Chronic Pain

Why Crack?

~ Dr. Robert Speirs DC ~ Leave a comment

Shrug

​We all know what it’s like to have neck pain—whether it’s after a long drive, pinching the phone between the head and shoulder, star-gazing, or from talking to someone who is seated off to the side. There are many causes of neck pain, but the question of the month is, how do chiropractic adjustments help neck pain? Let’s take a look!

Chiropractic, when broken down into its fundamental Greek derivatives, means “hand” (cheir) and “action” (praxis). The technique most often associated with chiropractic is spinal manipulation where a “high velocity, low amplitude” thrust is applied to specific vertebrae in the spine, which does several things: 1) It restores mobility in an area with restricted movement; 2) It stimulates the sensory “neuroreceptors” in joint capsules, which has a muscle relaxing reflex effect; 3) It can affect surrounding neurological structures in certain parts of the spine such as the parasympathetic (cranial & sacral regions) and sympathetic (mid-back) nervous systems, which can have beneficial effects on the digestive system, cardiovascular system, and other body systems not typically thought about when seeking chiropractic care.

Joint manipulation is not new, as it can be traced back to as early as 400 BCE. The profession of chiropractic began in the later 1800s and has grown in popularity ever since. There is now an overwhelming body of evidence that supports spinal manipulation as both a safe and highly effective treatment for neck and back pain, headaches, and many other maladies.

It’s important to note that there are many different types of manual therapies that chiropractors utilize when caring for neck pain patients. There are “low-velocity, low amplitude” or non-thrust techniques that do NOT produce the “crack” that is frequently associated with chiropractic adjustments. The term “mobilization” is often used when referencing these non-thrust methods, and this often incorporates a combination of manual traction (pulling of the neck), left to right and front to back “gliding” movements usually starting lightly and gradually increasing the pressure as tolerated. In many cases, a doctor of chiropractic may utilize a combination of manipulation and mobilization as well as “trigger point therapy” (applying sustained pressure over tight “knots” in muscles), depending on a patient’s needs.

Meds or Chiro first?

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Head and Neck

​Although both medication and chiropractic are utilized by neck pain sufferers, not everyone wants to or can take certain medications due to unwanted side effects. For those who aren’t sure what to do, wouldn’t it be nice if research was available that could answer the question posted above? Let’s take a look!

When people have neck pain, they have options as to where they can go for care. Many seek treatment from their primary care physician (PCP). The PCP’s approach to neck pain management usually results in a prescription that may include an anti-inflammatory drug (like ibuprofen or Naproxen), a muscle relaxant (like Flexeril / cyclobenzaprine), and/or a pain pill (like hydrocodone / Vicodin). The choice of which medication a PCP recommends hinges on the patient’s presentation, patient preference (driven from advertisements or prior experiences), and/or the PCP’s own preference.

Although it’s becoming increasingly common to have a PCP refer a neck pain patient for chiropractic care, this still does not happen for all neck pain patients in spite of strong research supporting the significant benefits of spinal manipulation to treat neck pain. One such study compared spinal manipulation, acupuncture, and anti-inflammatory medication with the objective of assessing the long-term benefits (at one year) of these three approaches in patients with chronic (>13 weeks) neck pain. The study randomly divided 115 patients into one of three groups that were all treated for nine weeks. Comparison at the one-year point showed that ONLY those who received spinal manipulation had maintained long-term benefits based on a review of seven main outcome measures. The study concludes that for patients with chronic neck pain, spinal manipulation was the ONLY treatment that maintained a significant long-term (one-year) benefit after nine weeks of treatment!

In a 2012 study published in medical journal The Annals of Internal Medicine, 272 acute or sub-acute neck pain patients received one of three treatment approaches: medication, exercise with advice from a health care practitioner, or chiropractic care. Participants were treated for twelve weeks, with outcomes assessed at 2, 4, 8, 12, 26, and 52 weeks. The patients in the chiropractic care and exercise groups significantly outperformed the medication group at the 26-week point AND had more than DOUBLE the likelihood of complete neck pain relief. However, at the one-year point, ONLY the chiropractic group continued to demonstrate long-term benefits! The significant benefits achieved from both exercise and chiropractic treatments when compared with medication make sense as both address the cause of neck pain as opposed to only masking the symptoms.

