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Causes of Knee Pain in Kids

11 May

Knee pain accounts for at least one-third of musculoskeletal complaints in the pediatric
population seen in healthcare clinics, including chiropractic offices. This is especially common
in active children during the growth spurts of early adolescence. Let’s review some of the most
common causes of knee pain in kids and teens and how they are typically managed.
Patellofemoral pain syndrome, or kneecap pain, is the most common cause of knee pain
in children and adolescents. Pain typically arises from behind the patella and worsens with
activities involving knee flexion, such as climbing stairs, squatting, or prolonged sitting. On
examination, pain may be reproduced with a single-leg squat, often with inward knee collapse.
Treatment includes both weight-bearing and non-weight-bearing exercises targeting the posterior
hip and quadriceps. Manual therapy and movement retraining may be used to restore normal
joint mechanics. Treatment may include a foot orthotic if excessive ankle pronation is
contributing to pain.
Osgood-Schlatter disease (OSD) is inflammation of the growth plate at the tibial tubercle
just below the kneecap, often producing a prominent bump that can irritate the patellar tendon
during running, jumping, squatting, and kneeling. Treatment typically includes patient education,
activity modification, exercise therapy, and use of an infrapatellar strap. Sinding-LarsenJohansson syndrome is similar to OSD but involves the bottom of the patella rather than the
tibial tubercle. Management follows a similar approach.
Patellar tendinopathy, or jumper’s knee, results from cumulative microtears due to
repetitive jumping, landing, and sprinting. Management includes reducing high-load activities
(while avoiding complete rest), gradually reloading the tendon as symptoms improve, and
performing strengthening and flexibility exercises for the quadriceps and hamstrings. Manual
therapy and biomechanical corrections may also help improve loading patterns.

In cases such as juvenile idiopathic arthritis, chiropractors may work in coordination with
the child’s medical physician or rheumatologist to provide supportive care—such as gentle
manual therapy and soft tissue techniques—to improve mobility and reduce muscle tension.
The good news is these conditions generally respond well to conservative management,
helping most children return to their normal activities without the need for invasive treatment.

Brent Binder, D.C.

4909 Louise Dr. Suite 102

Mechanicsburg, PA 17055 (717) 697-1888

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Chiropractic Care for Headache Relief

4 May

Statistically, up to 20% of adults experience frequent headaches, with approximately 1–
4% reporting headaches on more than 15 days per month. While there are many types of
headaches—and within each subtype, multiple underlying causes and triggers—research
suggests that musculoskeletal factors can contribute to certain headache presentations. What
would a doctor of chiropractic look for during the initial visits to determine whether a course of
chiropractic care could benefit the headache sufferer?
The first step is to take a patient history that explores past and present health, as well as
details specific to the chief complaint—headaches, in this case. The responses help determine
whether the headache pattern is consistent with musculoskeletal referral from the neck or
surrounding tissues. Important clues include band-like pressure around the head; pain that begins
in the neck or base of the skull and may spread to the temples, forehead, or behind the eyes;
headaches triggered by prolonged computer work, poor posture, neck movement, stress, or jaw
clenching; pain that worsens after desk work or driving; improvement with massage, stretching,
or heat; and co-occurring neck stiffness or shoulder tightness.
If the patient presents with red flags—such as a new type of headache after age 50, the
worst headache of their life, recent head trauma, signs of infection (e.g., fever), or neurological
symptoms such as weakness, numbness, or vision changes—they may be referred for urgent
medical evaluation.
The history guides the physical examination, during which the chiropractor assesses
range of motion of the cervical spine—particularly the upper cervical segments—for restrictions,
asymmetries, or reproduction of symptoms. They will also palpate soft tissues in the head and
neck, including the suboccipital muscles, upper trapezius, sternocleidomastoid, temporalis,
masseter, and levator scapulae, to identify tenderness or trigger points and determine whether
these reproduce the patient’s headache. Orthopedic testing and postural assessment further help
identify musculoskeletal contributors.
The specific treatment approach varies by patient, but generally involves conservative
therapies aimed at restoring joint mobility and reducing muscle tension. This may include spinal
manipulation or mobilization, soft tissue therapy, trigger point techniques, physiotherapy
modalities, targeted exercises, and postural education. If a musculoskeletal disorder is a primary
contributor—as is often the case in tension-type or cervicogenic headaches—patients may
experience significant improvement or resolution. For other headache types, such as migraines,
care may help reduce the frequency, intensity, and duration of episodes.

Brent Binder, D.C.

