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Managing Neck Pain and Headaches Part 3

Neck pain and Headaches are a very common issue in our society, and understanding the causes and prevention of them will go a long way to leading a healthy and pain free life. In this educational summary, we discuss some of the most common conditions we see in our office. Below we will discuss the following neck-related pain conditions.

  1. Upper Crossed Syndrome
  2. Headaches
  3. Neck Sprain/Strain
  4. Disc Pain
  5. Cervical Radiculopathy
  6. TMJ Dysfunction

Potential causes of Cervical Discogenic Pain Syndrome

  • Direct trauma – falls, motor vehicle accident, whiplash, sports injury
  • Overuse, fatigue, repetitive microtrauma – over hours, days, months of the same position
  • Postural – can be either an intrinsic postural problem (e.g. loss of cervical curvature) or an extrinsic postural problem (e.g. prolonged stressful position, protruded head posture).
  • Sudden unguarded movement.
  • Degenerative disc disease.

Symptoms of Cervical Discogenic Pain Syndrome

The symptoms will vary depending on whether the condition is caused by a herniated disc or by a degenerative disc. With a herniated disc, some people will not experience pain in the neck but will have radiating pain, tingling, and numbness down the arm or around the shoulder blade due to pressure put on the nerve root. Discogenic pain due to an injury can result in immediate pain or pain shortly after the injury. Headaches (usually cervicogenic) can also result from cervical disc pain.

Treatment of Cervical Discogenic Pain Syndrome

Treatment for cervical discogenic pain will depend on the clinical presentation. Conservative treatment can successfully manage many cervical disc herniations. Initial treatment will focus on controlling pain and inflammation. Once pain and inflammation have decreased, early rehabilitation will help prevent chronic pain and disability. This will consist of osseous manipulation, soft tissue therapy, activity as tolerated, and pain-free range of motion exercises. Late rehabilitation will be administered as the condition improves and will include stabilization exercises, patient education, and postural training. Education in proper training, biomechanics, and a home exercise program will help strengthen the spine and decreases the likelihood of future injury. If you fail to respond to conservative treatment, or in cases of severe pain, diagnostic imaging (x-ray, MRI) will be warranted, and an orthopedic consult may be necessary.

Cervical Radiculopathy

Cervical Radiculopathy is a dysfunction of the cervical nerve roots resulting in various neurologic findings. The cervical spine consists of seven cervical vertebrae and eight cervical nerve roots. Cervical radiculopathy can result in pain, numbness, or weakness and though the problem occurs at the nerve root of the cervical spine, these symptoms will often radiate to parts of the body controlled by that nerve. The seventh (C7) and sixth (C6) cervical nerve roots are most commonly affected.

In younger patients, cervical radiculopathy is usually the result of a disc herniation or an acute injury causing foraminal impingement of the exiting nerve. In the older population, cervical radiculopathy is usually due to foraminal narrowing from osteophyte formation, decreased disc height, or degenerative changes. In elderly patients with osteophyte formation, repetitive neck movements may result in a more insidious injury. Cervical radiculopathy due to sports injuries can result from several mechanisms. Typical these injuries occur from forced extension, lateral bending, or a rotation mechanism, which closes the foramen and results in the exiting nerve root being injured.

Risk Factors for Cervical Radiculopathy

  • Heavy manual labor requiring lifting more than 25 pounds (especially repetitive activity)
  • Driving or operating vibrating equipment
  • Smoking
  • Collision sports (e.g. football, hockey)
  • Prior injuries, degenerative disc disease/osteoarthritis

History and Symptoms of Cervical Radiculopathy

The condition may follow a neck injury or be of insidious onset, and there may be a history of multiple episodes of previous neck pain or arthritis of the cervical spine. The pain may range from deep aching to severe burning neck pain. Usually, the pain will be referred to the shoulder blade, which might be described as shoulder pain. If the radiculopathy progresses, radicular arm pain (“sharp, shooting, electrical”) or sensory changes (“numbness, tingling, loss of sensation”) may develop down the arm and into the hand. Arm symptoms will depend on which nerve root is involved. Occasionally, a motor weakness may develop of the shoulder or arm. Certain neck positions which cause increased foraminal narrowing may increase the pain. The symptoms may be relieved by lifting the arm over the head which decreases the tension at the nerve root.

Treatment of Cervical Radiculopathy

Initial treatment will focus on reducing pain and inflammation and prevention of further neurological loss. The focus will also be on centralizing (reducing) any radicular symptoms by decreasing nerve root compression and pressure within the herniated discs. This will consist of manual traction and pain-free active non-resisted ranges of motion while avoiding positions that increase neck and arm symptoms. A cervical pillow at night can be helpful in maintaining the neck in a neutral position and limiting head positions that cause foraminal narrowing. Electrotherapy modalities may be used to help reduce any associated muscle pain and muscle spasms. Once pain and inflammation have decreased, therapy will progress to restore full range of motion and mobility of the neck and shoulder. This will include muscle stretching, strengthening and proprioceptive training, and corrective exercises as tolerated. Cervical manipulation and soft tissue therapy may be administered as tolerated and as long as it does not cause an increase in symptoms. If you fail to respond to conservative treatment, or in cases of severe neurological loss, a secondary consultation with a neurologist or neurosurgeon will be recommended.

