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Can Chiropractic Adjustments Help Headaches?

18 Feb

Experts report that 157 million work days are lost each year in the United States due to headaches at a cost of about $50 billion in work absenteeism and medical expenses. According to current estimates, about 18% of chronic headache patients are believed to have cervicogenic headaches (CGH), or headaches that originate from dysfunction in the neck.

Many CGH sufferers utilize complementary and integrative health treatment approaches for neck pain and headaches, of which spinal manipulative therapy (SMT) is the most common. While past studies have demonstrated SMT to be a superior form of treatment for CGH, no one has investigated how many treatments are needed to achieve the maximum clinical benefit for CGH patients – at least not until recently!

In order to determine what dose of SMT may best benefit patients with headaches originating from the neck, researchers randomized 256 CGH patients into four treatment groups that received 0, 6, 12, or 18 SMT treatments over the course of six weeks. The researchers found a dose-dependent relationship between SMT and days without CGH over the following year with patients in the 18 visit group experiencing 16 fewer days with CGH over the next twelve months than those in the zero treatment group.

The chiropractic spinal manipulative therapy treatment used in the study consisted of high-velocity, low-amplitude thrust manipulation in the neck and upper back regions (specifically, occiput to T3) aimed at sites with detected joint dysfunction (fixation or pain), which is typically the method most chiropractors determine where to apply spinal manipulation.

This study is VERY important for a few reasons: 1) it proves SMT helps patients with CGH; 2) it provides doctors of chiropractic with an idea of how many visits it may take to obtain optimum results; and 3) it can be used as a guideline when managing CGH patients, stressing the important point that EACH patient is UNIQUE and modifications may be appropriate depending on each 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.
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How Do Adjustments Help Patients with Neck Pain?

14 Jan

Mechanical neck pain—neck pain without neurological compromise, often without a specific cause—is associated with a loss of mobility, poor activity tolerance, increased pressure pain sensitivity (or hypersensitivity to a normal stimulus), and increased joint position sense error (JPSE—difficulty reproducing the same movement when repeated multiple times). Patients with mechanical neck pain often seek treatment from doctors of chiropractic. Let’s look at how high-velocity, low-amplitude (HVLA) manipulation—the primary form of treatment used by chiropractors, commonly referred to as an adjustment—helps these patients…

In a 2018 study involving 54 patients with mechanical neck pain, participants received either HVLA cervical thrust manipulation or a sham cervical thrust manipulation. Evaluations conducted immediately following treatment showed that patients in the HVLA group experienced improvements with regards to JPSE (specifically neck rotation and extension), pressure pain threshold, and disability. (A related study showed that patients who received HVLA cervical thrust manipulation experienced an immediate 41% improvement in JPSE.)

A week later, the participants in the HVLA group continued to experience improvements related to disability. Again, this was after just a single treatment. Typically, doctors of chiropractic administer a series of HVLA manipulations one to three times per week for one to two weeks followed by a re-assessment to determine if care should continue (at the same frequency or at a reduced frequency) or if the patient should be released from care and advised to return for care on an as-needed or maintenance basis.

Chiropractors often combine several treatment approaches when managing patients with mechanical neck pain and other musculoskeletal conditions to both reduce pain and improve function. A partial list of commonly applied services include the following: HVLA manipulation (thrust with cavitation), mobilization (non-thrust), soft tissue therapies (massage, vibration, muscle release techniques, trigger point therapy, myofascial release, and more), home and/or in-office exercise training, nutritional counseling, physical therapy modalities, and more. Chiropractic HVLA manipulation has strong research support as being a VERY effective management approach for patients with either 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.

Chiropractic Care for Headache Relief?

13 Dec

Headaches have a significant impact on quality of life in both adults and children. Approximately 13% of patients who sought chiropractic care over the last decade did so for headache relief. Several studies have found that manual therapies, such as spinal manipulation and mobilization, can provide significant benefits for patients with both tension-type and migraine headaches—even better than standard medical care, in some cases.

In 2011, Canadian researchers reviewed data from 21 published studies to develop specific recommendations for chiropractic management of headaches. For episodic or chronic migraine and cervicogenic headaches (those caused by specific neck problems), they recommended spinal manipulation and other manual interventions, such as massage. Additionally, researchers noted that joint mobilization and strengthening exercises for the deep neck flexor muscles may also improve symptoms associated with cervicogenic headaches.

