Neck Pain - Where Is It Coming From?

Neck pain can arise from a number of different tissues in the neck. Quite often, pain is generated from the small joints in the back of the vertebra (called facets). Pain can also arise from disk related conditions where the liquid-like center part of the disk works its way out through cracks and tears in the thicker outer part of the disk and can press on nerves producing numbness and/or weakness in the arm. It is possible to “sprain” the neck in car accidents, sports injuries, or from slips and falls. This is where ligaments tear and lose their stability resulting in excessive sliding back and forth of the vertebrae during neck movements. When muscle or their tendon attachments to bone are injured, these injuries are called “strains” and pain can occur wherever the muscle is tore. There is also referred pain. Here, the injury is at a distance away from where the pain is felt. Here, the injury is at a distance away from where the pain is felt. A classic referred pain pattern is shoulder blade pain when a disk in the neck herniates. Let’s take a closer look at two conditions we often diagnose and treat as chiropractors:

 Spinal Stenosis: This occurs when the canals in the spine narrow to the point of pinching the spinal cord in the trefoil shaped central canal (called “central stenosis”) or when the nerve roots get pinched in the lateral recessed (called lateral recess stenosis). This can occur from arthritis in the facet joints, disk bulging or herniations, thickening of ligaments, shifting of one vertebra over another, aging, heredity (being born with a narrowed can), and/or from tumors. Usually, combinations of several of the above occur simultaneously. When this is present in the neck, it can be more serious compared to stenosis in the low back as the spinal cord ends at the upper part of the low back (T12 level) so only the nerves get pinched. Stenosis in the neck however pinches the spinal cord itself. Symptoms can include pain in one or both arms, but it’s more dangerous when leg pain, numbness, or weakness occur (called myelopathy). Rarely, low of bowel or bladder control can occur which is then considered a “medical emergency” and requires prompt surgery.

 Cervical Disk Herniation: As previously stated, the liquid-like center of the disk can work its way through cracks and tears in the outer layer of the disk and press on a nerve resulting in numbness, pain, and/or weakness in the arm. The classic presentation is the patient finding relief by holding the arm over the head, as this puts slack in the nerve and it hurts less in this position. The position o the head also makes a difference as looking up usually hurts more and can increase the arm pain/numbness while looking down reduces the symptoms. We will carefully test your upper extremity neurological function (reflexes, muscle strength, and sensation as each nerve performs a different function in the arm), and we can tell you which nerve is pinched after a careful examination. This condition can lead to surgery so please take this seriously.

 The good new is that chiropractic care can manage both spinal stenosis and cervical disk herniations BEFORE they reach the point of requiring surgery. So make chiropractic your FIRST choice when neck pain occurs!

 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 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. For more information, check out www.olsonchiropracticcenter.com

Traction - Non Surgical Spinal Decompression - Does It Help Neck Pain and Headaches?

Traction is defined as, “…the act of pulling a body part.” Therefore, it is commonly used in many regions including legs, arm, low back, mid-back, and the neck. We will be limiting this discussion to cervical or neck traction, and the question of the month is, “…does it help patients with neck pain and headaches?” Though I’m assuming you already know, the answer is YES! You may want a little “proof,” so here it goes!

1. REDUCES DISK PROTRUSIONS: 
In 2002, a medically based study found taction to be very effective in the treatment of cervical radiculopathies (pinched nerves in the neck that radiate into the arms). A 2008 study using MRI (images) described the effect traction had on the disk protrusions in the neck reporting 25 of 35 (or 71%) were reduced while in traction with a 19% increase in the spacing (disk height) and improved neck range of motion after the traction was applied. They postulated that by pulling the vertebrae in the neck apart, there was a suction-like effect pulling the disk material back in place.

2. RECOMMENDED BY GUIDELINES: Around the world, guidelines have been published giving doctors information that allows us to know how well certain forms of treatment work for different conditions. In a 2008 publication, it was reported that, “Clinicians should consider the use of mechanical intermittent cervical traction, combined with other interventions such as manual therapy and strengthening exercises, for reducing pain and disability in patients with neck and neck-related arm pain.”

3. CLINICAL PREDICTION RULES: These help us determine who is most likely to benefit from a certain type of treatment (in this case cervical traction and exercise). If 3 of 5 variables are found, the likelihood of success with traction & exercise was reported to be 79%, and if 4 of the 5 are found, 90%. The 5 variables are: 1. Radiating neck to arm pain in certain positions; 2. Positive shoulder abduction sign; 3. Age >55 years old; 4. Positive limb tension test; 5. Relief of symptoms using manual distraction test (if pain is relieved while the neck is being pulled).

4. INTERMITTENT AND CONTINUOUS TRACTION: Either way, significant improvement in neck and arm pain, neck mobility, and nerve function occurred with both approaches.

5. TRACTION VS. SURGERY: In this study, patients with radiating arm pain and positive neurological findings on exam were offered a course of traction before surgical options. They reported 63 of 81, or 78%, of the patients experienced significant or total relief, 3 could not tolerate traction and 15 simply didn’t respond. They concluded that when neck and arm symptoms with neurological deficits were present for 6 weeks, that 75% will respond to neck traction over the next 6 week.

