Chiropractic

Living Pain-free without medication

Raya is a photographer and was suffering with pain in her left shoulder and through her rib cage, especially when she was working a long or stressful photo shoot. As you can imagine, this continuous problem was beginning to take a toll her body and get in the way of her ability to function while doing her job. 

After getting her spine checked and "getting her head on straight", Raya's body balance has been restored, relieving her nagging pain. She has been holding her alignment (meaning she does not need to be adjusted) for three months. She is able to power through those long photo shoots and stressful situations without resorting to medications and is out there sharing her passion with the world!

Protect your lower back in standing forehead to knee Pose

Standing poses are fantastic for improving balance and as an added benefit, this pose stretches those often too tight hamstrings.  Yet the standing forehead to knee pose is one that I see done incorrectly the most.  The chiropractor in me winces because I know how easy it is to compromise the lower back when this one is done incorrectly.  

If you are holding up that outstretched leg with your arms, and you know who you are, then you are at risk for straining your lower back.  With the weight of the leg in the arms and your lower back folded over, you're putting a lot of pressure on your spine, and the muscles in the lower back.  The group of muscles at risk is called your erector spinae muscles.  In an ideal world, the leg should actually be held up by its own strength and supported with the abdomen. 

Test yourself to see if you can stand on one leg and extend the other out without using your hands for support.  If you can, you're ready for this pose.  If not, then back off a bit: standing up right with the leg outstretched just at a lower angle or even with the knee bent.  In these modified versions you will still get the benefit of improved balance and increase muscle strength, all while your lower back is being protected! 

Low Back Pain and Headaches Improved with Upper Cervical Care

We all know that pain and fear of injury can stop us from doing the things in life that we really want to do and make us feel...well...just not like ourselves. Ryan came to us experiencing low back pain, which was keeping him from exercising. Ryan was becoming frustrated because when he would exercise, his low back would flair up. He was also getting headaches two to three times a week and neck pain. Ryan’s upper cervical spine was corrected and immediately he felt the pressure off his low back. He has now had four upper cervical corrections and his low back pain, neck pain and headaches are all dramatically improved just by getting his head on straight! Is your head on straight?

WARRIOR THREE POSE FOR A STRONGER CORE AND BACK

Warrior three pose or Virabhadrasana III is a more advanced posture and requires the practitioner to have a solid foundation and balance.  This is a pose that is wonderful for strengthening: ankles, legs, back, core, and shoulders.  It is also a pose that if done incorrectly can cause some problems in the body, especially for the hip of the standing leg and for the lower back.  For the ideal benefits of this pose make sure that your foot, knee, hip, shoulders, head and arm of the raised leg are in a straight line, and that the raised leg, toes, hip points, and fronts of the shoulder all point towards the ground.  

This pose also helps with focus, concentration and invigorating the body.   

Remember that keeping a body moving is an important part of keeping a body healthy! 

Happy Practicing. 

HELP FOR MIGRAINE SUFFERERS IN PORTSMOUTH, NH

When you body has a recurring symptom that doesn't resolve medication can be helpful to get you through the day to day, it masks the symptom but you should ask yourself... WHY?   Why can't my body self correct this?  Why does the problem continually recur?  With migraines often the causes can be many factors from environmental triggers like chemicals to life stress but often a big factor is also neurological and structural. 

At Arete Chiropractic, we work at correcting the underlying problem that causes migraines. For many, this is a misalignment of the C1 and C2 vertebrae. These vertebrae are located at the base of the skull. The C1 (atlas) provides protection for the brainstem. If misaligned, however, pressure may be placed on the atlas resulting in various symptoms such as migraines.

Also, a misalignment in this sensitive part of the body may restrict blood flow to the brain keeping it from getting enough oxygen. It could also result in reduced drainage of cerebrospinal fluid, thus causing pressure to build up.

Regardless of the way in which the misalignment causes or contributes the migraines, a correction can help to resolve the issue.   Watch the story below of a woman who's entire life was affected by chronic daily headaches.  

