CONDITIONS


What conditions do we treat?

What kinds of Chiropractic Therapy do we offer?

We provide adjustments in a variety of ways ranging from light force instruments to gentle hands-on manipulation. Some of our additional procedures to reduce inflammation, provide pain relief, or enhance the healing process may be used.

 Car Accident Related Injuries

Even “fender-benders” can cause hidden injuries that can develop into pain, headaches, and arthritis. Even worse, most people who have been involved in an auto accident may not even know that they’ve been hurt. Most doctors give pain killers to hide these injuries. The chiropractic approach to these types of injuries is to use specific chiropractic adjustments to help return spinal function. After a thorough case history and examination, we will recommend any necessary care to help restore proper motion and position of spinal bones. If caught early enough, inflammation can be reduced, and scar tissue can often be minimized.

Whiplash

Whiplash is a non-medical term used to describe neck pain following an injury to the soft tissues of your neck (specifically ligaments, tendons, and muscles). It is caused by an abnormal motion or force applied to your neck that causes movement beyond the neck’s normal range of motion.

Whiplash Causes:

The most frequent cause of whiplash is a car accident. The speed of the cars involved in the accident or the amount of physical damage to the car may not relate to the intensity of neck injury; speeds as low as 15 miles per hour can produce enough energy to cause whiplash in occupants, whether or not they wear seat belts.

Other common causes of whiplash include contact sport injuries and blows to the head from a falling object or being assaulted. Also, Repetitive stress injuries or chronic strain involving the neck (such as using your neck to hold the phone) are a common, non-acute causes.

Sprains and Strains

The body is meant to move. Muscles allow that movement to happen by contracting and making joints flex, extend and rotate. Muscles attach on each side of the joint to bone by thick bands of fibrous tissue called tendons. When a muscle contracts, it shortens and pulls on the tendon, which allows the joint to go through a range of motion.

A strain occurs when the muscle tendon unit is stretched or torn. The most common reason is the overuse and stretching of the muscle. The damage may occur in three areas:

  • The muscle itself may tear.
  • The area where the muscle and tendon blend can tear.
  • The tendon may tear partially or completely (rupture).

Joints are stabilized by thick bands of tissue called ligaments which surround them. These ligaments allow the joint to move only in specific directions. Some joints move in multiple planes; therefore, they need more than one group of ligaments to hold the joint in proper alignment. The ligaments are anchored to bone on each side of the joint. If a ligament is stretched or torn, the injury is called a sprain.

Shoulder and Neck Pain

 Your neck and shoulders contain muscles, bones, nerves, arteries, and veins, as well as many ligaments and other supporting structures. Many conditions can cause pain in the neck and shoulder area. Some are life threatening (such as heart attack and major trauma), and others are not so dangerous (such as simple strains or contusions).

Shoulder and Neck Pain Causes

Most shoulder and neck pain results from injury to muscles and ligaments. The spinal cord, heart, lungs, and some abdominal organs also can cause neck and shoulder pain. Here are some examples:

Broken collarbone: Falling on your outstretched arm can cause your collarbone to break.

  • Bursitis: A bursa is a sac over the joints to provide a cushion to the joints and muscles. These bursae can become swollen and painful after injuries.
  • Heart attacks: Although the problem is the heart, heart attacks can cause shoulder or neck pain, known as “referred” pain.
  • Broken shoulder blade: An injury to the shoulder blade usually is associated with relatively forceful trauma.
  • Rotator cuff injuries: The rotator cuff is a group of muscles at the shoulder. These muscles can be injured playing sports with a lot of throwing or after repetitive use over a long time.
  • Shoulder or A-C separation: The collarbone and shoulder blade are connected by a ligament. With trauma to the shoulder, this ligament can be stretched or torn.
  • Whiplash injury: Injury to the ligamentous and muscular structures of the neck and shoulder can be caused by sudden acceleration or deceleration, as in a car accident.
  • Tendonitis: The tendons connect the muscles to the bones. With strain, the tendons can become swollen and cause pain.
  • Gallbladder disease: This can cause a pain referred to the right shoulder.

Headaches

Many times, after a car accident people will have initial neck pain, are seen in the emergency room and treated. If the injuries are not life threatening, they are sent home with some medication and told to rest. Unfortunately, many will start to have headaches, even if they have never had headaches before. Those with a history of headaches will find their headaches are getting worse. Most of the time the headache will dissipate over a week or two and everything will be fine.

But what if the headaches don’t go away? What happens and what do people do if the headache gets worse? Post traumatic headaches that get better in four to six weeks are considered acute headaches, but those that stay at the same pain level, start to get worse, or go beyond six weeks are more concerning. The headaches may be all over the head and moderate in pain with breakthrough stabbing, throbbing pain on one side. This more severe form of headache is associated with migraine symptoms and indeed is a migraine.

The key to post traumatic headache syndrome is to find a headache specialist and be patient. If the headaches are severe, chances are that it will take several months for any one treatment to have an effect. Most people are not aware of this fact in headache treatment, so they tend to start and stop treatments after a few days or weeks and become discouraged. The longer the brain has the treatments on board, the greater the chance it will heal.

Numbness

 Numbness and tingling down the arms and legs, also known as paresthesia, can also include symptoms such as pain, burning, pricking, or creeping along the skin. These symptoms generally indicate a malfunction of sensory nerves. While many sufferers of numbness, tingling, and pain in their arms and legs recall specific traumas such as head injuries, auto accidents or falls, which could have injured their spines, some do not. An examination is necessary in each individual’s case to assess whether an injury is present and what care can be achieved.

Dizziness & Vertigo

 Dizziness is a common description for many different feelings. Vertigo/dizziness is a complaint that has been documented as a finding after car crashes much scientific literature. One source stated that 15% of car crash victims will experience vertiginous symptoms and 4% will have associated tinnitus (ringing in the ears). This is especially true in the case of rear impact collisions. The feeling of dizziness may be very familiar to you, yet difficult to describe.

Vertigo is a medical term to describe the feeling of spinning, whirling, or motion either of yourself or your surroundings. This is the same feeling you might have after getting off a merry-go-round or spinning in place. Several diseases of the balance organs of the inner ear can cause vertigo, or it may be a symptom of a tumor or stroke. It may also be a result of an injury.

Dizziness may be just mildly annoying or caused by something possibly life threatening. Often after an auto accident injury people experience this as a symptom of the injury sustained.

When you might feel dizziness:

Fainting or near fainting such as “at the sight of blood” or with emotional upset

  • Fainting or near fainting from standing up too quickly or standing still too long
  • Weakness during a flu, cold, or other illness
  • Seasickness or motion sickness
  • Queasiness, nausea, or vomiting
  • Confused thinking
  • Fatigue, tiredness, or daytime sleepiness
  • Clumsy hands or stumbling walking

Joints are stabilized by thick bands of tissue called ligaments which surround them. These ligaments allow the joint to move only in specific directions. Some joints move in multiple planes; therefore, they need more than one group of ligaments to hold the joint in proper alignment. The ligaments are anchored to bone on each side of the joint. If a ligament is stretched or torn, the injury is called a sprain.

Lower Back Pain

 Car accident back pain is one of the worst and most prevalent types of chronic pain. The tremendous forces created during a car accident are enough to tear apart soft tissue and shatter bone. Life altering spinal injuries are often the result of serious automobile wrecks and even minor fender benders can create some significant back ache complaints.

