In the October 2009 issue of The Spine Journal, Western States Chiropractic College, Center for Outcomes Studies, reported benefits are obtained with the utilization of spinal manipulation in the treatment of chronic cervicogenic headaches.  The word “chronic” means at least 3 months of headache pain has been present.  This new study compared 2 different doses of therapy using several outcome measures including the pain grade, the number of headaches in the last 4 weeks and the amount of medication utilized.  Data was collected every 4 weeks for a 24 week period and patients were treated 1-2 times/week and separated into either an 8 or a 16 treatment session with half the group receiving either spinal manipulative therapy or a minimal light massage (LM) control group.

The results of the study revealed the spinal manipulation group obtained better results than the control group at all time intervals.  There was a small benefit in the group that received the greater number of treatments with the mean number of cervicogenic headaches reduced by 50% in both pain intensity and headache frequency. 

The importance of this study is significant as there are many side effects to medications frequently utilized in the treatment of headaches.  Many patients prefer not taking medications for this reason and spinal manipulation therapy (SMT) offers a perfect remedy for these patients.  Couple SMT with dietary management, lifestyle modifications, stress management, and a natural, vitamin/herbal anti-inflammatory (such as ginger, turmeric, boswellia) when needed, a natural, holistic approach to the management of chronic headaches is accomplished. 

We are proud that chiropractic care has consistently scored the highest level of satisfaction when compared to other forms of health care provision and look forward in serving you and your family presently and in the future.

WHY?  There are many possible causes but in general, whether its swelling, a spur, or a metabolic condition, the common denominator is median nerve pinch in the confined space within the carpal tunnel.  A common cause of swelling can occur with performing repetitive motion work such as line assembly, meat packing, carpentry, and so on, and over time, the tendons inside the tunnel inflame or swell and the median nerve is pressed into the ligament that crosses over the roof of the tunnel on the palm side of the wrist.  Once the contents inside the tunnel swell, all positions of the wrist other than neutral or, holding the wrist in line with the forearm further increases the pressure inside the tunnel.  That is why sleeping with the wrist cocked in any direction often wakes up CTS patients. Those most at risk are women over 50 years of age. CTS can also be associated with other health conditions including (but not limited to) Lymes Disease, inflammatory arthritis, and hormone-related conditions including pregnancy, taking birth control pills (BCPs), hypothyroidism, diabetes, and menopause. Lifestyle issues that affect CTS may include high caffeine intake, smoking, alcohol consumption, as well as obesity.

HOW?  So the key question is how are we going to help those with CTS?  First, we must identify all the possible reasons why CTS developed in the first place and manage those issues.  Therefore, an ergonomic (work place) assessment or, discussing and possibly observing the patient at work can be very helpful.  Sometimes, a few simple changes to a work station such as moving the monitor of a computer in line with the keyboard/mouse or adjusting the height of the computer can really help.  Changing a tool handle type (pistol vs. straight grip), propping up a part that is frequently worked on, moving the product closer to where it is being assembled, eliminate overhead reach requirements, standing on a raised platform, and so on, may be most important in long term results.  Identifying and treating any condition that may be participating in the cause like thyroid disease, diabetes, medication (like BCPs), and weight management, is very important.  Wearing a night splint is also very productive.  Unique to chiropractic, treatments include manipulation of the neck, shoulder, elbow, forearm, wrist and fingers, soft-tissue therapy including massage, mobilizing the forearm muscles and tendons, teaching carpal stretch and other upper extremity exercises, and nutritional counseling.  Strategies here can include eliminating any suspected food allergy related products including dairy, glutens (wheat, oats, barley, rye), soy, corn, transfats, preservatives and some chemical additives.  Increasing B-vitamins (especially B6), by increasing dark leafy vegetables and, increasing antioxidants including fruits and veggies.  An anti-inflammatory vitamin program of fish oil, Vit. D3, magnesium, CoQ10, and a multiple vit./mineral may facilitate as well. Once CTS is controlled, preventing a recurrence is important by promoting good posture, exercise, and sticking with the life style adjustments described above. If you, a friend or family member requires care for CTS, we would be honored to render our services.

