Subluxation means a vertebral joint of the spine is out of its normal position. It’s the same as a sprain because the ligaments are stretched when this occurs. But how does a joint get out of its normal position? Usually, the culprit is some sort of trauma but not necessarily at the level of a high fall or a major car accident (although these trauma do cause problems).

Many times, the spine is injured because it is more vulnerable in awkward positions, such as when we bend forward and add a little twist to a lift. Perhaps it’s putting a baby seat into the back seat, or pulling weeds in the garden.

For many patients, it’s life’s trips and tumbles as a child that set the stage for a problem years later. We can all remember how we thought our spines were once invincible. The reality is something much less. Those jumps from the rooftop did have a consequence.

That small sprain of the ligaments did just enough to make the joints function abnormally. Over time the muscles adapt and our movements become less even. Then some twenty years later, a simple sneeze or less throws our back out. Some patients get back pain when they are under work stress or have to sit for long periods of time.

The important thing is to get subluxations reduced or corrected. The adjustments we perform at the clinic are meant to align the spine and make the movements of spine symmetrical from side to side. This tends to reduce the tensions on ligaments and muscles, and most importantly, makes you feel better.

When your spine moves normally, you may have less pain when you exercise or move the spine in a stressful way. We can’t make the ligaments perfect, there will always be scar tissue, but we can optimize your life and improve its quality. For many, just working without constant pain can be a real lifesaver. Many patients find their moods improve and they cannot wait to return to the sports or hobbies they once did. This is true wellness, healing not just the body but also the mind. Being in chronic pain is not much fun. While drugs can help many people and get them out of excruciating pain, they do have their limitations. Chiropractic can be a drug-free and natural alternative for health.

Fibromyalgia (FM) has long been considered a condition involving the soft tissues of the body, that is, the muscles, ligaments, tendons and fascia. It is defined as “a chronic, generalized pain condition associated with symptoms of fatigue, stiffness, and sleep disturbance and is characterized by the physical findings of local tenderness in many specific but widely dispersed sites. Fibromyalgia is the most common cause of widespread pain. The prevalence of this disorder in the general population is between 3% and 5%… Most patients with fibromyalgia remain symptomatic for several years, and no cure has been identified.”  Disturbances in the central nervous system (CNS) has also been linked to this condition.

In one study, 168 FM patients had the CNS evaluated by hearing tests, eye movement tests, and a test that evaluates balance/dizziness.  Abnormal findings were common in the FM patient group compared to non-FM subjects. Another study utilized an electrical current treatment approach through the skull to stimulate part of the brain to see if that would help a group of patients with FM. Two different parts of the brain were stimulated as well as a sham or fake treatment approach.  One of two parts of the brain that was stimulated resulted in reductions of pain that lasted for three weeks and mild improvements in quality of life were reported.

Comparing 287 general practitioners (GPs), 160 orthopedists, 160 physiatrists, and 160 rheumatologists, evaluating a patient injured in a motor vehicle crash, those most likely to diagnose FM were rheumatologists (83%) with physiatrists and GPs in the middle at 60% and 71%, respectively.  Orthopedists were least likely at 29%. There were five factors found to be important in the respondent’s agreement or disagreement with the FM diagnosis:
1.    The number of FM cases diagnosed weekly by the respondent (strong predictor).
2.    The patient’s gender (females > males was a strong predictor).
3.    The force of the initial impact (least important).
4.    The patient’s psychiatric history before the trauma (more important).
5.    The initial injury severity (least important).
This information is important as the shift from considering FM to be strictly a condition of the muscles and other soft tissues to being a condition of the central nervous system will affect our future treatment strategies.  Obtaining multiple opinions from various types of practitioners will most likely result in a variety of opinions.  Previous reports of treatment benefit utilizing chiropractic approaches, exercise, and strategies to facilitate sleep restoration remain strong in the management process of FM.

There are many treatment options for those suffering from neck pain.  There is conventional medical care where the family doctor will usually prescribe a muscle relaxant, anti-inflammatory, and/or pain killer to help patients through episodes of acute neck pain.  However, many patients with neck pain have been through the process of treatments associated with medications and simply cannot tolerate the adverse side effects of stomach pain common with anti-inflammatory drugs such as ibuprofen (Advil, Nuprin, Mediprin, etc.), Aleve (Naproxen), or aspirin.  Others don’t like the groggy, drunk-like feelings associated with pain killers or the sleepiness associated with muscle relaxants.  Therefore, these patients often turn to complementary / alternative care. 

