Can Chiropractic Adjustments Help Headaches?

Experts report that 157 million work days are lost each year in the United States due to headaches at a cost of about $50 billion in work absenteeism and medical expenses. According to current estimates, about 18% of chronic headache patients are believed to have cervicogenic headaches (CGH), or headaches that originate from dysfunction in the neck. 

Many CGH sufferers utilize complementary and integrative health treatment approaches for neck pain and headaches, of which spinal manipulative therapy (SMT) is the most common. While past studies have demonstrated SMT to be a superior form of treatment for CGH, no one has investigated how many treatments are needed to achieve the maximum clinical benefit for CGH patients – at least not until recently!

In order to determine what dose of SMT may best benefit patients with headaches originating from the neck, researchers randomized 256 CGH patients into four treatment groups that received 0, 6, 12, or 18 SMT treatments over the course of six weeks. The researchers found a dose-dependent relationship between SMT and days without CGH over the following year with patients in the 18 visit group experiencing 16 fewer days with CGH over the next twelve months than those in the zero treatment group.

The chiropractic spinal manipulative therapy treatment used in the study consisted of high-velocity, low-amplitude thrust manipulation in the neck and upper back regions (specifically, occiput to T3) aimed at sites with detected joint dysfunction (fixation or pain), which is typically the method most chiropractors determine where to apply spinal manipulation.

This study is VERY important for a few reasons: 1) it proves SMT helps patients with CGH; 2) it provides doctors of chiropractic with an idea of how many visits it may take to obtain optimum results; and 3) it can be used as a guideline when managing CGH patients, stressing the important point that EACH patient is UNIQUE and modifications may be appropriate depending on each case.

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A Weak Core May Contribute to Hip Pain

When people think of hip pain, they generally turn to hip-specific exercises as a self–help strategy.  However, recent evidence shows there’s a correlation between poor core stability of the trunk and injury to the lower extremities, which includes the hips.  In March 2018, Belgian researchers reviewed data from nine previously published studies with a focus on the importance of core stability and its relationship to lower extremity musculoskeletal injuries in a healthy athletic population. The investigators reported that core strength, core proprioception (balance), and neuromuscular control (coordination) of the core are directly linked to the likelihood of lower extremity injuries.  

Let’s take a closer look at three specific core strengthening exercises that can be done relatively fast and are highly effective (you can view several demonstration videos on YouTube if you search for “stuart mcgill’s big-3 core exercises”).

1) The Curl-Up (abdominal strength): STEP 1 — Lie on your back, straighten your left leg, and bend your right leg, placing the right foot next to the left knee.  STEP 2 — Tuck your hands under your low back to prop up the lumbar curve (so it does not flatten out).  STEP 3 — Curl up by lifting your head, neck, and shoulders only a few inches off the floor (keep your chin tucked).  STEP 4 — Hold for 7–8 seconds (or work up to this).  STEP 5 — Slowly lower your trunk back to the ground.  Repeat five times with the right leg bent and five times with the left leg bent, while keeping the opposite leg straight.  This exercise helps reduce low back disk compression, which is significant when performing a conventional sit-up exercise.

 2) The Bird-Dog (core, back, and gluts):  STEP 1 — Kneel on all-fours (hands and knees).  STEP 2 — Keeping your back flat, lift and straighten out the LEFT arm and RIGHT leg parallel to the floor. STEP 3 — To further activate the core muscles, draw a square with the arm and leg while bracing the abdominal muscles (firm up your abs, as if to brace for being punched in the stomach). STEP 4 — Return to the starting position and repeat on the opposite side (repeat STEP 3 again). 

3) The Side-Bridge (obliques): STEP 1 — Lie on your side, elbow directly under your shoulder and bend your knees 90°. To increase the difficulty, keep the legs/knees straight. STEP 2 — Lift your hips off the ground so you are holding your weight with your elbow and knees (or feet). STEP 3 — Hold the “Up” position for as long as possible. STEP 4 — Repeat steps 1-3 on the opposite side. 

