Back Pain

Each year millions of people suffer from an episode of back pain. It can arise from trauma, lifting, bending at the waist; or it can suddenly appear unprovoked. Back pain affects young and old and prevents people from doing their day to day activities.

To understand the many causes of back pain one needs to have some knowledge about the anatomy of the spine. The spine is made up of twenty four segments called vertebrae and is divided into three sections. The first seven 7 vertebrae make up the cervical spine (neck), the next twelve 12 vertebrae, which have a rib attachment on both sides make up the thoracic spine (mid-back) and the last five 5 vertebrae, make up the lumbar spine (lower back).

Each vertebra, with the exception of the first one directly underneath the skull, consists of a vertebral body in the front and a pair of smaller facet joints in the back. Connecting the vertebrae together (except the first two) at the vertebral bodies are very tough ligaments better known as discs. The vertebral bodies bear most of the weight, about 80% of the body when standing upright. The facet joints bear the other 20% and primarily function to allow controlled movement such as bending, rotating.

There are five 5 muscle layers surrounding the spine which are the multifidi, rotators, erector spinae, iliocostalis, and quadratus lumborum. These muscles work synergistically to move and support the spine. Although bending forward at the waist doesn't look all that complicated, it is a highly complex sequence of events: the central nervous system (brain and spinal cord) coordinate the precise intensity and timing of contraction of each muscle group to make the spine move as intended.

Back pain can originate from:

Sprains and strains is an injury to muscle fibers, tendons and or ligaments. When the load exceeds the strength of soft tissue structures, they tear. When soft tissue is injured, inflammatory products are released, which leads to swelling and pain.

Arthralgia / Facet Syndrome - Facet joint surfaces are imbedded with nerve endings underneath the cartilage. If this cartilage layer wears thin from degenerative joint disease or from trauma like whiplash, the nerve endings will be irritated and this results in pain.

Disc herniation - Between each vertebra is cartilage acting as shock absorber. This is called the intervertebral disc. The disc has an outer layer called the annulus, and an inner, jelly-like material called the nucleus pulposus. If the annulus fibers weaken, the nucleus can "escape", puncturing through the annulus. This usually occurs from a lifting incident, or may gradually occur over time without any specific trauma. If the nucleus protrudes and presses on a nerve root, this can cause radicular pain (pain radiating down the leg, usually the back and side of leg). In severe cases, sensation and muscle strength in the leg are affected.

Spinal stenosis - the space between the vertebral body and facet joints forms a canal, which contains the spinal cord. Arthritic changes to the vertebral body can cause bony projections to narrow this canal. This can cause pinching of the spinal cord, and can lead to neurological deficits in the lower extremities (numbness, tingling, weakness, muscle wasting).

Compression fractures - The vertebral body can fracture from trauma (a fall, a violent collision). Older people with osteoporosis can experience a spontaneous compression fracture. The affected vertebra loses its normal height and loses its ability to move properly in synergy with the adjacent vertebrae above and below. Recent compression fractures usually hurt with certain movements (extending the back, flexing the back, side bending) and are easy to visualize on x-ray.

Other fractures - The facet joints, transverse process, or spinous process can fracture from trauma.

Congenital anomalies - Sometimes spinal segments don't completely separate into individual units during embryonic development. Groups of two or three may be fused together. This typically occurs in the cervical spine (neck) and sacrum (triangular bone below the spine. When this occurs, it alters normal biomechanics (movement) in that area: segments above and below the fusion are forced to move more to compensate, which can lead to degenerative changes and pain.

Ankylosing spondylitis - This is an inflammatory condition that ultimately leads to fusion of spinal vertebrae and the sacroiliac joints of the pelvis. Persons with AS will demonstrate difficulty moving the neck, and a hunched posture.

Arthritis - There are two basic types: Osteoarthritis is advanced wear and tear of a joint and is found in weight-bearing joints like the spine, hips, and knees. Rheumatoid arthritis is an auto-immune disease that typically affects the finger joints and spine. Both are inflammatory.

Pathology - Various bone pathologies including cancer can cause back pain. Renal disease can refer pain to the lower back.

