Thursday, October 31, 2013

CTS - Carpal Tunnel Syndrome - "Facts"

WHAT is Carpal Tunnel Syndrome (CTS)? CTS occurs when pressure is applied to the median nerve which travels from the neck, through the shoulder, upper arm, elbow, forearm, and through the carpal tunnel where the “pinch” is located. The median nerve innervates most of the palm of the hand, the thumb, the index finger, middle finger, and the thumb side of the ring finger. The carpal tunnel is made up of eight little bones in the wrist that form the arch and a ligament that forms the floor. There are nine muscle tendons, the median nerve, as well as blood vessels that travel through the tunnel. WHAT are the symptoms of CTS? The “classic” symptoms include burning, itching, tingling, and/or numbness of the second to fourth fingers with the need to shake or “flick” the fingers to “wake up the hand.” When present long enough, or when the pressure is hard enough on the nerve, weakness in the grip occurs and accidental dropping of tools, coffee cups, and so on can occur. Pressure on the nerve increases when the wrist is bent backwards or forwards, especially for long time frames and/or when the wrist is moving in a fast, repetitive manner with jobs like carpentry using vibrating tools, a screw driver, hand drill, a hammer, line production work, waitressing, and so on. Often, symptoms are first noticed at night, as we tend to sleep with our wrists bent and tucked under our chin or neck. Symptoms can also occur during the day, especially when driving or when performing repetitive work. Difficulties buttoning a shirt, making a fist, grasping small objects and/or performing manual tasks are common complaints of CTS. WHAT are some causes of CTS? CTS is most commonly caused by a combination of factors that result in swelling of the tendons that travel through the carpal tunnel. This includes over working the arm and hand in any of the jobs described above, but it is more likely to happen when conditions that create generalized swelling occur. Some of these conditions include trauma (like a sprained wrist), hypothyroidism, an over-active pituitary gland, during menstruation or pregnancy, menopause, rheumatoid arthritis, diabetes, mechanical wrist problems, repetitious work (work stress), or the repeated use of vibratory hand tools. It is also possible to develop a cyst (like a ganglion) or a fatty tumor within the tunnel. CTS is also more common with obesity, but sometimes, no logical cause can be identified! WHO is at risk of developing CTS? Women are three to four times more likely to develop CTS. This may be because of the hormonal aspects described above and/or the relative smaller wrist, which results in a smaller carpal tunnel. There’s also an increased risk of CTS in people over the age of 50. Other at risk individuals include diabetics, people with hormonal imbalances (taking birth control pills, pregnancy, hypothyroid, etc.), and people who work on assembly lines. How is CTS diagnosed? EARLY diagnosis and treatment is KEY to a successful outcome! The physical exam includes assessing the structures of the neck and entire upper extremity, as the pinch is often in more than one place. A blood test for thyroid disease, diabetes, and rheumatoid arthritis is also practical. Other tests that may help us diagnose CTS can include and EMG (nerve test) and/or x-ray/MRI. Next month, we’ll discuss treatment and prevention! 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.

Wednesday, October 30, 2013

The Headache Epidemic

Over the past few decades, chronic migraine headaches have increased dramatically among the U.S population. There has been an approximately 60% increase in rates over the years. Most of this increase has occurred in adults younger than 45 years, and women are slightly more affected than men. One study showed that 80% of women and 70% of men reporting chronic migraine headaches had at least one physician contact per year because of migraine headaches; 8% and 7% of women and men, respectively, were hospitalized at least once a year because of the condition. In addition, chronic migraine headaches had a substantial impact on functional capacity: 4% of men and 3% of women reported a chronic limitation in normal activity because of migraine headaches and associated symptoms. Clearly headaches are having a big impact on society today, with major dollars spent on disability payments, hospitalizations, doctor visits, and medication prescriptions. Most patients also self medicate with over-the-counter drugs. The use of these drugs has increased exponentially over the past ten years. All of this “treatment” has had little effect on the occurrence of headaches, or shown a healthy way to any sort of lasting cure. The chiropractic approach to headaches is much different. The chiropractor looks at injuries to the spine (e.g. sprain/subluxation), which are affecting the nervous system. Headaches are just one of many symptoms than can occur when the spine is injured. Rather than masking the symptom with ineffective and potentially unsafe medications, the chiropractor treats the cause of the problem. Scientific studies have shown this approach to have merit. The chiropractor will use specific adjustments and postural exercises to improve how your spine functions, which may in turn reduce your need for medications, lower the intensity of the pain, or even eliminate the headaches all together. Depending on how badly your spine is injured or how long you have suffered, will both affect how you may progress during care. Only a comprehensive examination will determine if you are a good candidate for chiropractic care. The examination should include a detailed history of how the pain has affected your life, tests of your nervous system, and x-ray examination, to see how the vertebrae are positioned in your neck. If you are a part of the headache epidemic, it can be a sign that you have a spinal condition the chiropractor may be able to help. Taking medications to cover-up the problem rarely makes the actual problem go away. Visit for more information.

Tuesday, October 29, 2013

Low Back Pain and Sleep - Part 3

During the past two blog posts, we’ve discussed the importance of sleep and its effect on low back pain (LBP). Last month, we offered 9 ways to improve sleep quality, and this month we will conclude this topic with 11 more. Sleep deprivation has been called, “…an epidemic” by the Centers for Disease Control and Prevention. To achieve and maintain good health, we must ensure restorative sleep! Here are additional ways to do that (continued from last month): Avoid snacks at bedtime …especially grains and sugars as these will raise your blood sugar and delay sleep. Later, when blood sugar drops too low (hypoglycemia), you not only wake up but falling back to sleep becomes problematic. Dairy foods can also interrupt sleep. Take a hot bath, shower or sauna before bed. This will raise your body temperature and cooling off facilitates sleep. The temperature drop from getting out of the bath signals to your body that “it’s time for bed.” Keep your feet warm! Consider wearing socks to bed as our feet often feel cold before the rest of the body because they have the poorest circulation. Cold feet make falling asleep difficult! Rest your mind! Stop “brain work” at least 1 hour before bed to give your mind a rest so you can calm down. Don’t think about tomorrow’s schedule or deadlines. Avoid TV right before bed. TV can be too stimulating to the brain, preventing you from falling asleep quickly as it disrupts your pineal gland function. Consider a “sound machine.” Listen to the sound of white noise or nature sounds, such as the ocean or forest, to drown out upsetting background noise and soothe you to sleep. Relaxation reading. Don’t read anything stimulating, such as a mystery or suspense novels, as it makes sleeping a challenge. Avoid PM caffeine. Studies show that caffeine can stay active in your system long after consumption. Avoid alcohol. Though drowsiness can occur, many will often wake up several hours later, unable to fall back asleep. This can prohibit deep sleep, the most restoring sleep (~4th hour). Exercise regularly! Exercising for at least 30 minutes per day can improve your sleep. Increase your melatonin. If you can’t increase levels naturally with exposure to bright sunlight in the daytime and absolute complete darkness at night, consider supplementation. We realize you have a choice in who you choose to provide your healthcare services. If you, a friend or family member requires care for low back 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.

Monday, October 28, 2013

Low Back Pain and Sleep - Part 2

Low Back Pain and Sleep - Part 2 Previously, we discussed the relationship between sleep deprivation and low back pain (LBP) and found that LBP can cause sleep loss AND sleep loss can cause LBP. It’s a 2-way street! This month, we will look at ways to improve your sleep quality, which in return, will reduce your LBP. There are many ways we can improve our sleep quality. Here are some of them: Turn off the lights: Complete darkness (or as close to it as possible) is best. Even the tiniest bit of light in the room can disrupt your internal clock and your pineal gland’s production of melatonin and serotonin. Cover your windows with blackout shades or drapes. Stay cool! The bedroom’s temperature should be ≤70 degrees F (21 degrees C). At about four hours after you fall asleep, your body’s internal temperature drops to its lowest level. Scientists report a cooler bedroom mimics your body’s natural temperature drop. Move the alarm clock. Keeping it out of reach (at least 3 feet) forces you to get out of bed and get moving in the AM. Also, you won’t be inclined to stare at it during the night! Avoid loud alarm clocks. It is very stressful on your body to be suddenly jolted awake. If you are regularly getting enough sleep, an alarm may even be unnecessary. Reserve your bed for sleeping. Avoid watching TV or doing work in bed, you may find it harder to relax and drift off to sleep. Get to bed before 11pm. Your adrenal system does a majority of its recharging between the hours of 11 p.m. and 1 a.m. and adrenal “burn-out” results in fatigue and other problems. Be consistent about your bed time. Try to go to bed and wake up at the same times each day, including weekends. This will help your body to get into a sleep rhythm and make it easier to fall asleep and get up in the morning. Establish a bedtime routine. Consider meditation, deep breathing, using aromatherapy, or essential oils, or massage from your partner. Relax and reduce your tension from the day. Eat a high-protein snack several hours before bed to provide the L-tryptophan needed for your melatonin and serotonin production. There are other “tricks” that ensure a good night’s rest that we will continue with next month as this is a VERY important subject and can literally add years to your life and life to your years. We realize you have a choice in who you choose to provide your healthcare services. If you, a friend or family member requires care for low back 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.