Doctors of chiropractic are trained to evaluate the entire person from the feet up to the head to identify issues elsewhere in the body that may contribute to or even cause the patient’s chief complaint. For many patients, managing hip-related conditions may involve treatment to address issues in the core (as described in this post), the lower back, and even the feet or knees!

Back Pain: Does Maintenance Care Work?

Non-specific low back pain (nsLBP) is one of the most common and costly healthcare problems affecting society, and it is also the leading cause of activity limitation and work absence around the world. 

Following a course of treatment to reduce pain and improve function for patients with a musculoskeletal complaint—such as back pain—doctors of chiropractic commonly make recommendations to reduce the risk of a future episode (or at least minimize its severity should one occur). These recommendations may include adopting a fitness routine, dietary modifications, specific exercises, foot orthotics, and/or routine “maintenance” chiropractic adjustments, such as once a month or every six weeks. 

Though further research is necessary to more clearly understand precisely how maintenance care (MC) works to reduce the risk of future episodes of back pain, researchers currently hypothesize that such treatments may improve any biomechanical or neuromuscular dysfunctions before they become symptomatic. 

Studies published in both 2004 and 2011 note that patients with chronic low back pain who received maintenance care for nine months reported less pain and disability than participants who did not receiving ongoing care. 

In a 2018 study that included 328 nsLBP patients, researchers found that those who received ongoing maintenance care following their initial course of treatment experienced 12.8 fewer days with LBP over the following year. Compared with patients who were advised to return for further care on an as-needed basis, the participants in the MC group only made an average of 1.7 additional chiropractic visits during the study. 

The authors of this study concluded, “For selected patients with recurrent or persistent non-specific LBP who respond well to an initial course of chiropractic care, MC should be considered an option for tertiary prevention.”

Chiropractic Care for Headache Relief?

Woman Suffering From A HeadacheHeadaches have a significant impact on quality of life in both adults and children. Approximately 13% of patients who sought chiropractic care over the last decade did so for headache relief. Several studies have found that manual therapies, such as spinal manipulation and mobilization, can provide significant benefits for patients with both tension-type and migraine headaches—even better than standard medical care, in some cases.

In 2011, Canadian researchers reviewed data from 21 published studies to develop specific recommendations for chiropractic management of headaches. For episodic or chronic migraine and cervicogenic headaches (those caused by specific neck problems), they recommended spinal manipulation and other manual interventions, such as massage. Additionally, researchers noted that joint mobilization and strengthening exercises for the deep neck flexor muscles may also improve symptoms associated with cervicogenic headaches.

For episodic tension-type headache, the investigators did not find enough published evidence to support the use of spinal manipulation. They stated that, at the current time, “a recommendation cannot be made for or against the use of spinal manipulation for patients with chronic tension-type headache” (CTTH). However, they did report that low-load craniocervical mobilization “may be beneficial for longer term management of patients with episodic or chronic tension-type headaches.”

In contrast, following a randomized clinical trial of 80 patients with chronic tension-type headaches, Dutch researchers reported that “Manual therapy is more effective than usual [general practitioner] care in the short- and longer term in reducing symptoms of CTTH.”

Chiropractors utilize many types of manual therapies as a primary form of care for several complaints and conditions, including headaches.

Great Exercises for Carpal Tunnel Syndrome

Carpal tunnel syndrome (CTS) is caused when the median nerve is compressed as it passes through the tight bony carpal tunnel at the wrist. The condition can result in pain, numbness, tingling, and weakness in the hand, and it can affect one’s ability to carry out everyday life and work tasks. Here are a few GREAT exercises for CTS that require no equipment and can be done anytime and anywhere:

Calm slim model standing in tree pose in bright room

PRAYER: Place your hands in a “prayer” position. Touch the palm-side finger pads together and slowly push the palms into one another while keeping the elbows up as much as possible as you feel a strong stretch in the hands, fingers, and palm-side of the forearms.

