LifeCare Chiropractic

The Best Chiropractic Care in Mesa, Arizona

Neck Pain

Chronic Neck Pain in Active Adults: Where Should You Go?

by

chronic neck pain in seniors and chiropractic
Photo courtesy of https://www.flickr.com/photos/bearpark/

As we age, those nagging aches and pains start to impact on your quality of life.  Chronic neck pain is high on the list.

Almost since the opening of my practice I have taught a variety of classes at a senior-oriented branch of a local community college called NAILS (New Adventures In Learning for Seniors).  That’s where I first met Marge.  Marge secretly wanted to come in to my office for treatment because she suffered from chronic neck pain.  However, she also had osteoporosis so her primary care doctor told her not to see a chiropractor because she had weak bones.

Good thing she followed his recommendations.  After all, I climb on my desk and, with a Tarzan-like roar, jump onto my unsuspecting patient in an attempt to adjust their spines.  When I’m really busy I just stack them on top of each other and adjust them all at once.  Very dangerous for weak bones.

For the next few years, Marge continued to see me occasionally at the NAILS events and continued to suffer with neck pain based on her primary care doctor’s recommendation.  At some point, however, her confidence in my ability to safely treat her overcame her primary care’s warning.

Good thing she did.  I treated Marge on and off over the next 10 years or so until she passed, even visiting her in hospice when her time was near.  She not only achieved wonderful relief from her neck pain, but her energy levels improved because she was no longe battling pain all day long.  She even took my advice to get into yoga, which turned out bad for business because she was seen less frequently in the office after she started yoga.

The sad part is that she still spent several extra years in pain because of biased and incorrect advice from her primary care.  We certainly did not treat her in the same manner we would treat a college football player or MMA fighter, but we were able to balance treatment and safety to give her wonderful results.

All of this leads up to the results of this particular study.  In it, researchers looked at 241 participants aged 65 years or older with neck pain, rated at a 3 or higher (on a scale from 0–10) of at least 12 weeks duration.  They were then put into three groups:

  1. A group who were only given home exercises (standard approach)
  2. The same home exercises along with a supervised exercise group (the basic physical therapy approach)
  3. The final group was given the home exercises but also received manipulation for 12 weeks.

After 12 weeks of treatment, the group that received manipulation had the best results (10% greater decrease in pain compared with the home exercises alone group and 5% better results over supervised exercise plus home exercise).

As an added bonus, none of the seniors treated with manipulation in this study died or ended up with multiple neck fractures as a result of any over-zealous neck manipulations.

Not that the results of this should come as any big surprise to anyone who has seen a chiropractor before for neck pain or to any of my colleagues, but sometimes it’s nice to see it in writing.  And hopefully, studies like these can keep future Marges from suffering unnecessary pain when safe and effective treatments are available.

 

Cervical Disc Bulge: Do I Need Surgery?

by

Disc bulge in neck
Disc bulges usually do not need surgery

Now, before I state that our office does very well with disc bulges in the neck, I need to preface this with the fact that we’ve had 2 patients in the past 6 months end up in surgery.

That being said, the vast majority of patients who have cervical disc bulges accompanied by pain in the arm due to that disc bulge that are seen in our office recover nicely. Because back and leg pain are more widely publicized, there is more knowledge about sciatica from back pain; patients frequently come in stating that his or her “Atica” or “schizophrenia” is flared up. Most of these cases are not actually true sciatica (despite what he or she has been told) but are either local pain (no leg pain) or a referred pain from the hip or sacroiliac joint.

Pain in the arm originating from the neck is also very common, but less patients who walk through the door seem to be aware of this relationship. The typical patterns of disc pain in the arm or leg follow a very typical pattern called dermatomes. The problem is that there are many other things that also cause pain into the arm such as the rotator cuff, problems in the forearm such as carpal tunnel and problems stemming from the muscles around the neck such as the anterior scalene or pec minor.

Because there are so many causes of pain into the arm, it can be challenging to nail down exactly what may be causing your problem. For me, sometimes the answer isn’t clear on the first visit or two, but rather, takes some time to clarify exactly what’s causing the pain. Disc bulges in the neck causing pain in the arm can look an awful lot like a rotator cuff referral into the arm. If I work on the rotator cuff for a visit or two and nothing changes, we shift gears towards a treatment of a disc bulge.

Treatment of a cervical disc bulge in our office involves soft tissue work (Graston, stretching, fascial work), chiropractic adjusting and traction. I’m a big fan of home traction devices as well that can allow you to treat the disc bulge several times a day (we recommend this one from Amazon: Instapark® Cervical Neck Traction).

