Manual Therapy for Neck Pain

14 Dec

Doctors of chiropractic often approach neck pain with manual therapy as the primary form of treatment. However, there are several types of manual therapy, including high velocity, low amplitude (HVLA) thrust manipulation; mobilization; and/or soft tissue techniques. Is one type of manual therapy superior when it comes to managing neck pain? What does the research show? A 2017 systematic review of 23 randomized controlled trials compared various manual therapy techniques on their own (or combined), with or without the addition of specific exercise recommendations.

For acute (recent onset) to sub-acute neck pain, the review concluded:

  • High-velocity, low-amplitude thrust manipulation combined with exercise resulted in better outcomes when treatment was applied to the cervical vs. the thoracic spine.
  • High-velocity, low-amplitude thrust manipulation combined with soft tissue techniques and exercise applied to both the neck and mid-back led to better outcomes than when soft tissue techniques plus exercise only targeted the neck.

For chronic neck pain, the data show:

  • Both HVLA thrust manipulation and soft tissue techniques in addition to exercise are more effective than either manual therapy or exercise alone for improving pain and function.
  • Thrust manipulation applied to the neck and mid-back was more effective for improving neck mobility than mobilization.
  • Mobilization and soft tissue techniques are both more effective than no treatment for improving pain and disability.

This systematic review favors all types of manual therapies for the management of all stages of neck pain (acute, sub-acute, chronic), especially when combined with exercise. The data also suggests the incorporating treatment of the mid-back may lead to better outcomes.

While manual therapies in general can benefit the neck pain patient, the approach a doctor of chiropractic takes will depend on the patient’s unique case (based on patient history and exam findings) and preferences. For example, a patient may prefer a gentle, low force technique or their chiropractor may use a combination of manual therapy techniques. Additionally, care may also include nutritional/dietary recommendations or physical modalities.

This information should not be substituted for medical or chiropractic advice. Any and all healthcare concerns, decisions, and actions must be done through the advice and counsel of a healthcare professional who is familiar with your updated medical history.

Managing Chronic Hamstring Strains

10 Dec

Chronic hamstring strains are more difficult to diagnose because the pain (in the hip region and deep in the buttocks and upper thigh) comes on gradually and is aggravated by repetitive activities like running, rowing, or biking and worsens with prolonged sitting. Hamstring injuries become chronic when a damaged or torn tendon fails to properly heal, often caused by returning to the sport too quickly and/or from mismanagement. Chronic tendonitis can lead to degenerative changes resulting in a weaker tendon, which can lead to long-term pain and disability.

Non-surgical care for chronic high hamstring tendinopathy is often challenging because the usual treatment approaches for acute hamstring strains are less responsive. It’s not unusual for a prolonged recovery of three to six months, with many only partially recovering with a high recurrence rate. Treatment may include:

  1. Rest (time away from a sport), though cross training of a different body region during this time can combat the psychological stress associated with chronic injuries.
  2. Ice and heat (ice packs, baths, and ice massage is initially recommended to reduce pain and inflammation) applied for ten to twenty minutes, every two to four hours each day. Contrast therapy includes alternating between ice and heat to create a “pump” as heat vasodialates blood vesicles and draws in fluids, which loosens fibrotic scar tissue and relaxes muscles, while ice vasoconstricts and pushes out fluid (inflammation).
  3. Because lack of flexibility is “the norm” for chronic high hamstring tendinopathy, regular stretching will be necessary for recovery. Stretches can include lying on the back, pulling the bent knee toward the chest, and slowly straightening the knee; the popular “hurdler” stretch, or sitting with one leg straight on a bench or ground and slowly trying to lock the knee straight while reaching for the toes; or from standing, placing the heel on a chair seat followed by an anterior pelvic tilt (arch the low back by tilting the buttocks upwards).
  4. A mix of concentric (resistance as the muscle shortens, such as bringing the heel toward the buttocks) and eccentric (resistance during the opposite of concentric or the straightening of the knee during a hamstring curl) strengthening exercises will typically benefit patients with chronic high hamstring tendinopathy.

Your doctor of chiropractic can guide you in the treatment process as well as address musculoskeletal issues, such as low back pain, that may have preceded the hamstring injury. As is typical with musculoskeletal injuries, the sooner a patient seeks care, the more likely they will achieve a satisfactory treatment outcome.

This information should not be substituted for medical or chiropractic advice. Any and all healthcare concerns, decisions, and actions must be done through the advice and counsel of a healthcare professional who is familiar with your updated medical history.

