The Hamstring and Tension-Type Headache Connection

15 Apr

Patients with tension-type headaches (TTH) often experience neck pain and stiffness, which may be a contributing factor in their present headaches. Thus, it’s not uncommon for a doctor of chiropractic to use manual therapies and provide home exercise instruction focused on improving neck function in the effort to reduce headache frequency and intensity. It may surprise a TTH patient that care may also address areas of the body that seem unrelated to the head. For the TTH patient, they may receive treatment and be asked to perform at-home stretches to address their tight hamstrings. Why is that? 

The superficial back line is comprised of the muscles and associated tissues that start in the back of the head and run down the neck, back, and legs. These muscles work together to keep the body upright, but when there’s a problem in one part of this chain, it can lead to issues elsewhere.  Several studies have observed an association between tightness in the hamstrings—the largest muscle in the superficial chain—and tightness in the neck muscles. One study found that individuals with increased tension and shortening of the hamstrings are more likely to have neck and shoulder pain. A possible explanation is that tight hamstrings can cause the pelvis to tilt backward, which can contribute to the forward head posture—a postural fault that can place increased strain on the muscles in the back of the neck and contribute to headaches.

In a study that included 30 TTH patients, researchers split participants into two groups: one group received treatment to relax the hamstrings through a guided stretching routine in the office and the other received electrotherapy to stimulate the hamstring muscles. Both groups received instruction to perform self-myofascial release at home. Assessments conducted after four weeks of treatment revealed the hamstring relaxation group experienced greater outcomes with respect to headache-related disability, neck pain, and cervical range of motion. 

This finding highlights the importance of examining the whole patient—something chiropractors are trained to do—and not just focusing on the area of chief complaint as issues elsewhere in the body may be the underlying cause or a contributing cause to the patient’s condition. 

Pain Relief Chiropractic

4909 Louise Dr

Mechanicsburg, PA 17055

 (717) 697-1888

Member of Chiro-Trust.org 

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Pre-Surgical Treatment for Carpal Tunnel Syndrome 

10 Apr

Outside of an emergency situation, such as a wrist fracture, treatment guidelines for carpal tunnel syndrome generally recommend exhausting non-surgical options before consulting with a surgeon. But how well are guidelines followed? To find out, researchers surveyed 770 members of the American Society for Surgery of the Hand to better understand the current practice patterns regarding the non-surgical care for CTS patients. Roughly half of respondents had two decades or more of experience in the field with 80% completing a residency in orthopedic surgery and 81% either currently have or previously had a subspecialty in hand surgery.

According to the survey, 72.9% of the CTS patients the surgeons consulted with had previously had two or more corticosteroid injections with 41.2% of surgeons recommending an additional injection before recommending surgery. About four-in-five surgeons did not believe oral steroids are effective for managing CTS though they are included in clinical treatment guidelines developed by the American Academy of Orthopedic Surgery (AAOS). The authors of the study note there is a lack of feedback to the patient’s primary care doctor (and other authorities) when these approaches fail, which may perpetuate their use unnecessarily. 

The researchers point out that the current AAOS clinical treatment guidelines cite strong evidence to support corticosteroid injections and moderate evidence that oral steroids could improve patient-reported outcomes compared to placebo. The study authors continue by noting a study that found corticosteroid injections may only provide short-term benefits compared to a placebo, and another study that concluded a second corticosteroid injections may not offer additional benefit. 

The survey results appear to be contrary to the guidelines put forth by the AAOS, which may be misguiding primary care and general orthopedic physicians. The authors conclude that their findings highlight the importance of better implementation of non-surgical CTS treatment strategies that follow current evidence-based information, rather than following the clinical practice guidelines of the AAOS.

The good news is that the various treatments provided by doctors of chiropractic are highly effective in managing mild-to-moderate CTS as studies have demonstrated that such conservative therapies can be as effective as surgery over the long-term with fewer adverse events. 

