Archive | Neck Pain RSS feed for this section

The Four Grades of Whiplash Associated Disorders

15 Dec

Whiplash occurs when the head suddenly accelerates and then rapidly decelerates, placing
excessive strain on the soft tissues that support the neck. In addition to neck pain and stiffness, this
motion can produce a variety of symptoms collectively known as whiplash-associated disorders
(WAD). To better define and manage these injuries, the Quebec Task Force on Whiplash-Associated
Disorders (1995) developed a classification system that grades whiplash severity from I to IV.
WAD I is characterized by neck pain and stiffness without any objective findings on physical
examination. In other words, there is no loss of range of motion; no muscle spasm or guarding; no
swelling, bruising, or deformity; no neurological deficit; and no imaging abnormalities.
Approximately 15–25% of whiplash patients fall into this category.
In WAD II, neck symptoms are accompanied by physical examination findings such as
decreased range of motion, localized tenderness in neck muscles, muscle spasm, and sometimes
headache. However, there are no neurological deficits or abnormalities visible on diagnostic imaging.
About two-thirds of whiplash patients are graded WAD II.
At the WAD III level, patients present with both musculoskeletal findings (as seen in WAD
II) and neurological signs, which may include sensory loss (numbness or tingling), motor weakness
(reduced strength in muscles supplied by affected cervical nerves), altered reflexes, or radiating arm
pain. As with WAD I and II, the injury still involves soft tissues that typically do not appear on X-ray
or advanced imaging. Approximately 5–10% of whiplash patients fall into this grade of WAD.
The classification of WAD IV is utilized when there is structural damage to the cervical spine
that is present on diagnostic imaging and is usually associated with severe symptoms. Patients with
WAD IV typically require emergency treatment to stabilize the spine. Fortunately, fewer than 1–2%
of whiplash patients meet this criterion.
The good news is that WAD I, II, and III typically respond well to a multimodal chiropractic
approach aimed at reducing pain and restoring function as quickly as possible. Manual therapies may
include gentle, low-velocity, low-amplitude techniques; thrust manipulation (high-velocity, lowamplitude); facet gliding; long-axis cervical traction; passive range-of-motion exercises; massage;
trigger-point therapy; dry needling; or acupuncture. Adjunctive physical therapy modalities such as
electrical stimulation, therapeutic ultrasound, laser therapy, pulsed electromagnetic field (PEMF)
therapy, in-office or home cervical traction, and others are also frequently utilized. Exercise training
is a crucial component of care, as long-term improvement depends on patient self-management and
reduces provider dependency that can sometimes arise. In the event a patient does not respond to care
or if additional issues are present that fall outside the chiropractic scope, the case may be co-managed
with an allied healthcare provider.
Brent Binder, D.C.

4909 Louise Dr. Suite 102 Mechanicsburg, PA 17055 (717) 697-1888

Tags: , , ,

Chiropractic Approach for Tension-Type Headaches

13 Nov

Almost everyone will experience headaches during their lifetime, with roughly half of adults reporting at least one episode each year. While many may be transitory, some patients develop recurring or persistent headaches. The most common form is the tension-type headache (TTH), accounting for an estimated 60–70% of all chronic headache cases.

Tension-type headaches are characterized by bilateral, non-pulsatile pain of mild to moderate intensity, typically described as a tightening or pressing sensation lasting from 30 minutes to seven days. Many patients liken the pain to a band-like pressure encircling their head. Unlike migraines, TTH is not associated with nausea or vomiting, and patients can usually tolerate routine physical activity. Some may report sensitivity to either light or noise (but not both), and about 20% experience mild loss of appetite.

There is no specific diagnostic test or imaging finding for TTH. Diagnosis is based on its characteristic symptom pattern—bilateral, pressing pain not worsened by activity combined with the absence of migraine features and exclusion of secondary causes through clinical history, physical exam, and neurological assessment. If red flags are present—such as sudden severe onset, progressive worsening, systemic illness, or neurological deficits—urgent referral to an emergency department or specialist is warranted.

A 2023 study in Musculoskeletal Science & Practice found that many TTH patients also experience neck pain, limited range of motion, and impaired motor control. Palpation of trigger points in the neck muscles or upper cervical joints can often reproduce the headache pain pattern. These findings suggest cervical spine examination is an important component of evaluation, and addressing dysfunction through manual therapies—such as spinal manipulation, mobilization, soft tissue work, and neck-specific exercise—may provide benefit.

Studies have found that manual therapies applied to the cervical region to address trigger points in the muscles and restore normal movement to joints and other soft tissues can reduce the intensity, duration, and frequency of tension-type headaches. However, a multimodal approach that includes modalities, therapeutic exercises, and diet and lifestyle improvements may be necessary to more effectively manage the condition.