With this approach, the vast majority of patients respond well. This particular study supports this position. In it, chiropractic researchers looked at a group of studies to get a better idea of how long it takes someone to recover from a cervical disc herniation. Here’s what they found:

  • On the down side, they found that complete recovery could take as long as 24-36 months.
  • Luckily, patients were already noting substantial improvements within the first 4-6 months.
  • Overall 83% of patients resolved completely.
  • Patients with a workers’ compensation claim appeared to have a poorer prognosis.

Before you start getting depressed about the 4-6 months timeframe, in our office, if we are going to be able to help a disc pain patient, improvement starts within a few visits and usually progresses forward from there. The use of the traction device helps.

As for the worker’s compensation portion of the equation, I wonder if the poorer prognosis has to do with less of these patients making it into chiropractic offices in a timely matter. Many primary care doctors don’t consider chiropractic for disc problems and will usually use medications and pain injections first.

Car Accidents and Mild Traumatic Brain Injury; Is It Real?

by

If you’re an insurance adjustor reading this, you KNOW that patients involved in a car accident are faking it.

Those of you out there who have actually been on the receiving end of a whiplash injury would beg to differ. Sure, maybe not at the scene of the accident, but by the next morning you’re feeling it. Owning a chiropractic office, we see patients who have been involved in car accidents all the time. Most recover on a very straightforward trajectory, especially when we apply soft tissue treatment along with manipulative therapy.

Some, however, refuse to heal at a rate that is expected. Damn patients. If only we handed out the pamphlets beforehand so these patients would know how fast they are supposed to heal. We are currently dealing with a case right now that continued FAR longer than we had thought originally (care extended beyond a year—NOT at all a usual length of treatment in our office). The insurance people who reviewed the case stated that she should’ve been all better by 12 weeks.

She definitely should’ve read the pamphlet.

The real world, however, does not always follow the guidelines we make for it. And sometimes, we later find out that the guidelines weren’t really all that representative of what happens when later research informs us. The problem here is that these guidelines change with the speed of a snail on 1,000 mg of gabapentin TID.

This particular study has so many interesting aspects to it that I’m not really sure where to begin. But, since the article really focuses on mild traumatic brain injury, maybe that’s a good place to start. For those of you unlucky ones who have never experienced MTBI follow head trauma, either in sports or in a car accident, let me enlighten you to just a few of the symptoms:

  • Fatigue
  • Irritability / behavioral changes
  • Inability to focus / fuzzy thinking
  • Headaches
  • Dizziness

In a nutshell, it sucks. Worse, if you are involved in a relationship, have a job or a life, it begins to disrupt all of these by frustrating those around you.

When this happens to my patients, the best answer I usually have for them is that it just takes time to recover. In some it’s weeks, in some up to a year. When symptoms are more severe, there are certain supplements that may help protect the brain and allow it to heal faster. These can include CoQ10, vitamin E and magnesium threonate.

In this research study of 7170 adult residents injured in car accidents from Saskatchewan, Canada (for those of you who ever wondered where Bigfoot is hiding out—it’s here), 1716 met the criteria for MTBI. For those of you good with math, that’s 24%. A pretty hefty number and far higher than I would ever have expected. Here are some details of the MTBI sufferers:

  • Most common in the 18- to 23-year-old group.
  • Most were not hospitalized (73%).
  • Loss of consciousness in 28% and 23% reported posttraumatic amnesia.
  • Average time to recovery was 100 days, or a little over 3 months.
  • 23% did not recover by 1 year.

Looking at what we have here, we can make a quick assessment that a very large chunk of people involved in car accidents end up with criteria for MTBI, yet a quick screen based on loss of consciousness or memory would’ve missed a huge chunk of those suffering MTBI. After seeing this information I KNOW I have missed patients over the years by not looking for MTBI because there was no overt signs of head trauma reported or a loss of consciousness or memory.

Now, before you walk away already amazed at the information in this study, there’s more (and it’s NOT free shipping). The researchers were able to identify factors associated with slower than expected recovery from MTBI:

  • Age above 50 years
  • Having less than a high school education
  • Having poor expectations for recovery
  • Depressive symptoms
  • Having arm numbness
  • Having hearing problems
  • Having headaches (good thing no one has a headache after a car accident)
  • Having low back pain
  • Having thoracic back pain
  • Surprisingly, loss of consciousness and posttraumatic amnesia were NOT associated with recovery.

After reading through this article and thinking back to the aforementioned patient, she absolutely, positively met many of the symptoms for MTBI as well as experienced 5 of the above factors associated with a delayed recovery. Is it possible that I could’ve done something different early on to change the outcome trajectory? It’s not exactly clear, but maybe I could’ve expected a more realistic outcome and burned the pamphlets.

