The Neck and Tinnitus Relationship

18 Jan

Experts estimate that approximately 10% of the adult population in the United States experienced an episode of tinnitus—the perception of sound or noise without any external auditory stimulus being present—within the last year. Tinnitus can be caused by wax buildup in the ear, medication side effect, noise-induced hearing lost, ear and sinus infections, cardiovascular disease, Meniere’s disease, brain tumors, hormonal changes in women, and thyroid disorders. One cause that gets less attention is dysfunction in the cervical spine.

While the prevalence of cervicogenic tinnitus—tinnitus that originates from the neck—is unknown, a 2015 study that evaluated 87 chronic tinnitus patients found that nearly half (47%) tested positive for cervicogenic tinnitus. Thus, individuals with ongoing tinnitus symptoms may benefit from receiving a thorough examination of their cervical spine by a doctor of chiropractic.

A 2020 case report detailed the experience of a 67-year-old female patient with a five-year history of left-sided chronic tinnitus, neck pain, and headache. Her treatment plan included exercises that emphasized the direction(s) that produced symptom relief and postural correction. Not only did the patient report significant improvements in her symptoms following her course of care, but she continued to experience relief at a follow-up appointment six months later.

This case study exemplifies the significant short- and long-term benefits that focused, tailored self-exercise (that the patient can perform at home) can have in improving chronic cervicogenic tinnitus. Chiropractic management centers on three common goals: pain management, posture improvement, and prevention. Many studies support significant short-term benefits that can be achieved with manual therapies, particularly spinal manipulation. Patients can achieve and sustain long-term benefits with exercise training when it’s specifically tailored to 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.

Baker’s Cyst and Knee Pain

14 Jan

A Baker’s cyst is a swelling located in the back of the knee that can be either asymptomatic or bothersome, especially when bending the knee. Researchers estimate that up to 94% of popliteal (back of the knee) cysts are associated with an intra-articular disorder, most commonly meniscus (“cartilage”) tears, as well as osteoarthritis, inflammatory arthritis (like rheumatoid), and ACL tears.

In about 50% of healthy adult knees, there is a valvular opening located high on the inside of the knee joint that connects the joint capsule to a bursa (a fluid filled sac that functions to lubricate muscle attachments). It is thought that when there is an effusion or swelling inside the knee joint, the excess fluid flows one way to the inner knee joint bursa (called “pes anserine bursitis), which reduces pressure from inside the joint. Although there are other causes of popliteal cysts, this is the most common.

So, what can chiropractors do for the patient with a Baker’s cyst?  Chiropractic management includes both passive and active care approaches that focus on the knee joint and surrounding soft tissues to help reduce pain and swelling and improving function, as well as home exercise instruction to maintain the health of the knee joint. Such exercise recommendations can include the following:

  1. Standing calf stretch: stand upright grasping a chair or wall for balance; step back with the involved leg and flatten the heel to the floor with toes pointing as straight as comfortably possible; slowly straighten the bent knee until you feel a firm stretch behind your knee; hold for five to ten seconds and repeat five to ten times or until the muscle feels less tight; repeat on the opposite leg.
  2. Heel lift: sit with your feet flat on the floor with your knees bent 90°, lift one heel keeping the ball of the foot on the floor; push down on the knee and slowly lower the heel to its starting position; repeat ten times as tolerated and switch sides, gradually increasing reps and sets, as tolerated.
  3. Sitting hamstring stretch: sit on the ground with one leg straight out, keeping the heel on the floor; bend the ankle and bring your toes toward you; arch your low back until you feel a strong stretch in the back of the thigh and knee; lean forward as tolerated for a greater stretch; repeat five to ten times with  a three to five second hold, as tolerated.
  4. Heel Slides: lie on your back, legs straight; slowly bend one knee while sliding the heel toward your buttocks; repeat five to ten times, as tolerated, and repeat on the opposite side.
  5. Wall squats: stand with your back against a wall and slide down slowly, keeping the toes well in front of the knees; only squat down as far as you can; repeat five to ten times, as tolerated.
  6. Side-steps: place a loop or resistance band around your ankles; partially bend the knees; step sideways, alternating between the left and right foot, stepping wide enough to always keep tension on the band.

Your doctor of chiropractic can train you in these exercises and provide care to address any musculoskeletal issues that may contribute to your knee pain.

A Baker’s cyst is a swelling located in the back of the knee that can be either asymptomatic or bothersome, especially when bending the knee. Researchers estimate that up to 94% of popliteal (back of the knee) cysts are associated with an intra-articular disorder, most commonly meniscus (“cartilage”) tears, as well as osteoarthritis, inflammatory arthritis (like rheumatoid), and ACL tears.

In about 50% of healthy adult knees, there is a valvular opening located high on the inside of the knee joint that connects the joint capsule to a bursa (a fluid filled sac that functions to lubricate muscle attachments). It is thought that when there is an effusion or swelling inside the knee joint, the excess fluid flows one way to the inner knee joint bursa (called “pes anserine bursitis), which reduces pressure from inside the joint. Although there are other causes of popliteal cysts, this is the most common.