As noted in the May, 2009 issue of Consumer’s Report for low back pain, chiropractic was the most sought after form of treatment, but there has been no extensive review of neck pain regarding evidence-based treatment approaches - at least not until February, 2008.  An international “team” representing 9 countries screened over 31,000 titles of articles published between 1980 and 2006, reviewed more than 1200 articles and eventually reported on 552 studies in their final report.  Their findings included the following:

• In the US, 54% utilized complementary (alternative) treatment approaches compared to 37% that obtained conventional medical care.
• Neck pain was the 2^nd most common reason Americans obtained chiropractic care.
• Chiropractic was found to be the most frequently reported form of treatment for upper back or neck pain (ahead of massage therapy, relaxation therapy, acupuncture).
• Those who obtained complementary AND conventional medical care were much more likely to perceive the complementary/alternative therapy as being helpful (61% vs. 6.4% for neck conditions and 39.1% vs. 19% for headaches).
• Women more commonly obtained care than men for neck/shoulder pain (29% vs. 18% men) over a 4-6 year time frame.
• Manual therapy (mobilization, manipulation, stretching) was associated with greater pain reduction in the short-term among patients with acute whiplash when compared with usual medical care, soft collars, passive modalities, or general advice.
• For non-whiplash neck pain (without arm radiating pain), manipulation or mobilization, exercise, low level laser therapy (LLLT), and “…perhaps acupuncture…” were reported as more effective than no treatment, sham, or other alternative interventions.
• For both whiplash and non-traumatic neck pain, supervised exercise with or without manual therapy was favored over usual medical care or no care.

What does all this mean?  Simple!  Everyone who is suffering from neck or upper back pain should seek chiropractic care which includes manipulation, mobilization, exercise training, and activity modifying advice, as these approaches have been found to be more effective than usual medical care!  Why waste time with a “wait and watch” with or without drug intervention approach when the evidence favors chiropractic related interventions.  If you, a friend, or a loved one is struggling with neck or upper back pain, we will properly assess your condition and administer the appropriate care that is required.  We will coordinate care with other health care services when necessary.  This recommendation may represent one of most significant acts of kindness you can offer those that you truly care about.

Last week while driving to work, you’re stopped at a red light and glance in the rearview mirror and notice that a car is approaching from behind way too fast.  The next thing you remember is the squeal of the tires and a loud crash with an accompanied sudden jolt as your car is propelled forward by the impact. Your initial reaction is one of shock, wondering is anyone hurt? How bad is my car damaged? Will there be another hit? Should I get out of the car? I’m going to be late for work! Within a few minutes, the police arrive and after about an hour of taking statements from the two drivers and a few witnesses, you decline an ambulance offer to take you to a nearby hospital for an examination as, “…this little stiffness and ache in my neck is no big deal.”  Happy you can still drive your car, you arrive at work an hour and a half late.  After reviewing the details of the crash with co-workers several times, you begin to notice a headache, your neck stiffening up and movements becoming limited and painful.  After another couple of hours and a few Ibuprofen, the pain has increased and you now have a whopping headache. You decide, “I better go see my chiropractor to see if something is wrong.”

After the exam and x-rays, the chiropractor shows you a chart and explains the mechanism of injury that usually occurs in a low speed rear-end collision.  A couple of things that were said really hit home in helping you to understand how such a seemingly minor crash can create so much pain.  The first is that it is not possible to voluntarily contract a muscle quick enough and “brace” to prevent the acceleration of the head. Upon impact, as the car is propelled forwards, the head initially goes backwards and then when the muscles in front of the neck are stretched to their limits, the head is then “whipped” forwards in a “crack the whip” type of response and all of this takes less than 600-700 milliseconds!  Because of the far limits of neck motion being reached during this process, the ligaments that hold the vertebra together are often stretched and/or torn.  This can be appreciated on the bending neck x-rays which shows one vertebra sliding forwards on the one below and the angle created being greater when compared to the surrounding vertebra.  The second point of discussion that stands out was the fact that your head was rotated at the time of impact from looking in the rearview mirror places the neck at a greater risk of injury because of the twisting motion that occurs during the “crack the whip” process.  Another interesting point: because there wasn’t a lot of car damage, the shock and force of the impact was not absorbed by crushing metal and that energy is therefore transferred to the contents in the vehicle, including the occupants.  That is why your briefcase ended up on the floor and your glasses flew off during the crash. Another point of discussion was made concerning the difference between genders and the degree of injury, as women are more likely to be injured more severely because of the less muscular and sometimes longer female neck.  The degree of injury is also at greater risk when there is osteoarthritis in the neck that pre-exists the crash.  An analogy of how a young sapling branch can bend without breaking verses the “old oak branch” which snaps and breaks when its only bent slightly. So, if you are a middle aged, female with a long slender neck with pre-existing arthritis looking in the rearview mirror prior to impact in a rear-end collision, ligament over stretching / tearing is highly probable.

