LifeCare Chiropractic

The Best Chiropractic Care in Mesa, Arizona

neck pain

Should All Patients with a Migraine See a Chiropractor in Mesa?

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Ok..given my bias everyone probably knows my answer here when it comes to chiropractic in Mesa.
It never ceases to amaze me when a patient has had headaches for years or even decades that have never been to a chiropractor.  Given the evidence, it really should be considered malpractice (lack of informed consent) for a neurologist to NOT refer to a doctor of chiropractic for an evaluation of any headache patient.
And yet the referral to a chiropractor who specializes in soft tissue treatment of the neck almost never happens.  It is the migraine sufferer that loses out.
Just how common is neck pain in migraine headache sufferers?  This particular article looks at this question in 113 migraineurs, who had headache frequencies ranging from episodic to chronic migraine.  These headaches sufferers were examined by headache medicine specialists to confirm the diagnosis of migraine and rule out both cervicogenic headache and fibromyalgia.
For each attack over the next few months, sufferers recorded the whether nausea was present as well as the intensity of headache and neck pain (graded as none, mild, moderate, or severe).  Here’s what they found:
  • There were 2411 headache days, 786 of which were migraines.
  • The majority of migraines were in the moderate pain stage.
  • Regardless of the intensity of headache pain, neck pain was a more frequently present than was nausea.
  • Those diagnosed with chronic daily headache were more likely to have neck pain.

So what does this mean?  From a standard migraine approach, this means that, although the presence of nausea is a characteristic of a migraine headache, neck pain (which is not a characteristic) is actually more common.

From my standpoint of almost 20 years of treating migraine patients, we have totally, absolutely missed the ball.  Since most headache specialist do not touch the patient and wouldn’t even know how to treat problems in the neck is he or she found them, these patients are mis-diagnosed.

I can’t tell you how many times I’ve had patients come in with a diagnosis of “migraine” only to have the headaches go away with soft tissue treatment of the neck structures combined with manipulation.  These were NOT migraines.  Migraines generally do not respond as well to manual therapies, but most often need a lifestyle overhaul to manage the headaches.

The bottom line?  Neck pain is strongly associated with headaches.  If you have headaches, it is absolutely essential for you to find a chiropractor competent in soft tissue treatment to see if this will help.

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

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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?

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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.

So What Do I Do for My Neck Pain?

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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)

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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)

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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.

Is Chiropractic Care Required for Neck Pain?

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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.

 

Cervical Bulging Disc? 6 Reasons to See a Chiropractor

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Going to a chiropractor for run of the mill neck pain seems like a good idea, but what about something more severe like a cervical bulging disc?

An honest to goodness true cervical bulging disc creating pain in the arm are not really as common as many think.  I can’t tell you how many times I’ve seen a patient with leg or arm pain who thought, or had been told, that his or her symptoms were from a bulging disc get complete resolution of the arm or leg pain in maybe 2 or 3 visits.  These cases were obviously not disc bulges, but are often mistaken for a disc bulge by someone who does not know what to look for.

Oddly, our clinic recently had 4 cervical disc bulge patients come in a row.  Just odd how that works out.  And these were clear-cut, no need to waste money on an MRI, disc bulges in the neck.  Bakody’s sign and all (a situation where the patient finds the most relief by putting the affected hand on top of the head to find relief).  The fear in a patient’s eyes when you tell them they have a disc bulge is almost palpable, which is why I very quickly launch into the “these types of cases rarely need surgery” speech.

Somewhere along the way the dogmatic belief that disc bulges all require surgery got started and society never seemed to have gotten the message that this is rarely the case.  Certainly over the years I’ve had patients who, despite pulling out all the stops and doing everything we can, have still progressed to surgery.  But this usually not the case.  In our office we treat with soft tissue techniques to address the muscle, ligament, tendon and fascial problems, in office traction as well as home traction units or pillows and manipulation.

Manipulation???  Of a neck that has a disc bulge?

Yep.

Along with the dogma of the obligatory surgery mentioned above, “they” seemed to have created the dogma that chiropractors can’t treat disc bulges.  Good thing no one ever told me this little tidbit.

And, just in case you think I’m alone in this crazy belief that chiropractic manipulation can help a disc bulge in the neck, I present this particular article.  Researchers took 50 patients with a MRI confirmed cervical bulging disc and had them undergo cervical spinal manipulation for treatment.  Here’s the results:

  1. At 2 weeks, 55.3% were “improved.
  2. At one month the number rose to 68.9%.
  3. At 3 months a respectable 85.7% were improved.
  4. As early as one month, decreases in neck pain, arm pain, and Neck Disability Index (NDI) scores were seen.
  5. Of the patients who had initially been identified as subacute or chronic, 76.2% were improved at 3 months.
  6. On top of all of this, NO adverse events were reported.

Keep in mind this is just chiropractic spinal manipulation and not the full arsenal of tools that the typical chiropractor would bring into play.  These numbers are solid and, although the study was small, certainly adds to the concept that chiropractic care absolutely should be initiated early on for any patients with a cervical bulging disc.  But of course, I’m just a little biased…