Pain Relief Chiropractic

Wouldn’t it be nice if we could assess three common types of treatment for neck and back pain to determine which is the most effective? Here is a look at three studies that compared three popular forms of care for chronic spinal pain to determine the short-term and more importantly, the LONG-TERM benefits of chiropractic manipulation, acupuncture, and non-steroid anti-inflammatory drugs (NSAIDs, like Advil).

The FIRST published study included a pilot group of 77 patients complaining of chronic spinal pain (neck, mid-back, or low-back pain). These patients were separated into one of the three treatment groups and received either NSAIDs, acupuncture, or chiropractic manipulation. Patients received care for four weeks with outcome measures (questionnaires) used to assess changes in pain and disability. After a 30-day time frame, only patients who received chiropractic manipulation (CM) reached a level of statistically significant improvement, supporting CM to offer the best SHORT-TERM BENEFITS for those with chronic back/neck pain.

The SECOND study included 115 patients, again randomized, to receive either one of the same three treatments, but this time the outcome data was gathered two, five, and nine weeks after the start of treatment. Again, those who received chiropractic manipulation (CM) experienced the best overall improvement at nine weeks.

The THIRD study involved follow-up from the same patient group from the SECOND study two years later. Once again, participants completed outcome assessments that measure pain and disability. This time, the results showed that only patients in the chiropractic manipulation group maintained long-term improvements in pain and disability.

There have been other studies looking at the efficacy and benefits of SMT (spinal manipulative therapy) both in comparison with other forms of care (as presented here) as well as with different conditions or diagnoses. Perhaps the most exciting results were published in 2008 by the International Bone and Joint Decade 2000-2010 Task Force on Neck Pain. They divided patients into four groups (Group 1: Neck pain with little to no interference with activities of daily living – ADLs; Group 2: Neck pain that limits ADLs; Group 3: Neck pain with radiculopathy or radiating arm pain from a pinched nerve; Group 4: Neck pain with serious pathology such as cancer, fracture, infection, and/or systemic disease.) The researchers concluded that chiropractic care was highly recommended especially in Grades 1 and 2 (which includes the majority of neck pain sufferers). Interestingly, many multidisciplinary physician groups now incorporate chiropractic care as part of their “team” approach, which also offer pain management in the form of medications, injections, PT, and when necessary, surgery. They have seen the value of spinal manipulation for neck pain and often seek out chiropractic because it’s safe, beneficial, and cost effective!

We realize you have a choice in whom you consider for your health care provision and we sincerely appreciate your trust in choosing our service for those needs.  If you, a friend, or family member requires care for neck pain or headaches, we would be honored to render our services.

As stated last month, exercises that focus on improving posture, flexibility, strength, and coordination are important for creating a well-rounded cervical rehabilitation program. Our discussion continues this month with stretching and strengthening exercises.

STRETCHING: Since our neck muscles have to hold up our 12 pound (~5.5 kg) head, it’s no wonder why our neck muscles seem to be tight almost all the time. Here are two ways to stretch the neck: 1) You can simply drop the chin to the chest, look at the ceiling, try to touch your ear to your shoulder (without shoulder shrugging) on both sides, and rotate the head left to right and vice versa (six directions). 2) You can use gentle pressure with your hand and assist in the active stretch by gently pulling into the six directions described in #1 by applying “over-pressure” at the end-range of motion (staying within “reasonable pain boundaries”).

STRENGTHENING: Most people have a forward head carriage, meaning their head normally rests in front of their shoulders. The further forward the head sits, the greater the load on the muscles in the back of the neck and upper back to hold it up. This position promotes a negative spiral or “vicious cycle” that can lead to many complaints including (but not limited to) neck pain, headaches, balance disturbances, and in the long-term, osteoarthritis. There are two important groups of muscles that require strengthening: the deep neck flexors and deep neck extensors.

1)    The deep neck flexors are muscles located directly on the front of the cervical spine and are described as being “involuntary” or unable to be voluntarily contracted. Hence, we have to “trick” the voluntary outer “extrinsic” (stronger) muscles into NOT WORKING so the deep, intrinsic ones will contract. You can do this by flexing your chin to the chest and pushing your neck (not head) back over your shoulders into resistance caused a towel wrapped around the back of the neck. If you feel your chin raise towards the ceiling, you’re doing it WRONG! Keep the chin tucked as close to the chest as possible as you push your neck (not your head) backwards. If you’re doing it correctly, your chest should raise towards the ceiling as you push your chin down and neck back. Try it!

