Pain Relief Chiropractic

Research regarding whiplash or whiplash associated disorders (WAD) classically focuses on neck pain; however, the data show acute thoracic spine / mid-back pain (MBP) occurs in 66% of WAD injures with 23% still complaining of MBP at one-year post-injury. It's easy to visualize how the cervical spine or neck can be injured in an automobile collision (or sport-related collision or a fall) as the head, which weighs an average or twelve pounds, whips back and forth in a “crack-the-whip” like manner, often well beyond the normal, physiological range of motion. This same stretching (eccentric loading) followed by compression (concentric loading) also occurs in the mid-back, which can injure ligaments, joint capsules, neural structures, and more. Also, the thoracic spine contributes to 33% of flexion and 21% of rotation IN THE NECK, making the mid-back a vital spinal region that facilitates neck movement and function! In WAD cases, mid-back pain often hides in the shadows of a more obvious and often more serious neck injury, as the brain typically perceives pain from the greatest source. Additionally, the neuronal input to the sensory cortex of the brain (the area of the brain that perceives pain) is most highly represented from the head, hands, and feet and less from the mid-back or torso. The seat belt may also contribute to injury—both to the anterior chest region including rib cage, sternum, breast tissue, abdominal organs, as well as to the mid-back. The oblique angle of the chest-restraint is an important factor when discussing the mechanism of injury, as it causes trunk/torso rotation during the rebound or flexion phase of WAD. Another mechanism of injury includes blunt trauma, of which the driver is especially at risk due to the close proximity of the steering wheel and the chest. This can lead to contusion or bruising, fracture, and/or injury to the abdominal and/or chest organs (heart and lungs). Obviously, the speed of impact, angle of the collision, bracing of the person (or lack thereof), and overall physical condition of the patient can greatly affect the outcome of WAD-related injuries. The importance of assessing the whole person is essential in obtaining an accurate diagnosis and establishing a comprehensive treatment plan for the WAD patient. Chiropractic management focuses on the entire person, frequently uncovering complaints in other spinal regions as well as in the extremities in WAD-related injured patients. Moreover, treating postural issues such as a short leg, ankle pronation, oblique pelvis, forward head posture, protracted shoulders, and more is vitally important in obtaining satisfying patient outcomes! www.PainReliefChiroOnline.com

When treating patients with carpal tunnel syndrome (CTS), doctors of chiropractic can employ a variety of options to reduce pressure on the median nerve. While this can include dietary recommendations (to reduce inflammation), adjustments to address dysfunction elsewhere along the course of the median nerve, or even working with other healthcare providers to manage conditions that contribute to CTS (like diabetes), treatment will often focus on the wrist itself. One such approach is referred to as neurodynamic techniques, or mobilization. In a study involving 103 patients with mild-to-moderate CTS, those who received treatment twice a week for ten weeks experienced greater improvements with respect to pain reduction, symptom severity, functional status, and nerve function than participants in a control group who received no treatment. The authors concluded, “The use of neurodynamic techniques in conservative treatment for mild to moderate forms of carpal tunnel syndrome has significant therapeutic benefits.” This finding is supported by two previous studies that found the use of manual therapies on the wrist can alter the shape of the carpal tunnel itself and allow more room for the tendons, blood vessels, and median nerve. Additionally, studies show that when the wrist moves beyond a neutral position, it can alter the shape of the carpal tunnel and increase pressure on its contents. In a healthy wrist, full extension/flexion can double pressure in the carpal tunnel; however, for CTS patients, the pressure can increase as much as 600%. That's why many treatment guidelines recommend wearing a wrist splint (especially at night) and modifying work and life activities to keep the wrist in a neutral position as much as possible. The good news is that in most cases of CTS, patients will benefit from a conservative treatment approach; however, achieving a successful outcome can be more difficult if the patient delays treatment. That's why it's important to consult with your doctor of chiropractic when you experience the signs and symptoms associated with CTS (pain, numbness, tingling, or weakness in the hands or fingers) sooner rather than later. www.PainReliefChiroOnline.com

The term whiplash associated disorders (WAD) describes a constellation of symptoms that includes (partial list) pain, stiffness/limited motion, dizziness, headache, depression/anxiety, and brain-fog. The condition is associated with accelerations/deceleration events like car accidents, sports collisions, or slip and falls. Such injuries are classified into four categories: WAD I (no/minimal complaints/injury), WAD II (soft-tissue injury – muscle/tendon and/or ligament injury), WAD III (nerve injury), WAD IV (fracture). More than 85% of those involved in a motor vehicle collision (MVC) experience neck pain, with 29-40% recovering within a little more than three months and about 23% still not having recovered after one year. A 2016 systematic review generated treatment guidelines for patients with WAD and/or neck associated disorders (NAD) in the context of both a recent injury and for cases in which pain has persisted for longer than three months. Importantly, these guidelines were formed with input from several types of healthcare providers, including doctors of chiropractic, medical doctors, and physical therapists. For recent-onset neck pain (0-3 months), the authors recommend multimodal care (multiple types); manipulation or mobilization; range-of-motion home exercise or multimodal manual therapy (for grades I-II NAD); adding supervised graded strengthening exercise (grade III NAD); and multimodal care (grade III WAD). For persistent neck pain (more than 3 months), the review recommends multimodal care or stress self-management; manipulation with soft tissue therapy; high-dose massage; supervised group exercise; supervised yoga; supervised strengthening exercises or home exercises (grades I-II NAD); multimodal care or practitioner's advice (grades I-III NAD); and supervised exercise with advice or advice alone (grades I-II WAD). For patients with persistent neck and shoulder pain, evidence supports mixed supervised and unsupervised high-intensity strength training or advice alone (grades I-III NAD). The term, “multi-modal care” is defined as a grouping of manipulation, mobilization, and soft tissue techniques (myofascial release, contract-hold, trigger point therapy, muscle energy, and more). Multi-modal care may also incorporate the use of hot or cold packs, assisted stretching, advice to stay active or modify activity, and neck/shoulder exercise training. Doctors of chiropractic often take a multi-modal approach when treating patients with musculoskeletal pain, including those with whiplash associated disorders. www.PainReliefChiroOnline.com

As with most musculoskeletal conditions, treatment guidelines for carpal tunnel syndrome (CTS) recommend non-surgical or conservative management initially, with surgery only in emergency situations or after non-surgical options are exhausted. So, is there a way to know who will respond best to non-surgical approaches? To answer this, researchers conducted a two-stage study that included an initial evaluation followed by non-surgical treatment and a re-evaluation one year after non-surgical treatment concluded. The primary goal of the study was to assess factors contributing to the long-term effects of non-surgical treatment of CTS and to identify failure risk factors. The study involved 49 subjects diagnosed with CTS, of which an occupational cause was identified in 37 (76%). Because some patients had CTS in both hands (bilateral CTS), a total of 78 hands/wrists were included in the study. Treatment included a total of ten sessions of whirlpool massage to the wrist and hand, ultrasound, and median nerve glide exercises performed at home. The subjects were divided into three age groups:

As screens (televisions, computers, and smartphones/tablets) become an increasingly important part of daily life, many people gradually take on a more slumped posture, which can place added strain on the neck and shoulders, raising the risk for neck pain and headaches. Luckily, it's possible to improve forward head posture, rounded shoulder posture, and scapular instability with neck-specific exercises and chiropractic care. In a 2018 study, patients with forward head posture performed either scapular stabilization or neck stabilization exercises for 30 minutes three times a week for four weeks. Participants in both groups experienced improvements related to their craniocervical angle and muscle activity around the upper back and neck, with greater results reported by the scapular stabilization group. Several studies have shown similar results for improving forward head posture using both scapular and neck stabilization exercises. In another study, high schoolers with forward head posture performed scapular and neck stabilization exercises and exhibited good posture up to four months later. A 2019 study looked at the effect of a six-week intervention featuring manual therapy and/or stabilizing exercises on 60 women with neck pain and forward head posture. Participants in both the manual therapy/stabilization exercise-combo group and the stabilization exercises-only group reported better outcomes with respect to head posture, pain reduction, and improved function, but the results were best in the combined treatment group. The authors concluded that manual therapy adds a meaningful role to a structured exercise program that addresses scapular and neck instability and forward head and rounded shoulder posture. Doctors of chiropractic often incorporate exercise training in their treatment recommendations, especially when postural issues may contribute to the patient's symptoms, like neck pain and headaches. www.PainReliefChiroOnline.com

While doctors of chiropractic enjoy helping their patients get better, the preference is to avoid injury in the first place, and if that's not possible, to reduce the risk for serious injury. This is especially important when it comes to car accidents, as whiplash associated disorders (WAD) injuries can persist for months to years and greatly reduce one's ability to carry out their normal activities. One of the most important steps you can take is to focus on the road while driving and eliminate distractions, which includes not texting while driving. In one study, researchers observed that even using hands-free functions increased the risk a driver would drift into another lane, drive too closely to the car in front of them, and be less responsive to changing road conditions. Other common distractions include fiddling with the radio, eating, reading (yes, people do this!), talking with other passengers (especially if you turn your head to look at them), and driving while intoxicated, while under the influence of legal/illicit drugs or medications, or while tired. Strategies to stay safe on the road include taking regular breaks (if driving a long distance), keeping your eyes moving (check mirrors frequently), not speeding or driving faster than road conditions allow, following traffic rules, using your signals, avoiding night and bad weather driving, heeding caution signs, and keeping your car properly serviced (including making sure there is enough air in your tires and that your tires are in good condition). Additionally, it's important to respond quickly to vehicle recalls. As they say, “An ounce of prevention is worth a pound of cure!” Sometimes it's not always possible to avoid an accident. Wearing a seatbelt can reduce the risk you'll be ejected from the vehicle in the event of an accident (which almost certainly results in fatality) or suffer more serious injuries. Making sure your head rest is properly adjusted can also reduce your risk for a serious head/neck injury. Automobile manufacturers continue to implement safety improvements in their vehicles. For example, a review of data between 1995 to 2016 supports that vehicle safety design improvements reduced the frequency of rollover crashes from 7% to 3.5% when comparing 1995-1999 vs. 2010-2016 model year vehicles, respectively. Starting in 1997, General Motors (GM) introduced high retention seats in their new model cars, SUVs, vans, and light trucks. A recent study compared the 1991 to 2000 Fatality Analysis Reporting System (FARS) data to the 2001-2008 FARS data to evaluate the impact of high retention seats. The data show that in rear impacts, high retention seats reduced the fatality risk from 27.1% to 16.6% and the risk of serious injury by 70.2%. If you're involved in a car accident, even a low-speed collision, it's important to be evaluated by a doctor of chiropractic to ensure any soft-tissue injuries that result are properly treated as soon as possible in order to reduce your risk for ongoing pain and disability. www.PainReliefChiroOnline.com

Carpal tunnel syndrome (CTS) has long been recognized as an occupational disease, and though the incidence of many other occupational diseases has decreased over time, CTS appears to be becoming more prevalent. A 2019 study looked at the impact/benefit of wrist-specific exercises and oral enzyme therapy on automotive assembly line workers with CTS (excluding those treated previously or who had a positive history of hormone replacement or current pregnancy, inflammatory joint disease, trauma to the affected hand, polyneuropathy, other relevant conditions). Participants in the exercise group performed the following exercises at home for nine weeks: Deep “push & pull”: Massage the palm-side of the wrist using the thumb from the opposite hand for 30 seconds. “Prayer Position”: Place the palms together in front of your chest; press the fingers slowly against each other for five seconds and release for five seconds; press the palms together and then slowly lower the hands toward the floor. Repeat as tolerated, gradually increasing reps. Neuromobilization: Stand sideways to a wall; place the palm of the left hand on the wall, fingers pointing back to a “10 o'clock” position. Start with the elbow bent and slowly straighten it while bending the head sideways toward the wall (left). Slowly bend the elbow and bend the neck/head to the right. Repeat six to eight times with each hand. The enzyme group took oral enzymes (which are known for their anti-inflammatory, anti-edematous, and analgesic effects) that included 2,000 mg pancreatin, 900 mg bromelain, 1,200 mg papain, 480 mg trypsin, 20 mg chymotrypsin, 200 mg amylase, 200 mg lipase, and 1,000 mg of rutin for nine weeks divided into two doses a day. Compared with a third group that continued their usual activities, participants in both the enzyme and exercise groups reported improvements with their CTS symptoms. Nerve conduction velocity tests also revealed improved function in the median nerve. Doctors of chiropractic commonly utilize a multi-modal approach when treating CTS, which often include manual therapies, nutritional recommendations, exercises, activity/modifications, and overnight wrist splinting. www.PainReliefChiroOnline.com