With results of these studies showing acute, subacute, as well as chronic neck pain responding BEST to chiropractic care, it only makes sense to TRY THIS FIRST!

Whole Body Approach to Fibromyalgia

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​Fibromyalgia is a complicated disorder that’s difficult to diagnose because it involves multiple body systems. As a result, there are a myriad of factors in the body that can play a role in a patient’s symptoms. That said, it’s best to take a whole body approach when it comes to treating a complex condition like FM, starting with the nervous system.

When a patient presents to a chiropractor, the initial examination will look at the body as a whole and will not be limited the main area of complaint. This includes a postural examination in regards to individual leg length (to see if one is shorter); the height of the pelvis, shoulder, and occiput (head); and a gait assessment to evaluate the function of the foot, ankle, knee, hip/pelvis, spine, and head.

Because the nervous system is housed in the spine and cranium, chiropractors specifically look at how the spine compensates for abnormal function elsewhere in the body. When spinal segmental dysfunction is present, altered neurological function often coincides, which results in the symptoms that drive people to the office.

The benefits of spinal manipulative therapy (SMT)—the primary form of treatment delivered by doctors of chiropractic—have been recognized by all other healthcare professions including medical doctors, physical therapists, and osteopathic physicians. In fact, referring patients to chiropractors for SMT has become very commonplace in the healthcare environment. Research has proven SMT to be a FIRST course of care and highly recommended for MANY complaints, especially low back, mid-back, and neck pain, headaches, and many more!

Because fibromyalgia (FM) involves the WHOLE BODY—hence its definition of “wide spread pain,” chiropractic offers a unique approach because it too benefits the whole body by restoring function to the nervous system. For example, when balance is off due to a short leg (this affects 90% of the population to some degree), it can tilt the pelvis, which then places stress on the spine so that it must curve (scoliosis) to keep the head level. Correcting the short leg with a heel lift can restore balance to the pelvis, take pressure off the spine, and relieve some of a patient’s pain symptoms.

In prior articles, we have looked at the many benefits chiropractic offers the FM patient in addition to SMT and other manual therapies. Some of these include tips for improving sleep, exercise training (very important in managing FM), diet—specifically an anti-inflammatory diet (rich in anti-oxidants)—and supplementation (such as magnesium, malic acid, omega-3 fatty acids, vitamin D3, Co-enzyme Q10, and more).

Most importantly, studies show that the FM patient is BEST served when a “team” of healthcare professionals work together on behalf of the FM patient. Depending on a patient’s needs, the team can include a doctor of chiropractic, a primary care doctor, a massage therapist, a clinical psychologist, and others.

 

 

Chiropractic & Headaches

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Migrane

​According to the World Health Organization, headaches are among the most common disorders of the nervous system affecting an estimated 47% of adults during the past year. Headaches place a significant burden on both quality of life (personal, social, and occupational) and financial health. They are usually misdiagnosed by healthcare practitioners, and in general, are underestimated, under-recognized, and under-treated around the world. So, what about chiropractic and headaches… Does it help?

Suffice it to say, there are MANY studies showing chiropractic care helps headache sufferers. For instance, in a review of past research studies using an “evidence-based” approach, chiropractic treatment of adults with different types of headaches revealed very positive findings! Researchers note that chiropractic care helps those with episodic or chronic migraine headaches, cervicogenic headache (that is, headaches caused by neck problems), and tension-type headaches (chronic more than episodic). There appears to be additional benefit when chiropractic adjustments are combined with massage, mobilization, and/or adding certain types of exercises, although this was not consistently studied. In the studies that discussed adverse or negative effects of treatment, the researchers noted no serious adverse effects.