So What Do I Do for My Neck Pain?

by

I hear this question quite often for just about every ache and pain you can imagine. Many people want miraculous answers or miracle treatments. I find that most of us don’t really want the simple answer.

Many times the simple answer requires a change on the patients part. And not just a month long change, but a lifelong change. This is a wee bit harder to accept.

For low back pain, it would seem that moving around more and exercise is intuitively a good idea. And sure enough, studies on exercise and yoga have proven to help chronic low back pain sufferers as well as patients in my office that are more active. I always say that couch potatoes are much harder to fix than athletes.

But if exercise is good for low back pain, what about neck pain? In 2008, the worldwide Neck Pain Task Force took a very hard look at the evidence surrounding neck pain (causes, prognosis, treatments) and determined that exercise was a strong recommendation for whiplash associated neck pain, but there was not enough evidence at the time to make a judgment call on exercise for other types of neck pain.

This particular study is a new look, done by the same group, at research that has been done in the past decade on exercise for other types of neck pain. Here’s what they found:

  1. Supervised qigong and Iyengar yoga were helpful for the management of persistent neck pain.
  2. In addition, therapies combining strengthening, range of motion, and flexibility are also effective for the management of persistent neck pain.

Qigong is of Chinese origin and has its roots in Chinese medicine, martial arts and philosophy. There are similarities to Tai-chi, although Tai-chi’s forms are generally considered more complex.

Iyengar yoga is a form of yoga derived from Hatha yoga.

While you may not practice either of these, keep in mind that these are the types of exercise that the joint task force found evidence for, but you can rest assured that all forms of exercise are going to be beneficial for neck pain. Movement is good. Sitting on the couch or spending hours of the computer is not.

Stainless Steel Cervical Disc Beneficial For Patients W/ DJD – (10-26-00)

by

Stainless Steel Cervical Disc Beneficial For Patients W/ DJD

While it’s very nice to have a new surgical option for patients with severe neck pain, I personally would race try less severe methods first, such as chiropractic, glucosamine/chondroitin sulfate, MSM…all of which have shown efficacy with neck pain. But, they researchers did use this disc in place of surgical fusion, which can have devastating consequences years after the procedure.

(article) Surgical insertion of a stainless steel disc may alleviate the symptoms of cervical spine degeneration, researchers from the Frenchay Hospital, in Bristol, England, reported today at the 50th annual meeting of the Congress of Neurological Surgeons in San Antonio. Dr. Wigfield and colleagues compared the responses of 12 patients who received the artificial disc to those of 13 patients who underwent traditional discectomy and fusion. All 12 patients who received the artificial disc were able to maintain total range of movement in the treated area. They also showed a reduction in stress on adjacent unaffected discs. Dr. Wigfield credits the design of the artificial disc for its preliminary success. The disc consists of two parts that sit on each other, like a cup and saucer. The design permits the vertebrae to rotate, tilt and move backward and forward, similar to normal spinal movement. “We are encouraged by these early studies,” Dr. Wigfield said.

Cost effectiveness of physiotherapy, manual therapy, and general practitioner care for neck pain – (05-05-03)

by

Cost effectiveness of physiotherapy, manual therapy, and general practitioner care for neck pain.

Being that manual therapy is the bread and butter of my practice, I had to add this one into the Update…

bmj.com Abstracts: Bos et al. 326 (7395): 911

Click here for more information.

Radio Frequency Ablation Dangers – 4 Things to Know

by

“They’re going to burn out the nerves in my neck.”  Sounds pretty permanent, but fortunately, not accurate.

Radiofrequency ablation or neurotomy, aka RFA, is a procedure done in a pain management or anesthesiologist’s office.  RFA is the next step after a series of epidural steroid spinal injections have failed to provide lasting relief.  Usually, a nerve block procedure is done first as a test to see if burning out the nerve is going to be done on the correct level or area.

As I mentioned, this does not “burn out” the nerve.  Rather, it is a procedure that uses a high frequency electrical current at a very specific temperature to destroy the myelin sheath that surrounds the nerve, while not damaging the nerve itself.  For low back pain (not sacroiliac pain) caused by the facet joints, the nerve that is cauterised is the medial branch nerve that provides feedback between the joint and the brain.  If there is a problem with this facet that is creating inflammation, it is likely that there is a constant message up to the brain that you perceive as pain.  Burning off the myelin sheath cuts off communication between that facet and the pain centers in the brain.

Sounds like a great idea and sometimes, it is one of the few options left to patients.  While I don’t have any numbers to back me up, I would not be surprised if a large chunk of patients referred for RFA have never seen a chiropractor.

