Tag Archives: chiropractor

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Tools for Migraines

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Migraines are a common head that effects, about 6% of men and 18% of women get a migraine in a given year, in the united states.

1. Manual Therapy

Spinal manipulation is a useful tool in migraine prophylaxis. One study demonstrated a “significant reduction” of migraine intensity in almost half of those patients receiving spinal manipulation.  Nearly ¼ of migraine patients reported greater than 90% fewer attacks.  Spinal manipulation has demonstrated similar effectiveness but longer-lasting benefit with fewer side effects when compared to a well-known and efficacious medical treatment (amitriptyline). 

  1. Rist PM, Hernandez A, Bernstein C, Kowalski M, Osypiuk K, Vining R, Long CR, Goertz C, Song R, Wayne PM. The Impactof Spinal Manipulation on Migraine Pain and Disability: A Systematic Review and Meta-Analysis. Headache: The Journal of Head and Face Pain. 2019 Apr;59(4):532-42. Link
  2. Chaibi A, Benth JŠ, Tuchin PJ, Russell MB. Adverse events in a chiropractic spinal manipulative therapy single-blinded, placebo, randomized controlled trial for migraineurs. Musculoskeletal Science and Practice. 2017 Jun 1;29:66-71. Link

A Harvard study found that SMT significantly reduced migraine days as well as pain intensity. And SMT is safe; a study to define adverse events following chiropractic spinal manipulation for migraines found that “adverse events were mild and transient, and severe or serious adverse events were not observed.” 

1. Acupuncture

Several recent studies have shown that acupuncture is another viable tool for managing migraines.

  1. Vázquez-Justes D, Yarzábal-Rodríguez R, Doménech-García V, Herrero P, Bellosta-López P. Analysis of the effectiveness of the dry puncture technique in headaches: systematic review. Neurology. 2020 Jan 13. Link
  2. Xu S, Yu L, Luo X, Wang M, Chen G, Zhang Q, Liu W, Zhou Z, Song J, Jing H, Huang G. Manual acupuncture versus sham acupuncture and usual care for prophylaxis of episodic migraine without aura: multicentre, randomised clinical trial. BMJ. 2020 Mar 25;368. Link
  3. Rist PM, Hernandez A, Bernstein C, Kowalski M, Osypiuk K, Vining R, Long CR, Goertz C, Song R, Wayne PM. The Impact of Spinal Manipulation on Migraine Pain and Disability: A Systematic Review and Meta-Analysis. Headache: The Journal of Head and Face Pain. 2019 Apr;59(4):532-42. Link

2. Eat Smart & Maintain an Ideal Weight

Dietary fats trigger the synthesis of prostaglandins which are known migraine triggers (19). Low-fat diets have been shown to play a role in migraine prophylaxis. (20,21) Weight loss may decrease the frequency of migraine and other primary headaches (tension, cluster). (16-18)  Patients on a low sodium (DASH) diet report a decrease in headache frequency vs those on a high sodium diet.  (23) One new study showed that “adherence to the Harvard Healthy Eating Plate advice, particularly the reduction in carb, red and processed meat consumption, is useful in migraine management, reducing migraine frequency and disability.” (47)

3. Drink Water

Drinking more water and drinking less soda and sugar beveragesis all ways a good idea. . A study published earlier this month, showed “The results showed that the severity of migraine disability pain severity headaches frequency and duration of headaches were significantly lower in those who consumed more total water.” (Khorsha F, Mirzababaei A, Togha M, Mirzaei K. Association of drinking water and migraine headache severity. Journal of Clinical Neuroscience. 2020 May 20. Link)

4. Vitamin D

Vitamin D is important hormone in the body. that right its a hormone and is involved in many different processing the body. Vitamin D deficiency is associated with migraine attacks. Vitamin D supplementation in a dose of 1000-4000 IU/d has been shown to reduce the frequency of migraine attacks.

  1. owaczewska M, Wiciski M, Osi?ski S, Kamierczak H. The Role of Vitamin D in Primary Headache–from Potential Mechanism to Treatment. Nutrients. 2020 Jan;12(1):243.
  2. Ghorbani Z, Togha M, Rafiee P, Ahmadi ZS, Magham RR, Djalali M, Shahemi S, Martami F, Zareei M, Jahromi SR, Ariyanfar S. Vitamin D3 might improve headache characteristics and protect against inflammation in migraine: a randomized clinical trial. Neurological Sciences. 2020 Jan 2:1-0. 

