Neck Pain

Chiropractic as THE alternative to Opioids.

~ Dr. Robert Speirs DC ~ Leave a comment

In 2015, two million Americans had a substance abuse disorder involving prescription pain relievers; with more than 20,000 overdose deaths related to these drugs. In the past decade, death rates and substance use rates quadrupled in parallel to sales of prescription pain relievers.

Chronic LBP is a primary generator for opioid prescriptions. This year, both JAMA and Annals of Internal Medicine have published and supported new clinical practice guidelines that recommend prescribing spinal manipulation over medication for LBP patients.

“For acute, subacute, or chronic low back pain, physicians and patients initially utilize spinal manipulation and delay pharmacologic management.”

Research shows that low back pain patients who undergo chiropractic care have improved outcomes with lower rates of opioid use, surgery, and overall healthcare costs.

Not surprisingly, various governing bodies, including the FDA, CDC, and 37 State Attorney General’s, have concurred that physicians and healthcare decision makers should consider non- pharmacologic therapy for LBP patients. In fact, the 2018 Joint Commission guidelines mandate that hospitals include conservative options for chronic musculoskeletal pain management, specifically naming chiropractic as a potential option.

Chiropractic care is not a replacement for traditional medical treatment of LBP, rather a complementary tool to integrate within your current management paradigm. We hope that you will continue to consider our office for those cases that may be favorably served by conservative manual therapy. We are grateful for your confidence and will work hard to maintain your trust.

What the heck is a trigger point?

~ bryancobb ~ Leave a comment

By Bryan Cobb, Advanced Remedial Massage Therapist

trigger-point-referred-pain-shutterstock_228843211

What is a Trigger Point?

Trigger Points (TP’s) are defined as a “hyper-irritable spot within a taut band of skeletal muscle. The spot is painful on compression and can evoke characteristic referred pain and autonomic phenomena.”1

Put into plain language, a TP is a painful knot in muscle tissue that can refer pain to other areas of the body. You have probably felt the characteristic achy pain and stiffness that TP’s produce, at some time in your life.

TP’s were first brought to the attention of the medical world by Dr. Janet G. Travell. Dr. Travell, physician to President John F. Kennedy, is the acknowledged Mother of Myofascial Trigger Points. In fact, “Trigger Point massage, the most effective modality used by massage therapists for the relief of pain, is based almost entirely on Dr. Travell’s insights.”2 Dr. Travell’s partner in her research was Dr. David G. Simons, a research scientist and aerospace physician.

Trigger Points are very common. In fact, Travell and Simons state that TP’s are responsible for, or associated with, 75% of pain complaints or conditions.1 With this kind of prevalence, it’s no wonder that TP’s are often referred to as the “scourge of mankind”.

Trigger Points can produce a wide variety of pain complaints. Some of the most common are migraine headaches, back pain, and pain and tingling into the extremities. They are usually responsible for most cases of achy deep pain that is hard to localize.

A TP will refer pain in a predictable pattern, based on its location in a given muscle. Also, since these spots are bundles of contracted muscle fibres, they can cause stiffness and a decreased range of motion. Chronic conditions with many TP’s can also cause general fatigue and malaise, as well as muscle weakness.

Trigger Points are remarkably easy to get, but the most common causes are

TP’s (black X) can refer pain to other areas (red)

 

Sudden overload of a muscle

  • Poor posture
  • Chronic frozen posture (e.g., from a desk job), and
  • Repetitive strain

 

Once in place, a TP can remain there for the remainder of your life unless an intervention takes place.

 

Trigger Points Not Well Known

With thousands of people dealing with chronic pain, and with TP’s being responsible for — or associated with — a high percentage of chronic pain, it is very disappointing to find that a large portion of doctors and other health care practitioners don’t know about TP’s and their symptoms.

Scientific research on TP’s dates back to the 1700’s. There are numerous medical texts and papers written on the subject.

But, it still has been largely overlooked by the health care field. This has led to needless frustration and suffering, as well as thousands of lost work hours and a poorer quality of life.

