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Cervical Spondylosis, Neck Stiffness, and Neck Pain

5 May

As we age, the shock-absorbing disks that sit between the spinal vertebrae in the neck can become dehydrated, leading to a condition known as cervical spondylosis (CS). Due to the thinning and reduced flexibility of the disks in the neck, the patient will experience a limited range of motion which they may describe as stiffness. In fact, the Mayo Clinic reports this is very common and affects about 85% of older adults. While a stiff neck can interfere with some daily activities, it’s when CS leads to neck pain that such a patient is most likely to visit their doctor of chiropractic. Why does neck pain affect CS patients when it does?

The first explanation is that CS compromises the disk’s ability to absorb energy and to flex and extend in response to external forces. Just picture how an old rubber ball that’s been left in the sun not only has less bounce but can break if it hits the ground hard enough. Likewise, a simple fall that may not have any effect on a young neck may be much more traumatic to that of an older person. Even something as mundane as sleeping in an awkward position can leave the CS patient with a sore neck. 

Another pain generator is the result of bone spurs that form in response to the vertebrae being pulled closer to one another. This bone growth can narrow the spaces in the vertebrae the spinal nerves pass through leading to both local pain and pain referred down into the upper extremities—a conditional known as cervical myelopathy. 

Currently, about 13% of adults in their third decade of life show signs of CS on X-ray. Unfortunately, with forward head posture from excessive device use that places added strain on the neck becoming more common, as well as increased obesity rates and sedentary lifestyles, there’s a great potential CS will start to become common at earlier ages. This highlights the importance of maintaining a healthy lifestyle.

When a CS patient seeks chiropractic care, their doctor of chiropractic will use information from the patient’s history, physical examination, and sometimes x-rays or other imaging tests to establish an accurate diagnosis and decide on a treatment approach. Care will typically include the application of manual therapies with at-home exercises to try and restore as much movement to the neck as possible. In more challenging cases, they may work in coordination with the patient’s medical doctor or a specialist or other healthcare provider.

Pain Relief Chiropractic

4909 Louise Dr

Mechanicsburg, PA 17055

 (717) 697-1888

Member of Chiro-Trust.org

The Hamstring and Tension-Type Headache Connection

15 Apr

Patients with tension-type headaches (TTH) often experience neck pain and stiffness, which may be a contributing factor in their present headaches. Thus, it’s not uncommon for a doctor of chiropractic to use manual therapies and provide home exercise instruction focused on improving neck function in the effort to reduce headache frequency and intensity. It may surprise a TTH patient that care may also address areas of the body that seem unrelated to the head. For the TTH patient, they may receive treatment and be asked to perform at-home stretches to address their tight hamstrings. Why is that? 

The superficial back line is comprised of the muscles and associated tissues that start in the back of the head and run down the neck, back, and legs. These muscles work together to keep the body upright, but when there’s a problem in one part of this chain, it can lead to issues elsewhere.  Several studies have observed an association between tightness in the hamstrings—the largest muscle in the superficial chain—and tightness in the neck muscles. One study found that individuals with increased tension and shortening of the hamstrings are more likely to have neck and shoulder pain. A possible explanation is that tight hamstrings can cause the pelvis to tilt backward, which can contribute to the forward head posture—a postural fault that can place increased strain on the muscles in the back of the neck and contribute to headaches.

In a study that included 30 TTH patients, researchers split participants into two groups: one group received treatment to relax the hamstrings through a guided stretching routine in the office and the other received electrotherapy to stimulate the hamstring muscles. Both groups received instruction to perform self-myofascial release at home. Assessments conducted after four weeks of treatment revealed the hamstring relaxation group experienced greater outcomes with respect to headache-related disability, neck pain, and cervical range of motion. 

This finding highlights the importance of examining the whole patient—something chiropractors are trained to do—and not just focusing on the area of chief complaint as issues elsewhere in the body may be the underlying cause or a contributing cause to the patient’s condition. 

