Different Headaches and Chiropractic Care

Adults may experience many different kinds of headaches. A primary headache is a headache that is not a part of another disease process. Secondary headaches can come from a poor eyeglass prescription, diabetes, the flu, or even a brain tumor. The most common primary headaches are tension-type, migraine, and cervicogenic (from the neck).

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In cervicogenic headache, neck function is prominently disturbed. In addition to neck pain, there are usually tight neck and shoulder muscles, and a limited range of motion.

Tension type headaches feel like a tight band around your head. Stress seems to aggravate them and women tend to get this type of headache more frequently.

Females are also more affected by migraine headaches.

There are two types of migraine: classical and common.

The classical migraine headache may start with nausea or sickness in the stomach and proceed to an intense throbbing pain on one side of the head.

The common migraine lacks this nausea and is more common than the classical type.

Research has shown that the three above described headaches can also overlap with one another. In chiropractic, we look to the spine as an often-overlooked factor in headache treatment. By objectively analyzing spine function, the doctor will identify the joints that are restricted in their range of motion or show abnormal posture and alignment. Many patients on x-ray, or through external postural analysis from the side, can show forward head posture. This is where the neck seems to arise from the front of the chest rather than back over your shoulders. The head is very heavy and with this poor posture, the muscles at the back of the neck must contract to restrain this heavy load.

There isn’t one particular bone that is treated for these different types of headaches, the premise being that the headache is a symptom of another problem in the spine.

Chiropractic care has an excellent safety profile and several studies have shown that patients with headaches positively respond to chiropractic care without the side effects often seen with drug treatments. Chiropractic care is one of the most researched non-drug options available for patients. Unfortunately, many patients choose over-the-counter and prescription medications and don’t consider more natural approaches that may get at the cause of the condition rather than just its effects.

 

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Low Back Pain: Is It Your Feet?

The foot and ankle are unique in that their range of motion includes not only the front-to-back, hinge-like motion we associate with walking but also the lateral or side-to-side movement needed to change directions quickly. A problem in the foot can have a “domino effect’ that alters the biomechanics or the ankles, knees, hips, pelvis, low back, and even the neck—potentially increasing the risk of injury in each these areas.

Back in 1995, Rothbart and colleagues reported that hyperpronation—or excessive rolling inwards of the foot and ankle—is a leading cause of pelvic repositioning and mechanical LBP. Just watch people from behind as they walk in a mall, airport, or grocery store and you’ll notice almost everyone’s ankle rolls inwards as they step downward. To maintain proper foot posture, the use of foot orthotics is the most practical approach— coupled with wearing well-fitted, comfortable shoes, of course.

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In a 2017 study, researchers recruited 225 adults with chronic LBP (more than three months) and randomly assigned them into one of three treatment groups: shoe orthotic (SO)-only, a “plus” group (SO + chiropractic manipulation/CM), or a waitlist group. The research team measured each participant’s pain and function/disability initially, after six weeks (the length of the treatment period), and then three, six, and twelve months later.

After six weeks, only members in the intervention groups reported any improvement in function. When comparing the waitlist and SO-only groups, the SO-only group demonstrated significantly greater improvements in both pain and function. The researchers also noted that members of the SO+CM group experienced even greater levels of clinically significant functional improvement.

This large-scale study supports the importance of examining the whole patient to identify and treat all factors that may contribute to a patient’s chief complaint.

Carpal Tunnel Syndrome: Don’t Wait!

Carpal tunnel syndrome (CTS) occurs when the median nerve is compressed as it passes through the wrist. Researches estimate that the average person has a one-in-ten chance of developing the condition in their lifetime, and the risk is higher for individuals in certain professions (such as those using heavy, vibrating tools) and with medical conditions (like diabetes). The symptoms associated with CTS involve pain, numbness, tingling, and weakness in the hands and fingers, typically sparing the pinky and outer half of the fourth digit.carpal tunnel

Given that some of us are more likely than others to develop CTS, what should we do if we start to encounter symptoms associated with the condition?

Is it important to seek treatment right away or is it safe to wait?

Generally speaking, the faster a patient seeks care, the quicker they will respond to conservative treatment options like those offered in a chiropractic clinic. Delaying treatment may mean a longer recovery or even having to consider more invasive options, like a surgical procedure. But why is that?

Like many cells in the body, the nerves are provided nutrients by way of blood vessels. When even a small amount of pressure is applied to the median nerve, it can damage those blood vessels. Unless the vessels are given a chance to heal, the nerve can suffer. If the nerve damage is severe enough, even surgery may not be an option, and a patient may have to learn to live with their pain or find other ways to mask their symptoms.

One big problem with CTS is that patients rarely wake up with severe wrist pain that prompts them to seek treatment. Often, the condition is subtle with pain, numbness, and tingling that comes and goes. Individuals with CTS may find it more of an annoyance than anything and tend to put off treatment until the symptoms cause too much of an impact on their quality of life to ignore and they’re forced to call the doctor.

