Pain Relief Chiropractic

There is a lot of convincing peer reviewed literature (research) that supports chiropractic as one of the first and best courses of care to consider when choosing a treatment option for neck pain and headaches. This is because there is low risk, few rare side-effects, and most importantly, IT REALLY WORKS!  But, there are other considerations in the management of neck and headache pain that perhaps we haven’t thought about. One is smoking.

There are several convincing studies that have looked at the exposure to tobacco smoke and smoking in terms of its effect on neck pain. Let’s look at some statistics. One study reported that as many as 213 per 1000 people reported neck pain. The 12-month prevalence of neck pain ranged between 30-50% of which activity-limiting pain was reportedly as high as 11.5%. Women were found to be more at risk than men which peaks in middle age. Risk factors for neck pain include genetics, poor psychological health, and EXPOSURE TO TOBACCO. Interestingly, smoking / exposure to tobacco is listed as a risk factors but disk degeneration is not! Researchers also pointed out that the use of equipment made to prevent injury to the head/neck such as helmets and face shields was NOT associated with increased risk for neck injury in bicycling, hockey or skiing as some have suggested that wearing protective head gear increases vulnerability to injury. THIS IS NOT THE CASE, so wear your helmet! This study concluded that there are some things we can’t modify regarding increased risk of developing neck pain (such as gender, genetics, and age); however, the modifiable risk factors of smoking, exposure to tobacco, and psychological health CAN be helped so that’s the LEAST WE SHOULD DO!

Two new studies show that smoking is directly tied to neck / back pain and the development of arthritis. Interestingly, the Harvard study reported that the risk of developing psoriatic arthritis was twice as high for current vs. past smokers, and both current and past smokers were at greater risk when compared to those who had never smoked. The 2nd study (Paris, France) found that smokers had an earlier onset of inflammatory back / neck pain and a worse course of the disease than non-smokers. Taking these two studies together, the interactions between environmental factors and the onset, the degree of severity and the ultimate outcomes of rheumatic diseases, “…it’s becoming increasingly clear how detrimental the influence of smoking is on most of these diseases.” The worst scenario was found in those who smoked >25 years and, >20 “pack years” (>1 pack/day for 20+ years).  The “bottom line” is that smoking and exposure to smoke have significant negative health affects, not only for present health, but also for future pain, suffering and quality of life. Thankfully, it’s been shown that if you quit smoking, the likelihood of improved health affects is high so of course, QUIT NOW and you’ll be ahead of the curve.

In fact, a conscientious surgeon recommending a spinal fusion may say, “…you must quit smoking or else I will not perform the surgery that you need.” The reason for this insistence is because the risk of fusion failure goes up 500% in smokers (fusions are needed in certain types of back and neck surgeries).

We realize that you have a choice in where you choose your healthcare services.  If you, a friend or family member requires care for neck pain, we sincerely appreciate the trust and confidence shown by choosing our services and look forward in serving you and your family presently and, in the future.

Neck pain can arise from many different sources, and the patient’s clinical presentation can be quite similar making it a challenge to diagnose. One of those related, and sometimes co-existing conditions, is called thoracic outlet syndrome, or TOS. Let’s first discuss the anatomy of the neck and the thoracic outlet so we all have a good “picture” in mind of what we’re talking about.

TOS can arise from either blood vessel compression, nerve compression or both, making the ease of diagnosis difficult. Adding to the challenge, the “pinch” of the structure can occur at more than one place! The nerves and blood vessels can get pinched at the exiting holes in the spine (“neuroforamen”), by tight “scalene” muscles, under the collar bone (clavicle) and/or by a tight pectoralis minor muscle near the arm pit. Hence, the symptoms usually include pain and numbness in the shoulder, arm and hand (usually affecting the 4th & 5th fingers). It’s our job to run different tests to figure out where the primary pinch or pinches are located so we can treat the right area.

The causes of TOS can be many, with one of the obvious being a fractured collar bone or clavicle. Another is from having an extra rib. As there is not a lot of room for an extra structure, this can be a point of compression for some (but doesn’t create TOS in everyone). An overly tight scalene muscle, scar tissue, an extra large muscle and so on can also result in pinching of the nerves and/or blood vessels.

Purses, backpacks, carrying golf clubs, a mailbag and the like can also cause a pinch. A seat belt injury in a car accident is yet another cause, either from the direct trauma, or later when scar tissue forms in the area.

Our posture alone (without trauma), such as a slouchy, slumped posture where the shoulders roll forwards can cause TOS and, large breasts and obesity also add to the list of risk factors. Women are affected 3x more than men. Certain jobs where reaching overhead or outwards such as waitresses, carpenters, electricians, increase TOS risk.

You can depend on us to identify, locate and treat the areas that need attending as chiropractic includes many effective TOS treatment methods. The surgical outcomes are less than impressive so do EVERYTHING else first (a good surgeon will tell you that).

We realize that you have a choice in where you choose your healthcare services.  If you, a friend or family member requires care for neck pain, we sincerely appreciate the trust and confidence shown by choosing our services and look forward in serving you and your family presently and, in the future.

