Neck-Specific Exercise for Headaches & Neck Pain

13 Jun

As screens (televisions, computers, and smartphones/tablets) become an increasingly important part of daily life, many people gradually take on a more slumped posture, which can place added strain on the neck and shoulders, raising the risk for neck pain and headaches. Luckily, it’s possible to improve forward head posture, rounded shoulder posture, and scapular instability with neck-specific exercises and chiropractic care.

In a 2018 study, patients with forward head posture performed either scapular stabilization or neck stabilization exercises for 30 minutes three times a week for four weeks. Participants in both groups experienced improvements related to their craniocervical angle and muscle activity around the upper back and neck, with greater results reported by the scapular stabilization group.

Several studies have shown similar results for improving forward head posture using both scapular and neck stabilization exercises. In another study, high schoolers with forward head posture performed scapular and neck stabilization exercises and exhibited good posture up to four months later.

A 2019 study looked at the effect of a six-week intervention featuring manual therapy and/or stabilizing exercises on 60 women with neck pain and forward head posture. Participants in both the manual therapy/stabilization exercise-combo group and the stabilization exercises-only group reported better outcomes with respect to head posture, pain reduction, and improved function, but the results were best in the combined treatment group. The authors concluded that manual therapy adds a meaningful role to a structured exercise program that addresses scapular and neck instability and forward head and rounded shoulder posture.

Doctors of chiropractic often incorporate exercise training in their treatment recommendations, especially when postural issues may contribute to the patient’s symptoms, like neck pain and headaches.

 

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.
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Dynamic Stretching for Hip Pain

10 Jun

As we grow older, stretching becomes a more important part of our routine, especially when hip pain is present. Whether you are about to engage in a sport, a job, weight lifting, or errands, it’s best to prepare your muscles for activity. With that said, stretching can be broken down into two main types: static (or passive) and dynamic (or active) stretching.

The available research notes that static stretching (stretching while holding one position, like reaching for your toes) has recovery benefits and is most effective at the end of a workout/competition. However, it can reduce performance when done beforehand, as it relaxes muscles, reduces blood flow and muscle strength, and decreases central nervous system (CNS) activity.

Active warm-ups or dynamic stretching have the opposite effect—they boost blood flow and activate the CNS, which enhances strength, power, and range of motion (ROM) resulting in BOTH immediate and long-term benefits. A 2014 systematic review of 31 studies reported that dynamic stretching that included sprints and plyometrics (movements against resistance) enhanced power and strength performance when compared to static stretching—which did not reduce strength. In a 2010 systematic review of 32 studies investigating active warm-up before engaging in a sport, researchers found that an active warm-up improved performance by 79% across all criteria investigated.

But what about the hip? A 2019 study compared static stretching vs. dynamic stretching of the hip joint with no-load (DSNL), with a light-load (DSLL, 0.25kg), and with a heavy-load (DSHL, 0.5kg) in an elderly population (63.2 ± 7.13 years). Participants stood sideways behind a chair (for balance), and swung one leg, as able. Researchers measured hip flexion and extension range of motion before the test, immediately after, and 60 minutes later. Compared to static stretches, all three types of dynamic stretches improved hip ROM more effectively at all time points, with DSNL being the most effective.

Here are a few hip-specific dynamic stretch options: 1) Standing Hip Circle: Stand on one leg, raise the opposite knee to 90º (thigh parallel to the floor); move the knee outward (open your hip), and make wide circles for 30 seconds/side or to fatigue (start gradually). 2) Lunge: Step forward with the right foot, lower the back knee toward the floor (as able); pause and repeat on the other leg. 3) Half Squat: From standing, slowly bend the knees until the thighs are parallel to the ground while bracing the core and maintaining a neutral low back curve.

 

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.

Factors That Can Hinder Carpal Tunnel Syndrome Recovery

6 Jun

As with most musculoskeletal conditions, treatment guidelines for carpal tunnel syndrome (CTS) recommend non-surgical or conservative management initially, with surgery only in emergency situations or after non-surgical options are exhausted. So, is there a way to know who will respond best to non-surgical approaches?

To answer this, researchers conducted a two-stage study that included an initial evaluation followed by non-surgical treatment and a re-evaluation one year after non-surgical treatment concluded. The primary goal of the study was to assess factors contributing to the long-term effects of non-surgical treatment of CTS and to identify failure risk factors.

The study involved 49 subjects diagnosed with CTS, of which an occupational cause was identified in 37 (76%). Because some patients had CTS in both hands (bilateral CTS), a total of 78 hands/wrists were included in the study. Treatment included a total of ten sessions of whirlpool massage to the wrist and hand, ultrasound, and median nerve glide exercises performed at home. The subjects were divided into three age groups: <50, 51-59, ≥60 years old.

While most patients experienced significant improvement in both stages of the study, some did not. Patients with more severe cases, as evidenced by poor results on a nerve conduction velocity (NCV) test, were less likely to respond to care, which underscores the importance of seeking care for CTS as soon as symptoms develop. Furthermore, participants who continued to overuse their hands at work or who did not modify their work procedures or workstation to reduce the forces applied on the hands and wrist were less likely to report significant improvements at the one-year point. Interestingly, age was not found to be a significant risk factor, which is surprising, as past studies have reported that being age over 50 is a risk factor.

Not only are doctors of chiropractic trained in the same non-surgical treatment methods used in this study, but they can combine such approaches with nutritional counseling (to reduce inflammation) and manual therapies to improve function in the wrist and other sites along the course of the median nerve to achieve the best possible results for their patients.

 

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.