The spine is the most important part of our skeletons. Spinal injuries are common in serious automobile accidents. Vertebral fracture and spinal instability can result from the nightmarish force of a high-speed collision. Occupants who are ejected from a moving vehicle face an even greater risk of spinal fracture, serious injury or death. Many spinal injuries require immediate back surgery and may leave the patient permanently affected in form and function.

If you have been seriously hurt in an automobile accident, be happy to be alive. Your situation could always be worse, regardless of the extent of your injuries. Concentrate on your recovery and try to make the best of the functionality you still possess. Contacting a licensed Chiropractor and/or Physical Therapist that concentrates in Auto Injury relief and therapy is one of the first moves to make.

Pain in Legs or Arms

 The cause of many instances of shoulder or arm pain is obvious. You do something to injure the arm or shoulder and immediately feel pain, such as in an auto accident. You may have broken a bone or dislocated your shoulder. Perhaps you strained tendons or ligaments by carrying too much weight for too long, by lifting something that was too heavy, overreaching or overexerting your arm-as when playing sports when you’re out of shape-or by keeping your arm in an awkward position or even by sleeping on the shoulder. The resulting pain may range from an annoying ache to an acute pain that makes it hard for you to use the injured arm.

There are other, less-obvious causes of shoulder or arm pain. Each is distinguished by where it is felt, whether it comes on suddenly or over time, when it is at its worst, if the pain extends to other joints in your body, and if other symptoms—such as swelling, numbness, tingling, fever, fatigue, and insomnia—accompany the pain. The causes of shoulder and arm pain include tendonitis, bursitis, arthritis, and gout. Such pain may also result from a reaction to medications such as penicillin, anti-anxiety drugs, and oral contraceptives. Whiplash injuries, common in auto accidents, can also cause shoulder and arm pain.

Shoulder and arm pain may be referred from some other region of the body, as when someone suffering a heart attack feels pain in the left shoulder and down the left arm. The pain may also be referred from nerves associated with the joints in the upper spine or “trigger points” in the back, which are particularly responsive to chiropractic spinal adjustments designed to treat such problems.

Legs are generally abused from standing or sitting for long periods of time. It is important to stretch, massage, and incorporate joint movement to get pain relief. The knee is a complex joint influenced by muscles from above and below the joint. Knee instability is often compensated for by increased muscle tension in the leg muscles and shortening of the iliotibial tract (large connective tissue structure on the outside of the leg). Car accident injuries that damage these parts of the leg require special attention.

Car Seatbelt Injury

 Another common type of personal injury experienced from a car accident is seatbelt injury. This is hardly surprising really when you think what happens in a car accident. Whether some car has rear ended your car or another car has rammed into the side of your car you will be jerked forward or sideways. This thrust will have an effect on your body even if you are wearing a seatbelt. Obviously wearing a seatbelt is law and rightly so. There have been a number of studies into the safety of passengers and the tests showed that if you wear a seatbelt you are less likely to be injured as seriously than if you were not wearing one. All the same you can still be damaged by a seatbelt and in some case quite seriously.

Although lifesaving, the seatbelt causes misaligned ribs and vertebrae which in turn pinch and pull the nerves which are connected to these affected areas. The result is pain. Why go untreated after an automobile accident? Pain does not have to become a way of life after an accident. If you’re involved in an accident, whether it occurs on the job or on the road, contact our office for a complete post-accident examination. It could save you from having to say, “….it’s never been the same after the accident.”

BACK PAIN

Lower Back Pain, Upper Back Pain, Spine Pain Relief

 While there are many causes of lower back pain, most cases of low back pain can typically be linked to either a general cause – such as muscle strain – or a specific and diagnosable condition, such as degenerative disc disease or a lumbar herniated disc.

In the US, lower back pain is one of the most common conditions and one of the leading causes of physician visits. In fact, at least four out of five adults will experience it at some point in their lives.

Ironically, the severity of the pain is often unrelated to the extent of physical damage. For example, muscle spasm from a simple back strain can cause excruciating lower back pain that can make it difficult to walk or even stand, whereas a large herniated disc or completely degenerated disc can actually be completely painless.

Types of Lower Back Pain

Low back pain is typically classified as either acute or chronic:

  • Acute back pain is short term, generally lasting from a few days to a few weeks. Some acute pain syndromes can become more serious if left untreated.
  • Chronic back pain is generally defined as pain that persists for more than three months. The pain may be progressive, or may occasionally flare up and then return to a lower level of pain. With chronic pain, the exact cause of the pain can sometimes be difficult to determine.

Lower Back Anatomy

The causes of low back pain can be very complex, and there are many structures in the spine that can cause pain. Any of the following parts of spinal anatomy are typical sources of low back pain:

  • The large nerve roots in the low back that go to the legs and arms may be irritated.
  • The smaller nerves that innervate the spine in the low back may be irritated
  • The large paired lower back muscles (erector spinae) may be strained
  • The bones, ligaments or joints may be damaged
  • The intervertebral disc may be damaged

Sometimes there is a neurological component, such as leg or foot weakness or numbness, as well.

It is important to note that many types of low back pain actually have no known anatomical cause; but this doesn’t mean that the pain doesn’t exist. The patient’s pain generator may not be identifiable, but this does not necessarily signify that the pain is all psychosomatic. Actually, an estimated 90% of patients with pain will not have an identifiable cause of their pain.

 Sciatica

Our doctors regularly treat sciatica as a result of a sports or work injury. Sciatica is characterized by pain that originates in the low back or buttock that travels into one or both legs. Sciatic nerve pain varies in intensity and frequency; minimal, moderate, severe and occasional, intermittent, frequent or constant.

Pain is described as dull, achy, sharp, toothache-like, pins and needles or similar to electric shocks. Other symptoms associated with sciatica include burning, numbness and tingling sensations. Sciatica is also called radiating or referred pain, neuropathy, or neuralgia. A misconception is that sciatica is a disorder – however, sciatica is really a symptom of a disorder.

Sciatica is generally caused by sciatic nerve compression. Disorders known to cause sciatic nerve pain include lumbar spine subluxations (misaligned vertebral body/ies), herniated or bulging discs (slipped discs), pregnancy and childbirth, tumors, and non-spinal disorders such as diabetes, constipation, injury, or sitting on one’s back pocket wallet.

One common cause of sciatica is Piriformis Syndrome. Piriformis syndrome is named after the piriformis muscle. The piriformis muscle is located in the lower part of the spine, connects to the thighbone, and assists in hip rotation. The sciatic nerve runs beneath the piriformis muscle. This muscle is susceptible to injury from a slip and fall, sports injury, work injury, hip arthritis, or a difference in leg length. Such situations can cause cramping and spasm to develop in the piriformis muscle, thereby pinching the sciatic nerve and causing inflammation and pain.

Sciatic nerve compression may result in the loss of feeling (sensory loss), paralysis of a single limb or group of muscles (monoplegia), and insomnia.

Herniated Disc, Disc Bulge & Protrusion

What is a “slipped” disc?

The disc is a circle of cartilage between each vertebra in the spine that acts as both a shock absorber and a shock distributor. If you jump up and down, imagine what would happen to the stack of bony vertebra that make up the spine without the cushioning of the discs. Move your back side to side. Again, you can visualize the give and take of the discs between the vertebrae. Without discs, the spine simply could not function.