5. B Vitamins

Riboflavin (Vit B2) may help prevent migraines. (26, 29-38) Dosage recommendations vary, however, the average dose used in the studies was 400mg/day. Vitamin B6 supplementation (with or without concurrent B9 and B12) has also demonstrated prophylactic benefit.

  1. Maizels M, Blumenfeld A and Burchette R. A combination of riboflavin, magnesium, and feverfew for migraine prophylaxis: A randomized trial. Headache 2004; 44: 885–890.
  2. Smith C. The role of riboflavin in migraine. Can Med Assoc J 1946; 54: 589–591.

8. Magnesium (400-600mg)

Magnesium a mineral that can help with headaches. Magnesium play a role in energy production , bone formation, nerve function and blood vessel function. An umbrella review found strong evidence that “Magnesium supplementation can reduce the intensity/frequency of migraine.”  Dosage recommendations vary, however, the average dose used in the studies is 400-600mg/ day for the prevention of migraine in non-pregnant patients.

  1. Ko¨seoglu E, Talaslioglu A, Go¨nu¨l AS, et al. The effects of magnesium prophylaxis in migraine without aura. Magnes Res 2008; 21: 101–108.
  2. Esfanjani A, Mahdavi R, Ebrahimi Mameghani M, et al. The effects of magnesium, L-carnitine, and concurrent magnesium-L-carnitine supplementation in migraine prophylaxis. Biol Trace Elem Res 2012; 150: 42048.
  3. Peikert A, Wilimzig C and Ko¨hne-Volland R. Prophylaxis of migraine with oral magnesium: Results from a prospective, multi-center, placebo-controlled and double-blind randomized study. Cephalalgia 1996; 16: 257–263.

10. Melatonin (2-3mg)

Melatonin is a important hormone release by the brain during sleep. Melatonin should be taken 30 minutes before bed. One systematic review and meta-analysis concluded: “Melatonin may be of potential benefit in the treatment‐prevention of migraine in adults.”  Study doses varied widely (0.05-50mg), however, the typical dose used in the studies was 2-3mg, taken before bedtime. Liampas I, Siokas V, Brotis A, Vikelis M, Dardiotis E. Endogenous Melatonin Levels and Therapeutic Use of Exogenous Melatonin in Migraine: Systematic Review and Meta-Analysis. Headache: The Journal of Head and Face Pain. 2020 Apr 30.

Suffering from migraines? Make an appointment to get started on the road to relief!

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Evaluate, Fix, Prevent

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Far too often in today’s healthcare system, patients are being let down by their healthcare providers. As the patient, you deserve to be guided back to health appropriately and efficiently. Too many injured and ailing people are not being thoroughly evaluated, therefore not receiving appropriate conservative care, nor are they given a game plan to prevent the pain or injury from returning in the future. There are many types of ailments and illnesses, but for the purpose of this article we will be discussing musculoskeletal pain and injuries.

There are 3 fundamental aspects of care you deserve as the patient

  1. Comprehensive Evaluation and Assessment
  2. Conservative Treatment Options
  3. Prevention Training 

Comprehensive Evaluation and Assessment

Too often a patient presents to their primary care physician or specialist and they are given a proper history and consultation, but a very low-level musculoskeletal exam. Many times, the doctor doesn’t even assess the muscle tissue, joint function and/or the movement of the patient. In many cases they perform a few orthopedic tests, may refer you for some diagnostic imaging, before concluding that you must rest for 6 weeks and finally prescribe you some medication to help “manage” your condition.

As a patient it is important to understand what you should expect from a comprehensive evaluation and assessment. Your evaluation and assessment should provide you with a working diagnosis and the potential indirect causes of the pain or injury. The diagnosis should be specific and clearly communicated.

In order to determine an appropriate working diagnosis a comprehensive evaluation should include, but is not limited to:

  • A thorough History & Consultation
  • Functional Assessment: Assessing weakness, tightness, faulty movement patterns.
  • Orthopedic Exams, Range Of Motion, Neurological testing as needed.
  • Muscle and Joint Palpation/Testing.
  • Gait Analysis (if deemed necessary)

When a thorough evaluation and assessment is performed it provides the healthcare provider with the information required to determine the appropriate course of care. This allows for an informed decision regarding which conservative treatment options would be best suited for your individual case.

Conservative Treatment Options

In my opinion, you deserve to have a comprehensive hands-on approach to your pain or injury. Most patient presentations respond best to a specific combination of therapies. This may include muscle therapy, joint restriction chiropractic adjustments, rehab exercises, and advice on how to train and prevent further exacerbations of the injury. You may not need both the muscle therapy and chiropractic adjustment for all pain or injuries, but many will optimally benefit from all four approaches above.

