When it comes to neck pain, many patients seek out chiropractic care. In fact, there are several studies demonstrating that manual therapies performed by doctors of chiropractic can offer significant benefits for non-specific or mechanical neck pain as well as neck pain arising from injuries related to sports, car accidents, and falls. What are some of these manual therapies?
Spinal manipulative therapy (SMT) involves moving the head and neck to a firm end-range of movement followed by a fast, thrust aimed at specific joints that are fixed, subluxated (partially out of position), and tender. The thrust is described as a “high-velocity, low amplitude” (HVLA) movement, and it’s also called “an adjustment”, which is more unique to the chiropractic profession. Joint cavitation (the “cracking” sound) often occurs as gas (nitrogen, oxygen, carbon dioxide) either forms within or is released from the joint.
Spinal mobilization (SM) is a low-velocity, low amplitude movement that is typically slow and rhythmic, gradually increasing the depth of a back-and-forth movement, often combined with manual traction. Here, joint cavitation is less common.
Exercise training that focuses on strengthening the deep neck flexor muscles and other exercises that are specifically designed for each individual patient based on their specific needs can result in better treatment outcomes compared to a generalized, non-specific exercise program. Studies in which SMT/SM and exercise are combined report better long-term outcomes than SMT/SM alone, but SMT/SM typically out-performs exercise therapy alone.
Physical therapy modalities (PTM) can include ultrasound, interferential, low and high volt, galvanic current, diathermy, lasers (class 3B and IV primarily), ultraviolet, ionto- and phono- phoresis, pulsed electro-magnetic field, hot/cold, and more.
Muscle release techniques (MRTs) include massage therapy, myofascial release, trigger point therapy, muscle energy techniques, active release therapy, gua sha, and many more.
Cervical traction devices can be used either in the office or at home, depending on the patient’s needs; however, it’s common for both approaches to be used. The obvious benefits of home traction include the ability to repeat its use multiple times a day, and it’s generally more cost effective. Types include static traction that can be applied sitting or supine (on the back) and intermittent traction, which is typically performed supine and is computerized, and hence, is often limited to in-office use only.
Which approaches are used in the course of care depend on the preference of the patient as well as the treating chiropractor. It’s important to discuss your preferences with your chiropractor when seeking care.
Since the late 1980s, researchers have embraced the biopsychosocial model (BPS) to understand both the causative and prognostic factors associated with neuromusculoskeletal disorders, which includes back pain. In order to achieve the best possible outcomes for patients with back pain, it’s important to understand the role that factors outside of the biomechanical injury model play in both the injury and recovery processes. Unfortunately, there’s a lot of misinformation out there that can be detrimental to the patient.
In one study that included 130 low back pain (LBP) patients with persistent or recurring back pain, participants answered questions about the cause of their LBP, including what they’ve learned since receiving care. Their answers revealed that such patients see their LBP as: 1) due to the body being like a broken machine; 2) permanent; 3) complex; and 4) very negative. Nearly 9 in 10 patients (89%) indicated they learned these beliefs from healthcare professionals.
The study’s findings indicate that healthcare providers may be in the best position to educate patients about their condition. However, responses from 103 primary care physicians (PCPs) suggested that they considered biomechanical risk factors to be the most important short-term and long-term factors for a sudden episode of acute LBP.
When it comes to giving yourself the best possible chance of recovery from LBP, here are some things to keep in mind in addition to utilizing non-surgical treatments that are recommended by current guidelines, of which chiropractic care is an excellent choice: 1) Research has demonstrated that depression, anxiety, and self-limiting beliefs about future ability to work or do physical activity are psychosocial factors that are associated with poor outcomes. 2) Insufficient sleep and smoking are also lifestyle behaviors that can slow one’s recovery from injury, which includes low back pain! 3) Because movement is necessary to diffuse nutrients into cartilaginous tissue, it’s important to stay active during the recovery process to maintain joint health. Physical activity also keeps the muscles from deconditioning, especially the deep muscles that control posture.
Doctors of chiropractic are trained to approach treatment from a biopsychosocial perspective and to consider all factors that affect the patient’s chief complaint and quality of life. Through patient education, spinal manipulation, mobilization, exercise training, the use of modalities, and more, chiropractors can greatly help those struggling with back pain and other musculoskeletal conditions!
The first thing to understand is that while migraines may not necessarily be caused by cervical dysfunction, it’s becoming increasingly clear that issues in the neck may play some role in the migraine headache process.
For example, in a 2019 study published in the European Spine Journal, researchers examined the neck of 52 female migraineurs and 52 women without a history of neck pain or headaches and found that participants in the migraine group were significantly more likely to exhibit cervical dysfunction.
Another 2019 study, this time published in the journal Cephalagia, reported that migraine patients with concurrent neck pain had significantly more migraine-related disability than those without neck pain. Other studies have shown that individuals with migraines are more likely to have trigger points in the cervical muscles.
So, can chiropractic treatment to improve cervical function benefit migraine patients? A review of data from six randomized control trials that included a total of 667 migraine headache patients who received spinal manipulative therapy (SMT) concluded that SMT is “an effective therapeutic technique to reduce migraine days and pain/intensity.”