 

How Are Trigger Points Treated?

As nasty and troublesome as TP’s are, the treatment for them is surely straight-forward. A skilled practitioner will assess the individual’s pain complaint to determine the most likely location of the TP’s and then apply one of several therapeutic modalities, the most effective of which is a massage technique called “ischemic compression”.

 

Basically, the therapist will apply a firm, steady pressure to the TP, strong enough to reproduce the symptoms. The pressure will remain until the tissue softens and then the pressure will increase appropriately until the next barrier is felt. This pressure is continued until the referral pain has subsided and the TP is released. (Note: a full release of TP’s could take several sessions.)

 

Other effective modalities include dry needling (needle placed into the belly of the TP) or wet needling (injection into the TP). The use of moist heat and stretching prove effective, as well. The best practitioners for TP release are Massage Therapists, Physiotherapists, and Athletic Therapists. An educated individual can also apply ischemic compression to themselves, but should start out seeing one of the above therapists to become familiar with the modality and how to apply pressure safely.

 

 

 

1 Simons, D.G., Travell, D.G., & Simons, L.S. Travell and Simons’Myofascial Pain and Dysfunction: the Trigger Point Manual.

Vol. 1. 2nd ed. Lippincott, Williams, and Wilkins, 1999.

Chronic Neck Pain and Anxiety-Depression.

~ Dr. Robert Speirs DC ~ Leave a comment

Chronic neck pain often results in a psychological impact that can affect daily life. A new study involving 80 patients with chronic neck pain investigated the prevalence of anxiety and depression in patients with neck pain as well as associated risk factors and found that 68.4 % suffered from anxiety and 55.7% patients were depressed. Furthermore, disability and cervicobrachial neuralgia (neck pain radiating into the arm) associated with chronic neck pain predicted which patients had at higher risk of psychological distress.

The Pan-African Medical Journal, May 2016

whiplash

Active Seniors Recover More Easily from Injury.

~ Dr. Robert Speirs DC ~ Leave a comment

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Seniors who regularly exercise appear less likely to suffer a disability, and if they do, they tend to recover quicker. A study that included 1,600 older adults showed that active seniors were 13% less likely to develop a physical disability, and exercisers were one-third more likely to recover from impairment than those who lived a sedentary lifestyle. The findings suggest that it’s never too late to reap the benefits of exercise.

Annals of Internal Medicine, September 2016

Avoid Doing This Before Bedtime.

~ Dr. Robert Speirs DC ~ Leave a comment

169

 

Your habits just before going to bed could be sabotaging your sleep.

 

The National Sleep Foundation recommends avoiding the following: over-the-counter medications that contain pseudoephedrine, which can be found in common cold medicines; texting, watching TV, or spending time on the computer shortly before bed; indulging in a greasy, fattening, salty bedtime snack, which can be stimulating and trigger nightmares; and drinking caffeine beyond the morning, as it can stay in your system for as long as twelve hours.

 

National Sleep Foundation, October 2016

Canada’s Pain Crisis

~ Dr. Robert Speirs DC ~ Leave a comment

In a nation of only 36 million people, over 5 million people turned to opioid use for their pain despite the availability of better options. Opioids should never be the first step in pain management; preventing overuse takes education of both the public who are using and the professionals prescribing these drugs.

At Aberdeen Chiropractic we are proud to be part of the solution to Canada’s opioid crisis by providing safe, effective care for back pain, neck pain and headaches. Our goal is to assess, correct and prevent your pain with a variety of interventions including Chiropractic, Acupuncture, Laser, Exercise Rehabilitation and Trigger Point Therapy.

 

Pain Crisis

How does my neck cause headaches?

~ Dr. Robert Speirs DC ~ Leave a comment

Cervicogenic

 

Headaches can arise from many different causes. A partial list includes stress, lack of sleep, allergies, neck trauma (particularly sports injuries and car accidents), and more. In some cases, the cause may be unknown.