Tools for Managing Carpal Tunnel Syndrome

7 Dec

In addition to manual therapies and specific exercises to relieve pressure along the course of the median nerve as it passes through the wrist and elsewhere, doctors of chiropractic may utilize other high- and low-tech tools to manage the condition:

  • Electric stimulation (e-stim) directs an electric current via electrodes placed on the skin over or near the painful area to either stimulate healing (higher frequencies) or reduce pain (lower frequency).
  • Pulsed electromagnetic field (PEMF) uses an electromagnetic field to reduce pain, lower inflammation and muscle spasm, stimulate healing, and facilitate nerve and circulatory function. (Note: This cannot be used in a patient with a pacemaker.)
  • Ultrasound uses sound waves that travel at 1-3 million cycles per second to cause cells to vibrate and produce heat leading to an increase in circulation and the stimulation of nerve cells to aid in the healing process. There is no sensation because the speed of the sound waves is far too fast.
  • Low level laser therapy (LLLT) uses a specific wavelength of light that penetrates the skin to produce therapeutic effects. The term photobiomodulation is often used to describe its beneficial effects—including accelerated tissue repair—and to reduced pain and inflammation. These devices use less than 0.5 watts and are classified as a class IIIb laser, while those this more than 0.5 watts are class IV lasers, which penetrate deeper.
  • Dietary modifications and supplement guidance may be offered since consuming foods/vitamins that reduce inflammation may aid in the healing process (Mediterranean diet, ginger, turmeric, Boswellia, etc.).
  • Ice reduces inflammation and is beneficial in the acute stages of CTS. This is most effectively applied by directly massaging the wrist/carpal tunnel with an ice cube. Heat may help in the chronic, less inflamed stages of CTS. Rub- or roll-on analgesics may offer short-term pain-reducing benefits.

How your doctor of chiropractic approaches your care will depend on your patient history and examination/diagnostic findings as well as their clinical experience. The good news is the conservative treatment approaches used by chiropractors are often very effective, but if necessary, your doctor of chiropractic can co-manage your condition with other healthcare providers.

This information should not be substituted for medical or chiropractic advice. Any and all healthcare concerns, decisions, and actions must be done through the advice and counsel of a healthcare professional who is familiar with your updated medical history.

The Lower Back, Leg Pain, and Sciatica

3 Dec

The roots of the sciatic nerve exit the spine through several levels in the lower back, join in the buttock region, and travel down into the lower extremities. When pressure is applied to the sciatic nerve in the lower back area, it can generate pain and other sensations down the nerve into one of the legs—a condition we commonly refer to as sciatica.

In younger and middle-aged adults, the most common cause of sciatica is a herniated disk in the lower back in one or more locations. Because of the structure of the sciatic nerve, the characteristics of the patient’s symptoms can direct their doctor of chiropractic on where to look for potential causes in the lower back:

  • S1-2 Level (S1 nerve root): outer foot numb, difficulty walking on toes, weak Achilles tendon reflex
  • L5-S1 Disk (L5 nerve root): inner foot numb, weak big toe and heel walking, no reflex changes
  • L4-5 Disk (L4 nerve root): shin numb, weak heel walking, patellar tendon reflex loss
  • L3-4 Disk (L3 nerve root): medial knee numb, weak walking up steps, weak patellar tendon reflex
  • L2-3 Disk (L2 nerve root): front of thigh pain/numb, weak walking up steps, positive patellar reflex
  • L1-2 Disk (L1 nerve root): groin pain/numb, weak squat and steps, no deep tendon reflex
  • T12-L1 Disk (T12 nerve root): buttock numb, weak lower abdominal muscles, possible spinal cord compression

In sciatica patients under 55 years of age, the two lowest disks in the lower back—the L4-5 and L5-S1—are the culprit 95% of the time. The good news is that a systemic review of 49 published studies found that spinal manipulative therapy, the primary form of care provided by doctors of chiropractic, is an effective non-surgical treatment option for relieve local and radiating pain in patients with a herniated disk in the lower back.

Even though sciatic pain is often initially sharp and severe, most cases can by successfully managed non-surgically within three to six weeks; however, a referral to a specialist or a referral for advanced imaging (such as an MRI) may be necessary to identify additional pain sources if the patient’s pain persists. Surgery is usually restricted to those who have neurological loss and/or bowel or bladder control problems (the latter may become emergent in order to avoid permanency). As with many musculoskeletal conditions, the sooner one seeks care in the course of the disease, the more likely (and the faster) they will achieve a successful treatment outcome.

This information should not be substituted for medical or chiropractic advice. Any and all healthcare concerns, decisions, and actions must be done through the advice and counsel of a healthcare professional who is familiar with your updated medical history.

