What Do Chiropractors Do for Shoulder Pain?

14 Feb

When people think of chiropractic care, they usually imagine back pain, neck pain, and headaches, as research STRONGLY supports chiropractic treatment for these complaints. But what about chiropractic care for shoulder pain?

In 2010 and again in 2014, the United Kingdom government published landmark studies that reviewed previously published research on various forms of treatment for MANY conditions, both musculoskeletal and non-musculoskeletal (like asthma). These reviews noted there is favorable scientific evidence for the use of chiropractic treatment with regards to shoulder-related conditions including shoulder girdle pain/dysfunction, rotator cuff pain, and adhesive capsulitis (frozen shoulder).

When doctors of chiropractic approach treatment for patients with shoulder pain, care typically focuses on restoring shoulder range of motion using various manipulative and mobilization techniques directed at the three joints of the shoulder: the glenohumeral (the ball & socket joint), the acromioclavicular (AC) joint (clavicle & scapula), and the scapulothoracic joint (shoulder blade & rib cage). Chiropractic care may also include exercise training focused on restoring motion, strength, and stability to the muscles and soft tissues surrounding the shoulder region. A host of physical therapy modalities are also utilized as adjunctive procedures in many chiropractic settings at various stages of healing following shoulder injury. The goal of care is to return patients to their normal level of everyday function.

But what about shoulder pain AFTER surgery? Can chiropractic still help? A 2018 study found that post-surgical patients who received mid-back (thoracic spine) manipulation experienced significant increases in shoulder movement (flexion and abduction) and increased subacromial space measurements (in neutral and external rotation). The authors cited other studies that reported similar improvements in shoulder mobility as well as shoulder blade (scapular) kinematics (movement & stability).

Another study looked at changes in shoulder pain, disability, and perceived recovery after two sessions of upper thoracic and upper rib manipulation in patients with shoulder pain. Here too, participants reported significant improvement in all parameters tested that persisted for up to three months.

Given the solid research support of manual therapies directed at not only the shoulder but also to the neck, upper, and mid-back spinal regions, chiropractic care for patients with shoulder pain is simply a must!

 

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.

Do Splints Help Carpal Tunnel Syndrome?

11 Feb

Carpal tunnel syndrome (CTS) is a very common condition caused by inflammation of the median nerve that runs through the palm side of the wrist. When the median nerve is pinched and irritated, numbness, tingling, and/or weakness in the hand can result.

Wrist splinting is a common recommendation given to CTS patients by all healthcare providers, including chiropractors, based on the theory that pressure increases dramatically inside the tunnel at the extremes of wrist bending, so restricting motion may allow the associated soft tissues to become less inflamed. But, does splinting actually work?

One study that included 36 participants looked at the outcomes of night-time splinting only, using a common thermoplastic neutral wrist splint. The researchers observed that the patients in the study reported improvements related to their hand/wrist symptoms at the three-month point, while after six months, the participants had also experienced improvements related to wrist function.

To determine if all splints and braces for CTS were the same or if some were better than others, a 2018 study compared the efficacy of a neutral wrist splint vs. one the incorporated a “lumbrical unit” that extended further into the hand. After six weeks, patients in both groups reported improvements related to pinch and grip strength, but the patients given the longer splint also experience statistically significant improvements related to pain and function.

What about combining nerve and tendon stretching exercises WITH wrist splinting? One study that included 51 mild-moderate CTS patients found that those who performed nerve/tendon gliding exercises (three times a day for four weeks) reported better outcomes regardless of which splint they used. A similar study found that patients who engaged in a home stretching program and who wore the longer splint were less likely to require surgical intervention.

These studies support the use of a longer splint and stretching exercises in the management of CTS. When treating patients with CTS, doctors of chiropractic typically take a multimodal approach that includes wrist splinting, specific exercises/stretches, and manual therapies in order to reduce pain and improve function in the wrist and surrounding tissues.

 

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 the Best Treatment for Chronic Low Back Pain?

7 Feb

When it comes to treating patients with chronic low back pain (cLBP), doctors of chiropractic commonly use a multi-modal approach that involves manual therapies, like spinal manipulation and mobilization, combined with supervised and/or home-based exercises. Why is that?

In many cases, the superficial paraspinal muscles of patients with back pain will tighten as a reflex in an effort to restrict movement and protect the area from further injury. Unfortunately, such a restriction can result in altered movement patterns that raise the risk for further injury (and pain) elsewhere in the lower back (or even in other areas of the body). On top of that, because the superficial back muscles have abnormally assumed the job of maintaining posture, the deep muscles in the back can become deconditioned and weak, which only raises the risk for further back issues.

So, when it comes to chronic back pain, the job of a chiropractor is two-fold: restore proper joint motion to “turn off” this abnormal reflex muscle spasm and to strengthen the deep muscles so the superficial muscles can return to their normal function.

In a 2011 study, researchers randomly assigned 301 cLBP patients (adults over 65 years old with a five or more year history of chronic low back pain) to one of three treatment groups: supervised exercise therapy (SET); spinal manipulative therapy (SMT), or home exercise and advice (HEA).

Researchers monitored each participant’s progress for over a year and found that members of each group achieved similar short- and long-term improvements with respect to pain, disability, global improvement, general health status, and medication use. Though the patients in the SET group experienced greater gains with respect to trunk muscle strength, endurance, and range of motion in comparison with the home-based exercise group, the difference in results is understandable as the SET protocol was much more intensive.

Though this study did not specifically look at the effect of combining exercise and spinal manipulation for the treatment of cLBP, several guidelines that have looked at the available evidence recommend using such a multi-pronged approach for this group of patients. For example, in 2018, the Canadian Chiropractic Guideline Initiative wrote, “A multimodal approach including SMT, other commonly used active interventions, self-management advice, and exercise is an effective treatment strategy for acute and chronic back pain, with or without leg 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.

