Pain Relief Chiropractic

In the last decade, the increased use of smartphones, tablets, and other electronic devices has resulted in more and more individuals taking on a slumped posture as they spend excessive amounts of time looking down to check email, browse the web, play games, or use social media. This forward head posture can place added strain on the neck and mid-back, increasing the risk for pain in these areas.  That’s hardly news to anyone. However, is it possible these same devices can be used to manage one’s neck pain?

In 2017, researchers conducted a study using a smartphone app designed for office workers with neck pain. Based on the users’ responses to questions about the nature of their neck pain, the app provided an individualized neck exercise program to be used for ten to twelve minutes a day, three days a week, for eight weeks. At the conclusion of the program, the participants reported significant improvement in neck pain intensity and disability and improved quality of life. However, the app did not appear to improve fear avoidance behavior or cervical range of motion.

An experiment conducted in 2020 with an app that promotes neck pain self-management through stretching and deep breathing exercises found that this approach resulted in improvements with respect to pain intensity, muscle tension, pressure pain threshold, and cervical range of motion. 

Because there’s an abundance of research showing that neck-specific exercises can benefit patients with neck pain, these results aren’t very surprising. However, apps have the ability to remind users to perform their exercises and track their progress, which is important since exercise protocol adherence is often an issue.

For individuals with neck pain who are unable to manage their condition with exercise alone, chiropractic care can be an excellent choice. Doctors of chiropractic are trained to diagnose the root causes of a patient’s mechanical neck pain and to deliver manual therapies to restore motion to the affected joints, which can reduce pain and disability. Treatment may also involve nutritional recommendations to aid the healing process and the prescription of specific exercises to strengthen weakened deep neck muscles and reduce the risk for neck pain recurrence.

While devices have become a part of life and advice to limit screen time will go unheeded, there are steps that can be taken to reduce one’s risk for device-related neck pain. For example, avoid looking downward when using an electronic device. Instead, hold it at eye level so you can maintain good posture. Additionally, get regular exercise as the stress of movement is how the joints in the body (including those in the neck) are nurtured and hydrated. Since low grade inflammation in the body may increase the risk for neck pain, get plenty of sleep, manage stress, and eat more fruits and vegetables (and less processed food). If you have any questions on which neck-specific exercises may be most beneficial for your individual case, ask your doctor of chiropractic at your next visit.

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 and headaches often co-occur and are two of the most common reasons patients seek chiropractic care. Thus, it’s important for a doctor of chiropractic to conduct a careful history and examination to determine if the patient’s headaches and neck pain are indeed related or if the issues need to be addressed independently. Here’s the process most patients with a combination of neck pain and headaches can expect when consulting with a chiropractor.

Doctors of chiropractic start out with a past history that includes the following: 1) prior injuries or accidents; 2) family history, social history (including education level and occupation, sleep habits, tobacco/alcohol use, and more) 3) allergy history; 4) vaccination history; 5) current medication use to identify potential side effects; 6) review of your systems (cardiovascular, respiratory, ears/nose/throat, genito-urinary, and more).

The present history then looks at each complaint individually to determine onset, palliative, and provoking positions/activities/situations, quality of symptoms, radiation and location of complaints, severity of complaints (pain—right now, on average, at best and at worst), and timing (better in the morning or night, work-relatedness, hormonal shifts, or patterns).

The examination may include vital signs (blood pressure, pulse, respirations, height, weight, temperature, etc.); observation of posture, gait, movement, affect, facial grimace; palpation of muscles, trigger points, joint noise (crepitation), warmth; orthopedic tests that provoke an increase and/or decrease in pain/symptoms; neurological tests; and consideration for special tests like x-ray, blood tests, or specialty evaluation.

This information results in a working diagnosis from which a doctor of chiropractic can create a treatment plan for the patient. Commonly used approaches you can expect from your chiropractor may include manual therapies such as spinal manipulation (thrust and non-thrust types); mobilization (stretch-type); “drop table” methods; manual traction, trigger point, and other “soft-tissue” techniques; and modalities such as vibration, ice/heat, electric stim, ultrasound, and more. Additional self-care or at-home strategies may include specific exercise training, posture retraining, nutritional recommendations, and activity modifications.

Some patients may experience initial soreness following their first treatment but will typically feel improvements in pain and disability following a handful of visits, at which time their doctor of chiropractic may adjust the treatment plan or release the patient from 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.

When neck pain strikes, it’s often assumed the cause is also in the neck. It’s only logical, right? In many cases, focusing on the neck for diagnosis and treatment may lead to a satisfying result but not all the time. For some patients, neck pain may be related to a condition elsewhere in the body, which would need to be addressed for the patient to find lasting relief.

One such area of the body is the shoulder. Past research has shown the conditions can co-occur, and there are also cases in which managing a cervical condition led to improved pain and function in the shoulder joint. A review of findings from four published studies found the opposite can also be the case. The review revealed that patients with chronic neck pain experienced improvements in pain and disability following a three-week course of treatment featuring scapular stabilization exercises. 

A review of findings from 14 studies showed that manipulative therapy applied to the mid-back resulted in improvements in cervical pain and disability among patients with chronic neck pain.

While it makes sense that areas adjacent to the neck like the shoulder and mid-back can contribute to neck pain, the research suggests that even issues farther down in the body can play a role. A 2019 study revealed that individuals with chronic neck pain exhibited differences in walking symmetry, a known risk factor for problems in the knee and hip joints. Another 2019 study showed that patients with chronic neck pain walked with a stiffer spine. It has also been demonstrated that leg length inequality can lead to dysfunction in the knees, hips, and lower back.

The neck plays an important role in keeping the head upright and keeping the eyes level. If the neck needs to overcompensate for deficiencies in movement in the back or lower extremities, it can lead to a painful cervical condition. Doctors of chiropractic are trained to evaluate the whole patient and identify factors contributing to the patient’s chief complaint. In many cases, a combination of manual therapies (manipulation/mobilization), specific exercises, ergonomic modifications, nutritional counseling, and physical therapy modalities can result in a satisfying treatment outcome.

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.

Experts estimate that approximately 10% of the adult population in the United States experienced an episode of tinnitus—the perception of sound or noise without any external auditory stimulus being present—within the last year. Tinnitus can be caused by wax buildup in the ear, medication side effect, noise-induced hearing lost, ear and sinus infections, cardiovascular disease, Meniere’s disease, brain tumors, hormonal changes in women, and thyroid disorders. One cause that gets less attention is dysfunction in the cervical spine.

While the prevalence of cervicogenic tinnitus—tinnitus that originates from the neck—is unknown, a 2015 study that evaluated 87 chronic tinnitus patients found that nearly half (47%) tested positive for cervicogenic tinnitus. Thus, individuals with ongoing tinnitus symptoms may benefit from receiving a thorough examination of their cervical spine by a doctor of chiropractic.

A 2020 case report detailed the experience of a 67-year-old female patient with a five-year history of left-sided chronic tinnitus, neck pain, and headache. Her treatment plan included exercises that emphasized the direction(s) that produced symptom relief and postural correction. Not only did the patient report significant improvements in her symptoms following her course of care, but she continued to experience relief at a follow-up appointment six months later.

This case study exemplifies the significant short- and long-term benefits that focused, tailored self-exercise (that the patient can perform at home) can have in improving chronic cervicogenic tinnitus. Chiropractic management centers on three common goals: pain management, posture improvement, and prevention. Many studies support significant short-term benefits that can be achieved with manual therapies, particularly spinal manipulation. Patients can achieve and sustain long-term benefits with exercise training when it’s specifically tailored to them.

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.

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.