Is There a Difference Between Whiplash and Non-Whiplash Neck Pain?

22 Apr

When we hear the term “whiplash injury,” we likely think of car crashes, though whiplash can result from other causes, like a fall or sports collision. Though whiplash is associated with a variety of symptoms, neck pain with lower pain thresholds (called central sensitization) is one of the most common. Neck pain can also occur in the absence of trauma or a known pathology. This is called mechanical neck pain (MNP).

Past research has shown that the combination of manual therapies (including mobilization and manipulation) and neck-specific exercises can benefit patients with neck pain, but is there a different treatment response between whiplash patients and MNP patients?

A 2017 study evaluated this very question. The authors recruited 28 patients with either grade I or II whiplash (pain with or without exam findings but no neurological losses) and 22 MNP patients. The patients in the MNP group were only included if their symptoms could be provoked by changes in cervical posture, neck movement, and palpation of certain neck muscles. The research team measured neck pain intensity, neck-related disability, pain area, cervical range of motion, and pressure pain thresholds (the amount of pressure measured to induce pain using a spring-loaded pressure gauge) both initially at baseline and again after six treatment sessions.

The results showed that whiplash sufferers initially had significantly higher pain-related disability, larger pain area, and central sensitization. In spite of this, the investigators observed that after six treatments, the patients in both groups achieved similar improvements with respect to cervical range of motion (flexion/extension, left/right side bending, and rotation), neck pain intensity, neck pain-related disability, pain area, and pressure point thresholds. However, the whiplash patients continued to experience a lower pain threshold than participants in the MNP group.

The good news for whiplash patients is that another 2017 study demonstrated that treating painful myofascial trigger points can help restore pain thresholds. Doctors of chiropractic frequently utilize the two treatment approaches from this study—manual therapy and specific neck exercises—in addition to other management approaches to achieve successful outcomes for patients with neck pain, either whiplash or MNP.

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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Let’s Have Some “Pillow Talk!”

18 Apr

Individuals with neck pain may find it difficult for get a night of restful, restorative sleep due to pain keeping them awake or interrupting their slumber. Not only can a restless night make it more difficult to complete tasks related to everyday living or make neck pain worse, but poor sleep habits over time can raise one’s risk for chronic disease and even early death—perhaps as much as physical inactivity or a bad diet. When treating a patient with neck pain, doctors of chiropractic often inquire about the patient’s sleeping position and pillow, as addressing these factors may be important for getting a good night’s rest.

When it comes to a “good” position for the head while sleeping, most experts would recommend assuming a position that most closely mimics a good upright posture. If lying on the back, the head should not be forced toward the chest (hyper-flexed) or dropped too far backward into hyper-extension. When lying on the side, the head should not be forced upward or downward, away from the neutral position. If you habitually sleep on your stomach—which is generally NOT a good position for the neck due to the prolonged static rotation—you may want to consider a very thin pillow (or not using a pillow) to not force the neck too far up or down when rotated. Placing a body-pillow between the knees that extends up in front of the pelvis and chest can function as a “kick-stand” to keep you from rolling onto your stomach during the night.

What about pillow materials?  There are many to choose from, such as feathers, foam (memory and others), water, buckwheat, and/or combinations of these. While there is probably not a “best” choice, there are characteristic differences that are worth discussing. For example, memory foam molds nicely to the contours of the head and neck but can be hot and may have an unpleasant odor. Latex foam has the advantage of molding well to contours without becoming hot and comes in various densities to suit preferences, which can be quite helpful for those with neck pain and headaches. Generally, higher density foam offers less breakdown and more support. Latex is also resistant to mold and dust mites, another distinct advantage. Feathers and down pillows can mold to fit the body contours nicely but have a tendency to lose that initial position as the feathers often spread out while sleeping. Some people are also bothered by allergies or skin sensitivities making feather pillows and certain types of foam undesirable. Buckwheat hulls tend to mold well and be cool but then can be noisy when moving. Mattress firmness should also be taken into consideration, as the amount of “sinking in” will affect the pillow thickness decision.

If musculoskeletal pain is interfering with your sleep, consult with your doctor of chiropractic to help determine the best position and pillow for your individual case. Your chiropractor may also offer nutritional recommendations with the aim of improving sleep quality.

