Pain

How can I reduce stress on my spine while standing?

~ Dr. Robert Speirs DC ~ Leave a comment

STress

To avoid extra stress on your spine while standing:

✓ Avoid high-heeled shoes or boots

✓ Use a footrest measuring 10% of your height

✓ To decrease stress on your back and feet consider leaning on a tall chair.

✓ If excessive standing can’t be avoided, consider shock-absorbent shoes or an anti-fatigue mat.

✓ When transitioning from a sitting workstation to a standing desk, begin gradually by standing 20 minutes per hour and not necessarily in a continuous period. Add an extra 10 minutes per hour each day as long as there is no prolonged stiffness or discomfort.

Up Close & Personal With Headaches.

~ Dr. Robert Speirs DC ~ Leave a comment

​Migrane

Headaches are REALLY common! In fact, two out of three children will have a headache by the time they are fifteen years old, and more than 90% of adults will experience a headache at some point in their life. It appears safe to say that almost ALL of us will have firsthand knowledge of what a headache is like sooner or later!

Certain types of headaches run in families (due to genetics), and headaches can occur during different stages of life. Some have a consistent pattern, while others do not. To make this even more complicated, it’s not uncommon to have more than one type of headache at the same time!

Headaches can vary in frequency and intensity, as some people can have several headaches in one day that come and go, while others have multiple headaches per month or maybe only one or two a year. Headaches may be continuous and last for days or weeks and may or may not fluctuate in intensity.

For some, lying down in a dark, quiet room is a must. For others, life can continue on like normal. Headaches are a major reason for missed work or school days as well as for doctor visits. The “cost” of headaches is enormous—running into the billions of dollars per year in the United States (US) in both direct costs and productivity losses. Indirect costs such as the potential future costs in children with headaches who miss school and the associated interference with their academic progress are much more difficult to calculate.

There are MANY types of headaches, which are classified into types. With each type, there is a different cause or group of causes. For example, migraine headaches, which affect about 12% of the US population (both children and adults), are vascular in nature—where the blood vessels dilate or enlarge and irritate nerve-sensitive tissues inside the head. This usually results in throbbing, pulsating pain often on one side of the head and can include nausea and/or vomiting. Some migraine sufferers have an “aura” such as a flashing or bright light that occurs within 10-15 minutes prior to the onset while other migraine sufferers do not have an aura.

The tension-type headache is the most common type and as the name implies, is triggered by stress or some type of tension. The intensity ranges between mild and severe, usually on both sides of the head and often begin during adolescence and peak around age 30, affecting women slightly more than men. These can be episodic (come and go, ten to fifteen times a month, lasting 30 min. to several days) or chronic (more than fifteen times a month over a three-month period).

There are many other types of headaches that may be primary or secondary—when caused by an underlying illness or condition. The GOOD news is chiropractic care is often extremely helpful in managing headaches of all varieties and should be included in the healthcare team when management requires a multidisciplinary treatment approach.

Most of know someone who has been affected by headaches. If they are looking for help and information please feel free to contact us at 204-586-8424 or at info@aberdeenchiropractic.com.

Trigger points in the suboccipitals.

~ bryancobb ~ Leave a comment

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The suboccipitals are a group or four muscles that attach to the transverse and spinous process of C1 and C2 and the occipital bone.

These muscles provide extension side bending and rotation movements between the occiput and C1 and C2. These muscles are often overloaded due to postural strain. A classic example being sitting in front of a computer all day.

When these muscles are overloaded trigger points can develop. Pain and symptoms of trigger points in the suboccipitals include head pain that penetrates into the skull but is difficult to localize.

Patients are likely to describe the pain as “all over” including the occiput, eye and forehead, but without any clarity. Trigger points in these muscles are often associated with tension head aches

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Brain injury after whiplash?

~ Dr. Robert Speirs DC ~ Leave a comment

Cerebellum​

In a 2010 study, researchers examined MRIs taken from 1,200 patients (600 whiplash and 600 non-whiplash neck pain patients) and noted that those who had sustained whiplash were more likely to have a brain injury than non-whiplash neck pain patients.

The specific type of brain injury found is a form of herniation called Chiari malformation, where the bottom part of the brain (the cerebellum) drops through the opening in the base of the skull called the foramen magnum. Their findings showed an alarming 23% of the whiplash cases studied had this anatomical abnormality.

Dr. Michael Freeman, Dr. Ezriel Kormel, and colleagues collaborated in this effort and evaluated the patients using MRI in both recumbent (laying down) AND upright positions. Interestingly, they found 5.7% and 5.3% of those in the non-whiplash neck pain group and 9.8% and 23.3% in the whiplash group had the Chiari malformation using the recumbent vs. upright MRI positions, respectfully.

