Tag Archives: neck pain

The Four Grades of Whiplash Associated Disorders

15 Dec

Whiplash occurs when the head suddenly accelerates and then rapidly decelerates, placing
excessive strain on the soft tissues that support the neck. In addition to neck pain and stiffness, this
motion can produce a variety of symptoms collectively known as whiplash-associated disorders
(WAD). To better define and manage these injuries, the Quebec Task Force on Whiplash-Associated
Disorders (1995) developed a classification system that grades whiplash severity from I to IV.
WAD I is characterized by neck pain and stiffness without any objective findings on physical
examination. In other words, there is no loss of range of motion; no muscle spasm or guarding; no
swelling, bruising, or deformity; no neurological deficit; and no imaging abnormalities.
Approximately 15–25% of whiplash patients fall into this category.
In WAD II, neck symptoms are accompanied by physical examination findings such as
decreased range of motion, localized tenderness in neck muscles, muscle spasm, and sometimes
headache. However, there are no neurological deficits or abnormalities visible on diagnostic imaging.
About two-thirds of whiplash patients are graded WAD II.
At the WAD III level, patients present with both musculoskeletal findings (as seen in WAD
II) and neurological signs, which may include sensory loss (numbness or tingling), motor weakness
(reduced strength in muscles supplied by affected cervical nerves), altered reflexes, or radiating arm
pain. As with WAD I and II, the injury still involves soft tissues that typically do not appear on X-ray
or advanced imaging. Approximately 5–10% of whiplash patients fall into this grade of WAD.
The classification of WAD IV is utilized when there is structural damage to the cervical spine
that is present on diagnostic imaging and is usually associated with severe symptoms. Patients with
WAD IV typically require emergency treatment to stabilize the spine. Fortunately, fewer than 1–2%
of whiplash patients meet this criterion.
The good news is that WAD I, II, and III typically respond well to a multimodal chiropractic
approach aimed at reducing pain and restoring function as quickly as possible. Manual therapies may
include gentle, low-velocity, low-amplitude techniques; thrust manipulation (high-velocity, lowamplitude); facet gliding; long-axis cervical traction; passive range-of-motion exercises; massage;
trigger-point therapy; dry needling; or acupuncture. Adjunctive physical therapy modalities such as
electrical stimulation, therapeutic ultrasound, laser therapy, pulsed electromagnetic field (PEMF)
therapy, in-office or home cervical traction, and others are also frequently utilized. Exercise training
is a crucial component of care, as long-term improvement depends on patient self-management and
reduces provider dependency that can sometimes arise. In the event a patient does not respond to care
or if additional issues are present that fall outside the chiropractic scope, the case may be co-managed
with an allied healthcare provider.
Brent Binder, D.C.

4909 Louise Dr. Suite 102 Mechanicsburg, PA 17055 (717) 697-1888

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Chiropractic Approach for Tension-Type Headaches

13 Nov

Almost everyone will experience headaches during their lifetime, with roughly half of adults reporting at least one episode each year. While many may be transitory, some patients develop recurring or persistent headaches. The most common form is the tension-type headache (TTH), accounting for an estimated 60–70% of all chronic headache cases.

Tension-type headaches are characterized by bilateral, non-pulsatile pain of mild to moderate intensity, typically described as a tightening or pressing sensation lasting from 30 minutes to seven days. Many patients liken the pain to a band-like pressure encircling their head. Unlike migraines, TTH is not associated with nausea or vomiting, and patients can usually tolerate routine physical activity. Some may report sensitivity to either light or noise (but not both), and about 20% experience mild loss of appetite.

There is no specific diagnostic test or imaging finding for TTH. Diagnosis is based on its characteristic symptom pattern—bilateral, pressing pain not worsened by activity combined with the absence of migraine features and exclusion of secondary causes through clinical history, physical exam, and neurological assessment. If red flags are present—such as sudden severe onset, progressive worsening, systemic illness, or neurological deficits—urgent referral to an emergency department or specialist is warranted.

A 2023 study in Musculoskeletal Science & Practice found that many TTH patients also experience neck pain, limited range of motion, and impaired motor control. Palpation of trigger points in the neck muscles or upper cervical joints can often reproduce the headache pain pattern. These findings suggest cervical spine examination is an important component of evaluation, and addressing dysfunction through manual therapies—such as spinal manipulation, mobilization, soft tissue work, and neck-specific exercise—may provide benefit.

Studies have found that manual therapies applied to the cervical region to address trigger points in the muscles and restore normal movement to joints and other soft tissues can reduce the intensity, duration, and frequency of tension-type headaches. However, a multimodal approach that includes modalities, therapeutic exercises, and diet and lifestyle improvements may be necessary to more effectively manage the condition.