While tinnitus is commonly associated with a ringing sound in the ears, it can also involve a buzzing, hissing, or whistling noise. The sound can be intermittent or constant and can change in volume. The noise often intensifies in a quiet room when background noise is absent, such as at night, which can interfere with sleep. Approximately 50 million adults in the United States are affected by tinnitus, and up to 90% of people with tinnitus have some degree of noise-induced hearing loss. Though tinnitus can be due to many different causes, trauma-induced tinnitus from motor vehicle collisions is common. Studies have demonstrated that an 8 mph (12.87 kmph) rear-end collision can result in 4.5g of neck acceleration, which can cause a sprain/strain injury to the neck that can lead to the cluster of symptoms that characterize whiplash associated disorders (WAD) such as neck pain, back pain, mental fog, headache, balance disturbance, depression, anxiety, tinnitus, and more. Additionally, this process can also accelerate the head, essentially slamming the brain against the inside of the skull, followed by a rebound into the opposite side of the skull. This can lead to bruising on the brain, which is commonly called a concussion but is more formally known as a mild-traumatic brain injury (mTBI). This type of injury shares many symptoms with WAD, including tinnitus. If symptoms persist, the condition is known as post-concussive syndrome (PCS). This has led researchers to speculate that WAD and mTBI often co-occur, and treatment to address cervical spine dysfunction commonly observed in WAD patients may also help patients with PCS. In a 2015 study involving five patients with diagnosed PCS, researchers observed that when the patients received manual therapy treatment to address cervical spine dysfunction, they reported improvements in several symptoms associated with PCS. Doctors of chiropractic are highly trained to manage cervical spine dysfunction, a common sequela following a motor vehicle collision. Frequently, the many symptoms associated with WAD, including tinnitus, improve once the dysfunction is managed through manual therapies applied to the muscles and joints in the neck. If you are suffering from the aftermath of an MVC, please see your chiropractor! www.PainReliefChiroOnline.com

Osteoarthritis (OA) is the most common form of arthritis and is caused when the smooth cartilage surface of an articulating/moving joint wears away until there is bone-on-bone contact that results in both loss of movement and pain. Although OA most commonly affects the joints under the greatest load (the hips and the knees), it can occur in any moving joint, including those that make up the shoulder. Because cartilage lacks a direct blood supply, it relies on a process called diffusion in which nutrients are absorbed into cartilage when it's compressed by movement. Anything that restricts the movement of the joint (like inflammation or injury) can slow or cut off its supply of nutrients, placing the tissue at risk for injury and degeneration. When a patient presents for care involving OA of the shoulder, chiropractic treatment will generally focus on improving the motion of the affected joints with manipulation, mobilization, manual traction, manual massage, active release techniques, acupuncture, physical therapy modalities (such as ultrasound or electronic stim), nutritional counseling, and home-based exercises. Here are some additional ways to self-manage osteoarthritis of the shoulder: Stay Active: Movement/exercise is the BEST way to keep joint cartilage nourished and healthy. Many people can manage the pain often without medication by simply pacing themselves and by staying active. Eat a Healthy Diet: Keep your diet balanced and emphasize foods that reduce inflammation or swelling like omega-3 fatty acids (fish oil), ginger, turmeric, Boswellia, and more. Reduce the Load on the Joints: This includes losing weight, as well as modifying job/lifestyle activities that routinely place force on the affected joints. Get Plenty of Sleep: Several studies show that getting too little or too much sleep each night can lead to poor outcomes. Aim for seven to nine hours of restful sleep. Use Hot/Cold Packs: This is a great way to reduce inflammation. Supplements: Consider glucosamine and chondroitin. Generally, the more advanced the case, the longer it will take to achieve a successful outcome, if at all. That's why it's important to seek care sooner rather than later when you experience pain in the shoulder or any other part of the body. www.PainReliefChiroOnline.com

When someone is diagnosed with carpal tunnel syndrome (CTS), there seems to be an automatic assumption that surgery is imminent or at least inevitable. However, treatment guidelines for CTS that are intended to be followed by ALL healthcare professionals ALWAYS recommend an initial course of non-surgical treatment, NOT jumping directly to surgery. Unfortunately, evidence-based treatment guidelines are not always followed, and many patients are not given an option for anything other than surgery. The following is an excerpt from a 2017 Washington State CTS treatment guideline: All of the following criteria must be met for surgery to be authorized: The clinical presentation is consistent with CTS The EDS [electrodiagnostic studies] criteria for CTS have been met The patient has failed to respond to conservative treatment that included wrist splinting and/or injection Medical-based non-surgical care for CTS includes: neutral position wrist splints worn at night and (in certain cases) at times during the day (studies report that 30-70% of patients respond favorably within several months of initial wrist splint use); glucocorticoids injections into the carpal tunnel (these can provide short-term relief with about 50% of patients requiring surgery within one year); and forearm and wrist exercises. Doctors of chiropractic often use a combined approach based on the patient's unique case, which can include wrist splints and exercise training (as described above) along with manual therapies like manipulation and mobilization on the wrist and elsewhere along the course of the median nerve; physical therapy modalities such as laser therapy, ultrasound, and pulsed electromagnetic field; nutritional counseling, especially anti-inflammatory herbs like ginger, turmeric, and Boswellia; and ergonomic medications such as changing a workstation setup or the grip on tools used to perform job functions. Studies show that, in most cases, mild-to-moderate CTS can respond to non-surgical approaches just as well as surgery (though without the potential side effects associated with going under the knife), which underscores the importance of seeking care for CTS as soon as possible. www.PainReliefChiroOnline.com

In the face of musculoskeletal pain, it's common to restrict activity. Unfortunately, doing so can weaken the muscles and joints in the affected area, which can prolong pain and elevate the risk for future injury. Patients with osteoarthritis of the knee often fall into this trap. So, what type of exercises are best for improving knee strength in the presence of knee osteoarthritis? First, let's define two types of muscle activity that can occur during exercise: eccentric and concentric. During a bench press, when you're pushing the barbell upward, the muscles in the chest shorten in a concentric motion. As you lower the bar downward, your pectoralis muscles lengthen, which is an eccentric motion. A 2019 study that involved 54 seniors with knee osteoarthritis investigated which of the two phases builds better strength for the knee – the concentric/muscle shortening phase or the eccentric/muscle lengthening phase of muscle activity. The participants were split into three groups: CNC RT (concentric resistance), ECC RT (eccentric resistance), or CON (control group – no exercise/wait-list group). The two exercise groups received four months of supervised exercise training using traditional weight machines with proper set-ups and instructions that emphasized the concentric or eccentric phase of the exercise. Each week, participants completed questionnaires to measure knee pain and disability. The researchers also recorded the maximum weight each subject could lift with respect to knee flexion, knee extension, and the leg press. The results showed that BOTH exercise groups experienced strength increases in comparison to the control group, with the eccentric resistance group achieving greater gains on the leg press and knee flexion exercises, but not for knee extension. Both exercise groups also reported less pain and disability than the control group. The authors concluded that both types of resistance training effectively improved leg strength, pain, and function, and they recommend that the mode an individual emphasizes should be based on personal preference, goals, tolerance, and equipment availability. This study is a great example of the many benefits that exercise can offer for an elderly population suffering from knee osteoarthritis. Doctors of chiropractic often prescribe exercises for patients with knee pain in addition to providing manual therapies, modalities, orthotics (knee braces and foot orthotics), as well as dietary and nutritional counselling for inflammation reduction and pain management purposes. Before throwing in the towel and jumping to a total knee arthroplasty (replacement), you owe it to yourself to seek less invasive management strategies FIRST. www.PainReliefChiroOnline.com

The cervical spine relies heavily on muscular support, particularly from the deep muscles in the front and back of the neck. Some experts estimate that up to 70% of the stability of the cervical spine arises from these deep neck muscles, particularly those in front of the spine. Studies have demonstrated that the rapid acceleration-deceleration forces that are placed on the neck during a motor vehicle collision can injure these deep neck muscles. Indeed, electromyographic (EMG) testing conducted on WAD patients has shown that those with higher pain intensity also had reduced deep muscle function in both the front and back of the spine. Treatment guidelines for non-specific neck pain recommend incorporating neck-specific exercises into the treatment process. But what about for WAD patients with neck pain? A 2018 study that involved 26 patients with chronic WAD (symptoms lasting longer than three months) evaluated the role of neck-specific exercises (such as cranio-cervical flexion—tucking in the chin and approximating the chin toward the chest while looking straight ahead without bending the head forward) had in improving muscle performance, disability, and pain intensity over the course of a three-month time frame. After three months, the researchers used a special type of diagnostic ultrasound to measure function in one large superficial muscle and two deep muscles that all reside in the front of the neck. Investigators observed that the participants in the neck-specific exercises (NSE) group experienced significant improvements with respect to muscle function, disability, and pain intensity that were not observed among those in a “wait list” group who served as controls. Here's where it gets more interesting… At the three-month point, the members of the control group were added to the NSE group, and three months later, the researchers observed that these participants experienced the same improvements that they previously noted in the first NSE group! This study supports the need for specific neck exercises to reduce pain and disability and improve function. When the deep muscles are injured, it's common for the body to recruit superficial muscles to help stabilize the body and maintain posture. While this can protect the deep muscles from further injury in the short term, it can decondition these muscles over time and allow fatty deposits to infiltrate its tissue. This helps to explain why exercises are so important in the recovery process from musculoskeletal injuries, especially since there's research that says that up to half of WAD patients will still experience pain and disability a year after their accident. This underscores the importance of seeking treatment for WAD as soon as possible in order to reduce the risk for chronicity and while the chances for full recovery are greatest. www.PainReliefChiroOnline.com

Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy, or pinched nerve, in the extremities. The condition is estimated to affect 3-6% of the population, often in both hands. Let's discuss what causes CTS, its symptoms, how it's diagnosed, and how it's treated… Causation: Carpal tunnel syndrome occurs when pressure is placed on the median nerve as it travels through the wrist. This can be due to inflammation caused by obesity, repetitive movements, pregnancy, arthritis, hypothyroidism, diabetes mellitus, trauma, mass lesions, amyloidosis, sarcoidosis, multiple myeloma, leukemia, and more. Women are at a greater risk for CTS than men, due to having a smaller wrist and possibly hormonal reasons. Symptoms: Pain, numbness, and tingling are common CTS symptoms that affect the thumb, index finger, middle finger, and the thumb-side of the ring finger. Symptoms can radiate up into the forearm and even into the shoulder and neck. Weakness in grip strength and nighttime/sleep interruptions are also common symptoms. Diagnosis: The patient history is very important for diagnosing CTS, as it provides the doctor information to help determine if CTS is likely or if another condition is causing the patient's symptoms, such as ulnar tunnel syndrome or dysfunction elsewhere along the course of the median nerve. The “flick sign” (flicking the fingers to “wake them up”) predicts electrodiagnostic abnormalities 93% of the time with a false-positive rate of