Health Optimization Strategies

23 Nov

Though some element of our overall wellbeing is defined by our genetics, there is a  lot you can do to live a long and healthy life. Here’s a short list:

  • Get enough sleep. While the average adult needs only seven to nine hours of sleep a night to feel rested, younger age groups usually require much more: infants (0-3 months): 14-17 hours/day; 4-11 months: 12-15 hours/day; toddlers: (1-2 years old) 11-14 hours/day; pre-school (3-5 years old): 10-13 hours/day; school age (6-13 years old): 9-11 hours/day; and teenagers (14-17 years old): 8-10 hours/day. An expectant mother may need additional sleep, especially early in the pregnancy.
  • Exercise at moderate intensity for at least 30 minutes a day (brisk walk, bike ride, jog, yoga, tai chi, etc.). Federal guidelines also recommend strength training the major muscle groups twice a week.
  • Avoid added sugars, sugary drinks, and processed foods. Eat more whole grains, fruits, and vegetables. Not only will it help you maintain a healthier body weight, but you’ll also improve the make-up of your gut microbiota, which can bolster your immune system.
  • Consider supplementation if your diet is deficient in important vitamins and minerals. For example, a 2017 study published in the journal Nutrients reported that vitamin C can enhance the production of B- and T-cells, which are related to the body’s ability to fight off infections. Moreover, the study noted that vitamin C deficiency is associated with impaired immunity resulting in higher susceptibility to infection.
  • When (not if) stress hits, take five slow, deep breaths (in your nose and out of your mouth). Consider mindful meditation or schedule relaxing activities into your day.
  • Engage in social networks (senior centers, church, and book clubs or go to plays, music events, and art galleries with a friend), preferably in person but virtually (phone or video chat) if that’s not feasible.
  • Laughing reduces stress hormones, boosts white blood cells, and keeps you healthy.
  • Wash your hands with soap and water regularly, use hand sanitizer regularly (if it’s not possible to wash your hands), don’t touch your eyes, nose, and mouth; cover your mouth with your arm when you sneeze, and stay home when you’re ill.
  • Spend time in the sun or take a vitamin D supplement. Studies show that individuals with poor vitamin D status may be at an increased risk for upper respiratory infection and impaired immune response.

Of course, if you experience musculoskeletal pain, like neck or back pain, schedule an appointment with your doctor of chiropractic. Typically, the sooner you seek care, the faster you’ll be able to return to your daily activities without pain.

This information should not be substituted for medical or chiropractic advice. Any and all healthcare concerns, decisions, and actions must be done through the advice and counsel of a healthcare professional who is familiar with your updated medical history.

Whiplash and Weakened Neck Muscles

19 Nov

The whiplash process can lead to a number of concurrent symptoms (neck pain, headaches, limited cervical range of motion, etc.) referred to as whiplash associated disorders, or WAD. It’s estimated that about one in five WAD patients will also develop potentially chronic, concussion-like symptoms like brain fog, difficulty concentrating, and other cognitive impairments. A 2020 study shed light on a way to help identify such patients early on so targeted treatment could help keep their WAD from becoming chronic and persistent.

In the study, researchers used resting-state-fMRI (rs-fMRI) to image 23 patients with chronic WAD and compared their findings with assessments used to objectively measure neck disability, traumatic distress, depression, and pain. The research team identified an association between fat infiltration into the cervical muscles and abnormalities in the brain network structure associated with WAD-related neuropsychological issues. That is, the patients with more fatty tissue in their neck muscles were also those with more signs of brain injury or altered brain function.

When deep muscles and associated soft tissue in the neck are injured in a whiplash event, the body may recruit superficial muscles to help stabilize the body and maintain posture. While this can protect the deep muscles from further injury in the short term, it can decondition these muscles over time and allow fatty deposits to infiltrate its tissue.

In another study that followed 141 WAD patients and 40 non-injured subjects for one year, researchers observed that the WAD patients demonstrated a loss in neck muscle strength throughout the year, even if their neck pain resolved and their cervical range of motion returned to normal. Additionally, the patients who had not recovered enough to return to work after a year had an average of 50% loss of strength in their neck muscles.

The findings of these studies suggest that when the whiplash process is forceful enough to  injure the soft tissues of the neck in a manner that leads to abnormal muscle activity that allows important muscles to weaken and for fatty deposits to develop, then the same event can also lead to a potential brain injury, with resulting cognitive symptoms. If so, then identifying WAD patients with cervical muscle weakness early may help doctors uncover which patients may need more substantive care to reduce their risk for ongoing WAD issues. 

Several treatment guidelines indicate that chiropractic care is a great first-choice treatment option for the WAD patient, which may involve a multimodal approach to restore motion in the affected joints and strength in the deep and superficial cervical muscles.

This information should not be substituted for medical or chiropractic advice. Any and all healthcare concerns, decisions, and actions must be done through the advice and counsel of a healthcare professional who is familiar with your updated medical history.