Headaches: Does Chiropractic Help?

Headaches (HA) can be tremendously disabling, forcing sufferers away from work or play into a dark, quiet room to minimize any noise and light that intensifies the pain. According to the National Headache Foundation, there are over 45 million Americans who suffer from chronic, re-occurring headaches, of which 28 million are of the migraine variety. Also, approximately 20% of children and adolescents deal with headaches that can interfere significantly with their daily routines. There are many different types of headaches and many sub-types within the main categories. Here are a few: Tension HA (also, called cervicogenic HA), migraine, mixed headache syndrome (a mixture of migraine and tension HAs), cluster (less common but the most severe), sinus headaches, acute headaches, hormone headaches, chronic progressive headaches (traction or inflammatory HAs), and MANY more! Just “GOOGLE” “headache classification” for the daunting list! Let’s take a look at how chiropractic manages these headaches!
According to a study completed in 2005, a review of the published literature revealed good evidence that intensity and frequency of HAs are indeed helped by chiropractic intervention. They limited their review to cervicogenic headaches and spinal manipulation and noted the need for larger scale studies. The well-respected Cochrane database reported spinal manipulation (SM) as an effective treatment option with short-term benefits similar to amitriptyline, a commonly prescribed medication for migraine HA patients.
For cervicogenic HA, the combination of neck exercises and SM was found to be effective in both the short- and long-term, and SM was superior to massage or placebo (sham or “fake” manipulation). Regarding the question of treatment frequency of SM plus up to two modalities (heat and soft tissue therapy), a preliminary study found that when comparing patients receiving one, three, or four visits per week for three weeks, those receiving 9-12 treatments during the three weeks had the most benefit. Regarding the questions, “what is affected by SM” and, “why does SM work” for cervicogenic HA patients, a study describes the intimate relationship between the upper cervical nerve roots (C1-3), the trigeminal (cranial nerve V), the spinal accessory (cranial nerve XI), and the vascular system. Inflammation within these structures and their relationship with the trapezius and SCM muscles help us understand the “why” and “how” of SM and referred pain pattern to the face and head in those with cervicogenic HAs. Realizing this is a bit “technical”, feel free to GOOGLE these structures and you’ll appreciate the close proximity they have to each other and how adjustments, or SM, applied to the upper cervical spine can affect this region. It has also been reported that SM and strengthening of the deep neck flexor muscles benefits the cervicogenic HA patient. Many HA sufferers have combinations of symptoms including dizziness, neck pain, concentration “fog”, fatigue, and others, which were found to also respond to SM applied to the upper cervical spine. One study reported a 36% reduction in pain killer medication use in a group of cervicogenic headache patients receiving SM but no reduction in the patient group receiving soft-tissue therapy. The list of research studies goes on and on! So WHAT are you waiting for? TRY CHIROPRACTIC for your headache management!!!
We realize you have a choice in whom you consider for your health care provision and we sincerely appreciate your trust in choosing our service for those needs.  If you, a friend, or family member requires care for headaches, we would be honored to render our services.

Whiplash Management

Whiplash usually occurs as a result of a car crash when the head moves in a fast, uncontrolled way in many possible directions. The forwards-backwards movement is described in a classic “whiplash” injury but side-to-side, rotational, or a combination of movements often occur, especially if we add in the factor of the head being turned or rotated when the impact occurs, regardless of how the car is hit. This month, let’s talk treatment!

Think of “Whiplash Management” in steps:

STEP 1: IMMEDIATELY seek chiropractic attention following a whiplash injury: This is important as studies show delayed treatment is associated with worse outcomes after the dust settles. To avoid long-term disability, DON’T WAIT! Pain usually scares people into a guarded, protective way of thinking. The longer you wait, the greater the muscle tightness, spasm, weakening, and your increased fear of activity because of the pain!

STEP 2: Reduce Inflammation: The words “pain” and “inflammation” are quite synonymous. If you feel “hurt,” you are “inflamed.” We must begin anti-swelling/inflammation measures ASAP after an injury like whiplash. The BEST/safest approach is an ICE PACK – rotate it on/off/on/off/on every 15 minutes (1.25 hours/session) three times a day OR, CONTRAST ice with heat (10 min. ice/5 min. heat x3, ending with ice = 40 min.). BOTH methods produce a PUMP-like effect to quickly get rid of the inflammation. You also have the option of OTC medications (Aspirin, ibuprofen, and naproxen) but these NSAIDs (non-steroidal anti-inflammatory drugs) carry significant side-effects for some people, the most evident early on being stomach upset/irritation (later, liver and kidney damage) so be careful! You don’t want to have to treat an ulcer on top of your whiplash! Consider anti-inflammatory nutrients, herbs, vitamins, and food – they’re safe and effective (we’ve discussed these previously – SEARCH the web for more information).

