Neck Pain Reducing “Tricks” (Part 3 of 3)

            This series has included exercise recommendations to self-manage neck pain, headache, upper back pain, and dizziness. This month’s topic involves enhancing coordination, which may be the most important topic in this three-part series!

            Coordination-based exercises are important because they stimulate our neuro-motor system and can help restore normal function. We can all relate to the challenge of learning new activities. In many cases, we may struggle with the basics, but over time, they become easier to perform and we're eventually able to accomplish these neuromuscular sequences without even thinking about it. When we are injured, we COMPENSATE and change our methods of doing the various tasks associated with our work and daily living. Unfortunately, these altered neuromotor sequences can become our “new normal” and can lead to other faulty compensatory motor functions (a negative vicious cycle). To “fix” this, we must First “Identify” the faulty pattern, Second “Fix” the faulty pattern consciously, Third “Practice” the new or proper method long enough so that, Fourth The proper/new/fixed method becomes automatic or “unconscious.” So, HOW do we re-establish proper motor function after an injury?

            We can all start stimulating the neuromotor system by adding coordination-based components to our current fitness program. For example, when performing an exercise, release slowly but keep resisting. This “eccentric” resistance (resistance as the muscle elongates) builds coordination while the “concentric” resistance (resistance as the muscle shortens/contracts) builds strength. Apply this principle to ALL resistance exercises, and remember only use a light amount of resistance when exercising your neck muscles – only 10-20% of a maximum push! Another “principle” that is applicable to ALL exercises is to start simple and slowly add or integrate more complex movements or start doing two things at once (like pinch a ball between your knees or stand on one leg while performing your neck exercises). Be “mindful” or THINK about what you are doing to further stimulate the nervous system. Some other ways to add variety to your exercises include incorporating sitting on a gym ball, jumping, or standing on a rocker or wobble board. MAKE IT FUN and challenging! ALWAYS build on what you have previously mastered!

            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 neck pain or headaches, we would be honored to render our services.

Neck Pain – The MOST Important Exercises (Part 2)

            As stated last month, exercises that focus on improving posture, flexibility, strength, and coordination are important for creating a well-rounded cervical rehabilitation program. Our discussion continues this month with stretching and strengthening exercises.

            STRETCHING: Since our neck muscles have to hold up our 12 pound (~5.5 kg) head, it’s no wonder why our neck muscles seem to be tight almost all the time. Here are two ways to stretch the neck: 1) You can simply drop the chin to the chest, look at the ceiling, try to touch your ear to your shoulder (without shoulder shrugging) on both sides, and rotate the head left to right and vice versa (six directions). 2) You can use gentle pressure with your hand and assist in the active stretch by gently pulling into the six directions described in #1 by applying “over-pressure” at the end-range of motion (staying within “reasonable pain boundaries”).

            STRENGTHENING: Most people have a forward head carriage, meaning their head normally rests in front of their shoulders. The further forward the head sits, the greater the load on the muscles in the back of the neck and upper back to hold it up. This position promotes a negative spiral or “vicious cycle” that can lead to many complaints including (but not limited to) neck pain, headaches, balance disturbances, and in the long-term, osteoarthritis. There are two important groups of muscles that require strengthening: the deep neck flexors and deep neck extensors.

1)      The deep neck flexors are muscles located directly on the front of the cervical spine and are described as being “involuntary” or unable to be voluntarily contracted. Hence, we have to “trick” the voluntary outer “extrinsic” (stronger) muscles into NOT WORKING so the deep, intrinsic ones will contract. You can do this by flexing your chin to the chest and pushing your neck (not head) back over your shoulders into resistance caused a towel wrapped around the back of the neck. If you feel your chin raise towards the ceiling, you’re doing it WRONG! Keep the chin tucked as close to the chest as possible as you push your neck (not your head) backwards. If you’re doing it correctly, your chest should raise towards the ceiling as you push your chin down and neck back. Try it!

2)      The deep neck extensors are strengthened in a very similar way EXCEPT here you DO push the back of HEAD back into your towel while keeping your chin tucked tightly into your chest. Do three reps, holding each for three to five seconds and switch between the two for two to three sets.

            We will finish this discussion next month with important coordination exercises!

Neck Pain – The MOST Important Exercises (Part 1)

            Neck pain can occur for many different reasons, but what can you do about it? That’s the BIG question! As discussed last month, exercise training is an important part of the chiropractic management process. Let’s take a close look at which exercises are MOST important with respect to self-management strategies.

            There are several goals or reasons to perform neck exercises. We will break these down into four main categories: Posture, stretch, strengthening, and coordination.

