Whiplash

Condition Of The Month: Thoracic Joint Restriction

~ Dr. Robert Speirs DC ~ Leave a comment

T Spine Joint

Your spine is made up of 24 bones stacked on top of each other with a soft “disc” between each segment to allow for flexibility. Normally, each joint in your spine should move freely and independently. When one or more of your spinal vertebra is slightly misaligned and restricted, we call this condition a “spinal segmental joint restriction”. A “thoracic joint restriction” means that this misalignment or restriction is located in your upper or mid-back region.

To help visualize this, imagine a normal spine functioning like a big spring moving freely in every direction. A spine with a joint restriction is like having a section of that spring welded together. The spring may still move as a whole, but a portion of it is no longer functioning.

Joint restrictions can develop in many ways. Sometimes they are brought on by an accident or an injury. Other times, they develop from repetitive strains or poor posture. Being overweight, smoking, strenuous work, and emotional stress can make you more susceptible to problems.

Restricted joints give rise to a self-perpetuating cycle of discomfort. Joint restriction causes swelling and inflammation, which triggers muscular guarding leading to more restriction. Since your spine functions as a unit, rather than as isolated pieces, a joint restriction in one area of your spine often causes “compensatory” problems in another. Think of this as a rowboat with multiple oarsmen on each side. When one rower quits, the others are placed under additional stress and can become overworked.

Joint restrictions most commonly cause local tenderness and discomfort. You may notice that your range of motion is limited. Movement may increase your discomfort. Pain from a restricted joint often trickles around your rib cage or up & down your spine. Be sure to tell your chiropractor if your symptoms include any chest pain, shortness of breath, unusual cough, indigestion or flu- like complaints.

Long-standing restrictions are thought to result in arthritis – much like the way a slightly misaligned wheel on your car causes premature wearing of your tire.

You should recognize that your problem is common and generally treatable. Chiropractic care has been shown to be the safest and most effective treatment for joint restrictions. Our office offers several tools to help ease your pain. To speed your recovery, you should avoid activities that increase your pain. Be sure to take frequent breaks from sedentary activity. Yoga has been shown to help back pain sufferers so consider joining a class or picking up a DVD.

Chiro & Concussions

~ Dr. Robert Speirs DC ~ Leave a comment

head-shot2

​Whiplash Associated Disorders (WAD) is the appropriate terminology to use when addressing the myriad of symptoms that can occur as a result of a motor vehicle collision (MVC). In a recent publication in The Physician and Sports Medicine (Volume 43, Issue 3, 2015; 7/3/15 online:1-11), the article “The role of the cervical spine in post-concussive syndrome” takes a look at the neck when it’s injured in a car accident and how this relates to concussion.

It’s estimated about 3.8 million concussion injuries, also referred to as “mild traumatic brain injury” (mTBI), occur each year in the United States. Ironically, it’s one of the least understood injuries in the sports medicine and neuroscience communities. The GOOD NEWS is that concussion symptoms resolve within 7-10 days in the majority of cases; unfortunately, this isn’t the case with 10-15% of patients. Symptoms can last weeks, months, or even years in this group for which the term “post-concussive syndrome” (PCS) is used (defined as three or more symptoms lasting for four weeks as defined by the ICD-10) or three months following a minor head injury (as defined by the Diagnostic and Statistical Manual of Mental Disorders).

There have been significant advances in understanding what takes place in the acute phase of mTBI, but unfortunately, there is no clear physiological explanation for the chronic phase. Studies show the range of force to the head needed to cause concussion is between 60-160g (“g” = gravity) with 96.1g representing the highest predictive value in a football injury, whereas as little as 4.5g of neck acceleration can cause mild strain injury to the neck. In spite of this difference, the signs and symptoms reported by those injured in low-speed MVCs vs. football collisions are strikingly similar!

Research shows if an individual sustains an injury where the head is accelerated between 60-160g, it is HIGHLY likely that the tissues of the cervical spine (neck) have also reached their injury threshold of 4.5g. In a study that looked at hockey players, those who sustained a concussion also had WAD / neck injuries indicating that these injuries occur concurrently. Injuries to the neck in WAD include the same symptoms that occur in concussion including headache, dizziness/balance loss, nausea, visual and auditory problems, and cognitive dysfunction, just to name a few.

The paper concludes with five cases of PCS that responded well to a combination of active exercise/rehabilitation AND passive manual therapy (cervical spine manipulation). The favourable outcome supports the concept that the neck injury portion of WAD is a very important aspect to consider when treating patients with PCS!

This “link” between neck injury and concussion explains why chiropractic care is essential in the treatment of the concussion patient! This is especially true when the symptoms of concussion persist longer than one month!

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 Whiplash, we would be honoured to render our services.

What the heck is a trigger point?

~ bryancobb ~ Leave a comment

By Bryan Cobb, Advanced Remedial Massage Therapist

trigger-point-referred-pain-shutterstock_228843211

What is a Trigger Point?

