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Neck Pain – Where Is It Coming From?

10 Dec

Neck pain can arise from a number of different tissues in the neck. Quite often, pain is generated from the small joints in the back of the vertebra (called facets). Pain can also arise from disk related conditions where the liquid-like center part of the disk works its way out through cracks and tears in the thicker outer part of the disk and can press on nerves producing numbness and/or weakness in the arm. It is possible to “sprain” the neck in car accidents, sports injuries, or from slips and falls. This is where ligaments tear and lose their stability resulting in excessive sliding back and forth of the vertebrae during neck movements. When muscles or their tendon attachments to bone are injured, these injuries are called “strains” and pain can occur wherever the muscle is torn. There is also referred pain. Here, the injury is at a distance away from where the pain is felt. A classic referred pain pattern is shoulder blade pain when a disk in the neck herniates. Let’s take a closer look at two conditions we often diagnose and treat as chiropractors:

Spinal Stenosis: This occurs when the canals in the spine narrow to the point of pinching the spinal cord in the trefoil shaped central canal (called “central stenosis”) or when the nerve roots get pinched in the lateral recesses (called lateral recess stenosis). This can occur from arthritis in the facet joints, disk bulging or herniations, thickening of ligaments, shifting of one vertebra over another, aging, heredity (being born with a narrowed canal), and/or from tumors. Usually, combinations of several of the above occur simultaneously. When this is present in the neck, it can be more serious compared to stenosis in the low back as the spinal cord ends at the upper part of the low back (T12 level) so only the nerves get pinched. Stenosis in the neck however pinches the spinal cord itself. Symptoms can include pain in one or both arms, but it’s more dangerous when leg pain, numbness, or weakness occur (called myelopathy). Rarely, loss of bowel or bladder control can occur which is then considered a “medical emergency” and requires prompt surgery.

Cervical Disk Herniation: As previously stated, the liquid-like center of the disk can work its way through cracks and tears in the outer layer of the disk and press on a nerve resulting in numbness, pain, and/or weakness in the arm. The classic presentation is the patient finding relief by holding the arm over the head, as this puts slack in the nerve and it hurts less in this position. The position of the head also makes a difference as looking up usually hurts more and can increase the arm pain/numbness while looking down reduces the symptoms. We will carefully test your upper extremity neurological functions (reflexes, muscle strength, and sensation as each nerve performs a different function in the arm), and we can tell you which nerve is pinched after a careful examination. This condition can lead to surgery so please take this seriously.

The good news is that chiropractic care can manage both spinal stenosis and cervical disk herniations BEFORE they reach the point of requiring surgery. So make chiropractic your FIRST choice when neck pain occurs!

 

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Whiplash Diagnosis.

10 Dec

Whiplash is, by definition, the rapid acceleration followed by deceleration of the head causing the neck to “crack like a whip” forwards and backwards at a rate so fast that the muscles cannot react quickly enough to control the motion. As reported last month, if a collision occurs in an automobile and the head rests are too low and/or seat backs too reclined and the head moves beyond the allowable tissue boundaries, “whiplash” injury occurs.

When gathering information from the patient, this portion of the history is called “mechanism of injury” and it is VERY IMPORTANT, as it helps us piece together what happened at the time of impact. For example, was the head turned upon impact? Was the impact anticipated? What were the weather conditions (visual, road conditions)? What was the direction of the strike (front, rear, side, angular, or combinations of several)? Did a roll over occur? Was a seat belt used (lap and chest) and were there any seat belt related injuries (to the low back/pelvis, breasts/chest, shoulder, neck)? Any head impact injuries with or without loss of consciousness (if so, how long)? Any short-term memory loss and residual communication challenges (post-concussive syndrome)? All of the answers to these questions are very important when determining the examination path, establishing the diagnoses, and determining the treatment plan.

We also discussed last month the WAD classification or, Whiplash Associated Disorders, which was coined in 1995 by the Quebec Task Force. Types I, II, and III are defined by the type of tissues injured and the history and examination findings. In 2001, the Quebec Task Force found that WAD II (loss of range of motion or ROM/negative neurological findings) and WAD III (both ROM loss and neurological loss) carried progressively greater risk of prolonged recovery compared to WAD I injuries (those with pain but no loss of motion or neurological findings).

