation can occur.
Diagnosis is based on the history, physical exam, x-ray, MRI, and if nerve damage occurs (WAD III), an EMG. Treatment includes rest, ice and later heat, exercise, pain management and avoiding prolonged use of a collar. Chiropractic includes all of these as well as manipulation, mobilization, muscle release methods, and patient education. Prompt return to normal activity including work is important to avoid the negative spiral into long term disability.
What Really Causes Whiplash?
Whiplash is a non-medical term for a condition that occurs when the neck and head move rapidly forwards and backwards or, sideways, at a speed so fast our neck muscles are unable to stop the movement from happening. This sudden force results in the normal range of motion being exceeded and causes injury to the soft tissues (muscles, tendons and ligaments) of the neck. Classically, whiplash is associated with car accidents or, motor vehicle collisions (MVCs) but can also be caused by other injuries such as a fall on the ice and banging the head, sports injuries, as well as being assaulted, including “shaken baby syndrome.”
The History Of Whiplash. The term “Whiplash” was first coined in 1928 when pilots were injured by landing airplanes on air craft carriers in the ocean. Their heads were snapped forwards and back as they came to a sudden stop. There are many synonyms for the term “whiplash” including, but not limited to, cervical hyperextension injury, acceleration-deceleration syndrome, cervical sprain (meaning ligament injury) and cervical strain (meaning muscle / tendon injury). In spite of this, the term “whiplash” has continued to be used usually in reference to MVCs.
Why Whiplash Occurs. As noted previously, we cannot voluntarily stop our head from moving beyond the normal range of motion as it takes only about 500 milliseconds for whiplash to occur during a MVC, and we cannot voluntarily contract our neck muscles in less than 800-1000 msec. The confusing part about whiplash is that it can occur in low speed collisions such as 5-10 mph, sometimes more often than at speeds of 20 mph or more. The reason for this has to do with the vehicle absorbing the energy of the collision. At lower speeds, there is less crushing of the metal (less damage to the vehicle) and therefore, less of the energy from the collision is absorbed. The energy from the impact is then transferred to the contents inside the vehicle (that is, you)! This is technically called elastic deformity – when there is less damage to the car, more energy is transferred to the contents inside the car. When metal crushes, energy is absorbed and less energy affects the vehicle's contents (technically called plastic deformity). This is exemplified by race cars. When they crash, they are made to break apart so the contents (the driver) is less jostled by the force of the collision. Sometimes, all that is left after the collision is the cage surrounding the driver.
Whiplash Symptoms. Symptoms can occur immediately or within minutes to hours after the initial injury. Also, less injured areas may be overshadowed initially by more seriously injured areas and may only “surface” after the more serious injured areas improve. The most common symptoms include neck pain, headaches, and limited neck movement (stiffness). Neck pain may radiate into the middle back area and/or down an arm. If arm pain is present, a pinched nerve is a distinct possibility. Also, mild brain injury can occur even when the head is not bumped or hit. These symptoms include difficulty staying on task, losing your place in the middle of thought or sentences and tireness/fatigue. These symptoms often resolve within 6 weeks with a 40% chance of still hurting after 3 months, and 18% chance after 2 years. There is no reliable method to predict the outcome. Studies have shown that early mobilization and manipulation results in a better outcome than waiting for weeks or months to seek chiropractic treatment. The best results are found by obtaining prompt chiropractic care.
Whiplash – What is the Best Type of Treatment?
Whiplash usually occurs when the head is suddenly whipped or snapped due to a sudden jolt, usually involving a motor vehicle collision. However, it can also occur from a slip and fall injury. So the question on deck is, which of the health care services best addresses the injured whiplash patient?