The treatment of whiplash varies from “watchful waiting” to a multidisciplinary team approach that includes neurology, physical therapy, chiropractic, psychology, and possibly surgery (rare).  In a recent article published in the American Journal of Physical Medicine and Rehabilitation (2009, March Vol. 88, No. 3, pp 231-8), the relationship between clinical, psychological and functional health status factors was investigated in a group of patients with chronic whiplash-associated disorder (WAD).  A total of 86 patients with chronic WAD participated in the study and outcomes were tracked using questionnaires that measure pain, disability and psychological issues including depression, anxiety and catastrophizing.  Physical examination factors included measuring the cervical range of motion.  An analysis of the degree of neck disability and the relative contribution of physical vs. psychological factors revealed catastrophizing and depression played greater roles than did cervical range of motion.  This suggests psychological factors play an important role in the outcome of whiplash. 

The importance of this is that more than just the physical factors like range of motion should be focused on when treating chronic whiplash patients.  Answering the patient’s questions, explaining the mechanism of injury and how that relates to their specific condition, and addressing depression, anxiety, coping, and other psychological issues is very important. Discussing treatment goals with patients is also very important.  For example, making light of the injury by stating something like, “…you’ll be fine after the treatments,” may harm the patient as anything short of “fine” may be interpreted as failed treatment by the patient.  It is also important not to paint too dismal of a picture as that can have negative psychological effects as well, as this may suggest that they will never improve.  Explaining the difference between “hurt” and “harm” is of great value to the chronic whiplash patient as they are often told, “if it hurts, don’t do it.”  This sends an unfortunate message to the patient that any activity where an increase in pain occurs is “bad” when in fact, that activity may help the patient get better in the long run.  This can make or break an acceptable outcome as many may feel like they shouldn’t do anything and this can lead to unemployment, boredom, and the many psychological issues previously described.  The best advice is to remain active and try to ignore discomfort by staying within “reasonable activity boundaries.” Reasonable activity tolerance is learned as time passes and trying different activities for different lengths of time.  This type of coaching should be at the center of chronic whiplash management rather than over focusing on physical factors such as range of motion.

If you, a loved one, or a friend is struggling with whiplash residuals from a motor vehicle collision, you can depend on receiving a multi-dimensional chiropractic assessment and therapeutic approach at this office. We sincerely appreciate your confidence in choosing our office for your health care needs!

So the question is raised, “what can I do to reduce the pain and suffering that I feel from FM?” The answer is multifactorial as there are many treatment approaches reported to be helpful.  Perhaps the most prevalent is exercise.  This seems logical as often, the presence of pain is misinterpreted as a reason to rest or reduce activity.  This inappropriate thought leads to de-conditioning or weakening of muscles, stiffness in joints, lowered aerobic capacity and a host of negative physical and mental effects that can have negative effects on quality of life.  Because many patients with FM are “out of shape,” the worst approach with exercise is jumping into it too quickly.  The post-exercise soreness when people first engage in a new activity can be profound if the introduction into exercise is too vigorous, and again, the pain intensity may be misinterpreted as a reason to discontinue any and all future exercise programs. 

Therefore, the key to success is realizing pain thresholds are reached faster in the FM patient and hence, a slow but steady introduction into exercising is needed. 

For example, start out with a walking program of 5 minutes, 1-3 times a day, and gradually increase it to 10, 15, 20 and eventually, 30 or more minutes per session.  Stretching exercises of the overly tight postural muscles like the hamstrings, calf muscles, hip flexors, lower, middle, and upper back muscles are very helpful.  Applying light resistance during the stretch using a “slow motion” approach improves results. 

