Assuming patients and healthcare providers follow clinical guidelines for managing neck
pain, most neck pain sufferers can experience resolution of their pain and disability with the aid
of a conservative, multimodal treatment approach, such as those provided by chiropractors.
However, for a variety of reasons, some patients may still undergo surgical intervention, and it is
estimated that up to 40% may continue to experience persistent or disabling neck pain. Why is
this the case, and is there anything chiropractic care can do to help these patients?
The first potential cause of persistent post-surgical neck pain is an incomplete or
incorrect diagnosis. This can occur when imaging reveals positive findings—such as a disk
herniation—that are attributed to the patient’s symptoms but may not, in fact, be the underlying
cause. In some cases, a disk herniation may play a role; however, other contributing factors that
are not visible on imaging or are missed during a physical examination may also be involved.
There are also cases in which the pain generator is correctly identified and treated, but
complications from surgery result in ongoing neck pain. For example, scar tissue formation
around nerves and soft tissues can tether nerves or create a chronic inflammatory environment
that triggers pain. In addition, a decompressed nerve may continue to experience impaired
function as though it were still compressed.
Finally, a new source of neck pain may develop following an otherwise successful
surgical procedure. This can occur when spinal alignment is restored but the joints and soft
tissues are not accustomed to supporting the altered loads and forces and subsequently become
injured. Additionally, in cases of surgical fusion that restrict movement at a cervical spinal level,
the vertebrae above and below the fusion may become hypermobile to compensate, pushing them
beyond their normal range of motion and increasing the risk of injury.
With all of this in mind, how can a doctor of chiropractic help manage post-surgical neck
pain? The first step is a thorough review of the patient’s history, which guides the physical
examination. The examination not only seeks to identify potential pain generators but also helps
detect red flags that contraindicate chiropractic treatment. In addition to traditional red flags
(such as fracture, infection, tumor, severe osteoporosis, and vascular abnormalities), the
chiropractor will also assess for signs of cervical instability or incomplete healing. To help
restore normal movement and function of the cervical spine, a doctor of chiropractic will often
employ a multimodal approach that combines low-force manual therapies, gentle traction,
therapeutic exercises, and physiotherapy modalities.
Brent Binder, D.C. 4909 Louise Dr. Suite 102 Mechanicsburg, PA 17055 (717) 697-1888
Potential Causes of Post-Surgical Neck Pain
4 FebTen Persistent Myths About Low Back Pain in the Elderly
2 FebLow back pain (LBP) is one of the costliest and most disabling conditions affecting older adults. Not only
can pain and disability interfere with the ability to carry out activities of daily living, but proprioceptive deficits
associated with low back pain can impair balance, increasing the risk of serious falls and injuries that can
dramatically affect long-term health and independence. Despite clinical guidelines on effective management of low
back pain in the senior population, these ten prominent myths persist and continue to hinder recovery:
- MYTH: Back pain is inevitable with aging. FACT: Back pain is common but not inevitable. Prevalence
increases with age and then levels off after approximately age 60. - MYTH: Back pain usually indicates serious disease in older adults. FACT: Serious underlying conditions
account for fewer than 5% of cases. Most low back pain is classified as “non-specific” and is not associated
with serious pathology. - MYTH: Imaging is necessary in adults over age 50 with low back pain. FACT: Imaging in the absence of
“red flags” (such as cancer, fracture, infection, or cauda equina syndrome) can lead to unnecessary
interventions and can cause more harm than benefit. - MYTH: Pain should guide behavior—avoid lifting, twisting, and bending when experiencing low back
pain. FACT: Physical activity promotes recovery, while prolonged avoidance and inactivity are associated
with worse outcomes. Pain during activity does not usually indicate tissue damage. - MYTH: Bed rest is recommended for low back pain in older adults. FACT: Bed rest can cause more harm
than good, particularly when prolonged, and may contribute to deconditioning and delayed recovery. - MYTH: Medication should be the first-line treatment for low back pain. FACT: Clinical guidelines support
nonpharmacological treatments as first-line approaches, including manual therapies such as those provided
by chiropractors. - MYTH: Surgery is effective for primary back-dominant low back pain. FACT: Surgery is not
recommended for primary back-dominant pain and may result in worse outcomes or unnecessary
complications. - MYTH: Chronic low back pain in older adults is always caused by structural damage. FACT: Structural
changes seen on imaging correlate poorly with pain severity or disability. Psychosocial factors play a
substantial role in persistent pain. - MYTH: Injections, ablation, and nerve blocks are highly effective treatments. FACT: For nonspecific low
back pain, these interventions often provide no greater benefit than sham treatments and are associated with
increased adverse events in older adults. - MYTH: Disk herniations commonly cause leg pain in older adults. FACT: Disk herniations are less
common in this population; clinical findings are often more reliable than imaging alone.