What can a migraine patient expect when they visit a doctor of chiropractic? First, the patient will undergo a thorough examination to determine which locations in the cervical region to apply treatment, usually by examining the degree of joint “play” or restriction, point tenderness, and localized muscle guarding using static and motion palpation methods. The treatment approach will typically include a combination of spinal manipulation, mobilization, specific exercises, modalities, and nutritional recommendations, depending on the patient’s needs and preferences.
When people think of chiropractic care, they usually imagine back pain, neck pain, and headaches, as research STRONGLY supports chiropractic treatment for these complaints. But what about chiropractic care for shoulder pain?
In 2010 and again in 2014, the United Kingdom government published landmark studies that reviewed previously published research on various forms of treatment for MANY conditions, both musculoskeletal and non-musculoskeletal (like asthma). These reviews noted there is favorable scientific evidence for the use of chiropractic treatment with regards to shoulder-related conditions including shoulder girdle pain/dysfunction, rotator cuff pain, and adhesive capsulitis (frozen shoulder).
When doctors of chiropractic approach treatment for patients with shoulder pain, care typically focuses on restoring shoulder range of motion using various manipulative and mobilization techniques directed at the three joints of the shoulder: the glenohumeral (the ball & socket joint), the acromioclavicular (AC) joint (clavicle & scapula), and the scapulothoracic joint (shoulder blade & rib cage). Chiropractic care may also include exercise training focused on restoring motion, strength, and stability to the muscles and soft tissues surrounding the shoulder region. A host of physical therapy modalities are also utilized as adjunctive procedures in many chiropractic settings at various stages of healing following shoulder injury. The goal of care is to return patients to their normal level of everyday function.
But what about shoulder pain AFTER surgery? Can chiropractic still help? A 2018 study found that post-surgical patients who received mid-back (thoracic spine) manipulation experienced significant increases in shoulder movement (flexion and abduction) and increased subacromial space measurements (in neutral and external rotation). The authors cited other studies that reported similar improvements in shoulder mobility as well as shoulder blade (scapular) kinematics (movement & stability).
Another study looked at changes in shoulder pain, disability, and perceived recovery after two sessions of upper thoracic and upper rib manipulation in patients with shoulder pain. Here too, participants reported significant improvement in all parameters tested that persisted for up to three months.
Given the solid research support of manual therapies directed at not only the shoulder but also to the neck, upper, and mid-back spinal regions, chiropractic care for patients with shoulder pain is simply a must!
Low back pain (LBP) can be localized and contained to only the low back area or it can radiate pain down the leg. This distinction is important as the former, LBP only, is often less complicated and carries a more favorable prognosis for complete recovery. In fact, a large part of the history and examination when you seek treatment for back pain is focused on this differentiation. This month’s article will look at the different types of leg pain that can occur with different LBP conditions.
We’ve all heard of the word “sciatica” and it (usually) is loosely used to describe everything from LBP arising from the joints in the back, from the sacroiliac joint, from the muscles of the low back, and even from a pinched nerve caused by a ruptured disk. Strictly speaking, the term “sciatica” should ONLY be used when the sciatic nerve is pinched. The sciatic nerve is made up of five smaller nerves (L4, L5, S1, S2, S3) that arise from the spine and join together to form one large nerve (about the size of our pinky) called the sciatic nerve – like five small rivers merging into one BIG river. Sciatica occurs when any one of the small nerves (L4-S3) or when the sciatic nerve itself becomes compressed or irritated. This can be (and often is) caused from a lumbar disk herniation (the “ruptured disk”), a mis-positioned vertebra (such as a forward slip of the vertebra called “spondylolisthesis”), pressure from an arthritic spur off the spine where the nerve exits (“spinal stenosis”), or from a tumor near or around the nerve. A term called “pseudosciatica” (a non-disk cause) includes a pinch from the piriformis muscle where the nerve passes through the pelvis (in the “cheek” or the buttocks), which has been commonly referred to as “wallet sciatica” as sitting on the wallet in the back pocket is often the cause. When this occurs, the term “peripheral neuropathy” is the most accurate term to use. Other “pseudosciatic” causes include referred pain from the facet joints which is described by the patient as a “deep ache” inside the leg or from a metabolic condition where the nerve is affected by diabetes or other conditions. Here, the term “neuropathy” is the better label when diabetes, hypothyroid, lead poisoning, alcohol toxicity, and/or another cause is the culprit. Direct trauma, like a bruise to the buttocks from falling or hitting the nerve during an injection into the buttocks, can also trigger “sciatica.”
