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Tag: Nexpert Chiropractic

Nexpert Chiropractic - Dr. Andre PisarevNewsNexpert Chiropractic
By Office Staff Back Pain ,

Low Back Pain and Balance Exercises

You may recall last month, we talked about the relationship between low back pain and balance, particularly our unfortunate increased tendency to fall as we “mature.” This month, we’re going to look at ways to improve our balance by learning specific exercises that utilize the parts of our nervous system that regulate balance or, proprioception. Particularly, our cerebellum (back of the brain that regulates coordination), the vestibular system (the inner ear where the semi-circular canals are located), the ascending tracts in our spinal cord (the “highways” that bring information to the brain from our feet and the rest of our body), and the small “mechano-receptors” located in our joints that pick up our movements as we walk and run and sends that information through our nerves, up the spinal cord tracts to the brain. Here are some very practical exercises to do, “…for the rest of our lives.” Start with the easy ones!

  1. Easy (Level 1): Standing eyes open/closed – Start with the feet shoulder width apart, look straight ahead to get your balance and then close the eyes and try not to sway counting to 30 by, “…one thousand one, one thousand two, one thousand three, etc.” Repeat this with your feet closer together until they touch each other. You can make this harder by standing on a pillow or cushion — but don’t start that way!
  2. Medium (Level 2): Lunges – from a similar starting position as #1, step forwards with one leg and squat slightly before returning back to the start position. Repeat this 5x with each foot/leg. As you progress, you can take a longer stride and/or squat down further with each repetition. You can even hold onto light dumbbells and/or close your eyes to make it more challenging.
  3. Hard (Level 3): Rocker or wobble board exercises – use a platform that rocks back & forth or, wobbles in multiple directions. Rock back and forth, eyes open and then closed, once you get comfortable on the board. You can rotate your body on the board, standing straight ahead (12 o’clock) followed by 45 degree angles as you work your way around in a circle at 45 degree increments (12, 1:30, 3, 4:30, 6, 7:30, 9, 10:30 and back to noon). Repeat these eyes open and closed. The Wii Balance board is a fun way to exercise – check that out as well.

You can “improvise” and mix up different exercises and create your own routine. Just remember, stay safe, work slowly until you build up your confidence and keep challenging yourself.

By Office Staff Back Pain ,

Low Back Pain: Where Is My Pain Coming From?

Low back pain can emanate from many anatomical locations (as well as a combination of locations), which always makes it interesting when a patient asks, “…doc, where in my back is my pain coming from?” In context of an office visit, we take an accurate history and perform our physical exam to try to reproduce symptoms to give us clues as to what tissue(s) may be the primary pain generators. In spite of our strong intent to be accurate, did you know, regardless of the doctor type, there is only about a 45% accuracy rate when making a low back pain diagnosis? This is partially because there are many tissues that can be damaged or injured that are innervated by the same nerve fibers and hence, clinically they look very similar to each other. In order to improve this rather sad statistic, in 1995 the Quebec Task Force published research reporting that accuracy could be improved to over 90% if we utilize a classification approach where low back conditions are divided into 1 of 3 broad categories:

  1. Red flags – These include dangerous conditions such as cancer, infection, fracture, cauda equina syndrome (which is a severe neurological condition where bowel and bladder function is impaired). These conditions generally require emergency care due to the life threatening and/or surgical potential.
  2. Mechanical back pain – These diagnoses include facet syndromes, ligament and joint capsule sprains, muscle strains, degenerative joint disease (also called osteoarthritis), and spondylolisthesis.
  3. Nerve Root compression – These conditions include pinching of the nerve roots, most frequently from herniated disks. This category can include spinal stenosis (SS) or, combinations of both, but if severe enough where the spinal cord is compromised (more commonly in the neck), SS might then be placed in the 1st of the 3 categories described above.

The most common category is mechanical back pain of which “facet syndrome” is the most common condition. This is the classic patient who over did it (“The Weekend Warrior”) and can hardly get out of bed the next day. These conditions can include tearing or stretching of the capsule surrounding the facet joint due to performing too many bending, lifting, or twisting related activities. The back pain is usually localized to the area of injury but can radiate down into the buttocks or back of the thigh and can be mild to very severe.

By Office Staff Back Pain ,

Low Back Pain: Why Is It So Common?