Dr. Kormel stated, “This condition can be quite painful and endanger the patient’s health, with symptoms that may include headaches, neck pain, upper extremity numbness and tingling, and weakness. In a few cases, there can also be lower extremity weakness and brain dysfunction.” In a radio interview, he added the advice that ANYONE suffering from whiplash should see a healthcare provider immediately.

This study is important for a number of reasons. First, it revealed that there is often a more serious injury when whiplash occurs than what is initially found. Second, psychological findings like depression, anxiety, and difficulty coping with the decreased ability or inability to be productive at home or work may suggest the presence of an anatomical injury which simply has not yet been found. Third, MRI is frequently ONLY performed in a laying down position. This study didn’t find much difference between laying vs. weight-bearing MRI positions in the non-whiplash neck pain patients but not so in the whiplash neck pain group! In this group, the ability for MRI to detect Chiari malformation/brain injury more than doubled using weight-bearing MRI.

Expanding the last point, since one out of five whiplash patients had a brain injury that is more likely to be detected using a non-traditional upright MRI position, a “new” standard” for the use of MRI in the evaluation of the whiplash patient should be considered. This is especially important in those cases that are non-responsive to quality care or if their doctor had only ordered a recumbent MRI previously.

Doctors of all disciplines should be aware of this study and the need for a more thorough evaluation, especially when a whiplash patient is not responding as one might expect.

Fibromyalgia and Exercise

~ Dr. Robert Speirs DC ~ Leave a comment

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​Are there differences in lifestyle between people with vs. without fibromyalgia (FM)?

A recent study found women with FM found spend more time engaged in sedentary behaviors and less time in physical activity. In the study, researchers followed 413 female patients with FM and 188 age-matched healthy female controls. Researchers used three different approaches to access physical activity: a triaxial accelerometer to examine sedentary time, time spent in physical activity, and step counts.

They discovered those who suffered from FM spent an average of 39 more minutes per day in sedentary activity and 21 fewer minutes per day in light physical activity, 17 fewer minutes per day in moderate physical activity, and 19 fewer minutes per day in moderate-to-vigorous physical activity. In addition, those with FM took a mean of 1,881 fewer steps that those without FM.

Now, this isn’t really a surprise given the fact that people with FM are in pain and more likely to have difficulties sleeping and tolerating prolonged activities. After comparing the sufferers to the non-sufferers, the researchers found only 21% of FM patients vs. 46% of non-FM controls achieved the recommended 150 minutes/week (a little over 20 min. / day) of “moderate-to-vigorous” physical activity. They also found that only 16% vs. 45%, respectively, walked the recommended ≥10,000 steps per day.

One of the BEST forms of exercise for most people is walking. A walking program should be a staple exercise. It’s important to note that this should be GRADUALLY introduced so as to avoid an overuse injury—strain or sprain of the muscles and joints. This gradual introduction into activity is ESPECIALLY important for the FM sufferer as overuse injuries can make them afraid to do something that can REALLY help when done correctly!

Headache & Dizzy. When To Be Concerned.

~ Dr. Robert Speirs DC ~ Leave a comment

Last week, we discussed some startling new research that found that lightheadedness upon standing up (orthostatic hypotension) may be more serious than previously thought. This month, we’ll look specifically at headache AND dizziness and if we should we be concerned about this combination of complaints and if so, when?

A team of researchers from Johns Hopkins University reviewed past medical records of 187,188 patients presenting to over 1,000 emergency departments (EDs) between 2008 and 2009. They found the combination of headache and dizziness—especially in women, minorities, and young patients—was a potential signal of an impending stroke!

Specifically, they reported that 12.7% of people complaining of headache and dizziness were later admitted for stroke and had been misdiagnosed and inappropriately sent home from the ED within the previous 30 days. Patients were told they had a “benign condition” such as inner ear infection or migraine, and in some cases, they weren’t given a diagnosis at all. Slightly less than half of this population had a stroke within seven days and over half had a stoke within the first 48 hours of the initial pre-stroke ED presentation!

The study reported that women were 33% and minorities 20-30% more likely to be misdiagnosed, suggesting gender and racial disparities may play a role. The researchers estimate that doctors miss 15,000 to 165,000 strokes that result in harm to the patient each year.

Studies have found that the early diagnosis and quick treatment of strokes is critical in reducing serious residuals in patients having a transient ischemic attach (TIA), sometimes referred to as a “mini-stroke” or “pre-stroke.” TIAs are often pre-cursors to a more catastrophic stroke leading to death or permanent disability without appropriate treatment.