So what’s the problem if it works?  Even if it is just temporary (the myelin sheath ultimately grows back and the communication between the facet and brain is restored, usually taking anywhere from 3-12 months)?  The problem, like all medical procedures, is that there are dangerous side effects.  But before we get into the gist of this blog post, I need to highlight some problems that occur when the nervous system is cut off from a joint.

Charcot joint (aka neuropathic arthropathy) occurs when damage is done to the nerves feeding a joint.  This can be from diabetes, leprosy, syphilis or any other disease process that destroys the nerves.  Ultimately, the joint breaks down and severe joint damage occurs.  While the exact mechanism is still not understood, part of this process is believed to occur by dysregulation of the autonomic nervous system that leads to an increased blood flow to the denervated joint.  This increased blood flow results in weakening of the bones surrounding the joint and breakdown of the joint.

In addition, it is possible that the lack of feedback from the joint due to the nerve damage leads to further damage and destruction of the joint.

Back to this particular study.  In it, researchers looked at the long-term effects of radiofrequency ablation on the disc, joints and muscles surrounding the joint (specifically the multifidus).  Here’s the details:

  1. 27 patients were identified that had before and after MRIs done.
  2. Spinal levels not treated with RFA were used for comparison.
  3. The disc in the area of the radiofrequency ablation had 342% more degeneration (14.9% versus 4.6%).
  4. Luckily, there was no difference in the multifidus cross-sectional area or rates of deterioration in the facet joints.

The greatly increased disc breakdown is not a good thing.  There is a chance that all of the damage was not caused by the RFA since we already know that epidural steroid spinal injections also increase the degeneration that occurs within the disc  and it is highly likely that patients had epidurals before they got to the point of needing a RFA.

Either way, this information once again supports the idea that chiropractic care should, unequivocally be at the front end of care for musculoskeletal complaints and especially spinal complaints.  This does not ensure that epidurals and radiofrequency ablations will not happen, but it darn well makes sure it’s only used as a last resort.  And a last resort is where it should sit.

 

Is Chiropractic Care Required for Neck Pain?

by

Maybe “required” is a strong word, but is it possible that negative changes occur with neck pain that can only be fixed by chiropractic adjusting?

As always, this is the time for my disclaimer:  As a chiropractor, my viewpoint on this topic is clearly biased, but very well informed.

It seems like most of medicine jumps on a short course of anti-inflammatories and muscle relaxers for non-specific neck or back pain.  Give it a few days of medications and see what happens.  If the patient doesn’t get better, than consider referring out for (most likely) PT or chiropractic care.  If they do get better, everything’s great.  Or is it?

Are there changes that occur either from neck pain, or that lead to neck pain that are at a much deeper level than just symptoms?

I know that, for far too long my profession has promoted the “bone out of place” theory about chiropractic adjusting.  However, this is just not how things work and I think many of my colleagues just found it easier to described what we do in overly simplistic terms.  Closer to reality is what is called the “dysafferentation” model.  Joints like to move and are surrounded by a massive amount of receptors that fire off to the brain when we move.

That’s why we can close our eyes and still touch our noses with our fingertips.  When we have an injury, or spend too much time in a single position at the computer for hours each day or we wake up with severe neck pain, the input from these receptors surrounding the affected joints will slow down.  This means less input into your brain from these receptors.   The brain doesn’t like this and sends a signal out to your pain centers that something is wrong.

At this point, what do you think that any type of medication, regardless of the class it is in, will do to fix this loss of input to the brain?  The correct answer is a big fat nothing.

So what does all this have to do with this particular study?  While a small study, it raises some very interesting questions about neck pain and how what kind of an impact chiropractic care has.  Here’s a summary:

  • Patients had subclinical neck pain, or minor neck pain for which they had not yet sought treatment (specifically, intermittent neck pain such as mild neck pain, ache, and/or stiffness experienced over at least 3 months’ duration)
  • Patients demonstrated  a 19% decrease in reaction time as well as a decrease in cerebellar inhibition (CBI–the brain was no longer reacting the way it was supposed to be).
  • Follwoing a keypad based exercise to increase moto sequence learning, there was a decrease in CBI following chiropractic manipulation.
  • The control group also had a 25% improvement in task performance, but no changes to CBI.

While the article itself gets a little technical, the bottom line is that, in these patients with mild, occasional neck pain, the neurological system is no longer functioning the way it is supposed to.  Additionally, chiropractic adjusting has a positive impact on the nervous system in these patients.

While no hard conclusions can be drawn from this, I would suggest, in my very biased opinion, that NO cases of neck pain can be properly addressed without the use of chiropractic adjusting.  Medications alone, which is a common route of treatment, does nothing to fix the negative changes in the nervous system that are present in neck pain patients.