Pain Relief Chiropractic

4909 Louise Dr

Mechanicsburg, PA 17055

 (717) 697-1888

Member of Chiro-Trust.org 

Migraine Headache Triggers, Protectors, and Predictors

17 Jun

Migraines are characterized by recurrent headache and a hypersensitivity to sensory stimuli that can trigger an episode. Unfortunately, migraine triggers can vary from patient to patient, which can make understanding and managing the patient’s condition a difficult proposition for both the patient and their doctor.

            In one study, researchers reviewed data from surveys, patient diaries, and clinical trials and identified stress, menstruation, weather changes, sleep disturbances, alcohol, and food sensitivities as common migraine triggers. In another study, researchers asked 62 migraine patients to use a smartphone app to keep track of their headaches for a three-month time frame. Participants reported headaches on nearly 1 in 4 days. Subsequent analysis identified that the most common triggers among the patients in the study were travelling, hormonal changes, noise, alcohol, over-eating, stress, fatigue, sleep deprivation, and weather changes.  Keeping a written record of anything that precedes a migraine such as diet or environmental changes can help a patient develop a sense of what they should avoid.

In the general sense, living a healthier lifestyle appears to reduce the likelihood of encountering migraine triggers. Therefore, patients are encouraged to get adequate sleep, exercise, eat a healthy diet, avoid excessive alcohol consumption, not smoke, and manage stress. In fact, the American Academy of Neurology reported in April 2021 that regular exercise could reduce headache frequency in migraine patients by up to 50%, largely due to exercise’s effect on reducing stress, depression, and poor sleep, all of which are potential migraine triggers.

What about chiropractic care? Can it help patients with migraines? The short answer is yes, to some degree. The current research suggests that patients with migraines often have greater sensitivity to pain in the neck muscles, which suggests abnormal function in the cervical spine. A 2021 study reported that cervical flexor muscle endurance is reduced in migraine patients, and the patients experienced pain in the head when the muscles become fatigued. Manual therapies provided by doctors of chiropractic to reduce trigger points and restore normal neck range of motion has been demonstrated to reduce migraine intensity and frequency, which was reported in a 2019 systematic review of six randomized control trials. A study published in 2021 found similar results in children with a history of migraines. Thus, regardless of age, patients with migraines (as well as other forms of headache), could benefit from an examination of the cervical spine and treatment to address any dysfunction that’s uncovered.

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 and the Headache Patient

13 Apr

According to a 2020 study, up to 1 in 5 new chiropractic patients list headaches as one of their chief reasons for seeking care. Let’s take a look at the features and characteristics that are often found in the chiropractic patient population…

A survey that included input from 224 adult patients with headaches as their chief complaint and 70 doctors of chiropractic revealed that 25% of patients who consult with a chiropractor concerning their headaches have headaches lasting longer than three months, known as chronic headaches, and 42% rate their headache pain as severe.

Based on International Classification of Headache Disorders criteria, 21% of these patients exhibited characteristics of migraine headaches, 17% likely had tension-type headaches, and a third experienced characteristics of two or more types of headaches. However, among the patients who rated their pain as severe, 62% had migraines and two-thirds had more than one type of headache.

A series of studies published in 2020 and 2021 compared multi-modal chiropractic care (ten treatments spread over 14 weeks) and enhanced usual care (medical treatment with migraine education literature) in the treatment of 61 adult women with episodic migraines. The patients in the chiropractic group experienced a near three-fold reduction in migraine days per month (2.9 days vs. 1 day).

Follow-up interviews with the participants in the chiropractic group on their perception of chiropractic care revealed three common themes: 1) over the course of treatment, participants became more aware of the role of muscle tension, pain, and posture in triggering a migraine; 2) participants revised their prior conceptions of chiropractic care beyond spinal manipulation; 3) participants viewed the chiropractor-patient relationship as essential and valuable for effective migraine management.