This question has plagued all of us, including researchers for a long time! Could it be because we’re all inherently lazy and don’t exercise enough? Or maybe it’s because we have a job that’s too demanding on our back? To properly address this question, here are some interesting facts:

  1. The prevalence of low back pain (LBP) is common, as 70-85% of ALL PEOPLE have back pain that requires treatment of some sort at some time in life.
  2. On a yearly basis, the annual prevalence of back pain averages 30% and once you have back pain, the likelihood of recurrence is high.
  3. Back pain is the most common cause of activity limitation in people less than 45 years of age.
  4. Back pain is the 2nd most frequent reason for physician visits, the 5th ranking reason for hospital admissions, and is the 3rd most common cause for surgical procedures.
  5. About 2% of the US workforce receives compensation for back injuries annually.
  6. Similar statistics exist for other countries, including the UK and Sweden.

So, what are the common links as to why back pain is so common? One reason has to do with the biomechanics of the biped – that is, the two legged animal. When compared to the 4- legged species, the vertically loaded spine carries more weight in the low back, shows disk and joint deterioration and/or arthritis much sooner, and we overload the back more frequently because, well, we can! We have 2 free arms to lift and carry items that often weigh way too much for our back to be able to safely handle. We also lift and carry using poor technique. Another reason is anatomical as the blood supply to our disks is poor at best, and becomes virtually non-existent after age 30. That makes healing of disk tears or cracks nearly impossible. Risk factors for increased back injury include heavy manual lifting requirements, poor or low control of the work environment, and prior incidence of low back pain.

Other risk factors include psychosocial issues such as fear of injury, beliefs that pain means one should not work, beliefs that treatment or time will not help resolve a back episode, the inability to control the condition, high anxiety and/or depression levels, and more. Because there are so many reasons back problems exist, since the early 1990’s, it has been strongly encouraged that we as health care providers utilize a “biopsychosocial model” of managing those suffering with low back pain, which requires not only treatment but proper patient education putting to rest unnecessary fears about back pain.

By Office Staff Neck Pain ,

The Neck is Your Life Line

The nervous system is the master control network for your body, directing virtually every function and action, from monitoring your life needs, to precisely responding to threats to your health.

Each system, from your heart and blood vessels, to your digestive and immune systems, is directed through nerve impulses originating in your brain or spinal cord that travel through its protective bony structure: the spinal column.

The neck region is the most vulnerable region of the spine to injury. Indeed, even death can be brought through significant trauma to the neck. When the trauma is not fatal, the consequences can still be severe, such as when paralysis strikes.

Most people will not experience these severe injuries, however sprains of the delicate ligaments with subluxation (misalignment) do commonly occur. Despite the injury being smaller, their location (the neck) makes their impact more profound. Functions throughout the body can be impaired when the nerves in the upper neck are compromised.

Within chiropractic, there are specialists who focus their entire care on the uppermost two vertebrae of the spine.

Because every nerve passes through the neck, if irritation or compression is present, virtually any system of the body can be affected. The point being is that a neck disorder will not necessarily just cause neck pain or headache. Dizziness, digestive problems, fatigue, high blood pressure and generally reduced quality of life are some of the symptoms patients commonly experience.

If you have suffered a severe whiplash, you may have noticed far more than a stiff neck. Indeed, recent research suggests whiplash needs to more thought of as a whole body disorder.

We take these injuries in our office and address them in both a specific and comprehensive manner. Most patients who have suffered a neck trauma will require x-rays to analyze the posture of their spine. X-rays may also need to be taken in motion to test the stability of your ligaments and to determine precise levels of impaired movements. Without this road map, it is difficult to determine how care should be directed and factors that could influence your long-term prognosis, such as degeneration.

By Office Staff Neck Pain ,

Neck Pain Exercise Options

Exercise for the neck is very important since weak muscles are related to many painful conditions of the neck and, can contribute to fatigue, irritability, headache, sleep loss, and more. When done correctly (perform slowly, staying within “reasonable” pain boundaries), they can increase your range of motion, reduce stiffness/tightness, and strengthen your neck muscles.

The exercises below combine range of motion (ROM) against light/partial resistance in 4 directions (forwards, backwards, and L/R side bending). To do these correctly: Similar to an arm wrestling contest: 1. Push your head into your hand while moving the head to the end of the range, “…letting the head win” (See A, C, E, G). 2. Repeat this going back in the opposite direction by “letting the hand win” (see B, D, F, H), again, moving through the entire range of motion. ALWAYS push the head into the hands, Make sure you move the head against resistance in BOTH directions, 3 times each (A-B then B-A x3; C-D then D-C x3) then, (E-F then F-E x3, and lastly, G-H then H-G, x3 reps). The trick is doing this VERY slowly (to build motor control and coordination) and to move through the entire “comfortable” range of motion. Repeat 3x slowly. If pain worsens, lighten up on the amount of pressure used or, stop the movement just prior to the sharp pain onset. If you can’t make it to the end of the movement due to pain, make a note of how many reps it took before the onset or increase of pain and how far you could move your head. Do 3 slow reps and then move to the next exercise direction.