TMJ Dysfunction

“I’ve got TMJ”  It’s a pretty common statement which is a bit of a misnomer.  Everyone has TMJ.  Why?  The TMJ is the tempo-mandibular joint(TMJ).  We all have it.  What people are probably trying to say is that they have TMJ disorder, aka pain and dysfunction of the jaw while opening or closing your mouth.

What happens is the mandible (your jaw) connects to the rest of your head at the temporal bone.  It’s a hinge joint that pivots through a cartilage disc called a meniscus in between the two bones of this joint.  Unfortunately, it’s a common place for the TMJ to become subluxated or in other words, a little bit dislodged.  After that, you can get overuse and degeneration of that joint.  One way to tell if you have this disorder is to open your mouth and measure, can you open your mouth the height of 3 fingers for your hand?  If not, you might have TMJ disorder.

The main physical causes of this condition are:

  • trauma
  • overuse from a commonly chewing on one side of your mouth
  • keeping the mouth open for extended periods of time (like at the dentist)
  • improper bite
  • grinding

From a physical standpoint, the best way to prevent TMJ disorder is to wear proper mouthpieces while playing sports, wearing mouth guards while sleeping, making sure to chew food evenly on both sides of your mouth, cutting tough meats and other foods into small pieces and minimizing gum chewing. Having better posture also improve the alignment of the TMJ.

Can bad posture effect how your nervous system works?

Is forward head posture relevant to autonomic nervous system function and cervical sensorimotor control?

Forward head posture can lead to many things! Besides looking bad it can cause such things as headaches, neck pain, shoulder pain as well as TMJ problems.

Highlights from the study show:

Forward head posture negatively affects cervical sensorimotor control. Forward head posture negatively affects the autonomic nervous system. There is strong correlation between the Craniovertebral angle (CVA) and cervical sensorimotor outcomes. There is strong correlation between the Craniovertebral angle (CVA) and cervical sensorimotor outcomes. There is strong correlation between the Craniovertebral angle(CVA) and skin sympathetic outcomes.

Here’s a picture of forward head posture or a poor CVA. The picture to the left is the worse CVA. The one on the right is very good posture.

CONCLUSION: “We have identified a forward head posture is associated with abnormal autonomic nervous system function and disturbances of cervical sensorimotor control. This finding has important implications for the assessment and rehabilitation of these subjects.”

If you need help with your posture contact the office! We can help!

https://www.sciencedirect.com/science/article/abs/pii/S0966636220300059?via%3Dihub

When Is Standing Too Much?

The new craze in standing at your desk has many asking if standing is for them, and how long should they stand for? Does everyone need a standing desk?  Not everyone needs a standing desk.  If you do have pain with sitting and  you sit for your job, then a sit to stand opinion might be for you.  Below are some tips to make the transition from sitting all day, to using a sit to standing desk without hurting yourself.

  • Standing too much can cause low back pain and leg pain.
  • Body is designed to sit and stand throughout the day. There are many ways to get your standing throughout the day without the need for a sit-to-stand option.
  • Sit-to-stand options can be useful and make the ability to stand more readily available. If you do have this options, here is what you need to look out to ensure proper utilization.
    • Most start at 15-20 mins within the hour in the beginning then it grows.
    • 4-6 hours per day after 30 days.
    • Start off slowly- taking breaks.
    • Listen to your body.
    • Flat surface and flat shoes (no heels!)
    • Weight distribution right below hips and arms at a right angle looking straight ahead and slightly down.
    • Don’t do continuous 8 hours of standing.  

What Pillow should I get?

Are you Sleeping on the Right Pillow?

Determining the right pillow is a personal choice that a person will make every so often. When it comes to thinking about sleep equipment, most people solely focus on the mattress. The mattress is one of the most important sleep equipment you will buy, but when it comes to sleep quality pillows are just as important. How you lay your head when sleeping plays a huge role in determining the type of support you need. Pillows not only impact the quality of sleep but can prevent any neck discomfort.

Why Does Your Pillow Matter?

A proper pillow will facilitate a good night’s sleep without you waking up at night or waking up with pain or a stiff neck. Having the wrong pillow over time can exacerbate unnecessary neck pain. There are a few factors that go into making a guide for yourself to determine the proper pillow for you.

Back Sleeper:

Sleeping on your back might appear to be comfy, but will highlight the underlying issue of snoring if you have a pillow that allows your head to sink. As you lay your head back, gravity will push the tongue back and block your throat. A better alternative will be a pillow that offers height, neck support and keeps the throat at a comfortable level.

Side Sleeper:

One of the most common positions to sleep in is on the side. You will need more support to keep the neck at a neutral angle.

Stomach Sleeper:

Sleeping on your stomach might be comfortable for a few nights, but after a while can become taxing on your back and neck. However, having the right pillow can negate some of these issues. A firm/plump pillow will force your neck into an odd angle that might lead to some discomfort. A better alternative would be a softer option.

