LifeCare Chiropractic

The Best Chiropractic Care in Mesa, Arizona

Neck Pain

Whiplash Injury Changes Everything

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As a chiropractor, I have an opinion on this one. Whiplash injuries are common & so is the patient whose chronic neck pain has been present “since that accident.”

Whiplash occurs when the head gets thrown back and forth as a result of a sudden change in momentum of the head relative to the neck, resulting in strains affecting the bones, discs, muscles, nerves, or tendons of the neck.

We used to call them hyperflexion / hyperextension injuries, but more careful evaluation showed that the neck does not always go beyond it’s normal range of motion. Rather, small regions of the cervical spine undergo too much flexion and too much extension. Consider an “S” shaped spring getting crunched down from the top–there will be areas of the spring that get scrunched and areas that get stretched. This is closer to what we understand happens during a whiplash type of injury.

Because of this type of injury, studies have identified multiple problems with patients who suffer this type of injury. Fat deposits in the muscles. Change in the muscular coordination of the neck. Jaw pain. Chronic pain. All are potential outcomes following a whiplash type injury.

This particular study continues to paint a depressing picture for those who have had this type of injury. Researchers found changes in those who are suffering from chronic whiplash pain during exercise.

Normally, exercise stimulates the release of built in pain relievers (endogenous). Everyone’s heard of the experience known as “runner’s high” when these opioid-like compounds are released by the body. However, in the chronic whiplash patients, they did not experience the pain reduction associated with exercise like the normal patients did. They were more likely to have an increase in pain after they exercise rather than improvement.

So what is the solution? I’ve already mentioned my bias. I can tell you, from personal experience over 15 years of practice, that when patients get in to our office for treatment within hours of an accident, they never seem to get to the severe levels of pain that we see when compared to patients who come in days or weeks after the injury.

Regardless of where you go for treatment, make sure that all of the potentially injured tissues (ligaments, tendons, fascia, joints, etc..) are treated. Just exercising or just adjusting or just medications will likely not fully address the nature of the tissue damage that occurs in a whiplash type of injury. Only treatments that encompass both the joints (adjusting) and the soft tissues that are injured is likely to be successful at preventing your injury from becoming chronic.

If you have had a whiplash injury in the past, what did you do to fully recover? Or do you still deal with chronic pain?

If You Get Migraine or Tension Headaches, You MUST Do This

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Headaches suck.  Period.  When severe, they disrupt your entire life.  Even mild, they affect your mood and relationships.

The current culture in medicine generally supports the primary care route for headaches.  The primary care doctor may try a few prescription meds like ibuprofen or Tylenol.  When these don’t help they may try a medication like Topamax, which has been shown to reduce headache frequency a paltry 1.5 days in 3 months.

Imaging may or may not be done at this point, but a referral to a neurologist at this point is imminent.  This is where the mistake is made.

For some strange reason, the general public does not normally associated chiropractic care and headaches.  I can tell you from the results we get in our office alone that we can complete alleviate the vast majority of headaches that come into our office.  Some are simply structural and respond with soft tissue work and adjusting.  Some require much more by-in from the patient that will likely include significant lifestyle changes to include quitting smoking, stress management, exercise and dietary changes.

This particular study suggests that the PCP to neurologist pathway is likely not the best choice.  Chiropractic care first would appear to be the best use of resources.  Researchers looked at headache sufferers to see how many of them had pain over the base of the skull that reproduced their headaches.  Results were very telling:

  1. ALL tension headache patients experienced reproduction of their headaches
  2. All but 1 migraine headache patients experienced reproduction of their headaches
  3. In every case, the referred head pain was similar to the pain they usually experienced during headache

You may say “Wow!” but I say “Duh!”  This is an extremely common finding in patients who experience all types of headaches.  In my upcoming book, Migraines and Epilepsy: You are not alone, I cover this aspect of headaches in greater detail.

So how many patients never made it past the neurologist?  How many thousands, tens or hundreds of thousands of headache patients have NEVER had a physician evaluate the structures of their neck, let alone administer any treatment?

What have you found to be the most helpful for your headaches?