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.

What Is Patellofemoral Pain?

15 Apr

While chiropractic care commonly focuses on improving function in the spine to reduce neck pain and back pain, in many cases achieving a successful outcome is only possible when treatment addresses conditions elsewhere in the body. For example, ANY painful condition of the knee can alter one’s gait pattern, which can result in abnormal movement in the ankle, pelvis, and lower back, potentially leading to musculoskeletal pain in those areas as well. In this article, we’ll focus on patellofemoral (PF) pain, or pain that arises in the region of the knee cap, as it’s one of the more common knee conditions.

The anatomy in and around the patella is unique in several ways. First, the patella is the largest “sesamoid” (free-floating) bone of the body. The role of all sesamoid bones is to improve the function of the muscle/tendon connecting to the sesamoid bone by optimizing the angle of action. In effect, it acts like a pulley, which significantly improves the strength and force of the muscle. The quadriceps muscles attach above at the pelvis and below at the upper pole of the patella. The patella then glides in a grove, or track, located in the distal femur (thigh bone) and a tendon then attaches the lower pole of the patella to a bony prominence located just below the knee on the proximal tibia, or upper “shin bone.”

When we flex and extend our knee, the patella slides up and down in the track as the quadriceps contract and relax. This occurs automatically when walking, running, climbing, etc. Of the four muscles that make up the quadriceps, three (rectus femoris, vastus lateralis, and vastus intermedius) pull the patella up and out when we extend or straighten the knee and only one (vastus medialis) pulls the kneecap up and inward. To compensate for this disadvantage, the vastus medialis normally fires first during knee extension, which allows for proper patellar tracking and normal function.

A 2018 study published in the Archives of Medicine and Rehabilitation looked at the “neural drive” of the four quadriceps muscles in 56 women with or without PF pain. Subjects were asked to sustain an isometric, or static knee, extension contraction at 10% of their maximum effort for 70 seconds. Specialized nerve testing tools measured the average firing rates at various time points during muscle contraction.  In the non-PF pain subjects, the vastus medialis fired at higher rates vs. the largest muscle (the vastus lateralis) that pulls the patella up and out. This was the opposite case in the women with PF pain, which investigators suspect may cause and/or perpetuate PF pain.

This finding has led to the recommendation of isolating the vastus medialis with a specific strengthening exercise. This is accomplished by emphasizing the last ten degrees of full knee extension by completely locking or straightening out the knee in extension followed by only a slight bend. This is repeated 10-20 times with or without weight, depending on the degree of injury, pain, and muscle weakness. Your doctor of chiropractic can help train you in performing this exercise properly, as well as offer other highly effective exercises and treatments for knee 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.

How Does Wrist Position Affect the Carpal Tunnel?

11 Apr

Carpal tunnel syndrome (CTS) is the most common “peripheral neuropathy” (pinched nerves in the arms or legs) and is known to be caused by prolonged repetitive, forceful grip-related tasks involving the hands. The condition occurs when pressure is placed on the median nerve as it passes through the carpal tunnel, either from inflammation, mechanical injury, or both.

The position of the wrist and hand are very important, as the pressure inside a healthy wrist “normally” doubles when we bend the wrist/hand. However, when CTS is present, the pressure doesn’t double at the extreme end-ranges of motion. Rather, when inflammation is present, pressure can increase up to six times at the end-ranges of motion! This can be highly problematic at night because we don’t have much control over how we position our wrist. Not only can increased pressure on the median nerve cause you to wake up but it can set the stage for worsening symptoms in both the short and long term. This is why doctors often advise CTS patients to wear a night splint and to avoid prolonged awkward wrist positions during the day when working.

In a 2014 study involving 31 healthy college students, researchers used ultrasonography to measure median nerve deformation as participants bent their wrists and performed finger movement-intensive movements. Investigators observed that the median nerve flattened out with as little as 30º of wrist extension and became swollen after students performed rapid mobile-phone keying for five minutes with a corresponding increase in the cross-sectional area of the carpal tunnel. In a follow-up experiment, the research team found that the motion involved with clicking a mouse repeatedly had an even greater effect on the median nerve. The authors concluded that the increased use of electronic devices, especially in non-neutral wrist positions, increases the risk of CTS.