4909 Louise Dr. Suite 102

Mechanicsburg, PA 17055 (717) 697-1888

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Spinal Manipulation for Lumbar Disk Lesions

1 May

The majority of low back pain cases are classified as non-specific in nature, meaning they
are not attributable to an identifiable, single structural cause such as a fracture, infection, tumor,
or nerve compression. But, in roughly 5–10% of cases, the cause of localized pain in the lower
back can be linked to injury to the intervertebral disks—which sit between each of the lumbar
vertebrae and function as shock absorbers while facilitating spinal movement. If a nearby nerve
root is affected, the patient may experience symptoms that radiate along the course of the nerve
into the leg. What role, if any, can chiropractic play in managing lumbar disk–related low back
pain?
When a patient presents with low back pain, the chiropractor evaluates specific patterns
to determine whether a disk lesion may be contributing to the patient’s symptoms. Disk-related
pain is more likely when symptoms worsen with sitting, bending, leaning forward, or lifting, and
improve with standing, walking, or extension-based movements. Pain may be centralized in the
low back or refer into the buttock or thigh. In some cases, symptoms can extend further down the
leg. A particularly important clinical finding is centralization, where pain that radiates into the
leg moves back toward the spine during repeated movements.
In contrast, findings such as localized tenderness, pain primarily with extension and
rotation, no change in symptoms with repeated movement, or pain unaffected by loading patterns
suggest that a disk may not be the primary pain generator. Advanced imaging is typically not
recommended as an initial step in the diagnostic process. This is because a significant portion of
middle-aged adults have disk abnormalities visible on MRI that are often asymptomatic, and
treating these findings may not benefit the patient. Imaging is more appropriately reserved for
cases involving red flags such as progressive neurological deficits, bowel or bladder dysfunction,
or suspicion of serious pathology such as cancer, infection, or fracture.
The goal of treatment is to reduce mechanical stress on the affected disk and surrounding
structures, particularly when herniation is irritating nearby nerve roots, allowing the condition to
improve over time. Doctors of chiropractic often use a multimodal approach that may include
spinal manipulation or mobilization, soft tissue therapies, physiotherapy modalities, traction,
therapeutic exercise, and postural education. Patients who continue to experience significant
symptoms after 6–12 weeks may be referred for further evaluation. Fortunately, the prognosis is
favorable. Studies show that more than 4 in 5 cases of lumbar disk herniation improve with
conservative care and do not require surgery.

Brent Binder, D.C.

4909 Louise Dr. Suite 102

Mechanicsburg, PA 17055 (717) 697-1888

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How Much Screen Time Is Too Much for Teens?

30 Apr

Adolescence is a period of rapid development, and behaviors established during this time can
influence emotional, mental, and physical health well into adulthood. Over the past two decades, the
proliferation of smartphones, handheld devices, and social media has dramatically reshaped daily
life—including for teenagers. Numerous studies have linked excessive screen time to poor posture,
physical inactivity, adverse metabolic outcomes, neck pain, behavioral concerns, lower academic
performance, and mood disorders. But how much screen time is too much?
According to a January 2026 article published in the Journal of the American Medical
Association, teens aged 13 to 18 average more than 8.5 hours per day on screen-based
entertainment—including more than an hour during school hours. The data suggest that the most
frequently used app categories among teenagers include social media, video streaming, gaming,
communication, and general entertainment.
In another study, researchers found that adolescents’ risk of adverse outcomes—including
elevated stress, depression, suicidal ideation, and substance use—increased noticeably after four
hours of daily screen use. These findings suggest that limiting total recreational screen time to under
four hours per day may be a reasonable goal for many teens. When examining social media use
specifically, assessments completed by more than 100,000 Australian youths found that spending
more than two hours per day on social platforms was associated with lower scores for happiness, life
satisfaction, and emotional regulation. Interestingly, the same study found that complete avoidance of
social media was also associated with poorer wellbeing, suggesting that some degree of online social
interaction may be beneficial for adolescents.
So how can parents help their children better regulate screen time? For starters, research
suggests that giving children their own smartphone before age 12 is associated with higher rates of
depression, obesity, and insufficient sleep, so delaying a child’s first phone until later adolescence
may be wise. It’s also recommended to establish screen-free times during the day—such as during
meals or in the hour before bedtime—as well as screen-free zones like bedrooms or dining areas.
Many mobile service providers offer family plans with parental controls that allow parents to set app
restrictions and built-in time limits. Perhaps most importantly, parents should model healthy
technology habits themselves. If children see adults constantly on their phones, they are likely to
imitate that behavior—consciously or not.
Of course, if excessive screen time has contributed to poor posture or musculoskeletal
discomfort in either parent or child, consider scheduling an appointment with your chiropractor. In
addition to hands-on care aimed at restoring movement to stiff joints, they can recommend simple
exercises to perform throughout the day to reduce strain and help prevent future episodes.

Brent Binder, D.C.