            POSTURE: The biggest culprit in this category is the forward head carriage. If you look around a crowded airport, bus stop, train station, or mall, you can see MANY examples of this. If fact, this faulty posture is estimated to occur in 66-90% of the population! Also, forward head posture is STRONGLY associated with decreased respiratory muscle strength, which can reduce lung capacity and our ability to breath by as much as 30%! It’s also linked to tension headaches, altered eye and ear function, high blood pressure, and over time it can lead to arthritis, herniated disks, pinched nerves, and more. The “classic” appearance is the position of the head is too far forward, the shoulders roll forwards and the upper back sticks out. Did you know that for every inch the head glides forwards from the proper position, there is a 10 lbs (~4.5 kg) increase of weight that the neck and upper back muscles have to hold up? Using an average 12 lbs (~5.4 kg) head, a 5 inch (~12.7 cm) forward head carriage places an extra 50 lbs (~23 kg) of weight on the upper back/neck muscles for a 62 lbs (~28 kg) total! So, LET’S FIX IT!

            Here is one exercise that may help your posture: Look straight ahead and 1) Tighten your core by performing an abdominal brace. This is done by contracting your belly muscles so that when you poke your thumbs into your sides and front, you feel a firm abdominal muscle wall. You don’t have to “brace” at a 100% of maximum, shoot for 25-50% or just enough to feel the muscles contract. Relax and contract several times so you’re sure you can feel the muscles tighten up. Keep a curve in your lower back when you do this (don’t slouch). 2) Lift your chest – don’t just tuck you head back! This will improve the rounded shoulders and slouched upper back posture. Think of lifting your chest towards the ceiling more than just sticking it out. Notice in a mirror how much improvement occurs already! 3) Perform chin retractions – do 10 retractions every hour (set the timer on your cell phone to remind you)! Do this gently, slowly, and to a firm end-point of movement. If you feel like you are creating a “double or triple chin,” you are doing it right! If you do the ten reps every hour, then in an eight hour work day, you'll have done 80 posture corrections! This a GREAT way to “re-program” your nervous system and when you find yourself doing this WITHOUT THINKING, it will have become a new (and good) habit! Stay tuned next several months for more neck exercises focused on STRETCH, STRENGTHEN, and COORDINATION training!

Neck Pain – Management Strategies

            As discussed last month, when you make an appointment for a chiropractic evaluation for your neck pain, your doctor of chiropractic will provide both in-office procedures as well as teach you many self-help approaches so that as a “team”, together WE can manage your neck pain or headache complaint to a satisfying end-point. So, what are some of these procedures? Let’s take a look!

            In the office, you can expect to receive a thorough history, examination, x-ray (if warranted), and a discussion about what chiropractic care can be done for you and your condition. Your doctor will map out a treatment plan and discuss commonly shared goals of 1) Pain reduction, 2) Posture/alignment restoration, and 3) Prevention of future episodes. Pain reduction approaches include (but are not limited to) joint mobilization and/or manipulation, muscle/ligament stretching techniques, inflammation control by the use of physical therapy modalities (such as electrical stimulation), ice, and possibly anti-inflammatory vitamin / herbal therapies. Your chiropractor will also teach you proper body mechanics for bending/lifting/pulling/pushing, and help you avoid positions or situations where you might re-injure the area. Posture/alignment restoration can include methods such as spinal manipulation / mobilization and leg length correction strategies (heel and/or sole lifts, special orthotic shoes, and/or foot orthotic inserts). These are often GREAT recommendations as they “work” all the time they are in your shoes and you don’t have to do anything (except wear them)! The third goal of future episode prevention is often a combination ongoing treatments in the office and strategies you can employ at home. This includes (but is not limited to): 1) whether you should use ice, heat, or both at times of acute exacerbation; 2) avoiding positions or movements that create sharp/lancinating pain; 3) DOING THE EXERCISES that you’ve been taught ON A REGULAR BASIS; and 4) eating and an “anti-inflammatory” diet (lean meats, lots of fruits/veggies, and avoid gluten – wheat, oats, barley, rye).   

            Let’s talk exercise! Your doctor of chiropractic will teach you exercises that are designed to increase range of motion (ROM), re-educate a flat or reversed curve in the neck, and strengthen / stabilize the muscles in the neck. Studies show that the deep neck flexor muscles – those that are located deep, next to the spine in the front of the neck – are frequently weak in patients with neck pain. These muscles are NOT voluntary so you have to “trick” them into contracting with very specific exercises. Your doctor will also teach you exercises that you can do EVERY HOUR of your work day (for 10-15 seconds) that are designed to prevent neck pain from gradually worsening so you aren’t miserable by the end of work. Along these lines, he/she will discuss the set-up of your work station and how you might improve it – whether it’s a chair, desk, computer position, a table/work station height issue, or a reaching problem; using proper “ergonomics” can REALLY HELP! Your doctor will also advise you not to talk on the phone pinching the receiver between your head and shoulder, to face the person you are talking to (avoiding prolonged head rotation), to tuck in your chin as a posture training exercise, and more. Cervical traction can be a GREAT home-applied, self-help strategy, and these come in many varieties. Proper positions for the head when sleeping and a properly fitted contoured pillow is also important since we spend about 1/3 of our lives asleep!