 
A unique common denominator of headaches has to do with cervical spine anatomy, in particular the upper part of the neck. There are seven cervical vertebrae, and the top three (C1-3) give rise to three nerves that travel into the head. These nerves also share a pain nucleus with the trigeminal nerve (cranial nerve V), which can route pain signals to the brain.

 
Depending on which nerve is most irritated, the location of the headache can vary. For example, C2—the greater occipital nerve—travels up the back of the head to the top. From there, it can communicate with another nerve (cranial nerve V or the trigeminal nerve), which can refer pain to the forehead and/or behind the eye.

 
When C1—the lesser occipital nerve—is irritated, pain travels to the back of the head, while irritation to C3—the greater auricular nerve—results in pain to an area just above the ear. When a nerve is pinched, the altered sensation can include pain, numbness, tingling, burning, itching, aching, or a combination of these sensations.

 
These are classified as cervicogenic headaches (CGH), and as the name implies, the origin of pain/altered sensation arises from the neck.

 
A 2013 study reviewing the literature on CGH found that manipulation and mobilization improved pain, disability, and function. The most effective approach included manipulation combined with neck-upper back strengthening exercises.

 
But what about migraine headaches? Migraines are vascular headaches, and some (but not all) are preceded by an aura or a pre-headache warning that may include blurry vision, tingling, strange olfactory sensations, etc. One study of 127 migraine sufferers reported fewer attacks and less medication required by those who received chiropractic care.

 
The good news is that spinal manipulation is very safe, and a trial is often very rewarding for many types of headaches.

Can We Prevent Carpel Tunnel?

~ Dr. Robert Speirs DC ~ Leave a comment

Carpal Tunnel

 

Carpal tunnel syndrome (CTS) is the most common of the many “entrapment neuropathies”— nerve pinches in the arms or legs—likely because we use our hands and fingers repetitively for long time frames at work and during many of our hobbies. In addition, the wrist is a very complicated joint because it’s not a simple ball-and-socket or hinge, like the hip, elbow, or knee.

 
The wrist is made up of eight small “carpal” bones that are all shaped very differently and fit together a bit like a puzzle. These eight bones are lined up in two rows of four bones that form the “roof“ of the tunnel.

 
The shape of the tunnel changes with different activities, and the contents within the tunnel have to accommodate for this. Nine of the tendons that allow the hand to move the fingers also travel through the tunnel. Look at the palm-side of your wrist as you wiggle your fingers. See all the activity going on there? The median nerve travels through the tunnel as well, just under the “floor”, which is a very strong ligament that stretches from the pinky to the thumb-side of the tunnel.

 
Virtually ANY condition that increases the pressure inside the already tightly packed tunnel can create CTS symptoms like numbness, tingling, burning, etc. Over time, grip strength may weaken, causing one to accidentally drop objects.

 
To add to the causation list of CTS, conditions like obesity, pregnancy, diabetes, hypothyroid, rheumatoid arthritis (and other “arthropathies”), taking birth control pills (BCPs), and more can cause CTS without any increase in hand/wrist activities!
So HOW can we prevent CTS?

 

First, consider your job and your “workstation.” There are ergonomic keyboard and mouse options that can help you maintain a “neutral” wrist posture. If you have to bend your wrist a lot to do your work tasks—like placing items in a package, assembly work, etc.—see if you can change the angle of the package or assembly set up that allows your wrist to be straight, NOT BENT! Also, sit/stand up straight, chin tucked back, and DON’T SLOUCH!

 
A “night splint” forces the wrist to stay straight and can REALLY help! Managing your weight and health (manage your diabetes, thyroid, and medications that increase swelling like BCPs) is VERY important! There are also natural anti-inflammatory vitamins and herbs like ginger, turmeric, and bioflavonoid you may want to consider—your doctor of chiropractic can help you with this!

 
Chiropractors can manage CTS very well and can frequently help patients avoid the need for a surgical release. The “KEY” is to not wait—get treated early on!