Benefits of Planking For A Healthy Body

Continuing our series of yoga poses that we LOVE for improving balance, aligning your spine, and keeping you healthy, another favorite one of ours is the plank pose. 

Performed properly, the plank can increase flexibility, improve balance, reduce back pain, and elevate your mood. 

1. Reduce Back Pain:  According to the American Council on Exercise (ACE):2

“Because the plank exercise requires minimal movement while contracting all layers of the abdominal fascia, it is an excellent way to strengthen the core, which, in turn, helps reduce low-back pain.”

2. Improve Flexibility:

While building strength, planks also increase flexibility in your posterior muscle groups. The muscles around your shoulders, collarbone, and shoulder blades will expand and stretch (an area that often receives little attention), as will your hamstrings and even the arches of your feet and your toes.

3. Improving Your Mood:

Virtually every exercise has the potential to give you a mood boost, and planks are no exception. Planks are unique, however, in that they help stretch and ultimately relax muscles groups that often become stiff and tense from prolonged sitting. The tension release that planks provide is uplifting for your spirit.

4. Improving Balance & Posture: 

To do a plank correctly, you must engage your abs to stay upright. Side planks or planks with extensions are particularly beneficial for building balance, as are planks performed on a stability ball. To test and strengthen your balance, try a side plank with a leg raise – get into side plank position, then lift your top leg and hold for one count. Lower it and repeat, then switch sides. In addition, planks work all the muscles you need to maintain proper posture, like your back, chest, shoulders, abs, and neck. If you do planks regularly, you’ll find you’re able to sit or stand up straighter with ease.

Imaging of the ligaments in the Upper Neck

Follow-Up MR Imaging of the Alar and Transverse Ligaments after Whiplash Injury:

A Prospective Controlled Study

Vetti N., Krakenes J. et al. American Journal of Neuroradiology 32: 1836-41, Nov 2011

 

Why do we do research? To answer questions?  Yet, how often do we seek out research that validates our paradigm?  My guess would be almost always.  Therein is the problem.  To be a true question, we must not think we already know the answer or outcome.  That was the reason that this study caught my eye.

This study was a prospective case controlled study that followed 91 symptomatic whiplash patients and 52 neck pain control patients for 1 year.  MR Imaging was done at baseline on neck pain patients and after the accident and on a 1 year follow up, results were also correlated with the neck disability index. 

The inclusion criteria for the whiplash included: MVA in the past 7 days with onset of neck pain within 48 hours.  No previous history of neck pain, and classified as WAD 1-2 (Whiplash Associated Disorders without any neurological signs, factures or dislocations).

The symptomatic control patients were included when they reported to an outpatient spine clinic with a history >3 months of neck pain with a non-traumatic onset.

The researchers concluded that the areas of high signal intensity (indicating inflammation/fibrosis/fat replacement) in the alar and transverse ligaments did not change significantly at baseline or at 1 year follow up for WAD patients.  Further the prevalence of the alar and transverse ligament high signal intensity did not differ significantly between traumatic and non-injured neck pain controls.

What the researchers concluded is that the alar and transverse ligament high signal intensity in patients with WAD1-2 observed in the first year after injury cannot be explained by the trauma.

Clinical Pearls:

“High signal intensity could theoretically be due to altered ligament function cause by neck pain.”

“Pain induced immobility causes morphologic changes in muscles, tendons and ligaments.”

“High signal intensity of the alar and transverse ligaments is also reported to be frequent in healthy non-injured persons without neck pain.”

Author’s Note: This study is a bit confounding however provides an interesting observation on neck pain related MR imaging. 

Fibromyalgia responds to upper cervical care: A Case Study

Alibhoy N. Resolution of Fibromyalgia Following Upper Cervical Chiropractic Care: A Case Study. J. Upper Cervical Chiropractic Research; June 20, 2011.