RECIPE TO CREATE A DRUG USER

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The Federal Bureau of Narcotics was formed over 80 years ago in 1930.  In 1954, President Eisenhower formed a council to battle narcotics use here in the United States.  In 1971 President Nixon coined the term “war on drugs.”  This was further strengthened by President Reagan in 1982.  Overall, untold billions of federal dollars have been spent on this effort.  Man did we get it all wrong.

We were spending our money and efforts at illicit drug use, while slowly building a society that not only condoned prescription narcotic drug use, but PAID FOR IT!  Beginning at least in 2008, the number of deaths associated with prescription narcotic use exceeded those deaths caused by illicit drug use.

Codeine, OxyContin, Percocet, Vicodin, morphine,  Xanax and Valium (these 2 are benzodiazapines–but frequently abused), Valium, Tramadol, Tylenol 3.

It never ceases to amaze me how quickly prescriptions for narcotic pain relievers are given out.  In the ER it is almost a given.  High likelihood in urgent care.  Still far too common in a primary care settings.

And then there are the non-steroidal anti-inflammatory drugs (NSAIDs).  Why should we throw something as safe and harmless as NSAIDs in with the narcotic drugs?

I firmly believe that, as time progresses (decades, probably) we will begin to understand just how dangerous this class of drugs is.  Arthritis /  joint damage, heart attacks, strokes, impotence, GI bleeds, disruption of intestinal barriers, dementia…this list of known effects seems to lengthen every month.

The problem here is that of sheer scale of use. Between over the counter use and the 70 Million prescriptions per year, it is estimated that there are 30 BILLION doses used per year.  That’s with a “b.”  Even uncommon side effects become magnified by this volume of use.  Of course, bleeding ulcers, heart attacks and strokes are not uncommon, so the math just gets more complicated from there.

So what does all of this have to do with this particular article?  This article looked at analgesic use after low risk surgery (gall bladder, cataract, TURP for prostate enlargement and varicose vein stripping) and what happens after 7 days and one year.  The results were surprising:

  1. Opioids were newly prescribed to 7.1% within 7 days of being discharged from the hospital
  2. Opioids were prescribed to 7.7% at 1 year from surgery
  3. Instead of going down, the number of patients receiving a prescription for opioids at 1 year increased to 15.9%
  4. Overall, an opioid prescriptions within 7 days of surgery made it  44% more likely to be a long term user
  5.  NSAIDs were prescribed to 0.3% within 7 days of discharge
  6. NSAIDs prescriptions jumped to 7.8% at 1 year from surgery
  7. Those taking NSAIDs within 7 days of surgery were almost 400% more likely to become long-term NSAID users

Wow.  Talked about generating a society that is addicted to drugs.  And while this study looks at low risk surgery, how similar would the numbers be for neck pain?  Low back pain?  Knee pain or headache?  Makes me happy to be a chiropractor.

Again, I would ask…is the “War on Drugs” looking at the wrong side of the prescription pad?

PULLED A MUSCLE? WHY POPPING THAT ALEIVE IS A VERY BAD IDEA

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Obviously, this article is going to sound a little self serving since I am, after all, a chiropractor in Mesa with a vested interest in my patients not taking drugs of any kind unless absolutely necessary. My more inquisitive patients all seem to ask a similar question…if the body is so brilliantly designed, where do chronic musculoskeletal complaints come from?

Certainly there are injuries that are severe and result in tissue damage that is much greater in degree and have a high likelihood of producing chronic pain. Think skiing, skateboarding or snowboarding injury. High speed car crashes. Motorcycle accidents. Equestrian wipeouts. Surgery.

But what about the weekend warrior who pulls a hamstring? The 8 hour per day computer user? Or me, as a lifelong martial artist, who has had untold injuries over the decades to pretty much every potential area of my body? Why do these situations lead to chronic pain?

My personal thought (backed by lots of research and years of clinical practice) is that the development of chronicity has much to do with how we handle the immediate period after the injury or onset of symptoms. What do the vast majority of us do (which is, of course, the direction indicated by billions of dollars of advertising) in this immediate period? Rest the area and pop an over the counter pain medication or anti-inflammatory. This is arguably the worst possible combination possible.