STEP 3: AVOID INACTIVITY: This is important since the “natural” thing to do is nothing, “…because it hurts!” WE will guide you in this process as you need to know how much and what type of activity is safe and appropriate. You have to “interpret” the pain as being either safe or harmful and then you react accordingly. You MUST tell us the type of pain (sharp, knife-like is harmful vs. a “good” stretch type of hurt is safe), how much pain there is (7-10 on a 0-10 scale is potentially harmful), how constant it is, and what helps/hurt (what have you tried and learned so far). THEN, we will guide you appropriately (with your help)!

STEP 4: DO NORMAL ACTIVITY: This dovetails our last point. Get on with your normal activities as avoiding work and other ADLs (activities of daily living) leads to “disability thinking” or thinking you’re worse than you are. DON’T LET THAT HAPPEN. Talk to us!!!  

STEP 5: AVOID prolonged faulty postures: Whether it’s a conversation with a person who is NOT directly in front of you, a faulty computer screen position, talking in a car without turning your body (look straight ahead), or talking on the phone, CHANGE IT!  

STEP 6: COMPLY with a home-based exercise program: This is HUGE! We will guide you in this process. We will start with ice and then possibly a home traction device, isometrics followed by Theratube or band (isotonic) exercises, posture training, and much more. You NEED guidance in this area – let us HELP YOU!  

We realize you have a choice in whom you consider for your health care provision and we sincerely appreciate your trust in choosing our service for those needs.  If you, a friend, or family member requires care for Whiplash, we would be honored to render our services.

Carpal Tunnel- More Fun Facts!

Did you know that Carpal Tunnel Syndrome (CTS) can affect anyone? None of us are immune to developing CTS as roughly 1 out of 20 of us will develop CTS in our lifetime! This month, let’s look at some of the risk factors for developing CTS.

1)  Race: Caucasians carry the greatest risk of developing CTS.

2)  Gender: Women are three times more likely than men to develop CTS. This may be because female wrists are smaller and shaped a little differently than male wrists, but hormonal differences are probably the most important reason for this variance.

3)  Pregnancy: Up to 62% of pregnant women develop CTS. This is thought to be due to the excess fluid retention that normally occurs during pregnancy and most likely stems from the elevation in hormone levels that NORMALLY occurs during pregnancy. The prevalence in the first, second, and third trimesters is 11%, 26%, and 63%, respectively, thus supporting the fact that the risk increases with the length of the pregnancy. Though CTS usually resolves after giving birth, symptoms can continue for as long as three years following delivery!

4)  Birth Control Pill (BCP): The use of BCPs increases CTS risk due to an increase in hormonal levels similar to the CTS risk increase during pregnancy.

5)  Occupational: Workers in highly repetitive, hand-intensive occupations (such as line work, sewing, finishing, meat processing, poultry or fish packing) have a higher rate of developing CTS.

6)  Injury to the wrist or hand: An obvious example is a wrist fracture from a slip and fall, sports injury, or blunt trauma like a car accident. When there is a direct pinch on the median nerve, nerve damage can occur quite quickly, and as a result, the onset of symptoms can be very fast. Less obvious injuries, which usually have significantly slower onsets, include repetitive motion injuries, often referred to as “cumulative trauma disorders” and include a group of conditions such as tendonitis, sprain/strain, bursitis, and other types of soft tissue injuries.

7)  Certain conditions: Nerve damaging conditions that can cause CTS include diabetes and alcoholism. Other conditions that can contribute and/or cause CTS include menopause, obesity, thyroid disorders, kidney failure, and more.

8)  Inflammatory conditions: These include several types of arthritis such as rheumatoid, lupus, and others. Osteoarthritis is technically NOT an “inflammatory” condition but it can cause CTS by compressing the median nerve via a bone spur formed within the carpal tunnel.