Pain Relief Chiropractic

4909 Louise Drive Suite 102

Mechanicsburg, PA 17055

Tags: ,

Multimodal Treatment for Chronic Neck Pain

13 Oct

Chronic neck pain is one of the most common musculoskeletal disorders, with up to half of adults experiencing it in a given year, and it accounts for as much as 4% of all visits to healthcare providers. The most common classification is non-specific neck pain, meaning the condition arises from musculoskeletal strain or dysfunction in the neck region without a clearly identifiable medical pathology such as fracture, infection, tumor, or inflammatory disease. Because the exact pain generator is often difficult to determine, treatment focuses instead on restoring normal motion to the cervical spine using a multimodal approach.

The mainstay of chiropractic treatment for neck pain and other musculoskeletal disorders is manual therapy, delivered either hands-on or with the assistance of instruments. The most common technique is spinal manipulation, also called spinal manipulative therapy, which involves high-velocity, low-amplitude movements applied at the end of a joint’s range of motion to restore mobility, reduce pain through neuromechanical effects, and normalize function of the spine and surrounding tissues. Other forms of manual therapies may also be used, such as mobilization (slower, gentler movements within the range of motion), myofascial therapy (sustained pressure or stretching to release restrictions in connective tissue), and trigger point therapy (direct, focused pressure to relieve taut muscle bands). All share the goal of restoring normal movement and reducing pain.

Exercise is another key component of managing neck pain, both to relieve current symptoms and to reduce the risk of recurrence. Neck pain often relates to poor posture that places excess strain on some muscles while deconditioning others. For instance, forward head posture shifts the head in front of the shoulders, forcing posterior neck muscles to overwork while anterior neck muscles weaken. To address these imbalances and other deficits, patients may be prescribed range-of-motion drills, stretching, strengthening, postural retraining, and proprioceptive exercises.

Additional treatment strategies may be incorporated depending on the patient’s needs and preferences, the provider’s clinical training, and examination findings. These may include ergonomic advice, physiotherapy modalities, ice/heat, dietary modifications, and nutritional supplementation. Multimodal approaches are well supported in the literature, consistently providing better outcomes than any single therapy alone. When needed, chiropractors may co-manage care with other healthcare providers, always with the goal of reducing pain, improving function, and helping patients return to normal activities as quickly as possible.

Pain Relief Chiropractic

4909 Louise Drive Suite 102

Mechanicsburg, PA 17055

Treating the Neck of the Carpal Tunnel Syndrome Patient

6 Mar

Carpal tunnel syndrome (CTS) is the most frequently diagnosed peripheral neuropathy and one of the most common conditions affecting the hand. The disorder typically results from compression of the median nerve on the palm side of the wrist, leading to numbness, tingling, and sometimes weakness in the thumb and fingers—except for the pinky and the pinky-side of the ring finger, which are innervated by the ulnar nerve. To avoid surgery, many CTS patients seek chiropractic care, which often includes manual therapies applied beyond the wrist and even to the neck due to the nature of the median nerve.

The median nerve originates from the C6-T1 spinal nerve roots in the neck and provides sensory and motor functions to the palm-side forearm and hand. It enables gripping, forming a fist, and detecting temperature and texture. If the mobility of the median nerve is restricted along its course, the resulting symptoms may mimic or overlap with traditional CTS. To complicate matters further, compression can occur at multiple sites, all of which need to be addressed for effective treatment.

In an October 2024 study, researchers divided 48 CTS patients into two groups. Both groups received wrist-focused treatment, including ten sessions of wrist mobilization, electrotherapy, and the use of a nocturnal wrist splint to maintain a neutral wrist posture overnight. However, one group also received manual therapies targeting the cervical spine. Patients underwent motor and sensory nerve conduction testing and completed questionnaires on CTS-related disability at baseline, immediately after treatment, and at six-month follow-ups.

Initially, both groups reported similar improvements in all outcome measures. However, at the six-month follow-up, the group that received cervical spine care showed greater improvements, suggesting that long-term benefits favor incorporating cervical spine treatment into CTS care.

Doctors of chiropractic are well-equipped to assess the entire course of the median nerve—from the neck to the hand—and identify all potential areas of restriction. They can provide conservative treatments to restore normal nerve function and help patients return to their daily activities. In more complex cases, chiropractors may coordinate care with specialists or medical physicians as needed.

Pain Relief Chiropractic

4909 Louise Drive, Suite 102

Mechanicsburg, PA 17055

Painreliefcare.net

Member of Chiro-Trust.org

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.

Tags: , , , , , ,

The Jaw Pain and Neck Pain Connection

7 Sep

Temporomandibular disorders (TMDs) are a common condition characterized by pain and discomfort while chewing. Traditionally, when patients complain of jaw pain, the focus has been on structures like the temporomandibular joint or the masseter muscles. However, there’s a growing body of research suggesting the intimate relationship between the jaw and the neck may be a contributing factor or even the underling cause of a patient’s TMD.