Pain Relief Chiropractic

4909 Louise Dr

Mechanicsburg, PA 17055

(717) 697-1888

Member of Chiro-Trust.org 

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Chiropractic Care for the Pediatric Population

5 Apr

While the typical chiropractic patient is a working-age adult, children and teenagers also experience neck pain, back pain, headaches, and other musculoskeletal conditions that may respond favorably to chiropractic treatment. In fact, a 2017 study that monitored 1,400 Danish school children for three years found that 55% experienced spinal pain during the course of the study. With the increased prevalence of sedentary behavior and obesity in the pediatric population, it’s reasonable to suggest that musculoskeletal disorders may become more common in individuals under age 18 in the coming years. To better understand the use of chiropractic care by this population, researchers in Quebec surveyed 245 chiropractors in the province.

According to the survey, pediatric patients account for less than five patient visits per week—between about .5% and 4% of a typical chiropractic practice. Among the pediatric patient population, the majority of patients were children ages 6-12 and teens aged 13-17; however, babies under 23 months of age (and under six months, in particular) are often seen in chiropractic clinics.

The data show that the most common referral source for pediatric patients is a parent, family member, or friend (presumably also a patient in the clinic), with family doctors, other chiropractors, and other healthcare professionals accounting for the remainder. Among the patients aged six and up, the most common presentations appear to be back pain and headache with conditions such as torticollis, colic/irritability, head asymmetry, motor development issues, gastrointestinal problems, sleeping difficulty, jaw/temporomandibular joint issues, and gait/walking problems being more common complaints in the under-age two patients. 

Of the doctors surveyed, 24.9% report they had attained a “Diplomate in clinical chiropractic pediatrics” meaning they had undergone post-graduate training and board examination. Additionally, 54% were active members of a pediatric and perinatal care association. The participants also noted a willingness to co-manage patients with other healthcare providers and they’d immediately refer a patient to their medical physician or hospital if they uncovered any red flags including but not limited to facture/dislocation, fever, chest pain, suicidal ideation, dehydration, persistent vomiting, persistent abdominal pain, etc.

Though the authors of the study note that specific research on chiropractic treatment in the pediatric population is lacking compared to older age groups, they report that adverse events following manual therapy are rare. For pediatric patients who do not respond to conventional treatment, a consultation with a doctor of chiropractic for evaluation may be considered for a short-term course of care to evaluate the effectiveness of treatment.

Pain Relief Chiropractic

4909 Louise Dr

Mechanicsburg, PA 17055

 (717) 697-1888

Member of Chiro-Trust.org 

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A Different Perspective on Chronic Whiplash

30 Mar

It’s estimated that up to 50% of whiplash associated disorders (WAD) patients will continue to experience long-term symptoms that interfere with their ability to carry out activities of daily living. According to experts, the economic burden associated with chronic WAD may exceed $42 billion each year. As such, many studies have sought to better understand whiplash, both from the mechanisms of injury to why some patients recover and some don’t. 

With respect to chronic WAD resulting from a motor vehicle collision (the most common cause of whiplash), factors associated with the crash itself like speed, impact direction, awareness of collision, and airbag deployment do not appear to be significantly linked to an elevated risk for chronicity. On the other hand, researchers have found that higher self-rated pain and disability, fear of movement, catastrophizing, passing coping, and low expectations of recovery are indicative of failure to fully recover. 

In a 2017 study, researchers reframed the trauma of a motor vehicle collision as an event that is both potentially injurious and distressing. When an acute injury occurs (in this case whiplash), there is often damage to various anatomical structures in the head, neck, and/or upper-mid back. Additionally, there is also a stress response associated with the overall incident (including subsequent events like a trip to the hospital and dealing with the insurance company and legal system) that can interfere with the healing process. When the combination of psychological vulnerabilities and neurobiological processes exceeds a person’s given threshold, their risk for chronic WAD rises.

This finding highlights the importance of treating the whole patient when it comes to WAD as it can affect both the body and mind. In addition to therapies delivered in the office to help the soft tissues in and around the neck to heal, doctors of chiropractic and other healthcare providers need to educate the patient and assure them that they will recover and encourage them to carry on their normal activities within pain tolerance. If necessary, the patient may need a referral to a mental healthcare professional to address psychological factors that can impede recovery. 