Sunday, October 27, 2013

Low Back Pain and Sleep

Low back pain (LBP) can arise from a lot of causes, most commonly from bending, lifting, pulling, pushing, and twisting. However, there are other possible causes, including sleep. This not only includes sleeping in a crooked or faulty position, such as falling asleep on a couch, in a chair or while riding in a car, but also from the lack of sleep. So the question is, how much sleep is needed to feel restored and how much sleep is needed to avoid low back pain? It’s been shown that the lack of sleep, or chronic sleep loss, can lead to serious diseases including (but not limited to): heart disease, heart attack, heart failure, irregular heartbeat, high blood pressure, stroke and diabetes. Sleepiness can also result in a disaster; as was the case in the 1979 nuclear accident at Three Mile Island, the oil spill from the Exxon Valdez, as well as the 1986 nuclear disaster at Chernobyl. With sleep deprivation, our reaction time is slowed down, and hence, driving safety is a major issue. The National Highway Traffic Safety Administration estimates that fatigue causes more than 100,000 crashes per year with 1500 annual crash-related deaths in the US alone. This problem is greatest in people under 25 years old. Job related injuries are also reportedly more frequently, especially repeat injuries in workers complaining of daytime sleepiness which resulted in more sick days. It’s also well published that sleep plays a crucial role in thinking and learning. Lack of sleep impairs concentration, attention, alertness, reasoning, and general cognitive function. In essence, it makes it more difficult to learn efficiently. Also, getting into a deep sleep cycle plays a critical role in “consolidating memories” in the brain, so if you don’t get to a deep sleep stage (about 4 hours of uninterrupted sleep), it’s more difficult to remember what you’ve learned. An interesting study (U. of Pennsylvania) reported that people who slept less than 5 hours/night for 7 nights felt stressed, angry, sad, and mentally exhausted. As shown in another study of 10,000 people, over time, insomnia (the lack of sleep) increases the chances by 5-fold for developing clinical depression. Other clinical studies have published many other negative effects of sleep deprivation, of which some include aging of the skin, forgetfulness, weight gain, and more. Regarding low back pain, what comes first? Does LBP cause sleep interference or does sleep deprivation cause the LBP (or both)? It’s been shown that sleep loss can lower your pain threshold and pain tolerance, making any existing pain feel worse, so it works both ways. Specific to LBP, in a 28-year, 902 metal industry worker study, sleep disturbances (insomnia and/or nightmares) predicted a 2.1-fold increase in back pain hospitalizations with one and a 2.4-fold increase with both sleep disturbance causes (insomnia and nightmares). Other studies have shown patients with chronic LBP had less restful sleep and more “alpha EEG” sleep compared to controls. Similar sleep pattern differences using EEG (electroencephalogram – measures brain waves) have been shown when comparing chronic LBP patients with vs. without depression compared to controls (non-LBP, non-depressed subjects). So the BOTTOM LINE, talk to us about how chiropractic helps reduce LBP, stress and facilitates sleep. There are also nutritional benefits from Melatonin, valarian root, and others that we can discuss. Now, go to bed and get a good night’s sleep! We realize you have a choice in who you choose to provide your healthcare services. If you, a friend or family member requires care for low back 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.

Saturday, October 26, 2013

Do Chronic Sinus Problems Cause Headaches?

Many of us have had sinus related headaches, right? You know, these are the headaches that hurt over the sinuses (above the eyes or in the cheek bones next to your nose) and, when you blow your nose, it’s not pretty! Sinus infections often lead to sinus headaches – wouldn’t you say that’s a true statement? A recent November 2011 study begs to differ. Researchers took 58 patients with a diagnosis of “sinus headache” made by their primary care physician and asked them the following questions: Have you had a previous diagnosis of migraine or tension-type headache? Is their clinical evidence of a sinus infection during the past 6 months? Is there the presence of “mucopurulent secretions” (that’s the “not so pretty stuff” when we blow our nose)? All 58 patients clearly seemed to have chronic sinusitis with an acute flair up and were given complete thorough examinations by a neurologist and an ears, nose, throat specialist (otolaryngologist) on a monthly basis for 6 months during treatment. The surprising results showed that final diagnosis in these 58 cases were 68%, 27% and 5% of the patients really had migraine, tension-type headache and chronic sinusitis with recurrent acute episodes, respectively. Treatment during the 6 months included antibiotic therapy in 73% of the patients with tension-type headache and 66% with migraine. Sinus endoscopy (taking a look up the sinuses with a scope – ouch!) was performed in 26% of the patients, and therapeutic nasal septoplasty (surgery!) was performed in 16% of the migraine patients and 13% of patients with tension-type headache (a pretty BIG mistake, wouldn’t you say?). The conclusion was that many patients with self-described or primary care physician diagnosed “sinus headaches” have no sinonasal abnormalities but instead, met the criteria for migraine or tension-type headache. So, what does this mean? Well, for one thing, too many antibiotics are prescribed for tension-type or migraine headaches and have no place in the treatment process of these two common headache categories. Side effects of antibiotics include (but are not limited to): stomach and intestinal irritation, nausea, and if one is allergic to the antibiotic, a potentially life-threatening condition call anaphylactic shock. Let’s not forget to mention that sinus surgery was performed in 29% of the cases where the sinuses were NOT causing the headaches and we all know the risks of undergoing anesthesia and surgery can include death and infections, among other problems. Chiropractic was reported to be a wise choice in the treatment of headaches by several publications, one of which provided a large review of the literature on the “Effectiveness of manual therapies: the UK evidence report,” released in 2010 ( In this report, both migraine and cervicogenic-type (headaches that start in the neck) headaches were found to have strong research support for manipulation or, chiropractic adjustments. In this day and age, you can be very confident that choosing chiropractic services for headache treatment is a wise, safe, and very cost-effective approach for a very disabling condition. We realize that you have a choice in where you choose your healthcare services. If you, a friend or family member requires care for headaches, 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.

Friday, October 25, 2013

Spinal Manipulation vs. Acetaminophen for Chronic Neck Pain

Spinal Manipulation vs. Acetaminophen for Chronic Neck Pain In this University of Colorado study, researchers compared chiropractic spinal manipulation with Acetaminophen for the treatment of chronic neck pain. On average, patients had been suffering from neck pain on and off for approximately 10 years. Patients were split into 2 groups, receiving either: •12 chiropractic spinal adjustments over a 6 week period, or •Acetaminophen 4X/day plus 12 visits with a nurse over a 6 week period. Both groups were also instructed to exercise and use a heating pad. At the end of the 6 weeks, patients who received the chiropractic spinal manipulation reported a significant improvement in neck pain and function, showing increased range of motion and strength. Patients receiving medication and nurse care showed no significant changes or improvements. Researchers are currently performing a long-term follow-up. i.Baker B. Family Practice News 1996; June 1:14.

Low Back Pain & Spinal Manipulation: How Does It Work?