Why?

First, let’s address the immobilization aspect. Literally within minutes of immobilization, the soft tissues surrounding the immobilized joint begin to break down. The longer that joint is kept from a full range of motion, the worse the tissue damage. Anyone who’s ever broken a bone and had it casted can attest to how much joint motion is lost once the cast comes off. Recovery time can be even longer than the immobilization time.

With tissue injury, ultimately, the size of the region affected is larger than the original injury size. Consider the swelling associated with an ankle sprain—the area of the ligament injury may actually be very small, but the entire ankle, foot and lower leg swells up to the size of a balloon and becomes discolored. Now the amount of injured tissue is much larger than the original injury and this tissue has to heal. But healing occurs in a haphazard fashion if the area is not used. I give the analogy of a leak in your bathroom faucet. You call in the plumber. He shows up with a crew that’s been drinking at the bar for half the day. They proceed to rip out half the bathroom to fix the leak and rebuild with a level of skill only a three-sheets-to-the-wind Irishman can achieve.

Our body is no different. As we heal after an injury, the new tissue, whether it is bone, muscle, ligaments, fascia or tendons, is laid down in a disorganized manner. Only as that region goes through movement do these healing tissues become stressed and become organized along the lines of force. Immobilization becomes the enemy of proper healing.

Next, let’s address the routine use of over the counter anti-inflammatories, or prescription, for that matter. All anti-inflammatory medications are, by their very nature, designed to interfere with the inflammatory process. Unfortunately, inflammation is the normal process of healing. Disrupt this and you disrupt the ability of our tissues to heal the way they were designed. Contrast this with the use of ice right after an injury. Ice works simply by reducing blood flow to the newly injured area, thus keeping the damage of the drunken plumbing crew from getting too out of hand. Arguably a good idea. But then blocking the crew from repairing the area in specific ways, like maybe taking all their crescent wrenches away from them, is going to result in improper repair.

Hopefully you can begin to understand why the combination of immobilization and anti-inflammatory medications immediately after an injury may be the first step in developing chronic pain. Repeat this cycle the next time you injure the area and the dysfunction begins to mount.

This particular study demonstrates just how bad the outcome can be when non-steroidal anti-inflammatories (NSAIDs) are used after a rotator cuff surgery tendon repair. Researchers looked at the tendon to bone healing that occurred in the presence of NSAIDs and found that every case was affected, from complete failure of healing to weakened tissue. No normal healing tissue was present when compared to the group in which no NSAIDs were used.

While this relates to surgical cases in animals, the same process is interfered with in every case of tissue injury that happens in our body when NSAIDs are used. While my opinion that you should run to your chiropractor at the first hint of any type of pain may sound self-serving, the reality is that you may be diverting the development of chronic pain.

NECK PAIN AND RESPIRATORY DISEASE – (03-08-10)

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Neck pain and Respiratory Disease

Of course, as a chiropractor, I have to comment on this article. Overall, while this is a small pilot study, the concept is not that hard to grasp. Some of the anterior neck muscles (notably the anterior scalenes) assist in respiration, so if there is some type of dysfunction that can affect the neck, it could very well affect breathing. Sounds like a good reason to visit your local chiropractor.

Read entire article here

MYOFASCIAL FINDINGS IN PATIENTS AFTER WHIPLASH INJURY – (05-04-09)

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A distinct pattern of myofascial findings in patients after whiplash injury

As a chiropractor that specializes in soft tissue treatment, studies like this confirm my decision to practice in this manner. Too often following whiplash type injuries patients will seek the care of a PT, their PCP or a DC. The statistics linking long term problems from whiplash injuries is frighteningly high, but I believe this is because few approaches attack the comprehensive nature of these injuries. The joints, soft tissues and the psychological impacts of the injury all need to be addressed. Without this comprehensive approach, it is likely that patients will fall into that category of long term neck pain.

Read entire article here

POOR BLOOD FLOW IN THE BRAIN LINKED TO CHIROPRACTIC CONDITION

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Can we all agree that more blood flow to the brain is a good thing?  I’m sure anyone experiencing a blood choke in ju-jitsu would agree-it’s NOT the best feeling in the world.

