Post-Whiplash Headache Risk Factors and Treatment

25 Sep

The International Headache Society lists “headache attributed to whiplash” as a headache that appears or existing headaches that worsen within seven days after a whiplash event (i.e., automobile collision, sports collision, slip and fall, etc.). It’s estimated that up to 60% of whiplash associated disorders (WAD) patients experience such headaches and nearly 40% will continue to do so a year after their initial injury. Thus, studies that focus on what factors are linked to post-whiplash headaches, especially those that persist in the long term, are important.

In a 2022 study, researchers monitored 47 recent WAD grade II patients (pain, stiffness, or tenderness of the neck with soft tissue injury signs, loss of range of motion, and/or point tenderness of the neck) without a previous history of headache or musculoskeletal disorders associated with headache. All participants completed self–reported questionnaires including Visual Analogue Scale for neck pain intensity, the Neck Disability Index, Pain Catastrophizing Scale, and the Tampa Scale Kinesiophobia–11. Of the 47 patients in the study, 28 developed headaches within a week of the whiplash event, which correlates to findings from previous studies. 

Analysis of questionnaire data revealed that neck pain intensity, neck disability, pain catastrophizing, kinesiophobia, and anxiety were ALL higher in those with post-whiplash headaches. Previous research has also linked central sensitization (experiencing painful sensations to non-painful stimuli) to post-whiplash headaches. This suggests that worse injury to the musculoskeletal system, particularly in the vicinity of the cervical spine may contribute to post-whiplash headaches and the neck should be evaluated in WAD patients, especially those with new-onset or worsening headaches.

The 2016 update to the 2000-2010 Bone and Joint Decade Task Force on That Pain and its Associated Disorders concluded that episodic tension-type headaches, chronic tension-type headaches and cervicogenic headaches are effectively managed with low load endurance craniocervical and cervical scapular exercises, relaxation training with stress coping therapy, and/or multimodal care that includes spinal manipulation, mobilization, and postural correction.  Both cervical and thoracic spine manipulation with or without mobilization was found effective for cervicogenic headaches.  Doctors of chiropractic frequently employ these and other treatment options as part of a multimodal approach for the management of WAD patients, including those with post-whiplash headaches.

Pain Relief Chiropractic

4909 Louise Dr

Mechanicsburg, PA 17055

(717) 697-1888

Member of Chiro-Trust.org 

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Headaches and a Traffic Light Prognosis System

20 Sep

The 2022 Global Burden of Disease study listed headaches as one of the most prevalent and disabling conditions worldwide, noting that more than half of adults actively suffer from headaches and nearly 5% of adults report headaches on more than 15 days per month. Because headaches come in many forms (at least 300 distinct types according to some researchers) and can be secondary to an underlying and potentially serious condition, doctors of chiropractic utilize a traffic light prognosis system when examining patient with headaches.

GREEN LIGHT: Primary and secondary headaches with musculoskeletal components. Primary headaches—a term which refers to headaches in the absence of a clear underlining caused pathology, trauma, or systemic disease—are the most common type of headache. Most often, these headaches are classified as either tension-type or migraine headaches. Secondary headaches describe headaches caused by a specific underlying medical condition (such as a metabolic disorder) or they can have a musculoskeletal origin, such as cervicogenic headache (which originate from dysfunction in the neck) or headaches associated with temporomandibular dysfunction or whiplash associated disorders. Because of the sensory input arising from the upper cervical spine, the upper neck and even the masticatory system have strong potential to play a role in the neurophysiology of both primary and secondary headaches. This explains why headaches not thought to be musculoskeletal in origin—such as migraines—can benefit from chiropractic care addressing issues present in the neck.

YELLOW LIGHT: Headaches with a strong psychological component. The current data suggests that around a fifth of migraine and a tenth of tension-type headache patients have co-occurring depression and/or anxiety. When a mood disorder is present, patients may engage in behaviors that can worsen or prolong their condition, such as physical inactivity, fear of movement, or poor coping strategies. In such cases, the patient may require co-management with a mental health professional to achieve a satisfactory outcome.

RED LIGHT: Headaches caused from a potentially dangerous pathology that requires emergent evaluation prior to the use of musculoskeletal care approaches. These are situations when headache may be a symptom of a much more serious issue like infection, cancer, or cervical artery dissection. In such instances, patients are immediately referred to emergency care before in-office treatment is provided.

If your current headache management strategy is not providing lasting relief with respect to reduced frequency, intensity, or duration, then contact your local doctor of chiropractic to see if a conservative multimodal treatment approach can be of benefit for your unique circumstances. 