For many years, Chiropractic has been at the forefront of treating low back pain (LBP) with both greater patient satisfaction and less lost time at work when compared to other non-surgical treatment approaches. There have been many explanations as to why chiropractic manipulation therapy (CMT) works but many of these studies include other treatment modalities or methods and the benefits are ,therefore, not clearly derived only from CMT. A recent study has tried to clear this up and the results are very interesting! This study included two chiropractors and two a physical therapists (PT) from Canada and the US. What is unique about this study is that they measured clinical or symptomatic improvement by tracking improvement in activity tolerance using a standard questionnaire commonly used by chiropractors and PTs all over the world, as well as changes in the spinal stiffness using a valid/reliable instrument before and after CMT was utilized. The importance of these findings is that only CMT was utilized and hence, other forms of treatment commonly utilized by chiropractors did not cloud the findings. There were 48 patients included in the study and the initial 2 treatments were administered 3-4 days apart, followed by an assessment 3-4 days after the 2nd treatment. Assessments were also performed before and after each treatment. The assessments included use of the questionnaire and a stiffness measurement using the special instrument. Also, “recruitment of the lumbar multifidus muscle” (a muscle in the low back that helps stabilize the trunk or core) was measured by ultrasound. After each treatment, significant improvement was found in the overall pain level and in reduced spinal stiffness (which remained improved 3-4 days after the last/second treatment). The study conclusions revealed less pain, more activity tolerance and less spinal stiffness after the administration of the 2 treatments. The greatest clinical improvement was found in those who had the most dramatic reduction in stiffness after each treatment. They found that the level of muscle recruitment was directly related to the degree of spinal stiffness. They also found that patients who received thrust manipulation (CMT) had immediate improvements with reduced pain, stiffness and improved muscle recruitment measurements. However, this same effect was NOT obtained when non-thrust mobilization techniques were used. This means many non-thrust manual techniques such as mobilization, massage, and other soft tissue release methods do not create the immediate benefits that were produced by thrust manipulation. With this new information, we are now able to explain with confidence to patients the reasons why they typically feel better after the spinal adjustment. The patient can then appreciate receiving an answer that makes clear sense and has been “proven.” It’s important to realize that the “bonus” of receiving chiropractic care for low back pain includes not only just pain reduction, but more importantly, improvement in tolerating activities such as vacuuming, washing dishes, golfing, walking and of course, working. We realize you have a choice in who you choose to provide your healthcare services. If you, a friend or family member requires care for low back 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.

Thursday, October 24, 2013

Neck Pain and Smoking - What's the Connection?

There is a lot of convincing peer reviewed literature (research) that supports chiropractic as one of the first and best courses of care to consider when choosing a treatment option for neck pain and headaches. This is because there is low risk, few rare side-effects, and most importantly, IT REALLY WORKS! But, there are other considerations in the management of neck and headache pain that perhaps we haven’t thought about. One is smoking. There are several convincing studies that have looked at the exposure to tobacco smoke and smoking in terms of its effect on neck pain. Let’s look at some statistics. One study reported that as many as 213 per 1000 people reported neck pain. The 12-month prevalence of neck pain ranged between 30-50% of which activity-limiting pain was reportedly as high as 11.5%. Women were found to be more at risk than men which peaks in middle age. Risk factors for neck pain include genetics, poor psychological health, and EXPOSURE TO TOBACCO. Interestingly, smoking / exposure to tobacco is listed as a risk factors but disk degeneration is not! Researchers also pointed out that the use of equipment made to prevent injury to the head/neck such as helmets and face shields was NOT associated with increased risk for neck injury in bicycling, hockey or skiing as some have suggested that wearing protective head gear increases vulnerability to injury. THIS IS NOT THE CASE, so wear your helmet! This study concluded that there are some things we can’t modify regarding increased risk of developing neck pain (such as gender, genetics, and age); however, the modifiable risk factors of smoking, exposure to tobacco, and psychological health CAN be helped so that’s the LEAST WE SHOULD DO! Two new studies show that smoking is directly tied to neck / back pain and the development of arthritis. Interestingly, the Harvard study reported that the risk of developing psoriatic arthritis was twice as high for current vs. past smokers, and both current and past smokers were at greater risk when compared to those who had never smoked. The 2nd study (Paris, France) found that smokers had an earlier onset of inflammatory back / neck pain and a worse course of the disease than non-smokers. Taking these two studies together, the interactions between environmental factors and the onset, the degree of severity and the ultimate outcomes of rheumatic diseases, “…it’s becoming increasingly clear how detrimental the influence of smoking is on most of these diseases.” The worst scenario was found in those who smoked >25 years and, >20 “pack years” (>1 pack/day for 20+ years). The “bottom line” is that smoking and exposure to smoke have significant negative health affects, not only for present health, but also for future pain, suffering and quality of life. Thankfully, it’s been shown that if you quit smoking, the likelihood of improved health affects is high so of course, QUIT NOW and you’ll be ahead of the curve. In fact, a conscientious surgeon recommending a spinal fusion may say, “…you must quit smoking or else I will not perform the surgery that you need.” The reason for this insistence is because the risk of fusion failure goes up 500% in smokers (fusions are needed in certain types of back and neck surgeries). 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.

Wednesday, October 23, 2013

Headaches - Yankton Chiropractor - Brian Olson, DC

According to the latest research, 9% of men and 12% of women in the U.S. experience at least 1-2 headache episodes per month. And, more than 4% of the U.S. population suffers from frequent headaches, defined as headaches that occur at least 180 days a year. Needless to say, headaches have become a social and economic burden in the United States, as well as other parts of the world. Scientists have identified over 300 causes for headaches. Various pain-sensitive structures and tissues including the skin, subcutaneous tissue, muscles, arteries, periosteal bone covering, and the upper cervical and facial nerves produce headaches when irritated or injured. Fortunately, only a handful of causes are responsible for the majority of headaches. The most common of these headaches include:

 •Cervicogenic- problems within the neck
•Muscle-tension- neck and upper back muscular spasms
•Post-traumatic- following head/neck trauma, i.e. whiplash
•Drug-induced- from analgesic overuse

Doctors of chiropractic successfully help thousands of individuals everyday obtain safe, effective, long-term relief from their headaches. This is because most headaches have a spinal, muscular, or habitual component which the chiropractor has been trained to identify and treat. In fact, surveys show that 10-25% of patients initiate chiropractic care for the relief of headaches. 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.

Headache - What Can YOU Do?

Headaches are one of the most common complaints for which patients seek chiropractic care. Chiropractic is especially helpful in the treatment of headaches because the three nerves that exit the top of the spine (upper neck) are often the cause of or directly related to headaches. These three nerves travel into the head and have to pass through a very thick group of muscles in the upper part of the neck near where these muscles attach to the base of the skull. This is why when you have headaches and rub the back of the neck, the muscles may feel tight and or tender. In fact, if enough pressure is applied over one of these three nerves, pain will radiate into the head following the course of the nerve, sometimes all the way into the eyes. When chiropractic treatment is applied in the upper neck region, a reduction of the headache and neck pain occurs because the muscle tension is decreased and joint motion is restored. The International Headache Society (IHS) has classified headaches into two main categories, primary and secondary. Primary headaches occur for no known reason and there are four groups of these: migraine, tension-type, cluster, and “other” primary headaches. Secondary headaches are those with a specific cause such as sinus/allergy headaches, those associated with eye strain, a known medical condition or those due to cold or flu. Both migraine and cluster headaches are “vascular” (related to the blood vessels expanding inside the head) resulting in a unique set of symptoms that includes nausea, vomiting, pounding/throbbing and can be quite debilitating. The most common type is the tension-type of headache. A thorough history is necessary because there is no specific diagnostic test (lab or blood test) for tension-type headaches. Hence, the concept is to make sure the headache is not related to some other condition that is diagnosable by a blood or lab test and if present, having that condition properly managed. So, assuming all the tests come back “normal” and all other causes have been eliminated or “ruled out,” the most common type of tension-type headache is “episodic” or, occurs off and on, lasting minutes to days. The pain is usually described as, “…my whole head hurts.” There is typically tightness or tension (NOT throbbing) described in the neck muscles and the intensity ranges from mild to moderate, not usually severe, where laying down is needed. Physical activity does not usually make it worse and there is no sickness to the stomach (nausea/vomiting), and no intense reaction to bright lights or noise (like there is with migraine & cluster types of headaches). There are sub-types of tension headaches that can occur simultaneous with migraines headaches, but the classic “aura” (a before the headache warning associated with migraine headaches) is usually not present. Chiropractic treatment typically includes manipulation and mobilization of the neck, muscle release techniques, physical therapy modalities like electric stimulation, ultrasound, and others, exercise, stress and diet/nutritional management. 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.

Tuesday, October 22, 2013

Chiropractic Manipulation: A New Study Regarding Headaches

Headaches are a common complaint in patients presenting for professional care,
including chiropractic management.  Patients with headaches seek chiropractic
care because they find manipulation or adjustments applied to the cervical spine
and upper back region are highly effective in reducing the intensity, frequency
and duration of the headache pain.  This is because the cervical spine / neck,
is often the origin of the headache as the three nerves in the upper neck (C1, 2
and 3) pass through the thick, overly taught neck muscles in route to the scalp
/ head.  When the muscles of the neck are in spasm, the nerves get “pinched” or
squeezed by the overly tight muscles resulting in headache pain.  Each nerve
runs to a different part of the head and therefore, pain may be described as
“…radiating over the top of head (sometimes into the forehead and eyes),” or,
into the head and over the ear, sometimes reaching the temple.  Also, an area
located in the back and side of the head is the area where the C1 nerve
innervates, so pain may also be reported in that location.  When more than one
of the C1-3 nerves is pinched, the whole side to the top of the head may be

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

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

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.

