Chronic Pain

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

~ bryancobb ~ Leave a comment

Screen Shot 2017-12-01 at 10.39.50 AM.png

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.

Hip or Low Back?

~ Dr. Robert Speirs DC ~ Leave a comment

​Lumbar and Pelvis

Technically, the hip is the ball-and-socket joint between the long bone of the thigh and the pelvis; but more often than not, many people will point to a number of different places on their back or pelvis and say, “My hip is killing me” when it’s not really “the hip” at all!
Hip pain can be located in the front (groin area), the side, the back, or in the buttocks. The “classic sign” of hip pain is reproduced most consistently when you try to cross your legs—put your ankle on the far end of the thigh and then push down on your knee. This may feel tight and cause pain in the groin area. For many people, hip pain is also reproduced when they cross their legs and then pull their knee towards the opposite shoulder.
The hip is a VERY strong joint due to the deep receiving cup of the pelvis and the round ball that fits nicely into it. Because it’s a freely moving joint, there is a joint capsule. The capsule is lined with tissue that produces an oily substance that lubricates the joint (called synovial fluid), and when hip pain occurs, this can be caused by a capsulitis (inflammation of the capsule) with a buildup of synovial fluid (called synovitis).
When the smooth, shiny surface of the ball starts to wear thin (which can eventually wear away down to the bone), that’s a condition called “osteoarthritis.” This occurs over time for many and may eventually result in the need for a hip replacement. This usually isn’t needed until an individual is in their late 60s or older (if at all), but for those who injure a hip earlier in life, the “wearing out” process may accelerate and a hip replacement may be needed well before old age.
There are many studies that report low back and hip arthritis often occur together, and differentiating between the two can sometimes be a challenge. For example, pain can radiate from the hip to the knee, which many doctors will diagnose as “sciatic nerve.” But hip pain can present exactly the same, making it hard to determine if it’s low back-generated pain or hip-generated pain.
This is why it’s SO IMPORTANT that your doctor of chiropractic conduct a careful history and examination. There are specific tests that he or she will perform that help determine which of the two is causing the pain. There are times when they may find BOTH problems co-existing together, making it necessary to manage two problems, rather than just one.
There are many mobilization, manipulation, soft tissue therapies, modalities, and exercises available to patients with both hip and low back pain. So if you’re not sure what is bothering you and you don’t know what to do, visit your doctor of chiropractic and he or she will help you through this.

The Best Diet For Fibromyalgia?

~ Dr. Robert Speirs DC ~ Leave a comment

Anti-Inflam

​Fibromyalgia (FM) and its cause remains a mystery, but most studies suggest that FM is NOT the result of a single event but rather a combination of many physical, chemical, and emotional stressors.

The question of the month regarding the BEST FM diet is intriguing since one might assume that the many causes should mean that there isn’t one dietary solution. But is that true? Could there be a “best diet” to help ease the symptoms from such a multi-faceted disorder?

Certainly, healthy eating is VERY important for ALL of us regardless of our current ailment(s). Obesity is rampant largely due to the fact that 60% of the calories consumed by the “typical” American center around eating highly inflaming food that include those rich in Sugar, Omega-6 oil, Flour, and Trans fats (“SOFT” foods, if you will!). Obesity has been cited as “an epidemic” largely due to kids and adults becoming too sedentary (watching TV, playing on electronic devices, etc.) and eating poorly.

Perhaps the BEST way to manage the pain associated with FM and to maintain a healthy BMI (Body Mass Index, or ratio between height and weight) is to substitute ANTI-INFLAMING foods for those that inflame (or SOFT foods).

You can simplify your diet by substituting OUT “fast foods” for fruits, vegetables, and lean meats. So there you have it. It’s that simple. The problem is making up your mind to change and then actually doing it. Once these two things take place, most everyone can easily “recalibrate” their caloric intake and easily adapt.

Not only have studies shown that chronic illnesses like heart disease, stroke, and diabetes significantly benefit by following this simple dietary shift, but so does pain arising from the musculoskeletal system! This is because the human body is made up largely of chemicals, and chemical shifts are constantly taking place when it moves. If you reach for an anti-inflammatory drug like ibuprofen or naproxen and it helps, it’s because you ARE inflamed and the drug reduces the pain associated with that inflammation. This is an indication that an anti-inflammatory diet WILL HELP as well (but without the negative side effects)!