Neck Pain Causes

            We all know what it feels like to have limited neck motion, as most of us have had neck pain at some point in time. It makes doing simple things like backing up a car, rolling over in bed, reading, and watching TV difficult-to-impossible. The goal of this article is to review some of the many causes of neck pain and what to do about it! Let’s take a look at the various types of tissues that can generate pain:

1)      MUSCLES: There are MANY layers of muscles in the neck. There are the very small, deep “intrinsic” muscles that are important for stability of the spine and fine, intricate movements while the larger outside “extrinsic” muscles are long and strong, allowing us to sustain stresses like playing football, rugby, hockey, or falling on the ice. Long car drives/rides, computer work, studying/reading, or having a conversation with someone not sitting directly in front of you are just a few examples of how these muscles can experience overuse that can generate neck pain!

2)      LIGAMENTS: These are tough, non-stretching tissues that hold bone to bone and can tear in trauma like whiplash, while playing sports, or in a fall. Because ligaments are important in keeping our joints stable, disrupted ligaments can lead to excessive “play” in a joint and can wear down the cartilage or the smooth, silky covering at the ends of bones, which can lead to premature osteoarthritis (OA) – the “wear and tear” kind that everyone gets eventually.

3)      WORN JOINTS: There is something called “the natural history of degeneration” that naturally occurs if we live long enough. As previously discussed, ligament tearing leads to instability of the involved joint(s), and excessive motion in the joint leads to OA. In the neck, there are two sets of small joints between six of the seven vertebrae called facet joints and uncinate processes that are vulnerable for OA and are frequent pain generators.

4)      DISK INJURY: The disks rest between the big vertebral bodies and act as shock absorbers. They are like jelly donuts, and when the disk’s tough outer layers tear, the jelly can leak out and this may or may not hurt, depending on the direction, the amount of the leaked out “jelly,” and if the "jelly" pinches pain-sensitive tissues. A “herniated disk” is the most common cause for a pinched nerve (see next entry).

5)      NERVE COMPRESSION: The nerves in the neck travel into the arms, and nerve compression or pinching can result in numbness/tingling/burning pain in the arm and/or hand with or without weakness. Each nerve has a different role, and by mapping the numbness area and testing reflexes and muscle strength, it can help your doctor identify the specific nerve that is injured.

6)      DISEASES: Though significantly less common, neck pain can arise from certain diseases such as rheumatoid arthritis, meningitis, and/or cancer. When these are suspect, blood tests and special tests such as bone scan, CT/MRI, and/or biopsy can help to specifically identify the condition.

            WHAT TO DO: Make an appointment and your doctor of chiropractic will perform a history, physical examination, and possibly take x-rays to help determine what is generating your pain. Once the diagnosis is understood, he or she will put together a treatment plan for you. This usually includes procedures done in the office as well as those that they will teach you how to do at home and/or work to help you manage your neck pain back and return to normal activities as quickly as possible!      

Neck Function and Balance

            In the nervous system, there are three primary areas that regulate our balance: the cerebellum (located in the back of the brain), the dorsal columns (located in the back of the spinal cord), and the inner ear (the “vestibular” part of our cranial nerve VIII). There are also small, microscopic “proprioceptors” or mechanical receptors located in our joint capsules, muscles, and tendons that relay information to the brain and work hard to keep us upright when we walk, run, and play!

            Conditions that can result in balance problems include, but are not limited to, BPPV (Benign Paroxysmal Positional Vertigo), spinal stenosis (narrowing of the spinal canal where our spinal cord is located), dorsal column disease, cerebellar lesions, and/or circulation loss into the back of the brain. Other conditions associated with light headedness include low or high blood pressure, hydration, medications, postural or orthostatic hypotension, diabetes, endocrine disorders, hyperventilation, heart conditions, and vasovagal syncope. However, issues with BPPV/inner ear are the most common reported cause of dizziness. Emergency actions should be exercised when dizziness is associated with chest pain, shortness of breath, or palpitations. If eating helps resolve the dizziness, blood testing for hypoglycemia is appropriate. If confusion, memory lapses, changes in speech, facial droop, weakness on one side of the body, or acute headache occur, these could be signs of a stroke or a brain bleed or tumor and should be quickly evaluated. If ANY of these signs or symptoms is present, we will refer you to the appropriate specialty for further evaluation.