Carpal Tunnel Syndrome vs. A Pinched Nerve

Carpal Tunnel Syndrome (CTS) is a common complaint presented to chiropractic offices. Usually, patients wait for weeks, months, or even years before seeking care, thus making management more challenging. The history of the “classic” CTS patient includes a mild, sporadic onset that gradually becomes more frequent and intense. This usually leads to continued problems that start to affect other areas proximal to the hand, such as the elbow, shoulder and/or neck. We usually find that people will compensate during their activities, and instead of moving the wrist and hand to perform a task, they will start to move their elbow and shoulder more to avoid irritating movements of the hand/wrist. Over time, overloading the muscles in these areas can lead to one or more conditions commonly referred to as “cumulative trauma disorder” (CTD), which includes many diagnoses including (but not limited to) tendonitis of the thumb (de Quervain’s Disease), ganglion cysts, tennis elbow (lateral epicondylitis), golfer’s or bowler’s elbow (medial epicondylitis), cubital tunnel syndrome (ulnar nerve pinch at the medial elbow), tunnel of Guyon syndrome (ulnar nerve pinch at the wrist), shoulder tendonitis (biceps, rotator cuff), thoracic outlet syndrome (pinched nerve at the shoulder), and / or neck strain, neck herniated disk, pinched nerve, and/or headaches. Many times, these conditions co-exist if the patient has really abused themselves (such as music majors who may practice playing their instrument for 4-5 hours a day) to a point where they are REALLY injured in multiple areas. Limiting this discussion to pinched nerves in the neck and upper limb, the question often arises, “…how do you know where the nerve is pinched?” The answer centers around determining an accurate history to find out EXACTLY where the patient feels numbness, tingling, weakness, and/or pain as each nerve innervates a different area. For example, if a patient says, “…I feel numbness in my 4th and 5th finger,” this tells us that the ulnar nerve is pinched (as opposed to numbness in the 2nd, 3rd, or 4th fingers which suggests median nerve pinch—more classic of CTS). If the patient says the numbness affects the arm from the elbow down to the 4th and 5th finger, this suggests cubital tunnel syndrome (ulnar nerve pinch at the medial elbow). If the numbness affects the person from the shoulder to the 4th and 5th finger, thoracic outlet syndrome becomes a probable diagnosis. And lastly, if the neck, shoulder, arm and hand on the pinky side are numb, we are suspicious of a pinched nerve in the neck. Then, we confirm our suspicions with a more detailed physical examination. Here, we test for compression of a nerve at the neck by positioning the head in a backwards, rotated position and holding it for about 10 seconds to see if the numbness is reproduced. We can also manually (with our hands/fingers) compress the various nerve pathways to see if numbness occurs at the front of the neck, the shoulder under the collar bone, at the elbow and wrist counting the seconds to time the onset of numbness and mapping the numbness location. Placing the shoulder, elbow, and wrist in different positions can pinch the nerve as well, and mapping the location of the numbness tells us where and to what degree the nerve is pinched. We will also perform a neurological exam testing reflexes and strength, as well as sensory function using a sharp object. A special test called an EMG/NCV (electromyography and nerve conduction velocity) can be obtained to further verify the location and degree of nerve pinching and damage. The advantage of chiropractic management is that we will treat EVERY LOCATION that may be contributing to the CTS symptoms, whether the pinch is in the neck, shoulder, elbow and/or wrist. Managing the WHOLE PERSON, not just the wrist or CTS is KEY to a successful outcome. We realize you have a choice in who 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 require care for CTS, we would be honored to render our services.

Monday, October 21, 2013

Whiplash: Does Chiropractic Work?

The term “Whiplash” is associated with neck injuries that frequently occur as a result of motor vehicle collisions. There is much published about how injury occurs, the most compelling of which is that we simply cannot voluntarily contract our neck muscles fast enough to avoid injury, as injury to the neck occurs within 500msec. and voluntary contraction or bracing takes 800msec or longer. The question this month is, does chiropractic work in managing patients with whiplash associated disorders (WAD)? To answer this, a study published in the Journal of Orthopaedic Medicine reported that chiropractic was indeed superior to standard medical care. Most importantly, they studied chronic whiplash patients that (typically) are more challenging to treat compared to the acute, more recently injured whiplash patient. Their article starts out with the statement, “…conventional treatment of patients with whiplash symptoms is disappointing.” The term “conventional treatment” means medical (non-chiropractic) treatment. One of the studies referenced by the authors reported 26 of 28 patients suffering from chronic whiplash syndrome benefited from chiropractic treatment. The term “chronic” means that those injured have had ongoing complaints for longer than 3 to 6 months, and typically are less likely to respond compared to those more recently injured (acute injuries). The authors interviewed 100 consecutive chiropractic patients being treated for chronic whiplash of which 93 completed the entire study. Those 93 were divided into 3 symptom groups: Group 1 consisted of neck to shoulder area pain, restricted neck movement with no neurological injury; Group 2 consisted of neck pain, restricted movement, and neurological loss; Group 3 consisted of severe neck pain but had full/normal neck movement, no neurological loss, but had unusual symptoms including blackouts, visual disturbance, nausea, vomiting, chest pain, and non-anatomic neurological complaints, which means the pain or numbness does not correlate with exam findings or were inconsistent. An average of 19.3 chiropractic adjustments over a mean 4.1 month duration were rendered after which time the patients were surveyed and the results are as follows (“asymptomatic” = no pain or symptoms): Group 1: 24% Asymptomatic, 24% Improved by 2 symptom grades, 24% Improved by 1 symptom grade, 28% No improvement. Group 2: 38% Asymptomatic, 43% Improved by 2 symptom grades, 13% Improved by 1 symptom grade, and 6% No improvement. Group 3: 0% Asymptomatic, 9% Improved by 2 symptom grades, 18% Improved by 1 symptom grade, 64% No improvement, and 9% Got worse. In their discussion, they reported that similar to the study where chronic symptoms improved in 26 of 28 patients (93%), here 69 of 93 patients improved (74%). They identified a “non-responders” group (Group 3), where neck movement was normal in spite of pain, bizarre symptoms, and ongoing litigation. The mean age was lower in this group vs. the other two (29.5 vs. 36.8 years old). They concluded, “The results from this study provide further evidence that chiropractic is an effective treatment for chronic whiplash symptoms. However, our identification of a group of patients who fail to respond to such treatment highlights the need for a careful history and physical examination before commencing treatment.” Bottom line, try chiropractic FIRST!!! We realize you have a choice in where you choose your healthcare services. If you, a friend or family member requires care for whiplash, 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.

Does Neck Surgery Improve Long-Term Outcomes?

How many times have you heard, “I have a pinched nerve in my neck and have to have surgery.” Though there certainly are cases where surgical intervention is required, surgery should ONLY be considered after ALL non-surgical treatment approaches have been tried first (and failed). It is alarming how many cases of cervical radiculopathy (i.e., “pinched nerve”) end up being surgically treated with NO trial of non-surgical care. Hence, the focus of this month’s article will look at research (“MEDICAL EVIDENCE”) that clearly states neck surgery DOES NOT improve the long term outcomes of patients with chronic neck pain. Chronic neck pain (CNP) is, by definition, neck pain that has been present for a minimum of three months. This category of neck pain is very well represented, as many neck pain sufferers have had neck pain, “…for years” or, at least longer than three months. Depending on the intensity of pain and it’s effect on daily function, many patients with CNP often ask their primary care provider, “…is there anything surgically that can be done?” The desire for a “quick fix” is often the focus of those suffering with neck pain. Unfortunately, according to recent studies, there may not be a “quick fix” or, at least surgery is NOT the answer. The December 2012 issue of The European Spine Journal reports that spine surgery did NOT improve outcomes for patients with CNP. Moreover, they pointed to other studies that showed some VERY STRONG REASONS NOT to have spine surgery unless everything else has failed. One of the reasons was a higher hospital readmission rate after spine surgery. Another reported that most studies on surgical vs. conservative [non-surgical] care showed a high risk of bias, suggesting the research on surgical intervention was biased in the research approach used. They further reported, “The benefit of surgery over conservative care is not clearly demonstrated.” It is important to point out that the research analyzed studies that included patients with and without radiculopathy (radiating arm pain from a pinched nerve), and myelopathy (those with pinching of the spinal cord creating pain, numbness, weakness in the legs, and/or bowel / bladder dysfunction). In February of 2008, the Neck Pain Task Force published overwhelming evidence that research supports the use of cervical spinal manipulation in the treatment of both acute and chronic neck pain with or without radiculopathy. Bronfort published similar findings in 2010 in a large UK based study that looked at the published evidence supporting different types of treatment for various conditions. They found cervical spine manipulation was effective for neck pain of ANY duration (acute or chronic). Chiropractic utilizes manipulation, manual traction, mobilization, muscle release techniques, home cervical traction, exercise, as well as a multitude of physiotherapy modalities when managing patients with CNP. Given the overwhelming research evidence that surgical intervention for CNP is NOT any better than non-surgical care, the greater amount of negative side-effects, and the obviously long recovery time post-surgically, chiropractic treatment of anyone suffering from CNP should be tried FIRST. 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.