2)    The deep neck extensors are strengthened in a very similar way EXCEPT here you DO push the back of HEAD back into your towel while keeping your chin tucked tightly into your chest. Do three reps, holding each for three to five seconds and switch between the two for two to three sets.

We will finish this discussion next month with important coordination exercises!

We realize you have a choice in whom you consider for your health care provision and we sincerely appreciate your trust in choosing our service for those needs.  If you, a friend, or family member requires care for neck pain or headaches, we would be honored to render our services.

Neck pain can occur for many different reasons, but what can you do about it? That’s the BIG question! As discussed last month, exercise training is an important part of the chiropractic management process. Let’s take a close look at which exercises are MOST important with respect to self-management strategies. There are several goals or reasons to perform neck exercises. We will break these down into four main categories: Posture, stretch, strengthening, and coordination.

POSTURE: The biggest culprit in this category is the forward head carriage. If you look around a crowded airport, bus stop, train station, or mall, you can see MANY examples of this. If fact, this faulty posture is estimated to occur in 66-90% of the population! Also, forward head posture is STRONGLY associated with decreased respiratory muscle strength, which can reduce lung capacity and our ability to breath by as much as 30%! It’s also linked to tension headaches, altered eye and ear function, high blood pressure, and over time it can lead to arthritis, herniated disks, pinched nerves, and more. The “classic” appearance is the position of the head is too far forward, the shoulders roll forwards and the upper back sticks out. Did you know that for every inch the head glides forwards from the proper position, there is a 10 lbs (~4.5 kg) increase of weight that the neck and upper back muscles have to hold up? Using an average 12 lbs (~5.4 kg) head, a 5 inch (~12.7 cm) forward head carriage places an extra 50 lbs (~23 kg) of weight on the upper back/neck muscles for a 62 lbs (~28 kg) total! So, LET’S FIX IT!

Here is one exercise that may help your posture: Look straight ahead and 1) Tighten your core by performing an abdominal brace. This is done by contracting your belly muscles so that when you poke your thumbs into your sides and front, you feel a firm abdominal muscle wall. You don’t have to “brace” at a 100% of maximum, shoot for 25-50% or just enough to feel the muscles contract. Relax and contract several times so you’re sure you can feel the muscles tighten up. Keep a curve in your lower back when you do this (don’t slouch). 2) Lift your chest – don’t just tuck you head back! This will improve the rounded shoulders and slouched upper back posture. Think of lifting your chest towards the ceiling more than just sticking it out. Notice in a mirror how much improvement occurs already! 3) Perform chin retractions – do 10 retractions every hour (set the timer on your cell phone to remind you)! Do this gently, slowly, and to a firm end-point of movement. If you feel like you are creating a “double or triple chin,” you are doing it right! If you do the ten reps every hour, then in an eight hour work day, you’ll have done 80 posture corrections! This a GREAT way to “re-program” your nervous system and when you find yourself doing this WITHOUT THINKING, it will have become a new (and good) habit! Stay tuned next several months for more neck exercises focused on STRETCH, STRENGTHEN, and COORDINATION training!

We realize you have a choice in whom you consider for your health care provision and we sincerely appreciate your trust in choosing our service for those needs.  If you, a friend, or family member requires care for neck pain or headaches, we would be honored to render our services.

As discussed last month, when you make an appointment for a chiropractic evaluation for your neck pain, your doctor of chiropractic will provide both in-office procedures as well as teach you many self-help approaches so that as a “team”, together WE can manage your neck pain or headache complaint to a satisfying end-point. So, what are some of these procedures? Let’s take a look!

In the office, you can expect to receive a thorough history, examination, x-ray (if warranted), and a discussion about what chiropractic care can be done for you and your condition. Your doctor will map out a treatment plan and discuss commonly shared goals of 1) Pain reduction, 2) Posture/alignment restoration, and 3) Prevention of future episodes. Pain reduction approaches include (but are not limited to) joint mobilization and/or manipulation, muscle/ligament stretching techniques, inflammation control by the use of physical therapy modalities (such as electrical stimulation), ice, and possibly anti-inflammatory vitamin / herbal therapies. Your chiropractor will also teach you proper body mechanics for bending/lifting/pulling/pushing, and help you avoid positions or situations where you might re-injure the area. Posture/alignment restoration can include methods such as spinal manipulation / mobilization and leg length correction strategies (heel and/or sole lifts, special orthotic shoes, and/or foot orthotic inserts). These are often GREAT recommendations as they “work” all the time they are in your shoes and you don’t have to do anything (except wear them)! The third goal of future episode prevention is often a combination ongoing treatments in the office and strategies you can employ at home. This includes (but is not limited to): 1) whether you should use ice, heat, or both at times of acute exacerbation; 2) avoiding positions or movements that create sharp/lancinating pain; 3) DOING THE EXERCISES that you’ve been taught ON A REGULAR BASIS; and 4) eating and an “anti-inflammatory” diet (lean meats, lots of fruits/veggies, and avoid gluten – wheat, oats, barley, rye).