9)  Faulty work stations: A job site has A LOT to do with whether or not a person develops CTS. Though jobs that require fast, repetitive movements pose the greatest risk (see #5 above), other work-related factors that may be controllable can also significantly contribute to the development of CTS. Some of these include the shape of tools such as screwdriver handles shaped like a gun (pistol) which allow for better alignment of the wrist than a “normal” straight screwdriver handle. Another is a power tool that may have too much vibration or torques too hard at the end of a cycle. A handle that is too cold/hard (e.g., metal handle) or that may be too large for the worker’s hand is an additional factor to consider. Positioning the work so that the wrists can stay straight vs. bent can be VERY helpful. In fact, if some of these “ergonomic” factors are not fixed, CTS can be next to impossible to remedy. Also, poor posture in the back, neck, and the rest of the body can result in compensatory faulty postures elsewhere. Look in a mirror and poke your chin out towards the mirror. Now look at your shoulders. See how they roll forward and feel the strain in your upper back and neck? Keep your chin tucked in, NOT out. This can make a BIG difference in your posture!

We realize you have a choice in whom you consider for your health care provision and we sincerely appreciate your trust in choosing our service for those needs.  If you, a friend, or family member requires care for Carpal Tunnel Syndrome, we would be honored to render our services.

What kind of headache do I have?

Headaches come in MANY different sizes, shapes, and colors. In fact, if you search “headache classification,” you will find the IHS (International Headache Society) 152 page manual (PDF) lists MANY different types of headaches! Last month, we discussed migraine headaches. This month, we’ll talk about the other headache types. So WHY is this important? Very simply, if we know the type of headache you have, we will be able to provide you with the proper treatment. Headaches are classified into two main groups: “primary” and “secondary” headaches. The “Primary” headache list includes: 1) Migraine; 2) Tension-type; 3) Cluster; 4) “Other primary headaches,” of which eight are listed. One might think that with this simple breakdown of the different types of headaches it should be easy to diagnose a type of headache. Unfortunately, that’s NOT true! In fact, a 2004 study published that 80% of people with a recent history of either self or doctor diagnosed sinus headache had NO signs of sinus infection and actually met the criteria for migraine headaches! So, the more we can learn about the different types of headaches, the more likely that we will arrive at an accurate diagnosis.

Tension-Type Headaches: This is the most common type affecting between 30-78% of the general population. It is usually described as a constant ache or pressure either around the head, in the temples, or the back of the head and/or neck. There is typically NO nausea/vomiting, and tension-type headaches rarely stop you from performing normal activities. These headaches usually respond well to chiropractic adjustments and to over-the-counter medications like Advil, aspirin, Aleve, and/or Tylenol, though we’d prefer you first reach for an anti-inflammatory herb like ginger, turmeric, bioflavonoid, and the like as these have less stomach, liver, and/or kidney related side-effects. These headaches are typically caused by contraction of the neck and scalp muscles, which can be result of stress, trauma, lack of sleep, eyestrain, and more.

Cluster Headaches: These are less common, typically affect men more than women, and occur in groups or cycles. These are VERY DISABLING and usually arise suddenly and create severe, debilitating pain usually on only one side of the head. Other characteristics include: a watery eye, sinus congestion, or runny nose on the same side of the face as the headache. An “attack” often includes restlessness and difficulty finding a pain-reducing, comfortable position. There is no known cause of cluster headaches, though a genetic or hereditary link has been proposed. The good news is that chiropractic adjustments can reduce the intensity, frequency, and duration of cluster headaches!

Sinus Headaches: Sinusitis (inflamed sinuses) can be due to allergies or an infection that results in a headache. This may or may not include a fever, but the main distinguishing feature here is pain over the infected sinus. There are four sets of sinuses. Many people know about the frontal (above the eyes on the forehead) and maxillary (under the eyes in our cheeks) but the two sinuses deep in head (ethmoid and sphenoid sinuses) are much less known or talked about. These two deep sinuses refer pain to the back of the head, and when infected, it feels like the back of the head could explode. Lying flat is too painful so sitting up is necessary. Chiropractic adjustments applied to the sinuses, upper neck, and lymphatic drainage techniques work GREAT in these cases!

We will continue next month with the remaining types of headaches!

We realize you have a choice in whom you consider for your health care provision and we sincerely appreciate your trust in choosing our service for those needs.  If you, a friend, or family member requires care for headaches, we would be honored to render our services.

Can Chiropractic Help Post-Surgical Patients?