Manual therapy like chiropractic combined with physiotherapy modalities can help reduce back pain that is musculoskeletal in origin. If examination and diagnostic findings suggest pathology/ organic etiology, the patient will be referred to the appropriate specialist

Some of the symptoms of lower back pain may include a dull, burning or sharp pain. The pain may be localized to one area or spread out over a broad area. The onset of the pain maybe be either gradual or sudden and may be accompanied with muscle spasm or stiffness. Pain may be felt in the leg or sensations of numbness or tingling often below the knee. It is also possible to have symptoms in the leg without the presence of leg pain. Symptoms occurring in the leg are often due to conditions in the lower spine that are causing pressure on the nerve that travels down to the leg.

Lower back pain may either be acute if a spell (or episode) of pain lasts less than 3 months. Most back pain is acute and goes away with 4 to 6 weeks of home treatment. Recurrent if acute symptoms come back. Most people have at least one episode of recurrent low back pain. Chronic if your back bothers you most of the time for longer than 3 months.

After the first time you have had low back pain, you are likely to have it again. To help keep your back healthy and avoid further pain:

• Practice good posture when you sit, stand, and walk.
• Get regular, low-impact exercise. Walk, swim, or ride a stationary bike. Stretch before you exercise.
• Wear low-heeled shoes with good support.
• Sleep on your side. A medium-firm mattress may put the least stress on your back.
• Watch your weight. Being too heavy, especially around your waist, puts extra stress on your back.
• Don't try to lift things that are too heavy for you. When you must lift, bend your knees and keep your back straight, keep the object you are lifting close to your belly button, and avoid lifting and twisting at the same time.

If you sit or stand for long periods at work:

• Pay attention to your posture. Sit or stand up straight, with your shoulders back.
• Make sure your chair has good back support.
• Take regular breaks to walk around.

Scoliosis

Scoliosis is a problem with the curve in your spine. Some curves in your spine are normal. But a few people have spines that make a large curve from side to side in the shape of the letter "S" or the letter "C." If this curve is severe, it can cause pain and make breathing difficult.

The good news is that most cases of scoliosis are mild. If found early, they can usually be prevented from getting worse.

In most cases, the cause of scoliosis is not known. Scoliosis usually starts between the ages of 8 and 10. Scoliosis that is severe enough to need treatment is most common in girls.

A curve in the spine may get worse as your child grows, so it is important to find any problem early.

Scoliosis most often causes no symptoms in your child until the spinal curve becomes large. You might notice these early signs:

• Your child has one shoulder or hip that looks higher than the other.
• Your child’s head does not look centered over the body.
• Your child has one shoulder blade that sticks out more than the other.
• Your child’s waistline is flat on one side, or the ribs look higher on one side when your child bends forward at the waist.

In adults, scoliosis may cause back pain and trouble breathing.

The doctor will check to see if your child’s back or ribs are even. If the doctor finds that one side is higher than the other, your child may need an X-ray so the spinal curve can be measured.

Scoliosis is most serious in young children who are still growing. A curve in the spine may get worse as your child grows. So screening your child for scoliosis is important so that any curve in the spine can be found early and watched closely.

Mild cases of scoliosis usually do not need treatment. Your doctor will check the curve of your child’s spine every 4 to 6 months. If the curve gets worse, your child may need to wear a brace until he or she has finished growing. In severe cases, or if bracing doesn't help, your child may need to have surgery.

Scoliosis and its treatment can be a severe strain on your child. Wearing a brace can feel and look odd. It also limits your child’s activity. Your child needs your support and understanding to get through treatments successfully.

Your child may be more likely to have scoliosis if someone in your family has had it and if your child is a girl. Other things that increase the chance of scoliosis include:

• One of the bones in your child’s spine has moved forward out of place compared to the rest of the spine.
• Your child’s arms or legs are missing or are abnormally short.
• Your child has other problems with tissue growth that happened before birth.

Disc Herniation

The bones (vertebrae) that form the spine in your back are cushioned by small, spongy discs. When these discs are healthy, they act as shock absorbers for the spine and keep the spine flexible. But when a disc is damaged, it may bulge or break open. This is called a herniated disc. It may also be called a slipped or ruptured disc.

You can have a herniated disc in any part of your spine. But most herniated discs affect the lower back (lumbar spine). Some happen in the neck (cervical spine) and, more rarely, in the upper back (thoracic spine). This topic focuses mainly on the lower back.

What causes a herniated disc?

A herniated disc may be caused by:

• Wear and tear of the disc. As you age, your discs dry out and aren't as flexible.
• Injury to the spine. This may cause tiny tears or cracks in the hard outer layer of the disc. When this happens, the gel inside the disc can be forced out through the tears or cracks in the outer layer of the disc. This causes the disc to bulge, break open, or break into pieces.