In general, low-impact activities like water exercise, swimming, bicycling, and elliptical (low setting) are great options.  Using light dumbbells/hand weights emphasizing high rep/low weight is also very effective. 

Another highly successful type of exercise are balance stimulating exercises. That is, using a rocker board, wobble board, gym ball, and/or foam pad to incorporate balance challenges into the exercise process is very effective. Consistent exercise is a key to success. 

Also, don’t set your goals too high as you may be setting yourself up for disappointment.  Rather, make realistic goals and “grow” with the exercise process, changing and modifying goals on a monthly or quarterly basis.

We realize that there are many healthcare options available.  If you, a friend or family member require care for fibromyalgia, we would be honored to offer our services.

On October 20, 2009, a report was delivered on the impact on population, health and total health care spending.  It was found the addition of chiropractic care for the treatment of neck and low back pain “…will likely increase value-for-dollar in US employer-sponsored health benefit plans.”  Authored by an MD and an MD/PhD, and commissioned by the Foundation for Chiropractic Progress, the findings are clear; chiropractic care achieves higher satisfaction and superior outcomes for both neck and low back pain in a manner more cost effective than other commonly utilized approaches.

The study reviews the fact that low back and neck pain are extremely common conditions consuming large amounts of health care dollars. In 2002, 26% of surveyed US adults reported having back pain in the prior 3 months, 14% had neck pain and the lifetime prevalence of back pain was estimated at 85%.  LBP accounts for 2% of all physician office visits where only routine examinations, hypertension, and diabetes result in more.  Annual national spending is estimated at $85 billion in the US with an inflation-adjusted increase of 65% compared to 1997. Treatment options are diverse ranging from rest to surgery, including many various types of medications.  Chiropractic care, including spinal manipulation and mobilization, is reportedly also widely utilized with almost half of all patients with persisting back pain seeking chiropractic treatment.

In review of the scientific literature, it is noted that 1) chiropractic care is at least as effective as other widely used therapies for low back pain; 2) Chiropractic care, when combined with other modalities such as exercise, appears to be more effective than other treatments for patients with neck pain.  Other studies reviewed reported patients who had chiropractic coverage included in their insurance benefits found lower costs, reduced imaging studies, less hospitalizations, and surgical procedures compared to those with no chiropractic coverage.  They then utilized a method to compare medical physician care, chiropractic physician care, physiotherapy-led exercise and, manipulation plus physiotherapy-led exercise for low back pain care.  They found adding chiropractic physician care is associated with better outcomes at “…equivalent to an incremental cost-effectiveness ratio of $1837 per QALY (Quality-adjusted Life Year).” 

When combined with exercise, chiropractic physician care was also found to be very cost-effective when compared to exercise alone.  This combined approach would achieve improved health outcomes at a cost of $152 per patient, equivalent to an “incremental cost-effectiveness ratio of $4591 per QALY.”  When comparing the cost effectiveness of chiropractic care with or without exercise even at 5 times the cost of the care they utilized in their analysis, it was still found to be “substantially more cost-effective” compared to the other approaches.  It will be interesting given these findings if insurance companies and future treatment guidelines start to MANDATE the use of chiropractic FIRST - it would be in everyone’s best interest!

If you, a family member or a friend require care, 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.

Sound familiar?  This is a “typical” neck pain patient that presents to chiropractic offices around the world.  What is different is that every person is unique and each case must be individually managed. For example, some patients “hate doctors” or are extremely anxious about going to any doctor. This might stem back to a prior “bad experience” with a health care provider at a very young age or perhaps even a more recent event.  None-the-less, the approach used in this type of presentation may be best if it is very methodical, reassuring, and fully explained.  A “low-force” type of manipulation may be best suited for this type of person as “cracking” of the neck may be too frightening for this patient.  On the other hand, a different patient may not be happy unless there is a “good crack” and will not be satisfied until a chiropractic adjustment is performed.