Pain Relief Chiropractic

4909 Louise Dr

Mechanicsburg, PA 17055

 (717) 697-1888

Member of Chiro-Trust.org 

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How Older Individuals Can Manage Hip Pain  

15 Sep

Hip pain is a condition that becomes more common with age. It’s reported that 1 in 7 seniors experience significant hip pain on most days, particularly with simple movements such as sitting and standing. In addition to being painful, these individuals are also likely to report a diminished ability to carry out their regular activities. As such, it’s not unusual for a hip pain sufferer to schedule a visit with a doctor of chiropractic to see if a conservative course of care can benefit them without the need for medications, injections, or surgical intervention.

When a patient first presents for chiropractic care for hip pain, they will be asked to complete paperwork to describe both their past medical history and their current hip pain. This may also include questionnaires using diagrams and scales to assess pain and disability. The information provided will be useful to rule out red flags (fracture, infection, malignancy, and/or acute nerve injury) that may necessitate referral to a specialist or emergency services. The data will also provide insights as to the potential cause/s of the patient’s hip pain. 

The possible causes for hip pain are myriad. In addition to trauma, arthritis, congenital defects, and other issues that can affect the soft tissues and bones that comprise the hip joint, the pain experienced as “hip pain” may actually be referred pain from the low back or buttocks. Or the patient might not even have hip pain but may be mistaking pain from nearby locations as hip pain. There may even be indication that the underlying cause is not musculoskeletal in nature and part of a larger issue that may need to be co-managed with the patient’s medical physician. 

Once a chiropractor has reviewed the information provided by the patient, they will conduct a physical examination of the hip joint that may include analysis of gait or walking, sitting, and standing; ability to stand on one leg; range of motion (ROM) from seated and recumbent positions; leg length variance; muscle length checks; and neurovascular assessments in the lower limbs. This may also involve evaluation of the feet, ankles, knees, and lower back, as musculoskeletal disorders in these areas can place added stress on the affected hip during movement and would need to be treated to provide a satisfactory outcome for the patient.

While the specifics of treatment will vary from patient to patient, as well as the chiropractor’s training and clinical experience, care may involve a multimodal approach that includes manual therapies, exercise training, nutrition recommendations, and physiotherapy modalities aimed at restoring normal movement to the hip and other joints that could play a role in the patient’s chief complaint. As with many conditions, the longer it persists, the more time it can take to achieve a complete recovery, if at all. If you’re currently experiencing hip pain, call your doctor of chiropractic sooner rather than later. 

Pain Relief Chiropractic

4909 Louise Dr

Mechanicsburg, PA 17055

(717) 697-1888

Member of Chiro-Trust.org 

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How Do Manual Therapies Help Carpal Tunnel Syndrome?

10 Sep

Carpal tunnel syndrome (CTS) is a condition characterized by the slow onset of pain, tingling, or numbness (paresthesia) in the thumb, index, and middle and thumb-half of the ring finger. Over time, symptoms can increase in both frequency and severity to the point that the individual cannot comfortably carry out their regular work or leisure activities. Initially, a sufferer may manage the condition by shaking their hand or flicking their fingers, but as the symptoms worsen, they may try home and over-the-counter remedies to find temporary relief, at best. It’s at this point when they may seek treatment with a doctor of chiropractic. 

But why would a chiropractor be useful for managing CTS? It starts by understanding the anatomy of the carpal tunnel itself. This structure is made up of eight small bones that form the arch of the tunnel with the transverse carpal ligament serving as the floor. Several tendons as well as the median nerve pass through this tunnel. The median nerve emerges from the neck and travels through the shoulder, elbow, and forearm before entering the carpal tunnel. It then supplies motor instructions to part of the hand and relays sensory information back to the brain. Anything within the carpal tunnel that reduces the available space—tendon inflammation, water retention, or compression of the shape of the tunnel—will apply force on the median nerve that can affect its normal movement and function. When this occurs, symptoms will begin to manifest. 

The goal of treatment is to reduce pressure on the median nerve and improve its mobility as it passes through the carpal tunnel. Primarily, doctors of chiropractic accomplish this with the use of manual therapies—manual and instrumental soft tissue mobilizations, massage therapy, bone and joint mobilizations or manipulations, and neurodynamic techniques—to restore normal movement to the affected joints and associated soft tissues. A 2022 systematic review and meta-analysis (considered the most respected form of research) concluded that manual therapies provide statistically significant improvement in symptom severity, physical function, and sensory and motor nerve conduction in mild-to-moderate CTS cases. 

To achieve a satisfactory outcome for the patient, chiropractic care may also include addressing musculoskeletal issues along the course of the median nerve as dysfunction in the neck, shoulder/arm, and forearm/elbow often co-occur with CTS and can produce CTS-like symptoms. If non-musculoskeletal conditions are present, the case may need to be co-managed with the patient’s medical physician or a specialist. 