            The upper cervical spine has also been found to affect balance, and it’s a primary area of treatment that we as chiropractors focus on when patients complain about balance dysfunction. Unique to this upper cervical region is the fact that the nucleus of cranial nerve V (the trigeminal nerve) extends down the spinal canal to the C2 level and adjustments in this region can have significant benefits for several other conditions, including trigeminal nerve problems as well as BPPV (inner ear dysfunction such as dizziness) where small crystals dislodge from the ampulla of the semicircular canal and interfere with the flow of fluid inside the canal with resulting dizziness. Adjustments and the BPPV exercises (Epley’s and / or Brandt-Daroff) significantly benefit this cause of dizziness. You can depend on our evaluation to determine if chiropractic is the right choice in managing your balance disturbance!

Neck Pain, Headaches, and Low Back Stability?

            Neck pain and stiffness are very common complaints, and these problems can come and go chronically for years, even decades. Numerous studies point to exercises and chiropractic care as two of the best approaches for gaining control over this common, potentially long-lasting, and sometimes disabling condition. However, focusing only on the neck may NOT be the best approach, but rather, the management of weak pelvic / low back stabilizing muscles can have significant benefits for those suffering from neck pain. Let’s take a closer look...

            A group of physical therapists in Brazil and Australia performed a systematic literature review of the benefits of specific stabilization exercises for spinal and pelvic pain and looked at disability, return to work, number of episodes, global perceived benefit, and quality of life factors. They not only searched for the beneficial effects for low back and pelvic pain and dysfunction, but also the benefits for headache with or without neck pain and any related disability. Not only did they find significant research support for improving pelvic pain and for preventing recurrence after an acute episode of low back pain but they also found that cervicogenic headache and neck pain improved from the use of low back / pelvic stabilization exercises! Furthermore, researchers have found that patients achieve more significant improvement when stabilization exercises focus on the individual patient vs. the use of a generic “…one size fits all” stabilization program. Additionally, spinal manipulative therapy (SMT) has been reported as the most effective treatment for cervicogenic headache and neck pain patients. Other studies have found that the combination of exercise AND SMT is more effective than exercise alone.

            The bottom line is that stabilizing the lower quarter (low back and pelvis) helps, as it offers the neck and head a better foundation on which to rest. An analogy would be a house with a weak foundation resulting in the whole house being in jeopardy, especially the attic or the area farthest away from the ground. Like the attic, the head is perhaps more dramatically affected by the weak pelvic stability than areas closer to the pelvis / low back.

            Researchers have found that doctors of chiropractic can significantly improve neck pain, balance, and headaches in chronic neck pain patients by strengthening the deep neck flexors, or the muscles that attach directly to the front of the cervical spine. We also know that treatments that promote movement such as spinal manipulation, when rendered early-on, can results in better outcomes for the whiplash patient. Therefore, the “key” to the greatest success is chiropractic adjustments + cervical range of motion exercises + cervical stabilization exercises + lumbar/pelvis stabilization exercises! Traditionally, “rest and heat” are commonly prescribed for neck pain patients, or worse, they are placed in a cervical collar and taken off work and told to rest. The evidence published, especially since 2008, STRONGLY disagrees with this approach favoring a treatment plan that incorporates motion, “usual” activity (including work), manipulation, and exercise as soon as possible. Chiropractic embraces not only spinal manipulation but also patient specific range-of-motion and strengthening/stabilization forms of exercises as “main ingredients” to care when patients present for neck pain and headaches.

Neck Pain – When Should I Come In?

            Neck pain is one of the most common complaints patients have when they come to a chiropractic office for the first time, second only to low back pain. Neck pain affects all of us at some point in life, and for some, it can become a chronic, permanent problem that can interfere with many desired activities and lower their quality of life. There are many different causes, and prompt evaluation and treatment is important is some cases.

            Neck pain and stiffness are the two most common symptoms that present for evaluation and treatment. This can be located in the middle of the neck and/or on either side and can extend down to the shoulders and / or chest. It can contribute to or cause tension headaches that can travel up the back of the head and sometimes behind the eyes. Pain often increases with neck movement, such as when turning the head to check traffic while driving and/or it can hurt at rest while held in static positions, such as when reading a book. Neck pain can come on gradually or quickly and often cannot be traced to a specific injury or cause making it a challenge to figure out. While neck pain is often not serious or life-threatening, there are causes that should be evaluated promptly. If you wake up with acute neck pain associated with very limited range of motion, this may be due to torticollis, or wry neck, and prompt treatment helps it resolve more quickly than “waiting it out.” Torticollis can be caused by exposure to a draft, changes in weather, trauma, or after a cold or flu. When in doubt, come in for an evaluation and treatment, as anxiety associated with the “fear of the unknown” only adds to the stress associated with neck pain and it’s ALWAYS best to be “…safe than sorry!”