Discs don’t really “slip”. Instead, they bulge, herniate, or rupture. Saying a disc has “slipped” does suggest that something has “slipped out” and is not where it’s supposed to be, which is what happens in disc injuries.

Discs are made up of concentric circles or rings of fibrous material with a tough gelatinous center. When cracks or fissures occur in the fibrous rings, the gelatinous material in the center can begin to push out. A number of different factors may cause the disc to “slip”.

Discs depend on water to keep their height and perform efficiently. When we’re young, discs have their own circulation that helps keep them hydrated. As we get older, this circulation ends and the spine must move so that water can be drawn into the discs. If discs become dehydrated and lose their height, they become more vulnerable to cracks and fissures.

Discs are integral parts of our body’s mechanical system that allows us to move. Chiropractors are especially interested in seeing how injuries in one part of the body relate to the mechanical system of the body as a whole. Chiropractors look at injuries specifically, but they also try to determine in what way an injury is the outcome of disturbances elsewhere in the body.

Disturbed mechanics from lack of muscular support or muscular imbalance are important because discs can come under more stress from weak abdominal muscles, or too much weight around our abdomen. The resulting hyperextension can cause a wedging of the discs.

The opposite condition, hyperflexion, is caused when we round our low back because of weak back muscles or poor sitting habits. This causes stress on the disc in the opposite direction. Finally, if we put too much load on the back over a period of time, or occasionally in one dramatic episode, we can add another significant factor.

A “slipped disc” most often occurs when a number of these and other factors act together to cause disc injury. For example, a middle-aged accountant who sits for long periods, suffers from disc dehydration, and has poor mechanics from weak abdominals, then lifts a heavy piece of furniture and experiences acute low back and leg pain. Or perhaps many months after lifting the piece of furniture, he experiences no pain at all until he sneezes. Bingo. A slipped disc.

How do the Estner Injury Center doctors determine whether this is a “slipped disc”?

Careful history taking, vital signs, and orthopedic and neurological testing are standards of practice in chiropractic offices. Are the reflexes intact? Is there loss of muscle strength or signs of muscle wasting? Is there loss of sensation along an area supplied by a particular nerve? These are vital questions that the orthopedic and neurological exam can help answer.

Chiropractors utilize other diagnostic procedures that are unique to chiropractic and establish the foundation for a program of care. Chiropractors look carefully at posture and perform a postural analysis of the patient. They use techniques such as motion and static palpation to determine exact areas of restrictions in spinal joint motion. They palpate muscles and perform muscle testing, as well as perform tests for pelvic balance and determine whether there is a “short leg”. X-rays of the low back are taken, or the chiropractor might send the patient to an x-ray facility for these films. Depending on the findings, the chiropractor may call for an MRI or other imaging study of the back.

Chiropractic Care of Low Back Disc Conditions

 After analyzing this information, the chiropractor determines if the patient has suffered a disc injury. The crucial diagnostic question is, “what type of disc injury has occurred?” It is the answer to this question that will determine the chiropractic approach to treatment or referral.

There are some patients who are not good candidates for conservative chiropractic care. For example, if there is suspicion of a cauda equina syndrome in which loss of bladder control accompanies a disc injury, this is a medical emergency not treated by chiropractic. If there are unusual neurological findings with advanced loss of strength, sensation, and reflexes, the chiropractor will refer the patient to a spine surgeon (spine specialist) prior to initiating conservative care.

Most disc conditions do not fall into these more extreme categories. The great majority of disc injuries involve some degree of bulging of the disc. The “slipped” disc can be a slight, even temporary, push against the nerve or the spinal cord, or it can be a more definite mild, moderate, or marked bulge. Frank herniated discs occur when a fragment from the central part of the disc brakes completely through the fibrous rings.

Whatever the category of disc bulge, the low back pain, leg pain, and muscle spasms require examination and, in most cases, a period of conservative, non-surgical care prior to any consideration of surgical intervention.

What is chiropractic “Flexion-Distraction” technique?

 Flexion-distraction technique has become the most widely used approach to treating symptomatic disc injuries involving back pain and the often-accompanying leg pain. Flexion-distraction involves the use of a specialized table that gently distracts or stretches the spine, and which allows the chiropractor to isolate the area of disc involvement while slightly flexing the spine in a pumping rhythm. There is no pain involved in the treatment.

Theoretically, the tractioning or distraction of the disc combined with isolation and gentle pumping of the involved area allows the central area of the disc, the nucleus pulposus, to assume its central position in the disc. Flexion-distraction is thought to improve disc height.

These actions move the disc away from the nerve, reducing inflammation of the nerve root, and eventually the associated pain and inflammation into the leg.

Flexion-distraction is applied in a series of treatments combined with adjunctive physiotherapy, supplementation, and home instructions. Eventually, specific exercises for low back disc conditions are introduced. Patients are evaluated and monitored throughout the treatment program.

In flexion-distraction technique, chiropractors follow a “50% rule”: if a patient has not improved objectively and subjectively by 50% at the end of 12 sessions, then imaging studies are assigned and spine specialist referral is considered. If there is substantial worsening at any time during treatment, imaging and neurosurgical referral are the standard of care.

Lumbar Treatment

 Rehabilitation of the lumbar spine is a complex process that bridges both physical and emotional factors underlying chronic, recurrent, and postsurgical low-back and leg pain complaints. To understand the appropriate context for the use of chiropractic manipulation during rehabilitation, it is useful to examine the aims of the treatment plan as a whole.

The successful treatment plan must account for the constellation of factors that define the clinical status of the client when rehabilitation therapy begins. The principal aim of treatment is to address the physical deconditioning that arises from injury and related activity intolerance. Secondarily, rehabilitation offers a means to address residual symptoms fostered by incomplete clinical recovery during the acute care phase of treatment. The specific goals include increased function, reduction of pain levels, and enhanced quality of life; ideally, by promoting a rapid return to a work-ready or pre-injury status. Desirable clinical benefits include individual self-reliance and decreasing dependence on caregivers. The activity of rehabilitation must strike a balance appropriate to the severity of injury and the fitness of the person, versus the pace and intensity of executing the treatment plan.

Notably, experience and recent research suggest that appropriately used spinal manipulation can be an effective means of aiding persons with low-back and leg pain in transition from passive to active care. Manipulation also serves to control symptoms arising from the occasional exacerbations and related musculoskeletal injuries that arise during the course of therapy. The discussion to follow will review the scientific evidence and draw upon practical experience to consider the ways in which chiropractic manipulation can be useful in low-back pain (LBP) rehabilitation.

SI Joint Pain [Sacroiliitis-Sacroiliac Join Dysfunction]

What are the sacroiliac (SI) joints?

The sacroiliac (SI) joints are formed by the connection of the sacrum and the right and left iliac bones. The sacrum is the triangular-shaped bone in the lower portion of the spine, below the lumbar spine. While most of the bones (vertebrae) of the spine are mobile, the sacrum is made up of five vertebrae that are fused together and do not move. The iliac bones are the two large bones that make up the pelvis. As a result, the SI joints connect the spine to the pelvis. The sacrum and the iliac bones (ileum) are held together by a collection of strong ligaments. There is relatively little motion at the SI joints. There are normally less than 4 degrees of rotation and 2 mm of translation at these joints. Most of the motion in the area of the pelvis occurs either at the hips or the lumbar spine. These joints do need to support the entire weight of the upper body when we are erect, which places a large amount of stress across them. This can lead to wearing of the cartilage of the SI joints and arthritis.

