Chronic Pain

Can Chiro Help My Headache?

~ Dr. Robert Speirs DC ~ Leave a comment

​Migrane

Everyone, well at least almost everyone, has had headaches from time to time, and we all know how miserable they can make us feel. In fact, at some point in time, 9 out of 10 Americans suffer from headaches that range between mild and dull to throbbing, intense, and debilitating, sometimes to the point of requiring bed rest in a dark, quiet room.

The common reflex is to reach for that bottle of pills and pray the headache subsides so you don’t have to call in sick and lose another day of productivity when you have so much to do. Unfortunately, between the side effects of many medications designed to help headaches and the pain associated with the headache, this approach is frequently NOT the answer. So what is?

The good news is that many studies have identified spinal manipulation therapy (SMT), the main type of care utilized by chiropractors, as being very effective for popular types of headaches—in particular tension-type headaches that arise in the neck. An important 2001 study reported that SMT provided almost immediate relief for headaches that arose in the neck with SIGNIFICANTLY fewer side effects and longer-lasting results compared with commonly prescribed medications.

Another interesting study that found similar results included tracking the prevalence/frequency of headaches after treatment stopped. The authors of the study reported the patients receiving SMT had continued to experience sustained benefits throughout the following weeks, and even months, in contrast to those in a medication treatment group where headaches came back almost immediately after they discontinued treatment.

The most commonly prescribed medication for tension-type headaches are non-steroidal anti-inflammatory drugs (NSAIDs). Common over-the-counter options include ibuprofen (Advil, Nuprin, etc.) and Aleve (Naproxen). For those who can’t take NSAIDs because of blood thinning and/or stomach-liver-kidney problems, doctors commonly prescribe acetaminophen (Tylenol), but it can be hard on the liver and kidneys, especially when taken over time.

So, what can you expect from a visit to a chiropractor for your headaches? The typical approach begins with a thorough history and examination with an emphasis of evaluating the neck and its associated function. Your doctor of chiropractic may also perform tests designed to reduce pain and some that provoke a pain response to identify the “pain generator” or cause!

Because each patient is unique, the type of care provided will be individually determined based on the findings, the patient’s age, comfort, and preference of both the provider and patient.

So, the next time you find yourself reaching for pills because of headaches, remember that there are better options! Give chiropractic a try. You’ll be GLAD you did!!!

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.

Carpal Tunnel Syndrome #2

~ Dr. Robert Speirs DC ~ Leave a comment

Healthcare providers tend to agree that in non-emergency situations, patients with conditions like Carpal Tunnel Syndrome (CTS) should try non-surgical treatments before consulting with a surgeon. The “PRICE” concept, that is Protect, Rest, Ice, Compress, & Elevate can be applied to most injuries, including CTS, especially in the acute/inflammatory stage. However, many of these principles also apply in the chronic stage (more than three months) of CTS.

PROTECT: For the CTS patient, many doctors commonly prescribe a wrist cock-up splint to be worn overnight, which may surprise some of you! During the day, depending on the type of work you do, a wrist splint can actually get in the way and result in increased symptoms, and at times, cause bruising at both ends of the splint (mid-forearm & mid-hand). The primary reason to use the splint at night is that one cannot control the position of their wrist during sleep, and it can often wind up bent. This increases the pressure inside the carpal tunnel up to six to eight times more than normal, potentially causing enough pain and tingling to disturb sleep. The splint guarantees a neutral wrist position, which significantly improves sleep quality and allows healing to occur.

REST: The use of a splint allows the swollen median nerve to heal. However, in order to allow the wrist to rest so inflammation can subside and the condition can fully heal, patients often need to modify their daily activities, at least for a short time. This may require job restrictions, especially if the occupation involves a fast repetitive motion type of tasks and/or forceful gripping.

ICE: The use of an “ice cup”—or an ice cube held with a washcloth to protect the fingertips from getting cold—is by far the most effective approach. Rub the ice directly on the skin over the carpal tunnel so that you experience the four stages of cooling: Cold, Burning, Aching, and Numb (C-BAN). This usually takes about four minutes, and it’s important to stop when numbness occurs, as the next stage of cooling is frostbite. This can be repeated multiple times a day and is often as effective as cortisone shots with fewer side effects (and less pain!).