In summary, it is important to obtain prompt evaluation and treatment by your chiropractor as soon as possible as when time passes without treatment, it is more difficult to bring about a reduction of pain and increased motion and, it will generally take longer.  Taking medication for pain only postpones the needed process of restoring movement and function of the neck so that should not be the only treatment.  In general, a “wait and watch” approach is not wise in these types of injuries. If you or a loved one is suffering with whiplash, sharing this information may be one of most significant acts of kindness that you can give to those that you care about.

There are many different reasons why injuries sustained in car crashes result in chronic or long term pain.  First, there are several types of tissues in the neck that can give rise to pain.  The most intense pain comes from the tissues with the greatest density of nerve fibers, such as the joint capsules and the ligaments holding the bones of the neck together.  There are many ligaments in the neck that are vulnerable to being over-stretched and injured in a motor vehicle collision.  The mechanism of a “whiplash” injury in a rear-end collision is unique.  Upon impact, the vehicle rapidly accelerates forward while the head momentarily remains in its original position, resulting in an initial straightening of the neck followed by extension. At the extreme end-range of backward extension motion, the ligaments in the front of the neck are over stretched and can tear.  Within milliseconds, the head is then propelled forwards into flexion which can then injure the ligaments in the back of the neck placing a significant amount of force on the joint capsules and ligaments holding the bones in close proximity.  Another reason the neck is injured is the speed at which the head and neck “whip” in the backwards and forwards directions after the impact. This occurs faster than what we can voluntarily contract our neck muscles to resist–within 600 milliseconds!  Therefore, even if we brace ourselves in preparation for an impact, we can’t avoid injury to the ligaments and joint capsules. Damage to the ligaments is difficult to “prove” by conventional x-ray, which is why bending views or, flexion/extension x-ray methods are needed.  When there is damage to the ligaments, the vertebra will shift forwards or backwards excessively compared to neighboring vertebra.  This can be measured to determine the extent of ligament laxity or damage and can help explain why neck pain can be so intense and/or chronic.  Not all car accidents occur from behind. In fact, only about 1/3 occur from this direction.  One study investigating which direction created greater degrees of injury reported 57% of chronic pain patient group occurred from rear-end collisions.  It also found that woman sustained more ligamentous injury compared to men and that frontal and rear end collisions resulting in significantly higher levels of ligament injury compared to side impacts

Another well published reason why neck pain can “hurt so much” after a car crash is that the sensory input from the injured area to the brain can be so extreme that it leaves an “imprint” in the sensory portion of the nervous system and it becomes hypersensitive or sensitized, resulting in a lower pain threshold or being more sensitive to pain. This is similar to the “phantom limb” phenomenon that often occurs after a leg is amputated where the brain still “feels” leg pain after the limb has been removed.  This has also been reported to be a reason for the significant constellation of symptoms often accompanying “whiplash” injuries.  A partial list of associated symptoms with whiplash injuries includes neck pain, headache, TMJ / jaw pain, dizziness, coordination loss, memory loss, cognitive difficulty in formulating thought, communicating, losing your place during conversation, and more.

Understanding whiplash and all of its nuances regarding signs and symptoms, x-ray requirements and measurement techniques, and treatment / management strategies are well understood at this office.  Chiropractors have a unique advantage over other health care providers as manual therapies, including spinal manipulation, have been shown to yield higher levels of satisfaction and faster recovery rates compared to other forms of health care.  We pride ourselves in performing thorough history and physical examinations, offering high quality evidence-based therapeutic approaches and teaching necessary home-based, self-management procedures.  If you, a loved one, or a friend are struggling with whiplash residuals from a motor vehicle collision, you can depend on receiving a multi-dimensional assessment and therapeutic approach at this office.

While most of us have a look in the mirror at least once a day, few of us look at our appearance from a different angle, such as from the side. But, the view from the side can be quite revealing if you suffer from chronic neck pain.

First, note the position of your head in relation to you shoulders. Is it right above the shoulders or does it lean forward from your chest? If it does, this would be called forward head posture, and can come from a problem in your neck. Lower areas of your spine can also cause this problem. Some of us have increased our weight over the years with much of it added to our abdominal region. Because of this increased core weight, the body must counter-balance the weight gain by causing the lumbar spine to “sway- back.”