What are the symptoms?

When a herniated disc presses on nerve roots, it can cause pain, numbness, and weakness in the area of the body where the nerve travels. A herniated disc in the lower back can cause pain and numbness in the buttock and down the leg. This is called sciatica and it is the most common symptom of a herniated disc in the low back

How is a herniated disc diagnosed?

Dr. Kumar may diagnose a herniated disc by asking questions about your symptoms and examining you. If your symptoms clearly point to a herniated disc, you may not need tests.

Sometimes tests such as an MRI or a CT scan to confirm a herniated disc or rule out other health problems.

Degenerative Disc Disease

Degenerative disc disease is not really a disease but a term used to describe the normal changes in your spinal discs as you age. Spinal discs are soft, compressible discs that separate the interlocking bones (vertebrae) that make up the spine. The discs act as shock absorbers for the spine, allowing it to flex, bend, and twist. Degenerative disc disease can take place throughout the spine, but it most often occurs in the discs in the lower back (lumbar region) and the neck (cervical region).
The changes in the discs can result in back or neck pain as well as:

• Osteoarthritis, the breakdown of the tissue (cartilage) that protects and cushions joints.
• Herniated disc, an abnormal bulge or breaking open of a spinal disc.
• Spinal stenosis, the narrowing of the spinal canal, the open space in the spine that holds the spinal cord.

These conditions may put pressure on the spinal cord and nerves, leading to pain and possibly affecting nerve function.

What causes degenerative disc disease?

As we age, our spinal discs break down, or degenerate, which may result in degenerative disc disease in some people. These age-related changes include:

• The loss of fluid in your discs. This reduces the ability of the discs to act as shock absorbers and makes them less flexible. Loss of fluid also makes the disc thinner and narrows the distance between the vertebrae.
• Tiny tears or cracks in the outer layer (annulus or capsule) of the disc. The jellylike material inside the disc (nucleus) may be forced out through the tears or cracks in the capsule, which causes the disc to bulge, break open (rupture), or break into fragments.

These changes are more likely to occur in people who smoke cigarettes and those who do heavy physical work (such as repeated heavy lifting). People who are obese are also more likely to have symptoms of degenerative disc disease.

A sudden (acute) injury leading to a herniated disc (such as a fall) may also begin the degeneration process.

As the space between the vertebrae gets smaller, there is less padding between them, and the spine becomes less stable. The body reacts to this by constructing bony growths called bone spurs (osteophytes). Bone spurs can put pressure on the spinal nerve roots or spinal cord, resulting in pain and affecting nerve function.

Degenerative disc disease may result in back or neck pain, but this varies from person to person. Many people have no pain, while others with the same amount of disc damage have severe pain that limits their activities. Where the pain occurs depends on the location of the affected disc. An affected disc in the neck

Back Problems and Injuries

Most people will have a minor back problem at one time or another. Our body movements usually do not cause problems, but it's not surprising that symptoms develop from everyday wear and tear, overuse, or injury. Back problems and injuries often occur during sports or recreational activities, work-related tasks, or home projects.

Back pain can cause problems anywhere from the neck to the tailbone (coccyx). The back includes:

• The bones and joints of the spine (vertebrae).
• The discs that separate the vertebrae and absorb shock as you move.
• The muscles and ligaments that hold the spine together.

Back injuries are the most common cause of back pain. Injuries frequently occur when you use your back muscles in activities that you do not do very often, such as lifting a heavy object or doing yard work. Minor injuries also may occur from tripping, falling a short distance, or excessive twisting of the spine. Severe back injuries may result from car accidents, falls from significant heights, direct blows to the back or the top of the head, a high-energy fall onto the buttocks, or a penetrating injury such as a stab wound.

Although back pain is often caused by an injury to one or more of the structures of the back, it may have another cause. Some people are more likely to develop back pain than others. Factors that increase your risk for back pain and injury include getting older, having a family history of back pain, sitting for long periods, lifting or pulling heavy objects, or having a degenerative disease such as osteoporosis.

Low back pain may occur in children and teenagers, but children and teens are less likely to see a doctor for low back pain. Although most back problems occur in adults who are between the ages of 20 and 50, back problems in children who are younger than 20 and adults who are older than 50 are more likely to have a serious cause.

