Tag Archives: pain relief

The Neck and Low Back Connection

15 Jan

When 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

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Conservative Treatment for Hip Bursitis

12 Jan

Hip 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

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Nocturnal Wrist Bracing for Carpal Tunnel Syndrome

8 Jan

Carpal 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

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The Evidence Map of Low Back Pain Treatment Options

5 Jan

Low 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

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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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Internal vs. External Shoulder Impingement Syndrome

8 Dec

Most adults will experience shoulder pain at some point during their lifetime, and it’s estimated
that nearly one-third of adults are affected each year. Among the many possible diagnoses, shoulder
impingement syndrome accounts for roughly half of all shoulder pain cases. However, current
understanding indicates that shoulder impingement syndrome is not a single diagnosis, but rather a cluster
of symptoms that can arise from multiple anatomical and biomechanical factors. The condition is
typically classified as either internal or external, depending on where and how the impingement occurs.
The shoulder complex functions as an integrated system of four joints that together allow for an
exceptional range of motion. The glenohumeral joint that joins the humerus (upper arm bone) with the
glenoid fossa of the scapula is the primary joint responsible for most shoulder movement. It is stabilized
by the rotator cuff muscles, labrum, and surrounding ligaments. Under ideal conditions, this joint moves
freely to perform tasks like lifting, throwing, or reaching overhead. But when mechanical forces, either
within the joint itself or external to it, disrupt that motion, the result may be pain, inflammation, and
limited movement. Over time, chronic irritation may lead to scar tissue formation and even degenerative
changes.
External impingement occurs when the acromion or coracoacromial ligament compress the
rotator cuff during arm elevation. While anatomical variations such as a hooked acromion can predispose
some individuals to impingement, the most common contributors are poor scapular control, forward
shoulder posture, rotator cuff weakness, or degenerative changes from repetitive overhead activity or
aging.
Internal impingement, on the other hand, occurs when the humeral head pinches the rear portion
of the rotator cuff between the greater tuberosity and the posterior glenoid rim during high-velocity
overhead movements such as throwing or serving. Contributing factors often include posterior capsule
tightness, shoulder instability, scapular dyskinesis, excessive external rotation, and repetitive overuse.
Internal impingement is more common among younger, athletic, or physically active individuals.
While surgery is occasionally indicated as a first-line intervention in specific cases (such as
significant structural damage or full-thickness rotator cuff tears), clinical guidelines overwhelmingly
recommend conservative management as the initial approach, with chiropractic care serving an excellent
choice! Treatment typically aims to restore normal movement patterns within the shoulder complex
through a multimodal approach that may include manual therapies, joint mobilization, specific exercises,
physiotherapy modalities, traction, and postural retraining. The goal is to reduce inflammation, restore
joint motion, release adhesions, address trigger points, and strengthen weakened muscles.
The good news is that conservative care has a high success rate for both internal and external
impingement—especially when treatment begins early—helping most patients recover without the need
for surgery.
Brent Binder, D.C.

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

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