The list of chronic conditions that result in muscle pain not only includes FM but also obesity, metabolic syndrome, and type II diabetes. Conditions like tension-type and migraine headaches, neck and back pain, disk herniation, and tendonopathies and MANY more ALL respond WELL to making this SIMPLE change in the diet. For more information on how to “DEFLAME,” visit http://www.deflame.com! It could be a potential “lifesaver!”

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

~ Dr. Robert Speirs DC ~ Leave a comment

​Vertigo_view_03,_Andels_Hotel_Łódź.jpg

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.

What is Facet Syndrome?

~ Dr. Robert Speirs DC ~ Leave a comment

​

As stated in last week’s article, low back pain (LBP) can arise from many different structures. Lumbar facet syndrome is one that involves the facet joint and includes both acute (new) and chronic (old) varieties. The facet joint is synonymous with the zygapophyseal joint, so if you hear that word, don’t let it throw you off! Approximately 45% of patients with chronic low back pain suffer from “facet syndrome” (FS) in which the facets are the low back pain generator.
There are many conditions that give rise to FS. Some of these include the straining of the surrounding joint capsule (the capsule holds the joint securely together), joint hypomobility (reduced motion in the joint), a synovial cyst (similar to a ganglion on the back of the wrist but its located inside the joint), and degeneration (also called osteoarthritis—the wearing out type of arthritis).
Because facet syndrome can accompany other conditions, a doctor of chiropractic must evaluate each patient individually and manage each person appropriately. In “pure” facet syndrome, pain rarely ever passes the level of the knee and does not cause neurological loss (weakness, loss of reflex, etc.). It can create numbness but usually NOT beyond the knee. Pain is usually not worsened by hip movements such as straight leg raise or hip rotation.
The facet joint’s “job” (at least in part) is to limit or guard twisting movements in the upper lumbar/low back region, and the lower lumbar facets are shaped to limit motion when bending forwards and backwards. Facet joints are unique because they are innervated by specific nerves that can be blocked by injecting an anesthetic agent to determine if the facet (and its innervating nerve) is the main source of pain. The surrounding capsule around the facet joint contains mechanoreceptors (cells that detect movement) and nociceptors (cells that detect pain) that fire when the facet joint is compressed/jammed or over-stretched. These nociceptors can become “hypersensitized” (very irritable) when they remain inflamed over time.
In many patients, injury to a facet joint is the result of many microtraumas over a period of time and not one single isolated event. For example, repeatedly bending backwards, twisting, and leaning to one side can stretch the joint capsule and fatigue it until some capsular tissues finally “give” and it inflames which generates pain.
These joints commonly become arthritic with age, which is one reason people over 50-60 years old commonly present with FS. Osteoarthritis results in a narrowing of the joint space and causes a more permanently “jammed” joint. This is one reason many elderly people walk partially bent over—as bending forwards opens the facet joints and “feels good!”
facet joint
The good news is that chiropractic manipulation is a highly effective treatment for facet syndrome, and most patients feel much better within the first or second week of care (often within three to five visits).

What Exercises Should I Do For Fibro?

~ Dr. Robert Speirs DC ~ Leave a comment

outdoor-685417_960_720

​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!

Do I have a tension headache? Or Migranes?

~ Dr. Robert Speirs DC ~ Leave a comment

Cervicogenic

​Most likely, everyone reading this article has had a headache at one time or another. The American Headache Society reports that nearly 40% of the population suffers from episodic headaches each year while 3% have chronic tension-type headaches. The United States Department of Health and Human Services estimates that 29.5 million Americans experience migraines, but tension headaches are more common than migraines at a frequency of 5 to 1. Knowing the difference between the two is important, as the proper diagnosis can guide treatment in the right direction.

TENSION HEADACHES: These typically result in a steady ache and tightness located in the neck, particularly at the base of the skull, which can irritate the upper cervical nerve roots resulting in radiating pain and/or numbness into the head. At times, the pain can reach the eyes but often stops at the top of the head. Common triggers include stress, muscle strain, or anxiety.

MIGRAINE HEADACHES: Migraines are often much more intense, severe, and sometimes incapacitating. They usually remain on one side of the head and are associated with nausea and/or vomiting. An “aura”, or a pre-headache warning, often comes with symptoms such as a bright flashing light, ringing or noise in the ears, a visual floater, and more. For migraine headaches, there is often a strong family history, which indicates genetics may play a role in their origin.