The good news is that patients often respond well to conservative care. Chiropractors often diagnose CTS and can effectively manage it without the need for more invasive surgical intervention, but the prognosis for an effective treatment outcome declines with the greater the degree of nerve damage. Hence, patients are encouraged to seek treatment sooner rather than later when it comes to CTS. Care often includes manual therapies (manipulation/mobilization), education (rest, ice, brace, exercise), nutrition (anti-inflammatory in nature), and more.

Chiropractic and Hypertension

In a blood pressure reading, the higher number (“systolic”) represents the pressure that blood exerts against the arterial walls when the heart beats. The lower number (“diastolic”) represents the pressure blood exerts against the arterial walls when the heart rests between beats (measured in millimeters of mercury or mmHg). The definition of hypertension (HT), like so many other aspects of health, has been defined and redefined over the years. Let’s take a look at the current definition and what (if anything) chiropractic provides to help this VERY common condition.

The American Heart Association defines (as of November 2017) “NORMAL” as beinghypertension-and-diabetes-often-go-together <120/ and <80; “ELEVATED” as 120-129/ and <80; STAGE 1 HT: 130-139/ or 80-89; STAGE 2 HT: >140/ or, >90; HYPERTENSIVE CRISIS: >180/ and/or >120. Between the two numbers, the systolic blood pressure (BP) is generally given the most attention as a major risk factor for cardiovascular disease for people over age 50. A gradual increase in systolic BP normally occurs with increasing age as arteries gradually stiffen due to plaque build-up. Recent studies report that the risk of death from ischemic heart disease and stroke DOUBLES with every 20mmHg systolic or 10mm Hg diastolic BP increase in people from age 40-89.

So, CAN chiropractic help patients with hypertension? The answer is YES… at least in some cases. A placebo-controlled study published in 2007 (and spotlighted on “WebMD”) reported a specific type of chiropractic adjustment applied to the Atlas (C1) vertebra that

SIGNIFICANTLY lowered both systolic (by 14 mm Hg) and diastolic BP (by 8 mm Hg) in 25 patients with early-stage HT. This improvement did not occur in 25 control patients who received a sham procedure. This beneficial effect persisted for eight weeks during which time the patients took no medication for their condition.

Dr. George Bakris, the director of the University of Chicago hypertension center and lead author of the 2007 study wrote, “This procedure has the effect of not one, but two blood pressure medications given in combination. And it seems to be adverse-event free. We saw no side effects and no problems.”

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Case studies of chiropractic treatment lowering BP date back to the 1980s, and higher quality, larger scaled studies have been published in the last decade. One explanation on how chiropractic adjustments help to lower BP is that adjustments applied to C1 (the Atlas) affect the parasympathetic nervous system, which tends to lower the diastolic BP (lower number), while mid-thoracic manipulation—which stimulates the sympathetic nervous system—tends to lower the systolic BP (upper number) to a larger degree. Chiropractic care includes not only spinal manipulation, but also dietary counseling, and more—all WITHOUT the potential for the sometimes significant side-effects associated with medications.

What Causes Shoulder Pain?

Each year, Americans make 7.5 million doctor visits related to shoulder/upper arm pain. After neck and back pain, shoulder pain is one of the top reasons patients seek chiropractic care. So, why are shoulder injuries so prevalent?shoulder pain

Though there are many possible explanations that address this question, there’s a simple answer: anatomy. There are essentially three joints that make up the shoulder: 1) scapulothoracic joint, 2) the glenohumeral joint, and 3) the acromioclavicular joint. These joints work simultaneously and in harmony to carry out the many tasks we throw at our upper extremities from swimming to swinging a tennis racket or even reaching up to hang a curtain or change a light bulb. The overall structure of the shoulder favors mobility over stability and as a result, there is a greater chance for injury. So, what can we do to prevent shoulder injuries?

Perhaps the most important strategy is to think before you act; that is, don’t take unnecessary chances such as over-lifting in especially awkward positions. Try asking someone else for help instead. Also, use proper form and stay conditioned. Research shows that a strong core (back and belly) can help prevent shoulder injuries.

Common shoulder conditions include (but are not limited to): inflammation (bursitis and tendinitis), instability (“sloppy” joints), arthritis (bone/cartilage injury/wear), fracture, and nerve injuries. Injuries can be acute (from an obvious cause) or more commonly, they can be chronic from wear and tear and can occur gradually over time (from no obvious, single cause).

It’s important to understand that a shoulder complaint may be the end result of dysfunction throughout the body, just as a knee problem can place added stress on the hip (or vice versa). So in addition to direct treatment of the shoulder, your doctor of chiropractic may identify and treat problems elsewhere in the body (forward head carriage, poor core strength, leg length deficiency, etc.) that likely contribute to your shoulder pain complaint. In order to promote a speedy recovery, your chiropractor may also recommend certain food or vitamins/supplements with the aim of reducing inflammation.

 

This information should not be substituted for medical or chiropractic advice. Any and all health care concerns, decisions, and actions must be done through the advice and counsel of a health care professional who is familiar with your updated medical history.