Unfortunately, this misinformation is frequently reinforced by family members, friends, social media,
pharmaceutical companies, other industries, and even healthcare providers. These myths about back pain foster
inaccurate attitudes, beliefs, and behaviors that can lead to inappropriate, costly, and sometimes harmful treatments.
Additionally, such misconceptions can result in psychological consequences—including fear of movement, poor
self-efficacy, low motivation, anxiety, stress, and depression—all of which contribute to greater disability and
slower recovery. The good news is that, in most cases, chiropractic care serves as a conservative treatment option
that can help reduce pain and disability, enabling older adults to more easily maintain independence and perform
activities of daily living.
Brent Binder, D.C. 4909 Louise Dr. Suite 102 Mechanicsburg, PA 17055 (717) 697-1888
The Neck and Low Back Connection
15 JanWhen a patient seeks chiropractic care for a condition like neck pain or low back pain, it’s natural to assume the underlying cause is located in the region where the patient feels symptoms. But this isn’t always the case. Sometimes, the primary or contributing factor to the patient’s chief complaint can be elsewhere in the body. A July 2024 study involving patients with cervical myelopathy helps illustrate this point.
Cervical myelopathy is a condition in which the spinal canal narrows due to a variety of potential causes—age-related degeneration, cervical spinal stenosis, herniated disks, trauma, rheumatoid arthritis, ossification of the posterior longitudinal ligament, or even tumors, infections, or congenital narrowing—and compresses the spinal cord. While neck pain is common, irritation of the spinal cord can produce downstream effects in the areas those nerve fibers reach. In this study, which involved 786 individuals with cervical myelopathy, two-thirds also reported low back pain.
Following treatment for cervical myelopathy, about half of those with concurrent low back pain experienced meaningful improvement in both lower back pain and function, and some even reported complete resolution. This suggests that for roughly half of these patients, the issue in their neck was a major contributing factor to their low back symptoms.
Beyond cervical myelopathy itself, several soft-tissue systems span the entire spine—including fascia, long spinal muscles, and ligamentous structures—making it possible for restrictions or dysfunction in the upper spine to influence symptoms in the lower spine. The reverse is also true: issues affecting the feet, ankles, knees, hips, or low back can lead to compensatory postural changes that place additional strain on the neck as the body works to keep the eyes level.
This helps underscore the importance of evaluating the whole patient rather than narrowing attention to the immediate area of complaint—something doctors of chiropractic are trained to do. The good news is that the hands-on care chiropractors provide can often help resolve these contributing issues, and when necessary, your doctor of chiropractic will coordinate with allied healthcare providers to support the best possible outcome.
Pain Relief Chiropractic
4909 Louise Drive Suite 102
Mechanicsburg, PA 17055
Conservative Treatment for Hip Bursitis
12 JanHip bursitis most often refers to trochanteric bursitis, an inflammation of the trochanteric bursa, a small fluid-filled sac located on the outer side of the hip. The primary symptom is pain on the outside of the hip near the greater trochanter—the bony bump at the top of the femur. The pain may be sharp, dull, or throbbing and often worsens with activities that load the hip, such as walking, climbing stairs, or lying on the affected side. Other possible symptoms include swelling and tenderness around the hip, redness (less common), difficulty walking or running, and limping. What role can chiropractic play in managing this condition?