A study that included 150 patients with chronic tension-type headaches revealed that chiropractic care and the medication amitriptyline provided similar benefits during the treatment phase of the study. While three participants in the chiropractic treatment group reported neck soreness and stiffness, 82.1% of those in the group that took amitriptyline experienced side effects that included drowsiness, dry mouth, and weight gain. Of special note is that once treatment concluded, only the patients who received chiropractic care continued to experience reduced headache intensity and frequency while the participants in the medication group reverted to their initial headache intensity, frequency, and duration levels.

The findings from these and other studies support chiropractic care as an effective treatment option for patients with headaches, with few (if any) side effects and high patient satisfaction.

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 of the Elderly with Neck Pain

21 Sep

One-in-five adults over the age of 70 suffer from neck pain, which can dramatically affect their overall quality of life. So how effective is chiropractic care for a senior’s neck pain?

A 2019 study published in the journal Chiropractic & Manual Therapies surveyed 288 Australian chiropractors and found that individuals over 65 years of age account for nearly a third (28.5%) of total patient volume.

Of these elderly patients, nearly half (46%) sought treatment for neck pain, often with co-existing dizziness and headaches. The researchers found that this group of senior patients also has a fear of falling, which affected their ability to live independently.

The doctors of chiropractic in the survey reported they often approached treatment for seniors with neck pain using a combination of manual therapies (including spinal manipulation, instrument adjusting, mobilization, and active/passive stretches), modalities (ice/heat, ultrasound, electronic stimulation), specific exercises, and self-management recommendations to reduce pain and improve function in the neck and upper back.

Another benefit of a conservative treatment approach like chiropractic care for an older patient is that it does not involve over-the-counter or prescription medications, which can have undesirable side effects or interactions with other drugs the elderly patient may be taking.

In fact, a March 2020 study published in the journal Pain Medicine reported that patients who received chiropractic treatment for a musculoskeletal condition, like neck pain, were significantly less likely to fill a prescription for an opioid to manage their pain in the following year, especially if they consulted with a doctor of chiropractic first. Many of the patients in the study (nearly 99%) reported an improvement in their neck pain and associated symptoms following an average of nine treatments, though patients with both neck pain and migraines required two additional visits, on average. If you’re an older adult with new-onset or chronic neck pain, consider chiropractic 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.

Forward Head Posture and Neck Pain

13 Aug

Neck pain is one of the most common complaints that drive patients to seek chiropractic care. Sometimes the cause of injury is a known traumatic event, but in many cases, neck pain is the result of wear and tear from poor posture—forward head posture in particular.

The head, which weighs 10-11 lbs. (4.5-5 kg), typically rests above the shoulders. When an individual’s head leans forward to look at a computer screen or to look downwards at their smartphone/tablet, the muscles in the rear of the neck and upper back/shoulders need to work harder to keep the head upright.

Experts estimate that for each inch (2.54 cm) of forward head posture, the head feels about 10 lbs. heavier to the muscles that attach to the back of the head and neck. To illustrate this, pick up a 10-pound object like a bowling ball and hold it close to your body. Then, hold it away from your body with your arm outstretched and feel how much heavier it seems and the strain it places on your body to maintain that position for even a short time.

In the short term, forward head posture is something the body can manage, but over time, the muscles can fatigue and the strain can injure the soft tissues in the back of the neck, shoulders, and upper back. To adapt, some muscles may become stronger (and some may atrophy), the shoulders can roll forward, the cervical curve can straighten, etc. Researchers have observed that forward head posture can also reduce neck mobility, especially with rotation and forward flexion movements. While these changes can lead to several negative health issues, neck pain is perhaps the most obvious and common.

When a patient presents for chiropractic care for neck pain, postural deficits will likely need to be addressed to achieve a satisfactory outcome. This can be achieved with manual therapies to restore proper motion in the affected joints and with exercises to retrain the muscles that may have become deconditioned. Additionally, a patient will need to develop better postural habits, especially when interacting with their electronic devices. While the process can take time, the good news is that it’s possible to reduce forward head posture, which can also lower the risk for neck pain recurrence.

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.