There are many causes for headaches. Commonly, they include lack of sleep and/or stress and they can also result from a recent injury—such as a car accident, and/or a sports injury—especially when accompanied by a concussion.

Certain things can “trigger” a migraine including caffeine, chocolate, citrus fruits, cured meats, dehydration, depression, diet (skipping meals), dried fish, dried fruit, exercise (excessive), eyestrain, fatigue (extreme), food additives (nitrites, nitrates, MSG), lights (bright, flickering, glare), menstruation, some medications, noise, nuts, odors, onions, altered sleep, stress, watching TV, red wine/alcohol, weather, etc.

Posture is also a very important consideration. A forward head carriage is not only related to headaches, but also neck and back pain. We’ve previously pointed out that every inch (2.54 cm) the average 12 pound head (5.44 kg) shifts forwards adds an EXTRA ten pounds (4.5 kg) of load on the neck and upper back muscles to keep the head upright.

So, what can be done for people who suffer from headaches? First, research shows chiropractic care is highly effective for patients with both types of headaches. Spinal manipulation, deep tissue release techniques, and nutritional counseling are common approaches utilized by chiropractors. Patients are also advised to use some of these self-management strategies at home as part of their treatment plan: the use of ice, self-trigger point therapy, exercise (especially strengthening the deep neck flexors), and nutritional supplements.

Carpal Tunnel Syndrome #3

~ Dr. Robert Speirs DC ~ Leave a comment

​This week, we will conclude our three-part series on important facts regarding carpal tunnel syndrome (CTS).

CTS TREATMENT OPTIONS (continued): Aside from the carpal tunnel, there are several places where the median nerve can become compressed as it travels from the neck, down through the shoulder, through tight muscular areas of the upper arm and forearm, and finally through the carpal tunnel at the wrist. In order to achieve good, long-lasting results, treatment must focus on relieving compression at any point along the course of the nerve. This is why chiropractic works SO WELL as it addresses ALL of these areas using manual adjustments, muscle release techniques, and even physical therapy modalities.

CTS PREVENTION: Because there are multiple causes of CTS, prevention must be tailored to each person. For example, if the patient has diabetes mellitus, maintaining a proper blood sugar level is very important because the blood becomes thicker as the sugar levels increase and it simply cannot pass through our small blood vessels (capillaries), especially those located in the feet and hands. This can eventually lead to the need for amputation due to poor circulation and contribute to the numbness associated with diabetic neuropathy.

Similarly, low thyroid function results in a type of swelling called myxedema that can cause or worsen CTS, and keeping the thyroid hormone balanced in the bloodstream is very important. Managing other conditions that create inflammation or swelling, such as rheumatoid and other types of arthritis, will also help prevent CTS from developing or worsening.

Carpal tunnel syndrome can also occur during pregnancy due to the hormonal shifts similar for those taking birth control pills. The PRICE treatment options presented last month can be very helpful for the pregnant mother and represent important non-medication self-care approaches.

Certain occupations that require fast, repetitive work and/or firm gripping can result in carpal tunnel syndrome because of the friction that results in swelling that occurs when the muscle tendons inside the carpal tunnel rub excessively fast together (kind of like starting a fire with two sticks). Modifying the work task until the swelling is controlled is VERY important, as discussed last month.

Other preventative measures include exercises that keep the muscles and tendons in the forearm and inside the carpal tunnel stretched so that the tendons easily slide inside their respective muscle tendon sheaths. This is accomplished by placing the palm side of the hand (elbow straight) on a wall with the fingers pointing downwards while reaching across with the opposite hand and pulling the thumb back until you feel a good firm stretch. Hold this position for 5-10 seconds or until the forearm muscles feel like they are relaxing. Repeat this multiple times a day.

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.

Carpal Tunnel

What Causes Low Back Pain?