Again, to put this in perspective, MANY people present to healthcare providers with headaches and dizziness with NO relationship to stroke—about 87%—though it is sometimes not possible to know whether a potentially dangerous problem may arise in the near future. The good news is that it usually does not!

The importance of this study is to alert both healthcare providers AND patients of the potential risk. When in doubt, it’s ALWAYS best to seek out multiple opinions. An MRI may be the best way to confirm the most common type of stroke (according the study reviewed above), as a CT scan may not show the brain changes early on and could lead to false reassurance.

Doctors of chiropractic commonly see patients presenting with headaches and dizziness. When this occurs suddenly, out of the ordinary, and/or at a relatively young age (women > men), it’s better to be safe than sorry and obtain multiple opinions, especially WHEN IN DOUBT!

Trigger points in the sternocleidomastoid muscle. By Bryan Cobb RMT.

~ bryancobb ~ Leave a comment

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The sternocleidomastoid muscle or “scm” is a strap like muscle located in the front of the neck. It originates on the manubrium of the sternum and the medial clavicle, and inserts on the mastoid process of the temporal bone( the lump or bone behind the ear). When working together the scm flexes the head and neck. The actions of one muscle working by itself is to rotate the face to the opposite side and lift it toward the ceiling.

Trigger points in this muscle usually form due to acute injury or to chronic postural stress. These trigger points can cause a wide variety of symptoms including pain felt in the cheek, temple, forehead, top of the head, and base of the skull. Trigger points in these muscles can also refer deep into the ear and cause postural dizziness.

I get dizzy when I have a headache. Should I worry?

~ Dr. Robert Speirs DC ~ Leave a comment

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Dizziness, neck pain, and headaches are very common symptoms that may or may not occur at the same time. Though this interrelationship exists, this month’s article will focus primarily on dizziness, particularly related to dizziness that occurs after standing.

First, it is important to point out that it is VERY common to be light headed or dizzy when standing up too fast, which is typically referred to as orthostatic hypotension (OH). OH is frequently referred to as a benign symptom, but new information may challenge this thought.

Let’s review what happens. When we are lying down, our heart does not have to work as hard as when we are upright; therefore, our blood pressure (BP) is usually lower while we lay in bed. When standing up, blood initially pools in the legs until an increase in blood pressure brings oxygen to the brain. This either resolves or prevents dizziness.

Orthostatic hypotension is defined as a blood pressure drop of >20 mm Hg systolic (the upper number—heart at FULL contraction), 10 mm Hg diastolic (lower number—heart at FULL rest), or both. This typically occurs within seconds to a few minutes after rising to a standing position.

There are two types of OH—delayed OH (DOH) where the onset of symptoms are not immediate but occur within three minutes of standing and “full” OH, which is more serious and occurs immediately upon rising. According to a 2016 study published in the prestigious journal Neurology, researchers reviewed the medical records of 165 people who had undergone autonomic nervous system testing for dizziness. The subjects averaged 59 years of age, and 48 were diagnosed with DOH, 42 with full OH, and 75 subjects didn’t have either condition.

During a ten-year follow-up, 54% of the DOH group progressed to OH, of which 31% developed a degenerative brain condition such as Parkinson’s disease or dementia. Those with initial DOH who also had diabetes were more likely to develop full OH vs. those without diabetes.

The early death rate in this 165 patient group was 29% for those with DOH, 64% with full OH, vs. 9% for those with neither diagnosed condition. The authors point out that those initially diagnosed with DOH who did NOT progress into full OH were given treatment that may have improved their blood pressure.

The authors state that a premature death might be avoided by having DOH and OH diagnosed and properly managed as early as possible. They point out that a prospective study is needed since this study only looked back at medical records of subjects who had nervous system testing performed at a specialized center, and therefore, these findings may not apply to the general population.

The value of this study is that this is the FIRST time a study described OH (or DOH) as a potentially serious condition with recommendations NOT to take OH/DOH lightly or view it as a benign condition. Since doctors see this a lot, a closer evaluation of the patient is in order.

Exercise Of The Month: Pike On A Ball

~ Dr. Robert Speirs DC ~ Leave a comment

Pike on a Ball

Begin in a push-up position with your knees resting on an exercise ball. Maintain a neutral spine, and do not allow your back to arch down towards the floor. Roll the ball from your thighs to your ankles by bending your knees and bringing them towards your chest. Slowly return to the start position. Perform three sets of 10 repetitions daily or as directed.