            Numbness or tingling may accompany neck pain and can be located in the face, arms, hands, and/or fingers. This is one of those times to come in promptly, as these symptoms may indicate the pinching of a nerve root in the neck. There are MANY chiropractic treatment approaches that effectively treat nerve root pinching, and treatment should NOT be delayed. Other common symptoms may include clicking, crunching, or grinding noises, technically called crepitus, which may or may not be benign. If the noise is accompanied by pain, especially if it radiates down to the shoulder blades or arms (either side or both), it’s time to promptly come in. Any time symptoms occur acutely or come on fast, it’s best to get evaluated as soon as possible.

            Dizziness is another common symptom that can result from neck problems and is often associated with movement such as rising from laying or sitting. Certain positions of the neck can also bring on dizziness. This is sometimes caused by the "stones" in the inner ear shifting out of position and is technically called BPPV or “benign paroxysmal positional vertigo.” When this occurs, we can usually manage it very well with treatment and specific BPPV exercises. Other times, dizziness may be due to a restriction in blood flow reaching the brain. In which case, a prompt evaluation is VERY appropriate, especially if blackouts occur.

            Sleep interruption or difficulty falling asleep are other good reasons to seek prompt evaluation and treatment. Sleep loss can lead to many problems such as excessive fatigue, tiredness, irritability, and just generally feeling poor! Remember, prompt care usually results in prompt resolution!

Chiropractic Management of Neck Pain (Part 2)

            Last month, we covered the first two of four primary goals when it comes to the chiropractic management of neck pain (#1 - Pain Management and #2 - Structural realignment). This month, we will conclude this discussion with #3 - Functional Restoration and #4 - Prevention.

            3) FUNCTIONAL RESTORATION: Restoring function basically allows the patient to return to their pre-injury activities of daily living, which is the ultimate goal when managing all conditions! In order for this to happen, it is necessary to have the first two goals accomplished, and the primary “tool” that we use to accomplish this goal is exercise training. There are several options to determine which exercise is most needed. A physical performance test can be done, which consists of a series of exercise-like maneuvers that we measure with an instrument that measures degrees (for range of motion), count repetitions (when testing for strength), or count time – usually in seconds (when testing for endurance, balance, and aerobic capacity). We then can compare you to the “norms” that have been published to see if you need help in a particular area. This also establishes a “baseline” or starting point to compare a month later after you’ve performed the proper exercises designed to improve that “failed test.” The three primary goals of exercises include stretching, strengthening, and restoring coordination.

            STRETCH: A very effective exercise is performed by bending the head to the right, reaching over with the right hand, and gently pulling on the head until a good stretch is felt on the left side of the neck. Reaching down with the opposite (left) arm (as if there’s a dollar bill on the ground and you just can’t quite reach it) enhances the stretch. While stretching, tuck in your chin, drop your head forwards and backwards, and turn your head a little from side to side to feel for different tight muscle fibers. Continue this stretch for 10-20 seconds or long enough to feel that you’ve accomplished a good stretch. Then, repeat this on the opposite side. This can be done sitting or standing, and most importantly, do this multiple times a day, especially when you feel tight – like at work, for example. There are other stretches but this actually combines four different exercises into one, so it’s often enough!

            STRENGTHENING: Place your hand against the side of your head and push your head into your hand using about 10-20% maximum effort (not much pressure!). First, allow your head “to win” by moving your head further until a tight stretch is felt. Second, let your hand “win” by moving the head to the opposite direction while maintaining pressure against your hand. Allow the head to bend ALL THE WAY to the end-range and repeat three times in each direction.

            COORDINATION: Motor control, balance, and coordination are further enhanced by balancing on one foot with eyes open AND closed. Stand near a wall to avoid falling!

            4. PREVENTION: Keep exercising and eat right! Consider joining a health club, working out with a friend, riding a bike, walking, and/or swimming. You choose!

Chiropractic Management of Neck Pain (Part 1)

            Neck pain is a very common condition that drives many patients to seek chiropractic care. Treatment planning typically includes four primary goals: 1) Pain Management; 2) Structural Realignment; 3) Functional Restoration; and 4) Maintenance / Prevention.