Conservative treatment should not be a “one size fits all” approach. With multiple therapies available, each which targets different tissues it is important that your care plan is individualized based on the findings from your comprehensive assessment.

Prevention Training

There are few things more frustrating from both the patient’s or doctor’s perspective than the return of the pain or injury. There are many potential factors that can contribute to re-aggravation of your injury or symptoms. These include over-use strain from work, life or sport, not following the prescribed exercises, or the lack of injury prevention training from your healthcare provider. As an informed patient, these are a sample of some prevention options you should expect instructions on.

  • Activities of Daily Living Training: Many activities we do in our daily life cause physical strain when performed improperly.  
  • Return to Work/Sport Advice: Proper time frame for return and potential modifications.  
  • Body Awareness and Preparation: Proper lifting, bending, posture, etc.
  • Corrective Exercises: Core stability exercises.
  • Desk Ergonomics Tips: Desk sitting is causing many of your conditions.  
  • Proper Equipment recommendations: Proper running shoes for a runner.
  • Skills/Technique Training: Golf swing technique from a teaching professional.

To summarize, there are many potential shortcomings that you may experience when you see any healthcare provider for your musculoskeletal pain or injury. The first step is being an informed patient, and understanding what quality care entails. I have outlined some key points that you as an informed patient should come to expect from your provider when you seek treatment for any musculoskeletal condition.

  • A comprehensive assessment including but not limited to a thorough history, a functional movement assessment, palpation (assessing by hand) of the joints, muscles, tendons and ligaments
  • An exam that assesses the body as a whole in order to determine the root cause, and does not only focus on the point of pain. For example, many times a patient with low back pain has hip range-of-motion and mid-back mobility issues that have led to the low back being over-worked.
  • A specific working diagnosis based off of the comprehensive exam.
  • All your conservative treatment options should be explained and discussed, offering you a chance to ask any questions you might have and provide clarity regarding our plan.
  • You should expect to receive advice regarding preventative care for your injury, so once you are out of pain, you can avoid re-injury or aggravations.  
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Dose-response Relationship Between Physical Exercise and Risk of Physician-Diagnosed Dementia

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A new study found that diabetes was associated with a 51% increased risk of dementia but exercise was associated with a dose-dependent decrease.

Exercise 3‐5 days/week was associated with a 37% lower dementia risk and >5 days/week was linked to a 59% lower risk of dementia (compared to on exercise).

This was an observational study which means causation cannot be established. However, meta-analyses of randomized controlled trials have found the benefits of regular exercise on cognitive function. The dose-dependent effect on lower dementia risk also strengthens the data.

https://pubmed.ncbi.nlm.nih.gov/32441421/?fbclid=IwAR15viX1IlBHh2fCKhbw7K2v7KGNCWtA4Pqw2rRSR8Jy4hEjI_iH4nz7sbM

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What is Upper Cross Syndrome?

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Upper Cross Syndrome describes a type of common muscle imbalance.

This occurs when the neck flexors and the middle back become weak while the pectoral muscles and the muscles at the base of the skull become tight.  This produces a familiar pain pattern at the base of the neck and the shoulders, as well as joint dysfunction at the base of the skull and shoulders.

Upper Cross Syndrome can lead to neck pain.

The main physical causes of this condition are:

  • Desk job
  • Too much sitting
  • Driving long hours
  • Poor posture
  • Working out incorrectly
How many hours a day do you
sit in front?
Photo by subham saha


However, with the proper education, you can protect yourself from many of these causes. The primary sufferers of this condition, especially chronic cases, often have poor posture while sitting at a desk for most of the day. A co-morbid factor is a sedentary lifestyle with little physical activity. This poor sitting posture leads to a re-enforcement of the Upper Crossed Syndrome, and it is crucial that you arrange your workstation to facilitate a proper posture as best as possible.

The best way to combat this problem is, of course, to prevent it before it starts.

If possible, minimize sitting for long periods of time and take frequent work breaks to take short walks around the office to reset your posture.

There are methods of rehabilitative exercise that can be taught to you to reverse any damage already done and prevent a progression of this condition, as well as instill healthy habits for you to employ for the rest of your life.

What You Can Do About It

If you are currently experiencing neck pain that you may believe is related to Upper Cross Syndrome, this condition can be conservatively managed relatively quickly. Make an appointment today and get on the road to recovery.

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Can Stronger Hips Help Knee Arthritis?