In patients suffering from athletic injuries, particularly post-concussion headache (PC-HA), chiropractic care can play a very important role in the patient’s recovery. With an estimated 1.6 to 3.8 million sports-related brain injuries occurring each year, approximately 136,000 involve young high school athletes (although some argue this is “grossly underestimated”).

Several published case studies report significant benefits for post-concussion patients after receiving chiropractic care, some of which included PC-HA from motor vehicle collisions, as well as from slips and falls. For example, one described an improvement in symptoms that included deficits in short-term memory as well as attention problems. In this particular study, a six-year-old boy fell from a slide in the playground, and after 18 months of continuous problems, underwent a course of chiropractic care. After just three weeks of care, his spelling test scores improved from 20% to 80% with even more benefits observed by the eighth week of care!

Another case study looked at a 16-year-old male teenager with a five-week-old football injury who had daily headaches and “a sense of fogginess” (concentration difficulties). He reported significant improvement after the second visit, with near-complete symptom resolution after the fifth visit (within two weeks of care). After seven weeks of care, he successfully returned to normal activities, including playing football.

Dizziness and vertigo are also common residuals from concussion and were present in a 30-year-old woman just three days following a motor vehicle accident. She also complained of headache, neck pain, back pain, and numbness in both arms. The case study noted significant improvement after nine visits within an 18-day time frame.

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

What is CTS?

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If tingling/numbness primarily affects your thumb, index, third, and ring fingers, it very well could be carpal tunnel syndrome, or CTS. Chances are you’ve probably had this condition for months or even longer but it’s been more of a nuisance than a “major problem” and therefore, you probably haven’t “bothered” having it checked out. Let’s take a look at some “facts” about CTS!

WHAT IS CTS? CTS is basically a pinched nerve (the median nerve) that occurs on the palm side of the wrist that innervates the three middle fingers and the thumb on the palm side. This nerve starts in the neck, runs through the shoulder to enter the arm, and travels down the palm side forearm through the carpal tunnel. The carpal tunnel is made up by eight small bones (called “carpal bones”) that form the roof and walls of the tunnel. The floor of the tunnel is a ligament called the transverse carpal ligament. The median nerve lies immediately on the floor, and deeper inside the tunnel are nine tendons that connect the muscles of our forearm to the fingers, which allow us to make a fist and grip. When swelling occurs inside the tunnel, the nerve is pinched against the floor (ligament) and symptoms occur.
SYMPTOMS OF CTS: Symptoms typically start gradually with tingling, numbness, burning, itching, or a “half-sleep” feeling in the palm of the hand, thumb, and middle three fingers. The fingers can feel swollen and weak, though “swelling” is usually NOT visible. CTS can occur in one or both hands, but it is usually worse in the dominant hand. Initially, you may only notice symptoms at night or in the morning. As CTS worsens, sleep interruptions, grip weakness, difficulty distinguishing hot from cold, increased pain, pain radiating up the arm, and more may occur.
CAUSES OF CTS: There are many causes of CTS that often occur in combination: 1) Heredity or genetics — being born with a smaller wrist than others; 2) Trauma — a fall on the arm/hand (sprain or fracture); 3)  Overuse of the arms/hands (like repetitive line work, serving tables, or using a computer), 4) Hormonal causes — during menstruation, with pregnancy, during menopause, diabetes, hypothyroid, overactive pituitary gland; 5) Rheumatoid arthritis; 6) Fluid retention; 7) Cysts, tumors, or spurs inside the tunnel; 8) Vibrating tools, 9) Hobbies such as knitting, sewing, crocheting; 10) sports; or 11) an “Insidious” or unknown cause!
CTS RISK FACTORS: 1) Gender: Women are three times more likely to develop CTS, possibly because they generally have a smaller carpal tunnel than men, in addition to hormonal differences; 2) Diabetes or other metabolic disorders; 3) Adults, especially >50 years old; 4) Job demands.
CTS DIAGNOSIS: Your doctor of chiropractic will review your patient history and then evaluate the neck, shoulder, arm, and hand, as ALL can be involved in producing CTS-like symptoms. He/she may also order blood tests (to check for diabetes, thyroid levels, rheumatoid arthritis, etc.) and/or an EMG/NCV (electromyogram/nerve conduction studies) to test for nerve damage.
We will FINISH THIS interesting discussion next month covering: Treatment, prevention, and research.
We realize you have a choice in whom you consider for your health care provision and we sincerely appreciate your trust in choosing our service for those needs.  If you, a friend, or family member requires care for Carpal Tunnel Syndrome, we would be honored to render our services.
480px-Carpal_Tunnel_Syndrome