So, what can chiropractors do for the patient with a Baker’s cyst?  Chiropractic management includes both passive and active care approaches that focus on the knee joint and surrounding soft tissues to help reduce pain and swelling and improving function, as well as home exercise instruction to maintain the health of the knee joint. Such exercise recommendations can include the following:

  1. Standing calf stretch: stand upright grasping a chair or wall for balance; step back with the involved leg and flatten the heel to the floor with toes pointing as straight as comfortably possible; slowly straighten the bent knee until you feel a firm stretch behind your knee; hold for five to ten seconds and repeat five to ten times or until the muscle feels less tight; repeat on the opposite leg.
  2. Heel lift: sit with your feet flat on the floor with your knees bent 90°, lift one heel keeping the ball of the foot on the floor; push down on the knee and slowly lower the heel to its starting position; repeat ten times as tolerated and switch sides, gradually increasing reps and sets, as tolerated.
  3. Sitting hamstring stretch: sit on the ground with one leg straight out, keeping the heel on the floor; bend the ankle and bring your toes toward you; arch your low back until you feel a strong stretch in the back of the thigh and knee; lean forward as tolerated for a greater stretch; repeat five to ten times with  a three to five second hold, as tolerated.
  4. Heel Slides: lie on your back, legs straight; slowly bend one knee while sliding the heel toward your buttocks; repeat five to ten times, as tolerated, and repeat on the opposite side.
  5. Wall squats: stand with your back against a wall and slide down slowly, keeping the toes well in front of the knees; only squat down as far as you can; repeat five to ten times, as tolerated.
  6. Side-steps: place a loop or resistance band around your ankles; partially bend the knees; step sideways, alternating between the left and right foot, stepping wide enough to always keep tension on the band.

Your doctor of chiropractic can train you in these exercises and provide care to address any musculoskeletal issues that may contribute to your 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.

Chiropractic Care for Chronic Carpal Tunnel Syndrome

11 Jan

Because the early symptoms of carpal tunnel syndrome (CTS) can be mild and tolerable, many patients put off seeing a doctor until the pain, numbness, tingling, and weakness in their wrist and hand is no longer bearable. The current research supports chiropractic care as an excellent non-surgical option for new-onset CTS, but what about patients with chronic CTS?

In a case series study of 18 women with chronic CTS (defined as CTS lasting more than six months), researchers looked at the potential benefits of soft tissue mobilization combined with nerve slider neurodynamic technique on pain and pressure sensitivity at various points along the course of the median nerve from the cervical spine into the hand before, immediately after, and one week following just a single treatment.

The treatment session consisted of a 30-minutes of soft tissue techniques (including soft tissue mobilization, nerve slider neuromobilization, myofascial release, stretching, and cross-fiber friction over the muscular interfaces through which the median nerve travels) at four locations: the front/side of the neck (anterior scalene muscles), the distal to middle anterior upper arm (biceps brachii), the proximal palm-side forearm (pronator teres), and stretching the transverse carpal ligament and soft tissues on the palm-side of the hand. The patients reported a reduction in pain following treatment that persisted for up to one week following just one treatment.

Another study looked at the long-term effects from manual therapies on patients with chronic CTS. In this study, patients received two treatments a week for three weeks. Not only did the patients report improvement in their CTS symptoms following the conclusion of care, but these benefits persisted when researchers followed-up with participants six months later.

Manual therapies are a primary treatment approach utilized by chiropractors for both acute and chronic CTS, along with many standard management strategies such as night splints, physical modalities, and specific home-based exercise recommendations. This multi-modal approach places chiropractic at the top of the list as the ideal choice for the CTS patient!

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.

Cauda Equina Syndrome

7 Jan

The cauda equina (Latin for “horse’s tail”) is made up of many nerves that travel down and exit out the sides of the lumbar spine and sacrum (tail bone) and transfer information (motor and sensory) to and from our legs and brain.

If the cauda equina becomes compressed, the resulting cauda equina syndrome (CES) is characterized by symptoms such as severe low back pain (LBP); numbness and weakness in the legs, buttocks, and perineum (pelvic floor region); weakness of bowel and/or bladder control causing incontinence; and sexual dysfunction.

Potential causes for CES include a severe herniated disk in the lumbar spine (most common cause); narrowing of the spinal canal (called spinal stenosis); a lesion or tumor that applies pressure on the cauda equina; an infection, fracture, or trauma (such as a car crash); or a birth defect.

Cauda equina syndrome is typically diagnosed in the following ways: 1) the patient’s history—often of acute LBP with radiating leg symptoms; 2) a neurological exam to assess sensation, strength, gait, and reflexes; and 3) advanced imaging, such as an MRI or CT scan, of the lower back.

If CES has a fast onset, the patient should seek emergency care. Surgery may be required to avoid permanent sexual dysfunction, loss of bowel and/or bladder control, and in some cases, paralysis of the legs.