While this “sway-back” problem can create pain this the lumbar spine, it can also have far reaching effects in the posture of the neck. Usually someone with a protruding stomach and sway back will have somewhat rounded shoulders and a forward head posture. If treatment is only directed at the neck without considering how other areas may affect the stability of the neck, then the results may be less than optimum.

In an accident, many areas of the body can potentially be injured.

As a chiropractor, I not only look at your primary injuries but also how mechanically one area of the spine can affect a distant area. These more distant areas can cause neck pain by referral or they can impede complete recovery because the body is compensating for abnormal posture or movement elsewhere.

X-rays of the full spine can show this abnormal posture as can a detailed postural analysis from our office.

So do you like what you see when you view your posture from the side? If your posture leaves something to be desired, or you’re wondering whether your neck problem could be improved by changing another part of your spine, then it is important to be thoroughly checked. Just examining the neck after a whiplash may leave some injuries undiscovered. Are there tender spots in other areas of the spine? Does your overall upright posture seem lacking?

The neck is the most flexible part of your spine and just like any other area of the body, movement exercises and good posture are important to maintain its health. Neck pains can be brought on or aggravated by how you treat this vital structure. We often neglect our neck when it comes to exercises, focusing instead on our legs or heart. So try these helpful hints and incorporate them into your daily routine.

Moving your neck slowly through all its ranges is key. It is important to do pure movements rather than combinations, rolling the neck around like a ball and socket joint (such as the hip or shoulder) is to be avoided. Instead, flex the neck forward until your chin touches the top of your chest. Then, slowly bend your neck backwards, chin to the sky These movements should not cause pain if they are done slowly and you have no pre-existing injury.

The next movement is side bending and is accomplished by trying to bend either ear towards the shoulder. Do this in front of a mirror so that you keep your head straight looking forward. Note whether you can do this the same amount to each side.

The last movement is rotation. Simply rotate your chin slowly so that you are looking over one shoulder. None of these movements should cause pain or make you dizzy. If they do, then it’s a sign you have a neck injury.

An important aspect of neck function is how the shoulder girdle influences neck posture and motion. Try rolling your shoulders forwards and backwards, stretching slowly, to help ease tension at the neck. General exercises such as fast paced walking or hiking are important for your neck too. Remember, your spine is the core of your body and walking is one of the least “injury-producers,” something you can keep up well into your later years.

Lastly, make sure your neck posture is kept upright when you are talking on the phone, driving, reading, doing other tasks, or sleeping.  A very small pillow is usually best for sleeping and neck support pillows are available to help maintain the normal forward arch of the neck. A small pillow will allow your head to ease back, relaxing the muscles at the back of the neck.

Whiplash involves the stretching of nerves, muscles, and ligaments. The forces are so great during even low speed collisions, that the muscles cannot resist the forces. The injury of whiplash produces inflammation to repair the damaged tissues. During this time, fast movements of your head and neck will result in pain, so most patients become overly cautious and move their neck very little. Unfortunately over time, because of the lack of muscle use, you become weak. This sets up the difficult combination of both damaged ligaments and weak muscles. Now there is little strength and support for the neck. This may make you very vulnerable to a future injury. Even slight movements can produces flare-ups when the muscles are too weak. The patient may feel their head to be heavy. Sometimes patients’ injuries can be so severe that dizziness develops due to the asymmetrical muscle and nerve activity. This is called cervicogenic vertigo. If you get dizzy when you move your head, then you may have this condition.

While it may seem intuitively obvious that addressing weak neck muscles are important to a full recovery, few patients will do them unless prompted and explained by their doctor. Specific muscles need to be strengthened in a way that does not cause further damage to the ligaments. If the muscles are tight in certain areas, then stretching or deep tissue massage, or trigger point therapy, can help to loosen areas and decrease pain.

But the most important thing you can do on a daily basis is to keep exercising. Studies have shown this to be effective in whiplash treatment when there is a mechanical neck disorder. A specific exercise program can be prescribed by a doctor of chiropractic Special attention should be made to your posture and x-rays, and how specifically you were injured. Only in this way, will the treatment be effective and not risk further trauma.

Exercises such as rolling the head around the shoulders should be avoided since the neck is not a ball and socket joint like the shoulder. In some directions, the joints will have excessive laxity and the muscle exercises should be done in the neutral position versus at the end range or limit.