This question was investigated in a published study titled, A symptomatic classification of whiplash injury and the implications for treatment (Journal of Orthopaedic Medicine 1999;21(1):22-25). The authors state conventional [medical] treatment utilized in whiplash care, "is disappointing." The authors’ reference a study that demonstrated chiropractic treatment benefited 26 of 28 patients with chronic whiplash syndrome. The objective of their study was to determine which type of chronic whiplash patient would benefit the most from chiropractic treatment. They separated patients into one of 3 groups: Group 1: patients with "neck pain radiating in a 'coat hanger' distribution, associated with restricted range of neck movement but with no neurological deficit"; Group 2: patients with "neurological symptoms, signs or both in association with neck pain and a restricted range of neck movement"; Group 3: patients who described "severe neck pain but all of whom had a full range of motion and no neurological symptoms or signs distributed over specific myotomes or dermatomes." These patients also "described an unusual complex of symptoms," including "blackouts, visual disturbances, nausea, vomiting and chest pain, along with a nondermatomal distribution of pain."
The patients underwent an average of 19.3 adjustments over the course of 4.1 months (mean). The patients were then surveyed and their improvement was reported:
These findings show the best chiropractic treatment results occur in patients with mechanical neck pain (group 1) and / or those with neurological losses (group 2). The exaggerated group (group 3) was the most challenging and, the only group where a small percentage worsened. The good news is, the number of cases that responded well to chiropractic treatment (groups 1 & 2) far out number those that don’t (group 3). Hence, most patients with whiplash injuries should consider chiropractic as their first choice of health care provision.
“The Only Proven Effective Treatment” for Chronic Whiplash?
You may have wondered, “If I get hurt in a car accident, who should I go to for treatment of my whiplash problem?” This can be quite a challenge as you have many choices available in the healthcare system ranging from drug-related approaches from anti-inflammatory over-the-counter types all the way to potentially addicting narcotic medications. On the other side of the fence, there are nutritional based products such as vitamins and herbs as well as “alternative” or “complementary” forms of treatment such as chiropractic, exercise, and meditation, with many others in between. Trying to figure out which approach or perhaps combined approaches would best serve your needs is truly challenging. To help answer this question, one study reported the superiority of chiropractic management for patients with chronic whiplash, as well as which type of chronic whiplash patients responded best to the care. The research paper begins with the comment from a leading orthopedic medical journal stating, “Conventional [meaning medical] treatment of patients with whiplash symptoms is disappointing.” In the study, 93 patients were divided into three groups consisting of:
- Group 1: Patients with a “coat-hanger” pain distribution (neck and upper shoulders) and loss of neck range of motion (ROM), but no neurological deficits;
- Group 2: Patients with neurological problems (arm/hand numbness and/or weakness) plus neck pain and ROM loss); and,
- Group 3: Patients who reported severe neck pain but had normal neck ROM and no neurological losses.
Here are the results:
- Group 1: 72% reported improvement as follows: 24% were asymptomatic, 24% improved by 2 grades, 24% by 1 grade, and 28% reported no improvement.
- Group 2: 94% reported improvement as follows: 38% were asymptomatic, 43% improved by 2 grades, 13% by 1 grade, and 6% had no improvement.
- Group 3: 27% reported improvement as follows: 0% were asymptomatic, 9% improved by 2 grades, 18% by 1 grade, 64% showed no improvement, and 9% got worse.
Chiropractic Articles
Chiropractic Education
Many people seem surprised to find out that the chiropractic education process is so extensive. I usually reply, "...whether you're planning to become a chiropractor, medical doctor, or dentist, it takes four years of college followed by and additional 4-5 years of additional education (med school, dental school, chiropractic college) simply because there is that much to learn about the body to become a competent health care provider. "
Hence, depending on the area of interest a person has in the health care industry, it takes a similar amount of time to complete the educational program.
DID YOU KNOW...
· The initial step is completing a typical "pre-med" undergraduate or college degree.
· Courses including biology, inorganic and organic chemistry, physics, psychology, various science labs, as well as all the liberal art requirements needed to graduate are included in the undergraduate education process.