            1) PAIN MANAGEMENT: Getting rid of pain is the primary focus of ALL patients in the early stages of a neck injury. If we use the acronym “PRICE” (Protect, Rest, Ice, Compress, and Elevate), the first three apply when it comes to neck pain. We “protect” our neck by avoiding or changing the way we go about doing things such as our sleep position (this often prompts a “proper pillow discussion”), adjusting the outside rearview mirrors of our car (if you flair the outside mirrors outwards, it opens up the “blind spots” and may prevent a collision, especially if you cannot rotate your neck very far), and modifying other ADLs (activities of daily living). The bottom line is: if an activity creates a sharp pain sensation, it is a “warning sign” to modify or stop WHATEVER it is that you’re doing. Wearing a cervical collar for a SHORT duration of time can qualify for both “Protect” and “Rest.” Try resting your neck on a pillow when reading or watching TV, as it allows the neck muscles to rest. A cervical traction device can help reduce muscle spasm, improves flexibility (range of motion), and reduce pain. Alternating "Ice" and heat can be even more effective, as it “PUMPS” out inflammation or swelling. Heat is also a good natural muscle relaxant and ice reduces swelling (inflammation), both of which can help reduce pain. There really is no hard and fast rule as to how long you should continue using ice (days, weeks, or months) – if it helps, use it (unless you are hypersensitive and frostbite easily, in which case limit the ice time). However, heat can worsen a condition if it’s applied too soon or too long. Anti-inflammatory herbs like ginger, turmeric, boswellia, and others are very effective and actually may be BETTER than ibuprofen, Aleve, or aspirin. Recent studies indicate that there may be a delay in healing when over-the-counter pain medications are used, and the recommendation is to AVOID these drugs so healing won’t be delayed!

            2) STRUCTURAL REALIGNMENT: The goal here is to improve (to the best of our ability) faulty bony misalignments that frequently exist in the neck, upper, middle back as well as the low back, as all can contribute to neck pain. This is also a great long-term goal, as it may help PREVENT future episodes of neck pain. There is a natural process of aging called osteoarthritis that none of us can avoid, but allowing faulty curves and bony misalignments to persist may actually accelerate this degenerative process! Your Chiropractor may have you lie on a tightly rolled up towel (a frozen water bottle often feels even better) placed behind the neck and when it’s comfortable, performing this on the edge of the bed is a great way to re-educate a reversed cervical curve (and, it feels GREAT!). Even a heel lift in the shoe of a short leg can help the neck! Spinal manipulation, manual mobilization techniques, and trained exercises all address this treatment goal quite effectively!

            We will continue this conversation next month discussing the third and fourth topics: 3) Functional Restoration; and 4) Maintenance / Prevention, so STAY TUNED!

Neck Pain – Chiropractic and the Older Patient

            People of all ages suffer from neck pain, and many frequently turn to chiropractors for care because it's been found to be one of the most effective and efficient forms of treatment available, and it carries minimal side effects!  It has been projected that by 2030, nearly one in five US residents will be 65 or older. Currently, approximately 14% of the patients treated by chiropractors are 65 or older, making it one of the most frequently utilized forms of complementary and alternative care used by older adults. What kind of care can a senior citizen expect when seeking treatment from a chiropractor? Let’s take a look!

            Musculoskeletal pain, or pain in the neck, back, arms, and/or legs, drives the majority of elderly patients to chiropractors. While low back and neck pain are the most common complaints, it's not unusual for patients to also have one or two other conditions (or more) that they did NOT know chiropractic care could help. In fact, common “goals” for managing every patient (not just the elderly) include services related to patient assessment, maintenance of health, and prevention of illness, in addition to treatment of illness or injury. Common chiropractic treatment approaches include spinal manipulation and/or mobilization, nutritional counseling, physical activity/exercise, and (especially important for the elderly population) fall prevention.

            We will now focus on neck pain as it relates to the elderly population and the various chiropractic management strategies that might be encountered by an elderly patient. Common reasons patients present regarding the neck include limited movement, stiffness, and pain. Neck pain can also interfere with sleep, as finding a comfortable position in bed can be quite challenging! Lifting, carrying, and playing with grandchildren is a very common issue for either causing a new complaint or irritating an existing one. Neck pain may also interfere with reaching and lifting. Thus, activities like yard or garden work may become more difficult and less enjoyable. Neck pain is often associated with headaches, which can make daily tasks even more challenging.

            When an elderly patient visits a chiropractor for the first time or for a new complaint, he/she can expect to fill out some initial paperwork, as well as provide a history of the main complaint and any lesser complaints. This may also include providing a family and medical history. The examination usually includes general observations, palpating or feeling for muscle tightness, tenderness, warm/cool, range of spinal motion (neck, back, extremities), orthopedic tests, neurological tests, and possibly x-rays. Treatment of the neck may include massage or mobilization to loosen up the neck, manipulation to free up restricted joint motion, and even exercise training. The goal of treatment is to improve neck motion, activity tolerance, and quality of life (less pain, improved sleep, etc.). So, whether you are 10, 20, 50, 70, or 90 years old, give chiropractic a chance to help you manage your neck pain!