Chiropractic Care During Pregnancy for Back and Pelvic Pain

3 Jun

Low back pain (LBP) and posterior pelvic pain (PPP) are very common complaints during pregnancy. In fact, current estimates show that two-thirds of expectant mothers will experience back pain during pregnancy and one in five will report pelvic pain. These afflictions can have a significant impact on a woman’s quality of life and her ability to carry out everyday tasks. So, where does chiropractic care fit into this picture?

While some pain conditions associated with pregnancy may be related to changes in certain hormones, there is evidence that the growing fetus shifts the center of gravity forward in a woman’s body. This shift can greatly affect the biomechanics of the body and place added strain on the lumbar and sacroiliac joints, giving rise to pain in those areas.

A landmark 2014 study looked at the effect of chiropractic treatment on 115 pregnant women with LBP/PPP. In a nutshell, 52% improved with respect to pain and disability after just one week of care, 70% after one month, 85% after three months, and 90% after six months.

Interestingly, the patients who had LBP/PPP prior to pregnancy tended to have higher pain scores at the conclusion of the study than those without a previous history of LBP/PPP. This finding supports the theory that women who have a history of LBP prior to pregnancy are particularly good candidates for chiropractic care early in their pregnancy. Also, due to a common link between persistent LBP after pregnancy and pre-pregnancy LBP, chiropractic care post-partum may be equally important.

This study included many chiropractors in various locations, and treatment was not standardized to any one specific method or technique. That being said, high-velocity, low-amplitude spinal manipulative therapy was the most common approach utilized and is the “standard of care” utilized by most chiropractors around the world. As further research is conducted, it seems clear that the use of SMT during pregnancy will become “the norm.”

 

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.

Deep, Slow Breathing for Pain Management?

27 May

Deep slow breathing (DSB) has been widely used for managing various diseases of the heart and lungs as well as for psychiatric disorders including anxiety, depression, and stress-related conditions. There appears to be some research to support DSB as being helpful for pain management, but the results have been inconsistent. However, a 2012 study suggests that how you “think” while practicing DSB may be the key for reducing pain…

In the study, researchers monitored sixteen healthy adults as they performed DSB while in both a relaxed and distracted state. In the relaxed state, participants were instructed to focus only on taking slow, deep breaths while in the distracted state, participants had to actively manage their deep breathing in pace with instructions on a computer screen. In order to reduce any carry-over effects, the active/distracted portions of the study were spaced six months apart and participants were advised to avoid practicing DSB or meditation or to seek any outside education on the topic.

Interestingly, in both circumstances, participants experienced similar reductions in negative feelings (tension, anger, and depression). However, the researchers only observed improvements with respect to pain thresholds, autonomic activity (skin conductance or sympathetic tone), and thermal detection for cold and hot stimuli when participants were relaxed.

Hence, it appears to be important that focused concentration on inhaling and exhaling or “thinking about” each breath in DSB and removing distracting thoughts is KEY to achieving increasing sympathetic arousal and improving mood processing. These findings may help to explain why mindful mediation, or mindfulness, benefits patients and why Eastern disciplines such as yoga, Qi-Gong, and Tai Chi are associated with reduced pain and improved mood.

Doctors of chiropractic often advise patients to reduce stress as part of management process for chronic pain conditions, with DSB being a great choice. This study shows that when done in a relaxed state, not only can patients experience mood-related benefits but they may also be able to reduce the effect of pain on their daily lives so they can perform their usual work and life activities.

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 Mid-Back Pain – How Can This Happen?

20 May

Research regarding whiplash or whiplash associated disorders (WAD) classically focuses on neck pain; however, the data show acute thoracic spine / mid-back pain (MBP) occurs in 66% of WAD injures with 23% still complaining of MBP at one-year post-injury.

It’s easy to visualize how the cervical spine or neck can be injured in an automobile collision (or sport-related collision or a fall) as the head, which weighs an average or twelve pounds, whips back and forth in a “crack-the-whip” like manner, often well beyond the normal, physiological range of motion. This same stretching (eccentric loading) followed by compression (concentric loading) also occurs in the mid-back, which can injure ligaments, joint capsules, neural structures, and more. Also, the thoracic spine contributes to 33% of flexion and 21% of rotation IN THE NECK, making the mid-back a vital spinal region that facilitates neck movement and function!

In WAD cases, mid-back pain often hides in the shadows of a more obvious and often more serious neck injury, as the brain typically perceives pain from the greatest source. Additionally, the neuronal input to the sensory cortex of the brain (the area of the brain that perceives pain) is most highly represented from the head, hands, and feet and less from the mid-back or torso.

The seat belt may also contribute to injury—both to the anterior chest region including rib cage, sternum, breast tissue, abdominal organs, as well as to the mid-back. The oblique angle of the chest-restraint is an important factor when discussing the mechanism of injury, as it causes trunk/torso rotation during the rebound or flexion phase of WAD. Another mechanism of injury includes blunt trauma, of which the driver is especially at risk due to the close proximity of the steering wheel and the chest. This can lead to contusion or bruising, fracture, and/or injury to the abdominal and/or chest organs (heart and lungs).

Obviously, the speed of impact, angle of the collision, bracing of the person (or lack thereof), and overall physical condition of the patient can greatly affect the outcome of WAD-related injuries. The importance of assessing the whole person is essential in obtaining an accurate diagnosis and establishing a comprehensive treatment plan for the WAD patient.

Chiropractic management focuses on the entire person, frequently uncovering complaints in other spinal regions as well as in the extremities in WAD-related injured patients. Moreover, treating postural issues such as a short leg, ankle pronation, oblique pelvis, forward head posture, protracted shoulders, and more is vitally important in obtaining satisfying patient outcomes!

 

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.