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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.
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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.

What Exercises Are Best for Neck Pain?

16 Jul

Past research has demonstrated that combining spinal manipulative therapy (SMT) with exercise yields the best long-term results for individuals with neck pain. So what exercises should we consider when neck pain rears its ugly head?

In the acute phase of an injury, rest and ice may be appropriate, but patients will often benefit from lightly applied isometric exercises. Place your hand against the side of your head and lightly push your head into your hand for a count of five seconds. If tolerated, tip your head sideways five to ten degrees and repeat the process. This can be repeated multiple times at progressively greater angles until you’ve accessed your full range of motion (ROM).

The above isometric exercise can be repeated in the opposite direction as well as forwards, backwards, and into left and right rotation directions. The KEY is to always stay within reasonable pain boundaries—no sharp/”bad” pain allowed!

You can then move on to isotonic neck exercises. Using the same amount of light pressure, gently push your head into your hand as you did before, but this time, allow the head to move slowly toward the shoulder against the pressure of the hand. This too can be repeated on the opposite side, forwards, backwards, and into left and right rotation.

Using only one or two fingers rather than the whole hand helps to prevent you from pushing too hard with your hand or head when performing isometrics or isotonic exercises. Also, the same movements of the head can be done without any hand/finger resistance, but faster results seem to occur when pressure is applied.

Studies also show that weakness of the deep neck flexor muscles is very common in people with chronic (more than three months) neck pain. These are deep, involuntary muscles, so to properly strengthen them, look straight ahead, tuck in your chin as far as you can, hold for five to ten seconds, and repeat five to ten times.

Beyond treatment options for neck pain such as spinal manipulation, mobilization, and exercise, your doctor of chiropractic may utilize soft tissue therapies such as myofascial release, active release technique, as well as various physical therapy modalities, ergonomic modifications, and more in the effort to help you get out of pain and return to your normal activities.

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 Treatments Work Best for Neck Pain?

18 Jun

Experts estimate that up to 70% of people will experience an episode of neck pain in their lifetime. Though there are many potential forms of treatment available, little has been published comparing the various treatment options available to the neck pain patient.

A 2012 study that involved 272 neck pain patients compared three treatment options: chiropractic, medication, and exercise. After twelve weeks of treatment, the patients who received either chiropractic care or exercise instruction reported the greatest reduction in pain. The researchers followed up with the participants for up to a year and found that the patients in the chiropractic and exercise groups continued to report less pain than those in the medication group, and these benefits persisted until the end of the study. The researchers concluded that participants from both the chiropractic care and exercise therapy groups had more than double the likelihood of complete pain relief than with the patients in the medication group.

Quality studies on the short- and medium- term benefits of exercise and manual therapies applied to the cervical spine for patients with neck pain have been published since the 1980s. However, the benefits over the long term are not as well documented. With this in mind, a 2002 study followed 191 patients with chronic neck pain for two years comparing spinal manipulation (SM) with and without one of two types of exercises: low-tech (and low cost) rehabilitative exercise (LTEx) or high-tech MedX (machine assisted) rehabilitative exercises (HTEx).

The research team randomly assigned the 191 patients to eleven weeks of one of three treatments: SM only; SM + LTEx; or SM + HTEx. The investigators evaluated the patients at the start of the study, again after five weeks of treatment, and finally following the conclusion of the treatment phase of the study at eleven weeks. They followed-up with the patients three, six, twelve, and 24 months later as well.

The results showed that SM + LTEx and SM + HTEx were both superior to SM alone at both one- and two-year time points. Overall, the patients in the SM + LTEx group reported the greatest pain reduction and satisfaction with care. This finding is even more important, as the care delivered to the SM + LTEx group costs less than care involving specialized, more expensive equipment.

It’s clear that chiropractic care that includes spinal manipulation and/or mobilization with exercise training yields the best long-term outcomes. Add to that the use of soft tissue therapies such as myofascial release, active release technique, and various modalities, and chiropractic is CLEARLY the best choice for patients with 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.

Does Slouching Cause Neck and Shoulder Pain?

22 Mar

In a 2015 study, Swedish researchers compared the effect of a slouched vs. normal body posture with regards to performing lifting tasks.

In particular, investigators wanted a better understanding of how a slouched posture affects neck and shoulder function and muscle activity in three large muscle groups—the upper trapezius (UT), lower trapezius (LT), and serratus anterior (SA)—during arm elevation to see if it affects range of motion, muscle activation patterns, maximal muscle activity, and total muscle work.

Study participants—non-injured, young adult males—perform maximum arm elevations in upright and slouched postures that researchers observed using a combined 3D movement and EMG (electromyography) assessment system. This measured the arm range of motion, velocity, and spine curvature simultaneously with EMG activity in the UT, LT, and SA muscles.

The research team found that participants in the slouched position experienced significantly less arm elevation and decreased movement velocity both upwards and downwards, in addition to increased peak muscle activity (that is, the muscles had to work harder) in all three muscles tested.

It appears that increased thoracic kyphosis (slouching) leads to a marked increase in physical requirements when performing simple arm movements. Over time, such changes in function could place added stress on the muscles, tissues, and joints of the neck and shoulder, leading to pain and injury. These findings add to a growing body of research regarding the detrimental long-term effects of poor posture as well as an understanding of how exactly faulty postures increase the risk of musculoskeletal disorders.

In their conclusion, the authors of the study write, “[Patients] suffering from neck-shoulder pain and disability should be investigated and treated for defective thoracic curvature issues.”

 

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.

Migraine Headaches and Nutrition?

18 Jan

According to a World Health Report, migraines are the nineteenth most common patient complaint worldwide with an 18% of women and 6% of men in the United States experiencing at least one migraine headache episode each year.

There is evidence that patients with migraines have an energy deficit disorder associated with their glucose intake. As such, adopting a strict ketogenic diet (in which ketones are the primary source of energy for the body in place of glucose) does appear to benefit patients with migraines.

A 2017 study set out to determine if it was the absence of glucose or the increase in ketone bodies that made the difference for patients. In the study, researchers provided four female migraine patients with a specially designed ten-gram beverage containing a specific type of ketone  called B-hydroxybutyrate or bHB twice a day for four weeks.

After one month, their migraine frequency rate dropped 50% to eight days/month on average without any serious side effects.  The patients also lost weight, presumably due to consuming less glucose in their diet. An additional benefit of higher levels of ketones in the body is that they have an anti-inflammatory effect.

A larger double-blind, randomized, placebo-controlled trial is now underway with a group of 90 patients that will last three months The goal of the study is to determine if this nutritional supplement is capable of reducing migraine headaches without the significant side effects and associated disabilities that are currently associated with many migraine medications.

Chiropractic care often includes nutritional counseling as an important part of caring for the whole person. In fact, there is research supported evidence that spinal manipulation alone has a very positive benefit for migraine headache patients as noted in the 2010 and 2014 UK studies regarding the effectiveness of manual therapies. Based on the outcome of this large-scale study, the use of ketone-based supplementation for migraines may become a new standard.