Pain from an injury may be sudden and severe. Bruising and swelling may develop soon after the injury. Pain from an acute injury usually does not last longer than 6 weeks. Acute injuries include:

• An injury to the ligaments or muscles in the back, such as a sprain or a strain.
• A fracture or dislocation of the spine. This can cause a spinal cord injury that may lead to permanent paralysis. It is important to immobilize and transport the injured person correctly to reduce the risk of permanent paralysis. See first aid for a spinal injury.
• A torn or ruptured disc. If the tear is large enough, the jellylike material inside the disc may leak out (herniate) and press against a nerve. See a picture of a herniated disc or pressure on a nerve root.
• Compression of nerves in the lower back (cauda equina syndrome).

You may not remember a specific injury, especially if your symptoms began gradually or during everyday activities. These injuries occur most often from improper movement or posture while lifting, standing, walking, or sitting, or even while sleeping. Symptoms can include pain, muscle spasms, and stiffness. The pain often goes away within 4 weeks without any treatment.

Neck Pain

The neck, or cervical spine, is a complex structure that has great bearing on one's health and vitality. It is comprised of seven bones (vertebrae) that have the distinction of being the most flexible in the human spine. The topmost vertebra, called the atlas, is shaped like a hoop. The atlas rests on the second vertebra, called the axis, and pivots around a post-like structure called the dens, on the axis. There is no disc between the atlas and axis; this is where the majority of neck movement occurs when you turn your neck. The last five vertebrae, and the rest, are connected with discs.

The neck supports the weight of the head and contains part of the brain stem and the uppermost part of the spinal cord. Nerve roots branch out from between the neck vertebrae and converge to form the peripheral nerves that control the upper extremities (shoulder, upper arm, lower arm, wrist, and hand). Vertebral arteries run through the edges of the neck vertebrae and supply blood to the cerebellum- the part of the brain that is involved with balance and coordination. The esophagus (leads to the stomach) and larynx (throat, leads to the lungs) are situated in front of the cervical spine. Finally, several sets of muscles envelop the cervical spine and control precision movement. With all these delicate structures in one small area, it is easy to understand the neck's potential to cause numerous kinds of problems if everything isn't in working order.

Neck pain can arise from the following:

Old injuries-Injuries like those that occur from whiplash (rear-end car collisions) or falls on the head can lie dormant for years. Vertebrae can shift out of normal position, resulting in sub-optimal joint movement. Eventually, degenerative changes follow, leading to pain and dysfunction. A good analogy is a car's wheel alignment being knocked off center after hitting a curb: the wheel's mechanics are disturbed, and pretty soon the tire tread thins unevenly and the brake starts making noises. Pain is your neck's way of telling you that there is something mechanically wrong that you should get checked out.

Disc herniations - Discs are the tough ligaments that hold vertebrae together while allowing them to move in unison. A disc is comprised of two main parts: an outer annulus and an inner, jelly-like structure called the nucleus pulposus. When healthy, the tight rings of the annulus keep the nucleus inside. When weakened, the nucleus can punch though the annulus, making it to the outside. This usually occurs from trauma, lifting a heavy load, or in rare cases, simply coughing or sneezing. The condition is called a herniated nucleus pulposus, or HNP for short. Being that the outer layer of the annulus has a high density of nerve endings, HNPs can be very painful. If the nucleus presses against a nerve root, it may cause radiating pain down into the arm.

Stenosis - Degenerative joint disease can cause bony projections to narrow the canal where the spinal cord resides. As a result, the spinal cord can get compressed. This can lead to local pain and bilateral (both sides) numbness and weakness below the compression site.

Chiropractic adjustments and manual therapy techniques can help some cases of neck pain by gently moving the joint through its physiological range of motion, which improves disc hydration and facet movement. Adjustments also help to prevent the soft tissues surrounding the spine from shortening and calcifying.

Characteristics of neck pain include:

• Pain that occurs from the bottom of your head to the top of your shoulders. Pain may spread to the upper back or arms.
• Pain that is worse with movement.
• Limited head and neck movement. The neck may be stiff or tender.
• Headaches. These are common and may persist for months.

Nerve-related symptoms caused by pressure on the spinal nerve roots or spinal cord include:

• Numbness, tingling, or weakness in the arm or hand.
• A burning feeling when touched on the skin of the arm or hand.
• A pain that feels like a shock and extends into the arm or hand.

Headaches

According to the National Headache Foundation, over 45 million Americans suffer from chronic, recurring headaches and of these, 28 million suffer from migraines. About 20% of children and adolescents also have significant headaches.

