Pain Relief Chiropractic

Doctors of chiropractic often approach neck pain with manual therapy as the primary form of treatment. However, there are several types of manual therapy, including high velocity, low amplitude (HVLA) thrust manipulation; mobilization; and/or soft tissue techniques. Is one type of manual therapy superior when it comes to managing neck pain? What does the research show? A 2017 systematic review of 23 randomized controlled trials compared various manual therapy techniques on their own (or combined), with or without the addition of specific exercise recommendations.

For acute (recent onset) to sub-acute neck pain, the review concluded:

• High-velocity, low-amplitude thrust manipulation combined with exercise resulted in better outcomes when treatment was applied to the cervical vs. the thoracic spine.
• High-velocity, low-amplitude thrust manipulation combined with soft tissue techniques and exercise applied to both the neck and mid-back led to better outcomes than when soft tissue techniques plus exercise only targeted the neck.

For chronic neck pain, the data show:

• Both HVLA thrust manipulation and soft tissue techniques in addition to exercise are more effective than either manual therapy or exercise alone for improving pain and function.
• Thrust manipulation applied to the neck and mid-back was more effective for improving neck mobility than mobilization.
• Mobilization and soft tissue techniques are both more effective than no treatment for improving pain and disability.

This systematic review favors all types of manual therapies for the management of all stages of neck pain (acute, sub-acute, chronic), especially when combined with exercise. The data also suggests the incorporating treatment of the mid-back may lead to better outcomes.

While manual therapies in general can benefit the neck pain patient, the approach a doctor of chiropractic takes will depend on the patient’s unique case (based on patient history and exam findings) and preferences. For example, a patient may prefer a gentle, low force technique or their chiropractor may use a combination of manual therapy techniques. Additionally, care may also include nutritional/dietary recommendations or physical modalities.

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.

In normal head and neck posture, the center of the shoulder joints are located vertically in line with the bottom of the mastoid processes (the bone just behind the bottom of the ear at the base of the skull) while the muscles on the posterior (or back side) of the cervical spine (neck) act to maintain balance and keep the head back.

Sitting at a computer or using a smartphone for long lengths of time can lead to a muscular imbalance—referred to as an “upper-crossed syndrome” (UCS)—where specific muscles in the upper back and neck (upper trapezius and levator scapulae) and the chest muscles (pectorals) are too tight. These hypertonic muscles “cross” with weakness of the deep neck flexors (in the front neck) and middle and lower trapezius (in the mid-back).  This results in the classic forward head posture and rounded shoulders.

Fortunately, forward head posture can be remedied with exercises to strengthen the weak muscles and stretch the overly tight muscles. Here are a few:

• Perform a standard push-up (from knees or toes) and when in the “up” position, push further toward the ceiling (feel your shoulder blades spread further apart).
• Lie prone on a bench and raise your arms overhead to form a “Y”; follow with a “T” by lowering the arms to horizontal or 90°; move to a “W” (bend elbows 90° and lower arms to 45°); follow with an “L” (place arms at your sides keeping elbows bent at 90°, rotate outwards the forearms as far as possible). Squeeze your shoulder blades together, DON’T shrug the shoulders, HOLD each position for five to ten seconds and repeat the series two to three times.
• Tuck your chin inward and nod; add some resistance—using your thumb/index grasping the chin—resist in BOTH directions (down and up nods). As a posture re-trainer, keep your chin-tucked during the day.
• Lie on your side, elbow bend 90°; use a hand weight and raise it slowly toward the ceiling and lower it back down (five to ten slow reps); repeat on the other side.
• Stand in a doorway and hook your elbow on (or grasp with your hand) the door jamb; slowly turn your body away from the door jamb until you feel a strong stretch in your chest muscles. Start low and move your elbow/hand higher and repeat; continue upwards until its overhead. Repeat several times on each side.
• Look down and side bend RIGHT; reach over with your RIGHT hand and gently pull the head to a firm endpoint; reach with the LEFT hand toward the floor. 
• Look down, side bend, and rotate your head RIGHT; reach over with your RIGHT hand and gently pull the head to a firm endpoint; reach with the LEFT hand toward the floor. REPEAT on opposite side. Hold five to ten seconds and repeat two to three times.

Upper crossed syndrome and forward head posture can also lead to joint fixations in the cervical and thoracic spine, which can be addressed by a doctor of chiropractic using spinal manipulative therapy. Your chiropractor can also walk you through these and other exercises to restore normal posture, depending on your unique case.

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 pain is commonly associated with sitting in front of a computer for prolonged periods of time. So is there a “best” or “ideal” type of desk to use when working at a computer all day?

The sit-stand desk has gained significant popularity in recent years, especially with an 83% increase in sedentary jobs since the 1950s. In a 2018 study, researchers compared the effect of using a sitting and standing desk for 90 minutes among 20 healthy adults. Researchers monitored typing task performance and discomfort, vascular/blood flow, and muscular changes in the neck, shoulders, and arms and found that standing desk use resulted in greater engagement of the shoulder girdle stabilizing muscles (a good thing), less strain on the lower trapezius muscles, less upper body pain, and better typing performance. The authors of the study recommend further studies to identify how standing affects more complex computer tasks over longer work sessions in symptomatic workers.

Another type of desk that is available is a treadmill desk. In one study, researchers found that treadmill desk use resulted in less upper limb pain when compared with  seated desk use, as well as healthier muscle performance from the low back paraspinal muscles, wrist extensor muscles, external abdominal obliques, lower trapezius, and anterior deltoids.

What about the trend of having a small cycling device under the desk? In a 2019 study, researchers observed that participants performed better on typing tasks when cycling, especially at greater intensity. Doctors of chiropractic are frequently asked about sit/stand desk options, with or without lower limb exercising. A common answer is to mix it up, sit or stand as needed, and vary the level of under-the-desk exercise depending on how you feel. These studies support that standing, walking, and/or cycling may be a healthier option than the traditional sit-only, sedentary desk.

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 pain is the second most common reason patients seek chiropractic care, and it’s particularly a problem with office workers. One study estimated that neck pain affects 42-69% of those who work in office environments. Many such individuals will experience recurring episodes of neck pain, and at least one in six may develop chronic, ongoing neck pain. While chiropractic offers a safe and effective way to manage neck pain, are there any steps an office worker can take to reduce the risk for neck pain in the first place?

According to one study, taking a daily walk may be an effective neck pain prevention strategy. In the study, which included 387 office workers without spinal symptoms in the previous three months, researchers asked participants to wear a pedometer and note any spinal pain symptoms over the next year.

Of the 367 participants who completed the study, 16% reported the onset of neck pain. The results showed that for every 1,000 steps a participant averaged each day, their risk for neck pain fell by 14%. The authors concluded that increasing daily walking steps is protective for the onset of neck pain in those who work sedentary jobs, and managers should formulate and test strategies to encourage walking to reduce the incidence of neck pain among employees.

What about other forms of exercise? A meta-analysis of data from two randomized control trials that included over 500 participants showed moderate-quality evidence that participating in a workplace exercise program can reduce the risk for developing a new episode of neck pain by up to 68%. In the first trial, participants performed stretching and endurance training twice a day at work and twice a day at home. The second trial involved a combination of strength, stabilization, aerobic, and body awareness exercises that included health information, ergonomic training, and stress management training three times a week for one hour over a nine-month time frame.

While it’s not possible to completely avoid a condition like neck pain, the evidence suggests that regularly engaging in physical activity may substantially lower the risk. For those who do develop neck pain, it’s important to seek chiropractic care as soon as possible, which may lead to a faster resolution of symptoms and reduce the risk for both neck pain recurrence and 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.