Pain Relief Chiropractic

Cervical spinal stenosis (CSS) is a condition characterized by the narrowing of the spaces within the spine through which the spinal cord and the nerves pass. The condition becomes more common with age, affecting 6.8% of adults over age 50 and 9% of those over age 70. While it’s not unusual for a CSS patient to be asymptomatic, a sudden injury to neck tissues can compress, constrict, or injure the spinal cord (or associated nerves) and result in symptoms such as pain, numbness, and/or tingling along the course of that nerve that can affect physical function over time. 

It’s estimated that more than two million Americans sustain a whiplash injury each year, with automobile collisions being the primary cause. In a June 2023 study, researchers used a previously validated three-dimensional model of the human head-neck complex to assess the risk for spinal cord injury with CSS of varying sizes (from 14 mm to 6 mm—a lower number is worse) with rear-impact acceleration of both 1.8 m/s and 2.6 m/s. At the C5-6 level of the cervical spine, which sits toward the bottom of the neck, the stress on the spinal cord was enough to cause injury at both accelerations with a stenosis of 6 mm. However, for the less severe 8 mm stenosis, only 2.6 m/s acceleration applied sufficient forces to injure the spinal cord.  In general, the authors surmised that the narrower the opening for the nerve/spinal cord to pass through, the less force needed to reach the threshold for spinal cord injury. 

Aside from genetics, the risk factors for CSS include cumulative trauma, osteoporosis, cigarette smoking, and degenerative joint disease/osteoarthritis—all of which can affect the ability of the tissues of the neck to absorb the forces stemming from the sudden acceleration and deceleration during a rear-end collision, leading to a potentially more severe injury, which may require a more comprehensive treatment approach to reduce the risk for ongoing, chronic symptoms. The good news is that doctors of chiropractic offer an excellent conservative treatment option for managing both cervical spinal stenosis and whiplash injuries.

While it may not be possible to fully prevent CSS, there are measures one can take to reduce their risk for developing the condition. This includes eating a healthy diet, getting regular weight-bearing exercise, getting good sleep, not smoking, avoiding excessive alcohol intake, and avoiding the risk factors for metabolic syndrome including obesity, hypertension, diabetes, and dyslipidemia. A 2018 study found a link between worse spinal posture and spinal stenosis, so maintaining good posture and getting regular chiropractic care to keep the spine aligned may also lower the risk for CSS!

Pain Relief Chiropractic

4909 Louise Dr

Mechanicsburg, PA 17055

(717) 697-1888

Member of Chiro-Trust.org 

Tags: whiplash

The International Headache Society lists “headache attributed to whiplash” as a headache that appears or existing headaches that worsen within seven days after a whiplash event (i.e., automobile collision, sports collision, slip and fall, etc.). It’s estimated that up to 60% of whiplash associated disorders (WAD) patients experience such headaches and nearly 40% will continue to do so a year after their initial injury. Thus, studies that focus on what factors are linked to post-whiplash headaches, especially those that persist in the long term, are important.

In a 2022 study, researchers monitored 47 recent WAD grade II patients (pain, stiffness, or tenderness of the neck with soft tissue injury signs, loss of range of motion, and/or point tenderness of the neck) without a previous history of headache or musculoskeletal disorders associated with headache. All participants completed self–reported questionnaires including Visual Analogue Scale for neck pain intensity, the Neck Disability Index, Pain Catastrophizing Scale, and the Tampa Scale Kinesiophobia–11. Of the 47 patients in the study, 28 developed headaches within a week of the whiplash event, which correlates to findings from previous studies. 

Analysis of questionnaire data revealed that neck pain intensity, neck disability, pain catastrophizing, kinesiophobia, and anxiety were ALL higher in those with post-whiplash headaches. Previous research has also linked central sensitization (experiencing painful sensations to non-painful stimuli) to post-whiplash headaches. This suggests that worse injury to the musculoskeletal system, particularly in the vicinity of the cervical spine may contribute to post-whiplash headaches and the neck should be evaluated in WAD patients, especially those with new-onset or worsening headaches.

The 2016 update to the 2000-2010 Bone and Joint Decade Task Force on That Pain and its Associated Disorders concluded that episodic tension-type headaches, chronic tension-type headaches and cervicogenic headaches are effectively managed with low load endurance craniocervical and cervical scapular exercises, relaxation training with stress coping therapy, and/or multimodal care that includes spinal manipulation, mobilization, and postural correction.  Both cervical and thoracic spine manipulation with or without mobilization was found effective for cervicogenic headaches.  Doctors of chiropractic frequently employ these and other treatment options as part of a multimodal approach for the management of WAD patients, including those with post-whiplash headaches.