Experts estimate that whiplash associated disorders (WAD) from motor vehicle collisions (MVCs) affect about 300 for every 100,000 people in the Western each year. Suffice it to say, that's a lot of people! Crash tests have demonstrated that the risk for whiplash is much greater when the backrest is leaned backward and/or when a headrest is lacking (in older cars) or is too low in relation to the head. The key is to prevent the head from extending backward over the top of the seat, which can lead to more severe soft tissue injuries in the neck. While it's not always possible to anticipate an MVC, past research has shown that looking forward at the time of the collision may reduce WAD injury/severity risk. On the topic of necks, individuals with thinner necks have a greater risk for injury, which may explain why woman are more often affected by WAD than men. However, regardless of whether you are male or female, staying fit and keeping the neck muscles strong is important. It's been suggested that individuals with a history of neck pain are more likely to experience more severe whiplash injuries, as are those in poor general health. There are conflicting studies that report that seat belt use may increase the risk for WAD, but after reviewing multiple studies, the consensus is that seat belts save lives, so buckle up! In many cases, WAD patients may miss work, especially if they have a job with high physical demands. Patients with more severe injuries may miss up to twenty-five days of work, while those with minor injuries may still be out for up to ten days. One study found that about 31% of the 800 cases the researchers looked at took no time off work, 52% returned to work after only four days off, and 90% returned within thirty days off. About 4.9% of the patients in the study were still not working after twelve weeks. Several factors suggest a WAD patient may experience a slower or more limited recovery: a history of neck pain; loss of neck motion measured post-MVC; increased sensitivity to cold stimulation; high pain levels post-MVC; less severe crash-type; dizziness, arm pain or numbness; low back pain; and poor expectations of recovery. The good news is that treatment guidelines have consistently recommended spinal manipulation— he primary form of treatment provided by doctors of chiropractic—for managing whiplash-related injuries. www.PainReliefChiroOnline.com

A 2009 study that monitored over 8,800 elderly French adults found that an individual's blood pressure can fluctuate with the seasons. In particular, the researchers observed that as temperatures fell, both systolic and diastolic blood pressure could rise to unhealthy levels, but they were unable to determine why. However, a study published just five years later may have solved the mystery. The solution has to do with the molecule nitric oxide. Nitric oxide is a vasodilator, meaning that it causes the walls of blood vessels to relax and expand, with a resulting reduction in blood pressure. Researchers have discovered that nitric oxide is stored in the dermal vasculature at levels much greater than are found circulating in the bloodstream. When exposed to long-wave ultraviolet (UVA) rays, the skin releases some of that stored nitric oxide into the bloodstream. Because individuals tend to spend less time in the sun during the winter months, there are fewer opportunities for the skin to release nitric oxide into the blood, dilate blood vessels, and moderate blood pressure. This may also help to explain why stroke and blood vessel rupture (aneurism) are more common in the winter months among the elderly. How can one maintain healthier levels of nitric oxide in their bloodstream when it's not convenient to spend time in the sunshine? The answers may be found in diet and exercise. A 2018 study found that eating leafy greens and root vegetables and drinking beetroot juice effectively increased nitrate plasma (blood) levels for the purpose of enhancing exercise performance. In 2020, researchers observed that schoolteachers in South Africa with greater physical fitness levels had higher levels of nitric oxide in their blood, as well as lower systolic and diastolic blood pressure readings. The research team concluded, “These results may suggest that even moderate physical activity could increase nitric oxide synthesis capacity, which in turn may mitigate the development of cardiovascular disease in this population.” The take home message is that to maintain a healthier blood pressure, consider getting plenty of sunshine, eating leafy green and root vegetables (or drink beetroot juice), and exercising! www.PainReliefChiroOnline.com

One of the symptoms commonly associated with whiplash associated disorder (WAD) is headaches. The current research suggests that up to 50% of patients who experience whiplash-associated headaches may continue to suffer from them for up to a year or more, and many of those will continue to have headaches as late as five years following their whiplash injury event. There are many potential causes for WAD-related headaches, which can include cervical injury, jaw dysfunction (TMJ), psychological distress (depression and anxiety), brain structure abnormalities (concussion), and/or overuse of headache medications. To address these potential causes of whiplash associated headaches, treatment may include the following: MANUAL THERAPIES: Mobilization and manipulation, which are commonly used by doctors of chiropractic, have been demonstrated to be effective for reducing pain and improving function for many conditions, including WAD and headaches of cervical origin. Treatment may also involve massage and physical therapy modalities, depending on the patient's needs. EXERCISE: A review of research published between 1990 and 2015 found that craniocervical, cervicoscapular, and posture correction exercises can be helpful in the treatment of whiplash-related headaches. STAY ACTIVE: Try to carry on with normal activities within pain tolerances, as movement is needed to keep soft tissues healthy and to ensure a continuous supply of nutrients to the cervical disks. Don't use a cervical collar to immobilize the neck unless directed to do so by your doctor. NUTRITIONAL SUPPORT: There are several vitamins and supplements that have been shown to reduce inflammation and/or reduce pain. These include flavonoids, curcuminoids, omega-3 fatty acids, taurine, and vitamin D. Adopting an anti-inflammatory diet can also aid in the healing process. Doctors of chiropractic frequently use a combination of these approaches when managing WAD patients to help reduce pain and disability and assist the patient in returning to their normal activities as soon as possible. www.PainReliefChiroOnline.com

With many sports requiring overhead movements that can place the shoulder at the extreme end of its range of motion, it's not surprising that shoulder injuries are so common among athletes. For instance, up to 50% of NCAA college football players have some history of shoulder injury, which comprises about 10-20% of total injuries in the sport. When looking at collegiate quarterbacks, one study found that shoulder injuries accounted for more than half of injuries among players in the position. When it comes to sport-related shoulder injuries, these are the three most common (and to complicate matters, they often co-occur): 1) SLAP (or labrum) tears: Superior (top) Labral tear from Anterior (front) to Posterior (back) tear is a term used to describe a torn piece of cartilage located along the rim of the socket. The labrum adds depth to the cup, which helps to stabilize the ball in the socket. Individuals with a SLAP tear will often report a loss of motion and power, a feeling like their shoulder could pop out of socket, and a deep ache that is hard to pinpoint when attempting overhead movements. 2) Shoulder instability or dislocation: With contact sports, there's the opportunity for a collision that can dislocate the ball of the shoulder joint (the end of the humerus bone) from the shoulder socket. Because the muscles in the front of the shoulder tend to be larger and stronger, the dislocation will more often occur in that direction. Symptoms can include a severe, sudden initial pain followed by short bursts of pain as well as swelling and a noticeable deformity in the appearance of the shoulder. 3) Rotator cuff tears (RCTs): This is common in sports that require repetitive overhead motion like baseball (especially among pitchers), swimming, and tennis. Symptoms include a deep, hard to locate ache, weakness, and reduced range of motion (especially overhead or to the back). In general, early/prompt care yields the best results. While there are instances when a prompt surgical procedure is warranted, treatment guidelines typically emphasize non-surgical therapies first with surgery only after all other options have been exhausted. Chiropractic management of these conditions will often involve a multi-modal management approach that includes manual manipulation and mobilization to the shoulder's multiple joints, the neck, and the mid back; specific shoulder exercise instruction; physical therapy modalities (ice, electrical stim, ultrasound, laser, pulsed magnetic field, and more); and nutritional recommendations. www.PainReliefChiroOnline.com

Carpal tunnel syndrome (CTS) is a condition that occurs when the median nerve is compressed as it passes through the wrist. One treatment option available to patients is carpal tunnel release surgery, which severs the carpal tunnel ligament to reduce pressure on the affected nerve to resolve the numbness, pain, tingling, and weakness symptoms associated with CTS. When is surgical treatment for CTS necessary and when should a non-surgical option be pursued? The short answer is that surgery should only be considered as a first option in an emergency situation, such as a serious wrist fracture that pinches the median nerve. Beyond that, treatment guidelines generally advise patients to exhaust non-surgical, conservative approaches before consulting with a surgeon. Aside from potentially higher healthcare costs and a prolonged recovery, surgery also carries the risk for serious complications. Another thing to consider is that the current research suggests that jumping straight to surgery may not necessarily produce better long-term outcomes than non-surgical treatment options. In one randomized clinical trial, researchers recruited 120 female CTS patients to receive either surgery or a conservative treatment approach that involved manual therapies. The research team evaluated each patient after one month, three months, six months, and one year. In the short term—one month and three months—the results favored the conservative approach. However, both groups reported similar outcomes after six months and one year. The same research team repeated the study with another group of female CTS patients and reported similar results. In the short term, conservative care achieved greater results while both approaches had similar outcomes over the long term. A systemic review that looked at results from ten studies involving patients with confirmed CTS in one or both hands came to a similar conclusion. The review found that non-surgical care provided more satisfying results in the short term with both approaches achieving similar results over time. While these studies show that conservative treatment to reduce pressure in the carpal tunnel is an effective option for the CTS patient, doctors of chiropractic will also examine the full course of the median nerve to identify other places the it may be compressed, such as the neck, shoulder, and elbow. Median nerve compression in these areas can often co-occur with CTS and will need to be addressed to achieve a satisfactory result. www.PainReliefChiroOnline.com

Neck pain is one of the most common complaints that drive patients to seek chiropractic care. Sometimes the cause of injury is a known traumatic event, but in many cases, neck pain is the result of wear and tear from poor posture—forward head posture in particular. The head, which weighs 10-11 lbs. (4.5-5 kg), typically rests above the shoulders. When an individual's head leans forward to look at a computer screen or to look downwards at their smartphone/tablet, the muscles in the rear of the neck and upper back/shoulders need to work harder to keep the head upright. Experts estimate that for each inch (2.54 cm) of forward head posture, the head feels about 10 lbs. heavier to the muscles that attach to the back of the head and neck. To illustrate this, pick up a 10-pound object like a bowling ball and hold it close to your body. Then, hold it away from your body with your arm outstretched and feel how much heavier it seems and the strain it places on your body to maintain that position for even a short time. In the short term, forward head posture is something the body can manage, but over time, the muscles can fatigue and the strain can injure the soft tissues in the back of the neck, shoulders, and upper back. To adapt, some muscles may become stronger (and some may atrophy), the shoulders can roll forward, the cervical curve can straighten, etc. Researchers have observed that forward head posture can also reduce neck mobility, especially with rotation and forward flexion movements. While these changes can lead to several negative health issues, neck pain is perhaps the most obvious and common. When a patient presents for chiropractic care for neck pain, postural deficits will likely need to be addressed to achieve a satisfactory outcome. This can be achieved with manual therapies to restore proper motion in the affected joints and with exercises to retrain the muscles that may have become deconditioned. Additionally, a patient will need to develop better postural habits, especially when interacting with their electronic devices. While the process can take time, the good news is that it's possible to reduce forward head posture, which can also lower the risk for neck pain recurrence. www.PainReliefChiroOnline.com

When it comes to managing a low back condition, the goal of chiropractic treatment is for the patient return to their normal daily activities as soon as possible. This not only means addressing low back pain but also low back disability, including impaired postural control and reduced spinal stability, which can manifest in reduce position sense, increased postural sway, and impaired balance. Movement control and spinal stability are controlled the deep muscles, the superficial muscles, and the nervous system that sends information to and from the brain. Dysfunction in ANY of these can result in lumbar spine instability. To complicate matters, when an injury is present, the body will alter its neuromotor patterns as a protective mechanism. However, this can lead to some muscles becoming overworked while others may become deconditioned. If unaddressed, additional musculoskeletal conditions may result in nearby parts of the body, which explains why patients will often present with multiple seemingly unrelated complaints. In addition to manual therapies like manipulation and mobilization to restore proper joint movement, treatment for low back pain may also include core stabilization/strengthening exercises and balance exercises. For abdominal strengthening, one exercise that works well is a spine-sparing sit-up. Place the hands behind the lower back to prevent flattening of the lumbar curve and lift the head and chest as a unit a few inches off the floor, hold for ten seconds, and repeat to tolerance (five to ten reps to start out with). To strengthen your sides, try a side-bridge or side-plank (from feet or knees), holding for ten seconds and repeating as tolerated. To strengthen the back, try the front plank. Rest on your forearms in a push-up position for ten seconds and repeat as tolerated. The bird dog is another good exercise. Kneel on your hands and knees and raise the opposite arm and leg without twisting the trunk and hold for ten seconds, repeat with the other arm/leg. For improved balance, stand on one leg with your eyes open or closed (if able) as long as you can. This stimulates the neuromotor system. Be safe, and do these in a corner to prevent falling! Make these exercises a habit. Consistency will help improve low back function and you'll reduce your risk for a future episode of low back pain! www.PainReliefChiroOnline.com