The symptoms of sciatica include low back pain, buttocks pain, back of the thigh, calf, and/or foot pain and/or numbness-tingling. If the nerve is compressed enough, muscle weakness can occur making it hard to stand up on the tip toes creating a limp when walking. In the clinic, your doctor may raise your straightened leg and if there’s a pinched nerve, then sharp pain can occur as the nerve is stretched. If pain occurs anywhere between 30 and 70° of elevation of either the same side leg and/or the opposite leg, this constitutes a positive test for sciatica (better termed, “nerve root tension”). When a disk is herniated into the nerve, bending the spine backwards can move the disk away and off the nerve resulting in relief, which is very diagnostic of a herniated disk. Having a patient walk on their toes and then heels and watching for foot drop as well as testing the reflexes, the sensation with a sharp object, and testing the reflexes at the knee and Achilles tendon can give your doctor clues if there is nerve damage. The GOOD NEWS is that chiropractic methods can resolve this problem, thus helping you to avoid unnecessary surgery! So, check with your doctor of chiropractic FIRST, before electing for surgery!!!
Whiplash associated disorders (WAD) describes a constellation of symptoms that can arise following a motor vehicle collision (MVC), sports collision, or slip and fall. The typical initial treatment approach for WAD is non-surgical care, but what does the research say is the best non-surgical approach?
To start, most (if not all) studies on WAD center around the concept of preventing chronicity of WAD. In other words, the GOAL of care is to restore function and get the patient back to their normal lifestyle (work and play), which has been emphasized as being most important, even more so than pain resolution, though the two often go hand-in-hand. What are the best treatments in the initial stages—acute (less than two weeks) and sub-acute (two to twelve weeks)—of healing that can best reduce the risk of a patient developing chronic WAD (over twelve weeks)?
To answer the question, researchers reviewed studies from a 30-year time frame (1980-2009) and published their findings in a five-part series.
The first article in the series offered an overview and summary of the entire work. The second focused on the acute stage which included 23 studies that met the inclusion criteria. The researchers concluded that EXERCISE and MOBILIZATION treatment approaches had the strongest research support—two services STRONGLY EMBRACED by chiropractic.
The third article in the series focused on the subacute stage (2-12 weeks), which included 13 studies. The authors described research support for “the use of interdisciplinary interventions and chiropractic manipulation” but stated that the level of evidence was not strong for ANY treatment approach in the sub-acute stage. Investigators concluded that more research was needed with respect to this stage of care.
The fourth article in the series centered on the chronic stage (more than three months), of which 22 studies were included. Here, EXERCISE programs were reported to offer relief, at least over the short-term, while nine studies supported effectiveness for an interdisciplinary approach. Manual joint manipulation and myofeedback training were also reported as useful for pain relief.
The authors also stated that there was strong evidence to suggest that immobilization with a soft collar was not only ineffective but may impede recovery.
Do you see the “theme” of this research series? Services offered by chiropractic (exercise training, manipulation, and mobilization) are recommended at each stage of WAD recovery!
Acid Reflux Disease is an all too common problem in our society and they sell an awful lot of pharmaceuticals to try and cover it up. T.V. ads show volcanic lava flows to illustrate the negative effects of stomach acid on the walls of the esophagus. The cause is really quite simple but treating the symptoms is a more profitable solution, which just perpetuates the use of chemicals indefinitely to inhibit the production of, or neutralize, acid in the stomach. This, however, causes more problems in the digestive tract because the acid is what breaks down our food so that the nutrition can be readily absorbed. When you inhibit this process, whole food travels through the digestive tract and instead of being digested it putrefies and irritates the entire digestive tract. We take a different approach by addressing the cause of the problem- and therefore remove the symptoms. The most common cause of acid reflux is a hiatal hernia.
A hiatal hernia occurs when a part of the stomach slides above the diaphragm the thin muscle separating the stomach from the chest. This is a common problem and most people experience acid reflux or "heart burn". Your hernia may allow stomach acid to flow back into your esophagus, the tube that connects the mouth to the stomach. With time, the stomach acid may irritate your esophagus and cause problems. You are 5 times more likely to develop ulcers and 100 times more likely to develop esophageal cancer. You can be born with a hiatal hernia or develop one when you are older. A trauma or surgery can cause the problem too. Hiatal hernias are common, occurring in about one-quarter of people older than 50. They're especially likely to occur in women and in people who are overweight. The most common symptom is burning in your chest (heartburn), especially at night when you are lying down. Other possible signs include burping and trouble swallowing. Hiatal hernias - also known as diaphragmatic hernias - form at the opening (hiatus) in your diaphragm where your food pipe (esophagus) joins your stomach. When the muscle tissue around the hiatus becomes weak due to a lack of tone, the upper part of your stomach may bulge through the diaphragm into your chest cavity. By gently working the stomach down out from the diaphragm and restoring the nerve flow to the area by adjusting the spine we can greatly reduce or eliminate the effects of the hiatal hernia. Some cases will last indefinitely, although severe hiatal hernias sometimes need surgical repair.
Chiropractic has long been recognized for helping back pain. When people finally come to chiropractors with back pain they are often surprised to get relief from other painful conditions in the process, like headaches, neck or shoulder pain, and even leg pain. If you or someone you know is in pain, give our office a call today at 1-408-909-7246 for a consultation with our knowledgeable doctors who are specialists in the use of chiropractic and other non-intrusive, non-surgical methods for the relief of low back pain. We want to help.