Pain Relief Chiropractic

4909 Louise Dr

Mechanicsburg, PA 17055

(717) 697-1888

Member of Chiro-Trust.org 

Tags: whiplash

Whiplash-associated disorders (WAD) can be a challenging condition to manage, and the current data suggests that up to half of WAD patients may continue to experience pain and disability for up to a year following their car accident, slip and fall, or sports collision. Exercise therapy has long been considered a meaningful treatment option for many musculoskeletal conditions, but what does the current research reflect with respect to the role of exercise therapy for the WAD patient?

In 2021, researchers conducted a systematic review and meta-analysis that included 27 studies in order to gauge the effect of exercise therapy compared with other treatments, placebo interventions, or no treatment. They found that exercise therapy had short-term effects on neck pain and medium-term effects on neck-related disability, but they concluded that “the current evidence is weak” with respect to exercise as a sole treatment for WAD.

However, when used in combination with other treatments, exercise therapy can be quite beneficial to the WAD patient. In addition to the advice to stay active or even start exercising in some capacity (even if that means taking a short walk each evening to begin with), WAD patients may be prescribed more specific, neck/shoulder/upper back exercises to restore posture and strengthen the deep muscles that often become deconditioned in patients with the condition.

In addition to exercise recommendations, your doctor of chiropractic may employ a multimodal approach that includes manual therapies (massage, manipulation, mobilization, active release technique, trigger point therapy, and more); physical therapy modalities (electric stim, ultrasound, class IIIb and IV lasers, pulsed electromagnetic field, traction); patient education (including emphasizing the importance to resume normal activity as soon as possible); and ergonomic assessments (to minimize work stress and strain). When psychosocial barriers to recovery exist, your chiropractor may team with allied healthcare providers that offer cognitive behavioral therapy and other needed services.

Pain Relief Chiropractic

4909 Louise Dr

Mechanicsburg, PA 17055

 (717) 697-1888

Member of Chiro-Trust.org 

Tags: whiplash

Whiplash-associated disorder (WAD) is a condition characterized by a collection of symptoms that can arise after the sudden back-and-forth movement of the head and neck—most commonly from motor vehicle collisions. It’s estimated that 2-3 million Americans experience whiplash each year and the current data suggests as many as half may continue to experience ongoing, chronic WAD symptoms lasting longer than a year. Unfortunately, there’s no clear way to identify which patient may be at elevated risk for chronicity but a 2022 study suggests it part of the answer may have to do with drawing a picture.

In the study, researchers provided 205 chronic WAD patients with electronic diagrams of the human body and asked them to draw or fill in where they feel pain on their body. The patients also completed a Neck Disability Index questionnaire. They repeated the process a year later. The research team identified an association between perceived pain and disability (from the questionnaire responses) and the degree to which the patient’s pain was widespread (from their drawings). 

This widespread pain is indicative of central sensitization, which is described as greater sensitivity to pain, even stimuli that isn’t normally painful. The system in the body that relays pain signals to the brain is the nervous system, and these signals must pass through the neck. This suggests that a nerve injury or an injury that interferes with the nervous system’s function may be a driving risk factor for chronic WAD. Interestingly, a systematic review that looked at health data from more than 390,000 WAD patients found evidence that a third of grade II WAD patients show signs of nerve injury, which would classify them as grade III WAD and necessitate a more comprehensive treatment approach. Other risk factors for chronic WAD include high initial pain and disability, current low back pain at time of whiplash event, history of neck pain, new onset headaches, post-injury anxiety, and cold hyperalgesia (high sensitivity to cold). 

Doctors of chiropractic are trained to assess patients with whiplash injuries and to provide a conservative treatment approach that not only addresses the patient’s pain and disability, but also to educate them on the importance of maintaining their usual activity as best they can and to reassure them that they can get better—both of which are important for reducing the risk for persistent, ongoing symptoms. If necessary, they will team up with allied healthcare providers to provide the patient with the best possible chance for a satisfactory outcome.