Saturday, October 19, 2013

Tension - Type Headaches

At some point, everyone will have a headache, whether it’s from stress, lack of sleep, hormonal related or even self-induced after having way too much fun the night before! In fact, 9 out of 10 Americans suffer from headaches. For the most part, headaches are not indicative of a dangerous underlying condition, but they can be (…a topic for a future “Health Update”). The focus of this Health Update is to discuss the most common form of headache – the tension-type headache or, TTHA. Tension-type headaches (TTHA) are defined by the Mayo Clinic as “a diffuse, mild to moderate pain that’s often described as feeling like a tight band around your head.” Ironically, even though this is the most common form of headache, the causes of TTHA are not well understood. These are sometimes described as muscle contraction headaches but many experts no longer think muscle contractions are the cause. They now feel that “mixed signals” coming from nerve pathways to the brain are the cause and may be the result of “overactive pain receptors.” Regardless of the cause, the triggers of tension headaches are well known and include stress, depression/anxiety, poor posture, faulty awkward work station set-ups, jaw clenching and many others. Risk factors for TTHA include being a woman (studies show that almost 90% of woman experience tension headaches at some point in life) and being middle aged (TTHA’s appear to peak in our 40s, though TTHA’s are not limited to any one age group). Complications associated with TTHA’s may include job productivity loss, family and social interaction disruption, and relationship strain. The diagnosis is typically made by excluding other dangerous causes of headaches and when all the test results return “normal,” the diagnosis of TTHA is made. Treatment utilizing over the counter medications are often effective so long as side effects of stomach irritation and/or liver and kidney issues don’t arise. The use of heat and/or cold is often helpful as some prefer one over the other. Alternating between ice and heat is sometimes most effective. Controlling stress by trimming out less important duties or “…taking on less” can help. Yoga, meditation, biofeedback and relaxation therapy are also great! An “ergonomic” assessment of a workstation and how it “fits” the headache patient can also yield great results. Other highly effective therapies include acupuncture, massage therapy, behavior and/or cognitive therapy as well as of course, chiropractic! Chiropractic is a GREAT choice compared to standard medical care, especially when side effects to medications exist. This is because manipulation of the cervical spine addresses the cause of the headache and doesn’t just try to “cover up” the pain. In 2001, Duke University reported compelling evidence that spinal manipulation resulted in almost immediate improvement for those with headaches that originate in the neck with significantly fewer side effects and longer-lasting relief compared to commonly prescribed medication. Chiropractic treatment approaches include (partial list): spinal manipulation, trigger point therapy, mobilization techniques, exercise training, physical therapy modality use, dietary and supplementation education / advice, lifestyle coaching and ergonomic assessments. We realize you have a choice in where you choose your healthcare services. If you, a friend or family member requires care for headaches, 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.

Friday, October 18, 2013

Neck Pain and the Deep Neck Flexors

It’s safe to say that if you haven’t had neck and/or shoulder pain, you probably will. Like low back pain, there is a statistical increase in probability that once you’ve had neck pain, the chances of having another episode are significantly increased. A recent study reported that over a 12-month period, 16-18% of the population studied complained of neck and shoulder pain and each year, medical care was obtained by 21-38% of that same group. Moreover, 13-21% lost work time because of their neck and/or shoulder pain. The study reported there was a “…strong episodic nature…” as this condition was found to frequently come and go. Neck pain can arise from a number of structures including muscles, ligaments, bone, joint capsules, and more. Typically, a patient presenting with neck pain is treated for a few weeks and is then quite satisfied with their result… until the next time. Unfortunately, there is usually, “…a next time.” So, the question is, what can we do to prevent neck pain or its reoccurrence? When considering the many causes of neck pain and the high rate of recurrence, one common finding in those with this popular “come and go” neck/shoulder pain pattern is weakness of the deep flexors muscles located in the front of the neck. One reason for this common finding is that it is very difficult to strengthen the deep, intrinsic muscles of the neck as they are “involuntary.” That means, we cannot consciously “flex” or purposely contract our deep neck flexor muscles. Also, the larger extrinsic muscles tend to be too tight and by reflex, “turn off” or, inhibit the deep neck flexor muscles, compounding the problem. Therefore, in order to exercise them, we must “trick” the deep muscles into contracting without contracting the larger, extrinsic muscles. This can be accomplished by doing a very specific, controlled exercise with our neck by laying on the back with a partially inflated blood pressure cuff (or, by using a special device purposely made for this test and exercise) placed behind the neck. The inflatable bag is pumped up partially to about 20mmHg and then in a VERY controlled manner, we tuck in our chin and flatten our neck pressing into the bag raising the pressure by 2mmHg and holding that steady for 3-5 seconds. This is repeated in increments by pushing down a little harder until the gauge reads 24mmHg and again, holding that for 3-5 seconds. This pattern is repeated 5x or, until you reach 30mmHg and the process is then reversed releasing the pressure in 2mmHg increments at 3-5 second holds until you reach 20mmHg again. Sound easy? Not quite!!! This exercise requires “fine motor control” to accomplish the task and most of us haven’t specifically addressed these fine moving muscles and end up only exercising the larger extrinsic muscles by doing traditional neck strengthening exercises, which further inhibits the deep neck flexors. The first time you try this, you’ll be amazed at how challenging and tiring it is. But, after a few days of performing the exercise, you may find you feel much better! Of course, this depends on the degree of injury one has, but often, once cervical spine stability is improved by strengthening these deep neck flexors, symptoms usually improve. So, the question is, can we achieve good deep neck flexor strength by doing a more practical, upright position exercise rather than requiring a costly apparatus that requires a laying down position? In a recent study, a standing exercise where a similar movement called, a “neck-lengthening maneuver” was performed producing similar results as the laying down exercise (relaxation of the strong, extrinsic – outside - muscles and strengthening of the deep neck flexors). Simply tuck in the chin and stand tall, “lengthening” your neck! 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.

Wednesday, October 16, 2013

Whiplash "Basics"

Whiplash is a non-medical term typically describing what happens to the head and neck when a person is struck from behind in a motor vehicle collision. Let’s look at some basic facts about whiplash: Before cars, trains were the main source of whiplash and was called “railroad spine.” Better terms for whiplash injuries include “cervical acceleration-deceleration” (CAD) which describes the mechanism of the injury, and/or the term “whiplash associated disorders” (WAD), which describes the residual injury symptoms. Whiplash is one of the most common non-fatal injuries involved in car crashes. There are over one million whiplash injuries per year due to car crashes alone. An estimated 3.8 per 1,000 people per year have a whiplash injury. In the United States alone, 6.2% of the population has “late whiplash syndrome” (symptoms that do not resolve at one year). 1 in 5 cases (20%) remain symptomatic at one year post-injury of which only 11.5% returned to work and only 35.4% of that number returned to the same level of work after 20 years. The majority of whiplash cases occur in the fourth decade of life, females>males. Whiplash can occur from slips, falls, and brawls, as well as from horse-riding, cycling injuries, and contact sports. Injury from whiplash can occur at speeds of 15 mph or less. In the “classic” rear end collision, there are four phases of injury (time: 300msec) 1.) Initial (0msec) – before the collision (the neck is stable) 2.) Retraction (1-150msec) – “whiplash” starts where the head/neck stay in the original position but the trunk is moving forwards by the car seat. This is where the “S” shaped curve occurs (viewing the spine from the side). 3.) Extension (150-200msec) – the whole neck bends backwards (hopefully stopped by a properly placed head rest). 4.) Rebound (200-300msec) – the tight, stretched muscles in the front of the neck propels the head forward immediately after the extension phase. We simply cannot voluntarily contract our neck muscles fast enough to avoid injury, as injury to the neck occurs within 500msec. and voluntary contraction or bracing takes 800msec or longer. Injury is worse when the seat is reclined as our body can “ramp” up and over the seat and headrest. Also, a springy seat back increases the rebound affect. Prompt treatment is better than waiting for a long time. Manipulation is a highly effective (i.e., COME SEE US!) treatment option. We realize you have a choice in where you choose your healthcare services. If you, a friend or family member requires care for whiplash, we sincerely appreciate the trust and confidence shown by choosing our services and look forward in serving you and your family both presently and in the future.

