The trapezius muscle is a large diamond shaped muscle located in your back. This muscle is often overloaded due to poor sitting posture or excessive exercise. When this occurs trigger points will form. These points can cause back, neck, and shoulder pain. Trigger points in the upper traps are a leading cause of headache.
Is there a connection between fibromyalgia (FM) and sleep disturbance? Let’s take a look!
FM is a condition that causes widespread pain and stiffness in muscles and joints. Patients with FM often experience chronic daytime fatigue and some type of sleep problems like getting to sleep, staying asleep, and/or feeling restored in the morning upon waking. The National Institutes of Health estimates between 80-90% of those diagnosed with FM are middle-aged women, although it can affect men and happen at any age. As little as 10-20 years ago, it was hard to find a doctor who “believed” in FM, and it was common for the patient to be told that their pain “was all in their head.” FM has now been studied to the point that we know it is a real condition, and it affects between 2-6% of the general population around the world.
It is well established that sleep disturbance frequently occurs after surgery, which usually normalizes as time passes. One study used a group of healthy women who were deprived of sleep (particularly slow wave sleep) for three days to see if there was a link between sleep disturbance and pain. Results confirmed that the women experienced a decrease in pain tolerance and increased levels of discomfort and fatigue after three days—the same symptoms found among FM sufferers!
Fibromyalgia may have NO known cause, or it can be triggered by other conditions such as repetitive stress injuries, car crash injuries, and other forms of trauma. FM also appears to run in families though it’s still NOT clear if this is a true genetic link or caused by shared environmental factors. Some feel FM is a rheumatoid condition, and though FM is NOT a true form of arthritis, it has been found that people with arthritis are more likely to have FM.
FM sufferers frequently suffer from conditions such as irritable bowel syndrome, chronic fatigue syndrome, migraine headaches, arthritis, lupus, and major depressive disorders. Approximately 20% of FM patients have depression and/or anxiety disorders, and a link between chronic pain and depression exists and seems to play a role in people’s perception of pain.
Because conditions such as sleep apnea can result in symptoms similar to FM, it’s recommended that patients suspected of FM keep a sleep/sleepiness diary in order to rule out sleep apnea as a cause for their condition.
There are many “tips” for improving sleep quality, which we will dive into next month, as these may prove VERY HELPFUL in the management of FM!
If you, a friend or family member requires care for Fibromyalgia, we sincerely appreciate the trust and confidence shown by choosing our services!
The gluteus Maximus muscle makes up your buttock. It’s is a powerful hip extensor and thus used heavily during activities such as walking, running, and climbing up stairs. Most atheletes abuse this muscle. When overworked trigger points will form, and these points will cause pain to be felt in the hip, sacrum and the as well as deep in the gluteal area. Litterally a pain in the butt!! Trigger points won’t release on their own and require interventions like trigger point massage.
Whiplash is really a slang term for the rapid back and forth whipping of the head on the neck, usually associated with motor vehicle accidents. The title “Whiplash Associated Disorders”, or WAD, describes it best because it includes ALL of the MANY signs and symptoms of the disorder.
WAD basically comes in three sizes based on the degree of injury. A WAD I is present when there is pain but no physical examination findings; WAD II occurs when there are exam findings but no neurological loss (numbness or weakness); and WAD III includes loss of neurological function. There is also a separate WAD level that includes fractures and dislocations (WAD IV).
There are many things that can be done by the patient to assist in the healing process for WAD. The first well-studied recommendation is to “continue with your usual activities.” Try to keep active and not change your routine. The good news is that WAD (especially types I and II) usually resolves without complication, and recovery is even more likely to occur if you don’t deviate much from your routine.