· Many states now require 4 years of college in addition to the 4 to 5 academic years of chiropractic education to practice in their particular state.
· Once entering a chiropractic university, the same format exists as most health care disciplines.
· The basic sciences are covered in the first half of the educational process after which time successful completion of the National Boards Part I examination is required to move into the second half - the clinical sciences.
· From there, internships, residency programs, preceptorship programs become available to the chiropractic student.
· Once graduated, residence programs including (but not limited to) orthopedics, neurology, pediatrics, radiology, sports medicine, rehabilitation, internal medicine, and others are options. Many various Masters and doctorate programs in specialty areas are also available.
This chart shows the similarities between three health care delivery approaches, DC, MD, and DPT (doctor of physiotherapy). Curriculum Requirements For the Doctor of Chiropractic Degree (DC) in comparison to the Doctor of Medicine Degree (MD) and the Doctor of Physical Therapy Degree (DPT): *Does not include hours attributed to post-graduation residency programs.
AS YOU CAN SEE, THE ACTUAL NUMBER OF AVERAGE CLASSROOM AND CLINICAL STUDY HOURS PRIOR TO GRADUATION IS EVEN HIGHER FOR CHIROPRACTIC COMPARED TO THE MD AND DPT CURRICULUM.
It should be noted that this does not include additional educational training associated with residency programs, which are available in the three disciplines compared here.
At one of the chiropractic colleges, the academic core program or Clinical Practice Curriculum consists of 308 credit hours of course study and includes 4,620 contact hours of lecture, laboratory and clinical education.
There are 10 trimesters of education arranged in a prerequisite sequence.
The degree of Doctor of Chiropractic (D.C.) is awarded upon successful completion of the required course of study.
In order to receive a degree, a student must have satisfied all academic and clinical requirements and must have earned no less than the final 25 percent of the total credits required for the D.C. degree, allowing up to 75 percent of the total credits through advanced standing.
The academic program may be completed in three and one-third calendar years of continuous residency. Graduation, however, is contingent upon completion of the program in accordance with the standards of the College, which meet or exceed those of its accrediting agencies.
In addition to courses included in the core curriculum, a variety of procedure electives are available to the students. These electives are designed to complement the study of adjustive procedures included and facilitate investigation of specialized techniques.
As a doctor of chiropractic, we are committed to providing the highest quality care available to our patients. We coordinate care with other doctors when appropriate in quest of reaching the goal of our helping our patients in the most efficient, economic, and evidence-based approach possible.
Many Medical Doctors Recommending Chiropractic Care For Back Pain Relief
Harvard Study: Low Back Pain Patients Significantly More Satisfied With Chiropractic Than Conventional Medical Care.
At the 17th annual North American Spine Society meeting, three medical doctors defended Chiropractic by citing a Harvard study that found low back pain patients were significantly more satisfied with Chiropractic treatments compared to conventional medical care.
After researching "myths," Co-author , Dr. Zigler, MD found Chiropractic education is more similar to medical education than it is dissimilar.
Dr. Zigler had integrated Chiropractors into his multi-disciplinary spine center where the Chiropractors screen patients for surgical versus non-surgical care.
Another co-author, Dr. Cole, MD, stated, "overall, manipulation* has the advantage of reducing pain, decreasing medication, rapidly advancing physical therapy and requiring fewer passive modalities." (*Manipulation is one of the primary treatment techniques used by Doctors of Chiropractic.)
He also recommends spine surgeons refer their patients to Chiropractors.
Physical Therapy Vs. Chiropractic
The most obvious difference between doctors of chiropractic (DC's) and physical therapists (PT's) is virtually all DC's utilize some form of manipulation to restore joint function, whereas only a very small percentage of PT's utilize manipulation and virtually none of them have nearly as much experience "adjusting" patients or, the training to determine how and when to adjust for ultimate results go beyond just pain relief. Another very important difference is the education curriculum of chiropractors includes many class hours in physiology, pathology, clinical examination, radiology, laboratory testing and interpretation and diagnosis - these are not included in the PT educational process.