Monday, October 14, 2013

Dangerous Headaches

This topic will address dangerous headaches. To keep this in perspective, most headaches are NOT dangerous. In fact, tension-type headaches and migraines are very common and remain the focus of most health care providers and patients who suffer from headaches. With that said, it’s important to discuss the signs and symptoms that might help all of us differentiate between headaches that are safe versus those which are not safe. The most important factor to consider is when the “typical” headache is suddenly “different.” Some of these “different” symptoms may include slurred speech, difficulty communicating or formulating thought, seizures, fainting or loss of consciousness (even for a few seconds), memory lapses, double or blurred vision, profound dizziness, numbness in the face or half of the body, an “alarm” should sound off telling you to get this checked ASAP as these symptoms, when they deviate from “the norm” may be indicative of a more serious condition. This can be challenging as seizures are often related to migraines and might be a common symptom of a migraine headache for some migraine sufferers. Signs of a dangerous headache include: A headache that starts suddenly, especially if it’s of a severe degree. Headaches that start later in life, especially after the age of 50. A change in the quality of headaches. Visual changes, including double vision or loss of vision. Weakness, numbness, or any other neurological symptoms. Fevers – especially of rapid onset. Change in mental status including sleepiness, hallucinations, speech changes or confusion. Weight loss. If there is ever ANY doubt about a dangerous headache, your physician should be contacted. Typically, the migraine patient will notice a fairly consistent set of symptoms and even though the headaches can vary in intensity, the sequence of events is fairly consistent. Dangerous headaches are the ones that deviate significantly from that migraine sufferer’s “norm.” For example, suppose a patient’s “typical” migraine is: aura (bright, flashy lights in the visual field or, a strange odor precedes the migraine about 30 min. before the headache strikes), followed by a gradually increasing pain in half of the head which worsens to a point of nausea and sometimes vomiting if something isn’t done to stop it (such as a chiropractic adjustment and/or some form of medication). If this is that patient’s “usual,” IF any of the 8 items previously listed above accompany the headache, it should be further evaluated – often requiring an EEG (electroencephalogram) and/or MRI (Magnetic Resonant Image). The EEG will test for any electrical signal changes in the brain and the MRI will show space occupying structures such as tumors, bleeding, infection, aneurism, and if performed with a contrast agents, arterial malformations (that is, abnormal networks of blood vessels). We realize you have a choice in where you choose your healthcare services. If you, a friend or family member requires care for headaches, 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.

Sunday, October 13, 2013

The Neck and Headache Connection

The Neck and Headache Connection When we hear the term headache, we don’t usually think about the neck. Rather, we focus on the head, more specifically, “…what part of the head hurts?” But, upon careful questioning of patients, we usually find some connection or correlation between neck pain and headaches. The key to this connection can be found in looking at the anatomy of the neck. There are 7 vertebrae that make up the cervical spine and 8 sets of nerves that exit this part of the spine and innervate various parts of the head, neck, shoulders and arms, all the way to the fingers. Think of the nerves as electric wires that stretch between a switch and a light bulb. When you flip on the switch, the light illuminates. Each nerve, as it exits the spine, is like a switch and the target it travels to represents the light bulb. So, if one were to stimulate each of the nerves as they exit the spine, we could “map” exactly where each nerve travels (of course, this has been done). When we look specifically at the upper 3 sets of nerves that exit the spine (C1, C2, and C3), we see that as soon as they exit the spine, they immediately travel upwards into the head (the scalp). Like any nerve, if enough pressure is applied to the nerve, some alteration in nerve function occurs and usually a sensory change is noted (numbness, tingling, pain, burning, etc.). If the pressure continues, these symptoms can last for a long time. These types of headaches are often called “cervicogenic headaches” (literally meaning headaches that are caused by the neck). These can be caused by the nerves getting pinched by tight muscles through which they travel as they make their way to the scalp. Another connection between the neck and headaches includes the relationship between 2 of the 12 cranial nerves and the first three nerves in the neck described above. These types of headaches usually only affect one half of the head – the left or right side. One of the cranial nerves is called the trigeminal nerve (cranial nerve V). Because the trigeminal nerve innervates parts of the face and head, pain can also involve the face. Another cranial nerve (spinal accessory, cranial nerve IX) can also interact with the upper 3 cervical nerve roots, resulting in cervicogenic headaches. People with cervicogenic headaches will often present with an altered neck posture, restricted neck movement, and pain when pressure is applied to the base of the skull or to the upper vertebrae. Other than a possible numbness, there are no clinical tests that we can run to “show” this condition, though some patients may report scalp numbness or, it may be found during examination. Though medication, injections, and even surgical options exist, manipulation applied to the small joints of the neck, especially in the upper part where C1-3 exit, works really well so why not try that first as it’s the least invasive and, VERY EFFECTIVE! In some cases, a combination of approaches may be needed but many times, chiropractic treatment is all the patient needs for a successful outcome. 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. Check out for more information.

Saturday, October 12, 2013

Carpal Tunnel Treatment Options

The goal of any treatment approach for Carpal Tunnel Syndrome (CTS) is to return the patient to normal. That means addressing all OTHER health related conditions that can cause CTS such as diabetes, hypothyroidism, birth control pill use, pregnancy, rheumatoid arthritis (and many of the other related arthritic-like disorders), as well as double or multiple crush (pinched nerve) syndromes. That’s right! CTS can be caused by MANY other conditions besides simply overusing the arms and hands. When overuse PLUS any of the above mentioned conditions “gang-up” on you, managing BOTH is necessary. One “universal” goal in CTS treatment is to reduce inflammation. This can be accomplished by several approaches: 1) STOP, reduce, and/or modify the causing activity. Examples include repetitive use of a hammer, screw driver, stapler, assembly line work, typing/computer work, driving with a firm grip on the steering wheel, bicycle riding, and MANY more! The key to successful management of CTS is to slow down, stop/rest, and for long-term success, change how the task is performed (modify the work station). 2) Wearing a cock-up wrist splint. This is usually restricted to night time use since we cannot control our wrist position while sleeping and the pressure inside the carpal tunnel “normally” doubles at the extremes of the wrist forwards or backwards. Thus, keeping the wrist straight at night significantly reduces or eliminates the numbness/tingling that can cause multiple sleep interruptions. It can also be worn during the day IF it doesn’t interfere with the person’s activity. If the activity requires frequent bending of the wrist, you’ll end up fighting against the wrist splint and that can actually worsen your CTS! 3) Ice cupping or massage. Freeze water in a Styrofoam or paper Dixie cup (like home-made popsicles) and peel away the top third to expose the ice. Rub it over the palm side of the wrist until you feel numbness. At first, it will feel Cold, followed by Burning, Aching, and finally Numbness (hence the acronym, “C-BAN”). The length of time to achieve numbness is usually three to five minutes, but make sure you quit at the point of numbness as the next stage is frostbite! 4) Anti-inflammatory nutrients. An anti-inflammatory diet is one that is rich in fruits, vegetables, lean meats, omega-3 fatty acids, and avoids glutens, omega-6 fatty acids (fast foods, etc.), and refined carbohydrates (sweets, sodas, etc.). Also, there are many REALLY GOOD nutritional supplements that can effectively reduce inflammation without the typical side-effects that affect the stomach, liver, or kidneys which are common to NSAID drugs like aspirin, ibuprofen, or Aleve. Also, NSAIDs can inhibit an important chemical (a prostaglandin) that is needed for healing, and therefore, it can actually slow down the healing process (so try the nutritional approaches first)! Nutritional options include proteolytic enzymes, Bromelain, papain, bioflavonoid, Vitamin C, Vitamin D, Vitamin E, Coenzyme Q10, and many more. Treatment options beyond those mentioned above are typically surgical, IF you decide to go to a surgeon. However, chiropractic care includes identifying and treating the source(s) of nerve irritation, as it is often more than just nerve pinching at the carpal tunnel. Other common locations of median nerve entrapment includes the pronator teres muscle in the forearm just past the elbow on the palm side, less often at the shoulder, and again quite frequently in the neck where the nerve exits the spine. If these areas of nerve pinching are not released, recovery is less likely (with or without surgery)! Bottom line, you can always have surgery but you can’t “un-do it.” Try chiropractic first as it’s the least invasive, least costly, and often the quickest way to find relief from CTS! We realize you have a choice in who 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 require care for CTS, we would be honored to render our services.

