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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.

Myofascial Trigger Points and Headaches

20 Feb

A myofascial trigger point (TP) is a hyper-irritable area in skeletal muscle that is commonly detected by palpating (feeling with the fingers). Although more sophisticated ways exist for locating TPs—ultrasound, microdialysis, electromyography, infrared thermography, and MRI—palpation remains the most utilized due to its simplicity, efficiency, and low cost. For patients with migraine and tension-type headaches, TPs are commonly found at the base of the skull/upper neck, paraspinal neck muscles, the upper trapezius, and/or the levator scapulae musculature.

In one study that included 34 headaches sufferers (20 had migraine headaches without aura and 14 had tension-type headaches) and 34 non-headache controls, researchers looked at what happened when they used a specific technique to recreate the effect of a trigger point on muscles in the upper neck and in the arm.

When the researchers stimulated the upper neck, 8 of the 14 (57%) members of the non-headache control group, all 14 TTH subjects, and 19 of the 20 migraine sufferers reported headache-related symptoms. On the other hand, when the same technique was used on the arm of each participant, none reported headache-like symptoms.

The authors concluded that the high incidence and accuracy of headache reproduction from upper neck stimulation supports the importance of evaluation and treatment of trigger points in the upper neck region in those with TTH and migraine headaches. Doctors of chiropractic commonly perform manual techniques to the upper neck region and train their headache patients in identifying and self-managing TPs located in the upper neck muscles.

Several methods can be used to self-treat TPs in the upper neck region. Perhaps the easiest approach is to reach back with your thumb to the muscle attachments along the base of the skull and apply deep (but tolerated) pressure, feeling for areas that are most sensitive and sliding the thumb up/down and across the sore TP until it becomes less tender. Work the left side with the left thumb and vice versa. Doing the same with small head movements—up/down, left/right rotations, etc. helps.

Another method is to sit in a straight-back chair, slide down so that you cradle your upper neck over the top edge of chair back and then roll your head left to right. When you find a sore TP, add a nodding type of head motion while “digging in” over the chair-back edge (within tolerance) until it loosens and hurts less. If you suffer from headaches, your doctor of chiropractic can train you in these and other effective exercises and render treatment to improve cervical function that can be highly effective at reducing both the frequency and intensity of headaches.

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.

Headaches May Suggest a More Severe Concussion

13 Jan

Cervical dysfunction is often a cause or contributing factor of headaches, especially those that occur following a sports injury, slip and fall, or motor vehicle collision. The results of a 2019 study suggest that headaches may also indicate when a patient has a severe traumatic brain injury (TBI).

In the study, researchers asked 121 children with a history of TBI to fill out a questionnaire called the Sports Concussion Assessment Tool (SCAT). A higher score on the SCAT is indicative of a more severe TBI. Among the participants, the SCAT revealed that a third (40) reported headaches following their injury. When the researchers compared the SCAT scores of the kids with post-TBI headaches and those without headaches, they found that the participants who experienced headaches scored five times higher (median score 45.5 vs. 9). These children also performed worse on cognitive assessments involving color naming, matrix reasoning, letter sequencing, and letter switching.

The authors concluded that when headaches are associated with TBI, higher symptom scores (i.e. more severe symptoms) for ALL other symptom categories (sleep, mood, sensory, and cognitive domains) can be expected. In addition, those with headaches also tested worse on neurocognitive examinations.

Interestingly, a study that included a wider age range reported that headache “is consistently the most common symptom following concussion and occurs in over 90% of athletes with sport-related concussion,” which is much higher than the 33% found in the above- mentioned study.

Another study that analyzed information from two large databases found that patients who are hospitalized for headache symptoms associated with TBI are two times more likely to experience more frequent or worse headache symptoms over the following decade. Thus, the worse the initial TBI, the more likely headaches will persist or worsen.