What is sacroiliac joint dysfunction?

There are many different terms for sacroiliac joint problems including SI joint dysfunction, SI joint syndrome, SI joint strain, and SI joint inflammation. Each of these terms refers to a condition that causes pain in the SI joints from a variety of causes.

What are the causes of sacroiliac joint dysfunction?

As with most other joints in the body, the SI joints have a cartilage layer covering the bone. The cartilage allows for some movement and acts as a shock absorber between the bones. When this cartilage is damaged or worn away the bones begin to rub on each other, and degenerative arthritis (osteoarthritis) occurs. This is the most common cause of SI joint dysfunction. Degenerative arthritis occurs commonly in the SI joints just like other weight bearing joints of the body.

Another common cause of SI joint dysfunction is pregnancy. During pregnancy hormones are released in the woman’s body that allows ligaments to relax. This prepares the body for childbirth. Relaxation of the ligaments holding the SI joints together allows for increased motion in the joints and can lead to increased stresses and abnormal wear. The additional weight and walking pattern (altered gait) associated with pregnancy also places additional stress on the SI joints.

Any condition that alters the normal walking pattern places increased stress on the SI joints. This could include a leg length discrepancy (one leg longer than the other), or pain in the hip, knee, ankle or foot. Patients with severe pain in the lower extremity often develop problems with either the lower back (lumbar spine) or SI joints. In most cases if the underlying problem is treated the associated lumbar spine or SI joint dysfunction will also improve.

There are many disorders that affect the joints of the body that can also cause inflammation in the SI joints. These include gout, rheumatoid arthritis, psoriasis, and ankylosing spondylitis. These are all various forms of arthritis that can affect all joints.

What are the symptoms of sacroiliac joint dysfunction?

The most common symptom of SI joint dysfunction is pain. Patients often experience pain in the lower back or the back of the hips. Pain may also be present in the groin and thighs. In many cases it can be difficult to determine the exact source of the pain. Your physician can perform specific tests to help isolate the source of the pain. The pain is typically worse with standing and walking and improved when lying down. Inflammation and arthritis in the SI joint can also cause stiffness and a burning sensation in the pelvis.

How is sacroiliac joint dysfunction diagnosed?

The first step in diagnosis is typically a thorough history and physical examination by a physician. The physician will ask questions to determine if there are any underlying disorders that could be causing the patient’s pain. This can also help differentiate pain coming from the SI joints, lumbar spine, or hips. There are various tests a physician can perform during the physical examination that can help isolated the source of the pain. Other portions of the examination are to exclude certain possibilities that could mimic sacroiliac disease.

The next step in diagnosis is often plain radiographs (x-rays). The patient may have x-rays of the pelvis, hips or lumbar spine depending on what the physician finds on the history and physical examination. A computed tomography (CAT or CT) scan may also help in the diagnosis. CT scan gives a more detailed look at the joint and bones. A magnetic resonance imaging (MRI) scan can also be helpful. This provides a better evaluation of the soft tissues including muscles and ligaments. It can also identify subtle fractures that may not be seen on an x-ray. A bone scan can be obtained to help isolate the source of your pain and can be used to identify bony abnormalities. The bone scan can identify areas of increased activity in the bone. This is a nonspecific test and can be positive in cases of arthritis, infection, and fracture or tumors of bone.

Often the most accurate method of diagnosing SI joint dysfunction is by performing an injection that can numb the irritated area, thereby identifying the pain source. An anesthetic material (for example, lidocaine, nonvaccine) can be injected along with a steroid (cortisone) directly into the SI joint. This is usually performed with the aid of an x-ray machine to verify the injection is in the SI joint. The anesthetic and steroid can help relieve the pain from inflammation that is common with SI joint dysfunction. The duration of pain relief is variable, but this is very useful to determine that the SI joint is the source of the pain.

PRENATAL CARE

Is chiropractic care safe during pregnancy?

There are no known contraindications to chiropractic care throughout pregnancy. All chiropractors are trained to work with women who are pregnant. Investing in the fertility and pregnancy wellness of women who are pregnant or trying to conceive is a routine treatment for most chiropractors.

Some chiropractors take a specific interest in prenatal and peri-natal care and seek additional training. Below represents designations of chiropractors who have taken advanced steps in working with infertility and pregnancy wellness.

Chiropractors that have been trained to work with pregnant women may use tables that adjust for a pregnant woman’s body, and they will use techniques that avoid unneeded pressure on the abdomen.

Dr. Estner has been a staff physician at Women and Infants Hospital in Ob/Gyn and is well versed in the needs of women who are pregnant will also provide you with exercises and stretches that are safe to use during pregnancy and compliment any adjustments made to your spine.

Why should I have chiropractic care during pregnancy?

During pregnancy, there are several physiological and endocrinological changes that occur in preparation for creating the environment for the developing baby. The following changes could result in a misaligned spine or joint:

  • Protruding abdomen and increased back curve
  • Pelvic changes
  • Postural adaptations

Establishing pelvic balance and alignment is another reason to obtain chiropractic care during pregnancy. When the pelvis is misaligned, it may reduce the amount of room available for the developing baby. This restriction is called intrauterine constraint. A misaligned pelvis may also make it difficult for the baby to get into the best possible position for delivery.

The nervous system is the master communication system to all the body systems including the reproductive system. Keeping the spine aligned helps the entire body work more effectively.

What are the benefits of chiropractic care during pregnancy?

Chiropractic care during pregnancy may provide benefits for women who are pregnant. Potential benefits of chiropractic care during pregnancy include:

  • Maintaining a healthier pregnancy
  • Controlling symptoms of nausea
  • Reducing the time of labor and delivery
  • Relieving back, neck or joint pain
  • Prevent a potential cesarean section

CARPAL TUNNEL SYNDROME

 Carpal Tunnel Syndrome: Is it difficult to grasp a jar, bottle, or cup? Have you lost the strength to twist open a large jar? Do you have tingling or numbness in your hand, wrist, or fingers? Or, does your wrist just plain hurt? If you have some or all of these symptoms, you may have Carpal Tunnel Syndrome.

What is Carpal Tunnel Syndrome?

It is common to hear this term used frequently when patients have wrist or hand pain. The human body has two long bones that start at the elbow and extend to our wrists. These bones are called the ulna and the radius. Connective tissue attaches the bones near the wrist from one side to the other. Picture in your mind, a piece of silk attached to both bones and pulled tightly. The pressure on the nerves below is the most common cause of true carpal tunnel syndrome.

Fortunately, not all wrist pain should be called CTS. It is important to determine, if in fact, the symptoms are being caused by the pressure on the nerves of the wrist, or if there is a different cause of the problem. It is VERY common for these types of symptoms to exist when there is a neck misalignment, history of auto injury, or other spinal conditions. The nerves of the neck control all the nerves of our arms and hands. If the nerves of the neck are being compressed, wrist and hand pain is a common symptom. Your Doctor of Chiropractic is trained to determine whether your condition is a true carpal tunnel syndrome.

Treatment:

Chiropractic treatment, which directly releases pressure on the nerves, is highly beneficial to Carpal Tunnel Syndrome patients. Due to the extensive education in problems with the nervous system and muscle structure of the body, the chiropractors may be uniquely qualified to correct this type of pain and discomfort.