Let’s talk exercise! Your doctor of chiropractic will teach you exercises that are designed to increase range of motion (ROM), re-educate a flat or reversed curve in the neck, and strengthen / stabilize the muscles in the neck. Studies show that the deep neck flexor muscles – those that are located deep, next to the spine in the front of the neck – are frequently weak in patients with neck pain. These muscles are NOT voluntary so you have to “trick” them into contracting with very specific exercises. Your doctor will also teach you exercises that you can do EVERY HOUR of your work day (for 10-15 seconds) that are designed to prevent neck pain from gradually worsening so you aren’t miserable by the end of work. Along these lines, he/she will discuss the set-up of your work station and how you might improve it – whether it’s a chair, desk, computer position, a table/work station height issue, or a reaching problem; using proper “ergonomics” can REALLY HELP! Your doctor will also advise you not to talk on the phone pinching the receiver between your head and shoulder, to face the person you are talking to (avoiding prolonged head rotation), to tuck in your chin as a posture training exercise, and more. Cervical traction can be a GREAT home-applied, self-help strategy, and these come in many varieties. Proper positions for the head when sleeping and a properly fitted contoured pillow is also important since we spend about 1/3 of our lives asleep!

We realize you have a choice in whom you consider for your health care provision and we sincerely appreciate your trust in choosing our service for those needs.  If you, a friend, or family member requires care for neck pain or headaches, we would be honored to render our services.

In the nervous system, there are three primary areas that regulate our balance: the cerebellum (located in the back of the brain), the dorsal columns (located in the back of the spinal cord), and the inner ear (the “vestibular” part of our cranial nerve VIII). There are also small, microscopic “proprioceptors” or mechanical receptors located in our joint capsules, muscles, and tendons that relay information to the brain and work hard to keep us upright when we walk, run, and play!

Conditions that can result in balance problems include, but are not limited to, BPPV (Benign Paroxysmal Positional Vertigo), spinal stenosis (narrowing of the spinal canal where our spinal cord is located), dorsal column disease, cerebellar lesions, and/or circulation loss into the back of the brain. Other conditions associated with light headedness include low or high blood pressure, hydration, medications, postural or orthostatic hypotension, diabetes, endocrine disorders, hyperventilation, heart conditions, and vasovagal syncope. However, issues with BPPV/inner ear are the most common reported cause of dizziness. Emergency actions should be exercised when dizziness is associated with chest pain, shortness of breath, or palpitations. If eating helps resolve the dizziness, blood testing for hypoglycemia is appropriate. If confusion, memory lapses, changes in speech, facial droop, weakness on one side of the body, or acute headache occur, these could be signs of a stroke or a brain bleed or tumor and should be quickly evaluated. If ANY of these signs or symptoms is present, we will refer you to the appropriate specialty for further evaluation.

The upper cervical spine has also been found to affect balance, and it’s a primary area of treatment that we as chiropractors focus on when patients complain about balance dysfunction. Unique to this upper cervical region is the fact that the nucleus of cranial nerve V (the trigeminal nerve) extends down the spinal canal to the C2 level and adjustments in this region can have significant benefits for several other conditions, including trigeminal nerve problems as well as BPPV (inner ear dysfunction such as dizziness) where small crystals dislodge from the ampulla of the semicircular canal and interfere with the flow of fluid inside the canal with resulting dizziness. Adjustments and the BPPV exercises (Epley’s and / or Brandt-Daroff) significantly benefit this cause of dizziness. You can depend on our evaluation to determine if chiropractic is the right choice in managing your balance disturbance!

We realize you have a choice in whom you consider for your health care provision and we sincerely appreciate your trust in choosing our service for those needs. If you, a friend, or family member requires care for neck pain, we would be honored to render our services.