Establishing a strong diagnosis allows for accuracy in prognosis and treatment plan recommendations. For example, in WAD II & III injuries, flexion/extension x-rays are needed to determine the extent of ligament damage as normally, the individual vertebrae should not translate or shift forwards or backwards by more than 3.5mm. Similarly, the angle created between each vertebra in flexion & extension should be within 11 degrees of the adjacent angles, and if that’s exceeded, ligament damage is likely to have occurred. So often, ER records describe little to no information about the historical elements reviewed in the 1st paragraph and if x-rays were taken, they rarely include flexion/extension stress x-rays.

Headaches are another component of WAD. Here, the first three sets of nerves that exit the uppermost levels of the spine (C1, C2, and C3) innervate the head. When a patient describes headaches that start in the upper part of the neck and radiate up into the head, the distribution of the pain by history can tell us which nerve(s) are most affected. In the examination, applying manual pressure to the base of the skull can reproduce pain when a nerve is injured. Tracking these findings on a regular basis can tell us how the condition is healing. Chiropractic is at the forefront of diagnosis for WAD!

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CTS “Facts”

9 Dec

How is CTS treated? For the best success, treatment should begin as early as possible. Unfortunately, most people wait a long time before they get to the point where the symptoms interfere with daily activity enough to prompt them to act quickly and make an appointment. Once the cause or causes of CTS are determined, treatment can address ALL the presenting contributing conditions. The FIRST course of care should be NON-SURGICAL, though this is not always practiced – so be aware! Non-surgical care includes the following:

Chiropractic:

Manipulation: This usually includes adjusting the small bones of the hand, the wrist, the forearm, elbow, shoulder, and/or the neck.

Soft-tissue therapy: This includes loosening up the overly tight forearm muscles where the median nerve runs through (on the palm side of the forearm).

Modalities: Such as electrical stimulation and/or laser/light therapy can be very beneficial in reducing swelling or inflammation. In chronic CTS, ultrasound may be helpful as well.

Nutritional: Nutrients such as vitamin B6 have been shown in studies to be effective in some cases. Also, anti-inflammatory herbs (ginger, turmeric, bioflavinoids) and / or digestive enzymes (bromelain, papain, and others) taken between meals are quite effective.

Anti-inflammatory: The first important distinction is that ice can be very effective depending on how long the CTS has been present. In particular, ice cupping or rubbing ice directly on the skin over the carpal tunnel is the most effective way to use ice as an anti-inflammatory agent. When doing so, you will experience four stages of cooling: Cold, Burning, Achy, Numb or, “C-BAN.” It’s important to remember this as you are REALLY going to want to quit in the burning/achy stages when it feels uncomfortable. Once the skin over the wrist / carpal tunnel gets numb (which takes about four to five minutes) QUIT as the next “stage” of cooling is FROST BITE! Most medical practitioners promote the use of NSAIDs (non-steroidal anti-inflammatory drugs) like Advil, aspirin, or Aleve. However, these carry negative side effects including gastritis (burning in the stomach that can lead to ulcers), or liver and/or kidney damage. Try the nutritional anti-inflammatory approach FIRST as they are extremely helpful without the bad side effect potential!

Diet: An ant-inflammatory diet, like the Paleo-diet or gluten free diet, serves as a great tool in reducing the inflammatory markers in the body. Though only 7-10% of the population has celiac disease (gluten intolerance), it’s been estimated that over 80% of us are gluten “sensitive.” Reducing systemic inflammation can make a BIG DIFFERENCE in the management of many conditions including CTS!

Mechanical: Wrist “cock-up” splints can also be REALLY HELPFUL, especially for nighttime use. The reason for this is because when our wrist is bent forwards or backwards, which frequently occurs when sleeping, the pressure inside the carpal tunnel increases, and over time (minutes to hours), the increased pressure in the tunnel exerts compression on the median nerve which then creates numbness into the thumb, index, third and half of the fourth finger, which can wake you up out of a sound sleep. Keeping the wrist straight at night prevents you from curling your wrist under your jaw while sleeping.

Ergonomic Modifications: Changing your work station (computer station, line position, machine controls, pace or rate of repetitive movements, and more) is VERY effective.

NOTE: ALL of the above can be managed through the services offered at our clinic!!!

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Don’t Drop the Ball at Home, be Gentle with Broccoli, & Freeze it Fast.

9 Dec

Dr. Michael F. Roizen

Co-Author of 4 #1 NY Times Bestsellers including: YOU Staying Young.

