Upper Cervical Chiropractic

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! 

Are headstands safe for your neck?

Headstand or Sirsasana Pose:

As an upper cervical chiropractor, I get asked if headstands are safe for people's necks all the time.  My answer is yes, but with some very important distinctions.  The first distinction is that this posture is ALL about how you get into it and how you get out of it.  Standing on your head isn't actually the hard part, I promise!  What is difficult and can compromise your neck and body is getting up there and getting down.  When going into this posture, the most important aspect is that you have a solid base created by your shoulders and forearms.  The secret is that you should have almost no actual body weight on the crown of your head.  Your body weight is supported by the upper body, not your head and neck, which is why, when done correctly, a headstand is not going to hurt your neck.  Coming in and and out of the head stand is all about core engagement so that you are shifting weight appropriately and being sure to protect your neck during this movement. 

The health benefits of body inversion are well documented, and done correctly with attention to detail, headstands are beneficial for your body.

So... happy head-standing!

Vertigo, TMJ, and neck pain helped with Upper Cervical Care

Jeremy came in 6 months ago with severe bouts of vertigo. He had a concussion during a hockey game 3 years prior and had been struggling with vertigo for the last two years. The symptoms had progressed to the point where he wouldn’t be able to get off the floor or leave the house for days because he was too dizzy and nausea and couldn’t trust his balance. Jeremy experienced constant whooshing in his ears with temporomandibular joint (TMJ) pain and dysfunction (TMD). He also had neck and low back pain and stiffness.

Jeremy has been under upper cervical chiropractic care now for six months. He has not had any bouts of vertigo since starting care and his neck pain, jaw pain, whooshing in his ears and his low back pain are all much improved. Jeremy is back outdoors hiking and doing the things he loves again!

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?

Whiplash Relief with Upper Cervical Care

Craig was in a bad head-on motor vehicle accident about five years ago, which had suffered from bad whiplash.  When he first came in about eight months ago, he felt unstable in his spine, he had left arm pain, numbness and tingling, as well as low back and neck pain.  Also after the accident, he found that he couldn't work out with being in pain or injuring himself. After the first four weeks of corrections, Craig was reporting dramatic improvements and was able to get back in the gym. Now he has been holding his alignment for about six months - meaning he hasn’t needed to be adjusted! He has his confidence back and is feeling strong!

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. 

Grip Strength in Athletes improve with Cervical Adjusting

The Effects of Cervical Spine Manipulation on Judo Athlete’s Grip Strength

Botelho, M.B., DC, Andrade B. B. MD, PhD. JMPT, November 2011

 

This article is straight forward and provides an excellent reference for those Upper Cervical chiropractors interested in athletics.  The test population didn’t suffer from any particular condition, in fact they were male and female athletes from a nationally competitive judo team and cervical spinal manipulative therapy (or adjustments to the chiropractic community) made a statistically significant difference in their grip strength! 

 

The study includes 18 athletes randomly assigned to either a treatment group or a sham adjustment group.  The subjects where given 3 SMT within 3 weeks with a minimum of 36 hours between treatments.  Grip strength was tested using a hydraulic dynamometer immediately before and after treatment.   Grip strength improved in each hand pre and post intervention each time, the level of improvement was statistically significant, while no statistically significant difference was noted in the sham treatment group. 

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 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.