Low back pain (LBP) accounts for over 3 million emergency department visits per year in the United States alone. Worldwide, LBP affects approximately 84% of the general population, so eventually almost EVERYONE will have lower back pain that requires treatment! There is evidence dating back to the early Roman and Greek era that indicates back pain was also very prevalent, and that really hasn’t changed. Some feel it’s because we are bipedal (walk on two legs) rather than quadrupedal (walk on four limbs). When comparing the two, degenerative disk disease and spinal osteoarthritis are postponed in the four-legged species by approximately two (equivalent) decades. But regardless of the reason, back pain is “the rule,” NOT the exception when it comes to patient visits to chiropractors and medical doctors. Previously, we looked at the surgical rate of low back pain by comparing patients who initially went to spinal surgeons vs. to chiropractors, and we were amazed! Remember? Approximately 43% of workers who first saw a surgeon had surgery compared to ONLY 1.5% of those who first saw a chiropractor!  So, the questions this month are, how successful IS spinal surgery, and what about all those patients who have had surgery but still have problems – can chiropractic still help them?

A review of the literature published in the Journal of the American Academy of Orthopaedic Surgeons showed that in most cases of degenerative disk disease (DDD), non-surgical approaches are the most effective treatment choice (that includes chiropractic!). They report the success rate of spinal fusions for DDD has been only 50-60%. The advent of artificial disks, which originally proposed to be a “cure” for symptomatic disk disease, has fared no better with possible worse long-term problems that are not yet fully understood. They state, “Surgery should be the last option, but too often patients think of surgery as a cure-all and are eager to embark on it.” They go on to write, “Also, surgeons should pay close attention to the list of contraindications, and recommend surgery only for those patients who are truly likely to benefit from it.” Another study reported that, when followed for 10 years after artificial disk surgery, a similar 40% of the patients treated failed and had a second surgery within three years after the first! Similar findings are reported for post-surgical spinal stenosis as well as other spinal conditions.

So what about the success rate of chiropractic management for patients who have had low back surgery? In a 2012 article, three patients who had prior lumbar spinal fusions at least two years previous were treated with spinal manipulation (three treatments over three consecutive days) followed by rehabilitation for eight weeks. At the completion of care, all three (100%) had clinical improvement that were still maintained a year later. Another study reported 32 cases of post-surgical low back pain patients undergoing chiropractic care resulted in an average drop in pain from 6.4/10 to 2.3/10 (that means pain was reduced by 4.1 points out of 10 or, 64%). An even larger drop was reported when dividing up those who had a combination of spinal surgeries (diskectomy, fusion, and/or laminectomy) with a pain drop of 5.7 out of 10 points!

Typically, spinal surgery SHOULD be the last resort, but we now know that is not always practiced. IF a patient has had more than one surgery and still has pain, the term “failed back syndrome” is applied and carries many symptoms and disability. Again, to NOT utilize chiropractic post-surgically seems almost as foolish as not utilizing it pre-surgically! GIVE US A CALL!!!

We realize you have a choice in whom you consider for your health care provision and we sincerely appreciate your trust in choosing our service for those needs.  If you, a friend, or family member requires care for back pain, we would be honored to render our services.

Whiplash- Can we predict long term problems?

Whiplash (or the rapid acceleration forwards followed by deceleration or sudden stopping of the moving head during the whiplash event) occurs at a speed that is so fast, we can’t prepare for it. In other words, by the time it takes us to voluntarily contract a muscle to guard ourselves against injury, that rapid forward/backwards “whipping” of the head and neck is already over! When considering the details of the injury event, sometimes we lose focus on what REALLY matters. Is there a way to reduce the chances for a long-term chronic, disabling, neck pain / headache result? Last month, we found out that the long-term use of a cervical collar is NOT a good idea. What are some other ways to prevent long-term disability?

A very interesting study investigated the first 14 days of treatment during the acute stage of whiplash neck sprain injuries following a car accident. The researchers wanted to determine what long-term consequences resulted from two different treatment approaches. In one group (201 patients, 47% of the total group), the patients were encouraged to, “…act as usual,” and continue in their normal daily, pre-injury activities. The patients in the second group were given time off from work and were immobilized in a soft cervical collar during the first 14 days after the car crash. At the end of the 14 days, there was a significant reduction of symptoms between the first visit to the fifteenth day (24 hours after the 14 day initial treatment time frame in both groups). However, when evaluated at the six-month point, the group that continued their normal daily routine, did not take time off work, and did not wear a collar had, “…a significantly better outcome,” compared to the other group. This study supports that over-treatment with a collar and time off from work “sets people up” for adopting a “sick role” where the patient is overly-focused on their problem. This study parallels what we discussed last month and embraces the chiropractic philosophy to staying active, exercise, don’t use a collar, and the use of manipulation which exercises joints and keeps them from stiffening up, thus reducing pain and the fear of doing activity!