Can Omega-3 Fatty Acids Benefit Patients with Anxiety?

28 Jan

Omega-3 polyunsaturated fatty acid (omega-3-PUFA) consumption has been linked to reduced inflammation, a lower risk for heart attack and stroke, and even improved outcomes for patients with carpal tunnel syndrome. Here’s a benefit that may come as a surprise: ANXIETY relief!

Anxiety is the most commonly experienced psychiatric symptom, and it’s reported that it will affect one in three individuals in their lifetime. Anxiety is characterized as an inappropriate or exaggerated fear leading to distress and impairment and is often accompanied with other psychological disorders, including depression, and is associated with a lower health-related quality of life and increased risk of all-cause mortality.

Classic treatment options include cognitive-behavioral therapy (CBT) and pharmacological treatments, mainly with selective serotonin reuptake inhibitors. A common problem with treatment is potential medication side-effects (sedation and/or drug dependence), as well as time-consumption and cost factors. This often leads to a reluctance to engage in treatment, which is why these findings regarding a nutritional approach to managing anxiety are so important.

In a recent meta-analysis of data from 19 clinical trials that involved 2,240 participants from 11 countries, researchers uncovered evidence that participants who consumed omega-3 fatty acid supplements reported significant clinical improvements in anxiety signs and symptoms.

Interestingly, the researchers noted that the anti-anxiety benefits of omega-3-PUFAs were stronger in those with clinical anxiety compared with those whose conditions were classified as subclinical or borderline. The research team also observed that participants who were given a higher dose (>2000 mg/day) obtained the best anti-anxiety benefits.

Vitamin D, the “sunshine vitamin”, has also been found to improve mood, especially during the winter months. Moreover, people with low vitamin D levels (70% of Americans) may be more likely to experience anxiety.

Hence, a combined daily supplement of >2000 mg of omega-3-PUFAs AND 2000-5000 mg of vitamin D may help manage anxiety signs and symptoms.

 

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 Neck-Specific Exercise Reduce Chronic Whiplash Symptoms?

21 Jan

Did you know that an alarming 90% of neurologically injured whiplash patients DO NOT recover and have neck muscle dysfunction even up to a year after the date of their motor vehicle collision?

There is suspicion among researchers that such ongoing issues are the result of the body’s initial response to injury to the brachial plexus, the network of intersecting nerves that give rise to three main nerves that travel down the arm to the hand. To protect and ease tension on the brachial plexus, the superficial muscles to the side of the injury can become more active and take on the classic “shrugged” position, a posture commonly observed in patients with nerve damage associated with a whiplash associated disorder (WAD) injury.

Over time, this protective mechanism can weaken the deep neck muscles, which are important for maintaining proper vertebral alignment and posture. This may, in turn, result in secondary injury and the long-term problems observed in many WAD patients, even after the initial injury to the brachial plexus has resolved.

In a recent multi-center, randomized controlled trial involving 171 chronic WAD patients with radiating arm pain and associated signs of neurological deficit, researchers found that participants who performed neck-specific exercises for twelve weeks to strengthen the deep neck muscles reported improvements in overall pain, arm pain specifically, and pain frequency, with some neurological recovery. Participants who were instructed to engage in general/non-specific physical activity during the study did not report such improvements.

Two of the authors from the above study collaborated on a similar experiment and found that patients who engaged in neck-specific exercises not only experienced improvements in muscle strength and pain reduction, but they were more satisfied with the approach than participants in a general exercise group.

These studies show that when the deep muscles become the specific focus of neck exercises, the results are superior, AND this includes neurological recovery. Your doctor of chiropractic can help train you in these specific exercise approaches!

 

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 Do Adjustments Help Patients with Neck Pain?

14 Jan

Mechanical neck pain—neck pain without neurological compromise, often without a specific cause—is associated with a loss of mobility, poor activity tolerance, increased pressure pain sensitivity (or hypersensitivity to a normal stimulus), and increased joint position sense error (JPSE—difficulty reproducing the same movement when repeated multiple times). Patients with mechanical neck pain often seek treatment from doctors of chiropractic. Let’s look at how high-velocity, low-amplitude (HVLA) manipulation—the primary form of treatment used by chiropractors, commonly referred to as an adjustment—helps these patients…

In a 2018 study involving 54 patients with mechanical neck pain, participants received either HVLA cervical thrust manipulation or a sham cervical thrust manipulation. Evaluations conducted immediately following treatment showed that patients in the HVLA group experienced improvements with regards to JPSE (specifically neck rotation and extension), pressure pain threshold, and disability. (A related study showed that patients who received HVLA cervical thrust manipulation experienced an immediate 41% improvement in JPSE.)

A week later, the participants in the HVLA group continued to experience improvements related to disability. Again, this was after just a single treatment. Typically, doctors of chiropractic administer a series of HVLA manipulations one to three times per week for one to two weeks followed by a re-assessment to determine if care should continue (at the same frequency or at a reduced frequency) or if the patient should be released from care and advised to return for care on an as-needed or maintenance basis.

Chiropractors often combine several treatment approaches when managing patients with mechanical neck pain and other musculoskeletal conditions to both reduce pain and improve function. A partial list of commonly applied services include the following: HVLA manipulation (thrust with cavitation), mobilization (non-thrust), soft tissue therapies (massage, vibration, muscle release techniques, trigger point therapy, myofascial release, and more), home and/or in-office exercise training, nutritional counseling, physical therapy modalities, and more. Chiropractic HVLA manipulation has strong research support as being a VERY effective management approach for patients with either acute or chronic neck 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.
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