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

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

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

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

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

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

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

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

 

Sudden overload of a muscle

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

 

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

 

Trigger Points Not Well Known

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

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

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

 

How Are Trigger Points Treated?

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

 

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

 

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

 

 

 

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

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

Chronic Neck Pain and Anxiety-Depression.

~ Dr. Robert Speirs DC ~ Leave a comment

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

The Pan-African Medical Journal, May 2016

whiplash

How does my neck cause headaches?

~ Dr. Robert Speirs DC ~ Leave a comment

Cervicogenic

 

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

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

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

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

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

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

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

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

What is wrong with my shoulder?

~ Dr. Robert Speirs DC ~ Leave a comment

Impingement

 

Shoulder pain is a REALLY common problem that can arise from many causes. There are actually several joints that make up the shoulder, so shoulder injuries can be quite complex!
Probably the most common source of shoulder pain arises from the muscle tendons and the bursa—the fluid-filled sacs that lubricate, cushion, and protect the sliding tendons near their attachment to bone. The rotator cuff is made up from a group of four muscles and their connecting tendons. Typically, when the tendons tear, the bursa swells and “impingement” occurs. When this happens, it’s very painful to raise the arm up from the side.
The term “strain” applies to injuries of the muscles and tendons and are classified as mild, moderate, or severe (some refer to this as first, second, and third degree tears), depending on the amount of tissue that has torn. Overexertion, overuse, sports injuries, dislocation, fracture, frozen shoulder, joint instability, and pinched nerves can all give rise to shoulder pain.
The diagnosis of what’s actually causing a patient’s shoulder pain is often determined by the history of how the injury occurred, or the “mechanism of injury.” This is followed up by measuring the range of motion and performing provocative tests to see which positions bother the shoulder the most. A doctor may use X-rays to assess for fracture/dislocation and an MRI to assess muscle tendon tears, labral tears (a rim of cartilage surrounding the glenoid fossa or cup of the ball & socket joint), and other soft tissue injuries.
People with jobs that require heavy lifting or repetitive pounding (carpenters and jack-hammer operators, for example), who play sports such as football and rugby, and those who smoke, have diabetes, and/or an overactive thyroid are at higher risk of injury. Because the shoulder joint is normally not very stable, MANY people tear their rotator cuff or injure their shoulder during their lifetime. One study found 17% of participants had full thickness rotator cuff tears (as opposed to partial tears). The researchers reported that age was an important determinant, as the incidence of full tears was only 6% in those less than 60 years old vs. 30% in those over 60! So obviously, this IS NOT an injury limited to the younger active person!
Outside of a medical emergency, patients should always try non-surgical treatment options first. Doctors of chiropractic offer the shoulder injury patient a non-surgical option that emphasizes exercise and self-management strategies in addition to manual manipulation, mobilization, and more. The most important message is BE PATIENT as these usually take time to manage, often up to a year.

Whiplash Injury? Get Help Now!

~ Dr. Robert Speirs DC ~ Leave a comment

whiplash

 

Should I seek treatment for whiplash right away?

Even though whiplash or whiplash associated disorders (WAD) is very common, it remains poorly understood. Recent studies report that up to 60% of people may still have pain six months after their injury. Why is that?
Investigations have shown there are changes in the muscle and muscle function in the neck and shoulder regions in chronic WAD patients. Symptoms often include balance problems as well as increased sensitivity to a variety of stimuli including pressure, light vibration, and temperature.
Interestingly, this hypersensitivity not only occurs in the injured area, but also in areas away from the neck such as the front of the lower leg or the shin bone. This can only be explained by some type of neurobiological processing of pain within the central nervous system, which includes the spinal cord and brain.
It’s not surprising that when pain continues for lengthy time frames, people with these symptoms may also experience psychological distress. The confusing thing is that not every WAD injury case has this “central sensitization” and when it’s present—its intensity is highly variable.
Current research into WAD is focused on the following: 1) developing better treatments in the early or acute whiplash injury stage with the goal to PREVENT development of these chronic symptoms; 2) determining what factors can PREDICT slower recovery following a WAD injury; 3) investigation into how the stress response associated with motor vehicle crashes influence pain, other symptoms and recovery, and how to best address and MANAGE the stress response; 4) research into the effect a WAD injury has on daily life function; and 5) developing improved assessment methods for healthcare providers so that EARLY treatments can be more targeted and effective.
A Swedish study is currently looking at the importance of reducing the acceleration of the occupant during an automobile collision by redesigning the body of the vehicle and its safety systems. In rear-end crashes, the main issue is to design a seat and head restraint that absorbs energy in a controlled way and gives support to the whole spine. In frontal crashes, the air bag, seat belt pretensioner, and load limiter must work together in a coordinated way to reduce the acceleration between the vertebrae of the spine and occupant.
What is known is that a “wait and watch” approach may NOT be appropriate in a lot of cases. It appears there is a relatively short window of time, the first three months, when treatment seems to be most effective. Doctors of chiropractic are trained to identify and treat these types of injuries, so PLEASE, don’t delay your initial visit—time is truly of the essence.  Don’t waste it!