The Owner’s Manual For Extending Your Warranty (Free Press)

Our basic premise is that your body is amazing.  You get a do over. It doesn’t take that long, and it isn’t that hard if you know what to do.  In these notes, we give you a short course in what to do so it becomes easy for you, and for you to teach others. We want you to know how much control you have over both the  quality and length of your life.

Just because Mother Nature packs nutrients into fruits and vegetables more tightly than commuters on a Japanese subway doesn’t guarantee that the good stuff will last forever. How you treat produce before you eat it has a big impact on how many nutrients are still there when you consume it. Here’s how to handle three favorites:

1. Keep uncut watermelon out of the fridge. That’s a big whew, since there’s never room for one anyway. Whole watermelons stored at room temperature deliver more cell-protecting phytonutrients (specifically lycopene and beta carotene) than melons that are refrigerated or even fresh off the farm. That’s because watermelons continue to ripen and build phytonutrients after they’re picked and a big chill cuts that process short. For a cool treat, chill the sliced fruit right before serving (and of course store any leftovers in the fridge).

2. Slice fresh fruit yourself. Pre-cut fruit saves time but it opens the door for vitamin C to escape. Kiwifruit, pineapple, and cantaloupe seem particularly prone to vitamin C loss, according to one of our favorite physician/chefs, John La Puma, MD.

3. Be gentle with broccoli. Cooking broccoli at too high a temperature decreases levels of sulforaphane, its main cancer-fighting nutrient. Light cooking, however, actually boosts that good-for-you compound. Cooking broccoli to 140 degrees is ideal (158 degrees was the point at which sulforaphane content dropped)—but if you don’t want to make a science project out of your broccoli, know that lightly steaming or sautéing it does the trick.

Don’t drop the ball at home! Maintain your fridge at 40°F or lower, and keep hot foods at 140 degrees or hotter (not broccoli, though). You usually can’t see, smell, or taste disease-causing bacteria in food. But at temperatures between 40°F and 140°F, these dangerous germs multiply faster than rabbits in a pet store. So keep hot foods piping hot and cold foods frosty cold. Refrigerate perishables, prepared foods, and leftovers within two hours of buying, cooking, or serving. Wash all produce multiple times.  Keep your hands, knives, cutting boards, and countertops clean while preparing food and use separate knives and boards for meats and produce.

Freeze it fast. Limit how long you leave raw meats in the fridge: 1-2 days for fish, ground meats, sausage, and poultry and 3-5 days for beef, pork, or veal. If it’s going to be longer, freeze it. This won’t kill existing bacteria but it will prevent more from growing quickly.

Thanks for reading. Feel free to send more questions–you can always send us questions at youdocs@gmail.com , and some of them we may know enough to answer (we’ll try to get answers for you if we do not know).

Young Dr Mike Roizen (aka, The Enforcer)

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Fibromyalgia Holistic Care

9 Dec

Fibromyalgia (FM) is a very challenging condition to both diagnose and treat since there are different clinical signs and symptoms that make each patient with FM unique. Therefore, we usually make the diagnosis by excluding other possibilities. To make matters even more challenging, there are “primary” and “secondary” types of FM, or those who develop FM for no know reason (primary) vs. those whose FM arises from a known condition (secondary). Because of these challenges, there is no single treatment program to apply to all struggling FM patients. Rather, studies often suggest that a multidisciplinary “team” of health care providers be utilized in the management of patients with FM. It is recommended that EACH FM patient have their needs be uniquely treated. This month, we will look a “multimodal” approach to treating FM that incorporates a “team” approach.

For those less familiar with FM, many patients with this condition have symptoms that include fatigue, “all over” body pain, sleep problems, mood symptoms, and chronic pain. They may also have conditions including irritable bowel syndrome, palpitations, thyroid dysfunction, adrenal dysfunction, gastroenterological symptoms, chronic headaches, and MANY others. Dealing with these and other FM symptoms can have a tremendous negative impact on one’s quality of life and activities of daily living.

So as previously stated, the treatment of FM requires a comprehensive approach where the patient’s individual symptoms are targeted, as there is no “cookie cutter / one size fits all” management approach. Effective management approaches include chiropractic, allopathic, acupuncture, soft tissue therapy, sleep hygiene counseling, nutritional counseling, mind-body therapy, and dietary counciling including nutritional supplementation that target specific deficiencies determined by lab/blood tests and/or are based on the clinical history.