For episodic tension-type headache, the investigators did not find enough published evidence to support the use of spinal manipulation. They stated that, at the current time, “a recommendation cannot be made for or against the use of spinal manipulation for patients with chronic tension-type headache” (CTTH). However, they did report that low-load craniocervical mobilization “may be beneficial for longer term management of patients with episodic or chronic tension-type headaches.”

In contrast, following a randomized clinical trial of 80 patients with chronic tension-type headaches, Dutch researchers reported that “Manual therapy is more effective than usual [general practitioner] care in the short- and longer term in reducing symptoms of CTTH.”

Chiropractors utilize many types of manual therapies as a primary form of care for several complaints and conditions, including headaches.

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 – What Is Cervical Spinal Stenosis?

19 Nov

Simply put, spinal stenosis describes a narrowing at the openings of the spine. When spinal stenosis exists in the cervical spine, it’s called cervical spinal stenosis (CSS). This condition is usually the result of wear-and-tear or aging, and hence, is most common over the age of 50. However, CSS can occur at any age if a vertebra in the neck sustains a fracture.

There are two types of CSS: central and lateral CSS. Central CSS is narrowing of the central canal where the spinal cord travels and gives rise to the many pairs of nerves that exit out to the arms, trunk, and legs. Lateral stenosis is narrowing of the side openings (referred to as the lateral recess or the intervertebral foramen) through which the spinal nerves travel outward from the cord and into the left and right arms and legs.

Causes of CSS include the following: osteoarthritis (in which a narrowing of the central and/or lateral canals occurs and crowds the spinal cord and/or spinal nerves); a herniated disk (where the cushions between the vertebra crack or tear allowing the more liquid-like center to leak out and press into the cord or nerves); an injury (fracture); a tumor (growth); Paget’s disease (a condition where the bones grow abnormally large and brittle); and/or a combination of the above.

Symptoms may start out as a vague pain, numbness, and/or tingling in the innervated area(s). If a spinal nerve (lateral CSS) is affected, symptoms can present in the arms, torso, or legs. When the spinal cord itself is compressed (central CSS), symptoms can include loss of bladder or bowel control (in extreme cases); impaired balance; sciatica (pain down the back of the leg), foot drop (weakness standing on the heels), and more. A gradual loss in walking time/distance is common and stopping to sit or bend over is usually relieving (this is called “neurogenic claudication”).

The diagnosis is made by following a careful review of the patient’s history and a thorough examination, which may be aided by x-ray, MRI, and/or CT scans. Though guidelines recommend starting with non-surgical treatments, such as chiropractic care and at-home exercises, if bowel or bladder weakness is present, then surgery may be required to open the narrowed canal(s). The good news is that CSS can often be successfully managed via chiropractic treatment and other conservative options.

 

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 It Arthritis?

23 Oct

There are many different types of arthritis, with the most common being osteoarthritis (OA), also known as degenerative joint disease (DJD). Osteoarthritis is often referred to as the “wear-and-tear” type of arthritis, as the smooth, cushion-like, shiny cartilage covering the joints that allows for a nice gliding surface wears down. This can cause pain, swelling, loss of motion, and spurs that further limit motion. According to the Arthritis Foundation, OA/DJD affects about 27 million Americans and is most commonly found in the knees, hips, low back, neck, small joints of the fingers, and base of the thumb and big toe.

In one study, researchers reviewed cervical x-rays and detected spondylosis—degeneration of the intervertebral disks, which rest between the vertebrae of our spine—in approximately 60% of non-symptomatic persons more than 40 years old and in 95% of men and 70% of women over age 60. Similarly, cervical spine MRIs of individuals without neck pain frequently show a disk bulge or herniation.  According to the AMA Guides to the Evaluation of Permanent Impairment (5th edition), 30% of us who have never had neck or back pain will test positive for a herniated disk and 50% or more will have bulging disks on a CT or MRI!

So, if you have neck pain and your doctor takes images that show arthritis or a disk problem is present, how do you know whether or not DJD is to blame? The answer is: it varies and must be clinically determined on a case-by-case basis.

Though frustrating, the ability to determine what is truly generating a patient’s pain can be a challenge. This is why a careful, detailed history and examination of the patient, as well as tracking their response to treatment, is so important. Doctors of chiropractic approach these conditions with various forms of manual therapies including (but not limited to): joint manipulation; mobilization; massage; trigger point therapy; exercise training; activity modifications; self-management strategies, such as traction; the use of specially designed pillows; modalities such as electrical stimulation, ultrasound, and laser therapy; and nutritional counseling to reduce inflammatory markers. Guidelines published around the world recommend joint manipulation for neck pain and headaches as one of the first courses of care because it is both safe and effective.

 

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 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.