There are MANY additions studies available that show well beyond doubt that cervical traction is a GREAT option in the management of neck and arm pain and sometimes headaches. Next month, we will discuss “HOW TO” apply cervical traction.

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 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 www.olsonchiropracticcenter.com for more information.

　

　

Side Effects of Chiropractic vs. Medications for Headaches

Have you ever stopped and wondered, “…which type of doctor should I go to for treatment of my headaches?” In order to make an informed decision, it is appropriate to look at the side effects each treatment option carries and then consider the pros and cons of each treatment.

It has been reported that 45 million Americans suffer from headaches, many on a daily basis. Though some just put up with the pain, others become totally disabled during the headache. Most people initially turn to an over the counter drug such as a non-steroidal anti-inflammatory drug (NSAID) of which there are 3 types: 1) salicylates, such as aspirin; 2) traditional NSAIDS, such as Advil (ibuprofen), Aleve (naproxen); and, 3) COX –2 inhibitors, such as Celebrex.

According to the medical review board of About.com, complications of NSAID drugs include stomach irritation (gastritis, ulcer), bleeding tendencies, kidney failure, and liver dysfunction. Some NSAIDs (particularly indomethacin) can interfere with other medications used to control high blood pressure and cardiac failure and long term use of NSAIDs may actually hasten joint cartilage loss, leading to premature arthritis. Another over the counter commonly used drug is Tylenol (Aceteaminophen) in which liver toxicity can be a potential side effect (particularly with long term use).

Here’s the kicker – only about 60% of patients respond to a 3 week trial of an NSAID, NSAIDs can mask signs and symptoms of infection, it cannot be predicted which NSAID will work best, and no single NSAID has been proven to be superior over others for pain relief. Moreover, estimates of death associated with NSAID (mostly gastrointestinal causes) range between 3200 on the low side to higher than 16,500 deaths per year in the United States. Another BIG concern is that low daily doses of aspirin, “…clearly have the potential to cause GI injury as 10mg of aspirin daily causes gastric ulcers.

Others may turn to prescription medication for hopeful pain relief. One of the more frequently prescribed medication for headaches is amitriptyline (commonly known as Elavil, Endep, or Amitrol). This is actually an antidepressant but was found to work quite well for some headache sufferers. The potential side effects include blurred vision, change in sexual desire or ability, constipation or diarrhea, dizziness, drowsiness, dry mouth, headache (ironically), appetite loss, nausea, tiredness, trouble sleeping, tremors and weakness. Allergic reactions such as rash, hives, itching, difficulty breathing, tightness in the chest, swelling of the mouth, face, lips or tongue, chest pain, rapid and/or irregular heart rate, confusion, delusions, suicidal thoughts or actions AND MORE are reported.

The pros and cons of chiropractic include a report on children under 3 years of age, where only one reaction for every 749 adjustments (manipulations) occurred (it was crying, NO serious side effects were reported). In adults, transient soreness may occur. Though stroke has been reported as a cause of headache, it was concluded that stroke “…is a very rare event…”, and that, “…we found no evidence of excess risk of VBA stroke associated chiropractic care compared to primary care.” Another convincing study reported that chiropractic was 57% more effective than drug therapy in reducing headache and migraine pain! They concluded – chiropractic first, drugs second and surgery last.

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 your services and look forward in serving you and your family presently and, in the future.  Visit www.olsonchiropracticcenter.com for more information.

Where Does Low Back Pain Come From?



“Where does the pain come from?” is probably the most common asked question we hear as chiropractors and frequently, the patient is not told the answer to this simple question.  The problem is, the question is not simple.  This is because there are many structures in the low back that share a common nerve supply and hence, the pain arising from those structures is located in the same area of the back.  For example, the back portion of the disk, the facet capsule and some of the deep muscles in the spine are all innervated by the same nerve and therefore hurt is a similar location.  In all honesty, the only way to try to isolate the pain generator is to inject a local anesthetic to block the pain for a short while.  This is like when you go to the dentist and they “numb” your tooth so you don’t feel the pain when they work on it.  After a few hours, you start to feel some “life” coming back to your mouth and soon it regains its full feeling.  Of course, no one would consider “numbing” the back just to figure out exactly where the pain is arising as really, it’s not that important.  This is because the chiropractic treatment approach is similar regardless of the exact tissue that is involved.  However, it DOES matter in cases where a nerve root is shooting pain down the leg caused by a herniated disk vs. a localized pain in the back that doesn’t radiate.  Hence, we doctors of chiropractic will work hard to differentiate these two distinct types of conditions as the treatment is definitely different.

In 1995, the Quebec Task Force recognized the importance of this distinction and recommended all health care providers concentrate on differentiating the nerve root/herniated disk case from what is called “mechanical low back pain.” As noted in the model below, the arrow and pen point to the two most common structures that cause nerve root pain (the herniated disk)  and mechanical low back pain (the facet joint).

The facet joint, when sprained/injured, hurts worse when bending backwards and feels good bending forwards.  This is exactly the opposite for the herniated disk where bending backwards helps reduce pain and often reduces the shooting leg pain as well, while bending over even a little can create a sharp stabling pain in the back that may shoot down the leg.  Of course, there are variations of this and, to make matters more complicated, BOTH disk and the facet can generate pain at the same time, so it’s not always this cut and dry.

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.  For more information check out www.olsonchiropracticcenter.com