COMPRESS: The wrist cock-up splint can offer some compression, but an elastic carpal tunnel wrist band will not usually interfere with most activities of daily living. Some versions include a thumb loop to keep the wrist band in place, but that may get in the way. A version without the thumb loop also works very well.

EXERCISE: Exercises performed at home and work can significantly help manage the condition. (Note: For injuries like a sprained ankle, E typically stands for ELEVATE, though it’s not practical for the CTS patient.)

Tune in next month for the unique techniques that chiropractic offers to the non-surgical care of CTS as well as the importance of preventative measures 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.

 

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What is Cervical Spondylosis?

~ Dr. Robert Speirs DC ~ Leave a comment

CSpine

​Cervical spondylosis (CS) is another term for osteoarthritis (OA) of the neck. It is a common, age-related condition that you will probably develop if you live long enough. Or, if you suffered a neck injury as a youth, it can develop within five to ten years of the injury, depending on the severity. According to the Mayo Clinic, CS or OA affects more than 85% of people over 60 years old, and that is probably a conservative estimate!

Common symptoms associated with CS/OA vary widely from no symptoms whatsoever to debilitating pain and stiffness. For example, when CS crowds the holes through which the nerves and/or spinal cord travel, it creates a condition called spinal stenosis that can result in numbness, tingling, and/or weakness. In severe cases, this can even affect bowel or bladder control (which is an EMERGENCY)!

CS occurs when the normal slippery, shiny cartilage surfaces of the joint(s) gradually thin and eventually wear away. Bone spurs often form, which results from the body trying to stabilize an unstable joint. In some cases, the spurs can actually fuse a joint, which often helps reduce pain. (Bone spurs can also form if the intervertebral disks or shock-absorbing pads between the vertebrae are injured or become dehydrated due to arthritic conditions.)

Risk factors associated with CS include: aging, injury, years of heavy lift/carry job demands, and jobs and/or hobbies that require the neck to be outside of a neutral position (like years of pinching a phone between the ear and shoulder). Genetics and bad habits (like smoking) also play a role in CS. Obesity and inactivity also worsens the severity of CS symptoms.

The good news is that even though most of us will have CS, it is usually NOT a disabling condition. However, CS may interfere with our normal activities. Depending on its location, pain may feel worse in certain positions, like when sneezing or coughing or with movements like rotation or looking upwards.

Stiffness is a common symptom, which can vary with weather changes. Too little as well as too much activity can be a problem, but the BEST way to self-manage CS is to keep active! Range of motion exercises, strength training, and walking all help reduce the symptoms of CS.

Doctors of chiropractic are trained to identify CS/OA. Gentle manipulation, mobilization, nutritional counseling, exercise training, modalities (and more) can REALLY HELP!

I have Low Back Pain. Why?

~ Dr. Robert Speirs DC ~ Leave a comment

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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.

Whole Body Approach to Fibromyalgia

~ Dr. Robert Speirs DC ~ Leave a comment

​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

~ Dr. Robert Speirs DC ~ Leave a comment

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?

~ Dr. Robert Speirs DC ~ Leave a comment

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.
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My Hip Hurts….

~ Dr. Robert Speirs DC ~ Leave a comment

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.

“Other” Causes of Low Back Pain

~ Dr. Robert Speirs DC ~ Leave a comment

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Between 80% and 90% of the general population will experience an episode of lower back pain (LBP) at least once during their lives. When it affects the young to middle-aged, we often use the term “non-specific LBP” to describe the condition. The geriatric population suffers from the “aging effects” of the spine—things like degenerative joint disease, degenerative disk disease, and spinal stenosis. Fractures caused by osteoporosis can also result in back pain.