While neck pain is most commonly associated with whiplash associated disorder (WAD), patients often report jaw or temporomandibular joint (TMJ) pain following a car accident, sport injury, or slip and fall. Common symptoms associated with temporomandibular disorders (TMD) include pain in the jaw joint area (in front of the ear), neck and shoulder pain, ear area pain with chewing or yawning, a “stuck” or locked feeling, and clicking, popping, or grating sounds with jaw movements. Patients with TMD may also feel like their teeth don't fit well together, or report toothaches, headaches, dizziness, and tinnitus (ringing in the ear). An MRI (magnetic resonant imaging) study of TMD following a WAD injury revealed joint effusion or swelling and/or disk displacement in more than half of the participants, along with alterations in the thickness of the lateral pterygoid muscle (LPM) that helps open the mouth. Studies have shown that rear-end collisions can result in trauma to the muscles in the area of the TMJ, along with its joint capsule and fibroelastic disk. Post-traumatic muscle imbalance can then perpetuate the problem, leading to chronic TMD. A 2018 study found that patients with TMD following a whiplash injury (wTMD) had higher pain intensity scores, worse exam findings, worse function, and greater muscle atrophy in the LPM than patients whose TMD resulted from another cause. The patients with wTMD were also more likely to be affected by stress and headaches than the other TMD patients. The authors concluded that TMD is a common WAD-related injury, and MRI findings of disk displacement and LPM alterations are often found together. They also point out that TMD from whiplash appears to involve a different mechanism than TMD from other types of trauma or no trauma. Doctors of chiropractic are trained in the assessment and treatment of WAD, including TMD, which often involves a multi-faceted approach that includes manipulation, mobilization, and soft tissue techniques (myofascial release, contract-hold, trigger point therapy, muscle energy, and more). www.PainReliefChiroOnline.com

Carpal tunnel syndrome (CTS) is a condition that we typically associate with overuse activities, especially occupations that require fast, repetitive hand work such as typing, sewing, and packaging. However, the hormonal changes that occur in pregnancy can also lead to swelling or inflammation in the wrist, and subsequently, the symptoms associated with CTS. A 2019 study involving 382 women in the third trimester of pregnancy revealed that 111 (23.03%) experienced the signs and symptom consistent with mild-to-severe CTS. Further analysis showed that the women who were older, left-handed, and had gestational diabetes mellitus were more likely to have severe CTS symptoms. It makes sense to assume that pregnancy-related CTS would resolve once a woman has given birth, but another study suggests this isn't always the case. In one long-term study, researchers monitored the status of 45 women who presented with CTS during their pregnancy. One year following the birth of their child, only 40% of the participants reported that their symptoms (pain, tingling, numbness) and function had improved. Half of the women reported no change in their symptoms or function and a small portion said their condition worsened (13.3% symptoms, 4.4% function). Nerve conduction testing showed no problems in 17.8% of participants, with the rest experiencing some degree of nerve interference. At the three-year mark, 51% were symptom-free, while 49% were still symptomatic but less so compared to their situation at the start of the study and at the one-year follow-up. In conclusion, although many women who develop CTS during pregnancy will experience improvement over time, almost half will continue to report symptoms and functional impairments up to three years after the birth of their child. Doctors of chiropractic offer a non-surgical, effective combination of management strategies that can be easily and safely applied during pregnancy and after delivery. Because CTS can be highly disruptive to sleep and cause other quality-of-life issues, women with the condition should strongly consider chiropractic care during pregnancy and after if symptoms or problems persist. www.PainReliefChiroOnline.com

It's estimated that up to 50% of whiplash associated disorder (WAD) patients will develop chronic symptoms such as neck and upper back pain, headache, dizziness, emotional and cognitive disturbance, referred pain, and physical dysfunctions. Fibromyalgia (FM) is a condition that is also characterized by long-term, persistent symptoms such as chronic widespread musculoskeletal pain, sleep disturbance, cognitive disturbance, fatigue, and physical dysfunctions. Both WAD and FM patients share similar chronic, debilitating signs and symptoms. Why is this so? In one study, researchers evaluated cognitive loss, central sensitization, and health-related quality of life (QoL) in chronic WAD patients, FM patients, and individuals without any known chronic conditions to serve as a control group. Participants in both the WAD and FM group exhibited significant cognitive impairment, central sensitization, and decreased health-related QoL, suggesting that brain injury plays a significant role in each condition. In WAD injuries, the mechanism of injury causing cognitive loss (the brain's inability to process information) appears to arise from the brain slamming into the inside of the skull. In a classic rear-end collision, the brain first hits the back of the brain casing followed by the rebounding into the front of the skull, causing a concussion. A 2011 study found that among 58 women who had been admitted to the emergency room for a whiplash injury, three met the clinical criteria for FM three years later. Another 2011 study found that among 326 WAD patients with persistent neck pain lasting longer than three months, up to 14% met the criteria for FM. Based on these findings, it's clear that the whiplash process could be a strong contributing factor for developing FM. Indeed, a 2015 study that looked at the health histories of 939 FM patients identified trauma as a precipitating factor in 27% of cases. While we typically associated whiplash with motor vehicle collisions, such injuries can also occur in sport collisions, physical assaults, and falling. It's possible that a greater percentage of FM cases may be due to trauma the participant simply wasn't able to recall. Emotional trauma and post-traumatic stress disorder have also been associated with an elevated risk for FM. The disease process for FM isn't entirely understood, and in cases when the cause is not known, it's possible the condition could be the result of a cumulation of factors, including WAD. Nonetheless, it's clear that chronic WAD and FM are potentially debilitating conditions and seeking treatment after a trauma, such as a motor vehicle collision, is important for mitigating the risk for chronic symptoms. The good news is that both FM and WAD patients respond very favorably to chiropractic care! Doctors of chiropractic are trained to examine, diagnose, and treat those presenting with FM and WAD. Studies have reported that the inclusion of spinal manipulation enhances recovery in acute and chronic WAD, as well as FM. www.PainReliefChiroOnline.com

Alzheimer's disease (AD) is the #1 cause of dementia, representing an imminent threat to our senior population. It is one of mankind's cruelest afflictions that causes patients lose their memory, personality, and eventually self-care skills. According to the Centers for Disease Control and Prevention (CDC), about 6 million people currently have AD with projections of this doubling in the next two decades. The 2015 Framingham Heart study reported that 1 in 5 women and 1 in 10 men will develop AD. Though researchers have observed an association between beta-amyloid plaque build-up in the brain and AD, well-funded studies have failed to determine that beta-amyloid plaques are the cause of the disorder. Interestingly, two studies published nearly 40 years ago concluded that the virus that causes cold sores (HSV-1) may play a role in the development of AD. This suspicion was bolstered by a 2014 study that detected the virus in the brains of AD patients, particularly in the parts of the brain related to memory. Neuroscientists propose that the plaque build-up commonly seen in AD patients may a consequence of the immune system trying to battle the presence of HSV-1 in the brain. This finding suggests that AD could potentially be treated, or even prevented, by therapies that target HSV-1. Dr. Robert Rubey notes that as far back as 1968, researchers have known that HSV-1 requires the molecule arginine for replication, which can be blocked by the presence of the amino acid L-lysine. Double-blinded studies have demonstrated L-lysine is effective at both preventing or decreasing/reducing the severity of HSV-1 outbreaks. Dr. Rubey concludes that AD is a disease process, NOT an aging process. The importance of preventing viral reactivation leading to brain inflammation/damage is key in preventing AD. In 2010, Dr. Rubey speculated that supplementing with 1,500mg of L-lysine twice a day combined with a low-arginine diet (reduced intake of nuts, seeds, grains, and tofu) may protect against AD. However, more research is needed in this area before firm recommendations can be made. Doctors of chiropractic often recommend anti-inflammatory diets and supplements for both aiding the recovery process from musculoskeletal injuries and living a healthier lifestyle. www.PainReliefChiroOnline.com

The shoulder is one of the largest and most complex joints in the body. It's actually three joints—the AC or acromioclavicular joint (the collar bone/acromion of the shoulder blade joint), the glenohumeral joint (the ball-and-socket joint), and the scapulothoracic joint (the shoulder blade/rib cage “joint”)—all of which involve the scapula to some degree. The rotator cuff is made up of four muscles, three of which sit on the back side of the scapula and rotate the arm outward (external rotation) and one in front that rotates it inward (internal rotation). The trapezius muscle is made up of three parts: the upper part pulls the shoulder blade up and in, the middle portion pulls the shoulder inward, and the lower section of the muscle pulls the scapula down and inward. The chest muscles rotate the arms inward. There is also a “bursa” or a fluid-filled sac that cushions, lubricates, and protects the rotator cuff tendon attachments. The “labrum” attaches to the rim of the “socket” or cup, to give it more depth and stability for the ball to sit in. While this arrangement gives the shoulder a wide range of motion, it also makes it less stable and more vulnerable to injury. There are many injuries that can affect the shoulder, with one of the most common being tearing of the rotator cuff tendons (called “tendinitis” or “tendinopathies”), which often lead to a bursitis, or swelling of the bursa sac, resulting in shoulder impingement (pain raising the arm). In fact, over half of people in their 80s have tearing of the rotator cuff. There are many exercises that help return function to the shoulder in both non-surgical and post-surgical cases. Exercises are aimed at restoring motion, strengthening weak muscles, and stabilizing the shoulder. However, studies show that the best results are achieved when scapula stabilization exercises are included in the treatment process. One GREAT exercise for stabilizing the scapulae is called the Push-Up Plus (PUP). This is performed by positioning yourself into a push-up position (either toes or knees—you choose based on strength) with your hands shoulder width apart, elbows locked straight, and the fingers pointed outward (thumbs at 12 o'clock). Instead of dropping the chest to the floor, PUSH the middle of the back upward toward the ceiling. Hold the position for three seconds and SLOWLY return to the start position. Repeat five to ten times and gradually increase reps as you're able. There are several variations of this. For example, rotating your fingers inward increases activity in the rotator cuff muscles (the most important muscle group for shoulder stabilization) and reduces activity in the chest muscles (pectoralis major) and scapula elevators (levator scapula). You can also alter this by raising your feet to different heights, as the higher the feet, the greater the serratus anterior muscle activity! Your doctor of chiropractic can advise you on which shoulder stabilization exercises may provide the most benefit for your unique case. www.PainReliefChiroOnline.com

In addition to spinal manipulation, doctors of chiropractic often use other conservative therapies to reduce pain and improve function in patients with neck pain. When it comes to neck conditions involving herniated disks, radiating arm pain (“radiculopathy”), strains, facet syndromes or sprains, and myofascial pain, cervical traction is one such option. As part of the initial new patient examination, a chiropractor may use their hands to gently pull on the patient's neck while in sitting and/or supine (lying on the back) positions. If this feels good, then cervical traction may be warranted either in the office, with an at-home unit, or both. However, cervical traction is not advised if there is instability in the spine/ligaments, vertebral artery insufficiency, rheumatoid arthritis, osteomyelitis, discitis, neoplasm, severe osteoporosis, untreated hypertension, severe anxiety, cauda equina syndrome, or myelopathy. There are various forms of cervical traction devices, so treatment may be performed while the patient is in a standing, sitting, lying horizontal, or inclined either prone or supine position, and the traction force can be continuous or sustained vs. intermittent or pulsed. Variables include body/head weight and the associated friction against the traction table in lying down types of units, and the angle can often be varied with most types of traction units. There are pros and cons to different types of traction units. Lying down traction may allow for better relaxation vs. sitting, but more weight may be needed due to the friction of the body on the table. Generally, when hold times are longer (especially with sustained traction), less weight is used. Some doctors advocate starting at 5 lbs. (~2.67 kg) for 15 minutes with a sitting device (sustained traction) and gradually increasing the weight to maximum tolerance while keeping the time constant at 15 minutes. There are a number of theories on why traction relieves pain: it forces rest through immobilization and by supporting the weight of the head, it pulls apart or opens the facet joints, it improves nutrition to the joint cartilage, stretches ligaments, it decreases the pressure inside the disks, it reduces pressure on nerve roots (by widening the holes through which they travel), it improves head posture, and/or it stretches the neck muscles to improve blood flow and reduce muscle spasm. The bottom line, if you have neck pain and manual traction applied to the cervical spine provides pain relief, then your doctor of chiropractic may choose to incorporate this therapy into your treatment plan, either in the office, at home, or both. www.PainReliefChiroOnline.com