It is equally important in both cases that a complete explanation of, 1) What is the condition causing the symptoms? 2) What can be done to treat it (that is, “what are my treatment options”)? 3) Will the proposed treatment “fit” into my busy schedule, financial situation, and my philosophy about health care?  Providing answers to these questions will usually end with the best results, as the patient will understand the issues most important to them and will have confidence that those issues are understood and appreciated by the doctor.  In both cases, management may include 1) modifying the work station by switching to a head set rather than pinching a phone between the neck and shoulder; 2) evaluating the patient at their work station to check for proper posture at the desk, proper computer monitor positioning, etc. and making modifications as needed; 3) teaching the patient cervical range of motion exercises and other stretches that can be done at the work station, multiple times a day, that only take a minute or two; 4) cervical traction (if this “feels good” when tested during the exam); 5) use of a cervical or contoured pillow; 6) neck / upper body strengthening exercises; 7) the use of ice as needed; an anti-inflammatory diet (for example, a gluten-free diet); 9) nutritional supplementation, as indicated.  Of course, most of the time, all of these approaches do not have to be included, but are options.

Neck pain, headaches, and upper back pain are conditions are commonly treated by chiropractors.  If you, a family member or a friend require care, we sincerely appreciate the trust and confidence shown by choosing our service.  We are proud that chiropractic care has consistently scored the highest level of satisfaction when compared to other forms of health care provision and we look forward in serving you and your family presently and in the future.

So, let’s take a look at the evidence that supports the benefits of chiropractic for CTS:

1) Davis PT, Hulbert JR, Kassak KM, et al. “Comparative efficacy of conservative medical and chiropractic treatments for carpal tunnel syndrome: a randomized clinical trial”

J Manipulative Physiol Ther. 21.5 (June 1997): 317-326.

The most important finding reported in this 91 patient study was that chiropractic treatment was equally effective in reducing CTS symptoms as medical treatment.  The chiropractic care included ultrasound, nighttime wrist supports and manipulation of the wrist, arm and spine.  Medical care included ibuprofen (800 mg, 3x/day for 1 wk, 800 mg, 2x’day for 1 wk, &  800 mg as needed for 7 wks) plus a night wrist splint.  Both groups did equally well but given the side-effect potential of ibuprofen on the stomach, liver, and kidneys, a strong argument for the non-drug, chiropractic approach can be made.

2)  Bonebrake AR, Fernandez JE, Marley RJ et al. “A treatment for carpal tunnel syndrome: evaluation of objective and subjective measures” J Manipulative Physiol Ther. 13.9 (Nov-Dec 1990): 507-520

CTS sufferers (n=38) received chiropractic spinal manipulation and extremity adjusting.  Also,   soft tissue therapy, dietary modifications or supplements (B6) and daily exercises were prescribed. After treatment, results showed improvement in all strength and range of motion measures.  Also, a significant reduction in pain and distress ratings was reported.

3) Mariano KA, McDougle MA, Tanksley GW “Double crush syndrome: chiropractic care of an entrapment neuropathy” J Manipulative Physiol Ther. 14.4 (May 1991):262-5

In 1973, Upton and McComas first proposed the presence of the “double crush syndrome.” Their hypothesis was that when a nerve is pinched anywhere along its route, it makes the rest of the nerve more sensitive to otherwise “normal” stimulation. A case report of a man with both cervical radiculopathy and carpal tunnel syndrome, i.e., “double crush syndrome” was presented. Chiropractic management consisted of chiropractic manipulative therapy as well as ultrasound, electrical nerve stimulation, traction and a wrist splint. The experimental basis, clinical evidence, etiology, symptomatology and findings of this condition are discussed.  The Double Crush Syndrome helps explain why cervical/neck manipulation helps many CTS patients.

There are many additional articles that support the benefits of chiropractic for CTS.   If you, a friend or family member requires care for CTS, we would be honored to offer our services.