A literature review performed in the same year came to a similar conclusion: prolonged exposure to non-neutral wrist postures increased CTS risk by at least twofold.

In order to reduce pressure on the median nerve, doctors of chiropractic often use a combination of wrist splinting, patient education (including tool/workstation modifications), nutritional recommendations, and manual therapies. In many cases, this can lead to a successful outcome without the need for more invasive treatments. However, when necessary, your chiropractor can refer you to the appropriate provider and/or co-manage the condition with them.

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.

How Does Chiropractic Stack Up for Low Back Pain?

8 Apr

Doctors of chiropractic offer a non-surgical, treatment protocol for both acute and chronic low back pain (LBP), as do several other healthcare delivery systems. However, due to patient preference and a rising concern for potentially harmful side-effects, many LBP patients seek management strategies that offer a natural, non-pharmaceutical approach, of which chiropractic is the most commonly sought after practitioner-type. So what evidence is there regarding the benefits of chiropractic vs. other forms of care in managing LBP and its associated pain-related functional loss?

A 2018 study published in the online Journal of the American Medical Association focused directly on this question by comparing patient outcomes of those receiving usual medical care to a second group of patients that also received chiropractic care.

Data was collected at three sites—two large military medical centers and one smaller hospital at a military training site—over the 3.5-year time period. Eligible participants included active duty United States service members between 18 and 50 years in age who were diagnosed with mechanical low back pain.

Patients in each group received usual medical care for six weeks that included self-care, medications, physical therapy, and pain clinic referral. Participants in one group also received chiropractic care that included spinal manipulative therapy in the low back and adjacent regions and additional therapeutic procedures such as rehabilitative exercise, cryotherapy, superficial heat, and other manual therapies.

Up to six weeks after the conclusion of care, the researchers reported that patients in the  chiropractic group scored higher with respect to LBP intensity, disability, perceived improvement, satisfaction, and medication use. The researchers concluded that this trial clearly shows the need for chiropractic care for those suffering from LBP—reminding the reader that current LBP guidelines have embraced chiropractic care as a FIRST line of treatment for LBP.

This is not the first study to show the benefits of chiropractic care, as prior high-quality studies have reported higher patient satisfaction levels, less medication use, higher quality of life scores, and less LBP-related disability and recurrence rates for patients receiving chiropractic treatment vs. usual medical care. This article was published in a highly regarded medical journal (JAMA) and CLEARLY supports the need for chiropractic care in the management of LBP.

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.

Can Brain Exercises Help Those with ADHD?

25 Mar

For many individuals—especially those with attention-deficit/hyperactivity disorder (ADHD) and attention-deficit disorder (ADD)—staying “on task” can be a challenge. Though medications are commonly used as a first line treatment for these conditions, research has shown the benefits may only last for a few years. University of California, Irvine scientist Dr. James M. Swanson even reports that pharmacological interventions for ADHD offer no lasting, long-term benefits. Because of this, researchers have been on the lookout for non-drug treatments to improve mindfulness, and it appears meditation may be one useful approach.

Mindful meditation is the process of sitting silently and focusing on your breathing. If you notice your attention starting to wander, return your focus to your breath. Not only will this help you relax but this practice may improve the connections in the brain circuitry that are responsible for maintaining focus. Dr. Swanson notes that individuals with ADHD/ADD appear to have reduced activity in this area of the brain.

In one study that included 50 adults with ADD, researchers observed that those who participated in mindfulness-based cognitive therapy (MBCT) achieved comparable results to standard medications for ADHD/ADD with respect to motivation and inhibitory regulation.

In a 2017 study involving 82 patients with anxiety, researchers found that just ten minutes of mindful meditation helped participants stay better focused on their daily tasks. Researcher Dr. Mengran Xu adds, “Our results indicate that mindfulness training may have protective effects on mind wandering for anxious individuals.”

Mindfulness can also reduce anxiety and depression symptoms, which can also benefit individuals with ADHD/ADD, as the conditions can often co-exist. In one study, researchers found that engaging in one hour of mindful meditation not only reduced anxiety symptoms but also reduced stress and improved arterial function. Doctors of chiropractic often include meditation concepts as part of their treatment recommendations, especially in the promotion of prevention and wellness.

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.