Perhaps even more important, chiropractors are accessible to the general public - that is, a referral from a medical doctor is not required. This is not the case for physical therapy as a medical referral is required and, the medical doctor can limit the amount of care rendered. This is an area that the physical therapy groups are currently working hard to change with many debated issues being presented. There are now some states that allow direct access of patients to doctors of physical therapy (DPT's), a new program created to improve the limited accessibility to PT's.
With the debate raging on about health care reform, a pilot study indicating chiropractic care and other physical medicine approaches may reduce costs is VERY TIMELY!
In 2008, Welllmark Blue Cross and Blue Shield conducted a 1-year pilot program designed to study the patient quality of care. The researchers concluded that the use of chiropractic and other physical medicine services significantly improved clinical outcomes and reduced health care costs. The 2008 Iowa and South Dakota pilot study included 238 chiropractors, physical therapists and occupational therapists that provided care to 5500 Wellmark patients with musculoskeletal disorders. They reported 89% of all patients receiving physical mediclne services improved at least 30% within 30 days. These statistics were so impressive that they decided to continue the program.
Supporters of chiropractic treatment praised the findings, saying that the cost-effectiveness of the method has been documented in several studies.
The president of the American Chiropractic Association, Glenn Manceaux, referred to a 2005 study published in the Journal of Manipulative and Physiological Therapeutics that found chiropractic and medical care have comparable costs for treating chronic low-back pain, with chiropractic care producing significantly better outcomes. Similarly, a study published in a 2003 edition of Spine medical journal found that manual manipulation provides better short-term relief of chronic spinal pain than a variety of medications, he said - "Especially during the health care reform debate, it's important that chiropractic and other conservative care methods are taken into serious consideration as a cost-effective alternative to the utilization of expensive surgery and hospital-based care."
Is Chiropractic Dangerous?
The mission of chiropractic is to help sick people get well, as well as to help healthy people function better in the absence of drugs or surgery.
When people are asked, "...what do chiropractors do?" the frequent response is, "...they crack your neck and/or back."
Chiropractic spinal manipulation (frequently called an adjustment), often produces an audible popping or cracking noise.
This sound is known as joint cavitation and it is reported to be caused by the release of pressure created by gases (nitrogen, oxygen, and carbon dioxide) within the joint.
It is the same noise produced when one cracks their knuckles. One common myth is that cracking or cavitating a joint will produce arthritis in the joint - this is simply not true.
Several scientific studies of joint cavitation dispel this old wives tale. In fact, studies demonstrated that joint manipulation actually benefits patients with arthritis of the spine.
There have been a number of studies published on the topic of unwanted reactions to spinal manipulation.
In general, side effects, if any, are mild and transient.
When they do occur, they typically happen shortly after the first or second session of spinal manipulation, similar to the post-exercise soreness that occurs when first introducing a new sport or activity.
Unpleasant side effects may occur in between 10% and 30% of patients. They occur more often in women than men, and as previously stated, they seem to occur more often after the first session of spinal manipulation.
The most commonly reported unpleasant reaction is temporary and transient increased pain or stiffness. This reaction usually resolves in 24 hours or less. More rare reports of tiredness, light headedness, and occasional nausea have been infrequently reported.
The type and nature of these reactions may be associated with the severity and nature of the condition being treated.
It seems self evident that more severe problems have the potential to produce short term increases in symptoms. The use of ice, ultrasound and or other modalities can help to minimize any irritation that may occur due to spinal manipulative treatment.
SPINAL MANIPULATION HAS BEEN FOUND TO BE SAFE AND EFFECTIVE FOR UNCOMPLICATED SPINAL PAIN SYNDROMES. MORE IMPORTANTLY, IT MAY ALSO BE A VIABLE ALTERNATIVE TO SURGERY FOR LUMBAR OR CERVICAL DISK HERNIATIONS.