In some cases, your chiropractor can use physical therapy or manipulation of the wrist to alleviate the symptoms of true CTS. In more serious cases, a surgical referral may be required. If it is determined by your chiropractor that the cause of your symptoms is due to a neck-related situation, a series of chiropractic adjustments may be recommended. Whatever the cause, be assured that we will do our best to lead you in the most appropriate direction for the resolution of your health issue.

THORACIC OUTLET SYNDROME

 “Tingling fingers.” If you suffer from numbness and tingling in your hands it may be the result of a condition known as Thoracic Outlet Syndrome.

 How do you get Thoracic Outlet Syndrome?

There are several causes of thoracic outlet syndrome however most are due to poor posture, muscle imbalance, improper training methods or occupational stress.

There are certain occupations that have a greater number of employees with thoracic outlet syndrome. These include cash register operators, typists, packers and assembly line workers, due to the awkward work postures and amount of continuous muscle tension. Other signs of thoracic outlet syndrome include coldness, progressive weakness, early fatigability, and loss of coordination in the hands. There may be additional symptoms such as swelling, heaviness, fatigue and muscle cramping.

Imagine a bundle of nerves and blood vessels that travels down from your neck to supply your arms. When this bundle is narrowed or compressed the common result is numbness and tingling in your fourth and fifth fingers or entire hand. (Carpal Tunnel Syndrome more commonly affects the thumb, 2nd and 3rd fingers)

An easy to understand analogy is a common garden hose. If the hose is free from bends or kinks then the water flows freely, however, if there is a kink or bend in the hose then the flow becomes impeded, the same is true of the nervous system.

How is it treated?

Proper treatment of thoracic outlet requires an accurate understanding of the postural factors involved. Most recent treatment programs consider evaluation of joint mobility and muscular imbalance.

Once diagnosis of thoracic outlet syndrome is made by a Doctor of Chiropractic, a specific treatment program is designed for the patient.

More specifically, chiropractic management will focus on joint mobility in the cervical (neck) and thoracic (upper back) regions of the spine. Frequently, patients with thoracic outlet will have joint tightness in these areas which is treated with spinal manipulative therapy, stretching and rehabilitation in the office.

Keep in mind; there are other conditions that may cause similar symptoms. In either case, if you are currently suffering from similar symptoms, be sure to consult your chiropractor.

NECK PAIN

HERNIATED DISC, DISC BULGE & PROTRUSION

A common cause of neck, shoulder and arm pain is a ruptured or herniated cervical disc. Symptoms may include dull or sharp pain in the neck or between the shoulder blades, pain that radiates down the arm to the hand or fingers, or numbness or tingling in the shoulder or arm. Certain positions or movements of the neck can intensify the pain.

The symptoms of a cervical herniated disc often resemble other disorders such as carpal tunnel syndrome, problems with the rotator cuff and gout. In some patients, a cervical herniated disc can cause spinal cord compression where disc material pushes on the spinal cord. This is a much more serious condition and may require a more aggressive treatment plan. Spinal cord compression symptoms include awkward or stumbling gait, difficulty with fine motor skills in the hands and arms, and tingling or “shock” type feelings down the torso or into the legs.

Anatomy – Normal Cervical Disc

In between each of the vertebrae (bones) in the spine is a disc, a tough fibrous shock-absorbing pad. Endplates line the ends of each vertebra and help hold individual discs in place. Each disc contains a tire-like outer band (called the annulus fibrosus) that encases a gel-like substance (called the nucleus pulposus). Nerve roots exit the spinal canal through small passageways between the vertebrae and discs. Pain and other symptoms can develop when the damaged disc pushes into the spinal canal or nerve roots.

Cervical disc herniation occurs when the annulus fibrosus breaks open or cracks, allowing the nucleus pulposus to escape. This is called a Herniated Nucleus Pulposus (HNP) or herniated disc.

Progressive Steps Toward a Cervical Disc Herniation

 Many factors increase the risk for disc herniation: (1) lifestyle choices such as tobacco use, lack of regular exercise, and inadequate nutrition substantially contribute to poor disc health. (2) As the body ages, natural biochemical changes cause discs to gradually dry out affecting disc strength and resiliency. (3) Poor posture combined with the habitual use of incorrect body mechanics can place additional stress on the cervical spine.

Combine these factors with the effects from daily wear and tear, injury, incorrect lifting, or twisting and it is easy to understand why a disc may herniate. A herniation may develop suddenly or gradually over weeks or months.

The four stages to a herniated disc include:

  • Disc Degeneration: chemical changes associated with aging causes discs to weaken, but without a herniation.
  • Prolapse: the form or position of the disc changes with some slight impingement into the spinal canal. Also called a bulge or protrusion.
  • Extrusion: the gel-like nucleus pulposus breaks through the tire-like wall (annulus fibrosus) but remains within the disc.
  • Sequestration or Sequestered Disc: the nucleus pulposus breaks through the annulus fibrosus and lies outside the disc in the spinal canal (HNP).
  • Chiropractic Care for Cervical Neck Disorders

Consulting a chiropractor for neck pain might seem obvious to a patient who has experienced chiropractic and who associates an adjustment with the release of tension, increased motion, and pain relief.

For others, chiropractic treatment of the neck brings to mind a different picture. What could be the benefit of ‘popping’ the bones in the neck? When family doctors are asked about neck manipulation, they often visualize an abrupt twisting of the neck and are apt to sound a note of alarm when a patient seeks chiropractic care for a cervical injury.

Similar to medical doctors, chiropractors use diagnostic indicators to differentiate types of neck problems. How these indicators are used and what occurs during a cervical adjustment will help to increase awareness of the indications and limitations of chiropractic care for neck conditions.

Chiropractic offers a unique and valuable mechanical approach to a wide range of cervical problems. Chiropractors do not ‘twist’ the neck or perform painful maneuvers. Manipulation or adjusting as performed by chiropractors is a precise and gentle therapy whose aim is to return motion to restricted spinal joints and to improve the overall mechanics of the spine.

ARM NUMBNESS

 Numbness and tingling down the arms and legs, also known as paresthesia, can also include symptoms such as pain, burning, pricking, or creeping along the skin. These symptoms generally indicate a malfunction of sensory nerves. While many sufferers of numbness, tingling, and pain in their arms and legs recall specific traumas such as head injuries, auto accidents or falls, which could have injured their spines, some do not. An examination is necessary in each individual’s case to assess whether an injury is present and what care can be achieved.

Ribs Pain, Chest Pain, Costochondritis, and Seatbelt injuries

If you are experiencing pain in your chest or torso, such as pain radiating from the front of the chest, pain upon taking a deep breath, pain in between or under the shoulder blades, the issue is most likely the result of a problem with your ribs. Rib pain is usually described as a sharp stabbing pain.

You may have woken up with these pains after sleeping or you may have been suffering with this type of pain for some time.

Our rib cage is the body structure which protects and supports the major organs in our torso. It is a complex mixture of bones, joints, nerves, muscles and connective tissues.