When Is It Time To Replace Your Pillow?

On average, a pillow should be replaced every 18 months. The old age rule “ you pay for what you get” applies to this transaction. A higher quality pillow will last longer than an inexpensive option. Something you can do to your pillow to see if you need a new one is, take it out of the pillowcase to see if there are any stains or fold it in half and see if the pillow stays folded. If either of these are a yes then it is time to replace your pillow.

2019 saw dozens of impactful studies regarding the benefits of Spinal manipulation(adjustments)!

Chiropractic can help headaches! Thru my 20 years of practice I have helped a lot of patients with headaches. It’s nice to see the research is backing up what I and many of my patients have known for years. Chiropractic can help headaches.

Here’s a nice study form Harvard showing that.

1. Researchers from Harvard Medical School, Brigham & Women’s Hospital, and Palmer College of Chiropractic performed a systematic review of the effectiveness of SMT for migraine. They concluded: “We observed that spinal manipulation reduced migraine days as well as migraine pain intensity.” (5)

2. A BMJ study encompassing nearly a quarter-million LBP patients compared initial and long-term opioid use with choice of initial provider. The study concluded: “Patients who received initial treatment from chiropractors or physical therapists had decreased odds of short-term and long-term opioid use compared with those who received initial treatment from primary care physicians.” Drilling beyond the abstract, the data demonstrated that between PT’s and DC’s, chiropractic patients had significantly lower initial and long-term opioid use (0.10 vs. 0.15). (6)

Hip Weakness is Closely Linked to Knee Pain

In this study they found that hip weakness was linked to knee pain. I treat a lot of runners that have knee pain, and most of them have weak hips.

“Women with Patellofemoral Pain Syndrome had 33% lower hip abduction peak strength. They also had significant 70% lower knee extension force steadiness and 60% lower hip abduction force steadiness than pain-free women. Evidence-based treatments aiming at improving force steadiness may be a promising addition to PFP rehabilitation programs.

Below is a helpful exercise to strengthen your hips. As always, if you need any guidance do not hesitate to call the office!

Ferreira AS et al. Knee and Hip Isometric Force Steadiness Are Impaired in Women With Patellofemoral Pain. J Strength Cond Res. 2019 Jul 22. Link 

New Guidelines for Runner’s Knee

Active rather than passive treatments are the key to recovering from “Runner’s Knee”, according to new international treatment guidelines co-authored by La Trobe University physiotherapy researcher Dr Christian Barton.

❇️ People with kneecap pain should engage in exercise-therapy, namely hip & knee strengthening

❇️ An exercise program that gradually increases activities such as running, exercise classes, sports, or walking, is the best way to prevent kneecap pain

❇️ Risk of kneecap pain can be reduced through improved leg strength, particularly the thigh muscles

❇️ Pain does not necessarily equate to knee damage

https://www.latrobe.edu.au/news/articles/2019/release/new-guidelines-for-runners-knee2?fbclid=IwAR3UfqQ5rHFTjZxcgzED5ypLsL5ukXufo6iNta-ODNulM70_g0naKrc_DD4

Headaches Can Come From the Neck

Cervicogenic Headache are headaches coming from the neck. There are many cause of headaches. Chiropractic has been shown to help headaches caused by neck dysfunction.

A Spine Journal study found that in patients suffering from cervicogenic headache, spinal manipulation cuts the number of symptomatic days in half:

“256 adults with chronic cervicogenic headache (CGH) were randomized to four dose levels of chiropractic SMT: 0, 6, 12, or 18 sessions. Participants were treated three times per week for 6 weeks and received a focused light-massage control at sessions when SMT was not assigned. A linear dose-response was observed for all follow-ups, a reduction of approximately 1 CGH day/month for each additional 6 SMT visits. Cervicogenic headache days/month were reduced from about 16 to 8 for the highest and most effective dose of 18 SMT visits.”

Call the office if you have been suffering from headaches! If you have tried medicine but you are still having headaches then give chiropractic a try.

Haas M. et al. Dose-response and efficacy of spinal manipulation for care of cervicogenic headache: a dual-center randomized controlled trial. Spine J. 2018 Oct;18(10):1741-1754

Maintain a healthy brain: How to protect the body’s control center

Healthy brain function is essential for optimal wellness, but conditions such as Alzheimer’s disease and concussions are emerging as critical concerns for our health care system. as conventional medicine searches for solutions, cutting-edge research is starting to show that nutrients and herbal extracts may have beneficial effects on memory and brain function.

Top Supplements to Boost Brain Function:

  • Fish oils high in DHA
  • Turmeric (bioavailable forms)
  • Magnesium
  • Vitamins D and E
  • B vitamins (especially B12)
  • Bilberry (anthocyanins)

Did You Know?

  • Most concussions do not involve a loss of consciousness.
  • Sports-related concussions do not show evidence of damage on MRI or CT scans.
  • Across the same sports, girls have higher rates of concussions.

Hrkal, Paul ND (2019) Maintain a Healthy Brain Sage: A Healthy Living Magazine