The case follows a 45 year old fibromyalgia patient with additional complaints of migraines, neck, upper back and low back pain, numbness in her fingers, bilateral sciatica, right knee pain, depression and duodenal ulcer.   She had a history of two major cervical traumas and 11 car accidents, and had seen 5 different chiropractors in 12 years.  Her activity levels were severely limited and she frequently used a wheel chair. 

Knee Chest protocol was used and the patient was seen 79 times in 17 months with 47 adjustments performed to both atlas and axis. 

At resolution of care the patient did not need the use of her wheel chair and self-reported fibromyalgia and left leg sciatica, right knee pain, chronic back pain and migraines had completely resolved.  Right leg sciatica improved 98%.  The patient was also no longer taking any of her previous routine medications. 

 Case studies are an invaluable starting point for more in-depth research.    

 

Will how adjusting my neck affect my hip pain?

The Effect of Upper Cervical or Sacroiliac Manipulation on Hip Flexion and Range of Motion

Pollard, DC, MS, Ward, PhD.  JMPT 1998; 21(9);611-616

Your going to adjust my neck and it will help my hip feel better?   How often have you heard this question in your office?  The following study although a few years old points to a positive correlation and gives a compelling hypothesis for the connection.

This study compared the effectiveness of an upper cervical manipulation and a manipulation of the SI joint for increasing hip range of motion in 52 subjects ages 18-34.   Testing methods where performed using a hand held digital electrogonimometer.  The patients performed a straight leg raise before and after the treatment.  The three treatment groups included just cervical manipulation, just SI joint manipulation (side posture) and the third received a sham adjustment of pressure on the mastoid process.  Range of motion was tested prior to manipulation, the patient received one treatment and then range of motion was re-tested. 

Both spinal manipulation groups demonstrated increased flexion of the hip however only the upper cervical manipulation increased hip flexion range of motion significantly. 

The potential mechanism discussed is that of the tonic neck reflex.  Changes in the muscle spindle output of the suboccipital muscles may cause reflexive proprioceptive changes to centers that control posture.   The muscles of the pelvic girdle are some of our primary posture stabilizers.  

Is your neck pain affecting your balance?

Chronic neck pain, standing balance, and suboccipital muscle atrophy--a pilot study

 McPartland JM, Brodeur RR, Hallgren RC, JMPT 1997 Jan;20(1):24-9

 

This study was completed at the University of Michigan and looked at 7 chronic neck pain patients and 7 controls.

The purpose of the study was to examine the relationship between chronic neck pain, standing balance and sub-occipital (the base of the skull) muscle atrophy. 

Palpation was used to determine any somatic dysfunction (misalignment) of the upper cervical spine (top of the neck), a force platform was used to measure standing balance, and MRI was used to examine fatty infiltration (evidence of injury and disfunction) of the sub-occipital muscles.

The study found that chronic neck pain patients have almost twice the amount of somatic dysfunction (tenderness, asymmetry of joint position, restriction in range of motion, and tissue texture abnormality) as compared to normal subjects. 

The greatest changes where noted at C0-C1 (where your skull meets your neck) joints and the authors concluded that this area needed the greatest amount of consideration during evaluation.  (IE upper cervical chiropractic)

Further the study showed that chronic neck pain patients demonstrated a decrease standing balance using a force plate, and MR imaging indicated that they had increased atrophy of rectus capitus posterior minor and rectus capitus posterior major. 

The authors also have a wonderful discussion with a compelling hypothesis of the far reaching implications of chronic neck pain…

“Somatic dysfunction can cause a sustained facilitation of motor neurons and reflex contraction of muscles, which may lead to impaired circulation and localized tissue ischemia, followed by atrophic changes in muscles and fatty degeneration.  Muscle atrophy and degeneration have been associated with chronic pain.  Muscles in the cervical region also contain a high density of muscle spindles… Atrophy of these muscles might reduce proprioceptive input into the dorsal horn of the spinal cord and higher centers… A reduction of proprioceptive input might result in facilitation of neural activity which is perceived by the patient as chronic pain.”