Pain Relief Chiropractic

4909 Louise Dr

Mechanicsburg, PA 17055

(717) 697-1888

Member of Chiro-Trust.org 

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Spinal Manipulative Therapy for Seniors with Low Back Pain

5 Sep

While low back pain can affect people of all ages, it’s particularly problematic for older adults and is one of the top three reasons they see a doctor. Despite this, low back pain among seniors often persists for longer than three months, and in the presence of multiple comorbidities (which is often the case with advancing age), low back pain may be under treated or mismanaged. While guidelines for the management of low back pain often emphasize conservative approaches first and foremost, older patients tend to be underrepresented in the studies used to formulate such recommendations. Let’s take a look at the current research on the utilization of spinal manipulative therapy—the primary form of treatment provided by doctors of chiropractic—for the management of low back pain in older adults.

A 2022 study scoured electronic databases for randomized controlled trials conducted during the previous two decades that examined the effects of spinal manipulative therapy in older adults with chronic low back pain. The research identified ten studies consisting of a total of 786 individuals over 55 years of age, of which 261 were between 65 and 91 years old. The types of spinal manipulation included in this study are high-velocity low-amplitude (HVLA) techniques and mobilization or low-velocity low-amplitude (LVLA) techniques.  In particular, the research team looked at how these manual therapies fared with respect to improvements in pain and function against other approaches, including standard medical care and exercise therapy, in the short-, medium-, and long-term. 

In their final analysis, the authors concluded there is moderate-quality evidence that spinal manipulative therapy results in similar outcomes (compared to usual medical care and exercise therapy) for pain and functional improvement, and it should be considered a non-pharmacological treatment option for this patient population. This is important as up to 80% of older adults already take multiple prescription medications, with nearly a third taking five drugs, to manage their current health concerns. The addition of one or more prescriptions to manage low back pain increases the risk for adverse events and harmful drug interactions.

The researchers add that while their analysis was unable to establish a safety profile as the studies used had heterogenous data on adverse events, spinal manipulation appears to be safe for older patients. They further note that their findings are consistent with other systematic reviews on the effectiveness of spinal manipulative therapy for all age groups. 

The findings from this analysis confirm that spinal manipulative therapy has a place in the management of low back pain affecting older patients. If you suffer from chronic low back pain, don’t put it off or assume you need to live with it. Schedule an appointment with your local doctor of chiropractic to see if a course of conservative chiropractic care can help reduce your pain and improve your mobility.

Pain Relief Chiropractic

4909 Louise Dr

Mechanicsburg, PA 17055

(717) 697-1888

Member of Chiro-Trust.org 

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When Is Low Back Surgery Appropriate?

30 Jun

Low back pain is the most common musculoskeletal complaint, and it is the leading cause of activity limitation and absenteeism from work. There are many treatment options available to the low back pain patient, including surgical procedures. But when is surgery appropriate and in what cases should it be avoided? 

Generally, clinical guidelines don’t recommend surgery as an initial treatment, except in emergency or critical situations. For example, when a patient presents for chiropractic care, there are red flags that indicate the patient should be referred out to another healthcare provider, if not the emergency room. These include cancer, fracture with instability, infection, and cauda equina syndrome (includes loss of bowel and/or bladder control). In these cases, surgery may be the best available option for the patient to avoid a catastrophic outcome. 

In addition to these red flag scenarios, a literature review published in 2023 in the Medical Journal of Australia concluded that spinal surgery may have a role in the management of non-responsive nerve compression with radiating leg pain. That is, once conservative, non-surgical options have failed. However, outside of these situations, the review concluded, “Spinal surgery for all other forms of back pain is unsupported by clinical data, and the broader evidence base for spinal surgery in the management of LBP is poor and suggests it is ineffective.” Additionally, the authors note that spinal surgery for LBP “has substantially increased over recent decades, and disproportionately among privately insured patients, thus the contribution of industry and third-party payers to this increase, and their involvement in published research, requires careful consideration.”

Unfortunately, a 2022 study found that 41.7% of low back pain patients who underwent spinal surgery had minimal, if any, engagement with non-pharmacological, non-operative treatment in the six months before their procedure. A 2013 study that used data from Washington state worker’s compensation system found that 43% of workers with a back injury who initially consulted with a surgeon ended up having surgery while just 1.5% of those who first received chiropractic treatment eventually had a surgical procedure for their back pain. Not only are patients who visit a chiropractor first less likely to end up under the surgeon’s knife but they’re also less likely to be prescribed opioids within the following year, something that offers tremendous benefits to society in light of the opioid crisis.

If you experience an episode of low back pain, consider chiropractic care as your first treatment choice. If your condition doesn’t respond to a multimodal treatment approach, your chiropractor can refer you to an allied healthcare provider for additional care. 

Pain Relief Chiropractic

4909 Louise Dr

Mechanicsburg, PA 17055

(717) 697-1888

Member of Chiro-Trust.org 

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