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?
Have you ever stopped being active because of pain? Check out Lauren's story. Being in constant pain is draining. Regardless of if you have had specific head or neck trauma or if you are in the category of years of pore posture, neck pain runs the gamete from annoying to debilitating. Pain in the neck can arise from many of the various structures in this complex part of the body. One of the most common is due to degeneration of the vertebra and joints causing bone spurs or bony growths. Here we're going to break that process down. When a trauma occurs and a joint in the neck is locked out of place (most commonly the 1st cervical vertebra) it then changes how that joint and the rest of the joints in the neck move. When there is altered movement at a joint it creates inflammation and instability. The body's response to instability is quite brilliant in fact, it's going to lay down more bone to try to stabilize that area. This response is a natural process in the body, and like we said it's pretty brilliant because it takes DECADES for bone to degenerate to the point where it is drastically affecting function. When the human body was evolving and our life expectancy was 40 this process was not a problem. However if we want to stay pain free and active into our 70's-80's or even 90's we need to restore that joint motion as best we can! This is where gentle specific upper cervical chiropractic can help your body feel better and function better. Just ask Lauren.
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.
“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.
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.
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.
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.
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.