It's common for the elderly to have multiple chronic conditions, all of which can impact their ability to live a vibrant, independent lifestyle. While it may not be possible to avoid adverse health conditions in our later years, it appears there are steps we can take now to give ourselves the best possible chance to maintain good health for as long as possible. In an April 2020 study published in the Journal of the American Medical Association, 32 researchers from around the world collaborated to investigate the association of a healthy lifestyle with years lived free of major chronic diseases like type 2 diabetes, coronary heart disease (CHD), stroke, cancer, asthma, and chronic obstructive pulmonary disease (COPD). The data set for the study included 116,043 adults (average age 43.7 year) whom researchers followed for an average of 12.5 years. At baseline, the investigators looked at four lifestyle factors (smoking, body mass index, physical activity, and alcohol consumption) and assigned a scoring system for each factor (0=poor; 1=intermediate; 2=optimal) for a total score of 8. During the course of the study, 15% of participants developed at least one chronic disease. The research team's analysis showed that every one-point increase in an individual's healthy lifestyle score translated to an increase of .96 chronic disease-free years in men and .89 chronic disease-free years in women. Compared to individuals with a score of 0, those with a score of 16 benefited from an average of 9.4-9.9 additional chronic disease-free years! The findings showed that maintaining a healthy weight (BMI or body mass index of ~25), not smoking, avoiding excessive alcohol consumption, and getting regular exercise dramatically increased the odds of reaching age 70 without chronic disease. Doctors of chiropractic frequently encourage patients to live a healthy lifestyle because not only can it add years to your life, as this study suggests, it can add life to your years. www.PainReliefChiroOnline.com

A study published in 2019 found that nearly half of whiplash associated disorders (WAD) sufferers are still symptomatic one year after their injury. Why is that, and what can one do to reduce their risk for chronic WAD symptoms? The most common source of pain from WAD injuries arises from joint capsules and ligaments, which are tough, tight bands of tissue that hold joints together and help stabilize the cervical spine. When these soft tissues are damaged, the body will take measures to restrict movement so that the injury doesn't become more severe. This is one reason why cervical range of motion is reduced when the neck is injured. You may recall that a patient with whiplash used to be fitted with a cervical collar to protect the neck and limit movement. However, researchers have since discovered that, in many cases, restricting all cervical movement for a prolonged period of time can lead to a weakening of the deep neck muscles—which are important for maintaining cervical posture—and the buildup of potentially troublesome scar tissue. These days, patients are encouraged to remain active provided their movements do not generate acute pain. Not only does staying active reduce the risk of deep neck muscle atrophy, but movement is necessary to produce the compressive forces that help maintain the flow of nutrients to the cartilaginous tissues in the neck. The back-and-forth whiplash process can also result in trauma to the brain, also known as a concussion. The brain is suspended in the skull by ligaments and is cushioned by fluid. In a rear-end collision, the oblique angle of the chest restraint results in a twisting of the torso upon impact as the body accelerates forward. The brain slams into the front inside of the skull and then rebounds and hits the back inside of the skull as the trunk is forced backward during the deceleration phase of the injury. Depending on the degree of force, concussion can involve the front, back, or both parts of the brain resulting in memory problems, confusion, fatigue/drowsiness, dizziness, vision problems, headache, nausea/vomiting, light/noise sensitivity, and more. The good news is that chiropractic care applied to the cervical spine has been demonstrated to benefit patients with these post-concussive symptoms that often accompany WAD, which may reduce the chances that such symptoms become chronic in nature. The current research suggests that patients who seek treatment soon after a whiplash event— like a car accident, slip and fall, or sports collision—are not only more likely to experience a faster recovery but they are also less likely to develop a chronic condition. Chiropractic care offers a safe and conservative form of treatment for WAD that is often recommend by treatment guidelines. www.PainReliefChiroOnline.com

Osteoarthritis (OA) is the leading cause of knee pain and disability in the elderly population. While treatment to address knee OA will often focus on the knee itself, a patient may also need to change their footwear. Why is that? During normal walking, joint loading is NOT evenly distributed, and the distribution most often greatest on the medial (inner) side of the knee. This greater load can cause wear and tear over time and lead to thinning of the smooth, slippery cartilage surfaces on the medial side of the joint, which eventually leads to bone-on-bone contact, the end-stage of OA. By changing where joint loading occurs on the knee, it's possible to slow this process and potentially delay or even prevent the need for a knee joint replacement. This can be accomplished through either a change in footwear or adding an insole or orthotic to an existing shoe. On the footwear front, an OA patient may need to avoid clogs, barefoot shoes, high heels, and extra-rigid/stiff shoes. Rather, walking or running shoes or, for more formal occasions, a shoe with a shock-absorbing sole and padded collars that's not too rigid may be a better choice. A well-trained employee at a specialty shoe store can help identify which shoes will work best for your situation. One study investigated the use of lateral wedges both with and without custom arch supports for people with medial knee osteoarthritis (OA) and pronation (rolled in feet). Each of the 26 participants wore one or the other for two months and switched to the other option after a two-month “washout” or rest period. The researchers concluded that the lateral heel wedge WITH foot orthotic/arch supports provided the best benefit to the participants with respect to performance on a timed stair climb test. Another study found that adding a mobility shoe reduced medial joint loading to an even greater degree. For the knee OA patient, chiropractic treatment may also include specific exercise training, weight management/nutrition, manual therapies, modality use (electrical stim, magnetic field, laser, ultrasound, and more), and the use of a knee brace—all in the effort to reduce pain and improve mobility. www.PainReliefChiroOnline.com

Of all the potential contributing factors for carpal tunnel syndrome—diabetes, thyroid dysfunction, inflammatory arthritis, pregnancy, birth control usage, and obesity—perhaps the most well-known is participating in jobs and activities that require fast, repetitive hand movements that can place increased pressure on the median nerve as it passes through the wrist. What can someone do if they begin experiencing tingling and numbness or pain and weakness associated with carpal tunnel syndrome without giving up their livelihood or their hobby? First, understand that when the wrist is bent, the pressure on the contents of the carpal tunnel can increase substantially, especially when inflammation is present, which can affect the median nerve. So, if an activity frequently leads to numbness, tingling, or painful sensations in the hand and wrist, look for ways to maintain more neutral wrist posture. This may also involve using tools with a more ergonomic, wrist-friendly design. For the carpal tunnel syndrome patient, a doctor of chiropractic may also recommend wearing a splint overnight to keep the wrist from bending during sleep. It's also important to take frequent breaks (every 30 minutes, for example) to allow the affected wrist and hand to rest. Or if possible, switch to a different activity for a short time before returning to the task that places the greatest strain on the wrist. Here are three great exercise options to improve finger, thumb, wrist, and forearm flexibility, which may stretch the soft tissues in the wrist and increase activity tolerance: Thumb-finger “push-ups”: Place the pads of your fingers and thumbs together in front of you and keep the fingers straight, spread apart, and pointing down. Push the hands together (try to touch your palms) and then push them apart by flexing your fingers and repeat. This stretches all five digits and the palm/forearm muscles ALL at the same time. Shake ‘em out: …as if you're shaking your wet hands to dry them. Continue this for as long as one to two minutes every hour. Wall-stretches: Place your palm on a wall, elbow straight, fingers pointed down and push your palm flat into the wall as far as you can. Reach over and pull your thumb back off the wall with your other hand and hold for 20-30 seconds. Switch hands and repeat the stretch. This can be repeated two to three times per hand every hour. Of course, consult with your doctor of chiropractic so that he or she can take a look at your patient history and examine the entire course of the median nerve to identify any other factors that may contribute to your carpal tunnel syndrome-associated symptoms. www.PainReliefChiroOnline.com

Neck pain is the second most common reason patients seek chiropractic care, and it's particularly a problem with office workers. One study estimated that neck pain affects 42-69% of those who work in office environments. Many such individuals will experience recurring episodes of neck pain, and at least one in six may develop chronic, ongoing neck pain. While chiropractic offers a safe and effective way to manage neck pain, are there any steps an office worker can take to reduce the risk for neck pain in the first place? According to one study, taking a daily walk may be an effective neck pain prevention strategy. In the study, which included 387 office workers without spinal symptoms in the previous three months, researchers asked participants to wear a pedometer and note any spinal pain symptoms over the next year. Of the 367 participants who completed the study, 16% reported the onset of neck pain. The results showed that for every 1,000 steps a participant averaged each day, their risk for neck pain fell by 14%. The authors concluded that increasing daily walking steps is protective for the onset of neck pain in those who work sedentary jobs, and managers should formulate and test strategies to encourage walking to reduce the incidence of neck pain among employees. What about other forms of exercise? A meta-analysis of data from two randomized control trials that included over 500 participants showed moderate-quality evidence that participating in a workplace exercise program can reduce the risk for developing a new episode of neck pain by up to 68%. In the first trial, participants performed stretching and endurance training twice a day at work and twice a day at home. The second trial involved a combination of strength, stabilization, aerobic, and body awareness exercises that included health information, ergonomic training, and stress management training three times a week for one hour over a nine-month time frame. While it's not possible to completely avoid a condition like neck pain, the evidence suggests that regularly engaging in physical activity may substantially lower the risk. For those who do develop neck pain, it's important to seek chiropractic care as soon as possible, which may lead to a faster resolution of symptoms and reduce the risk for both neck pain recurrence and chronic neck pain. www.PainReliefChiroOnline.com

While under chiropractic treatment, it's not uncommon for a patient to report improvement for an issue that seems unrelated to their chief complaint. For example, a patient with a temporomandibular disorder may experience an improvement in their jaw symptoms following treatment to the neck or upper back. Or treatment to improve hip function may also benefit the ankle or knee. In this article, we're going to look at how treatment for low back pain may help a patient who also has urinary incontinence (UI) issues. There are many potential causes for UI, but one contributing factor is weak pelvic floor muscles. Thus, it makes sense that treatment to address impaired pelvic function may benefit some UI patients. A 2018 Cochrane systemic review concluded that pelvic floor muscle training (PFMT) is more effective than either a sham treatment (placebo) or no treatment for some individuals with UI. This is where back pain comes into play. It's estimated that back pain will affect more than 80% of us during our lifetime. We often adjust how we perform everyday activities to avoid pain, both consciously and unconsciously. These abnormal movements can place added stress on other parts of the body. In the case of the lower back, altered function in the hips and pelvis is common. A November 2019 study published in the Journal of Craniovertebral Junction & Spine concluded that individuals with lumbar degenerative disk disease, spondylolisthesis, and failed back surgery syndrome are more likely to exhibit abnormal spino-pelvic alignment. Overtime, these individuals can develop secondary conditions in the hip or pelvis, which can impair the function of soft tissues, including muscles, in the region. Or likewise, injury to the hips/pelvis can lead to dysfunction in the lower back, which may be why the patient sought care in the first place. Doctors of chiropractic are trained to review a patient's case history and conduct a thorough examination on the whole patient in order to identify contributing factors for the patient's chief complaint. Hence the importance of noting all symptoms, even those that seem unrelated or may be embarrassing. If a low back pain patient's history notes UI and the examination identifies abnormal pelvic posture, then treatment will likely address improving function in both the pelvis and low back to achieve a successful outcome. www.PainReliefChiroOnline.com