Chiropractic Care for Children

Chiropractic techniques are not limited to any particular group. Doctors of chiropractic see patients of all ages, sizes, genders, ethnicities, and so on. So, is the care of children “different” than chiropractic care applied to adults? If so, how?

There are studies that have reviewed the treatment of musculoskeletal (MSK) conditions (like low back pain), non-MSK conditions such as asthma, and chiropractic care of infants, adolescents, and teenagers for a variety of conditions. The management techniques utilized by chiropractors for children vary across the profession, but typically, they are modified methods of those applied to adult patients. When one thinks of “chiropractic care,” the immediate image is that of spinal manipulation where a high-velocity, low-amplitude “thrust” is made and joint cavitation occurs (the release of gas creating a cracking sound similar to knuckle cracking).

Chiropractic treatment can also include dietary advice, nutritional or herbal supplement recommendations, posture correction, exercise training, and the use of physiological therapeutic modalities (like electric stim, light, ice, heat, traction, ultrasound, and more). Behavioral counseling may be included, depending on the patient’s condition and the individual training the chiropractor has focused on, especially on a post-graduate level. Chiropractors, like many healthcare providers, have post-graduate board certification options, of which pediatrics is one of many. Looking at research for children and chiropractic, here is what the current literature base supports:

landerchiropracticforchildren1. Pediatric care: There is evidence that chiropractic methods, when properly modified and applied, are safe. However, more research is needed to determine what the current practice model should be for this patient group.

2. Children & adolescents: There is currently research support for treatment of this patient population for some MSK conditions, particularly low back pain. Again, additional, high-quality studies are needed to further support this category.

3. Non-musculoskeletal care (children & adolescents): A call for more research is a common recurring theme for the management of non-MSK conditions among children and teens. There are several case studies (and small-scale studies, in some instances) for conditions such as colic, otitis media, asthma, nocturnal enuresis (bed wetting), and attention deficit hyperactivity disorder, but all require additional high-quality studies before firm conclusions can be made. However, it has been recommended that a chiropractor may play a role on the pediatric healthcare team and it’s been suggested that it is appropriate to utilize a four to six treatment “trial” to determine effectiveness of care for a colicky infant where all other serious diagnoses have been excluded. Similarly, in cases of enuresis and asthma, chiropractic may have a role on the management team.

4. ADHD in children and adolescents: One focused systematic review reported the need for more high-quality research in this area before conclusions can be made either for or against the utilization of chiropractic care for ADHD.

5. Possible adverse effects: In review of (again) limited studies in this area, chiropractic care appears to have little negative issues associated with it. Serious side effects are reported as “rare.”

Bottom line: Though more research is needed, in the absence of underlying pathology, chiropractic care may be considered as part of the pediatric management team for a four to six visit trial to determine treatment effectiveness.

Chiropractic Care… Safe and Cost Effective

“Ever since I was in my early teens, I’ve had muscle and joint problems that would come and go but never put me down where I couldn’t function. I was very active and played basketball, tennis, and ran in track but over the last 10 years I’ve avoided a lot of activity due to my problems. Now, after having a couple of children and gaining some weight, I notice more frequent and intense back problems and I’m getting quite concerned over the changes that have been taking place and afraid to do things. I talked about this with my family and friends and some have recommended chiropractic, some recommend physical therapy, others suggest medication and one even suggested shots! Quite frankly, I’m totally confused as to what to do!”

This scenario may sound familiar to many people.

lower-back-pain-s1-factsThe choice of health care provision is a personal one, often influenced by those around you – family, friends, teachers, and more!

It seems like everyone is an “expert” with different opinions and their advice, often conflicting, can lead to confusion about what is best for you.

There are many ways to approach back trouble, regardless of the diagnosis or condition.

First, all health care providers are biased in that they naturally focus on their specialty. If you choose to consult with a surgeon, s/he will look at your condition from a surgical perspective. Various surgical options may be discussed, tests are usually recommended and the process begins.

When consulting with a family physician, the typical approach is pharmaceutical or drugs such as anti-inflammatory medications (Advil, Nuprin, Ibuprofen, Aspirin, Aleve, Tylenol, etc.), heat or ice, activity modifications (possibly rest or mild/moderate activity), and possibly referral for chiropractic or physical therapy.

In reviewing the various guidelines, it is recommended to start with the least invasive, safest, most cost effective approaches first.

Unless “red flags” like cancer, fracture, infection or progressive severe neurological losses are present, surgery is not a logical initial approach.

Chiropractic has been recommended as a first or initial choice as it has been found to be safe, highly satisfying, non-invasive, and cost effective.

The typical approach includes a thorough history, an examination that includes an analysis of posture, motion, function and includes the whole body.

For example, if one leg is short, the pelvis will tilt and spine is often crooked. That needs to be corrected for both long and short term results.

If the feet pronate and the arches are flat, the effects on gait/walking on the ankle, knee, hip and back can lead to trouble or perpetuate current problems.

Deconditioning or, being out of shape is an important aspect included in the chiropractic management process.

If these methods fail to bring about satisfying results, referral for more invasive approaches will be considered.