Ribs attach to your middle back (thoracic spine) and at the front at the breast-bone, also called the sternum. The thoracic spine is made up of 12 thoracic vertebrae with 12 ribs on each side. Each rib has two joints at the back the spine and the top seven ribs have a joint at the front attaching to the breast-bone. The last two ribs do not attach to anything at the front and are therefore called floating ribs. Each rib connects to the body of the vertebra and to a bone on the side of the vertebrae, and sometimes to the disks. The joints are stabilized by ligaments and muscles. There are muscles found between the ribs and there are many muscles overlaying the ribs. There is also a nerve between each rib, which extends from the spine to the sternum along the course of the rib. All of these tissues can be damaged by a rib injury.

The chiropractic examination is first aimed at ruling out serious medical problems. It is then followed by a detailed examination of the joints and muscles. Dr. Hopson will assess the movement of the individual ribs.

The aim of the treatment is to restore the movement, reduce pain and reduce any muscle spasm. Chiropractic is such a versatile treatment that is does not matter how old you are, if you are affected by osteoporosis or other medical problems. There is always a suitable treatment method the chiropractor can use that is safe and effective for you.

Chiropractic treatment is always worth considering if you have any chest, shoulder or arm pain. Never delay having a check-up. The longer you leave the problem the more difficult it will be to treat.

THORACIC MISALIGNMENTS

Thoracic Spine & Vertebrae

The thoracic spine contains 12 medium sized vertebrae all of which form articulations (joints) with 2 opposing ribs. Like other spinal vertebras in the neck and low back, the thoracic vertebrae act as attachments for muscles and ligaments in the middle portion of the spine and also encase and protect the middle portion of the spinal cord and thoracic nerve roots.

Because the thoracic vertebrae form strong articulations with the ribs, the mobility of the thoracic spine is less than that of the cervical and lumbar spines. Conversely, the restricted mobility of the thoracic spine protects the thoracic intervertebral discs and facet joints from the wear and tear experienced by the same structures in the other areas of the spine.

Common vertebral problems in the thoracic spine include vertebral subluxations, a condition where the vertebrae of the thoracic spine become statically misaligned and/or function abnormally resulting in pain, muscle spasm, and possible nerve malfunction.

Rib Articulations

The thoracic spine is unique in that a pair of ribs attaches to each of its vertebrae. There are 12 thoracic vertebrae and therefore, 24 ribs (12 on the left and 12 on the right). Just like the thoracic vertebrae can misalign and biomechanically malfunction, so too can its adjoining ribs. When ribs “go out” or misalign in relation to their connecting vertebrae, the individual will often experience sharp pains in the area of the misaligned rib head, especially on twisting movements, and difficulty and discomfort with taking a complete breath.

As with vertebral subluxations, chiropractic spinal adjustments are successful in treating rib misalignments. The adjustment repositions the rib to its correct position and normalizes impaired motion patterns.

Causes of Mid-Back Pain

Mid back pain is most commonly caused by irritation or injury to the muscles and ligaments of the thoracic spine. The commonness of poor postural habits, lack of adequate exercise and muscle conditioning, as well as the ever more popular “seated” lifestyles are all major contributors.

Chiropractors work hard to pinpoint and identify the exact problems of mid back pain so that only the safest and most effective treatments can be provided. Since the majority of mid back pain cases have a significant soft tissue component, chiropractic treatments are extremely beneficial.

Common contributing factors to the development of mid back pain include:

  • Lack of proper and periodic thoracic spinal adjustments
  • Presence of thoracic spine subluxations
  • Poor posture
  • Incomplete rehabilitation of past injuries
  • Prolonged sitting
  • Improper workstation setup
  • Prolonged use of non-ergonomically designed equipment
  • Improper bending and lifting techniques
  • Scoliosis (lateral deviation of the spine)
  • Excessive repetitive torso motions
  • Auto accidents
  • Physical inactivity
  • Poor diet and nutritional practices
  • Smoking
  • Structures that are often the source of mid back pain include:
  • Thoracic facet joints and capsules
  • Costovertebral joints (joints between the thoracic vertebrae and ribs)
  • Thoracic paraspinal muscles and ligaments
  • Thoracic spinal nerves
  • Thoracic intervertebral discs

Most individuals experiencing mid back pain have a combination of:

  • Vertebral subluxations
  • Faulty spinal biomechanics
  • Improper firing patterns of spinal musculature
  • Deconditioned and weak spinal musculature
  • Poor postural habits
  • History of activities generating high levels of spinal stress
  • Poor diet and nutritional practices

 Treatment

Through the use of natural and safe procedures Chiropractic doctors have successfully treated mid back pain for over 100 years by correcting the underlying problems which cause and contribute to the majority of mid back pain cases.

Chiropractors use the chiropractic spinal adjustment as the main treatment method. It is a noninvasive technique consisting of a gentle, manual or mechanical applied force into specific segments of the spine. Spinal adjustments have been shown to decrease pain, increase spinal range of motion, decrease muscle spasm, reduce inflammation, optimize spinal biomechanics, and reduce the recurrence of previous injuries.

Other manual therapies such as trigger point therapy, proprioceptive neuromuscular facilitation, massage, and acupressure therapy may be utilized to assist in the relaxation of paraspinal muscles and increase spinal mobility.

Back exercises designed to strengthen the paraspinal muscles are frequently prescribed to patients suffering from mid back pain so that they are less likely to fatigue during the day. When the muscles of the mid back fatigue easily and are weak the ability to maintain proper posture throughout the day is reduced and the risk for injury is increased. Stretches are also generally recommended to stretch the muscles of the chest as tightness in these muscles can place increased stress on the muscles of the mid back. Exercises and stretches can be performed outside the office without the assistance of the doctor.

In office physical therapies may also be used and can include hot and cold applications, muscle stimulation, interferential therapy, therapeutic ultrasound, and diathermy.

Diet and nutrition also play a key role in the health of the spine. Without the proper nutrients, the thoracic spine and rest of the body are less able to remain healthy and heal after an injury.

 RIB SUBLUXATION

In the back, the rib heads connect to the body of the vertebrae as they cross the transverse process. They connect with the vertebra above, the vertebra below, and the disc between them. Subluxations of the ribs can cause many problems because of compression on adjacent nerves. Subluxation of the upper ribs can cause referred pain and numbness down the arm. The pain may be so severe that you can hardly breathe and sleeping may be next to impossible.

Any extreme motion that pulls the arm back behind the body in a sudden jerking motion can also cause ribs to subluxate. An example would be someone whose upper ribs were subluxated by the force of an automobile accident. Someone like this may be in agony because the rib, whose joint capsule and ligaments were badly strained, continues to subluxate with even minor activity.

In dance, improperly turning the body is a situation that can lead to rib subluxation. The partner needs to be certain to keep the turning arm bent at the elbow and in front of her face. Weight lifting can cause the ribs to subluxate if the weight is too great or the breathing is improper. Wrestling and tackle football are more direct causes of knocking ribs out of place. Even coughing or breathing too deeply may cause ribs to subluxate.

Subluxated Ribs Chiropractic Treatment

The corrective adjustment is fairly simple. The chiropractor will use a drop table, activator (a hand-held instrument), or some efficient lever to quickly “pop” the rib back into its proper position. The adjustment must be made precisely and quickly. Total relaxation on the part of the patient is absolutely essential.

Patients should always:

Be aware of your posture – Avoid forward head posture – Get professional help if necessary, as I have explained in previous articles on proper posture.

Keep your back fit – A strong back with good posture is less likely to have problems.