The “good news” is that there are rare times when your doctor must consider a serious cause of LBP. That’s why he or she will ask about or check the following during your initial consultation: 1) Have you had bowel or bladder control problems? (This is to make sure a patient doesn’t have “cauda equina syndrome”—a very severely pinched nerve.) 2) Take a patient’s temperature and ask about any recent urinary or respiratory tract infections to rule out spinal infections. 3) To rule out cancer, a doctor may ask about a family or personal history of cancer, recent unexplained weight loss, LBP that won’t go away with time, or sleep interruptions that are out of the ordinary. 4) To rule out fractures, a doctor may also take x-rays if a patient is over age 70 regardless of trauma due to osteoporosis, over age 50 with minor trauma, and at any age with major trauma.
Once a doctor of chiropractic can rule out the “dangerous” causes of LBP, the “KEY” form of treatment is giving reassurance that LBP is manageable and advise LBP sufferers of ALL ages (especially the elderly) to KEEP MOVING! Of course, the speed at which we move depends on many things—first is safety, but perhaps more importantly is to NOT BECOME AFRAID to do things! As we age, we gradually fall out of shape and end up blaming our age for the inability to do simple normal activities. Regardless of age, we must GRADUALLY increase our activities to avoid the trap of sedentary habits resulting in deconditioning followed “fear avoidant behavior!”
Here are a few “surprising” reasons your back may be “killing you”: 1) You’re feeling down – That’s right, having “the blues” and more serious mood disorders, like depression, can make it more difficult to cope with pain. Also, depression often reduces the drive to exercise, may disturb sleep, and can affect dietary decisions—all of which are LBP contributors. 2) Your phone – Poor posture caused by holding a phone between your bent head and shoulder (get a headset!) or prolonged mobile phone use can increase your risk for spinal pain. 3) Your feet hurt, which makes you walk with an altered gait pattern, forcing compensatory movements up the “kinetic chain” leading to LBP. 4) Core muscle weakness, especially if you add to that a “pendulous abdomen” from being overweight—this is a recipe for disaster for LBP. 5) Tight short muscles such as hamstrings, hip rotator muscles, and/or tight hip joint capsules are common problems that contribute to LBP. Stretching exercises can REALLY help!

CTS Exercises?

~ Dr. Robert Speirs DC ~ Leave a comment

​CTS Stretch

Carpal Tunnel Syndrome (CTS) is the leading cause of numbness to the middle three fingers and thumb and affects millions of Americans each year. There are MANY potential causes of CTS, and these causes can be unclear or multi-factorial. We have discussed the importance of night splints and what chiropractic can do for CTS in the recent past. This month, let’s look at what YOU can do for CTS.
“Self-help” concepts are VERY important as they empower YOU to gain control of your condition’s signs and symptoms, thus placing less reliance on those of us who manage (in this case) CTS. There is a time for “PRICE” or, Protect, Rest, Ice, Compress, Elevate, such as when most activities make symptoms worse. This is the time for splinting, reducing activities of daily living (which sometimes includes work restrictions), and the use of ice cupping or massage. Patients should initiate movement or exercise-based approaches as soon as such activities can be tolerated. Here are four different exercises you can do:
1. Fist / “Bear Claw” / Open Wide Hand: This is a three-step exercise, and you can start or stop on any of the three “steps.” A. FIST:  Make a fist and squeeze as tightly as tolerated; B. BEAR CLAW: Starting from the fist position (A), open only the palm of the hand (keep your thumb and fingers bent but straighten the big knuckle joints at the base of the fingers); C. OPEN WIDE: Straighten and spread ALL your finger joints by opening up your hand as much as possible and feel for a good stretch in the palm. HOLD each position for one to five seconds (vary the “speed” of moving between the three positions – fast, medium, and slow; emphasize what feels best if you have a preference). Repeat five to ten times or until your hands feel looser.
2. “Church Steeple”: Place your hands together in front of you (“prayer position”) touching the pads of the thumbs and all four fingertips together and spread your fingers as wide as possible. Next, separate your palms as far as you can while applying pressure against your finger/thumb tips and repeat. Alter the speed and number of repetitions until your hands feel stretched out.
3. “Shake and Flick”: Simply shake your hands as if you just washed them and you’re shaking the water off to “air dry” them. Again, alter the speed and reps until they feel loosened up.
4. Forearm Stretches: Place one arm out in front, elbow straight, and fingers pointed straight, palm up (first set). Reach with the opposite hand and pull the fingers, hand, and wrist down and back towards you until you feel a strong “pull” in your forearm muscles. Hold until the forearm muscles feels stretched (5-10 seconds). Repeat this with the palm facing down for the second set to stretch the opposite (extensor) forearm muscles.
Do these on each side two to three times each (even the “good” side) EVERY HOUR (or as often as possible). Think about what you do on a daily basis and if you work in a repetitive manner (on the job or a hobby at home), try to do these exercises DURING THE REPETITIVE ACTIVITY to help keep your symptoms from getting out of control. If you can alter the position or speed of a work or avocational activity, do so for long-term prevention purposes!
If you cannot gain control of your CTS condition, you may need additional treatment options of which chiropractic offers a safe, non-surgical approach.
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.