Tag Archives: neck pain

Whiplash: Does Chiropractic Work?

3 Feb

The term “Whiplash” is associated with neck injuries that frequently occur as a result of motor vehicle collisions. There is much published about how injury occurs, the most compelling of which is that we simply cannot voluntarily contract our neck muscles fast enough to avoid injury, as injury to the neck occurs within 500msec. and voluntary contraction or bracing takes 800msec or longer. The question this month is, does chiropractic work in managing patients with whiplash associated disorders (WAD)?

To answer this, a study published in the Journal of Orthopaedic Medicine reported that chiropractic was indeed superior to standard medical care. Most importantly, they studied chronic whiplash patients that (typically) are more challenging to treat compared to the acute, more recently injured whiplash patient.  Their article starts out with the statement, “…conventional treatment of patients with whiplash symptoms is disappointing.” The term “conventional treatment” means medical (non-chiropractic) treatment. One of the studies referenced by the authors reported 26 of 28 patients suffering from chronic whiplash syndrome benefited from chiropractic treatment. The term “chronic” means that those injured have had ongoing complaints for longer than 3 to 6 months, and typically are less likely to respond compared to those more recently injured (acute injuries).

The authors interviewed 100 consecutive chiropractic patients being treated for chronic whiplash of which 93 completed the entire study. Those 93 were divided into 3 symptom groups: Group 1 consisted of neck to shoulder area pain, restricted neck movement with no neurological injury; Group 2 consisted of neck pain, restricted movement, and neurological loss; Group 3 consisted of severe neck pain but had full/normal neck movement, no neurological loss, but had unusual symptoms including blackouts, visual disturbance, nausea, vomiting, chest pain, and non-anatomic neurological complaints, which means the pain or numbness does not correlate with exam findings or were inconsistent.  An average of 19.3 chiropractic adjustments over a mean 4.1 month duration were rendered after which time the patients were surveyed and the results are as follows (“asymptomatic” = no pain or symptoms):

Group 1: 24% Asymptomatic, 24% Improved by 2 symptom grades, 24% Improved by 1 symptom grade, 28% No improvement.

Group 2: 38% Asymptomatic, 43% Improved by 2 symptom grades, 13% Improved by 1 symptom grade, and 6% No improvement.

Group 3: 0% Asymptomatic, 9% Improved by 2 symptom grades, 18% Improved by 1 symptom grade, 64% No improvement, and 9% Got worse.

In their discussion, they reported that similar to the study where chronic symptoms improved in 26 of 28 patients (93%), here 69 of 93 patients improved (74%). They identified a “non-responders” group (Group 3), where neck movement was normal in spite of pain, bizarre symptoms, and ongoing litigation. The mean age was lower in this group vs. the other two (29.5 vs. 36.8 years old). They concluded, “The results from this study provide further evidence that chiropractic is an effective treatment for chronic whiplash symptoms. However, our identification of a group of patients who fail to respond to such treatment highlights the need for a careful history and physical examination before commencing treatment.” Bottom line, try chiropractic FIRST!!!

 

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Cervical Traction – The Many Options and How To Use It!

30 Dec

The type of traction that this discussion will address will be limited to the kind that can be purchased and then used in the home, usually multiple times a day, giving it a clear advantage over in-office traction treatments which can only be applied a few times a week during office visits. In some cases however, it may be appropriate to use the in-office type for a few sessions to determine dosage and/or tolerance prior to administering a home unit, but this varies from case to case, and each type of traction unit is different. In the neck or cervical spine, there are many varieties including: sitting over-the-door types, cervical collar types, as well as supine (lying on the back) types. Each variety has its pros and cons and prices vary considerably from $10 to $600.

CONDITIONS: Probably the most common condition treated with cervical traction is “cervical radiculopathy,” or a pinched nerve. When a nerve root in the neck is pinched, pain, numbness, tingling, and/or muscle weakness occurs in the area the particular nerve innervates. For example, if a patient presents with pain and numbness radiating down the arm to the thumb and index finger and/or have weakness in bending their elbow and extending their wrist, then we know that the C6 nerve is pinched. When pulling or stretching the neck relieves the arm pain, traction is usually helpful. If pain worsens, the person is probably not ready for traction yet.