Use good lifting techniques – Avoid motions that might cause rib subluxations.

If a rib does subluxate, see a chiropractor as soon as possible for proper treatment.

COSTOCHONDRITIS

Costochondritis (with unknown cause) is a common cause of chest pain in children and adolescents. It accounts for 10-30% of all chest pain in children. Annually, doctors evaluate about 650,000 cases of chest pain in young people aged 10-21 years. The peak age for the condition is 12-14 years.

Costochondritis is also considered as a possible diagnosis for adults who have chest pain. Chest pain in adults is considered a potentially serious sign of a heart problem by most doctors until proven otherwise. Chest pain in adults usually leads to a battery of tests to rule out heart disease. If those tests are normal, and your physical exam is consistent with costochondritis, your doctor will diagnose costochondritis as the cause of your chest pain. It is important, however, for adults with chest pain to be examined and tested before being diagnosed with costochondritis. Often it is difficult to distinguish the two, without further testing. The condition affects females more than males (70% versus 30%). Costochondritis may also occur as the result of an infection or as a complication of surgery on your sternum.

Tietze syndrome is often referred to as costochondritis, but the two are distinct conditions. You can tell the difference by noting the following:

Tietze syndrome usually comes on abruptly, with chest pain radiating to your arms or shoulder and lasting several weeks.

Sneezing, coughing, deep breathing, or twisting your chest can increase the pain.

Unfortunately, millions of people have ribs go out of place every year – from athletics, coughing, falling, injuries, osteoporosis, and more. Most get better on their own. Some get stuck and cause week, months, and even years of pain and suffering, finally ending up with an arthritic joint. The really unlucky ones go to their family physician, who has no idea that ribs can subluxate (go slightly out of place), nor how to put them back into place.

Sometimes a highly scientific mis-diagnosis of costochondritis or neuritis will result. Doctors don’t seem to understand that ribs subluxate or go out of place from time to time. If ribs get stuck, usually nothing less than an external force or adjustment will put them back into place, thus resolving the problem.

If a patient suffers from a common rib subluxation, an adjustment is the first treatment of choice. Since 99% of cases of costochondritis are caused in this manner, you are saved from expensive and dangerous invasive procedures. And if a rib subluxation is not the cause, you will know it overnight because the adjustment will do no good.

Ribs can cause all kinds of back, side, chest, and torso pain. The ribs can get dislodged at their connection in the spine, at their connection at the breastbone, or both. The pain comes from inflammation of the cartilage, and even pinched nerves which lie immediately below the ribs.

There are many ways to correct these subluxations.

Today there are non-force adjustments available. The most common and effective of these is Activator Method. Used mostly by chiropractors, the doctor uses a little tool which delivers a tiny thrust which can hardly be felt. It can be directed precisely in the direction needed. The method is amazingly effective, and relief is usually enjoyed overnight. One to six adjustments will usually quickly and effectively resolve costochondritis caused by rib sublimation.

Headache and Migraine Chiropractic Treatment

What kinds of headaches are there?

More than 90 percent of headaches can be classified as tension-type, migraine or cervicogenic.

By far, most people get tension-type headaches and get them frequently. They typically suffer mild to moderate pain, on both sides of the head, that is often described as tight, stiff, constricting – like having something wrapped around your head and pressing tightly.

Migraines are periodic severe, throbbing headaches that afflict far fewer people (and more women than men), usually hurt on one side of the head, can cause loss of appetite, nausea and even vomiting, and may involve a visual change called an aura.

Cervicogenic headache is a musculoskeletal form of tension-type headache (which may also be related to migraines). Many times, cervicogenic headache goes undiagnosed as such due to the relative newness of this classification.

Who suffers from headaches?

Many millions of adults, worldwide, get headaches regularly. Headaches are among the most common physical complaints prompting people to treat themselves or get professional assistance. One estimate holds that some 50 million people in the U.S. get severe, long-lasting, recurring headaches. Most headaches are not signs of serious underlying conditions, but they can be very distracting, debilitating and account for significant amounts of time lost from work.

What should I be concerned about?

If you are a headache sufferer, your obvious concern is to obtain safe, dependable relief. You should avoid making things worse by using drugs – even over-the-counter, nonprescription drugs – that can have serious side effects and dangerous interactions with other medications or supplements you take. You should also be aware that many people experience what are termed “analgesic rebound headaches” from taking painkillers every day, or nearly every day. Watch out! The medicine you take to get rid of today’s headache may give you a headache tomorrow and the days after.

What can chiropractic do?

Chiropractors have had considerable success relieving the cause of headache pain and releasing headache sufferers from the dangerous vicious circle of taking ever-larger doses of ever-stronger painkillers that may even be causing new and worse headaches.

Chiropractic adjustments have shown to be as effective and even more effective than medications in reducing the severity and frequency of headaches. Chiropractic is particularly successful dealing with cervicogenic headache. Even though cervicogenic and other tension-type headaches may not actually involve stress or muscle tension, chiropractic’s ability to adjust spinal abnormalities seems to lessen or remove the forces contributing to many individuals¹ headache pain.

The Rhode Island Chiropractic clinic of Dr. Stephen Estner provides migraine and headache relief for many ailments including (Click on a topic below for more information):

  • Headache Chiropractor
  • Migraine Headaches
  • Tension Headaches
  • Cluster Headaches
  • Cervicogenic Headache
  • Suboccipital

What is chiropractic headache treatment?

Chiropractic care deals with subluxations (misalignments of vertebrae causing nerve irritation) anywhere along the spinal column, not just in the lower back. Sometimes the vertebrae of the spine become misaligned or lose their range of motion for one reason or another. This misalignment puts pressure on nerves leading to and from the brain. A chiropractor helps put them back in place by using gentle and highly skilled adjustments.

How and when should I try headache chiropractor treatment?

Chiropractic treatment is not something that is generally used on its own. One of the dangers of chiropractic is simply that someone will rely on the treatment alone and miss out on other issues that need to be treated. It’s best to talk to your doctor and let her know that you’re using an alternate therapy, and for what.

That being said, going to a headache chiropractor seems to be a safe and effective way to treat headache or migraine without drugs. The idea behind chiropractic is not that the condition itself is treated, but that the body is able to heal itself. Some people have dramatic results, and become completely headache free. Some migraine sufferers find complete relief. Others find relief simply from some symptoms or after effects of the migraine attack. The best thing to do is find a chiropractor that you’re comfortable with, and track the results of the treatment over time.

Cautions

There are three things to remember when considering headache chiropractor treatment. First, always talk to your doctor and let her know what you’re doing. You especially need to see your doctor if you’re having new symptoms.

Second, choose your chiropractor carefully. Make sure you’re comfortable, and that the person really is a trained Doctor of Chiropractic, not a well-intentioned neighbor.

Third, remember that headache chiropractor treatment is not a treatment of conditions. It helps the body heal itself. That means that chiropractic care often goes along with other treatments and general healthy living.

MIGRAINE HEADACHES

Migraines are severe, recurrent headaches that are generally accompanied by other symptoms such as visual disturbances or nausea. There are two types of migraine – classic and common. A classic migraine has an “aura” or warning associated with it that precedes the headache. The aura is often a visual disturbance (like seeing stars or zigzag lines or a temporary blind spot.) A common migraine does not have such a warning before the head pain begins. The experience of migraines, which affect 6 out of 100 people, tend to start between the ages of 10 and 46. More women than men have migraines.