These studies suggest that when an individual suffers a TBI from a sports injury, slip and fall, or car accident AND they have headaches, their condition may be more severe and may require more specialized care or intensive treatment to achieve a successful outcome. These injuries can also affect the cervical region, which may explain why patients with TBI benefit from many of the same treatment approaches doctors of chiropractic use to treat whiplash associated disorder patients.

 

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.

Spinal Manipulation and Headaches

19 Dec

Cervicogenic headache (CGH) refers to headaches caused by dysfunction in the neck, and experts estimate that 18% of chronic headache patients have cervicogenic headaches. Spinal manipulative therapy (SMT) is a form of treatment most commonly provided by doctors of chiropractic, and several studies have demonstrated that SMT is highly effective for patients suffering musculoskeletal disorders of the neck, including those with cervicogenic headaches. However, there remains little consensus on the appropriate number of SMT treatments to achieve maximum benefits for CGH.

In a 2018 study, a team of researchers conducted a large-scale study involving 256 chronic CGH patients to determine how many treatments are needed to achieve optimum results using SMT for CGH. The investigators randomly assigned participants to one of four dose levels (0, 6, 12, or 18 visits) of SMT for six weeks. The type of SMT consisted of a manual high-velocity, low-amplitude (HVLA) thrust manipulation in the cervical and upper thoracic regions. The location of the spinal adjustment was determined by a brief, standard spinal palpatory examination from the occiput to T3 to assess for pain and restricted motion. For older patients and/or those in acute pain, the manual therapy was modified to a low-velocity, low-amplitude mobilization. To control for visit consistency and provider attention, patients continued to receive a light massage treatment once a patient’s assigned number of visits was satisfied, until the six-week treatment period ended.

After the conclusion of the treatment phase of the study, the participants used a headache diary to keep track of their headaches for the next year. The results showed that the patients who received the most SMT treatments had fewer headaches over the following twelve months. More specifically, the researchers calculated that six additional SMT visits resulted in about twelve fewer days with headaches over the next year.

If you suffer from headaches, consider consulting with a doctor of chiropractic to determine if cervical dysfunction is a potential cause or contributing factor and whether you are a candidate for spinal manipulative therapy.

 

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 Cell Phones Cause Horns?

21 Oct

It’s not hard to argue that nearly everyone spends too much time on their electronic devices, especially smartphones. You may be familiar with the terms “text neck” or “forward head posture”, but have you heard that excessive cellphone use may cause your body to grow horns?

If you reach around to the back of your head, just above the top of the neck, you should feel a bump in the midline. This is NORMAL, and it’s called the external occipital protuberance (EOP). The EOP serves as an attachment point for the nuchal ligament and the trapezius muscle, which function to keep the head upright and tilted backward. The size of the EOP normally varies (averaging around 5mm), depending on race, gender, genetics, and occupation.

A 2016 study revealed that an alarming number of young people had spurs (technically called enthesophytes) extending from the EOP, an occurrence associated with the wear-and-tear of osteoarthritis that can develop later in life. In the study, researchers reviewed x-rays of 218 men and women 18 to 30 years old who either had back pain, neck pain, or headaches or no history of such conditions. The research team observed an enlarged EOP (EEOP for short) in 41% of participants, regardless of the presence or absence of musculoskeletal pain. However, the data did show that EEOP was three-times more common in men than women.

The same study authors conducted a larger study in 2018 that included 1,200 adults of all ages and found that the combination of male gender, the degree of forward head protraction (FHP), and age predicted the presence of EEOP. Their results showed that being a young male with a greater amount of FHP lead to the formation of EEOP.

The researchers suspect that the age component of their finding (after all, the frequency and severity of degenerative skeletal spur formation typically worsen with age) may be due to young adults placing a greater mechanical load on their necks due to forward head posture caused by excessive device use.

The good news is that studies have demonstrated forward head posture can be improved with specific resistance and stretching exercises, monitoring your posture while using electronic devices, and reducing electronic device use. Your doctor of chiropractic can show you exercises that you can perform at home to reduce forward head posture.

 

 

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.