Below is a list of the most common types of headaches.

Tension headaches: Also called chronic daily headaches or chronic non-progressive headaches, tension headaches are the most common type of headaches among adults and adolescents. These muscle contraction headaches cause mild to moderate pain and come and go over a prolonged period of time.

Migraines: The exact causes of migraines are unknown, although they are related to blood vessel contractions and other changes in the brain as well as inherited abnormalities in certain areas of the brain. Migraine pain is moderate to severe, often described as pounding, throbbing pain. They can last from 4 hours to 3 days and usually occur 1 to 4 times per month. Migraines are associated with symptoms such as light sensitivity; noise or odors; nausea or vomiting; loss of appetite; and stomach upset or abdominal pain. When a child is having a migraine they often look pale, feel dizzy, have blurred vision, fever, stomach upset, in addition to having the above listed symptoms.
A small percentage of pediatric migraines include recurrent (cyclic) gastrointestinal symptoms, in which vomiting is most common. Cyclic vomiting means that the symptoms occur on a regular basis -- about once a month. These types of migraines are sometimes called abdominal migraines.

Mixed headache syndrome: Also called transformed migraines, this is a combination of migraine and tension headaches. Both adults and children experience this type of headache.

Cluster headaches: The least common, although the most severe, type of primary headache, the pain of a cluster headache is intense and may be described as having a burning or piercing quality that is throbbing or constant. The pain is so severe that most cluster headache sufferers cannot sit still and will often pace during an attack. The pain is located behind one eye or in the eye region, without changing sides. The term "cluster headache" refers to headaches that have a characteristic grouping of attacks. Cluster headaches occur one to three times per day during a cluster period, which may last 2 weeks to 3 months. The headaches may disappear completely (go into "remission") for months or years, only to recur.

Sinus headaches: Sinus headaches are associated with a deep and constant pain in the cheekbones, forehead or bridge of the nose. The pain usually intensifies with sudden head movement or straining and usually occurs with other sinus symptoms, such as nasal discharge, feeling of fullness in the ears, fever, and facial swelling.

Acute headaches: Seen in children, these are headaches that occur suddenly and for the first time and have symptoms that subside after a relatively short period of time. Acute headaches most commonly result in a visit to the pediatrician's office and/or the emergency room. If there are no neurological signs or symptoms, the most common cause for acute headaches in children and adolescents is a respiratory or sinus infection.

Hormone headaches: Headaches in women are often associated with changing hormone levels that occur during menstruation, pregnancy, and menopause. Chemically induced hormone changes, such as with birth control pills, also trigger headaches in some women.

Chronic progressive headaches: Also called traction or inflammatory headaches, chronic progressive headaches get worse and happen more often over time. These are the least common type of headache, accounting for less than 5% of all headaches in adults and less than 2% of all headaches in kids. Chronic progressive headaches may be the result of an illness or disorder of the brain or skull.

Some studies have shown that hereditary may play a role in certain headaches especially migraines.

Headache pain results from signals interacting between the brain, blood vessels, and surrounding nerves. During a headache, specific nerves of the blood vessels and head muscles are activated and send pain signals to the brain. It's not clear, however, why these signals are activated in the first place.

There is a migraine "pain center" or generator in the mid-brain area. A migraine begins when hyperactive nerve cells send out impulses to the blood vessels, causing constriction, followed by the dilation of these vessels and the release of prostaglandins, serotonin, and other inflammatory substances that cause the pulsation to be painful. Serotonin is a naturally occurring chemical essential for certain body processes.

Other causes of tension headaches include eyestrain and neck or back strain due to poor posture.

Carpal Tunnel Syndrome

You're typing away at your desk and suddenly feel a sharp pain in your wrist, shooting into your thumb and hand. You take a small break and stretch your wrists, but it doesn't go away this time. It's quite possible that you are developing carpal tunnel syndrome - a neuropathy (nerve disorder) that often strikes people whose occupation requires frequent hand usage such as having a job that requires you to be at a work station. Frequent repetitive motions such as typing and use of a mouse accompanied by poor ergonomics can lead to this condition.