Signs and Symptoms

The headache from a migraine, classic or common, has the following characteristics:

Throbbing, pounding, or pulsating pain

  • Often, begins on one side of your head and may spread to both or stay localized
  • Most intense pain is often concentrated around the temple(s) (side of the forehead)
  • Commonly lasts from 6 to 48 hours

Accompanying symptoms that may precede or occur at the same time as the migraine include:

  • Nausea and vomiting
  • Dizziness described as lightheadedness or even vertigo (feeling like the room is spinning)
  • Loss of appetite
  • Fatigue Visual disturbances, like seeing flashing lights or zigzag lines, temporary blind spots (for example, loss of your peripheral vision), or blurred vision
  • Eye pain
  • Extreme sensitivity to light (called photophobia)
  • Parts of your body may feel numb, weak, or tingly
  • Light, noise, and movement—especially bending over—make your head hurt worse; you want to lie down in a dark, quiet room
  • Irritability

Symptoms that may linger even after the migraine has resolved:

  • Feeling mentally dull, like you’re thinking is not clear or sharp
  • Increased need for sleep
  • Neck pain

Causes

The symptoms of migraines occur as a result of changes in the diameter of blood vessels to the brain and surrounding structures. Initially, the blood vessels constrict (narrow), reducing blood flow to these areas and leading to visual disturbances, difficulty speaking, weakness, numbness, or tingling sensation in one area of the body, or other similar symptoms. When these symptoms start before the actual headache (as in classical migraine), it is called an aura. Minutes to hours later, the blood vessels dilate (enlarge) leading to increased blood flow and a severe headache. Things that can trigger migraine (that is, the change in the diameter of blood vessels) include the following:

  • Alcohol
  • Low blood sugar from, for example, missing meals
  • Certain foods such as those containing the amino acid tyramine (found in red wine, aged cheese, smoked fish, chicken livers, figs, and some beans), chocolate, nuts, peanut butter, some fruits (like avocado, banana, and citrus), foods with monosodium glutamate (MSG – an additive in many foods), onions, dairy products, meats containing nitrates (bacon, hot dogs, salami, cured meats) fermented or pickled foods
  • Fluctuations in hormones (for example, menstruation)
  • Certain odors, such as perfume
  • Allergic reaction
  • Bright lights
  • Loud noises
  • Stress, physical or emotional (often, the headache occurs during the period of relaxation just following a particularly stressful time)
  • Sleeping too little or too much
  • Caffeine
  • Smoking or exposure to tobacco smoke
  • Prolonged muscle tension (for example, from a tension headache can lead to a mixed migraine-tension headache)
  • Risk Factors
  • Women are more likely to get migraines than men
  • Having other family members with migraine headaches
  • Use of birth control pills, especially if you also smoke or have high blood pressure
  • Being under age 40; after that point, the likelihood of migraine declines for both men and women
  • Exposure and sensitivity to any of the potential triggers listed above

Treatment Approach

There is no specific cure for migraine headaches. The treatment is geared toward preventing such symptoms by avoiding or altering triggers. Once migraine symptoms begin, however, treatment is aimed at preventing the headache pain if you have an aura (namely, associated symptoms that precede the headache) or treating the head pain once it has set in. There are a number of ways to accomplish all three of these – reduce the number and intensity of your headaches, quickly abort the onset of a headache by treating the migraine at the time of the aura, or successfully diminish the head pain once you have it.

TENSION HEADACHES

One third of Americans suffer from tension headaches. These headaches can be felt on both sides of the head as a dull, steady pain that often becomes intense at the end of the day. Unfortunately, traditional medicine has little to offer chronic headache sufferers. Pain medicine and muscle relaxants will ease the pain. Stress reduction, relaxation and exercise can improve wellness and perhaps prevent the occurrence of the headache.

A recent study has suggested, however, that chiropractic treatments can decrease the frequency and length of headaches as well as the number of painkillers needed for relief. Dr. Niels Nilsson of Odense University in Odense, Denmark, and Dr. Geoffrey Bove of Beth Israel Deaconess Medical Center and Harvard Medical School, have studied the impact of chiropractic treatment on headaches. They have found that chiropractic treatment can work, but accurate diagnosis of the headache is key to efficacy. The diagnosis of tension headaches relies on very general symptoms.

Unfortunately, these symptoms can mask a headache of a different nature: cervicogenic headaches (originating in the cervical / neck region). Dr. Nilsson estimates that 15-20 percent of all recurrent headaches are cervicogenic.

Cervicogenic headaches are characterized by pain on one side of the head with associated neck pain on the same side. A patient with these headaches perceives pain in the head, but the actual source of the pain lies in the cervical spine.

CERVICOGENIC HEADACHES

 Cervicogenic headaches are headaches caused by the cervical spine.

Whether from chronic tension or acute whiplash injury, intervertebral disc disease or progressive facet joint arthritis, the neck can be a hidden and severely debilitating source of headaches. Such headaches are grouped under the term “cervicogenic headache,” indicating that the primary contributing structural source of the headache is the cervical spine. There are well mapped out patterns of headache relating to a multiplicity of muscular trigger points in the neck and shoulder-blade (or peri-scapular) region, as well as to disc and joint levels in the upper cervical spine. Even headaches located predominantly in the forehead, or behind, in and around the eyes are very often “referred” pain zones for pathology located in the back of the neck and at the base of the skull. This base of the skull area is called the suboccipital region, because it is below the occipital part of the head. The joints connecting the top two or three levels of the cervical spine to the base of the skull handle almost 50% of the total motion of the entire neck and head region, thus absorbing a continuous amount of repetitive stress and strain, in addition to bearing the primary load of the weight of the head. Fatigue, postural malalignment, injuries, disc problems, joint degeneration, muscular stress and even prior neck surgeries all can compound the wear and tear on this critical region of the human skeletal anatomy. One may also develop a narrowing of the spinal canal itself, through which runs the spinal cord and all of its exiting nerve roots, leading to a condition termed spinal stenosis, also a possible source of headaches, among other symptoms.

SUBOCCIPITAL

 Suboccipital Triangle of Muscles

These muscles are commonly taut in patients with upper neck pain. Trigger points in these muscles can refer pain to other areas of the head causing headaches. Adjusting this area usually eliminates these headaches completely. These cervicogenic headaches are the most common type of headache.

Tension headaches generally result from prolonged contraction of the suboccipital muscles. These muscles bridge the junction between the posterior (back) of the skull and the vertebrae (bones) of the cervical spine (neck). Several mechanisms seem to be involved in the causation of the common headache:

  • Muscle inflammation and “trigger points.”
  • Joint irritation and nerve compression.
  • Dural traction on the spinal cord and brainstem.
  • Muscle Inflammation and Trigger Points

Several of the nerves that exit the highest portion of the neck loop back to travel over the top of the head to the forehead. These nerves pass through a triangle of muscles called the suboccipital (“below the skull”) triangle. When these muscles at the base of the neck become irritated (due to either physical strain or emotional stress), they tend to tighten impinging the nerves passing through the triangle.

It should be fairly obvious that alleviating joint dysfunction and muscle tightness in the neck would eliminate headaches caused by physical stress. However, even if the headaches are caused entirely by emotional stress, decreasing irritation of the same joints, muscles and nerves can also greatly improve symptoms.


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