Treatment is centered on the human body’s deficiencies with the most important being the removal of any and all “trigger(s)” that causes inflammation in the body. Use of an anti-inflammatory herb such as ginger, turmeric, boswellia, (and others) can help until the causes are identified. A gluten-free diet is often very successful in reducing the autoimmune reaction that occurs with gluten sensitivity, which is estimated to be as high as 80% of the general population. This is NOT to be confused with gluten intolerance or celiac disease (they affect 7-10% of the general population). Once inflammation is controlled, weaning away of the anti-inflammatory supplements can be done successfully.

The hormonal levels of the body must also be in balance, especially the thyroid, adrenal, and sex hormone levels. Lab tests should include a complete thyroid panel (TSH, T3, T4, T7/free thyroxin), a salivary cortisol test (for adrenal function), and sex hormone levels (DHEA, pregnenolone, progesterone, estradiol, and, free and total testosterone). Assess and eliminate food sensitivities/allergies (gluten and dairy are most common). Nutritional supplementation should include vitamins (a multiple, omega 3 fatty acids, Vitamin D3, and Co-enzyme Q-10; minerals (calcium, potassium, magnesium), amino acids and sometimes others (case dependant)). These keep our organs functioning well, like a finely tuned machine! Care must also be taken not to over-dose as well, so let us guide you in this process – consider chiropractic your “coach” in this team-based approach!

 

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What Kind of Headache Do I Have?

9 Dec

Headaches come in MANY different sizes, shapes, and colors. In fact, if you search “headache classification,” you will find the IHS (International Headache Society) 152 page manual (PDF) lists MANY different types of headaches! Last month, we discussed migraine headaches. This month, we’ll talk about the other headache types. So WHY is this important? Very simply, if we know the type of headache you have, we will be able to provide you with the proper treatment. Headaches are classified into two main groups: “primary” and “secondary” headaches. The “Primary” headache list includes: 1) Migraine; 2) Tension-type; 3) Cluster; 4) “Other primary headaches,” of which eight are listed. One might think that with this simple breakdown of the different types of headaches it should be easy to diagnose a type of headache. Unfortunately, that’s NOT true! In fact, a 2004 study published that 80% of people with a recent history of either self or doctor diagnosed sinus headache had NO signs of sinus infection and actually met the criteria for migraine headaches! So, the more we can learn about the different types of headaches, the more likely that we will arrive at an accurate diagnosis.

Tension-Type Headaches: This is the most common type affecting between 30-78% of the general population. It is usually described as a constant ache or pressure either around the head, in the temples, or the back of the head and/or neck. There is typically NO nausea/vomiting, and tension-type headaches rarely stop you from performing normal activities. These headaches usually respond well to chiropractic adjustments and to over-the-counter medications like Advil, aspirin, Aleve, and/or Tylenol, though we’d prefer you first reach for an anti-inflammatory herb like ginger, turmeric, bioflavonoid, and the like as these have less stomach, liver, and/or kidney related side-effects. These headaches are typically caused by contraction of the neck and scalp muscles, which can be result of stress, trauma, lack of sleep, eyestrain, and more.

Cluster Headaches: These are less common, typically affect men more than women, and occur in groups or cycles. These are VERY DISABLING and usually arise suddenly and create severe, debilitating pain usually on only one side of the head. Other characteristics include: a watery eye, sinus congestion, or runny nose on the same side of the face as the headache. An “attack” often includes restlessness and difficulty finding a pain-reducing, comfortable position. There is no known cause of cluster headaches, though a genetic or hereditary link has been proposed. The good news is that chiropractic adjustments can reduce the intensity, frequency, and duration of cluster headaches!

Sinus Headaches: Sinusitis (inflamed sinuses) can be due to allergies or an infection that results in a headache. This may or may not include a fever, but the main distinguishing feature here is pain over the infected sinus. There are four sets of sinuses. Many people know about the frontal (above the eyes on the forehead) and maxillary (under the eyes in our cheeks) but the two sinuses deep in head (ethmoid and sphenoid sinuses) are much less known or talked about. These two deep sinuses refer pain to the back of the head, and when infected, it feels like the back of the head could explode. Lying flat is too painful so sitting up is necessary. Chiropractic adjustments applied to the sinuses, upper neck, and lymphatic drainage techniques work GREAT in these cases!

We will continue next month with the remaining types of headaches!

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 headaches, we would be honored to render our services.

 

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