PROTOCOL (DOSAGE): The key to a successful outcome using cervical traction is finding the right dosage. If you start with too much weight, it may leave you feeling sore, or worse, making you reluctant to try it a second time. Therefore, rather than relying on using a certain percentage of body weight, it’s safest to start with less weight and then gradually increase it, such as 5# (# = pounds or .45 kg) for 15-20 minutes. If that dose feels fine, try 7#/15-20 min., then 9#, 11#, 13#, etc., until you find it just isn’t quite as comfortable at the last weight. You have now found your current threshold and should drop down to the last most comfortable weight and use that for a few days and then MAYBE try increasing it again. Studies show a maximum stretch is usually achieved within 15-20 minutes, so extending the time longer may be less productive. Facing the over-the-door unit may be better tolerated than facing away. Try it both ways and you decide which feels best. The next most important issue is frequency.

How often to repeat the traction sessions depends on: 1. The condition’s severity and your response; 2. Your time availability. If there is a severe nerve pinch with muscle twitching, weakness and dense numbness/tingling, then the traction be repeated MANY times a day, gradually increasing the weight to find the optimum amount. We’ve had people repeat the traction 10x/day! With the option of wearing a cervical collar traction unit, you can actually travel and/or do certain activities during traction. We’ve had people travel to and from work while performing traction! Since each case is unique, we’ll discuss that individually. The bottom line, IT WORKS GREAT with proper chiropractic management and in many cases, surgery CAN be avoided!

We realize that you have a choice in where you choose your healthcare services.  If you, a friend or family member requires care for neck pain, we sincerely appreciate the trust and confidence shown by choosing our services and look forward in serving you and your family presently and, in the future.

 

Whiplash “Anatomy.”

20 Dec

To better understand Whiplash, let’s take a look at the anatomy and what is actually injured in a whiplash injury.  Our spine is basically a long chain made up of blocks that are larger at the bottom and smaller at the top. This means the low back vertebra are huge compared to the neck vertebrae. The vertebrae fit together in a way that “locks” them together by the small joints in the back called “facets” and in the front by the disks. These joints function as shock absorbers between the blocks or “vertebral bodies.” Also in the front, there is a tough piece of tissue called the “anterior longitudinal ligament” that provides a barrier so that when the neck is bent backwards (into “extension”), it becomes tight and stops that movement so it doesn’t over-extend, which could fracture the small facet joints in the back.

There are ligaments, or tissues that hold bone to bone, in the back of the spine that connect between the “spinous processes,” or bony “bumps” in the middle of the back. These ligaments check or stop excessive forward motion of the neck during whiplash. Joint capsules surround joints, which we all have seen when we separate a chicken leg from the thigh. Remember how smooth and shiny the end of the chicken leg is? That smooth surface at the end of long bones is call “hyaline cartilage”, and it allows for slippery gliding between the ends of our bones when we move any joint, including our fingers, wrists, shoulders, hip as well as the facet joints of the spine. Joint movement is facilitated by the presence of an oily substance called “synovial fluid” which acts like a lubricant for the joint allowing for pain-free movement.

A “sprain” occurs when we damage a joint capsule or a ligament, or when the muscle or its attachment (tendon) is injured. These are graded as mild, moderate or severe, or grades 1, 2,or 3, with grade 3 being the worst at 75% or greater tearing, and healing takes progressively longer with each grade.

During a whiplash injury, the classic rear-end collision results in over stretching of the ligaments in the neck, and tearing can occur (sprain, grades 1, 2 or 3). If one of the nerves gets pinched, then numbness, pain, and/or weakness can occur, radiating down the arm to a specific location. When this occurs, the long-term prognosis is worse. Concussion can also occur if the brain is slammed against the inside of the skull. Chiropractic adjustments, when administered early, yield the best results for treating whiplash, according to many studies.

We realize you have a choice in where you choose your healthcare services.  If you, a friend or family member requires care for whiplash, we sincerely appreciate the trust and confidence shown by choosing our services and look forward in serving you and your family presently and, in the future.

 

Neck Pain Treatment Options.