Pain Relief Chiropractic

4909 Louise Drive Suite 102

Mechanicsburg, PA 17055

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Cranio-Cervical Flexion Exercises for Chronic Neck Pain

13 Mar

Chronic neck pain is defined as pain persisting for longer than three months in the area between the base of the skull (occiput) and the upper thoracic region, specifically up to the T3 level of the thoracic spine. For many patients, chronic neck pain arises from the accumulation of microtraumas to the tissues in the neck and surrounding regions, often coupled with postural faults. Over time, these issues can lead to muscle imbalances and increased strain on the soft tissues that support the head.

When examining patients with chronic neck pain, chiropractors often observe weakness in the deep neck flexor muscles, which are critical for stabilizing the cervical spine. Strengthening these deep muscles is often a key goal for recovery. Unlike the superficial neck flexor muscles, the deep neck flexors cannot be voluntarily contracted in the same way. Instead, we must inhibit the superficial muscles to engage the deeper ones.

Here’s a simple exercise to strengthen the deep neck flexors: lie on your back, tuck your chin slightly, and lift your head while keeping your eyes forward. Hold this position for ten seconds. Initially, this may be challenging, but with consistent practice, it becomes easier. Once you can hold the position for ten seconds, you can progress by increasing the duration, adding sets with brief rest periods, or applying resistance by pressing your hands against the front of your head. Your chiropractor may recommend additional or alternative exercises tailored to your specific needs. To make this routine easier to incorporate into your day, consider doing these exercises before bed or in the morning.

Your doctor of chiropractic may also have you perform these exercises during office visits as part of your treatment plan. In one study involving 58 chronic neck pain patients, researchers found that cranio-cervical flexion exercises led to greater improvements in neck range of motion and pain intensity if they were performed immediately following the application of manual therapies to improve the mobility of the upper cervical spine. This suggests that restoring cervical spine mobility may be a necessary first step to maximize the benefits of cranio-cervical flexion exercises.

This finding highlights the advantages of a multimodal treatment approach for managing chronic neck pain. By combining the strengths of different therapies, such as manual therapy and targeted exercises, patients can benefit from their synergistic effects, potentially achieving faster and more effective relief.

Pain Relief Chiropractic

4909 Louise Drive, Suite 102

Mechanicsburg, PA 17055

painreliefcare.net

Member of Chiro-Trust.org

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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Treating the Neck of the Carpal Tunnel Syndrome Patient

6 Mar

Carpal tunnel syndrome (CTS) is the most frequently diagnosed peripheral neuropathy and one of the most common conditions affecting the hand. The disorder typically results from compression of the median nerve on the palm side of the wrist, leading to numbness, tingling, and sometimes weakness in the thumb and fingers—except for the pinky and the pinky-side of the ring finger, which are innervated by the ulnar nerve. To avoid surgery, many CTS patients seek chiropractic care, which often includes manual therapies applied beyond the wrist and even to the neck due to the nature of the median nerve.

The median nerve originates from the C6-T1 spinal nerve roots in the neck and provides sensory and motor functions to the palm-side forearm and hand. It enables gripping, forming a fist, and detecting temperature and texture. If the mobility of the median nerve is restricted along its course, the resulting symptoms may mimic or overlap with traditional CTS. To complicate matters further, compression can occur at multiple sites, all of which need to be addressed for effective treatment.

In an October 2024 study, researchers divided 48 CTS patients into two groups. Both groups received wrist-focused treatment, including ten sessions of wrist mobilization, electrotherapy, and the use of a nocturnal wrist splint to maintain a neutral wrist posture overnight. However, one group also received manual therapies targeting the cervical spine. Patients underwent motor and sensory nerve conduction testing and completed questionnaires on CTS-related disability at baseline, immediately after treatment, and at six-month follow-ups.

Initially, both groups reported similar improvements in all outcome measures. However, at the six-month follow-up, the group that received cervical spine care showed greater improvements, suggesting that long-term benefits favor incorporating cervical spine treatment into CTS care.

Doctors of chiropractic are well-equipped to assess the entire course of the median nerve—from the neck to the hand—and identify all potential areas of restriction. They can provide conservative treatments to restore normal nerve function and help patients return to their daily activities. In more complex cases, chiropractors may coordinate care with specialists or medical physicians as needed.

Pain Relief Chiropractic

4909 Louise Drive, Suite 102

Mechanicsburg, PA 17055

Painreliefcare.net

Member of Chiro-Trust.org

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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Neck Disorders and Their Connection to Migraines

20 Oct

It’s estimated that about 38 million American adults suffer from migraines and nine-in-ten report that to some degree, migraines affect their ability to carry out their normal social, leisure, work, and everyday activities. Unfortunately, there isn’t a one-size-fits-all treatment for migraines as the condition is not well understood and management tends to focus on lifestyle modifications to avoid potential triggers for a patient’s particular migraine profile. But what if a potential key to managing migraines wasn’t in the head at all? What if the neck had a role to play in migraine headaches?