While hip bursitis can result from direct trauma, infection, or complications following hip surgery—which are red flags requiring medical or emergency evaluation—the majority of cases are musculoskeletal in nature and can be managed conservatively. Common contributors include overuse or repetitive stress (friction between the iliotibial band and the greater trochanter), biomechanical abnormalities that alter gait mechanics, prolonged pressure on the hip from poor sitting posture, lumbar spine or sacroiliac joint dysfunction, or tight/overactive musculature that increases tension on the iliotibial band and irritates the bursa. Many of these factors overlap and can work together to inflame the hip bursa.
When a patient presents for chiropractic evaluation, the chiropractor will assess for postural and biomechanical changes beginning with the feet, as excessive pronation, flat feet, knee valgus (“knocking in”), and pelvic imbalance can contribute to functional leg-length differences—one of the factors associated with hip bursitis. The exam typically includes orthopedic tests to assess hip range of motion and pain provocation patterns. Imaging such as X-ray or MRI may be ordered when needed to exclude other pathology.
Short-term management focuses on reducing inflammation through rest, activity modification, and sometimes dietary changes or supplements with anti-inflammatory properties. Applying an ice pack for 15–20 minutes or performing brief ice massage (3–4 minutes) can help reduce pain and swelling. The main treatment goal is to correct the underlying mechanical issues irritating the bursa. This may involve manual therapy to improve mobility in the hip and related joints, targeted stretching and strengthening exercises to address muscle imbalances, and even a heel lift to reduce leg-length inequality, if needed. Because hip bursitis has multiple contributing factors, the specific treatment plan is individualized for each patient. If a patient does not respond to conservative care, they may be referred to their medical physician or a specialist for further evaluation to determine whether more invasive options—such as corticosteroid or platelet-rich plasma injections, or in rare cases surgery—may be appropriate.
As with many conditions, prevention is key. Maintaining a healthy weight, following an anti-inflammatory diet, stretching the hip muscles regularly, using proper posture and movement strategies during daily activities, keeping the core strong, and staying physically active all support hip health. Periodic chiropractic checkups can also help identify biomechanical issues early—before they become painful or interfere with normal function.
Pain Relief Chiropractic
4909 Louise Drive Suite 102
Mechanicsburg, PA 17055
Nocturnal Wrist Bracing for Carpal Tunnel Syndrome
8 JanCarpal tunnel syndrome occurs when pressure within the wrist restricts the function of the median nerve, leading to numbness, tingling, pain, and eventually weakness in the parts of the palm, thumb, index, middle and thumb-side of the ring finger. Management focuses on reducing pressure inside the carpal tunnel, which may include manual therapies, exercises, and activity modifications designed to decrease inflammation and help the tendons passing through the wrist glide more freely. In some cases, addressing hormonal or metabolic factors that contribute to inflammation, water retention, or impaired nerve health may also be necessary. One of the simplest and most effective strategies is using a wrist brace at night. But why is this so commonly recommended in clinical guidelines?
A key point is that the shape of the carpal tunnel is not fixed. The carpal bones form a concave arch, and the transverse carpal ligament forms the roof of the tunnel. When the wrist bends out of neutral alignment, the arch narrows and compresses the structures inside. These pressure increases are not subtle. A wrist positioned just 30 degrees into flexion or extension can triple pressure inside the carpal tunnel. At the extremes of flexion or extension, pressures can increase ten-fold. Even side-to-side wrist deviation can double or triple pressure on the median nerve and surrounding tendons. Not only does this directly stress the median nerve, but using the fingers while the wrist is bent causes the flexor tendons to generate heat and friction in a crowded space, which can promote inflammation and worsen symptoms.