14 Dec

Neck pain is a very common problem. In fact, 2/3rds of the population will have neck pain at some point in life. It can arise from stress, lack of sleep, prolonged postures (such as reading or driving), sports injuries, whiplash injuries, arthritis, referred pain from upper back problems, or even from sinusitis! Rarely, it can be caused from dangerous problems including referred pain during a heart attack, carotid or vertebral artery injuries, or head or neck cancer, but these, as previously stated, are very uncommon. However, since you don’t know why your neck hurts, it’s very important to have your neck pain properly evaluated so the cause can be properly treated and not just covered up from the use of pain killers!

Barring the dangerous causes of neck pain listed above, treatment methods vary depending on whom you elect to consult. Classically, if you see your primary care physician, pharmaceutical care is usually the approach. Medications can be directed at reducing pain (Tylenol, or one of many prescription “pain killers”), at reducing inflammation and pain (Aspirin, Ibuprofen, Aleve, etc.), to reduce muscle spasms (like muscle relaxers) or, medications may be directed to reduce depression, anxiety, or the like. When a sinus infection affects the 2 deep sinuses (ethmoid and sphenoid sinuses which are located deep in the head), the referred pain is directed to the back of the head and neck. Here, an antibiotic may be needed and/or something specifically directed at allergies when present. In general, in cases that do not respond to usual chiropractic care, co-management with the primary care physician is a good option.

However, the good news is that chiropractic care usually works well, and the need for medication can be avoided since the side effects of medication can sometimes be worse than the benefits. Recently, The Bone and Joint Decade Task Force on Neck Pain published arguably the best review of research published between 2000 and 2010 regarding neck pain treatment approaches. They concluded that spinal manipulation and mobilization are highly effective for many causes of neck pain, especially when arising from the muscles and joints – the most common cause. Therefore it would seem logical to consult with a Chiropractor FIRST since manipulation and mobilization are so effective and safe. When we add neck exercises, the results are even better, according to some studies. As chiropractors, we will often use different modalities including electric stimulation, ultrasound, hot and/or cold (which are usually given as a good home-applied remedy), and others. In particular, low level laser therapy (LLLT) has been shown, “…to reduce pain immediately after treatment in acute neck pain and up to 22 weeks after completion of treatment in patients with chronic neck pain” [Lancet, 2009; 374(9705)]. LLLT is a commonly used modality by chiropractors and when combined with spinal manipulation, the results can be even faster! We will also evaluate your posture, body mechanics, and consider “ergonomic” or work station problems and offer recommendations for improving your work environment. We also frequently utilize anti-inflammatory nutrients including vitamins, minerals, herbs, and more to avoid the negative side effects to the stomach, liver, and kidney negative that can result from using non-steroidal anti-inflammatory drugs (NSAIDs) like aspirin, ibuprofen, or Aleve. Make chiropractic your FIRST choice when neck pain strikes, NOT last resort!

We realize that you have a choice in where you choose your healthcare services.  If you, a friend or family member requires care for neck pain, we sincerely appreciate the trust and confidence shown by choosing our services and look forward in serving you and your family presently and, in the future.

 

Neck Pain and Chiropractic.

12 Dec

Neck pain represents a major problem for people throughout the world with considerable negative impact on individuals, families, communities, health care systems, and businesses. Up to 70% of the general population will have neck pain at some point in their life. Recovery within the year from neck pain ranges between 33% and 65%, AND relapses are common throughout the life time of the neck pain patient. Generally, neck pain is more common in women, higher in high-income countries, and higher in urban regions. The greatest risk of developing neck pain occurs between 35 and 49 years of age. Since neck pain, very similar to low back pain, is very common and likely to recur over and over again, the question is, what is the best course of action regarding treatment?