Because the ligaments are so badly damaged in whiplash, it’s important to maintain the supporting muscles (both strong and flexible), to keep the spine stable and pain free

Cervicogenic headache is the term used to describe a headache that has its cause in the neck region. It used to be thought headaches were caused by something in the head itself, but researchers have now learned that neck injuries can produce head pain.

A study from Norway (Acta Neurol Scand 2007;Nov.20; Sjaastad O, Bakketeig LS) showed that about 4% of the population will have this type of headache. Taking medications to cover the pain will not ultimately correct a mechanical neck problem.

The symptoms of a cervicogenic headache are as follows: one-sided head pain and same side shoulder and arm pain. Patients also have limited mobility of the neck region. Rarely a patient may also have a migraine trait such as nausea, vomiting, or throbbing sensations. Because of these different signs from a typical migraine headache a physician may have overlooked the neck as a potential source for the cause of your head pain. Self-diagnosing your headache can be even worse since potentially serious causes of your head pain, such as high blood pressure may go undiscovered and left untreated. In any case it’s unlikely that your headache has been caused by a deficiency of pain pills in your diet. There are also unintended side effects that have to be considered when weighing any health care option.

Another study from Norway (Funct Neurol 2007;22:145; Drottning M, Staff PH, Sjaastad O) looked at causes of cervicogenic headaches, specifically whiplash injuries of the neck. In this study, 587 whiplash patients were followed over a six-year period. About 8% of the whiplash sufferers developed a cervicogenic headache six weeks after the initial trauma. Thirty-five percent of these patients were still suffering six years later.

Our clinic specializes in the treatment spine-caused head pain especially cervicogenic headache. To determine this we have to perform a comprehensive examination of your spine to see if sprains of your cervical or thoracic joints are present and review whether you’ve suffered a trauma in years past that could have affected the posture and mobility of these delicate spinal structures.

For patients who do not go down the road of medications for treating their head pain chiropractic care can be a more healthful option.

Ouch! Did you know that 96% of children experienced some acute pain in the previous month? Headache, at 78%, is the most common type of pain reported. You may not have known that your child was experiencing pain. Sometimes children will show behavioral changes rather than complain of head pain. One study tested parents’ knowledge of headache vs. the children’s recollection. The children reported headache about 57.6% of the time for the previous month. Mothers, and especially fathers, tended to underestimate whether their child had suffered a headache.

It is alarming that so many children each month have headaches and 6% of schoolchildren have chronic pain. Over the past 30 years childhood migraine and “frequent headache” have substantially increased. No one really knows for sure what lifestyle changes are producing these painful trends.

Children with frequent and severe headaches are more likely to have difficulties with home life, friendships, classroom learning, and leisure activities. The child’s quality of life and life of those around them is substantially affected by headaches.

You’re probably not sure if taking pain pills at such an early age is the right thing to do. You have to be concerned because it is consumption of pills over many years that leads to problems. They’re not to be taken casually like vitamins, and serious internal bleeding or kidney problems can result from long-term use.

One study looked at headaches in childhood over a 20-year time span.  They found that medication use steadily increased, and 70% were still consuming medications daily, 20 years after being originally diagnosed. Most patients had tension-type and migraine, and rated the headaches as moderate to severe. 45% of those surveyed also said that non-drug approaches were the most effective for them. There are non-drug and non-surgical approaches that have been proven effective. It is important to consider these options especially they generally don’t carry with them as many side effects.

Spinal problems in children can begin with neck trauma during delivery. Also many infants fall from a high place during the first year of their life. This can occur as the diaper is changed. These and other tumbles and traumas may cause the spinal joints to sprain, irritating the nerve. The chiropractor’s approach is to look at the child’s spinal structure to determine if there is a spinal cause for the headache. Adjustments are delivered to specifically address the areas in the spine that have sprained or subluxated to allow them to function more normally.

Fibromyalgia (FM) has a long reputation for being a controversial diagnosis.  Some health care providers (HCPs) feel FM is a legitimate condition that warrants treatment and research while others feel it’s a “garbage can diagnosis” that HCPs throw patients into when they’re not sure what diagnostic label to use for a patient’s condition.  Regardless of the personal beliefs of individual HCPs, there have been two general classifications of FM - primary and secondary.  Primary FM occurs when there is no underlying health condition participating in the patient’s overall health status and onset of FM.  Secondary FM results from an underlying condition that contributes significantly to the patient’s health status, such as irritable bowel syndrome and over time, gives rise to the onset of FM.

