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Chiropractic Methods for Treating Neck Pain

13 May

When it comes to neck pain, many patients seek out chiropractic care. In fact, there are several studies demonstrating that manual therapies performed by doctors of chiropractic can offer significant benefits for non-specific or mechanical neck pain as well as neck pain arising from injuries related to sports, car accidents, and falls. What are some of these manual therapies?

Spinal manipulative therapy (SMT) involves moving the head and neck to a firm end-range of movement followed by a fast, thrust aimed at specific joints that are fixed, subluxated (partially out of position), and tender. The thrust is described as a “high-velocity, low amplitude” (HVLA) movement, and it’s also called “an adjustment”, which is more unique to the chiropractic profession. Joint cavitation (the “cracking” sound) often occurs as gas (nitrogen, oxygen, carbon dioxide) either forms within or is released from the joint.

Spinal mobilization (SM) is a low-velocity, low amplitude movement that is typically slow and rhythmic, gradually increasing the depth of a back-and-forth movement, often combined with manual traction. Here, joint cavitation is less common.

Exercise training that focuses on strengthening the deep neck flexor muscles and other exercises that are specifically designed for each individual patient based on their specific needs can result in better treatment outcomes compared to a generalized, non-specific exercise program. Studies in which SMT/SM and exercise are combined report better long-term outcomes than SMT/SM alone, but SMT/SM typically out-performs exercise therapy alone.

Physical therapy modalities (PTM) can include ultrasound, interferential, low and high volt, galvanic current, diathermy, lasers (class 3B and IV primarily), ultraviolet, ionto- and phono- phoresis, pulsed electro-magnetic field, hot/cold, and more.

Muscle release techniques (MRTs) include massage therapy, myofascial release, trigger point therapy, muscle energy techniques, active release therapy, gua sha, and many more.

Cervical traction devices can be used either in the office or at home, depending on the patient’s needs; however, it’s common for both approaches to be used. The obvious benefits of home traction include the ability to repeat its use multiple times a day, and it’s generally more cost effective. Types include static traction that can be applied sitting or supine (on the back) and intermittent traction, which is typically performed supine and is computerized, and hence, is often limited to in-office use only.

Which approaches are used in the course of care depend on the preference of the patient as well as the treating chiropractor. It’s important to discuss your preferences with your chiropractor when seeking care.

 

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.

Can Chiropractic Adjustments Help Headaches?

18 Feb

Experts report that 157 million work days are lost each year in the United States due to headaches at a cost of about $50 billion in work absenteeism and medical expenses. According to current estimates, about 18% of chronic headache patients are believed to have cervicogenic headaches (CGH), or headaches that originate from dysfunction in the neck.

Many CGH sufferers utilize complementary and integrative health treatment approaches for neck pain and headaches, of which spinal manipulative therapy (SMT) is the most common. While past studies have demonstrated SMT to be a superior form of treatment for CGH, no one has investigated how many treatments are needed to achieve the maximum clinical benefit for CGH patients – at least not until recently!

In order to determine what dose of SMT may best benefit patients with headaches originating from the neck, researchers randomized 256 CGH patients into four treatment groups that received 0, 6, 12, or 18 SMT treatments over the course of six weeks. The researchers found a dose-dependent relationship between SMT and days without CGH over the following year with patients in the 18 visit group experiencing 16 fewer days with CGH over the next twelve months than those in the zero treatment group.

The chiropractic spinal manipulative therapy treatment used in the study consisted of high-velocity, low-amplitude thrust manipulation in the neck and upper back regions (specifically, occiput to T3) aimed at sites with detected joint dysfunction (fixation or pain), which is typically the method most chiropractors determine where to apply spinal manipulation.

This study is VERY important for a few reasons: 1) it proves SMT helps patients with CGH; 2) it provides doctors of chiropractic with an idea of how many visits it may take to obtain optimum results; and 3) it can be used as a guideline when managing CGH patients, stressing the important point that EACH patient is UNIQUE and modifications may be appropriate depending on each case.

 

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.

What Is Congenital Torticollis?

20 Sep

The Latin terms tortus means twisted and collum means neck, hence the name torticollis. The common name for torticollis is wry neck, which is a dystonic condition defined by an abnormal, asymmetric position of the head and neck.

Congenital torticollis is the most common form of this condition, which is present at birth (incidence rate is 0.3-2.0%). The cause is unclear, but it is most likely the result of birth trauma and/or intrauterine faulty positioning pre-delivery. In a typical presentation of torticollis, damage to the sternocleidomastoid (SCM) muscle that attaches between the sternum and clavicle to the mastoid process behind the ear causes the head to extend back and sideways and rotate to the opposite side.

Congenital torticollis is diagnosed in the first one to four weeks of age and sometimes a firm mass in the SCM muscle can be seen on an ultrasound or even felt by hand. Treatment should commence promptly. Chiropractic treatment initially includes manual therapies such as stretching of the SCM, mobilization, and/or gentle manipulation of the cervical spine. Manual traction and microcurrent and/or ultrasound diathermy have been found to be helpful as well.

Teaching parents/care givers how to stretch the SCM and how to position the baby to reduce the altered posture is very important. Other helpful tips include: adding neck supports to a car seat; using toys, lights and/or sounds to encourage the child to look in the corrective direction; placing the infant in the crib with the affected side by the wall so they must turn to the non-affected side to face out; and lying prone (stomach first) with the affected side down.

It is reported that about 5-10% of cases fail to respond and may require surgery to release the muscle. The good news is that the vast majority of cases of congenital torticollis resolve with conservative care.

 

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.

When and When Not to Worry About Headaches…

16 Aug

Most people will experience some form of headache during their lifetime. The good news is that most headaches are related, at least in part, to the neck or cervical spine (a cervicogenic headache or CGH) and can be easily managed with chiropractic care.

Although the exact mechanism of CGH is still under debate, there are two possible explanations that are backed by research.  The first includes irritation of the sensory nerves in the upper cervical region that communicate with the fifth cranial nerve (the trigeminal nerve) and its nucleus, which is located in the upper cervical region of the spine. This irritation results in referred pain that radiates into the frontal aspect of the head. The second possible mechanism involves irritation of the greater occipital nerve by connective tissue bridges between the spinal cord covering (the dura) and the muscles located at the base of the skull.

Chiropractic treatment regarding CGH includes a combination of spinal manipulation; soft tissue therapies, such as myofascial release; active release techniques of the tight suboccipital muscles; manual and/or home cervical traction; and posture correction.

Unfortunately, the origin or cause of the headache may not be so benign and uncomplicated.  Warning signs of a complicated type of headache include (but are not limited to) the following: a very intense, unusual headache that comes on suddenly; significant visual and/or auditory problems; and other neurological signs and symptoms such as balance disturbance, dizziness, weakness, paralysis, speech difficulties, mental confusion, and nausea or vomiting. Until proven otherwise, the following types of headaches should be considered as potentially dangerous: a headache that progressively worsens over 24 hours; a headache that follows head trauma; and headaches that wake one up from sleeping, and/or last greater than 48 hours.

Doctors of chiropractic care are trained to evaluate and treat patients with headaches, and guidelines recommend chiropractic as an initial form of care based on its efficacy and safety.

 

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.