Multiple studies have shown that hyper-pronation (HP), or too much rolling-inwards of the ankle, can have effects on the body far beyond the foot. For example, abnormal motion of the ankle can lead to slight changes in how the knees and pelvis move as you carry out your normal daily activities, placing added strain on these structures and increasing the risk of injury in both the short and long term. These faulty movement patterns can also lead to improper motion and a higher risk for injury above the hips, including in the lower back. In one study that involved patients with low back pain (LBP), researchers found that improving both ankle pronation (with foot orthotics) and lower limb weakness (with exercise) resulted in improvements in knee, hip, and low back function. Foot orthotics often include a pronation-correcting wedge that is thicker on the inside and tapers narrow to the outside to correct the rolling-in effect of the ankle. One study measured the effects that a 5º heel wedge had on the lower limb up to the thorax, noting significant 3-dimensional kinematic changes occurred on the hip, pelvis, and thorax. However, over-correction (at 10º), had detrimental effects on proper motion elsewhere in the body, which underscores the importance of getting an accurate prescription when fitting foot orthotics. Likewise, other studies have demonstrated that a forefoot orthotic may also be required to ensure proper biomechanics while walking. A study that included 213 high school and college cross country runners (107 male, 106 female) found that 37 (17.4%) wore foot orthotics. Of the 37 orthotic users, 17 (54.8%) wore them for exercise-related leg pain, of which 15 of the 17 reported benefits. Another study compared the load on the Achilles tendon during running both with and without foot orthotics and reported that running with foot orthotics was associated with significant reductions in Achilles tendon loading compared to running without orthotics. These studies clearly support the MANY benefits foot orthotics have on the whole body or structure, which facilitate both the short- and long-term management of conditions like low back pain! Doctors of chiropractic frequently fit foot orthotics for lower extremity complaints, as well as LBP. www.PainReliefChiroOnline.com

For patients with chronic low back pain (cLBP), treatment guidelines recommend a non-surgical approach as the FIRST-LINE treatment. Ideally, the goal would be to avoid an initial surgery unless it's absolutely indicated. That means, unless there is loss of bowel or bladder control or retention (which represents a medical emergency) or if there is progressive neurological motor and sensory loss, one can safely avoid surgery and conservatively manage the condition. Interestingly enough, a systematic review of the results from three randomized controlled studies carried out in Norway and the United Kingdom found the outcomes or results between the surgical fusion vs. non-surgical treatment of patients with cLBP showed NO DIFFERENCE at an 11-year follow-up! Studies have shown chiropractic to be highly beneficial for acute and chronic low back pain cases. In one study, researchers reviewed data on 72,326 cLBP patients in the Medicare system who received one of four possible treatment combinations between 2006 and 2012: 1) chiropractic only; 2) chiropractic followed by conventional medical care (CMC); 3) CMC followed by chiropractic; 4) CMC alone. The research team found that chiropractic care alone (group 1) resulted in the lowest costs, and these patients had lower rates of back surgery and shorter episodes of care. The group receiving CMC alone (group 4) had the highest costs, with the second and third groups being similar—both costing less and being more effective than CMC alone. The conclusion of the study reads, “These findings support initial CMT [chiropractic manipulative therapy] use in the treatment of, and possibly broader chiropractic management of, older multiply-comorbid cLBP patients.” www.PainReliefChiroOnline.com

Low back pain (LBP) from a herniated disk often leads to surgical intervention. However, there are patients with this painful malady who can successfully “ride it out” and repeat MRI imaging six to twelve months later often fails to show little, if any, evidence of the original herniated disk that was initially very obvious. How is this possible? The proposed theory is that there must be some unique interplay between molecular signals that might explain why some herniated disks heal themselves while others do not. Researchers at Vanderbilt University Medical Center are investigating this and published a report on their progress in the January 2016 issue of the Journal of Clinical Investigation. LBP affects 60-80% of Americans during their lifetime, and there are upwards of 300,000 surgeries for herniated disks annually in the United States alone. A disk can herniate when its outer fibers tear or give way, allowing the semi-fluid center to leak out. If the herniated disk material hits the nerve root exiting the spine, the classic sciatica, or pain down the leg, can result. Dr. Dan Spengler states that about 50% of patients with disk herniation will improve within six weeks, and the actual herniated material may completely resorb over time. What troubles Dr. Spengler and other researchers is why this doesn't occur with everyone. Looking specifically at the molecules that are frequently present when disks herniate, researchers have identified a group of proteins called matrix metalloproteinases (MMPs). Certain MMPs have the ability to act like “Pac-Man” and literally chew through other proteins making it highly suspect that MMPs may be at the forefront of why some disks resorb while others do not! Additionally, when a disk herniates, bleeding occurs and white blood cells—specifically macrophages, which are immune system cells in our blood that ingest foreign materials and bacteria—also flood into the area. What most surprised the authors was the interplay between the macrophages and the MMPs. They found that when the blood/macrophages and one of two specific MMPs interacted in a very specific manner, disk resorption occurred and they were even able to replicate this process in a lab. They concluded the following, “These enzymes are more complicated and interesting than we originally thought. Rather than being big bulldozers, they're a fine pair of scissors that cut certain things.” The TAKE-HOME MESSAGE here is unless you are having progressive neurological loss (meaning muscle weakness or sensory pain that is progressing, and/or especially bowel or bladder weakness), there is NO RUSH to run and have surgery! Doctors of chiropractic can offer natural, non-invasive treatments to manage pain while you let your body manage the herniation! www.PainReliefChiroOnline.com

Previously, we discussed how herniated disks can resorb all by themselves, especially large herniated disks. But what about a damaged nerve—can it self-repair too? First, it's important to realize that damage can occur when enough pressure is applied to any living tissue. The anatomy of our nerves includes many micro-structures such as the blood vessels that bring needed oxygen to the several layers of the nerve. If the nerve is deprived of oxygen long enough, there can be damage to its infrastructure, similar to a heart attack damaging the heart muscle. A pinched nerve results in symptoms that include numbness, tingling, weakness, and in some cases, burning sensations. There are three stages of nerve damage that can be simplified into mild, moderate, and severe, and the ability for nerves to regenerate depends largely on the amount of damage and the length of time that has passed before treatment is sought out. Generally speaking, it has been well reported that the nerves that make up the peripheral nervous system (the nerves outside of the brain and spinal cord) have the ability to regenerate, while those within the central nervous system (CNS) generally do not. However, there is hope. Researchers have begun to identify the molecular mechanisms that can promote axon regeneration in CNS injuries. Much of the knowledge and insight derived from these studies comes from the experimental use of fruit flies, as is referred to as “Drosophila models of axonal regrowth.” The activation of an important receptor (called “insulin-like growth factor 1 receptor or IGF-1R) appears to be an essential step for axonal regeneration to occur in adult CNS neurons. Studies utilizing Insulin-like Growth Factor-1 (IGF-1) as a form of treatment in animal models after a brain injury found IGF-1 to be “neuroprotective” in the early stages of brain injury, and blood levels are often elevated soon after an injury. In a study of 45 patients who suffered traumatic spinal cord injuries, researchers detected higher levels of IGF-1 blood serum levels in those who had clinically documented neurological resolution as compared to lower levels that were found in those who did not have neurological remission. Unfortunately, researchers need to identify some of the missing pieces of the CNS-injury recovery puzzle before a consistent and predictable outcome can be expected for people who have sustained a serious spinal cord injury. Doctors of chiropractic are trained to identify injuries to peripheral nerves as well as to the spinal cord and they can also work closely with other experts who manage the more significant neurological injuries, all in the quest of getting you back on the road to as much recovery as possible! www.PainReliefChiroOnline.com

According to the National Institutes of Health, circadian rhythms include physical, mental, and behavioral changes that roughly follow a 24-hour cycle, responding largely to environmental light and darkness. Most living things possess this trait including animals, plants, and many microbes. So how does this relate to low back pain? Recent studies reveal that the intervertebral disk (IVD)—the “shock-absorbers” located between our vertebrae in our spine—contain intrinsic circadian clocks that are regulated by age and cytokines and are linked to degeneration. This means we have a 24-hour rhythm producing various changes in an organized way throughout the day in each of the disks in our spine! Researchers have found at least 600 genes with 24-hour patterns of expression representing several essential pathways associated with disk pathology. In experiments on mice, scientists have observed that when the normal expression of these genes is disrupted, disk degeneration may occur. The study concludes, “These results support the concept that disruptions to circadian rhythms may be a risk factor for degenerative IVD disease and low back pain.” So what can we do about this? These findings support an important concept that improves overall health, quality of life and longevity: our sleep habits! We know our circadian rhythms influence sleep-wake cycles, hormone release, body temperature, and many other important bodily functions and are linked to various sleep disorders. Researchers have linked abnormal rhythms with obesity, diabetes, depression, bipolar disorder, and seasonal affective disorder (SAD), to name a few. We also know how we feel when we fly from California to New York and the alarm rings at 7am in NYC but our biological clock says 4am! The importance of sleep cannot be overstated. Longevity is shortened when sleep duration is altered (either too little OR too much sleep) and we know quality of life is negatively affected in swing-shift workers. Now, we've learned that the cells in our disks also have a circadian rhythm, and alteration of that rhythm can lead to disk degeneration resulting in low back pain! www.PainReliefChiroOnline.com

Wry neck, also known as torticollis, is a painful condition in which the top of the head usually tilts to one side while the chin rotates to the opposite side. Torticollis can have several causes from infection (cold, flu, or otitis media, for example) to sleeping in a draft; however, the cause is usually unknown (idiopathic). In a typical case, torticollis may resolve itself within four to six weeks, but with chiropractic care, cervical function can return to a more normal state much faster, often within a week. Chiropractic treatment for torticollis often includes stretching, in which manual cervical traction, spinal mobilization, and myofascial release techniques help to restore the lost range of motion and faulty posture. Once enough motion has been restored, a doctor of chiropractic may utilize spinal manipulation, which often hastens the recovery rate of torticollis. Chiropractors may also use physical therapy modalities and/or provide instruction on home-based exercises and other self-management strategies. There's a type of torticollis called congenital torticollis in which an infant is born with torticollis that either developed in utero or during the birth process. Current guidelines support prompt treatment for congenital torticollis versus taking a wait-and-see approach. One study found that treating infants with gentle manual therapy approaches at one month of age led to higher success rates than waiting until they were six months or older when substantially more care was needed to restore full range of motion with lower odds of success. There is a less common but more serious type of torticollis called cervical dystonia, sometimes referred to as spasmodic torticollis, which is characterized by involuntary contraction of muscles in the neck that twist the head in a variety of directions. Cervical dystonia can occur at any age, but it's more common among middle-aged women. While there is no known cure for the condition, there are case studies showing that cervical dystonia may respond to chiropractic treatment. In one such case study, a 59-year-old woman with an eleven-year history of cervical dystonia experienced a dramatic improvement in function (from 3/10 to 9/10 on a scale of 0 to 10, 10 being full function and 0 being no function) following a treatment regimen that included cervical spinal manipulation, reflex therapy, eye exercises, and vibration therapy. www.PainReliefChiroOnline.com

People with migraines know all too well about that throbbing, pulsating, and nauseated feeling that accompanies their headaches and the associated disability that often results. The underlying cause of migraine headaches is still not well understood, but genetics (family history), chemical imbalances in the brain (serotonin, in particular), environmental factors (weather, allergens), and hormonal changes appear to play a part. Because medications to manage headaches can come with potentially serious side effects, especially with prolonged use, many patients opt for non-pharmaceutical treatment approaches to reduce the frequency and intensity of their migraines… A 2018 survey of 4,356 American adults with a history of migraines found that common symptoms associated with migraines include sensitivity to touch (32%), food cravings (28%), and hallucinations (18%), which include sound and smell. The most common foods to trigger a migraine were chocolate at 75%, cheese (especially aged cheeses) at 48%, citrus fruit at 30%, and alcohol (especially red wine) at 25%. Other foods that may be triggers include cured meats, monosodium glutamate (MSG), aspartame (and other artificial sweeteners), snack foods, fatty foods, dairy products, food dyes, coffee, tea, cola, and nuts. According to a 2019 study, people who suffer from migraines are often deficient in magnesium (Mg), a mineral naturally found in spinach, nuts, and whole grains. Magnesium is also important in regulating blood pressure, blood sugar (glucose), and muscle and nerve function. A meta-review of previous study findings revealed that migraine patients who received a Mg supplement reported reductions in both headache frequency and intensity. Other benefits included a decrease in hospitalization during pregnancy, and at a higher dose, a lower incidence of type-2 diabetes and stroke! Another nutritional anti-migraine option includes the use of fever few (Tanacetum parthenium) for both prevention and treatment of migraine headaches. Other benefits of fever few include fever reduction, irregular menstrual cycles, arthritis, psoriasis, allergies, asthma, tinnitus, dizziness, and nausea/vomiting. There is also research support for the use of riboflavin (vitamin B-2), melatonin and coenzyme Q10 by migraine patients. Doctors of chiropractic often manage their migraine headache patients using a multi-modal approach that includes cervical spinal manipulation and mobilization, physical therapy modalities, home exercise training, nutritional counselling (including supplementation advice), and other conservative treatment approaches based on the patient's specific needs. www.PainReliefChiroOnline.com