~ Dr. Robert Speirs DC ~ Leave a comment

​236

Low back pain (LBP) can arise from disks, nerves, joints, and the surrounding soft tissues.
To simplify the task of determining “What is causing my LBP?” the Quebec Task Force recommends that LBP be divided into three main categories: 1) Mechanical LBP; 2) Nerve root related back pain; and 3) Pathology or fracture. We will address the first two, as they are most commonly managed by chiropractors.
Making the proper diagnosis points your doctor in the right direction regarding treatment. It avoids time wasted by treating an unrelated condition, which runs the risk of increased chances of a poor and/or prolonged recovery. Low back pain is no exception! The “correct” diagnosis allows treatment to be focused and specific so that it will yield the best results.
Mechanical low back pain is the most commonly seen type of back pain, and it encompasses pain that arises from sprains, strains, facet and sacroiliac (SI) syndromes, and more. The main difference between this and nerve root-related LBP is the ABSENCE of a pinched nerve. Hence, pain typically does NOT radiate, and if it does, it rarely goes beyond the knee and normally does not cause weakness in the leg.
The mechanism of injury for both types of LBP can occur when a person does too much, maintains an awkward position for too long, or over bends, lifts, and/or twists. However, LBP can also occur “insidiously” or for seemingly no reason at all. However, in most cases, if one thinks hard enough, they can identify an event or a series of “micro-traumas” extending back in time that may be the “cause” of their current low back pain issues.
Nerve root-related LBP is less common but it is often more severe—as the pain associated with a pinched nerve is often very sharp, can radiate down a leg often to the foot, and cause numbness, tingling, and muscle weakness. The location of the weakness depends on which nerve is pinched. Think of the nerve as a wire to a light and the switch of the nerve is located in the back where it exits the spine. When the switch is turned on (the nerve is pinched), and the “light” turns on—possibly in the outer foot, middle foot, inner foot, or front, back or side of the thigh. In fact, there are seven nerves that innervate or “run” into our leg, so usually, a very specific location “lights up” in the limb.
Determining the cause of your low back pain helps your doctor of chiropractic determine which treatments may work best to alleviate your pain as well as where such treatments can be focused.

What to do about FM #pain?

~ Dr. Robert Speirs DC ~ 4 Comments

​Fibromyalgia (FM) is a very common condition affecting approximately ten million Americans (2-4% of the population)—with a ratio of about four women to each man with the disease. Part of the diagnosis and treatment challenge is that many of the complaints associated with FM occur in ALL of us at some point, such as fatigue, generalized whole body aches/pains, non-restorative sleep, depression, anxiety, etc. So what is the difference between the FM sufferer and those without it? Let’s take a look!

The primary distinction between patients with FM and the “rest of us” has to do with the word “chronic.” This term means “…persisting for a long time or constantly recurring; long-standing, long-term.” In fact, the term “fibromyalgia” is described as a complex chronic pain disorder that causes widespread pain and tenderness that may present body wide or migrate around the body. It is also known to “wax and wane over time,” meaning it flares up and down, off and on.

The diagnosis of FM is typically made by eliminating every other possible cause. Hence, after blood tests and x-ray or other imaging, the ABSENCE of other problems helps nail down the diagnosis of “primary fibromyalgia.” Then there is “secondary fibromyalgia,” which is DUE TO a known disorder or condition such as after trauma (like a car accident), rheumatoid arthritis, migraine headache, irritable bowel syndrome, “GERD” (which is heart burn due to reflux), pelvic pain, overactive bladder, tempromandibular joint dysfunction (jaw pain, with or without ringing in the ears), or stress. It’s also often accompanied by anxiety, depression, and/or some other mental health condition.

It should be clearly understood that there is no “cure” for FM. It has also been widely reported in many studies that the BEST management approach for FM is through a TEAM of healthcare providers. This team is frequently made up of primary care doctors, doctors of chiropractic, massage therapists, mental / behavioral specialists, physical therapists, and perhaps others (acupuncturist, nutritionist, stress management specialists, and more).

The “general” treatment approach is typically done with medications, cognitive behavioral therapies (CBT), gentle exercise, and manual therapies. Additionally, patients are encouraged to participate in the healing process via self-management strategies that focus on reducing stress and fatigue, optimizing diet, and developing a consistent sleep habit.

Think of the role of the chiropractor as a strong member of the team. A doctor of chiropractic can offer many of the known methods of managing FM described above, as their training includes diet and nutrition, stress management, exercise training, and ability to provide “whole person care.” Treatments delivered in the chiropractic setting like spinal manipulation, mobilization, and massage offer GREAT relief to FM patients! Again, coordinating care between various providers is the best approach, but you need someone willing and able to do that. A doctor of chiropractic is a great choice!

It is very difficult to manage FM on your own. Let a doctor of chiropractic tailor a treatment plan that is appealing to you and your specific interests. Managing FM is definitely NOT a “…one size fits all” approach like an inhaler is for asthma. Each individual’s situation is too highly unique!60+ Yoga