Friday, October 11, 2013

Neck Pain and Cervical Disk Herniation

Neck pain can arise from many sources. There are ligaments that hold bones to other bones that are non-elastic and very strong. When injured, the term, “sprain” is applied. The muscle and/or its attachment (the tendon) can tear as well, which is called a “strain.” But, what is it that people refer to when they say, “…I slipped a disk in my neck!”?

 The disks lay between the vertebrae in the front of the spine, and they are part of the primary support and shock absorbing system of our neck and back. There are 6 disks in the neck, 12 in the mid-back and 5 in the low back for a total of 23. The disks in the low back are big, like the vertebral bodies they lie between, and get progressively smaller as they go up the spine towards the head. When we bend our neck forwards, the disk compresses, and opens wider when we look up. It forms a wedge shape when we side bend left or right, and it twists when we rotate or turn the head.

 The terms, “…a slipped disk, a herniated disk, a ruptured disk, a bulging disk” (and more), all mean something similar, if not exactly the same thing. A central part of the disk is liquid-like and can herniate in any direction. When it does, it can create pain IF it pinches something, or it may be painless if it doesn’t. In fact, since the invention of the CAT scan and MRI, many (“normal”) people have been found on the scan to have some type of disk “derangement” (alteration of the normal integrity of the disk), with 50%+ showing bulging disk(s) and 21% showing frank herniations WITH NO PAIN AT ALL! So, in the absence of shooting pain down an arm from the neck, or when there is no numbness or weakness in the arm, why order an MRI? It may show bulges or herniations that are not “clinically” important, and may falsely lead a doctor to recommend surgery when it’s not needed.

 There are “KEY” findings in the history and examination that leads us to the diagnosis of a cervical disk injury. From the history, the disk patient often has arm pain, numbness, and/or muscle weakness that follows a specific pathway, such as numbness to the thumb/index finger (C6 nerve), middle of the hand & 3rd finger (C7) or to the pinky & ring finger (C8). Certain positions, such as looking up, usually irritate the neck and arm, and bending the head forward relieves it. Another unique history and exam finding is if the patient finds relief by putting the arm up and over their head. Similarly, letting the arm hang down is often associated with irritation.

Other examination findings unique to a cervical disk injury include reproducing the arm pain by placing the head in certain positions such as bending the head back and to the side simultaneously. Another is compressing the head into the shoulders. When lifting up on the head (traction), relief of arm pain is common. The neurological exam will usually show a reduction of sensation when we gently poke them with a sharp object, and/or they may have weakness when compared to the opposite side.

 Chiropractic treatments can be very successful in resolving cervical disk herniation signs and symptoms, and should CERTAINLY be tried before agreeing to a surgical correction. Often, the surgeon will recommend a fusion of 2 or more neck vertebrae, sometimes with a metal plate in the front of the spine. This increases the load on either side of the fusion and can create problems above and below the fusion. Trust me, try chiropractic first. You’ll be glad you did!

 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.  Visit for more information.

Thursday, October 10, 2013

Neck pain and Our Pillow!

The relationship between neck pain and our pillow is more important than most of
us realize! Though we all may have at one time or another slept on a variety of
surfaces, and used any number of pillows (flat, medium, bulky) made of different
materials (foam, feather, air, water, or memory foam), it’s usually not until
neck pain and/or headaches start to become an issue that we start to think,
“…how important is my pillow?” Thankfully, the question has been addressed in a
randomized peer-reviewed study. So, what did they find out?

The goal of a pillow is to support the neck more so than the head. In a study
headed by Dr. Liselott Persson, MD, of the department of neurosurgery at the
University of Lund in Sweden, researchers tested whether specific neck pillows
have any effect on neck pain, headache and sleep quality in people suffering
with chronic (>3months), non-specific neck pain. They also researched whether
there was an optimum or “best” type of pillow that was preferred by their 52
patient group. They used 4 different pillows, 1 “normal” pillow and 3 of which
were specially designed, each having a different shape and consistency. Over a
4-10 week time frame, the pillows were randomly distributed to the neck pain
group who then graded them according to comfort, the effects on neck pain, sleep
quality and headache using a questionnaire, and also described the
characteristics of an “ideal pillow.” Researchers and participants concluded the
“ideal pillow” (for reducing neck pain and headaches and improving quality of
sleep) includes a soft pillow with good support under the neck’s curve

There are many styles of contoured cervical or neck pillows that vary
considerably. This study supports the use of a specially designed style over a
normal pillow. So what are some of the things to look for? First, consider your
neck’s length and girth.  When you look in a mirror, do you have a neck that is
short vs. long or, narrow vs. wide? This will direct you to a pillow that has a
larger “hump” for your neck to be cradled in if it’s a long neck and, the height
of the hump – taller for the slender neck or, shorter for the wide neck. Some
pillows have 2 options of “hump” sizes (located on the long edges of the pillow)
– one short and flat and the other side taller and wider. Others recommend lying
in the middle of the pillow if you’re a back sleeper vs. lying on the edge of
pillow when sleeping on your sides. A measurement taken from the neck to the
point of the shoulder determines if the pillow should be a small, medium, or
large. Water filled and/or air filled pillows can be varied by the amount of
water or air added. The bottom line of which is “best” is based on comfort and
support. Regardless of which you choose, it can take several days to get used to
the new pillow, so we recommend using the pillow for at least 1 week. By then,
you’ll know if you chose the right style. 

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. Visit for more information.

Wednesday, October 9, 2013

Is It My Low Back or My Hip?

When patients present with low back pain, it is not uncommon for pain to arise from areas other than the low back, such as the hip. There are many tissues in the low back and hip region that are susceptible to injury with have overlapping pain pathways that often make it challenging to isolate the truly injured area. Hip pain can present in many different ways.

    When considering the anatomy of the low back (lumbar spine) and hip, and the nerves that innervate the hip come from the low back, it’s no wonder that differentiating between the two conditions is often difficult. Complaints may include the inside, outside, front or back of the thigh, the knee, the buttocks, the sacroiliac joint, or the low back and yet, the hip may truly be the pain generator with any of these presentations. To make diagnosis even more complex, the hip pain patient may present one day with what appears to be sciatic nerve pain (that is, pain shooting down the back of the leg to the knee if mild or, to the foot if more severe) but the next time, with only groin pain. When pain radiates down a leg, the almost automatic impression by both the patient and the health care provider is, “…it’s a pinched nerve.” But again, it could be the hip and NOT a pinched nerve that is creating the leg pain pattern. Throwing yet another wrench in the works is the fact that a patient can have more than one condition at the same time. So, they truly MAY simultaneously have BOTH a low back problem AND a hip problem. In fact, its actually unusual to x-ray the low back of a hip pain patient without seeing some low back condition(s) like degenerative disk disease, osteoarthritis (spurs off the vertebrae), or combination of these. So, how do we differentiate between hip vs. low back pain when it is common for both low back and hip pain to often coincide?

 During our history, we often ask the question, “…what activities make your pain worse?” If the patient replies that weight bearing activities like standing, walking, getting up from sitting, etc., provoke the pain (and they point to the front or side of the hip), a hip related diagnosis is favored but, it STILL may be arising from the low back or both! If they say, “…crossing my right leg over the other hurts in my groin,” that’s getting more hip pain specific as hip rotation is frequently lost before the forward flexion motion. When we ask the hip pain patient to point to the area of greatest discomfort, they usually point to the front of the hip or groin, and less often to the inner and/or anterior thigh or knee. Non-weight bearing positions like sitting or lying are almost always immediately pain relieving. When there is arthritis in the hip, motion loss is often reported and may include a shorter walking stride and pain usually gets worse the longer these patients are on their feet. Initiating motion often hurts, sometimes even in bed when rolling over. During the chiropractic examination, with the patient lying on the back with the knee and hip both bent 90°, moving the bent knee outwards or inwards will almost always reproduce hip/groin area pain. Pulling on or, applying traction to the affected leg usually, “…feels good.” Knee & ankle reflexes and sensation are normal but muscle strength may be weak due to pain. Bending the low back into different positions does not reproduce pain if the pain is only coming from the hip. Though challenging sometimes, we are well trained to be able to differentiate between hip and low back pain and will treat both areas when it is appropriate.