Exercise for Neck Pain
These exercises can be performed 1 to 3x/day, according to tolerance, and will increase ROM, increase strength, and build coordination, all at the same time.

By Office Staff Neck Pain ,

The Neck and Headache Connection

The Neck and Headache Connection

Patients with headaches also commonly complain of neck pain. This relationship is the rule, not the exception and therefore, treatment for headaches must include treatment of the neck to achieve optimum results. The term, “cervicogenic headaches” has been an accepted term because of the intimate connection between the neck and head for many years. There are many anatomical reasons why neck problems result in headaches. Some of these include:

  • The first 3 nerves exiting the spine in the upper neck go directly into the head. They penetrate the muscles at the top of the neck near the attachments to the skull and therefore, any excess pressure on these nerves by the muscles or spinal joints will result in irritation and subsequent pain.
  • The origin or nucleus of the 5th cranial nerve called the Trigeminal, innervates the sensation to the face and is located in the upper cervical region near the origin of the 2nd cervical spinal nerve, which innervates sensation to the back of the head up to the top. Therefore, problems located in the upper neck will often result in pain radiating up from the base of the skull/ upper neck over the top of the skull to the eyes and /or face.
  • The 11th cranial nerve that innervates the upper shoulders and muscles in the front of the neck arises from the top 5 to 7 spinal cord levels in the neck. Injury anywhere in the neck can result in spasm and pain in these large muscle groups.
  • Other interconnections between the 2nd cervical nerve and trigeminal/5th cranial nerve include communication with the 7th cranial / facial nerve, the 9th cranial / glossopharyngeal nerve, and the 10th cranial / vagus nerve. These connections can affect facial muscle strength/ movements, taste, tongue and throat movements, and stomach complaints such as nausea from these three cranial nerve interconnections, respectively.

When patients seek treatment for their headaches, a thorough examination of the neck, upper back, and cranial nerves is routinely performed for the above reasons. It is common to find upper cervical movement and vertebral alignment problems present in patients complaining of headaches. Tender points located between the shoulder blades, along the upper shoulders, on the sides of the neck and particularly, at the base of the skull are commonly found. Pain often radiates from the tender point over the top of the skull when pressure is applied in the upper neck/ base of the skull area. Tenderness on the sides of the head, in the temples, over the eyes, and near the jaw joint are also common. Traction or pulling the head to stretch the neck is often quite pain relieving and this is often performed as part of the chiropractic visit and can also be applied at home with the use of a home cervical traction unit. Chiropractic adjustments applied to the fixated or misaligned vertebra in the upper neck often brings very satisfying relief to the headache sufferer. Exercises that promote movement in the neck, as well as strengthening exercises are also helpful in both reducing headache pain and in preventing occurrences, especially with stress or tension headaches.

By Office Staff Neck Pain ,

What Is This Pain in My Neck!

What Is This Pain in My Neck!

“When I woke up this morning, I couldn’t move my neck! Every time I try to move it, I feel sharp pain on the left side of the neck shooting down into the shoulder blade. It just came out of nowhere!”

Chances are, you are suffering from a common condition called torticollis, which literally means, “twisted neck” after the Latin terms of “torti” (twisted) and “collis” (neck). The common name for this is “wry neck,” and it’s basically a painful muscle spasm, like a “Charlie-horse” but located in the neck muscles. Usually, a person wakes up in the morning with this and the cause is often related to sleeping with the window being open or a fan or air conditioner blowing on you. It can also relate to a “cold settling in the muscle” after a cold or flu virus. Trauma such as falling or a car accident can also cause torticollis. However, most of the time, patients with torticollis are not sure what caused the abrupt onset of symptoms.

Usually, torticollis will gradually improve over a 2 week time frame. However, it only takes a few days to a week (at the most) if you receive chiropractic adjustments. Most importantly, without treatments, the sharp pain can last a week and can severely limit your activity, often prohibiting work as well as your desired “fun” activities. Hence, most people prefer having this treated as opposed to “waiting it out.” In some cases, it can last longer than a month and in rare cases even longer, so getting this treated is highly recommended. Also, try to get in for a treatment immediately before the muscle spasm really sets up. We find this to be the most effective approach. Here are a list of symptoms and treatment suggestions for torticollis:

Acute Torticollis Symptoms

  • Muscle spasms
  • Neck and shoulder pain
  • Neck and spine contortion (neck twisted to right or left side of body)

 

Pain Relief Treatments for Acute Torticollis

  • Chiropractic neck and spinal adjustment
  • Analgesics
  • Heat packs
  • Muscle relaxants
  • Rubs and ointments (Icy Hot, BioFreeze)
  • Massage with essential oils
  • Reiki
  • Sleep / Relax
  • Supportive cervical collar
By Office Staff Neck Pain ,

Neck Pain – Can Chiropractic Really Help?

