Tag Archives: pain relief

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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What Is Iliotibial Band Syndrome?

10 Nov

Up to one-in-five adults experience knee pain each year, and many seek chiropractic care to find relief from both pain and disability. While knee pain can have many causes, when discomfort is concentrated on the outside of the knee in active adults, iliotibial band syndrome (ITBS) is an important condition to consider.

The iliotibial band is a tough, fibrous band of fascia that runs from the iliac crest at the top of the pelvis down to the outer surface of the tibia just below the knee. It serves as a dynamic stabilizer of both the knee and the hip during walking and running, and research has shown that it also stores and releases elastic energy during these activities, much like a spring.

Pain from ITBS rarely begins with a single traumatic event. Instead, it typically develops after a gradual increase in running loads, such as taking on longer distances or increasing speed. The condition is estimated to account for up to 14% of all running-related injuries, but there is still debate about the exact mechanism of injury. The traditional explanation is that the band becomes irritated as it rubs back and forth over the bony prominence of the lateral femoral epicondyle as the knee bends and straightens. More recent studies, however, suggest that the band is firmly anchored to the femur and that repetitive knee motion instead compresses the soft tissues beneath it, leading to pain. A third view emphasizes the role of weak hip muscles, which reduce pelvic control and place greater strain on the ITB, creating a sprain-like overload.

Because there is no blood test or imaging procedure that can definitively diagnose iliotibial band syndrome, clinicians rely on a combination of history and physical examination while ruling out other potential causes of lateral knee pain such as meniscus injury, synovial plica syndrome, or bone stress fracture. Iliotibial band syndrome is most strongly suggested when tenderness is present directly over the lateral femoral epicondyle, when pain worsens with prolonged running, downhill activity, or stair descent, and when there is no evidence of catching, locking, or clear trauma that would indicate another problem. Findings on clinical tests such as Noble’s compression test, Ober’s test, or Renne’s test can further support the diagnosis.

Treatment of ITBS usually requires a multimodal approach. Patients often need to modify their activity levels to reduce strain on the ITB, while also addressing underlying inflammation. Rehabilitation exercises to strengthen the hip and core muscles and improve posture can restore balance, while manual therapies may be used to improve the movement of joints and soft tissues. In some cases, orthotics or footwear changes are recommended to correct ankle or foot mechanics that place additional stress on the knee. As with most musculoskeletal conditions, the earlier care is initiated, the better the outcomes. With prompt attention, patients can usually expect a satisfactory recovery that allows them to return to their usual recreational and occupational activities without lingering limitations.

Pain Relief Chiropractic

4909 Louise Drive Suite 102

Mechanicsburg, PA 17055

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Monthly update on Lower Back Pain

14 Jul

Chiropractic Treatment for Lumbar Spinal Stenosis

            Lumbar spinal stenosis is a condition caused by the narrowing of spaces within the lower spine, which can compress either the spinal cord or nerve roots. This pressure can lead to pain, numbness, or weakness—either locally or radiating down the legs—especially during activities that involve spinal extension (e.g., bending backward or prolonged standing) or compressive loading. While stenosis may result from trauma, congenital anomalies, or systemic diseases, approximately 80% of lumbar spinal stenosis cases are degenerative in origin. Common degenerative contributors include intervertebral disk bulging or herniation, facet joint hypertrophy (arthritis), ligamentum flavum thickening, spondylolisthesis (vertebral slippage), and osteophyte (bone spur) formation. How might chiropractic care help a lumbar spinal stenosis patient both avoid surgical intervention and return to their normal activities to as high a degree as possible?

In the medical model, initial treatment may include physical therapy and/or medications. If those fail to provide relief, a common next step is epidural steroid injections (ESIs), which aim to reduce nerve inflammation and provide temporary symptom relief. A 2025 systematic review of 90 randomized controlled trials found that ESIs can offer short-term improvement in pain and disability but do not result in long-term symptom resolution. If a patient experiences minimal relief after one to two injections, if relief lasts less than one month, or if neurological symptoms progress, further injections are generally not recommended. Clinical guidelines typically limit ESIs to a maximum of three per year, and suggest limiting repeated use to no more than two to three consecutive years due to risks such as bone loss, adrenal suppression, and soft tissue damage.