Increased blood flow to the brain means more nutrients, more oxygen and more removal of waste products.  These are all ideal situations and lead to increased brain health.  The converse is equally as bad.

We already know of several things that increase blood flow to the brain, such as exercise and whole body vibration.  In addition to increasing blod flow, increasing the availability of nutrients that improve the production of ATP in the mitochondria such as choline, CoQ10, Vitamin E (as mixed tocopherols–NOT straight alpha tocoperol) and alpha-lipoic acid will also result in very positive improvements in brain function and will likely lead to reductions in the risk of Alzheimer’s, Parkinson’s, dementia, hearing loss, migraines and seizures.

So what’s missing from this list?

Based on this particular study, chiropractic treatment.

Researchers looked at the effect of chronic neck and upper back pain on the blood flow in the brain (cerebral perfusion).  They found that these patients with pain had less blood flow into their brains when compared to those who did not have chronic pain.  In the worst case, those with the most severe pain had 45% less blood flow to the parietal and frontal regions of the brain.  The parietal region functions heavily in evaluation the spatial relationships within our bodies and environment, while the frontal lobe is involved in higher mental functions like personality and decision making.

Given how important these regions of the brain are, I’m thinking that 45% sounds like way too much of a loss.  Now this does not mean that you run up to your favorite dolt and poke them in the upper trapezius muscle and ask if it hurts, but certainly entertains the additional value of chiropractic care to address pain in these regions.

If the combination of soft tissue treatment, at home stretches / yoga and chiropractic adjusting can help to increase movement in this region and reduce pain, it would make sense that blood flow to the brain would improve.  This would make chiropractic care an integral component of the treatment of the above mentioned conditions like seizures, migraines and dementia.  But that’s my biased opinion…

DID YOU SEE A CHIROPRACTOR FOR YOUR NECK PAIN?

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Given the initials after my name, you can assume there’s going to be a bias in this post.  Let’s just go ahead and assume it’s going to be a big one.  The overall question, however, is–how many neck pain sufferers have not seen a chiropractor?

I’m sure the number is far too high.  I remember sitting in the ER with a friend about 4 years ago.  The ER was overcrowded and we were in the hall separated by a curtain.  I could clearly hear the clinician talking with the patient in the area next to us (so much for HIPPA, huh?) and it was all I could do to not step next door, step in and suggest that I would be better off handling this.

Can we just accept that mainstream medicine gets a very poor education in musculoskeletal problems?  Just like you wouldn’t want me removing your gallbladder or discussing whether you should take 10 or 80 mg of Lipitor (yeah–like THAT would even be on the discussion board…), we really need to accept that the average PCP does not have the training necessary to adequately manage most musculoskeletal problems.

I had a new patient in last week that has relatively straightforward non-specific low back pain.  I expect her to be doing much, much better within 3-5 visits.  The problem is she has been under medical care for a year which has included cortisone injections, an MRI and now Percocet, ibuprofen and gabapentin.  She then mentions to me that her family has always had somewhat of a fear of chiropractors, and this is why she has been hesitant to see one.

Huh?  Afraid of chiropractors?  Let’s look a little closer at her care:

  • She’s had maybe $5K-15K worth of services
  •  One YEAR of pain (which now has her unemployed and unable to work)
  • She has been told by the pain management doctor that there are no other options
  • She’s on a drug that the manufacturer paid $2.3 BILLION to the Justice Dept for offlabel promotion of gabapentin
  • The list of dangerous side effects of NSAIDs like ibuprofen is so long as to be its own blog post
  • Narcotic pain relievers (Percocet) now exceed illicit drugs in deaths and ER visits in this country

While her case is for low back pain, the clinical scenario with neck pain is not much different.  This particular study just confirms what every practicing chiropractor already knows–chiropractic manipulation, in both the short and long term, was more effective than the medications typically used to treat them.

And, to my knowledge, no one’s ever experienced their stomachs rupturing with subsequent internal bleeding following an adjustment…