This question was investigated in a published study titled, A symptomatic classification of whiplash injury and the implications for treatment (Journal of Orthopaedic Medicine 1999;21(1):22-25). The authors state conventional [medical] treatment utilized in whiplash care, “is disappointing.” The authors’ reference a study that demonstrated chiropractic treatment benefited 26 of 28 patients with chronic whiplash syndrome. The objective of their study was to determine which type of chronic whiplash patient would benefit the most from chiropractic treatment. They separated patients into one of 3 groups: Group 1: patients with “neck pain radiating in a ‘coat hanger’ distribution, associated with restricted range of neck movement but with no neurological deficit”; Group 2: patients with “neurological symptoms, signs or both in association with neck pain and a restricted range of neck movement”; Group 3: patients who described “severe neck pain but all of whom had a full range of motion and no neurological symptoms or signs distributed over specific myotomes or dermatomes.” These patients also “described an unusual complex of symptoms,” including “blackouts, visual disturbances, nausea, vomiting and chest pain, along with a nondermatomal distribution of pain.”

The patients underwent an average of 19.3 adjustments over the course of 4.1 months (mean). The patients were then surveyed and their improvement was reported:

These findings show the best chiropractic treatment results occur in patients with mechanical neck pain (group 1) and / or those with neurological losses (group 2). The exaggerated group (group 3) was the most challenging and, the only group where a small percentage worsened. The good news is, the number of cases that responded well to chiropractic treatment (groups 1 & 2) far out number those that don’t (group 3). Hence, most patients with whiplash injuries should consider chiropractic as their first choice of health care provision.

If you, a loved one, or a friend is struggling with whiplash residuals from a motor vehicle collision, you can depend on receiving a multi-dimensional chiropractic assessment and therapeutic approach at this office. We sincerely appreciate your confidence in choosing our office for your health care needs!

Commonly utilized chiropractic treatment options found to be beneficial include massage, muscle strengthening exercises, acupuncture, spinal manipulation, movement/body awareness, vitamins, herbs, and dietary modification.  Cognitive behavioral therapy, not typically a chiropractic specific form of care, was also reported to be of significant benefit, as well as aerobic exercise.  This study places chiropractic in a very favorable position in the management of FM.

Chiropractic is unique in that it encompasses many non-drug, non-surgical forms of treatment, making it appealing to many who do not want to risk the chances of drug related side effects and post-surgical complications.  Patients with FM require a multi-dimensional treatment approach and a health care provider versed in whole-body, holistic concepts is in the best position to help this population. 

Fibromyalgia can be primary where the specific cause is not well understood or secondary to an underlying injury or condition.  Sometimes, it is difficult to determine the exact cause as other conditions can be present and/or arise simultaneously with FM making it difficult to differentiate between primary and secondary.  When other conditions are present, sometimes attending those specific conditions will improve the status of FM and focus on treatments that address all of the patient’s physical and emotional health issues yields the most patient satisfying results.

In past newsletters, we’ve discussed a gluten-free diet aimed at reducing inflammation, the core of all disease processes.  We’ve also discussed the importance of sleep quality, exercise, and other effective treatment approaches. 

We take pride in providing quality, evidence-based care and appreciate the opportunity to do so when patients choose our clinic for their chiropractic care.  We realize that there are many healthcare options available.  If you, a friend or family member require care for fibromyalgia, we would be honored to offer our services.

There are two types of conditions that commonly pinch nerves, which generally occur at different times of life - those with a herniated disk (younger > older patients) and those with arthritis (older > younger patients). A combination of the two conditions producing the pinching effect on the nerve can also occur making the diagnosis process a little trickier. The following diagram helps explain these conditions.

Both of these conditions are commonly treated by chiropractors. If you, a family member or a friend requires care, we sincerely appreciate the trust and confidence shown by choosing our service. We are proud that chiropractic care has consistently scored the highest level of satisfaction when compared to other forms of health care provision and look forward in serving you and your family presently and in the future.