Neck Pain – Can Chiropractic Really Help?

Neck pain is a very common problem affecting up to 70% of the adult population at some point in life. Though there are specific causes of neck pain such as arising from a sports injury, a car accident or “sleeping crooked,” the vast majority of the time, no direct cause can be identified and thus the term nonspecific is applied. There are many symptoms associated with patients complaining of neck pain and many of these symptoms can be confused with other conditions. Wouldn’t it be nice to know what neck related symptoms are most likely to respond to chiropractic manipulation before the treatment has started? This issue has been investigated with very favorable results!

The ability to predict a favorable response to treatment has been termed, “clinical prediction rules” which in general, are usually made up of combinations of things the patient says and findings from exams. In a large study, data from about 20,000 patients receiving about 29,000 treatments, was collected and analyzed to find out what complaints responded well to chiropractic treatment. The results showed that the presence of any 4 of these 7 presenting complaints predicted an immediate improvement in 70-95% of the patients: 1. Neck pain; 2. Shoulder, arm pain; 3. Reduced neck, shoulder, arm movement; 4. Stiffness; 5. Headache; 6. Upper, mid back pain, and 7. None or one presenting symptom. Items not associated with a favorable immediate response included “numbness, tingling upper limbs,” and “fainting, dizziness and light-headedness in 4-12% of the patients. The “take-home” message here is that was far more common to see a favorable response (70-95%) of the patients compared to an unfavorable response (4-12%), supporting the observation that most patients with neck complaints will respond favorably to chiropractic treatment.

So, what do we do as chiropractors when a patient presents with neck pain? First, after gathering preliminary information such as name, address and insurance information, a history of the presenting complaint is taken. This consists of information including what started the neck complaint (if you know), when it started, what makes it worse, what makes it better, the quality of pain (aches, stiff, numb, etc.), the location and if there is radiating complaints, the severity (0-10 pain scale), timing (such as worse in the morning, evening, etc.), and if there have been prior episodes. Various questionnaires are included that are scored so improvement down the road can be tracked and a past history that includes a medication list, past injuries or illnesses, family history and a systems review are standard. The exam includes vital signs (BP, pulse, height, weight, temperature and respiration), palpation, range of motion, orthopedic and neurological examination. X-ray and/or other “special tests” may also be included, when needed. A review of all the findings are discussed and after permission to treat is granted, a chiropractic adjustment may then be rendered. A list treatment options may include:

  1. Adjustments;
  2. Soft tissue therapy (trigger point stimulation, myofascial release);
  3. Physical therapy modalities;
  4. Posture correction exercises and other exercises/home self-administered therapies;
  5. Education about job modifications;
  6. Co-management with other health care providers if/when needed.
By Office Staff Chiropractic ,

The Difference in Effectiveness of Medical vs. Chiropractic In The Treatment of Acute and Chronic Back Pain

Have you ever considered who is the best suited to treat back pain? Since there are so many treatment options available today, it is quite challenging to make this decision without a little help.

To facilitate, a study looking at this very question compared the effectiveness between medical and chiropractic intervention. Over a 4-year time frame, 2780 patients were followed with questionnaires. Low Back Pain patients were treated using conventional approaches by both MDs (Medical Doctors) and DCs (Doctors of Chiropractic).

Chiropractic treatments included spinal manipulation, physical therapy, an exercise plan, and self-care education. Medical therapies included prescription drugs, an exercise plan, self- care advice and about 25% of the patients received physical therapy.

The study focused on present pain severity and functional disability (activity interference) measured by questionnaires mailed to the patients. It was reported that chiropractic was favored over medical treatment in the following areas:

  • Pain relief in the first 12 months (more evident in the chronic patients)
  • When LBP pain radiated below the knee (more evident in the chronic patients)
  • Chronic LBP patients with no leg pain (during the first 3 months)

Similar trends favoring chiropractic were seen for disability but were of smaller magnitude. All patient groups saw significant improvement in both pain and disability over the four year study period.

Acute patients saw the greatest degree of improvement with many achieving symptom relief after 3 months of care.