Mechanical neck pain—neck pain without neurological compromise, often without a specific cause—is associated with a loss of mobility, poor activity tolerance, increased pressure pain sensitivity (or hypersensitivity to a normal stimulus), and increased joint position sense error (JPSE—difficulty reproducing the same movement when repeated multiple times). Patients with mechanical neck pain often seek treatment from doctors of chiropractic. Let's look at how high-velocity, low-amplitude (HVLA) manipulation—the primary form of treatment used by chiropractors, commonly referred to as an adjustment—helps these patients… In a 2018 study involving 54 patients with mechanical neck pain, participants received either HVLA cervical thrust manipulation or a sham cervical thrust manipulation. Evaluations conducted immediately following treatment showed that patients in the HVLA group experienced improvements with regards to JPSE (specifically neck rotation and extension), pressure pain threshold, and disability. (A related study showed that patients who received HVLA cervical thrust manipulation experienced an immediate 41% improvement in JPSE.) A week later, the participants in the HVLA group continued to experience improvements related to disability. Again, this was after just a single treatment. Typically, doctors of chiropractic administer a series of HVLA manipulations one to three times per week for one to two weeks followed by a re-assessment to determine if care should continue (at the same frequency or at a reduced frequency) or if the patient should be released from care and advised to return for care on an as-needed or maintenance basis. Chiropractors often combine several treatment approaches when managing patients with mechanical neck pain and other musculoskeletal conditions to both reduce pain and improve function. A partial list of commonly applied services include the following: HVLA manipulation (thrust with cavitation), mobilization (non-thrust), soft tissue therapies (massage, vibration, muscle release techniques, trigger point therapy, myofascial release, and more), home and/or in-office exercise training, nutritional counseling, physical therapy modalities, and more. Chiropractic HVLA manipulation has strong research support as being a VERY affective management approach for patients with either acute or chronic neck pain! www.PainReliefChiroOnline.com

For the last two months (Part 1 and Part 2), we've discussed the importance of sleep and its effect on low back pain (LBP). Last month, we offered 9 ways to improve sleep quality, and this month we will conclude this topic with 11 more. Sleep deprivation has been called, “…an epidemic” by the Centers for Disease Control and Prevention. To achieve and maintain good health, we must ensure restorative sleep! Here are additional ways to do that (continued from last month): Avoid snacks at bedtime …especially grains and sugars as these will raise your blood sugar and delay sleep. Later, when blood sugar drops too low (hypoglycemia), you not only wake up but falling back to sleep becomes problematic. Dairy foods can also interrupt sleep. Take a hot bath, shower, or sauna before bed. This will raise your body temperature and cooling off facilitates sleep. The temperature drop from getting out of the bath signals to your body that “it's time for bed.” Keep your feet warm! Consider wearing socks to bed as our feet often feel cold before the rest of the body because they have the poorest circulation. Cold feet make falling asleep difficult! Rest your mind! Stop “brain work” at least one hour before bed to give your mind a rest so you can calm down. Don't think about tomorrow's schedule or deadlines. Avoid TV right before bed. TV can be too stimulating to the brain, preventing you from falling asleep quickly as it disrupts your pineal gland function. Consider a “sound machine.” Listen to the sound of white noise or nature sounds, such as the ocean or forest, to drown out upsetting background noise and soothe you to sleep. Relaxation reading. Don't read anything stimulating before bed, such as a mystery or suspense novels, as it makes sleeping a challenge. Avoid PM caffeine. Studies show that caffeine can stay active in your system long after consumption. Avoid alcohol. Though drowsiness can occur, many will often wake up several hours later, unable to fall back asleep. This can prohibit deep sleep, the most restoring sleep (~4th hour). Exercise regularly! Exercising for at least 30 minutes per day can improve your sleep. Increase your melatonin. If you can't increase levels naturally with exposure to bright sunlight in the daytime and absolute complete darkness at night, consider supplementation. www.PainReliefChiroOnline.com

On the last podcast, we discussed the relationship between sleep deprivation and low back pain (LBP) and found that LBP can cause sleep loss AND sleep loss can cause LBP. It's a two-way street! This episode, we will look at ways to improve your sleep quality, which in return, will reduce your LBP. There are many ways we can improve our sleep quality. Here are some of them: Turn off the lights: Complete darkness (or as close to it as possible) is best. Even the tiniest bit of light in the room can disrupt your internal clock and your pineal gland's production of melatonin and serotonin. Cover your windows with blackout shades or drapes. Stay cool! The bedroom's temperature should be around 70 degrees Fahrenheit (about 21 degrees Celsius). At about four hours after you fall asleep, your body's internal temperature drops to its lowest level. Scientists report a cooler bedroom mimics your body's natural temperature drop. Move the alarm clock. Keeping it out of reach (at least 3 feet or about 1 meter) forces you to get out of bed and get moving in the morning. Also, you won't be inclined to stare at it during the night! Avoid loud alarm clocks. It is very stressful on your body to be suddenly jolted awake. If you are regularly getting enough sleep, an alarm may even be unnecessary. Reserve your bed for sleeping. Avoid watching TV or doing work in bed, you may find it harder to relax and drift off to sleep. Get to bed before 11pm. Your adrenal system does a majority of its recharging between the hours of 11 p.m. and 1 a.m. and adrenal “burn-out” results in fatigue and other problems. Be consistent about your bed time. Try to go to bed and wake up at the same times each day, including weekends. This will help your body to get into a sleep rhythm and make it easier to fall asleep and get up in the morning. Establish a bedtime routine. Consider meditation, deep breathing, using aromatherapy, or essential oils, or a massage from your partner. Relax and reduce your tension from the day. Eat a high-protein snack several hours before bed to provide the L-tryptophan needed for melatonin and serotonin production. There are other “tricks” that ensure a good night's rest that we will continue with tomorrow as this is a VERY important subject and can literally add years to your life and life to your years.

Low back pain (LBP) can arise from a lot of causes, most commonly from bending, lifting, pulling, pushing, and twisting. However, there are other possible causes, including sleep. This not only includes sleeping in a crooked or faulty position, such as falling asleep on a couch, in a chair, or while riding in a car, but also from the lack of sleep. So the question is, how much sleep is needed to feel restored and how much sleep is needed to avoid low back pain? It's been shown that lack of sleep, or chronic sleep loss, can lead to serious diseases including (but not limited to): heart disease, heart attack, heart failure, irregular heartbeat, high blood pressure, stroke, and diabetes. Sleepiness can also result in a disaster, as was the case in the 1979 nuclear accident at Three Mile Island, the oil spill from the Exxon Valdez, as well as the 1986 nuclear disaster at Chernobyl. With sleep deprivation, our reaction time is slowed down, and hence, driving safety is a major issue. The National Highway Traffic Safety Administration estimates that fatigue causes more than 100,000 crashes per year with 1,500 annual crash-related deaths in the United States alone. This problem is greatest in people under 25 years old. Job-related injuries are also reportedly more frequently, especially repeat injuries, in workers complaining of daytime sleepiness—which also results in more sick days. It's also well published that sleep plays a crucial role in thinking and learning. Lack of sleep impairs concentration, attention, alertness, reasoning, and general cognitive function. In essence, it makes it more difficult to learn efficiently. Also, getting into a deep sleep cycle plays a critical role in “consolidating memories” in the brain, so if you don't get to a deep sleep stage (about 4 hours of uninterrupted sleep), it's more difficult to remember what you've learned. An interesting study (U. of Pennsylvania) reported that people who slept less than 5 hours/night for 7 nights felt stressed, angry, sad, and mentally exhausted. As shown in another study of 10,000 people, over time, insomnia (the lack of sleep) increases the chances for developing clinical depression by 5-fold. Other clinical studies have published many other negative effects of sleep deprivation, some of which include aging of the skin, forgetfulness, weight gain, and more. Regarding low back pain, what comes first? Does LBP cause sleep interference or does sleep deprivation cause the LBP (or both)? It's been shown that sleep loss can lower your pain threshold and pain tolerance, making any existing pain feel worse, so it works both ways. Specific to LBP, in a 28-year, 902 metal industry worker study, sleep disturbances (insomnia and/or nightmares) predicted a 2.1-fold increase in back pain hospitalizations with one and a 2.4-fold increase with both sleep disturbance causes (insomnia and nightmares). Other studies have shown patients with chronic LBP had less restful sleep and more “alpha EEG” sleep than controls. Similar sleep pattern differences using EEG (electroencephalogram – measures brain waves) have been shown when comparing chronic LBP patients with vs. without depression compared to controls (non-LBP, non-depressed subjects). So the BOTTOM LINE is: talk to your chiropractor about how chiropractic helps reduce LBP, stress, and facilitates sleep. There are also nutritional benefits from Melatonin, valarian root, and others that he or she can discuss. Now, go to bed and get a good night's sleep! www.PainReliefChiroOnline.com

Have you ever had leg pain and immediately blamed your lower back? Many patients (and unfortunately, many doctors) conclude such pain to be “sciatica” or a “pinched nerve.” When this diagnosis is wrong, it can lead to an inappropriate type of treatment which can delay more appropriate care, or worse, may result in death due to a missed diagnosis of a blood clot. Here's a news flash from September 15, 2008: WASHINGTON - Far too many Americans are dying of dangerous blood clots that can masquerade as simple leg pain, says a major new government effort to get both patients and their doctors to recognize the emergency in time.” “It's a silent killer. It's hard to diagnose,” said acting Surgeon General Dr. Steven Galson, who announced the new campaign Monday. “I don't think most people understand that this is a serious medical problem or what can be done to prevent it.” Blood clots make headlines when seemingly healthy people collapse after prolonged sitting, such as long airplane flights or being in similarly cramped quarters. Former Vice President Dick Cheney suffered one after a long trip in 2007. NBC correspondent David Bloom died of one in 2003 after spending days inside a tank while covering the Iraq invasion. According to the Surgeon General's 2008 campaign, there are about 100,000 deaths associated with blood clots each year. Risk factors include increasing age (especially over 65), recent surgery or fracture, falls, car crashes, prolonged bed rest, smoking, obesity, pregnancy, and hormone replacement drugs—including birth control pills. Other less controllable causes can include genetic conditions so it is important to tell your doctor if a relative has ever suffered a blood clot. The Surgeon General 2008 campaign warns that people with these factors should have “a very low threshold” for calling a doctor or even going to the emergency room if they have symptoms of a clot. Symptoms include swelling; pain, especially in the calf; or a warm spot or red or discolored skin on the leg; shortness of breath or pain when breathing deeply. www.PainReliefChiroOnline.com

You've probably heard of a friend or loved one whose back pain resulted in a spinal fusion surgery, but you may not understand what prompted surgery over non-surgical approaches, including chiropractic care. Simply put, spinal fusion is a surgical technique that aims to eliminate excessive motion (instability) in the spine by fusing two or more vertebrae together. Fractures related to trauma are a common reason for spinal instability, but excessive motion can also be caused by conditions such as spondylolisthesis (when one vertebra slides forward on another) and age-related disk degeneration. When is a fusion necessary? The short answer is after every non-surgical option fails to result in a satisfactory outcome. The long answer is when there is progressive neurological loss or deficit, cauda equina syndrome, failed non-surgical care, failed prior surgical care, x-ray evidence of instability with neurological signs, and unremitting pain that affects one's quality of life. Treatment guidelines are not always followed, as many patients consult with a doctor of chiropractic only after they've already been advised that their lower back condition requires surgery. The good news is that most conditions of the lower back can be managed with non-surgical chiropractic care, especially early on. With any musculoskeletal injury, it's almost always best to seek care right away when the symptoms may be milder. Ignoring an injury may cause it to worsen and/or lead to the formation of scar tissue in the affected area and secondary problems elsewhere as the body attempts to compensate for mobility impairments. Conditions like chronic back pain can still respond well to chiropractic care, but keep in mind, it may take longer to achieve a successful outcome. However, there are times when surgery is necessary. Surgery may include decompression of the nerve without fusion, but in cases of spinal instability, fusion may be needed, which is determined on a case-by-case basis. There are always risks associated with surgery, which is why it's so important to exhaust non-surgical options first. When appropriate, your doctor of chiropractic can help facilitate in the referral process for a surgical consultation. www.PainReliefChiroOnline.com