Pain Relief Chiropractic

4909 Louise Dr

Mechanicsburg, PA 17055

 (717) 697-1888

Member of Chiro-Trust.org 

Tags: whiplash

While the literature published on the topic of whiplash-associated disorders (WAD) is voluminous, it’s still somewhat of a mystery why some individuals can walk away from a motor vehicle collision without injury and others can experience chronic, persistent, and disabling symptoms. One area in which researchers have focused their efforts in recent years is on the extent that nerve injury occurs during a whiplash event, and when it occurs, whether it’s being detected early in the course of treatment.

Traditionally, WAD patients are classified the following way: WAD I—pain, stiffness, or tenderness of the neck as the only complaint with no physical exam findings (full range of motion and no muscle guarding or tenderness on examination); WAD II—pain, stiffness, or tenderness of the neck with soft tissue injury signs, loss of range of motion (ROM), and/or point tenderness of the neck (e.g., a sprain/strain neck injury); WAD III—pain, stiffness, or tenderness of the neck along with neurological signs sensory deficits, motor weakness, and/or decreased or absent deep tendon reflexes; WAD IV—pain, stiffness, or tenderness of the neck along with dislocation or fracture with or without spinal cord injury.

As you can expect, treatment guidelines can vary based on how WAD is graded. A systematic review of 54 studies that included more than 390,000 WAD patients and 900 individuals without a history of WAD (who served as controls) concluded that this classification system may need updating. The researchers found that about a third of WAD II patients—the most common WAD level—showed signs of neuropathic pain, though they had not been diagnosed as such. 

The authors stress the importance of a careful INITIAL clinical examination as the presence of nerve injury/pathology may alter the treatment recommendations given to the acute WAD patient such as a wait-and-watch method that is commonly recommended after the initial examination. Researchers point out that compared to other chronic pain conditions, people with neuropathic pain experience greater interference with function and activity tolerance as well as worse quality of life and emotional wellbeing assessments—each of which is associated with an increased risk for chronicity.  

Doctors of chiropractic are trained in the diagnosis and management of WAD using a multimodal approach that embraces spinal and extremity manipulation, mobilization, and other manual therapies; exercise training tailored to the individual patient; nutritional counseling for reducing inflammation and promoting healing; various PT modalities including ultrasound, electrical stimulation, laser, and pulsed magnetic field; acupuncture and/or dry needling; and more. In more severe cases, doctors of chiropractic can also co-manage treatment with the patient’s medical physician, specialist, or other healthcare providers.

Pain Relief Chiropractic

4909 Louise Dr

Mechanicsburg, PA 17055

 (717) 697-1888

Member of Chiro-Trust.org

Tags: whiplash

It’s estimated that up to 50% of whiplash associated disorders (WAD) patients will continue to experience long-term symptoms that interfere with their ability to carry out activities of daily living. According to experts, the economic burden associated with chronic WAD may exceed $42 billion each year. As such, many studies have sought to better understand whiplash, both from the mechanisms of injury to why some patients recover and some don’t. 

With respect to chronic WAD resulting from a motor vehicle collision (the most common cause of whiplash), factors associated with the crash itself like speed, impact direction, awareness of collision, and airbag deployment do not appear to be significantly linked to an elevated risk for chronicity. On the other hand, researchers have found that higher self-rated pain and disability, fear of movement, catastrophizing, passing coping, and low expectations of recovery are indicative of failure to fully recover. 

In a 2017 study, researchers reframed the trauma of a motor vehicle collision as an event that is both potentially injurious and distressing. When an acute injury occurs (in this case whiplash), there is often damage to various anatomical structures in the head, neck, and/or upper-mid back. Additionally, there is also a stress response associated with the overall incident (including subsequent events like a trip to the hospital and dealing with the insurance company and legal system) that can interfere with the healing process. When the combination of psychological vulnerabilities and neurobiological processes exceeds a person’s given threshold, their risk for chronic WAD rises.

This finding highlights the importance of treating the whole patient when it comes to WAD as it can affect both the body and mind. In addition to therapies delivered in the office to help the soft tissues in and around the neck to heal, doctors of chiropractic and other healthcare providers need to educate the patient and assure them that they will recover and encourage them to carry on their normal activities within pain tolerance. If necessary, the patient may need a referral to a mental healthcare professional to address psychological factors that can impede recovery. 

Pain Relief Chiropractic

4909 Louise Dr

Mechanicsburg, PA 17055

 (717) 697-1888

Member of Chiro-Trust.org 

Tags: whiplash