 

My Hip Hurts….

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hip FAI

​Is it a labral tear? 

One of the structures that is frequently blamed for hip pain is called the labrum—the rubbery tissue that surrounds the socket helping to stabilize the hip joint. This tissue often wears and tears with age, but it can also be torn as a result of a trauma or sports-related injury.

The clinical significance of a labral tear of the hip is controversial, as these can be found in people who don’t have any pain at all. We know from studies of the intervertebral disks located in the lower back that disk herniation is often found in pain-free subjects—between 20-50% of the normal population.  In other words, the presence of abnormalities on an MRI is often poorly associated with patient symptoms, and the presence of a labral tear of the hip appears to be quite similar.

For instance, in a study of 45 volunteers (average age 38, range: 15–66 years old; 60% males) with no history of hip pain, symptoms, injury, or prior surgery, MRIs reviewed by three board-certified radiologists revealed a total of 73% of the hips had abnormalities, of which more than two-thirds were labral tears.

Another interesting study found an equal number of labral tears in a group of professional ballet dancers (both with and without hip pain) and in non-dancer control subjects of similar age and gender.

Another study showed that diagnostic blocks—a pain killer injected into the hip for diagnostic purposes to determine if it’s a pain generator—failed to offer relief for those with labral tears.

Doctors of chiropractic are trained to identify the origins of pain arising from the low back, pelvis, hip, and knee, all of which can mimic or produce hip symptoms.  Utilizing information derived from a careful history, examination, imaging (when appropriate), and functional tests, chiropractors can offer a nonsurgical, noninvasive, safe method of managing hip pain.

Neck Pain Reduction Strategies

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​Cervical Strain

Neck pain is very common! According to one study, between 10-21% of the population will experience an episode of neck pain each year with a higher incidence rate among office workers. Between 33-65% will recover within one year, but most cases become “chronic, recurrent” meaning neck pain will come and go indefinitely. The more we can learn WHAT to do to prevent these episodes, the better.

1.  SLEEP: Use a cervical pillow so the NECK is fully supported during sleep. This keeps your head in alignment with your spine. Also, if possible, sleep on your back!

2. OFFICE: Position the computer screen so that it’s at or slightly below eye level and straight in front of you. The “KEY” point is that you feel comfortable with the height of the monitor. Keep your chin “tucked in” so the 10-11 pound (4.5-5 kg) weight of your head stays back over your shoulders—this will place less of a load on your upper back and neck muscles to hold your head upright! Set a timer on your cell phone to remind you to get up and move around every 30-60 minutes.

3. TELEPHONE: If you are using the phone a lot during the day, GET A HEADSET! If you are pinching the phone between your shoulder and ear, you WILL have neck problems!

4.  EXERCISE: Studies show people who are more physically active are less likely to report neck pain.

5.  NUTRITION: Search for information on the “anti-inflammatory diet.” It’s basically fruits, veggies, and lean meat, with a few other twists. Also, stay hydrated by drinking plenty of water each day.

6.  LIFT/CARRY: A heavy purse, brief case, or roller bag can really hurt your neck. Take ONLY what you need and put the rest in a secondary bag that stays in your car or where you can access it when needed. Switch to a backpack if possible vs. a heavy brief case.

7.  SELF-MASSAGE: Reach back and dig your fingers into your neck muscles and “work” the tight fibers back and forth until they loosen up. Roll your head over the top edge of a chair by sliding down until the top of the chair back rests in your neck. Search for the tight fibers and work them loose!