For those whose symptoms are more severe and/or not resolving, mobilization and manipulation of the neck and back are very effective treatment options. In addition to treatments you’d receive in a chiropractic office, there are MANY things you can do at home as “self-help strategies.” Some of these include (“PRICE”):
1) PROTECT: Though it’s important to continue with your usual daily activities, this is dependent on both the degree of tissue injury and your pain tolerance. So do as many of your usual daily activities as possible, but AVOID those that result in a sharp, lancinating type of pain or those where recovery from the pain is delayed. Therefore, this category may require modifying your ADLs (activities of daily living). A cervical collar (hard or
soft) should NOT to be used UNLESS you have an unstable injury (fracture or a grade III sprain).
2) REST: Doing too much is like picking at a cut (which can delay healing) and doing too little can lead to a delayed healing response as well. Staying within reasonable pain boundaries is a good guide.
3) ICE > HEAT: Ice reduces swelling, and your doctor will typically recommend it over applying heat, especially on a recent injury. Heat draws fluids in, and while it may feel good, it can make your symptoms worse.
4) COMPRESS: We can basically ignore this when referencing neck pain. This pertains better to wrapping an ankle, knee, wrist, or elbow with an elastic compression orthotic or brace.
5) ELEVATE: This too is meant for the acute stages of an extremity injury like a foot or ankle.
Exercises unique for neck pain in the acute, subacute, and chronic stages of healing are perhaps the most important of the self-help approaches. In the ACUTE phase, try these…
1) Range of Motion: Once again, stay within “reasonable pain boundaries” as you move your head forwards, backwards, side to side, and rotate left and right. These can be done either with or without LIGHT resistance applied using one or two fingers placed against your head. Limit the repetitions to three slow reps in each direction and emphasize the release of the movement.
2) Chin/head Glides: Tuck in the chin (think of creating a double or triple chin) followed by poking the chin/head out.
In the SUBACUTE and CHRONIC phases of healing, the importance of strengthening the deep neck flexors cannot be over emphasized. Please refer to last month’s article for a description of this (see #3 of the 6 recommendations listed).
Low back pain is a very common complaint. In fact, it’s the #1 reason for doctor visits in the United States! The economic burden of LBP on the working class is astronomical. Most people can’t afford to be off work for one day, much less a week, month, or more! Because of the popularity of hospital-based TV dramas over the past two decades, many people think getting an MRI of their back can help their doctor fix their lower back problem. Is this a good idea? Let’s take a look!
Patients will often bring in a CD that has an MRI of their lower back to a doctor of chiropractic and ask the ultimate question, “….can you fix me?” Or, worse, “…I think I need surgery.” Sure, it’s quite amazing how an MRI can “slice” through the spine and show bone, soft tissues, disks, muscles, nerves, the spinal cord, and more! Since the low back bears approximately 2/3 of our body’s weight, you can frequently find MANY ABNORMALITIES in a person over 40-50 years old. In fact, it would be quite odd NOT to see things like disk degeneration, disk bulges, joint arthritis, spur formation, etc.!
Hence, the “downside” of having ALL this information is the struggle to determine which finding on the MRI has clinical significance. In other words, where is the LBP coming from? Is it that degenerative disk, bulged disk, herniated disk, or the narrowed canal where the nerve travels? Interestingly, in a recent review of more than 3,200 cases of acute low back pain, those who had an MRI scan performed earlier in their care had a WORSE outcome, more surgery, and higher costs compared with those who didn’t succumb to the temptation of requesting an MRI!
This is not to say MRI, CT scans, and x-rays are not important, as they effectively show conditions like subtle fractures and dangerous conditions like cancer. But for LBP, MRI is often misleading. This is because the primary cause of LBP is “functional” NOT “structural,” so it’s EASY to get railroaded into thinking whatever shows up on that MRI has to be the problem.