A 2015 study found that 87% of chronic migraine headache patients also have neck pain. Compared with the non-headache sufferers the researchers questioned, individuals with migraines were roughly three-to-four times more likely to have neck pain. To highlight this relationship between the neck and migraines, a 2023 study looked at 295 migraine patients and found that more than half (51.9%) also had concurrent neck pain. Further analysis showed that migraine sufferers with concurrent neck pain reported more severe migraine symptoms, and the more disabling their neck pain, the worse their migraines. This makes some sense as the trigeminal nerve, which helps innervate the face and has been linked to migraines, exits the spinal cord through the upper cervical spine and travels into the face. In addition to irritation of the trigeminal nerve having a part to play in the migraine process, previous studies have identified a link between migraines and impaired cervical range of motion, reduced neck muscle endurance, and the presence of trigger points in the neck muscles. 

The good news is that doctors of chiropractic have a number of tools in their treatment repertoire for addressing these issues: spinal manipulation, mobilization, myofascial release, and other manual therapies to dry needling, neck-specific exercise, postural training, dietary recommendations, and more. It all depends on the patient’s unique presentation. This approach appears to be effective, as demonstrated in a recent three-armed trial that compared spinal manipulative therapy, sham manual treatment, and usual medical care after a three-month treatment period with follow-ups at three, six, and twelve months. The results favored chiropractic care at all time points. A systematic review of 13 studies published in 2022 concluded that mobilization techniques, trigger point therapy, manual lymphatic drainage, massage, and stretching techniques are each effective interventions for migraine headache patients, especially when used in combination. Other studies have demonstrated that addressing trigger points in the neck and other disorders in the cervical spine can result in reduced frequency, intensity, and duration of migraine episodes.

While managing migraines may require a comprehensive approach that includes exercise, diet, and lifestyle modifications, it’s clear that disorders of the neck can contribute to, if not be an underlying cause of, migraines and should be addressed. If you suffer from migraines, especially if you also have neck pain or stiffness, consult your doctor of chiropractic. 

Pain Relief Chiropractic

4909 Louise Dr

Mechanicsburg, PA 17055

(717) 697-1888

Member of Chiro-Trust.org 

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Headaches and a Traffic Light Prognosis System

20 Sep

The 2022 Global Burden of Disease study listed headaches as one of the most prevalent and disabling conditions worldwide, noting that more than half of adults actively suffer from headaches and nearly 5% of adults report headaches on more than 15 days per month. Because headaches come in many forms (at least 300 distinct types according to some researchers) and can be secondary to an underlying and potentially serious condition, doctors of chiropractic utilize a traffic light prognosis system when examining patient with headaches.

GREEN LIGHT: Primary and secondary headaches with musculoskeletal components. Primary headaches—a term which refers to headaches in the absence of a clear underlining caused pathology, trauma, or systemic disease—are the most common type of headache. Most often, these headaches are classified as either tension-type or migraine headaches. Secondary headaches describe headaches caused by a specific underlying medical condition (such as a metabolic disorder) or they can have a musculoskeletal origin, such as cervicogenic headache (which originate from dysfunction in the neck) or headaches associated with temporomandibular dysfunction or whiplash associated disorders. Because of the sensory input arising from the upper cervical spine, the upper neck and even the masticatory system have strong potential to play a role in the neurophysiology of both primary and secondary headaches. This explains why headaches not thought to be musculoskeletal in origin—such as migraines—can benefit from chiropractic care addressing issues present in the neck.

YELLOW LIGHT: Headaches with a strong psychological component. The current data suggests that around a fifth of migraine and a tenth of tension-type headache patients have co-occurring depression and/or anxiety. When a mood disorder is present, patients may engage in behaviors that can worsen or prolong their condition, such as physical inactivity, fear of movement, or poor coping strategies. In such cases, the patient may require co-management with a mental health professional to achieve a satisfactory outcome.

RED LIGHT: Headaches caused from a potentially dangerous pathology that requires emergent evaluation prior to the use of musculoskeletal care approaches. These are situations when headache may be a symptom of a much more serious issue like infection, cancer, or cervical artery dissection. In such instances, patients are immediately referred to emergency care before in-office treatment is provided.

If your current headache management strategy is not providing lasting relief with respect to reduced frequency, intensity, or duration, then contact your local doctor of chiropractic to see if a conservative multimodal treatment approach can be of benefit for your unique circumstances. 

Pain Relief Chiropractic

4909 Louise Dr

Mechanicsburg, PA 17055

 (717) 697-1888

Member of Chiro-Trust.org 

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