Pain Relief Chiropractic

4909 Louise Dr

Mechanicsburg, PA 17055

 (717) 697-1888

Member of Chiro-Trust.org 

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Chiropractic Therapy for Hip Pain and Function

25 Mar

Each year, surgeons perform hundreds of thousands of total hip arthroplasties (hip replacements), and the most common reason is osteoarthritis of the hip. This condition isn’t caused by an underlying disease, rather it’s due to wear and tear of the hip joint from everyday activities over time. Not only can osteoarthritis of the hip be painful, but it can reduce the range of motion of the joint, making it difficult to move around. Most patients seek to avoid or delay surgery as much as possible, which drives many to seek chiropractic care. The question is: what can a doctor of chiropractic do to manage osteoarthritis of the hip?

Doctors of chiropractic receive training in the application of several manual therapies of varying force, depending on the condition, patient preferences, and the practitioner’s clinical expertise. In one study that included 60 hip osteoarthritis patients, researchers used a technique called long-axis distraction mobilization (LADM) at varying levels of force and found that high-force LADM yielded superior results with respect to range of motion of the hip joint, although low- and medium-force treatment led to similar improvements in pain. 

A follow-up study by the same researchers with another group of 60 hip osteoarthritis patients found that low-force LADM performed better with respect to reducing pain sensitivity in the hip as well as the low back and knees. On the other hand, high-force LADM brought greater improvements in overall function. A systematic review from 2022 that included ten studies found that the combination of LADM with thrust manipulation and mobilization with movement (two-to-three treatments a week for two-to-six weeks) can provide even larger improvements with respect to pain and range of motion.

When managing a patient with musculoskeletal pain, chiropractors will often use a combination of several approaches—a multimodal approach—to achieve the best possible outcomes with respect to pain and function. This includes manual therapies, specific exercises, physiotherapy modalities, nutritional recommendations, and more. In addition to treatments directed at the hip itself like those listed above, doctors of chiropractic will also assess the motion of the joints in the lower back, knees, and ankle as abnormal mechanics in these areas can put added stress on the hip and affect recovery. 

Pain Relief Chiropractic

4909 Louise Dr

Mechanicsburg, PA 17055

 (717) 697-1888

Member of Chiro-Trust.org 

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Difficultly in Carpal Tunnel Syndrome Management

20 Mar

Carpal tunnel syndrome (CTS) can be a complex condition that can be a challenge to manage for several reasons.

  • There can be multiple contributing causes. Seldom is CTS the result of one traumatic event, like a broken wrist that produces instant symptoms that requires emergency surgical treatment. Rather, the condition tends to develop over time as the result of an accumulation of microtraumas that affect the tissues in the carpal tunnel and place pressure on the median nerve and hamper its mobility. To complicate matters even more, conditions like hypothyroidism, pregnancy, obesity, and the use of birth control pills can also affect the function of the median nerve, either directly or indirectly through swelling/inflammation.
  • Median nerve entrapment elsewhere. The median nerve originates in the cervical spine and travels from the neck to the shoulder and down the arm. Compression anywhere along the path of the nerve can stimulate CTS-like symptoms. Additionally, entrapment of the median nerve elsewhere on its course can often co-occur with entrapment at the wrist.
  • It might not be carpal tunnel syndrome. While we commonly associate symptoms in the hand and fingers with CTS, there are two additional nerves—the radial and ulnar—that innervate other parts of the hand and fingers. Radial and ulnar nerve entrapment can also co-occur with CTS.
  • Work can be the cause. Occupational exposure to vibration, repetitive movements, infrequent breaks, and awkward wrist postures can each increase the risk for CTS. It may not be possible for the patient to change how they perform their work, which can make recovery difficult. 
  • Some factors can’t be controlled. Women are three times more likely to develop CTS than men, which is believed to be due to females having a narrower carpal tunnel and possibly hormonal differences compared with males. The risk for CTS also increases with age. 
  • Patients often wait too long. Because CTS symptoms come on gradually, it’s easy to ignore them, and a patient may not seek care until their symptoms become so bothersome or severe that they simply can’t maintain their usual activities. Unfortunately, the longer a patient waits, the longer it may take to achieve a satisfactory resolution. In some cases, a full resolution may not be possible or surgery may be the only viable option. 

The good news is that chiropractic care can be an effective intervention for managing CTS, especially if you seek care sooner rather than later. If necessary, your doctor of chiropractic will co-manage the case with an allied healthcare provider to give you the best possible chance at recovery.

Pain Relief Chiropractic

4909 Louise Dr

Mecanicsburg, PA 17055

 (717) 697-1888

Member of Chiro-Trust.org 

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