Neck Pain and the Disk

When we say to you, “…you have a cervical disk problem,” do you know what that means? I didn’t think so. As doctors, we talk about these things so often, we sometimes just assume you know what we’re talking about. So first, sorry about that! Now, let’s clear up the question, what is a cervical disk problem?

The term “cervical” means neck, just like the terms “thoracic” means mid-back and “lumbar” means low back. The term “disk” refers to the shock absorbing fibro-elastic cartilage that rests between each vertebra of the spine. Think of the disk as being similar to a jelly donut. The center of the disk is liquid-like (the nucleus), kind of like petroleum jelly, and the outer part (the annulus) is tough and strong and circles the nucleus center like the rings of an freshly cut oak tree stump. What makes the annulus/outer layer so strong is the type of tissue it’s made up of and, maybe most important, the opposing criss-cross pattern of each layer or ring of the annulus. Studies have shown that when the disk is pierced with a knife and then compressed, this criss-cross pattern of the annulus layers self-seals the cut, resulting in no leakage of the liquid center.

So, the question is, how can a disk rupture, herniate or “slip” if it’s so tough, strong, and self-sealing? The answer: as the disk ages or when it’s injured, tears or “fissures” in the disk fibers occur creating rents or channels for the liquid part to work its way out towards the edge and eventually break through the outer most layer – hence, the term “herniated disk.” It’s similar to stepping on that jelly donut until the jelly leaks out to the point where you can see it.

Here’s the strange part. Research tells us that about 50% of people have bulging disks (not quite herniated through) and 20% of us have herniated disks (that have popped through) but have NO PAIN AT ALL! That makes it tough since an MRI or CT scan may show a herniated or bulging disk but how do we know that’s the disk that’s clinically important – the one that’s creating the pain? That’s why we treat patients and not their image (MRI, CT scan or x-ray). Even though a disk may be bulging or herniated, we may not necessarily treat that particular disk if it’s not expressing itself clinically by creating a shooting pain down a specific area in a arm, usually below the elbow often into either the thumb or pinky side of the hand, with associated abnormal tests for strength and/or sensation. That’s why we check your reflexes, your strength, and sensation for each nerve. We’re checking to see if that herniated disk is “pinching” the nerve and if it is, we utilize manipulation, traction, PT modalities, and issue home traction units to try to “un-pinch” that nerve to avoid surgery.

"My Neck Is Killing Me!"

When patients present with neck pain, they always ask, “where is the pain coming from?” Of course, this can only be answered after a careful history and thorough evaluation is completed, which is what we do in this office. Let’s take a closer look at what this involves.

The History: This includes a careful description of how the injury occurred, if there was an injury. For example, in a slip and fall injury, it makes a difference if the patient fell forwards, sideways, or backwards; if they landed on their knees, hips, buttocks, back or if they hit their head on the ground. Also, if there was a dazed feeling or loss of consciousness in the process. If there was a head strike, were there any signs of concussion: fatigue, mental “fog,” headache, difficulty communicating or forming words or sentences. When there is no specific injury, we will ask if there were perhaps one or more, “mini-“ or “micro-“ injuries that may have occurred sometime within 2-3 days prior to the onset of the neck pain. The cumulative effect of several small “micro-injuries” can result in a rather significant onset of symptoms several days later. The next batch of information gathered includes factors that increase and decrease the pain, the type of pain quality (sharp, dull, throb, burn, itch, etc.), pain location – “…put your finger on where it hurts and “does it radiate into the arms or legs, severity (pain level 0-10), and timing such as, “it’s worse for the 1st 30 min. in the morning and then loosens up.” Information regarding past history, family history, medical history (surgeries, medications), social history, habits (caffeine, tobacco, alcohol, etc.), and a systems review (heart, lungs, stomach, nervous system, etc.).

The Physical Exam: This includes vital signs (blood pressure, etc), observation – the way the head is positioned (forwards, to the side, rotated, etc.); palpation – touch/feel for muscle spasm, trigger points, spinal vertebra position and motion; range of motion, orthopedic and neurological tests. The exam procedure may also include x-ray, depending on each case.

The Diagnosis: This is determined after taking all your information and “…putting the puzzle pieces together” to determine what is causing your pain.

The Treatment: Chiropractic spinal manipulation (often referred to as “adjustments”) is performed by applying energy or force to the misaligned or fixed vertebra structures by one of many methods depending on the patient’s size, pain level, tolerance, and so on. Other “manual” treatment approaches include soft tissue therapy such as trigger point therapy, active release, massage, vibration, and others. The use of physical therapy modalities such as ice, heat, electrical stimulation, ultrasound, light – laser therapy, and/or others, again, depending on your specific situation and needs can also be very helpful. Similarly, exercises to teach you how to hold your proper posture, to improve flexibility or range of motion, and to strengthen the muscles that are weak really help to make the adjustments “hold” and the beneficial effects last longer. A work station/job assessment may also be needed if that appears to be irritating your condition.