The relationship between neck pain and our pillow is more important than most of us realize! Though we all may have at one time or another slept on a variety of surfaces, and used any number of pillows (flat, medium, bulky) made of different materials (foam, feather, air, water, or memory foam), it’s usually not until neck pain and/or headaches start to become an issue that we start to think, “…how important is my pillow?” Thankfully, the question has been addressed in a randomized peer-reviewed study. So, what did they find out?

The goal of a pillow is to support the neck more so than the head. In a study headed by Dr. Liselott Persson, MD, of the department of neurosurgery at the University of Lund in Sweden, researchers tested whether specific neck pillows have any effect on neck pain, headache and sleep quality in people suffering with chronic (>3months), non-specific neck pain. They also researched whether there was an optimum or “best” type of pillow that was preferred by their 52 patient group. They used 4 different pillows, 1 “normal” pillow and 3 of which were specially designed, each having a different shape and consistency. Over a 4-10 week time frame, the pillows were randomly distributed to the neck pain group who then graded them according to comfort, the effects on neck pain, sleep quality and headache using a questionnaire, and also described the characteristics of an “ideal pillow.” Researchers and participants concluded the “ideal pillow” (for reducing neck pain and headaches and improving quality of sleep) includes a soft pillow with good support under the neck’s curve (lordosis).

There are many styles of contoured cervical or neck pillows that vary considerably. This study supports the use of a specially designed style over a normal pillow. So what are some of the things to look for? First, consider your neck’s length and girth.  When you look in a mirror, do you have a neck that is short vs. long or, narrow vs. wide? This will direct you to a pillow that has a larger “hump” for your neck to be cradled in if it’s a long neck and, the height of the hump – taller for the slender neck or, shorter for the wide neck. Some pillows have 2 options of “hump” sizes (located on the long edges of the pillow) – one short and flat and the other side taller and wider. Others recommend lying in the middle of the pillow if you’re a back sleeper vs. lying on the edge of pillow when sleeping on your sides. A measurement taken from the neck to the point of the shoulder determines if the pillow should be a small, medium, or large. Water filled and/or air filled pillows can be varied by the amount of water or air added. The bottom line of which is “best” is based on comfort and support. Regardless of which you choose, it can take several days to get used to the new pillow, so we recommend using the pillow for at least 1 week. By then, you’ll know if you chose the right style.

We realize that you have a choice in where you choose your healthcare services.  If you, a friend or family member requires care for neck pain, we sincerely appreciate the trust and confidence shown by choosing our services and look forward in serving you and your family presently and, in the future.

How many times have you heard, “I have a pinched nerve in my neck and have to have surgery.” Though there certainly are cases where surgical intervention is required, surgery should ONLY be considered after ALL non-surgical treatment approaches have been tried first (and failed). It is alarming how many cases of cervical radiculopathy (i.e., “pinched nerve”) end up being surgically treated with NO trial of non-surgical care. Hence, the focus of this month’s article will look at research (“MEDICAL EVIDENCE”) that clearly states neck surgery DOES NOT improve the long term outcomes of patients with chronic neck pain.

Chronic neck pain (CNP) is, by definition, neck pain that has been present for a minimum of three months. This category of neck pain is very well represented, as many neck pain sufferers have had neck pain, “…for years” or, at least longer than three months. Depending on the intensity of pain and it’s effect on daily function, many patients with CNP often ask their primary care provider, “…is there anything surgically that can be done?” The desire for a “quick fix” is often the focus of those suffering with neck pain. Unfortunately, according to recent studies, there may not be a “quick fix” or, at least surgery is NOT the answer. The December 2012 issue of The European Spine Journal reports that spine surgery did NOT improve outcomes for patients with CNP. Moreover, they pointed to other studies that showed some VERY STRONG REASONS NOT to have spine surgery unless everything else has failed. One of the reasons was a higher hospital readmission rate after spine surgery. Another reported that most studies on surgical vs. conservative [non-surgical] care showed a high risk of bias, suggesting the research on surgical intervention was biased in the research approach used. They further reported, “The benefit of surgery over conservative care is not clearly demonstrated.” It is important to point out that the research analyzed studies that included patients with and without radiculopathy (radiating arm pain from a pinched nerve), and myelopathy (those with pinching of the spinal cord creating pain, numbness, weakness in the legs, and/or bowel / bladder dysfunction).

In February of 2008, the Neck Pain Task Force published overwhelming evidence that research supports the use of cervical spinal manipulation in the treatment of both acute and chronic neck pain with or without radiculopathy. Bronfort published similar findings in 2010 in a large UK based study that looked at the published evidence supporting different types of treatment for various conditions. They found cervical spine manipulation was effective for neck pain of ANY duration (acute or chronic). Chiropractic utilizes manipulation, manual traction, mobilization, muscle release techniques, home cervical traction, exercise, as well as a multitude of physiotherapy modalities when managing patients with CNP. Given the overwhelming research evidence that surgical intervention for CNP is NOT any better than non-surgical care, the greater amount of negative side-effects, and the obviously long recovery time post-surgically, chiropractic treatment of anyone suffering from CNP should be tried FIRST.

We realize that you have a choice in where you choose your healthcare services.  If you, a friend or family member requires care for neck pain, we sincerely appreciate the trust and confidence shown by choosing our services and look forward in serving you and your family presently and, in the future.