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Knee Osteoarthritis

Does adding hip exercises to quadriceps exercises result in superior outcomes in pain, function and quality of life for people with knee osteoarthritis? The short answer is YES.

Anyone with Osteoarthritis in their knees knows how it can limit their life. For one example walking could become difficult and painful.

A study from the British journal of sports medicine has found strengthening the hips muscle can help with knee osteoarthritis.

Walking improved after the addition of hip strengthening to quadriceps strengthening in people with knee Osteoarthritis. The addition of resistance hip exercises to quadriceps resulted in greater improvements in patient-reported pain and function

simple but effective hip exercise

Key points

  • Land-based exercise reduces pain and improves function in people with knee osteoarthritis (KOA) over the short to medium term.
  • People with KOA have weakness in hip abduction is (7%–24% weaker than control patients).
  • Hip abduction strength is positively related to function in people with KOA.
  • Hip strengthening is beneficial compared with non-exercise interventions in people with KOA.

Hislop AC, Collins NJ, Tucker K, Deasy M, Semciw AI. Does adding hip exercises to quadriceps exercises result in superior outcomes in pain, function and quality of life for people with knee osteoarthritis? A systematic review and meta-analysis. British Journal of Sports Medicine. 2020 Mar 1;54(5):263-71. Link

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Being Over weight Can Increase Risk For Tendon Issues

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Tendinopathy

“Obesity is associated with a higher risk of tendinopathy, tendon tear and rupture, and complications after tendon surgery than non-obesity.”

  • Medial epicondylitis: odds ratio (OR) 1.9 
  • Achilles tendinopathy: OR 3.81 
  • Patellar tendinopathy: OR 1.10 
  • Plantar fasciitis: OR 2.97 
  • Rotator cuff tendinopathy: OR 1.25 
  • Rotator cuff tear: OR 2.35 
  • Rotator cuff rupture leading to tendon surgery  OR 3.13 – 3.51 
Photo by Joenomias–2512814

Macchi M, Spezia M, Elli S, Schiaffini G, Chisari E. Obesity Increases the Risk of Tendinopathy, Tendon Tear and Rupture, and Postoperative Complications: A Systematic Review of Clinical Studies. A Publication of The Association of Bone and Joint Surgeons®| CORR®. 2020 Apr 14. Link

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Running Injury Prevention Strategies Part 2

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Having good running form is another way to prevent running injuries. There are many nuances to running form. We’ll discuss the big three. They are Cadence, Posture and Foot placement.

Cadence (Stride Length)

The amateur runner may not put much thought into their running beyond putting one foot in front of the other, however, if you are finding yourself with consistent pain in your shins or recurring lower leg injuries the way you run may be playing a role. New research has demonstrated that when you take a longer stride as you run, the ground reaction force on your legs will be increased. This increased force can lead to more injuries and micro traumas that can lead to chronic injuries and discomfort.

With Cadence think quick feet. A faster stride will reduce the amount of time you spend on the ground and decreased ground-reaction force. This reduces the impact on your body gets hitting the ground.

 If you think that this may be affecting your ability to run pain-free, try taking some shorter runs and actively think about taking shorter steps while running. Your legs will have to move faster to maintain the same pace as before. It will take some time to retrain your brain to alter your running pattern, but with some regular training, you should be able to make the transition.

Photo by sasint–3639875
See how long her stride is? If the foot is landing far in front of you, your cadence is most likely low.

Posture

Good posture will help you run with less pain and prevent injuries. Basically good posture will create good running posture. Your head should be over your ribcage and your rib cage should be over you pelvis and pelvis over your feet. This posture will let you run using less energy. If your posture is good it will be easier to fill your lungs with air. Next is to engage your core and build midline stabilization.

Foot Placement

Stand with your feet shoulder width apart. This is a very stable position. Now stand with one foot in front (heel to toe). That’s harder right? Standing this way or running this way takes a lot of balance and energy. We’ll call this cross over gait. When we run we should land with our foot under our knee and our knee under our hip. This will support your center of mass better. Think leaning tower of Pisa, the top is not over the bottom making it unstable.

Photo by John-Silver–3202135
The base would be the foot and the hip would be the top.
Take a look at this runner. His foot is on the midline of the body. The leg is not stacked The hip is not stacked over knee or foot. Can you see the pelvis dropping on the left side as well?

Photo by Andrea Piacquadio
Can you see the cross over gait? The foot is midline, the hip once again is not stacked over the knee and foot. Look at her stomach muscles. Can you see the twisting? Here’s an example of the core not being engage and lack of midline stabilization.

If you are new to running or experienced and need help we are here! Please call the office to set up an appointment.