Neck Pain – Can Chiropractic Really Help?

Neck pain is a very common problem affecting up to 70% of the adult population at some point in life. Though there are specific causes of neck pain such as arising from a sports injury, a car accident or “sleeping crooked,” the vast majority of the time, no direct cause can be identified and thus the term nonspecific is applied. There are many symptoms associated with patients complaining of neck pain and many of these symptoms can be confused with other conditions. Wouldn’t it be nice to know what neck related symptoms are most likely to respond to chiropractic manipulation before the treatment has started? This issue has been investigated with very favorable results!

The ability to predict a favorable response to treatment has been termed, “clinical prediction rules” which in general, are usually made up of combinations of things the patient says and findings from exams. In a large study, data from about 20,000 patients receiving about 29,000 treatments, was collected and analyzed to find out what complaints responded well to chiropractic treatment. The results showed that the presence of any 4 of these 7 presenting complaints predicted an immediate improvement in 70-95% of the patients: 1. Neck pain; 2. Shoulder, arm pain; 3. Reduced neck, shoulder, arm movement; 4. Stiffness; 5. Headache; 6. Upper, mid back pain, and 7. None or one presenting symptom. Items not associated with a favorable immediate response included “numbness, tingling upper limbs,” and “fainting, dizziness and light-headedness in 4-12% of the patients. The “take-home” message here is that was far more common to see a favorable response (70-95%) of the patients compared to an unfavorable response (4-12%), supporting the observation that most patients with neck complaints will respond favorably to chiropractic treatment.

So, what do we do as chiropractors when a patient presents with neck pain? First, after gathering preliminary information such as name, address and insurance information, a history of the presenting complaint is taken. This consists of information including what started the neck complaint (if you know), when it started, what makes it worse, what makes it better, the quality of pain (aches, stiff, numb, etc.), the location and if there is radiating complaints, the severity (0-10 pain scale), timing (such as worse in the morning, evening, etc.), and if there have been prior episodes. Various questionnaires are included that are scored so improvement down the road can be tracked and a past history that includes a medication list, past injuries or illnesses, family history and a systems review are standard. The exam includes vital signs (BP, pulse, height, weight, temperature and respiration), palpation, range of motion, orthopedic and neurological examination. X-ray and/or other “special tests” may also be included, when needed. A review of all the findings are discussed and after permission to treat is granted, a chiropractic adjustment may then be rendered. A list treatment options may include: 1. Adjustments; 2. Soft tissue therapy (trigger point stimulation, myofascial release); 3. Physical therapy modalities; 3. Posture correction exercises and other exercises/home self-administered therapies; 4. Education about job modifications; 5. Co-management with other health care providers if/when needed.

Neck Pain and Chiropractic Treatment

A 42 year old, female patient presented with neck pain that had been present for 2 months. The pain came on gradually and without a specific cause. Her vocation is answering the phone for a busy mail order shoe store. She works 40 hours a week, 5 days per week and never weekends. Pain worsens with work, especially by the end of the 8 hour shift. Other pain producers include driving more than 30 minutes, reading more than 30 minutes, and washing hair with the head back. Pain improves with resting the head on a chair or pillow, moving the head in circles, 600 mg of Ibuprofen (repeated 3x/day), and a hot shower. She describes the pain as an ache with intermittent sharp pain that is becoming more frequent, “…when I move the wrong way.” There is no shooting pain into the arms or hands.

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

It is equally important in both cases that a complete explanation of, 1) What is the condition causing the symptoms? 2) What can be done to treat it (that is, “what are my treatment options”)? 3) Will the proposed treatment “fit” into my busy schedule, financial situation, and my philosophy about health care? Providing answers to these questions will usually end with the best results, as the patient will understand the issues most important to them and will have confidence that those issues are understood and appreciated by the doctor. In both cases, management may include 1) modifying the work station by switching to a head set rather than pinching a phone between the neck and shoulder; 2) evaluating the patient at their work station to check for proper posture at the desk, proper computer monitor positioning, etc. and making modifications as needed; 3) teaching the patient cervical range of motion exercises and other stretches that can be done at the work station, multiple times a day, that only take a minute or two; 4) cervical traction (if this “feels good” when tested during the exam); 5) use of a cervical or contoured pillow; 6) neck / upper body strengthening exercises; 7) the use of ice as needed; 8) an anti-inflammatory diet (for example, a gluten-free diet); 9) nutritional supplementation, as indicated. Of course, most of the time, all of these approaches do not have to be included, but are options.

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