 We realize you have a choice in who you choose to provide your healthcare services. If you, a friend or family member requires care for low back 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. Check out for more information.

Neck Pain and Chiropractic

Neck pain represents a major problem for people throughout the world with considerable negative impact on individuals, families, communities, health care systems, and businesses. Up to 70% of the general population will have neck pain at some point in their life. Recovery within the year from neck pain ranges between 33% and 65%, AND relapses are common throughout the life time of the neck pain patient. Generally, neck pain is more common in women, higher in high-income countries, and higher in urban regions. The greatest risk of developing neck pain occurs between 35 and 49 years of age. Since neck pain, very similar to low back pain, is very common and likely to recur over and over again, the question is, what is the best course of action regarding treatment? A recent study on neck pain patients compared the effectiveness of manual therapy performed by a chiropractor, physical therapy performed by a physical therapist (PT), and medical care performed by medical physician (MD). The success rate determined at the seventh week was TWO TIMES BETTER for the manual therapy/chiropractic group (68.3%) compared to the medical care group. Those receiving manual therapy also had fewer absences from work compared to both the medical and PT treated groups. Lastly, both the manual therapy and PT groups used less pain relief medication compared to the medically treated group. Another study looked at the multiple approaches that chiropractors use for treating patients with neck pain to determine the “best” approach a chiropractor can use. They reported 94% had improvement or less neck pain after just one treatment when the mid-back (thoracic spine) was also adjusted. Similarly, after receiving two treatments over a one week time frame, the group receiving midback adjustments (vs. the group who did not) reported lower pain and disability scores. A similar study concluded that the best results occurred when the neck, upper back/lower neck, and mid-back were adjusted. This group, when compared to neck adjustments alone, reported greater reductions in disability scores. Thus, having the cervical spine, upper back, and mid-back all adjusted appears to yield quicker, more satisfying results than neck adjustments alone. What about the role of exercise in the management of neck pain patients? In November 2012, a systematic review of manual therapies for nonspecific neck pain reported that the addition of neck exercises to a treatment plan provided more benefits than spinal manipulation alone. Similarly, in September 2012 (The Annals of Internal Medicine), chiropractic adjustments were compared against exercise and pain medication treatment groups involving 272 patients tracked over a one-year time frame after a 12-week treatment. Both the chiropractic and exercise groups experienced the most significant pain reduction when compared to the medication treated group with more than double the likelihood of complete pain relief. The chiropractic and exercise groups also had the best short and long term results, but ONLY the chiropractic group found the benefits to last a year or more. The authors (Bronfort, et. al) reported the success of chiropractic treatment stems from its ability to address the CAUSE of the problem rather than simply addressing the symptoms! 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 both presently and in the future. Visit for more information.

Tuesday, October 8, 2013

What Are Cervicogenic Headaches?

Headaches are a very common problem that can have multiple causes ranging from

stress to trauma.  To make matters worse, there are MANY different types of

headaches. One such type is the “cervicogenic headache” (others include

migraines, cluster headaches, etc.).


The main distinction between the symptoms associated with cervicogenic headaches

and those associated with migraine headaches are a lack of nausea, vomiting,

aura (pre-headache warning that a headache is about to strike), light and noise

sensitivity, increased tearing with red eyes, one sided head, neck, shoulder

and/or arm pain, and dizziness. The items listed above are primarily found in

migraine headache sufferers.   The following is a list of clinical

characteristics common in those struggling with cervicogenic headaches:

 Unilateral (one-sided) head or face pain (rarely is it on both sides).

  Pain is localized or stays in one spot, usually the back of the head, frontal,

  temporal (side) or orbital (eye) regions.

  Moderate to severe pain intensity.

  Intermittent attacks of pain that last hours to days.

  Pain is usually deep, non-throbbing, unless migraines occur at the same time.

  Head pain is triggered by neck movement, sustained awkward head postures,

  applying deep pressure to the base of the skull or upper neck region, and/or

  taking a deep breath, cough or sneeze can trigger head pain.

  Limited neck motion with stiffness.

Infrequently, the cervicogenic headache sufferer can present with migraines at

the same time and have both presentations making it more challenging to


The cause of cervicogenic headaches can be obvious such as trauma (sports

injury, whiplash, slip and fall), or not so obvious, like posture. A forward

head posture can increase the relative weight applied to the back of the neck

and upper back as much as 2x-4x normal. Last month, we discussed the intimate

relationship between the upper 2 cervical vertebra (C1 & C2) and an anatomical

connection to the covering of the spinal cord (the dura) as giving rise to

cervicogenic headaches. In summary, the upper 3 nerves innervate the head and

any pressure on those upper 3 nerves can result in a cervicogenic headache. As

chiropractors, we are trained to examine, identify, and treat these types of

potentially debilitating headaches.

We realize that you have a choice in where you choose your healthcare services. 

If you, a friend or family member requires care for headaches, 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.   Visit for more information.


Low Back Pain: Surgery vs. Chiropractic?


Low back pain (LBP) is the second most common cause of disability in the United

States (US) and a very common reason for lost days at work with an estimated 149

million days of work lost per year. The total cost associated with this is

astronomical at between $100-200 billion/yr, of which 2/3rds are due to

decreased wages and productivity. More than 80% of the population will have an

episode of LBP at some point in their lifetime. The good news is that 95%

recover within two to three months of onset. However, some never recover which

leads to chronic LBP (LBP > 3 months), and 20-44% will have a recurrence of LBP

within one year with lifetime recurrences of up to 85%! What this means is that

most of us have, have had, or will have LBP, and we’ll get it again! So the

question is, what are we going to do about it?


Surgery has traditionally been considered a “last resort” with less invasive

approaches recommended first. Chiropractic adjustments and management strategies

have traditionally faired very well when compared to other non-surgical methods

like physical therapy, acupuncture, and massage therapy. But, is there evidence

that by receiving chiropractic treatment, low back surgery can be avoided? Let’s

take a look!


A recent study was designed to determine whether or not we could predict those

who would require low back surgery within three years of a job-related back

injury. This is a very important study as back injuries are the most common

occupational injury in the US, and few studies have investigated what, if any,

early predictors of future spine surgery after work-related injury exist. The

study reviewed cases of 1,885 Washington state workers, of which 174 or 9.2% had

low back surgery within three years. The initial predictors of surgery included

high disability scores on questionnaires, greater injury severity, and seeing a

surgeon as the first provider after the injury. Reduced odds of having surgery

included: 1) <35 years old; 2) Females; 3) Hispanics; and 4) those who FIRST saw

a chiropractor. Approximately 43% of workers who first saw a surgeon had surgery

compared to ONLY 1.5% of those who first saw a chiropractor! WOW!!! This study

supports the FACT that IF a low back injured worker first sees a chiropractor

vs. a surgeon, the likelihood of needing surgery in the three years after the

injury would be DRAMATICALLY reduced! In fact, the strongest predictor of

whether an injured worker would undergo surgery was found to be related to who

they saw first after the injury: a surgeon or a chiropractor.


If this isn’t enough evidence, another recent study (University of British

Columbia) looked at the safety of spine surgery and reported that (taken from a

group of 942 LBP surgical patients): 1) 87% had at least one documented

complication; 2) 39% of the 87% had to stay longer in the hospital as a result;

3) 10.5% had a complication during the surgery; 4) 73.5% had a post-surgical

complication (which included: 8% delirium, 7% pneumonia, 5% nerve pain, 4.5% had

difficulty swallowing, 3% nerve deterioration, 13.5% wound complication); 5) 14

people died as a surgical complication. Another study showed lower annual

healthcare costs for those receiving chiropractic vs. those who did not. The

“take-home” message is clear: TRY CHIROPRACTIC FIRST!!!


We realize you have a choice in who you choose to provide your healthcare

services.  If you, a friend or family member requires care for low back pain, we

sincerely appreciate the trust and confidence shown by choosing our services and

look forward in serving you and your family both presently and in the future.   Visit for more information.