During waking hours, we can consciously monitor our hand positions and adjust our activities to avoid these high-pressure postures. Overnight, however, this is impossible. Many patients with carpal tunnel syndrome experience sleep disturbances because their wrists naturally drift into prolonged flexion or extension while they sleep. A nocturnal wrist brace prevents this by keeping the wrist in a neutral, nerve-friendly position. Most braces look like a soft short arm cast that supports the wrist from the palm to the mid-forearm and prevents bending.
Wearing such a brace during the day would be impractical and could interfere with manual tasks—and continuous daytime bracing may even cause irritation where the ends of the brace contact the skin. For daily activity, other types of bracing and non-bracing options are more appropriate, such as ergonomic modifications for work tasks and using a soft, beanbag or memory-foam wrist support during computer use to reduce carpal tunnel pressure. However—and your chiropractor will likely emphasize this—over-reliance on bracing can hinder long-term recovery, as the muscles controlling the hand and fingers can weaken without regular use. That’s why it’s important to pair nighttime bracing with prescribed wrist exercises, frequent breaks, avoidance of extreme wrist postures, and healthy lifestyle habits that reduce systemic inflammation.
Pain Relief Chiropractic
4909 Louise Drive Suite 102
Mechanicsburg, PA, 17055
The Evidence Map of Low Back Pain Treatment Options
5 JanLow back pain is extremely common and remains one of the leading causes of disability worldwide, resulting in substantial healthcare utilization and cost. Because of this broad impact, identifying and implementing effective, safe, and cost-efficient strategies to diagnose, manage, and prevent low back pain is essential to improve patient outcomes and reduce overall healthcare burden. In 2022, researchers conducted a comprehensive analysis of the available evidence for ten commonly recommended treatments for low back pain—five medication-based and five non-medication-based—drawn from multiple clinical practice guidelines:
- Nonsteroidal anti-inflammatory drugs (NSAIDs) work by blocking the COX-1 and COX-2 enzymes responsible for producing prostaglandins, which influence pain sensitivity, inflammation, fever, and tissue blood flow. Evidence supports short-term improvements in pain and disability, but use is limited by potential side effects such as stomach irritation, increased bleeding risk, kidney strain, and caution in patients with certain heart conditions.
- Acetaminophen (paracetamol) also blocks prostaglandin production, but its effects are largely restricted to the central nervous system. Importantly, available evidence shows little to no meaningful benefit for pain, function, or quality of life in patients with low back pain.
- Opioids blunt incoming pain signals and alter how the brain interprets pain. Due to risks of misuse, dependence, and overdose, guidelines recommend restricting their use to severe acute pain or postoperative situations and strongly discourage long-term use.
- Muscle relaxants can reduce muscle spasm through several central mechanisms. Evidence supports short-term symptom relief, but high-quality evidence is limited, and side effects—including drowsiness, dizziness, cognitive slowing, dry mouth, low blood pressure, nausea, drug interactions, and dependence—must be carefully considered.
- Antibiotics are intended to treat infection. Evidence supporting their role in low back pain management is weak, inconsistent, and not broadly applicable.
- Psychological or behavioral therapies can be especially valuable for patients with persistent or recurrent low back pain, as psychological factors strongly influence whether patients engage in behaviors that support or hinder recovery.
- Staying active and avoiding bed rest are strongly recommended. Activity helps maintain function, reduce disability, and speed recovery.
- Reassurance—emphasizing that low back pain is common, manageable, and rarely dangerous—reduces fear and catastrophizing and lowers the risk of progression to chronic pain.
- Exercise, including both general physical activity and targeted movement strategies, provides modest but meaningful improvements in pain and disability. Exercise also reduces recurrence risk.
- Manual therapy, which includes manipulation and mobilization, helps restore normal movement to the spine and associated tissues, reducing pain and disability. Practitioners often combine different manual techniques based on examination findings, patient preference, and clinical training and experience.
The great news is that doctors of chiropractic frequently employ a multimodal treatment approach that includes manual therapy, exercise, reassurance, and activity recommendations—among the most strongly supported options in this evidence map!
Pain Relief Chiropractic
4909 Louise Drive Suite 102
Mechanicsburg, PA 17055
Pain Relief Chiropractic 