In one study, which included 40 women between 19 and 49 years of age, half of whom had chronic TMD, researchers observed that participants with jaw pain and discomfort were more likely to have neck pain and stiffness that limited their daily activities. Additionally, among the TMD patients, the more jaw muscle tenderness they exhibited, the higher their scores for both TMD- and neck-related disability. The research team observed a similar relationship between tenderness in the upper trapezius (the muscles in the shoulder and neck regions) as well as the temporalis muscles that function to close the jaw, located on the side of the head above the ear extending to the temporomandibular joint. The authors concluded that a significant correlation between neck disability and jaw disability exists and that healthcare providers should consider the neck and its related structures during the evaluation and management of patients with TMD.

These findings are echoed in a July 2022 study that found TMD patients with restricted cervical range of motion experience more severe TMD-related pain and disability than TMD patients with normal cervical range of motion. Another study published the same month found that patients with chronic (lasting longer than three months) TMD were two times more likely to have neck pain than individuals with acute (less than three months) TMD. A study published later that year linked neck pain with increased sensitivity of the masticatory muscles in TMD patients, leading the author to conclude, “In TMD treatment, we should pay attention to and actively relieve neck pain.”

In a study published in October 2021, researchers found that patients with concurrent neck pain and TMD experienced improvements in jaw function following care targeting the cervical spine. A systematic review conducted in 2023 confirmed these findings. The authors cited five studies that supported the application of manual therapies to restore normal movement to the cervical joints can improve pain, pain sensitivity, and function in the jaw. Interestingly, a systematic review published in March 2024 concluded that cervical rehabilitation interventions—such as manual therapies combined with neck-specific exercises—are effective for reducing pain intensity associated with myogenic temporomandibular disorders, which is TMD specifically linked to pain originating in the jaw muscles.

The good news is that doctors of chiropractic are well-versed in managing patients with neck pain as well as TMD using manual therapies and specific exercises to address trigger points in the jaw and neck muscles, as well as to restore normal motion to the temporomandibular joint and cervical spine.

Brent Binder, D.C. 4909 Louise Dr. Suite 102 Mechanicsburg, PA 17055 (717) 697-1888

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.

Neck Disorders and Their Connection to Migraines

20 Oct

It’s estimated that about 38 million American adults suffer from migraines and nine-in-ten report that to some degree, migraines affect their ability to carry out their normal social, leisure, work, and everyday activities. Unfortunately, there isn’t a one-size-fits-all treatment for migraines as the condition is not well understood and management tends to focus on lifestyle modifications to avoid potential triggers for a patient’s particular migraine profile. But what if a potential key to managing migraines wasn’t in the head at all? What if the neck had a role to play in migraine headaches?

A 2015 study found that 87% of chronic migraine headache patients also have neck pain. Compared with the non-headache sufferers the researchers questioned, individuals with migraines were roughly three-to-four times more likely to have neck pain. To highlight this relationship between the neck and migraines, a 2023 study looked at 295 migraine patients and found that more than half (51.9%) also had concurrent neck pain. Further analysis showed that migraine sufferers with concurrent neck pain reported more severe migraine symptoms, and the more disabling their neck pain, the worse their migraines. This makes some sense as the trigeminal nerve, which helps innervate the face and has been linked to migraines, exits the spinal cord through the upper cervical spine and travels into the face. In addition to irritation of the trigeminal nerve having a part to play in the migraine process, previous studies have identified a link between migraines and impaired cervical range of motion, reduced neck muscle endurance, and the presence of trigger points in the neck muscles. 

The good news is that doctors of chiropractic have a number of tools in their treatment repertoire for addressing these issues: spinal manipulation, mobilization, myofascial release, and other manual therapies to dry needling, neck-specific exercise, postural training, dietary recommendations, and more. It all depends on the patient’s unique presentation. This approach appears to be effective, as demonstrated in a recent three-armed trial that compared spinal manipulative therapy, sham manual treatment, and usual medical care after a three-month treatment period with follow-ups at three, six, and twelve months. The results favored chiropractic care at all time points. A systematic review of 13 studies published in 2022 concluded that mobilization techniques, trigger point therapy, manual lymphatic drainage, massage, and stretching techniques are each effective interventions for migraine headache patients, especially when used in combination. Other studies have demonstrated that addressing trigger points in the neck and other disorders in the cervical spine can result in reduced frequency, intensity, and duration of migraine episodes.

While managing migraines may require a comprehensive approach that includes exercise, diet, and lifestyle modifications, it’s clear that disorders of the neck can contribute to, if not be an underlying cause of, migraines and should be addressed. If you suffer from migraines, especially if you also have neck pain or stiffness, consult your doctor of chiropractic. 

Pain Relief Chiropractic

4909 Louise Dr

Mechanicsburg, PA 17055

(717) 697-1888

Member of Chiro-Trust.org 

Tags: ,

← Older Entries