Another study looked at different presenting physical factors that might be involved in the development of long-term handicaps after an acute whiplash injury in a group of 688 patients. They measured these physical factors at three, six, and twelve month intervals and found the relative risk for a disability a year after injury increased with the following: 1) A 3.5 times disability increase with initial high pain intensity of neck pain and headaches; 2) A 4.6 times increase with initial reduced neck movement or ranges of motion; and 3) A 4 times greater chance with initial multiple non-painful complaints (such as balance disturbance, dizziness, concentration loss, etc.). In yet another study, both physical and psychological factors were found to predict long-term disability. These included initial high levels of reported pain and poor activity tolerance, older age, cold sensitivity, altered circulation, and moderate post-traumatic stress.

The “bottom line” is that as chiropractors, we are in the BEST position to treat and manage whiplash injured patients based on the type of care we perform and offer. We promote exercise of muscles and joints, encourage activity not rest, and minimize dependence on medication, collars, and other negative treatment approaches.

We realize you have a choice in whom you consider for your health care provision and we sincerely appreciate your trust in choosing our service for those needs.  If you, a friend, or family member requires care for Whiplash, we would be honored to render our services.

Low Back Pain- Is it on the Rise?

As stated last month, the prevalence of low back pain (LBP) is REALLY high! In fact, it’s the second most common cause of disability among adults in the United States (US) and a very common reason for lost days at work. The total cost of back pain in the US, including treatment and lost productivity, ranges between $100 billion to $200 billion a year! Is low back pain on the rise, staying the same, or lessening? Let’s take a look!

In the past two decades, the use of health care services for chronic LBP (that means LBP > 3 months) has substantially increased. When reviewing studies reporting insurance claims information, researchers note a significant increase in the use of spinal injections, surgery, and narcotic prescriptions. There has been an increase in the use of spinal manipulation by chiropractors as well, along with increased physical therapy services and primary care physician driven non-narcotic prescriptions. In general, LBP sufferers who are chronic (vs. acute) are the group using most of these services and incurring the majority of costs. The reported utilization of the above mentioned services was only 3.9% in 1992 compared to 10.2% in 2006, just 11 years later. The question now becomes, why is this?Possible reasons for this increase health care use in chronic LBP sufferers may be: 1) There are simply more people suffering from chronic LBP; 2) More chronic LBP patients are deciding to seek care or treatment where previously they “just accepted and lived with it” and didn’t pursue treatment; or, 3) A combination of these factors. Regardless of which of the above three is most accurate, the most important issue is, what can we do to help chronic back pain sufferers?

As we’ve discussed in the past, an anti-inflammatory diet, exercise within YOUR personal tolerance level, not smoking, getting enough sleep, and obtaining chiropractic adjustments every two weeks are well documented methods of “controlling” chronic LBP (as there really ISN’T a “cure” in many cases). You may be surprised to hear that maintenance care has good literature support for controlling chronic LBP. In the 8/15/11 issue of SPINE (Vol. 36, No. 18, pp1427-1437), two Medical Doctors (MDs) penned the article, “Does Maintained Spinal Manipulation Therapy for Chronic Nonspecific Low Back Pain Result in Better Long-Term Outcomes?” Here, they took 60 patients with chronic LBP (cLBP) and randomly assigned them into one of three groups: 1) 12 treatments of sham (fake) SMT (spinal manipulation) have over a one month period; 2) 12 treatments, over a one month period but no treatment for the following nine months; or 3) 12 treatments for one month AND then SMT every two weeks for the following nine months. To measure the differences between the three groups, they measured pain, disability, generic health status, and back-specific patient satisfaction at baseline, 1-, 4-, 7-, and 10-month time intervals. They found only the patients in the second and third groups experienced significantly lower pain and disability scores vs. the first group after the first month of treatments (at three times a week). BUT, only the third group showed more improvement at the 10-month evaluation. Also, by the tenth month, the pain and disability scores returned back to nearly the initial baseline/initial level in group two. The authors concluded that, “To obtain long-term benefit, this study suggests maintenance SM after the initial intensive manipulative therapy.” Other studies have reported fewer medical tests, lower costs, fewer doctor visits, less work absenteeism, and a higher quality of life when maintenance chiropractic visits are utilized. The question is, WHEN will insurance companies and general practitioners start RECOMMENDING chiropractic maintenance care for chronic LBP patients?

We realize you have a choice in whom you consider for your health care provision and we sincerely appreciate your trust in choosing our service for those needs.  If you, a friend, or family member requires care for back pain, we would be honored to render our services.