Posttraumatic FM belongs to the secondary FM classification when the traumatic related injury results in the patient developing FM.  A Canadian study reported that 25-50% of FM patients reported a traumatic event just before the FM symptoms began. This study surveyed different specialty physician groups to determine which issues were most important in causing the onset of widespread chronic pain after a motor vehicle trauma.  Five factors were studied to determine how important each was to the HCP in arriving at a FM diagnosis in a case study of a 45 year-old female with a whiplash injury who developed chronic generalized pain, fatigue, difficulties in sleeping and diffuse muscle tenderness.  These five factors included:

1.  The number of FM cases diagnosed weekly by the HCP

2.  The patient’s gender

3.  The force of the initial impact

4.  The patient’s psychiatric history before the trauma

5.  The initial injury severity

Also described as important were the patient’s pre-injury health status, fitness level and psychological health.  All HCP groups were reluctant to blame the car accident as causing FM, but rather placed more importance on the patient attitude, personality, and level of emotional stress.  The least important of the five points were numbers 3 and 5.  The orthopedic group also included “ongoing litigation” as a cause but as a group, they were the least likely to agree on the FM diagnosis (29%) in the 45 year old case study.  Rheumatologists were highest at 83%, followed by general practitioners at 71%, and physiatrists at 60%.  A most interesting observation was that once the data was analyzed, ONLY the patient’s pre-accident psychiatric history remained in the model of predicting agreement or disagreement with the FM diagnosis. 

Posttraumatic FM can result from any type of trauma, not just motor vehicle collisions.  Other “secondary” FM causes besides trauma, can include systemic conditions such as irritable bowel syndrome, chronic fatigue syndrome, and other internal disorders that in part, alter the person’s ability to obtain restorative sleep.  Hence, an important focus of treatment should be placed on helping the FM patient obtain restful sleep.  Chiropractic management strategies have included manipulation, mobilization, soft tissue therapies, physiological therapeutic agents such as electrical stimulation, ultrasound, the training for home use of traction, the use of nutritional counseling and supplementation, and  the training of exercise.  Many studies support success with this multidimensional approach to treating FM as chiropractic attacks the FM condition from multiple directions, often yielding highly satisfying results.  We are committed to help you or a loved one that may be suffering with FM, and sharing this information may be one of most significant acts of kindness you can give.

Patients that present with neck pain along with arm numbness, pain, and/or weakness, often ask, “…what’s causing this pain down my arm?”  The condition is often caused from a bulging or herniated disk pinching a nerve in the neck.  The cause of this complaint can include both trauma as well as non-traumatic events.  In fact, sometimes, the patient has no idea what started their condition, as they cannot tie any specific event to the onset. 

The classic presentation includes neck pain that radiates into the arm in a specific area as each nerve affects different parts of the arm and hand.  Describing the exact location of the arm complaint such as, “I have numbness in the arm and hand that makes my 4^th and pinky fingers feel half asleep,” tells us that you have a pinched C8 nerve.  This nerve can also be pinched at the elbow and make the same two fingers numb.  The difference between the two different conditions is when the nerve is pinched in the neck, the pain is located from the neck down the entire arm and into digits 4 & 5 of the hand.  When the nerve is pinched at the elbow, the pain/numbness is located from the elbow down to the 4^th & 5^th digits, but no neck or upper arm pain exists. 

Examination findings usually include limitations in certain cervical (neck) ranges of motion (ROMs) - usually in the direction that increases the pinch on the nerve. Another common finding is the arm is often held over the head because there is more stretching on the nerve when the arm is hanging down and pain in the neck and arm increases.  Hence, raising the arm over the head reduces the neck/arm pain.  To determine where the nerve is pinched, there are a number of different compression tests that can recreate or increase the symptoms.  Some compression tests include placing downward pressure on the head with the head pointing straight ahead, bent or rotated to each side.  Other compression tests are performed by pressing in areas where the nerve travels such as in the lower front aspect of the neck, in the front of the shoulder where the arm connects to the chest/trunk, at the elbow and at the wrist.  If there is a pinched nerve, numbness, tingling and/or pain will be reproduced when pressure is applied to these regions.  Other tests include testing reflexes and muscle strength in the arm.  When a nerve is pinched, the reflexes will be sluggish or absent and certain movements in the arm are weak when compared to the opposite side.  Another very practical test is called the cervical (neck) distraction test where a traction force is applied to the neck.  When neck and/or arm pain is reduced, this means there is a pinched nerve.  This test is particularly useful because when pain is reduced, the test supports the need for a treatment approach called cervical traction.  It has been reported that the use of cervical traction when applied 3x/day for 15 minutes each, at 8-12 pounds, 78% of 81 patients reported a significant improvement in symptoms, which is very effective.  Other forms of care that can be highly effective include spinal manipulation, spinal mobilization, certain exercises, physical therapy modalities, and certain medications.