8.  WHIPLASH: If you are injured, DO NOT WAIT! Those who seek chiropractic care shortly after an accident have less long-term trouble!

Sleep Tips for Fibro 1-5

~ Dr. Robert Speirs DC ~ Leave a comment

In-bed-after-no-sleep

​Last week, we discussed the connection between sleep disturbance and the presence of widespread pain found with fibromyalgia (FM). This month’s topic will center on how we can improve our sleep quality with the goal of feeling restored upon waking in the morning!

1)  NOISE & LIGHT: Block out noise with earplugs or a sound machine and light with window blinds, heavy curtains, and/or an eye mask. The light emanating from the LED or LCD from TVs, DVRs, or stereos has been found to suppress the pineal gland’s melatonin production (the “sleep hormone”) and thus can interfere with sleep, so try to keep them away from the bedroom. However, a small night light can assist for nighttime bathroom callings!

2) FOOD: Avoid large meals at least two hours before bedtime. Try a glass of milk, yogurt, or a small protein snack if hunger overcomes you. Milk is unique as it contains the amino acid L-tryptophan, which studies show, helps people sleep!

3)  EXERCISE: Aerobic exercise during the day is HIGHLY therapeutic. It reduces stress, reduces pain, reduces depression, and wakes us up! Avoid heavy exercise within three hours before bedtime. Exercise on a REGULAR basis to promote high-quality deep sleep.

4)  SLEEP HABITS: Develop good sleeping habits by going to bed at a regular time. Avoid napping in the late afternoon. A “POWER NAP” of no more than 10-15 minutes, ideally about eight hours after waking, is a GOOD THING as it can help you feel refreshed.

5)  MENTAL TASKS: Avoid mentally stimulating activity one hour before bedtime to calm the brain.

 

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

Migrane Control? How?

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Migrane

​Migraines can be life-altering! They can stop us from being able to enjoy a child’s piano recital, participate in family events, go to work, or simply do household chores! Wouldn’t it be nice to have ways to self-manage these miserable, often disabling headaches? Here are some options!

1. RELAXATION THERAPY: Search for a calm environment, turn off the lights (photophobia, or light sensitivity, is a common migraine complaint), minimize sound/noise (due to “hyperacusis”), and sleep if possible. Monitor the room temperature and/or use hot/cold compresses to the head and/or neck regions to relax tight muscles (heat) and reduce pain and swelling (cold). Similarly, a warm shower or bath can have similar beneficial effects.

2. SLEEP WELL: Migraines can interfere with falling asleep, they can wake you up during the night, and they are often triggered by NOT getting a good night’s sleep. To improve your sleep quality: a) Establish regular sleeping hours. Wake up and go to bed at consistent times every day, including weekends. b) Keep daytime naps short (20-30 min. max). c) “Unwind” at the end of the day – try soothing music, a warm bath, or reading a favorite book (avoid suspenseful movies). d) Don’t eat/drink too much before bedtime as heavy meals, caffeine, nicotine, and alcohol can interfere with sleep. e) Don’t exercise intensely before bedtime (stretching is fine). f) Eliminate distractions in the bedroom, including TV and bringing work to bed. Close the bedroom door and use a fan to muffle out distracting noises. g) If you take any medications, check for known side effects, as many contain caffeine or other stimulants that can interfere with sleep – including some meds that treat migraines! Talk to your doctor and pharmacist!

3. EAT WELL: Be consistent about when you eat and don’t skip meals (fasting increases the risk for migraine). Keep a food journal to figure out your migraine triggers and avoid foods that commonly trigger migraines like chocolate, aged cheeses, caffeine, and alcohol. Try eliminating these and see how you feel!

4. EXERCISE REGULARLY:  This is MOST IMPORTANT for migraine management as it facilitates sleep cycles and stimulates the release of endorphins and enkephlins that help block pain. It also helps fight obesity, which is another risk factor for headaches.

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