There are many reports on both sides of this subject, with some stating spinal manipulation can increase compression of the spinal nerves in patients with disk herniations as well as the opposite - that it reduces nerve root pressure.
The good news is that the rate of occurrence is only about 1 in 1- 3 million cases, making spinal manipulation for disk problems an extremely safe treatment option for patient with herniated disks.
Chiropractors will often use low-force manipulation methods for treating herniated disks that do not require a standard type of manipulation thrust.
These spinal methods are sometimes preferred over traditional manipulative techniques for the treatment of herniated spinal disks, but this is case dependent.
To make an educated decision about any type of care you may be considering, you must consider "relative risks". Simply put, relative risks compare the risk of one procedure with the risk of a second procedure for the same condition.
For example, if you are taking medications to relieve your pain, how do the risks of the medications compare with the risks of an alternative treatment, like chiropractic care?
An example is chiropractic treatment versus drugs known as non-steroidal anti-inflammatory drugs (NSAIDs), which include aspirin, Aleve and Advil (TM).
THE RISK FOR SERIOUS SIDE EFFECTS FROM ANTI-INFLAMMATORY DRUG IS FROM 6000-9000 TIMES GREATER THAN THE RISK FOR SERIOUS SIDE EFFECTS FROM SPINAL MANIPULATION, MEANING THAT CHIROPRACTIC CARE IS A MUCH SAFER ALTERNATIVE THAN ASPIRIN OR OTHER NSAID DRUGS FOR TREATING INFLAMMATORY BACK OR NECK PAIN.
Further, there is no significant increased risk to add chiropractic care to an existing regime of NSAIDs, thus treating the condition with two different strategies.
Interestingly, studies have reported that patients receiving chiropractic care were able to reduce their intake of drugs, thus, reducing the risks of drug reactions/interactions.
If you are trying to avoid surgery for a spine related problem, your condition is more serious and potential side effects of surgery should be compared with chiropractic.
You should understand any patient who is a potential candidate for spine surgery has a serious medical condition. There is pressure on a nerve and the potential for permanent damage to that nerve exists.
Studies show that chiropractic care often can reduce the pressure on a compressed nerve in the lower back or neck, without surgery.
The Difference in Effectiveness of Medical vs. Chiropractic
In The Treatment of Acute and Chronic Back Pain
Have you ever considered who is the best suited to treat back pain? Since there are so many treatment options available today, it is quite challenging to make this decision without a little help.
To facilitate, a study looking at this very question compared the effectiveness between medical and chiropractic intervention. Over a 4-year time frame, 2780 patients were followed with questionnaires. Low Back Pain patients were treated using conventional approaches by both MDs (Medical Doctors) and DCs (Doctors of Chiropractic).
Chiropractic treatments included spinal manipulation, physical therapy, an exercise plan, and self-care education. Medical therapies included prescription drugs, an exercise plan, self-care advice and about 25% of the patients received physical therapy.
The study focused on present pain severity and functional disability (activity interference) measured by questionnaires mailed to the patients. It was reported that chiropractic was favored over medical treatment in the following areas:
· Pain relief in the first 12 months (more evident in the chronic patients)
· When LBP pain radiated below the knee (more evident in the chronic patients)
· Chronic LBP patients with no leg pain (during the first 3 months)
Similar trends favoring chiropractic were seen for disability but were of smaller magnitude. All patient groups saw significant improvement in both pain and disability over the four year study period.
Acute patients saw the greatest degree of improvement with many achieving symptom relief after 3 months of care.
This study also found early intervention reduced chronic pain and, at year 3, those acute LBP patients who received early intervention reported fewer days of LBP than those who waited longer for treatment.
While both MDs and DCs treatment approaches helped, it's quite clear from the information reported that chiropractic should be utilized first.
These findings support the importance of early intervention by chiropractic physicians and make the most sense for those of you struggling with the question of who to see for your LBP.