If you, a friend, or a loved one are struggling with a herniated disk in the neck with associated arm complaints, we will properly assess your condition, run the appropriate tests, and administer the appropriate care that is needed.  We also coordinate services with other health care providers when necessary.  This recommendation may represent one of most significant acts of kindness you can give to those that you care about.

Getting your health back after a spine injury can be problematic if you do not approach it holistically. What is meant by holism? In general it is caring for the person as a whole vs. individual parts, and using techniques that assist different bodily systems. It can be treating the mind as well as the body. It is well known that depression is an important risk factor for back pain.

When dealing with a mechanical spinal problem, the doctor needs to consider the condition of the disks and ligaments, scar tissue, muscle strength, posture, movement, and alignment. A simple prescription, while effective at reducing pain, is not a good solution in the long run. For example, the scar in muscles that is formed after injury when NSAIDs (ibuprofen) are used is much weaker. The patient needs to also consider the side effects of stomach or gastrointestinal bleeding that can come with long-term use. Leaving joints problems to sit for years while masking the pain, will just make future rehabilitation more difficult and less effective.

Pain is a signal for your body to avoid certain movements and can be very protective. While muscle pain is good during rehabilitation, if there is ligament or joint pain, then you’re pushing it too hard.

Exercise and stretching without attention to joint injuries, will also not work over time. It’s hard to maintain exercise when there is joint pain. Chiropractic care can keep the spine and other joints flexible while you also approach the other aspects of spine function with specific exercises and stretching.

Maintaining a healthy body weight is also part of any holistic approach. If you’re overweight, this adds tremendous stress to your spine. In some cases it may be important to first get your weight down, before commencing an exercise program, or weight training.

In addition to proper weight control you have to also consider sound nutrition in terms of vitamin and mineral consumption. Most patients need to do better at eating green leafy vegetables, fresh fruits and other nutritious foods. One has to avoid harmful fats, and chemicals/preservatives that are often present in highly processed foods. Supplements such as manganese and glucosamine chondroitin may help joint health. Although there are few studies on how effective these supplements help, the downside or side effects are quite minimal.

A doctor of chiropractic can advise you on integrating a holistic approach with spinal joint care, strength training, flexibility, and sound nutrition.

While 80% of us will suffer a severe back pain episode at some point in our lives, most of us at any given time should be more concerned about preventing or aggravating back pain, rather than resolving a set-back. As they say, an ounce of prevention is worth a pound of cure. There are two aspects to prevention of back pain: keeping strong and flexible, and avoiding mistakes during movements.

As far as exercise is concerned, nothing is more beneficial to the spine than walking. Remember that your spine is your “core,” and the core is activated with fast-paced walking. Most of us don’t think of how the spine is affected with walking, instead focusing on the legs. Make walking part of your daily routine. Walk a few blocks or across town to run an errand, rather than getting into a car for these short trips. Park a few blocks away when you have to use the car, so that you can get in a few minutes of walking. Some of us spend five minutes circling in a parking lot just to get a space close to the front door or we get frustrated when we can’t find a space close to the gym! In contrast to sitting, which increases pressure on our disks, walking strengthens muscles and dissipates the pressure on our lower disks.

Keep the back flexible through slow stretching in all of the different ranges. Tight muscles at the back of the thighs-the hamstrings are an often neglected area that affects the lower spine tremendously. To stretch these muscles, stand upright and put on foot on the back of a chair or sofa. Slowly bend forward and hold this position for 30-40 seconds. It should cause a tight burning pain at the back of the leg. It should not cause a shooting pain down your leg, or increase pain in the lower spine. If it does, then see a health care provider immediately. When the hamstrings are flexible, this allows the pelvis to rotate forward when you bend over. If the hamstrings are not flexible, then the lower spine will bend too much to accomplish any lifting task.

The second aspect to preventing back pain is avoiding mistakes, such as lifting with your back, instead of your legs. This is especially true if an object is very heavy. Sometimes the object is light, but we lift in an awkward position, standing with most of our weight on one leg, then bending and twisting, such as getting grocery bags from a back seat, or moving and positioning a child safety seat. Especially avoid twisting motions of the lower spine while bending over. Also, use one of your hands to help brace your spine, which will decrease the pressure on your disks.