If the patient pursues chiropractic care, the aim of treatment would be to reduce neural compression by improving lumbar spine mobility and joint spacing. For lumbar spinal stenosis, current guidelines discourage high-velocity, low-amplitude (HVLA) spinal manipulation. Instead, they support gentler techniques such as flexion-distraction, mobilization, and instrument-assisted soft tissue therapies. Chiropractic care may also include targeted exercise, posture training, and neuromuscular re-education to support spinal health and nerve mobility.

Just as critical as in-office treatment is the home management component. Patients are encouraged to perform flexion-based and low-impact exercises—such as stationary biking, inclined treadmill walking, wall sits, and knee-to-chest stretches—which can reduce pressure on lumbar nerves. Core stabilization improves spine support, while posture training and ergonomic adjustments (e.g., lumbar support, avoiding prolonged standing, sleeping with knees elevated) help maintain relief. Lifestyle modifications such as weight loss, an anti-inflammatory diet (rich in omega-3s, vegetables, and whole foods), hydration, and use of ice, heat, or TENS units for pain control can further support long-term improvement.

The good news: with consistent effort, as many as 70% of patients with lumbar spinal stenosis can improve or maintain stable symptoms without ever needing surgery. Only about 30% of patients progress to requiring surgical intervention—typically when pain is disabling, function is severely limited, or neurologic decline occurs.

Watching your back,

Dr. Binder

Pain Relief Chiropractic

painreliefcare.net

(717) 697-1888

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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Glute Weakness & Low Back Pain

30 Jan

Glute Weakness and Low Back Pain

While we traditionally view low back pain as the result of a problem localized to the low back itself, several studies have found that issues in adjacent parts of the body can play a role in the development of low back pain.  For example, chronically tight hamstrings can affect pelvic tilt, which in turn can alter the posture of the lumbar spine, potentially leading to low back pain. Another potential contributor to low back pain that’s often overlooked is glute muscle weakness.

In September 2024, the New York Times ran an article focused on a condition called gluteal amnesia, though it’s more colloquial name is dead butt syndrome. Gluteal amnesia is the result of prolonged inactivity of the three glute muscles (maximus, medius, and minimus). Prolonged inactivity can occur from things such as sitting at a desk or in a car for more than two to three hours at a time without getting up to move around and stretch. The gluteals help stabilize the hip, lift the leg, and rotate the thigh. This muscle group also serves an important role in the kinetic chain, and when not working properly, the risk for problems like hamstring tears, sciatica, shin splints, and knee arthritis increases.

Gluteal amnesia is NOT like the temporary numbness/tingling noticed when we sleep on an arm and it “falls asleep” or goes numb and recovers quickly when we change positions. Some people may feel a dull ache or pain after a long walk or after a jog or hike. Because muscle strength and activation are affected, the body may recruit nearby muscles to help perform regular movements, which can lead to pain in the lower back, for example.

            Though it’s best to be examined by a qualified healthcare provider, like a doctor of chiropractic, you can perform the following test to check if you may have dead butt syndrome: stand on one leg letting the other leg dangle (standing sideways on a step holding onto a railing works well) press into your buttocks region on the dangling leg, it should feel soft (not firing); do the same on the other side; now stand on both feet and squeeze your “cheeks” hard; you should feel the muscle contract or get firm; if it takes a few squeezes before you feel it get firm, then you may have gluteal amnesia.

            The key to overcoming this condition is to restore normal activation to the gluteal muscles. You can start by setting an alarm on your phone to stand up every 30-50 minutes and gently tap on your glut/butt cheeks with your fingertips. This reminds the brain that these muscles need to fire. Better yet, march in place, do some hip circles and squats and consciously tighten your gluts with each rep. Other exercises for this include clamshells, hip thrusts, side planks, split squats, and single-leg glut bridges. Just remember to consciously engage the glutes.

            If the condition persists, schedule an appointment with your doctor of chiropractic so they can determine if there are additional problems present that can be addressed with treatments provided in the office, such as manipulative or mobilization therapy, with the goal of helping restore normal function.

Pain Relief Chiropractic

4909 Louise Drive, Suite 102

Mechanicsburg, PA 17055

Painreliefcare.net

717-697-1888

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 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.

 

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