This study also found early intervention reduced chronic pain and, at year 3, those acute LBP patients who received early intervention reported fewer days of LBP than those who waited longer for treatment.

While both MDs and DCs treatment approaches helped, it’s quite clear from the information reported that chiropractic should be utilized first.

These findings support the importance of early intervention by chiropractic physicians and make the most sense for those of you struggling with the question of who to see for your LBP.

By Office Staff Chiropractic ,

Is Chiropractic Dangerous?

The mission of chiropractic is to help sick people get well, as well as to help healthy people function better in the absence of drugs or surgery. When people are asked, “…what do chiropractors do?” the frequent response is, “…they crack your neck and/or back.”

Chiropractic spinal manipulation (frequently called an adjustment), often produces an audible popping or cracking noise.

This sound is known as joint cavitation and it is reported to be caused by the release of pressure created by gases (nitrogen, oxygen, and carbon dioxide) within the joint. It is the same noise produced when one cracks their knuckles. One common myth is that cracking or cavitating a joint will produce arthritis in the joint – this is simply not true.

Several scientific studies of joint cavitation dispel this old wives tale. In fact, studies demonstrated that joint manipulation actually benefits patients with arthritis of the spine.

There have been a number of studies published on the topic of unwanted reactions to spinal manipulation.

In general, side effects, if any, are mild and transient.

When they do occur, they typically happen shortly after the first or second session of spinal manipulation, similar to the post-exercise soreness that occurs when first introducing a new sport or activity.

Unpleasant side effects may occur in between 10% and 30% of patients. They occur more often in women than men, and as previously stated, they seem to occur more often after the first session of spinal manipulation.

The most commonly reported unpleasant reaction is temporary and transient increased pain or stiffness. This reaction usually resolves in 24 hours or less. More rare reports of tiredness, light headedness, and occasional nausea have been infrequently reported.

The type and nature of these reactions may be associated with the severity and nature of the condition being treated.

It seems self evident that more severe problems have the potential to produce short term increases in symptoms. The use of ice, ultrasound and or other modalities can help to minimize any irritation that may occur due to spinal manipulative treatment.

SPINAL MANIPULATION HAS BEEN FOUND TO BE SAFE AND EFFECTIVE FOR UNCOMPLICATED SPINAL PAIN SYNDROMES. MORE IMPORTANTLY, IT MAY ALSO BE A VIABLE ALTERNATIVE TO SURGERY FOR LUMBAR OR CERVICAL DISK HERNIATIONS.

There are many reports on both sides of this subject, with some stating spinal manipulation can increase compression of the spinal nerves in patients with disk herniations as well as the opposite

– that it reduces nerve root pressure.

The good news is that the rate of occurrence is only about 1 in 1- 3 million cases, making spinal manipulation for disk problems an extremely safe treatment option for patient with herniated disks.

Chiropractors will often use low-force manipulation methods for treating herniated disks that do not require a standard type of manipulation thrust.

These spinal methods are sometimes preferred over traditional manipulative techniques for the treatment of herniated spinal disks, but this is case dependent.

To make an educated decision about any type of care you may be considering, you must consider “relative risks”. Simply put, relative risks compare the risk of one procedure with the risk of a second procedure for the same condition.

For example, if you are taking medications to relieve your pain, how do the risks of the medications compare with the risks of an alternative treatment, like chiropractic care?

An example is chiropractic treatment versus drugs known as non-steroidal anti-inflammatory drugs (NSAIDs), which include aspirin, Aleve and Advil (TM).

THE RISK FOR SERIOUS SIDE EFFECTS FROM ANTI-INFLAMMATORY DRUG IS FROM 6000-9000 TIMES GREATER THAN THE RISK FOR SERIOUS SIDE EFFECTS FROM SPINAL MANIPULATION, MEANING THAT CHIROPRACTIC CARE IS A MUCH SAFER ALTERNATIVE THAN ASPIRIN OR OTHER NSAID DRUGS FOR TREATING INFLAMMATORY BACK OR NECK PAIN.

Further, there is no significant increased risk to add chiropractic care to an existing regime of NSAIDs, thus treating the condition with two different strategies.

Interestingly, studies have reported that patients receiving chiropractic care were able to reduce their intake of drugs, thus, reducing the risks of drug reactions/interactions.

If you are trying to avoid surgery for a spine related problem, your condition is more serious and potential side effects of surgery should be compared with chiropractic.

You should understand any patient who is a potential candidate for spine surgery has a serious medical condition. There is pressure on a nerve and the potential for permanent damage to that nerve exists.

Studies show that chiropractic care often can reduce the pressure on a compressed nerve in the lower back or neck, without surgery.