In review:  Misalignment of the upper neck causes changes in the muscles and nerves in that area that affect your standing balance!  Standing balance influences your posture, your posture contributes to breathing, hormone production, blood pressure, and more because it’s all connected! Further, the longer you have the neck pain the more negative changes develop.  

Trigeminal neuralgia and migraine pain: One patient's response

Trigeminal neuralgia and migraine pain: One patient's response

Trigeminal Neuralgia and Chronic Migraine: One Patient's response to Blair Upper Cervical Care

Is your Back Pain shrinking your Brain?

Chronic Back Pain is Associated with Decreased Prefrontal and Thalamic Grey Matter Density

Apkarian V.A., et al.  Journal of Neuroscience, Nov 2004, 24(46):10410-10415

This research was out of Northwestern University in Chicago Illinois in 2004.  It was the first study to correlate chronic back pain (CBP) with decreased grey matter in the brain.  As we work with patients every day, people who have chronic unremitting back pain for 1 year or more have an accelerated neurodegenerative process underway in their brain.  If we are able to help them we are playing an active role in slowing that process!

The researchers studied 26 people with chronic back pain (unrelenting pain localized around lumbosacral area for greater than 1 year) and 26 control patients.  They performed 2 different types of analysis for estimating global grey matter in the brain and adjusted statistics for age, gender, and type of pain (musculoskeletal and neurogenic/radicular). 

Clinical Pearls:

Normal whole brain grey matter atrophy is 0.5% per year.

Atrophy caused by CBP was measured at 5-11% per year, the equivalent of 10-20 years of aging.

The reduction in grey matter was localized to the dorsolateral prefrontal cortex (DLPFC) and the thalamus.  The DLPFC is responsible for inhibition of the orbitofrontal activity of the brain.  The orbitofrontal area is responsible for perception of pain.  The researchers then extrapolated that with loss of inhibition of the orbitofrontal areas of the brain, chronic pain suffers perceive increased pain.

Patients with neuropathic pain showed a greater loss of cortical grey matter.

Is one leg shorter than the other?

Is one leg shorter than the other?

“approximately 90% of the population have anatomical difference in leg length, averaging 5.4mm(~3/16in)…whereas a difference of more than 20mm(~3/4in) is considered clinically significant in contributing to various musculoskeletal pathologies.”

Understanding Pain

Mechanisms of Musculoskeletal Pain

Bogduk N. The Journal of Orthopaedic Medicine 28(3) 2006

With three published texts and over 200 indexed articles , Nikolai Bogduk is one of the world’s foremost authorities on biomechanics of the spine and musculoskeletal pain, so when I came across this article I knew it would have some pertinent information that help us understand our patient’s pain.

Sample of Scalene Muscle trigger points and referred pain pattern

Sample of Scalene Muscle trigger points and referred pain pattern

Key Points:

Pain transduction is ascribed to free or unencapsulated nerve endings with the following hierarchy of sensitivity; Periosteum, ligament, joint capsule, tendon, fascia, and muscle.

Reminder: that pain from a muscle is more commonly felt over the joint that that muscle moves.

How pain is created in the body: Mechanical or chemical stimuli affect free nerve endings in a peripheral nerve.  Central transmission is then the term used for propagation of action potentials from the first order neurons (free nerve endings) to the second order neurons which form tracks in the spinal cord to higher centers in the brain and thalamus.  Modulation then occurs in these tracks which involved intersegmental and descending pathways from the brainstem that inhibit and control the first synapse in this pain pathway.  Physiologically it then follows that modulation is one of the mechanisms that upper cervical chiropractic helps control pain occurring almost anywhere in the body!

Sensory (afferent) nerves and Sympathetic nerves contribute to mechanisms of inflammation in the body.  Chiropractic adjustments decrease sympathetic tone in the body, help to reduce inflammation and therefore pain.

Clinical Pearl: The next time you have an IME telling you that a patient has a ‘non-anatomical’ distribution of pain and therefore their pain is not genuine,  you can also use this article to cite that ‘Ongoing pain sensitizes the central nervous system to produce larger areas of pain’ that may not follow classic anatomical distributions.