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Running Injury Prevention Strategies Part 1

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Running has become one of the most common forms of physical activity in today’s society. It can be a community building activity, a personal challenge and most importantly a great work out. It is a sport that everyone can participate in; all you need is a good pair of shoes and a little motivation. That being said running can be extremely hard on your body, especially when you are just starting.  We are finding that injuries among runners are very common. From shin splints to rolled ankles, no one is immune from getting hurt; however, here are some tips to keep you healthy and on pace.

Photo by RUN 4 FFWPU

Do not do too much, too fast

            When runners are just starting and begin to make progress, they tend to push their limits. Although this is a great way to challenge yourself, it is important that you understand your body has a threshold that when exceeded results in injury. Your mileage should be tracked on both a daily and weekly basis. If you have never done much long-distance running, then your weekly mileage should begin quite low. It is important that as you improve your mileage increases gradually. A consensus among the running community is the rule of 10%. Do not increase your mileage by any more than 10% on a week to week basis. For many runners and new runners specifically, 10% may even be too much of a jump. This is why when preparing for a distance race, whether it is a 10k, half marathon or a marathon it is recommended you start as early as possible. Could you train and complete a half marathon in 6 weeks? Maybe, but the toll it could take on your body and the injury risk you are exposing yourself to are likely not worth it. A recent study showed that runners who only increased their mileage by 3% a week had a much higher rate of success in their upcoming races than runners who ramped up their mileage quicker.

            So how do you know where to start? First, start with walking. If you can walk an hour a day with out any injury you may start running. As a new runner, start with short runs and accumulate miles over the week. It is important to understand how far you have been running, so I recommend using an app on your phone such as “Map My Run” to help track each run. Personally I have a Garmin GPS watch , that links to Garmin connect. Garmin connect is an app. Most GPS watches can be linked to an app.

Photo by Mateusz Dach

Do not run through significant pain

As runners, we all understand some discomfort is a part of the sport. Your legs and feet will likely be sore after a long run; however, if you begin to notice significant pain or discomfort while running consider taking a break. Breaks are one of the hardest things to convince a runner of doing, but it could save you from more severe injury. Aside from the odd rolled ankle, very few running injuries are acute and traumatic. Far more commonly runners ignore the pain and “tough it out” when they begin to feel discomfort.

This can result in a cumulative injury cycle. What is that you might ask? It means if you continue to stress an injury by running, you will continue to make it worse and it can become a much more significant issue. Sometimes all it takes is an extra day off when symptoms are minor to allow your body to recover. This is important because if you have an injury, it is very common for your body to adapt by altering your gait (running pattern).

This may lead you to be less efficient, develop bad habits or in a worst-case scenario cause an injury elsewhere in your body. Remember, everything is connected, so if you are running with a limp the biomechanical stresses will be placed on a different part of your body. Give your body a chance to recover and if you think that an injury is nagging have a medical professional look at it. It is much more beneficial to have an injury taken care with a couple of sessions of treatment rather than letting it persist and having to deal with it when it is much more serious, and your recovery time is extended.

Photo by RUN 4 FFWPU

Call the office if you’re having pain. Do not tough it out! It could only get worse. We work with a lot of athletes and help them return to activity. Athletes looking to prevent injuries or perform better see us.

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Tips While Working at a Desk part 2

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  • Movement
    • Mini-water breaks throughout the day.
    • 10,000 steps per day.
    • The triple exercise
    • Micro break
  • Stress Management
    • Mindfulness at your desk by closing eyes, sitting in good posture and slow deep breathing a few times per day. All technology off for the moment.
      • Improves mood, productivity and stress management
    • Abdominal breathing instead of chest breathing.
The triple exercise

We are here to help you with any pain you’re experiencing!

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Tips While Working at a Desk Part 1

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  • Move in every aspect of your life, at home and work
  • Set the alarm every hour to perform some movement. 3-5 minutes in length.
  • Place a Lacrosse Ball under your legs, top of legs, between shoulder blades while at the desk.  
  • Light dumbbells at your desk for fitness snacking throughout the day.
  • Park at the farthest spot away to get more walking throughout the day.
  • Walking meetings are a great way to get movement and productivity.
  • Seated Exercise throughout the day three times per work day minimum.
    • Seated Cat and Cows
    • Seated Twists
    • Neck Ranges of Motion
    • Shoulder Rolls
  • Find an accountability buddy.
  • Strategically plan your traveling to take your workouts with you.

More people are working from home now more than ever. If you are experiencing pain since this big change please give our office a call. We are here and ready to help!