In recent decades, several studies have identified risk factors for early death such as reduced cardio-respiratory fitness (CRF), obesity, smoking, diabetes, heart disease, pulmonary disease, etc. Of all the causes listed, poor CRF appears to be the leading risk factor for early death. If CRF is so important, can walking help? If so, how many steps do we really need to live longer and better? For years, experts have suggested walking 10,000 steps per day to live a long and healthy life, but there isn't much research to support this claim. A 2019 study looked at how many steps a group of 18,289 elderly females took over a seven-day period and compared that data with their health outcomes four years later. The researchers associated a reduced mortality risk with more steps taken per day, up until about 7,500 steps per day. Compared with participants taking 2,700 steps per day, those averaging 8,400 steps per day were 58% less likely to die during the course of the study. In a similar study involving 4,840 middle-aged adults, researchers compared daily step count data collected during 2003-2006 with health outcomes a decade later and identified an association between steps taken per day and a reduced risk for early death. Neither study concluded that a fast or slow walking speed played a role in overall mortality risk. However, several studies have linked a faster walking speed with better cognitive health and a reduced risk for disability. A thirteen-year study that compared members of a running club with those who didn't run found that those who regularly jogged were less likely to experience physical impairments or a premature death. These studies suggest that getting up and moving your body can improve your cardio-respiratory fitness and reduce the risk of early death. Additionally, staying active may be associated with a better quality of life. Other ways to prolong life include avoiding excessive alcohol consumption, not smoking, maintaining a healthy weight, preserving/building muscle mass, and eating a healthy diet. If you develop musculoskeletal pain that interferes with daily function, seek treatment from your doctor of chiropractic as soon as possible so that you can resume your normal activities pain-free. www.PainReliefChiroOnline.com

Whiplash associated disorders (WAD) is a collection of symptoms commonly associated with motor vehicle collisions. Because WAD can have such a negative effect on one's quality of life, it makes sense to take steps to reduce the risk for a car accident. Let's look at some of the modern technologies that our automobiles may include to lower the chances that a crash occurs: Hands-Free / Voice Controls: Cell-phone distractions are the underlying cause of many vehicle collisions, especially texting while driving. In fact, studies suggest that texting while driving may be as dangerous as driving while intoxicated. If you must make a call while driving, use a hands-free option. Fiddling with the radio can also be distracting, so use voice commands or steering wheel functions to change the station, if your car has them. Adaptive Cruise Control: This feature accelerate/deaccelerates your vehicle depending on what the car ahead of you is doing. This feature can reduce the stress of long highway drives and eliminates the need to constantly turn on/off or change your cruise control. Some systems will allow your car to stop and start in busy stop-and-go traffic. Lane Departure Warning/Lane Keeping Assist: This warns you when you drift out of your lane by vibrating the steering wheel, beeping, and/or giving a visual warning. Many vehicles also have an auto-correction steering feature that keeps you in your lane, provided there are line markings on the road for the sensors to detect. This feature is not meant to steer for you, but it can be particularly helpful, such as when driving at night on a winding road. Backing Up/Forwards Safety Features: These include a rear camera and a warning beep if unseen cross traffic is near. Your vehicle may also have an emergency brake assist feature where the vehicle automatically brakes to avoid a crash. Some vehicles also have a collision avoidance system that works when driving the car forward by detecting another car, a pedestrian, or some other obstacle and stops the car or steers the car out of harm's way. The Insurance Institute for Highway Safety REQUIRES this feature in order to earn its highest safety score. Blind-Spot Warning: This feature is usually located on your side mirrors, which illuminate when a vehicle is approaching from the rear of your vehicle and remains lit until the vehicle passes. Many systems will also sound an alarm if you attempt to change lanes or activate your turn signal. More advanced systems can also brake or steer the vehicle back to the center of your lane. There are many other features such as antilock brakes, traction control, electronic stability control, advanced safety belt features, brake assist, and more. While chiropractic care is an effective way to manage many of the soft tissue injuries associated with motor vehicle collisions, the best outcome is to completely avoid a crash in the first place! www.PainReliefChiroOnline.com

Groin pain syndrome is a term used to describe groin pain without clinical evidence of hernia or hip pathology. Though the condition is thought to affect between 2% and 20% of athletes, there is not a lot of conclusive research on its cause or the best way to treat it. Most of the published research on those with groin pain without hernia or hip joint pathology are case studies (primarily of professional male athletes), making it difficult to establish agreed upon treatment guidelines, as these types of studies are considered to be of low quality and do not apply to the general population. Understanding the anatomy of the trunk and pelvis helps us appreciate why physical activity applies tremendous strain to this region. First, the pubic joint is in the front/midline of the pelvis, the sacrum or “tail bone” is in the back, and ilium (or “wings” of the pelvis) make up the sacroiliac joints. These joints only partially move as we walk, run, twist, jump, etc. while the hip joints move freely. The muscles arising from the legs connect to multiple places on the pelvis and spine. With groin pain syndrome, there is a significant amount of tension directed at the pubic joint by the muscles, tendons, and ligaments (collectively called “soft tissues”) during intense athletic activities (and sometimes regular daily life). These soft tissues also provide shock absorption and add structural support to the pubic joint. Researchers speculate that groin pain syndrome is caused by the significant difference in strength of the opposing muscle forces from above (abdominal muscles) and below (adductors) leading to strain/sprain and eventually pubic joint pathology (osteoarthritis). Because of this high level of force, injury to the labrum that lines the rim of the hip joint may occur simultaneously resulting in two separate injuries or pain generators, making it easy to overlook the often more subtle, less known groin pain syndrome. Degeneration or joint arthritis can result in both the pubic joint and hip joint, again, adding to the confusion and differential diagnosis. One case study that involved three soccer players with groin pain syndrome reported that all three athletes experienced satisfactory outcomes after an eight-week course of conservative treatment that included manual joint and soft tissue manipulation. Another study that looked at outcomes from NFL players who underwent either conservative or surgical treatment for groin pain syndrome found no difference in performance between the two groups, though the data suggests that players who underwent surgery for groin pain syndrome may have had shorter careers than those in the non-surgical group. Doctors of chiropractic are trained to identify all potential causes for a patient's musculoskeletal condition and to offer conservative treatment options to reduce pain and restore function so the patient can resume their normal activities. www.PainReliefChiroOnline.com

Carpal tunnel syndrome (CTS) is the most common peripheral neuropathy that affects roughly 4-5% of the general population and about 10% of working adults. The chiropractic treatment approach for the CTS patient typically involves many of the same therapies as those used for conditions like neck and back pain, such as joint manipulation, mobilization, specific exercises, and nutritional recommendations to reduce inflammation. In some cases, patients with neck and back pain can benefit from traction. Could the CTS patient also benefit from traction applied to the wrist? Back in 2004, the Journal of the Canadian Chiropractic Association reported on a case series concerning four patients with confirmed CTS who underwent a mechanical traction treatment protocol that involved between five and twelve five-minute treatment sessions over a three-month time frame. The results showed an improvement on nerve conductive tests that persisted up to one year following the conclusion of treatment. In a study published in October 2017, researchers assigned 181 CTS patients to receive either mechanical traction (two treatments a week for six weeks) or usual medical care. The criterion used by the investigators for a successful outcome was whether or not the participants had elected to undergo carpal tunnel release surgery within the following six months. According to the research team, 43% of the participants in the usual care group had undergone surgical carpal tunnel release in the allotted timeframe compared to just 25% of the patients in the mechanical traction group. The authors concluded that mechanical traction appeared to be an effective conservative treatment option for the CTS patient. Treatment guidelines recommend that patients exhaust all non-surgical treatment options before considering surgery, unless warranted otherwise. However, as with any musculoskeletal condition, it's important to identify all contributing factors of a patient's chief complaint. In the case of a patient with suspected CTS, there may or may not be median nerve compression at the wrist. Similarly, median nerve compression can occur elsewhere along the course of the nerve from the neck into the hand. There may also be non-musculoskeletal causes for inflammation in the carpal tunnel that would need to be addressed in conjunction with other healthcare providers in order for the patient to achieve a satisfactory outcome. www.PainReliefChiroOnline.com

When individuals use their smartphone, they often adopt an awkward posture in which their head rests forward of their shoulders. This forward head posture, or “text neck,” places added strain on the muscles in the back of the neck, shoulders, and upper back, which can lead to musculoskeletal pain. Researchers are now looking into how electronic tablet use affects posture and can elevate the risk for pain in the neck, shoulders, and upper back. In a 2018 study, University of Nevada, Las Vegas researchers reviewed survey data from 412 university students, staff, faculty, and alumni regarding their electronic tablet use and associated musculoskeletal symptoms. The research team found that 55% of frequent tablet users reported at least moderate levels of neck and shoulder pain, which is a rate higher than the general population. Furthermore, 10% of the daily tablet users in the survey cited severe neck and/or shoulder pain associated with tablet use. However, only about half (46%) said they stopped using their device when experiencing discomfort. The researchers added that regular tablet users, especially younger individuals without a dedicated workspace, often used their device in awkward positions, such as sitting with their legs folded on the floor or laying on their stomach or side while looking down at their device. Such postures can place excessive stress on the neck, shoulders, and upper back, leading to musculoskeletal discomfort. The research team also found that women were over two times more likely to experience pain related to tablet use (70% vs. 30%). While this may partially be explained by women being more likely to sit on the floor with their legs crossed while using their tablet (77% vs. 23%), the researchers hypothesize that a primary driver of the disparity may be in the anatomical differences between men and women. Women often have more slender necks and less muscle mass/strength. Their shorter arms and narrower shoulders may also result in more extreme postural strain while typing on their device. These findings concern researchers because tablets are becoming more popular for personal, school, and business use, which may place a larger burden on the healthcare system in the years to come. To reduce the risk for musculoskeletal pain associated with tablet use, experts recommend sitting in a chair with back support; placing the screen slightly below eye level; using an external keyboard; typing with the elbows bent at 90 degrees; taking mini breaks to stretch; and performing forward posture correction exercises. If you continue to experience pain associated with tablet use, consult with your doctor of chiropractic. www.PainReliefChiroOnline.com

Scoliosis is a condition that affects about 3% of teenagers, though the cause is typically unknown. In most instances, the degree of spinal curvature is mild (10-15º curve), but in some cases, the curve may continue to increase as the child grows. Visible signs of adolescent idiopathic scoliosis include the following: uneven shoulders, one shoulder blade “sticking out” (more prominent) than the other; an uneven waist or a hip higher than the other; and/or a prominent rib cage, usually on the convex side of the curve. When the curve is small, there are often few if any symptoms. However, if the curve worsens, the child may experience complications, which may require treatment. Complications associated with scoliosis primarily occur in those with larger curves and involve heart and/or lung problems due to the spine shortening and rib cage distortion as the curve progresses, making it more difficult for the heart to pump or for the lungs to expand. Due to changes in spinal biomechanics, individuals with scoliosis may also report chronic back pain and other musculoskeletal conditions. Scoliosis is diagnosed following a routine patient history and physical examination, as well as standing x-ray of the lower and middle back in order to more accurate determine the degree of spinal curvature. In mild cases, treatment may not be required; however, if the condition worsens or in more severe cases, standard medical treatment may include wearing a back brace or possibly even surgery. Does chiropractic offer a treatment approach for scoliosis? In a study published in January 2017, researchers reviewed the case history of 60 scoliosis patients treated in a chiropractic setting. The patients received a combination of chiropractic spinal manipulation and exercise approaches including cantilever, postural weighting, fulcrum block, and rotatory torso therapy ball exercises. The results showed successful outcomes in 90% of the cases with 52% of patients experiencing a curve correction and curve stabilization in 38% of the patients. This adds to previous studies and case reports on the effectiveness of both therapeutic exercises and manual therapies for the management of scoliosis. www.PainReliefChiroOnline.com