Carpal Tunnel Syndrome (CTS) is a painful and often debilitating disorder affecting the hands and wrists. The symptoms of carpal tunnel syndrome include numbness and tingling in the hands, primarily the thumb and thumb pad, index, middle, and inner half of the ring fingers. Many sufferers of CTS report increased symptoms at night, making sleep difficult. Advanced stages of carpal tunnel syndrome result in decreased fine dexterity movements of the fingers, such as buttoning a blouse, and reduced grip strength. Also, the thenar pad (palms) may undergo muscle atrophy (shrinking).

Carpal Tunnel Syndrome occurs when the median nerve, one of the major nerves that supplies the upper extremity, is compressed in the carpal tunnel: a narrow passageway in the wrist formed by the carpal bones and the transverse carpal ligament- a strip of tendon that supports the wrist from the bottom.

The contents of the carpal tunnel include the median nerve and the flexor tendons of the wrist and fingers (the tendons that enable you to form a fist). Carpal tunnel syndrome is often the result of a combination of factors that press on the median nerve and tendons in the carpal tunnel. The disorder can also be due to a congenital (born with) predisposition where the carpal tunnel is smaller in some people than in others.

Many times the cause of pain earlier diagnosed or thought of as carpal tunnel is actually related to some other area that the median nerve follows. Other areas of median nerve root entraption include a ligament near the elbow, the area of the shoulder called the thoracic outlet and the cervical spine (neck area).

On your first visit at Northeast Chiropractic, Dr. Neel Kumar will evaluate all three of these areas plus investigate other factors that may be contributing to your symptoms of carpal tunnel.

Tendonitis

Tendonitis is a painful condition involving inflammation of tendons. Tendonitis is almost always caused by repetitive movements of a tendon, such as when keyboarding, guitar playing, golfing, baseball pitching, running and tennis. Tendonitis can develop in the wrists, elbows, shoulders, hips, knees, ankles, and feet. Common types of tendonitis show up in the following areas; patella, achilles, shoulder, hip, peroneal (outside part of ankle), plantar and elbow.

Tendons connect muscles to bone, whereas ligaments connect bone to bone in a joint. Tendons are constructed of connective tissue (collagen, elastin) where as muscles are constructed of actin and myosin (specialized protein strands). Tendons, although able to increase in length under a load, do not have contractile properties like muscles do. Tendons also do not have a very good blood supply (vascularization) compared to muscles. Tendons have very strong attachments to bone, so strong that it may pull of a section of bone instead of rupturing when subject to trauma. Some forms of tendonits involve the tendon actually pulling off the top layer of cells (periosteum) of a bone, resulting in an inflammatory response. Well known examples include plantar fascitis and shin splints.

When a muscle undergoes a concentric contraction (shortens in length as it contracts) it pulls the tendon towards it. Since a muscle is anchored to bone, its tendon will often contact and slide against the bone. Tendons are encased in sheaths whose function is to allow smooth gliding of the tendon against proximal structures like bone, other tendons, ligaments and nerves. However, with repeated movements of tendons, especially those under a load (hard gripping, extended vibration/ shocks, lifting, pushing) small tears occur in the tendons resulting in an inflammatory response. The inflammatory response is controlled by the immune system and produces a multitude of biochemical compounds that play critical roles in managing the injury, some of which are pain-generating (arachidonic acid). Sometimes the response "overshoots" turning into a problem of its own. As the inflammatory products build up, swelling takes place. Increased swelling leads to increased pressure in the injured area, which in turn leads to a hypoxic (reduced oxygen delivery) state, perpetuating the problem. This explains why tendonitis can often last for several years (become chronic).

At first onset of tendonitis, stop the precipitating activity. Rest is the first line of defense. Next, apply an ice wrap to the inflamed tendon. Do not apply heat, heat will increase the inflammatory response in the early stages. Wrap an ice pack around the tendon with ace wrap, applying firm pressure. Leave on for about 20 minutes. Repeat every two waking hours until pain subsides. For wrist tendonitis, wearing a supportive wrist brace.

Lasty, manual therapies like chiropractic along with physiotherapy modalities can be a good non-pharmaceutical option for treating acute and chronic cases of tendonitis. Modalities are adjunctive therapies such as ice, heat, traction, laser, and ultrasound.

If your tendonitis is caused by too much typing, make sure that your workstation is set up ergonomically: monitor at eye level; keyboard tray to allow arms to fall naturally to your side while typing; and a chair with good back support, and foot stool to take some pressure off your thighs. Keep your elbows at a 90-100 degree bend and keep your wrists straight, inline with your forearms. Keep your mouse and other accessories within a small arc from your keyboard to minimize repetitive reaching. Lastly, stretch your wrists, shoulders, neck and back every hour. If at all possible, try to rotate tasks every other month to avoid repetitive stress to your wrists.