Here is how we know this, when we take 1,000 people WITHOUT low back pain between ages 30 and 60 (male or female) and perform an MRI on their lower back, we will find up to 53% will have PAINLESS disk bulges in one or more lumbar disks. Moreover, we will find up to 30% will have partial disk herniations, and up to 18% will have an extruded disk (one that has herniated ALL the way out). Yet, these people are PAIN FREE and never knew they had disk “derangement” (since they have no LBP). When combining all of these possible disk problems together, several studies report that between 57% and 64% of the general population has some type of disk problem without ANY BACK PAIN!
Hence, when a patient with a simple sprain/strain and localized LBP presents with an MRI showing a disk problem, it usually ONLY CONFUSES the patient (and frequently the doctor), as that disk problem is usually not the problem causing the pain! So DON’T have an MRI UNLESS a surgical treatment decision depends on its findings. That is weakness, numbness, and non-resolving LBP in spite of 4-6 weeks of non-surgical care or unless there is weakness in bowel or bladder control. Remember, the majority of back pain sufferers DO NOT need surgery!
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 back pain, we would be honored to render our services.
Fibromyalgia (FM) is a very common, chronic condition where the patient describes “widespread pain” not limited to one area of the body. Hence, when addressing exercises for FM, one must consider the whole body. Perhaps one of the most important to consider is the squat.
If you think about it, we must squat every time we sit down, stand up, get in/out of our car, and in/out of bed. Even climbing and descending steps results in a squat-lunge type of movement.
The problem with squatting is that we frequently lose (or misuse) the proper way to do this when we’re in pain as the pain forces us to compensate, which can cause us to develop faulty movement patterns that can irritate our ankles, knees, hips, and spine (particularly the low back). In fact, performing a squatting exercise properly will strengthen the hips, which will help protect the spine, and also strengthens the glutel muscles, which can help you perform all the daily activities mentioned above.
The “BEST” type of squat is the free-standing squat. This is done by bending the ankles, knees, and hips while keeping a curve in the low back. The latter is accomplished by “…sticking the butt out” during the squat.
Do NOT allow the knees to drift beyond your toes! If you notice sounds coming from your knees they can be ignored IF they are not accompanied by pain. If you do have pain, try moving the foot of the painful knee about six inches (~15 cm) ahead of the other and don’t squat as far down. Move within “reasonable boundaries of pain” by staying away from positions that reproduce sharp, lancinating pain that lingers upon completion.
There are MANY exercises that help FM, but this one is particularly important!
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!
Some of you may have heard about how a modified form of boxing is helping patients with Parkinson’s disease (PD). If you haven’t, it’s been observed that people with Parkinson’s disease (PD) who engage in this boxing-like exercise routine can enhance their quality of life and even build impressive gains in posture, strength, flexibility, and speed. Proponents of the program report that regardless the degree of severity of PD, participants have a happier, healthier, and higher quality of life.
But must it be boxing? Maybe not. A report presented at the International Congress of Parkinson’s Disease and Movement Disorders in San Diego in June 2015 found that patients with Parkinson’s disease who began regular exercise early into the PD process had a much slower decline in their quality of life when compared with those who started exercising later. The researchers found just 2.5 hours per week of exercise is needed to improve quality of life scores. According to the report, it didn’t matter what exercise the participants did — simply getting up and moving for a total of 2.5 hours/week was reportedly enough (that’s only 20-25 minutes / day)!
Looking beyond Parkinson’s, other chronic conditions also benefit from adding exercise into a person’s lifestyle. Studies show that regular exercise as simple as walking helps reduce one’s risk for memory loss, and it slows down functional decline in the elderly. Incorporating aerobic exercise into one’s lifestyle can also improve reaction time in people at ALL AGES. Exercise has also been shown to improve both physical and emotional well-being in those afflicted with Alzheimer’s disease with as little as 60 minutes/week of moderate exercise! Patients with multiple sclerosis (MS) have also reported less stiffness and less muscle wasting when using exercise machines, aquatic exercise, and/or walking.