A recent study on neck pain patients compared the effectiveness of manual therapy performed by a chiropractor, physical therapy performed by a physical therapist (PT), and medical care performed by medical physician (MD). The success rate determined at the seventh week was TWO TIMES BETTER for the manual therapy/chiropractic group (68.3%) compared to the medical care group. Those receiving manual therapy also had fewer absences from work compared to both the medical and PT treated groups. Lastly, both the manual therapy and PT groups used less pain relief medication compared to the medically treated group. Another study looked at the multiple approaches that chiropractors use for treating patients with neck pain to determine the “best” approach a chiropractor can use. They reported 94% had improvement or less neck pain after just one treatment when the mid-back (thoracic spine) was also adjusted. Similarly, after receiving two treatments over a one week time frame, the group receiving midback adjustments (vs. the group who did not) reported lower pain and disability scores. A similar study concluded that the best results occurred when the neck, upper back/lower neck, and mid-back were adjusted. This group, when compared to neck adjustments alone, reported greater reductions in disability scores. Thus, having the cervical spine, upper back, and mid-back all adjusted appears to yield quicker, more satisfying results than neck adjustments alone.

What about the role of exercise in the management of neck pain patients? In November 2012, a systematic review of manual therapies for nonspecific neck pain reported that the addition of neck exercises to a treatment plan provided more benefits than spinal manipulation alone. Similarly, in September 2012 (The Annals of Internal Medicine), chiropractic adjustments were compared against exercise and pain medication treatment groups involving 272 patients tracked over a one-year time frame after a 12-week treatment. Both the chiropractic and exercise groups experienced the most significant pain reduction when compared to the medication treated group with more than double the likelihood of complete pain relief. The chiropractic and exercise groups also had the best short and long term results, but ONLY the chiropractic group found the benefits to last a year or more. The authors (Bronfort, et. al) reported the success of chiropractic treatment stems from its ability to address the CAUSE of the problem rather than simply addressing the symptoms!   

We realize that you have a choice in where you choose your healthcare services.  If you, a friend or family member requires care for neck pain, we sincerely appreciate the trust and confidence shown by choosing our services and look forward in serving you and your family both presently and in the future.

 

Whiplash “Basics.”

12 Dec

Whiplash is a non-medical term typically describing what happens to the head and neck when a person is struck from behind in a motor vehicle collision. Let’s look at some basic facts about whiplash:

Before cars, trains were the main source of whiplash and was called “railroad spine.”

Better terms for whiplash injuries include “cervical acceleration-deceleration” (CAD) which describes the mechanism of the injury, and/or the term “whiplash associated disorders” (WAD), which describes the residual injury symptoms.

Whiplash is one of the most common non-fatal injuries involved in car crashes.

There are over one million whiplash injuries per year due to car crashes alone.

An estimated 3.8 per 1,000 people per year have a whiplash injury.

In the United States alone, 6.2% of the population has “late whiplash syndrome” (symptoms that do not resolve at one year).

1 in 5 cases (20%) remain symptomatic at one year post-injury of which only 11.5% returned to work and only 35.4% of that number returned to the same level of work after 20 years.

The majority of whiplash cases occur in the fourth decade of life, females>males.

Whiplash can occur from slips, falls, and brawls, as well as from horse-riding, cycling injuries, and contact sports.

Injury from whiplash can occur at speeds of 15 mph or less.

In the “classic” rear end collision, there are four phases of injury (time: 300msec)

Initial (0msec) – before the collision (the neck is stable)

Retraction (1-150msec) – “whiplash” starts where the head/neck stay in the original position but the trunk is moving forwards by the car seat. This is where the “S” shaped curve occurs (viewing the spine from the side).

Extension (150-200msec) – the whole neck bends backwards (hopefully stopped by a properly placed head rest).

Rebound (200-300msec) – the tight, stretched muscles in the front of the neck propels the head forward immediately after the extension phase.

We simply cannot voluntarily contract our neck muscles fast enough to avoid injury, as injury to the neck occurs within 500msec. and voluntary contraction or bracing takes 800msec or longer.

Injury is worse when the seat is reclined as our body can “ramp” up and over the seat and headrest. Also, a springy seat back increases the rebound affect.

Prompt treatment is better than waiting for a long time. Manipulation is a highly effective (i.e., COME SEE US!) treatment option.

We realize you have a choice in where you choose your healthcare services.  If you, a friend or family member requires care for whiplash, we sincerely appreciate the trust and confidence shown by choosing our services and look forward in serving you and your family both presently and in the future.