SHAKE: Shake your hands for 10-15 seconds as if you just washed them and you’re trying to air dry them off.

WRIST FLEXION STRETCH: Hold your arm out in front of you with the elbow straight, palm facing down. With the opposite hand, bend the wrist as far downward as possible so the fingers point to the ground. This will produce a strong stretch in the muscles located in the back or top of the forearm. Repeat five to ten ties holding each stretch for 15–20 seconds (as tolerated).

These exercises can be repeated multiple times a day, as often as once per hour. It is often very helpful to set a timer on your cell phone to remind you to take a stretch break. A “good pain” (stretch) is considered safe while sharp or radiating pain may be potentially harmful. However, if you experience sharp, lancinating, or radiating pain, then stop or modify the exercise.

Frequently, CTS involves more than just the wrist, and exercises that target the neck, shoulder, and elbow can often hasten recovery. This is especially true when there is “double crush syndrome” where the median nerve is entrapped in more than one location such as the neck, shoulder, elbow, or forearm (as well as the wrist).

Chiropractic management of CTS can include manipulation and mobilization of the hand, wrist, forearm, elbow, shoulder, and neck. Muscle release techniques are often employed as well as the use of physical therapy modalities such as laser, electric stimulation, ultrasound, and others. The use of night splints to keep the wrist straight when sleeping is a “standard” used by most healthcare providers. Co-management with primary care may be appropriate if diabetes, inflammatory arthritis, or other complicating conditions are present

Can Exercise Prevent Low Back Pain?

While it’s not possible to totally prevent low back pain (LBP), individuals who regularly exercise appear to have a reduced risk for LBP. Additionally, fit adults who develop back pain may experience it less often, at a reduced intensity, and for a shorter duration than those who lead a more sedentary lifestyle.low backWhich type of exercise is the best? A general rule is to keep trying different activities, starting with those MOST appealing to you. After all, you should enjoy exercise, so start with your favorites: walking (one of the best), walk/run combinations, running/jogging, bicycling, swimming/water aerobics, yoga, Pilates, core strengthening, balance exercises, tennis, basketball, golfing, etc.

Specific exercises for the low back can be individualized by determining your “position preference”, or the position that feels best to your low back. For example, bend forward as if to touch your toes. How does that feel? Do you feel a good stretch or pain? Does it shoot pain down your leg? If it feels good, then that might be your preferred position and the one to emphasize with exercise. Examples of exercises that fit this scenario include (but are not limited to): posterior pelvic tilts (flatten your low back by rocking your pelvis forward); single and double knee to chest; and bending forward from a chair (as if to touch the floor).

If bending backward feels good (better than flexion and especially if the presence of leg pain lessens or disappears), then “extension-biased” exercises fit that scenario. Examples include standing back extensions (place your hands behind the low back and bend backward); prone “press-ups” (lift the chest off the floor while keeping the pelvis down); and laying back-first over a Bosu- or Gym-ball.

Pelvic dysfunction and core weakness can also increase the risk for LBP. Try these exercises: abdominal crunches (bend one knee, place your hands behind your low back, and raise the breast bone toward the ceiling only a few inches and hold); front and side planks (start from the knees if necessary); supine bridges (supine, knees bent, lift the buttocks off the floor); “bird-dog” (kneel on all fours and raise the opposite leg and arm, keep good form, and alternate); and the “dead-bug” (on your back, bend the hips and knees at 90 degrees with your arms reaching toward the ceiling; slowly lower your right arm and left leg and return them to their starting position; repeat with the other arm/leg).

When lifting, bend the knees and hips but NOT your low back; keep weights close to you and lift with your legs. Don’t attempt lifts that you know are too heavy.

If you have a history of low back pain, research shows that receiving maintenance chiropractic care can help reduce the number of days in which low back pain may hinder your activities.