We have several therapeutic approaches to treating acute and chronic wrist pain including joint mobilization, chiropractic extremity manipulation.

Fibromyalgia

Fibromyalgia is the term used to describe a condition involving idiopathic (unknown causation) diffuse muscle and joint pain and chronic fatigue. It is often the diagnosis given to a patient experiencing these symptoms when diagnostic tests like x-rays and blood tests are inconclusive. It is sometimes classified as a metabolic disorder and may be tied to rheumatism/ rheumatic disease. People who have a history of acute trauma can develop chronic pain, which may lead to fibromyalgia.

Treatment at our clinic for fibromyalgia may include light therapy, lymphatic massage, chiropractic manipulation, manual therapies, exercises, and anti-oxidant nutritional supplements.

Joint Pain

Most cases of joint pain, such as those occurring in the shoulder, hip, or elbow are the result of trauma, micro trauma, or arthritis.

The basic construction of a joint involves two bones joined by a ligamentous capsule and moved by several muscle attachments. The ends of the bones are covered with cartilage—a pliable but firm material that does not have its own blood supply. A thin layer of tissue called the synovium lines the interior of the joint. The synovium produces and holds synovial fluid—the joint’s lubrication. When everything is working correctly, the joint moves as it was designed. If the joint is subject to trauma, for example, a fall that moves it past its mechanical limitation, soft tissue structures get damaged and the joint’s mechanics are altered, very much like a wobbly wheel on a car. This leads to accelerated wear and tear as the cartilage thins and bone starts to contact bone.

Since ligaments and tendons are not vascularized (blood supply) to the degree that muscle and skin are vascularized, it takes a longer time for them to heal. When ligaments and tendons tear (microscopic or major), inflammation sets in. This is a major source of pain, as internal pressure and chemical agents irritate nerves in the region. In addition, fibrosis sets in. Fibrosis is the overproduction of collagen and elastin and can interfere with the joint’s proper movement.

Repetitive use of a joint, like those demanded by tennis and golf strain certain joints. This can lead to microtears, which can generate pain as well.

Treatment for joint disorders can include manual therapy, extremity adjustments, electric muscle stimulation, therapeutic ultrasound, laser therapy and exercises..

Whiplash

Technically, whiplash occurs when the body is suddenly accelerated then decelerated, which is precisely what happens in a "rear-ender" car accident: upon impact from behind, the torso accelerates rapidly to the same speed as the colliding car. Because of the neck's flexiblity, the head simultaneously arcs backward, injuring soft tissue structures (muscle, ligaments and tendons) around the neck and upper shoulders. When the force of the collision stops (within one second), the torso suddenly stops, but the head accelerates forward and over corrects, causing the neck to sharply flex (bend) forward resulting in further soft tissue injury. In severe cases, ligaments rupture causing joint instability; nerve injury may occur, as well as fractures. Some victims may even experience concussions or subdural hematomas (swelling in cranium).

Immediately after a whiplash event that results in soft tissue injury, swelling starts, very gradually. The injured tissues release a variety of inflammatory products which irritate nerve endings and cause pain. As the swelling progresses, it increases internal pressure in the joints, causing them to stiffen. Typically, swelling following a whiplash accident peaks 72 hours after the accident. This explains why your neck hurts the most several hours after the accident, instead of immediately after the accident

It is important to know that whiplash can occur from even low velocity collisions. The reason is that the kinetic energy (force) of a car is very high, even at five miles per hour, due to the large mass of the car. This energy is transferred to the occupants of the vehicle and is actually more violent if the cars do not deform (dent), which is often the case in low impact collisions. Therefore, even if you were in a low-impact accident that was enough to cause a whiplash effect, It is advisable to get checked to make sure problems don’t develop later on.

Treatment

For whiplash patients, the first order of business is to determine the extent of the injury. First and foremost, conditions requiring emergency medical attention will need to be ruled out. These include:

• Spinal fracture
• Ligament rupture
• Hematoma (bleeding in the brain)
• Peripheral Nerve damage
• Ruptured blood vessels

Advanced imaging like an MRI, CT scan, or video flouroscopy may be ordered if any of these conditions are suspected. Once they are ruled out, manual therapy with adjunctive physiotherapy is initiated.