Research has shown just 30 minutes of brisk exercise three times a week can help reduce depressive symptoms in patients with mild-to-moderate depression. In a study involving teenagers, those who engaged in sports reported a greater level of well-being than their sedentary peers, and the more vigorous the exercise, the better their emotion health! In kids 8-12 years old, physical inactivity is strongly linked to depression. Even anxiety, stress, and depression associated with menopause are less severe in those who exercise! So LET’S ALL GET OUT THERE AND EXERCISE!!!
Whiplash, or better termed “Whiplash Associated Disorders” (WAD), is a condition that carries multiple signs and symptoms ranging from neck pain and stiffness to headache, confusion, ringing in the ears, and more. But can WAD cause dizziness? Let’s take a look!
Dizziness is a general term that is used rather loosely by the general population. We’ve all experienced dizziness from time-to-time that is considered “normal,” such as standing up too quickly or while experiencing a rough flight.
Often, dizziness and problems with balance go hand in hand. There are three main organs that control our balance: 1) the vestibular system (the inner ear); 2) the cerebellum (lies in the back of the head); and, 3) the dorsal columns (located in the back part of the spinal cord). In this article, we will primarily focus on the inner ear because, of the three, it’s unique for causing dizziness. Our vision also plays an important role in maintaining balance, as we tend to lose our balance much faster when we close our eyes.
It’s appropriate to first discuss the transient, usually short episode of “normal” lightheadedness associated with rising quickly. This is typically caused by a momentary drop in blood pressure, and hence, oxygen simply doesn’t reach the brain quick enough when moving from sitting to standing. Again, this is normal and termed “orthostatic hypotension” (OH).
However, OH can be exaggerated by colds, the flu, allergy flair-ups, when hyperventilating, or at times of increased stress or anxiety. OH is also associated with the use of tobacco, alcohol, and/or some medications. Bleeding can represent a more serious cause of OH such as with bleeding ulcers or some types of colitis, and less seriously, with menstruation.
The term BPPV or benign paroxysmal positional vertigo, has to do with the inner ear where our semicircular canals are located. The canals lie in three planes and give us a 3D, 360º perspective about where we are in space. The fluid flowing through these canals bends little hair-like projections, which are connected to sensory nerves that tell the brain about our spatial position. If the function of these canals is disturbed, it can mix-up the messages the brain receives, thus resulting in dizziness. Exercises are available on the Internet that can help with BPPV (look for Epley’s and Brandt-Daroff exercises).
DANGEROUS causes of dizziness include: HEART – fainting (passing out) accompanied by chest pain, shortness of breath, nausea, pain or pressure in the back, neck, jaw, upper belly, or in one or both arms, sudden weakness, and/or a fast or irregular heartbeat. STROKE – sudden numbness, paralysis, or weakness in the face, arm, or leg, especially if only on one side of the body; drooling, slurred speech, short “black outs,” sudden visual changes, confusion/difficulty speaking, and/or a sudden and severe, “out of the ordinary” headache. CALL 911 (or the number for emergency services if you’re outside the United States) if you suspect you may be having a heart attack or stroke!
Session Description
A treatment with Bryan is very user friendly. And, no, you don’t have to remove any clothing. However, bringing a t-shirt and a pair of shorts or sweats is recommended.
The first time you come for a treatment you will be asked to fill out a Client History form. Bryan will go over the information you provide, asking for more detail and discussing the type of pain you are having and its location.
The treatment itself involves locating the Trigger Points in the muscle or soft tissue and applying a deep focused pressure to the Point. This will reproduce the pain and the referral pattern that is characteristic of that pain.
The treatment will be uncomfortable at first, but as the Trigger Points release, the pain will decrease. The pressure will always be adjusted to your tolerance level. If, at any time, you feel too uncomfortable you can ask Bryan to ease off a bit.
Depending on your specific problem, Bryan may also use some stretching and / or range-of-motion techniques, as needed.
After treatment, it is usually recommended that the client apply moist heat to the area treated.
Aberdeen Chiropractic 