If the onset of CES is gradual, then a non-surgical approach such as chiropractic care may be appropriate. Doctors of chiropractic are trained to identify and diagnose CES, but chiropractors usually see these patients long after the initial symptoms since most patients go directly to the ER due to their severity. However, a team of healthcare providers comprising of chiropractors, primary care physicians, physical therapists, occupational therapists, social workers, and/or mental health counselors can manage LBP and other residual problems associated with CES. As with all conditions that result in permanent impairment, those afflicted often need to manage symptoms to obtain an optimum quality of life that chiropractic care can greatly facilitate.

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.

Benign Paroxysmal Positional Vertigo Management Strategies

21 Dec

Benign paroxysmal positional vertigo (BPPV) is a common cause of vertigo, or dizziness, that is associated with movement of the head (though some motions may be more problematic than others) that goes away when movement ceases. Essentially, BPPV is caused by crystals becoming displaced within the semicircular canals (inner ear), which causes eddy currents in the fluid that circulates in the canals. Instead of the normal flow that bends small hair-like nerves in the same direction telling the brain that you’re standing, laying, running, etc., the brain is essentially given mixed messages of what position you’re in, resulting in a “sea-sickness” type of sensation.

There are several “canalith reposition maneuvers” available, and the choice of which maneuver to use depends on which canal(s) is affected. According to the Mayo Clinic, these maneuvers consist of several simple head movements, which can provide release in up to 80% of BPPV patients within a few treatment sessions, though the problem can recur.  

In an August 2020 study, researchers set out to determine whether vitamin D and calcium supplementation could prevent the recurrence of BPPV. A group of 518 BPPV patients from eight participating hospitals were provided with a twice daily 400 IU vitamin D and 500mg calcium carbonate supplement for a year. Another 532 BPPV patients served as a control group that did not receive a supplement.

The data show that patients in the supplement group were less likely to experience a recurrence in the following year (37.8% vs. 46.7%), especially those with low vitamin D levels at the start of the study. The researchers concluded that vitamin D and calcium can be considered in patients with frequent attacks of BPPV, especially when their blood level of vitamin D is low.

            Interestingly, another study published in August 2020 found that vitamin D deficiency may be associated with up to a 3.29 times increased risk for BPPV recurrence, giving individuals yet another reason to spend time in the sun, take a vitamin D supplement, and eat vitamin D-rich foods to improve their vitamin D status.

            A review of your health history and an examination can reveal if your vertigo/dizziness symptoms are indicative of BPPV. If so, your doctor of chiropractic can train you in the various canalith reposition maneuvers to relieve those frequently debilitating symptoms. He or she will also counsel you on nutritional supplementation and diet. As noted in the recent study, the recurrence rate of BPPV is high and the intake of vitamin D and calcium can significantly reduce that rate.

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.

Car Crash Characteristics and Whiplash Recovery

17 Dec

While many cases of whiplash that result from a motor vehicle collision (MVC) have a successful outcome, some experts estimate that up to 25% of whiplash patients will experience chronic pain and disability. Several studies have sought to identify characteristics that differentiate these individuals from those who recover so that additional treatment can be offered to reduce the risk for chronicity. Let’s see if the characteristics of a MVC can shed any light on this…

In a 2019 study, researchers assessed 37 acutely injured patients within a week of their MVC, two weeks later, and three months later in order to determine any association between pain and disability with both specific crash measurements (head turned at time of impact, seatbelt use, whether or not airbags deployed, if the vehicle was struck while stopped or while turning, the principle direction of force, damage cost estimates, speed of impact, etc.) and patient characteristics (sex, body mass index, signs of post-traumatic distress, negative affect, etc.).

The research team identified a positive association between the percentage of self-reported neck disability at three months post-MVC and post-traumatic distress, negative affect (such as anger or sadness), and uncontrolled pain. There was no direct effect with crash characteristics such as vehicle damage, principle direction of force, or speed change. Though they recommended a larger study to confirm their findings, researchers were unable to establish a link between chronic whiplash pain and disability and specific crash characteristics. That is, there was no apparent connection between a person’s risk for ongoing whiplash issues and the severity of the collision. This study points out that recovering from a whiplash associated disorder requires a biopsychosocial care approach, not just focusing on the biology or tissue damage/diagnosis, but also the patient’s attitude about the injury and getting better.

This echoes a similar study that linked post-traumatic stress disorder (PTSD) with prolonged whiplash associated disorders recovery. In the study, researchers found that hyperarousal/numbing PTSD symptoms were predictive of long-term neck pain-related disability.

In addition to managing musculoskeletal disorders with manual therapies, nutritional recommendations, modalities, and specific exercise recommendations, doctors of chiropractic may utilize more whole body, health-oriented approaches to help patients learn how to relax and reduce stress and anxiety with techniques such as deep-breathing, visualization, contract-relax or tensing exercises, and more. When needed, your chiropractor can coordinate with primary care and specialty care providers, such as mental health counselors and clinical psychologists.

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.
← Older Entries
Newer Entries →