4909 Louise Dr. Suite 102

Mechanicsburg, PA 17055 (717) 697-1888

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Whiplash and Memory Impairment

23 Apr

In addition to neck pain and stiffness, individuals who experience sudden acceleration
and deceleration of the head and neck—such as during a whiplash injury—may also develop
symptoms more commonly associated with brain injury, including memory impairment. These
cognitive symptoms can persist for a year or more in some patients and may significantly affect
daily functioning, including the ability to attend school or pursue a career. Why can memory
impairment occur in patients with whiplash-associated disorders (WAD), and is it possible to
reduce the risk of long-term problems following an automobile collision?
It’s important to understand that the brain does not rest directly against the inside of the
bony skull. Instead, it is supported by protective layers called the meninges and cushioned by
cerebrospinal fluid. This arrangement allows the brain to tolerate normal movement while also
offering limited protection during minor impacts. However, during a whiplash event, the rapid
forces placed on the body can cause the brain to continue moving within the skull as the head
and skull are suddenly pushed in the opposite direction. As a result, the brain may sustain strain
or injury to key structures involved in memory formation and storage, even if the head does not
directly strike an object.
Researchers have also proposed that memory impairment in patients with WAD may not
always stem from structural injury within the brain itself. In some cases, cognitive symptoms
may be influenced by pain-related interference with normal brain function. Persistent pain
signals from injured tissues—often in the cervical spine—can affect attention, concentration, and
memory. Encouragingly, studies have observed that cognitive symptoms in some patients
improve as neck pain and soft-tissue injuries recover.
To facilitate recovery, it’s important for treatment to begin soon after injury—ideally
within a few days, or immediately if symptoms are severe or there is concern for serious injury.
Research suggests that early, active management (preferably within 96 hours) is associated with
better outcomes than delaying care for several weeks. Chiropractic management of whiplashassociated disorders typically focuses on a combination of manual therapies, therapeutic
modalities, targeted exercises, and patient education. The goals are to restore normal motion to
injured tissues, reduce pain, and encourage patients to remain active within comfortable limits
while avoiding excessive fear-based activity restriction, which can increase the risk for chronic
symptoms.
If memory impairment is present and does not improve over time, referral to appropriate
specialists—such as a neuropsychologist or cognitive behavioral therapist—may be
recommended as part of a comprehensive care approach.

Brent Binder, D.C.

4909 Louise Dr. Suite 102

Mechanicsburg, PA 17055 (717) 697-1888

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Wrist Tendonitis vs. Carpal Tunnel Syndrome

16 Apr

When an individual experiences symptoms like pain, numbness, tingling, and weakness in the thumb,
index finger, middle finger, thumb-side of the ring finger, and part of the palm, the first thought may be carpal
tunnel syndrome. While it’s the most common peripheral neuropathy, other conditions with overlapping
symptoms must be ruled out during the initial physical examination. One potential contributing cause of carpal
tunnel-like symptoms is cervical radiculopathy.
Five nerve roots exit the lower cervical spine and combine into a structure called the brachial plexus,
from which the median nerve emerges and continues down the arm to supply sensation and muscle function to
part of the hand. Compression or irritation of several of these nerve roots—most commonly C6, C7, and C8—
can result in downstream symptoms in the arm and hand that closely resemble carpal tunnel syndrome.
In one study that included 866 patients with either suspected cervical radiculopathy or carpal tunnel
syndrome, researchers found that roughly one-in-four had both conditions. Another study examining patients
on a surgical waiting list for carpal tunnel release reported that a significant percentage also showed
degenerative changes in the cervical spine near the level where the C6 nerve root exits, suggesting that
coexisting neck pathology may contribute to hand symptoms in some cases.
If a patient presents with suspected carpal tunnel syndrome, how might their chiropractor determine if
cervical radiculopathy may be an underlying cause or contributing factor? First, the chiropractor will review
the patient’s intake history for clues such as whether hand symptoms flare during episodes of neck discomfort;
symptoms are felt anywhere between the neck and hand; numbness extends into the pinky or outer side of the
hand; certain neck positions worsen symptoms; if there’s coexisting neck pain or stiffness; if there is the
presence of headaches or shoulder blade pain; and if there is any history of neck trauma.
During the physical examination, several orthopedic and neurologic tests may be performed to
evaluate for possible cervical radiculopathy. These may include cervical distraction (gentle upward traction is
applied to the head to determine whether arm symptoms improve); the upper limb tension test (specific arm
and neck movements are used to reproduce or alter symptoms); and cervical range-of-motion testing to assess
whether certain neck movements, particularly at end range, provoke arm or hand symptoms. The chiropractor
may also assess deep tendon reflexes to identify asymmetries between sides; perform upper extremity strength
testing to evaluate for myotomal weakness; and conduct dermatomal sensory testing of the thumb (C6), middle
finger (C7), and pinky (C8) to determine whether sensory changes follow a cervical nerve root pattern rather
than an isolated median nerve distribution.
If cervical radiculopathy is identified as a contributing factor, treatment will focus on restoring normal
movement and function to the affected joints and surrounding tissues to relieve pressure on the involved nerve
roots. This may include manual therapies, therapeutic modalities, traction, nighttime bracing (when
appropriate), and specific exercises or stretches to perform between visits. Many patients experience
significant improvement with conservative care. However, if findings suggest a condition outside the
chiropractor’s scope of care or if more invasive treatment is required, referral to an appropriate medical
specialist will be recommended.

Brent Binder, D.C.

4909 Louise Dr. Suite 102

Mechanicsburg, PA 17055 (717) 697-1888

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