The overall goal of treatment is to reduce pain, restore function, and strengthen/rehab the neck so that proper healing occurs and the chances of chronic pain are minimized.
Headache after whiplash injury is common. After neck pain it is the second commonest symptom that whiplash injury patients experience. The whiplash headache can often outweigh the neck pain in terms of severity - particularly in the early weeks after injury.

Nearly two thirds of whiplash injury patients experience headache. About half of those who develop headache after whiplash injury feel the pain in the back of their head, a further third get headache all over the head and a smaller number feel the whiplash headache at their forehead or behind their eyes.

Headache after whiplash injury often shows itself for the first time on the morning after the accident. The pain sweeps up from the neck and over the back of the head. Most whiplash headache sufferers find that heat on the back of the neck will ease the headache. Cold makes it worse.

Neck movements often aggravate whiplash injury headache - particularly if the neck is moved towards extension: looking up to the ceiling is often very painful.

Patients with whiplash related headache often also get shoulder pain and touching the upper, middle and lower trapezius muscles over the back of the neck and shoulders often provokes pain or headache. There are often tender spots or trigger points in these muscles.

Women get headache after whiplash injury more often than men - the reason for this is unclear but might relate to the smaller structures of the female neck anatomy.

So what causes whiplash injury headache? Many research studies have looked to explain why whiplash injury causes headache. It seems most likely that the headache after whiplash injury arises from a mixture of inflammation in the neck muscles and irritation of the nerves that go from the neck, up and over the head.

Whiplash research has shown that whiplash injury headache can persist for a year or more in some patients - but for most the head pain improves within a month or two of the accident.

How should whiplash injury headache be treated? Well, the research is not good quality so there is no definitive answer to this. In my experience the headache is often quickly improved by hands on physical therapy or by acupuncture. Anti-inflammatory tablets help some patients and - for a minority of whiplash injury headache patients - injections deep into the spinal tissues can transform the situation.

Poor Posture

Remember when your mother said “stand up straight!”? She was right. Good posture is essential to health. Your brain expends a lot of energy controlling and coordinating hundreds of muscle groups whenever posture is “sub-optimal.” Less than optimal posture can include a high shoulder, a forward stooping head, a rotated trunk (torso), a hunch back, a high hip, and a side-bent neck. Abnormal posture can result from trauma (like a car accident or fall), repetitive movements (like turning your neck towards your monitor), and certain bad postural habits (like sleeping on your stomach).

Imagine a straight line drawn from between your eyes down to your feet: in order to have good posture, your body mass should be evenly divided on either side of the line when viewed from the front. When viewed from the side, a straight line should be able to pass through your earlobe, your shoulder joint, your hip socket, and your ankle.

Poor posture can lead to several problems: It can accelerate joint wear and tear (osteoarthritis), due to uneven weight distribution. It can make breathing difficult by interfering with proper ribcage expansion. This can result in fatigue and other symptoms. Poor posture, particularly extreme anterior (forward) head carriage can cause your muscles to feel sore along the back of your neck, shoulders and upper back. It can even lead to lower back pain as your spine struggles to counterbalance the forward position of the head.

We can help improve posture with posture-correction chiropractic spinal adjustments and specific, targeted exercises.

Numbness or tingling sensations in the upper or lower extremities can indicate a peripheral neuropathy condition. The nerve roots that branch out from between the neck vertebrae combine and form the major nerves of the arms. The nerve roots in the lower back combine and form the major nerves of the legs. If these nerves, called peripheral nerves are compressed in any way, sensory disturbances can occur. In addition to numbness, such disturbances have been described as “pins and needles,” “prickly” or “tingly” and even “burning” in nature. In most cases, compression occurs at the spine as the nerve root exits. This can come from a bulging disc or a bony, arthritic projection.

In the upper extremity, the compression can also occur at the collar bone area (thoracic outlet syndrome) or in the wrist (carpal tunnel syndrome). If allowed to persist, muscular weakness and atrophy (muscle wasting) can follow. If symptoms are present in both arms and both legs (bilaterally), this may indicate spinal cord compression and would require immediate medical attention.

After a thorough orthopedic and neurological evaluation that may include an x-ray study, a diagnosis will be made. If it is determined that the patient can benefit from manual therapy, a treatment plan centered on chiropractic spinal manipulation, extremity manipulation, modalities, and exercises will be designed. The patient may also be referred to an orthopedic doctor or MRI facility for further evaluation