Certain low back conditions give rise to more than just low back pain. For example, leg pain can be more intense than low back pain, even though the cause of the leg pain is coming from the low back.  When this happens, many patients complain that they have “sciatica,” which refers to radiating pain that starts in the low back and extends down into the leg.  When the intensity of leg pain is worse than the low back, it can make patients wonder, “…where is my problem really coming from?”

To understand this better, a short “anatomy lesson” is appropriate. The spine can be divided into two halves, front and back. The structures in the front half include the larger, heavier bones called vertebral bodies and the shock absorbing cushions that lie between the vertebral bodies called the intervertebral disks.  The disk is like a jelly donut where the center is liquid-like and the outer portion is a tough, criss-cross pattern cartilage arranged like the rings on a tree stump. There are also ligaments that hold the vertebrae and disks tightly together. The back half of the spine includes the spinal cord, nerve roots, as well as the small joints of the back called facet joints.  Every movable joint has a joint capsule that helps lubricate the joint and limits the amount of movement, along with surrounding ligaments.  The larger, heavier vertebral bodies and shock absorbing disks carry the majority of the weight (approximately 80%) while the smaller facet joints carry much less weight (only 20%) but are more responsible for guiding the movements of our back.

When leg pain is present, it can be caused by either a pinched nerve, or, an inflamed facet joint.

When a nerve is pinched, the cause is usually from the intervertebral disk where the jelly-like center leaks out and presses on the nerve that goes down the leg, commonly referred to as a “herniated disk with sciatica.” This type of pain is quite specific, easy to describe and often extends below the knee to the ankle or foot.  It can include muscle weakness, numbness in certain areas of the leg, and bending forward increases low back and leg pain while bending backwards reduces the leg pain (and sometimes the LBP).

When a facet joint capsule tears (technically, called a “sprain”), the pain is “referred” down the leg in a generalized, non-specific manner, usually described as a “deep ache,” often hard to describe and usually does not go below the level of the knee. Here, it feels better to bend forward and worse to bend backwards, of which neither movement changes or affects the leg in a specific way.  Disk related leg pain carries a potential for surgery if all non-surgical approaches fail, while facet joint referred leg pain rarely requires invasive treatments or surgery.

The good news is that both of these sources of low back and leg pain are very treatable with chiropractic care!  The important point to remember is that obtaining prompt treatment, when symptoms first appear is best – as waiting and hoping it will subside on its own often results in a longer treatment course and is less satisfying for all concerned.

One of the reported causes of both migraine and tension headache is cervical muscle tension and spinal joint abnormalities in the neck.   When considering treatment for headaches, whether it’s a tension-type or migraine, there are many choices available.  The question is, which of the many options offer the best benefit?

One study compared the effectiveness of physical therapy (PT) to that of relaxation and thermal biofeedback (RTB). Both groups were treated using one of these approaches, and if at least a 50% improvement was not achieved, the other form of treatment was then utilized.  Results were calculated at 3, 6, and 12 month timeframes.  The PT group of 30 females used standard physical therapy approaches that included:
•    Posture correction for alignment of head and spine
•    Cervical range of motion for neck and shoulders
•    Isometric strengthening of the neck
•    Flare-up management techniques
•    Active self mobilization of the spine
•    Whole body stretching
The goal was to target muscular abnormalities and those in this group were to perform the above twice per day for 30 min. The RTB group were instructed in relaxation and thermal biofeedback (RTB) treatment that focused on muscle relaxation, breathing exercises, and the use of a thermal feedback device that determines when the subject’s temperature changes telling them if they are successfully relaxing.  The participants were to practice at home and utilized audiotapes for relaxation and monitor success with the portable biofeedback unit.

Using the PT approaches, only 13% reported a successful outcome compared to 51% in the RTB group.  In the follow-up of 3, 6 and 12 months, both groups reported continued benefit.   When the subjects reported less than 50% benefit with either method, they were given the other treatment option, and the PT approach achieved a 47% success rate and the RTB 50%.  These findings suggest that treatments that focus on muscle tension reduction (such as the RTB group) might result in a better outcome compared to only addressing posture, range of motion and flexibility.  However, as illustrated in the follow-up group, PT did have a positive beneficial effect.  An important point – the subjects in the RTB group demonstrated the ability to reduce migraine pain and the associated disability by using a self-applied form of care.  When teaching the patient to self-manage their condition by instruction and training, the greater the likelihood is for a successful outcome.

Chiropractic focuses on many self-management training procedures including (but not limited to) the training of the use of ice vs. heat, exercises, proper methods of bending and lifting, as well as posture and strength.  The use and instruction of relaxation is also a commonly recommended form of care, which this study found to be most beneficial.