Tag Archives: headaches

Can a short leg cause back pain?

Take a look at this x-ray. Can you see how uneven the pelvis is? This is caused by an anatomical short leg. The spine is showing signs of degeneration (arthritis) as well as the left hip.

Frontal x-ray taken standing. The left side is the low side. Posted with permission.

So can a short leg cause back pain? The answer is yes. I have seen this multiple times in my practice. There are two major causes of a short leg. One can be functional. A function can be from twisting of the pelvis or tight or weak muscles. An example of this would be standing in a hole with one leg. There is no difference in the bone length in the leg but the pelvis can be uneven. The second can be an anatomical. This occurs when the one of the leg bone is a different size then the corresponding one. Think of a table with one leg a shorter then the others. Both can be treated with chiropractic care and home exercise but the way they are treated is different.

This patient had an accident when he was young that effected his Tibia (shin bone). This causes one of his legs to become a different length and cause an uneven pelvis. Years of walking and daily actives with a severely uneven pelvis lead to arthritis, disc degeneration and chronic pain.

Posted with permission.
The left tibia is the one with injury. Posted with permission.

Things that happen to our legs/feet can effect our spine. The body is great at compensating until it can’t. A broken bone that heals shorter than the opposite one will lead to changes in how the body moves causing increased biomechanical stress leading to break down. The break down can be of the muscle, bone, cartilage or disc.

I want to thank the patient for permission to post these picture.

Could This Be Causing Your Neck Pain?

New research has re-affirmed that weakness of one cervical muscle group is closely tied to chronic neck pain. This unit is also implicated as a provocative factor for cervical radiculopathy, cervicogenic headache, and cervicogenic vertigo.

A 2020 JMPT study re-affirmed that weakness of the deep neck flexors is common in cervical radiculopathy patients: 

“Current results confirmed the presence of cervical multifidus and longus colli  muscle atrophy in subjects with chronic radicular neck pain.” (1)

The deep neck flexors include four muscles that lie behind the trachea on the front of the cervical spine. The group includes the longus colli, longus capitis, rectus capitis, and longus cervicis. Due to their proximity to the spine and their short length, the muscles are primary stabilizers of the cervical spine.

If you’re experiencing neck pain contact the office! We help ease neck pain every day.

Amiri-Arimi S, Bandpei MA, Rezasoltani A, Javanshir K, Biglarian A. Asymmetry of Cervical Multifidus and Longus Colli Muscles Size in Participants With and Without Cervical Radicular Pain. Journal of Manipulative and Physiological Therapeutics. 2020 Mar 1;43(3):206-11.

WORKSTATION ERGONOMICS suggestions

WORKSTATION ERGONOMICS

Monitors should be visible without leaning or straining, and the top line of type should be 15 degrees below eye level.

Use audio equipment that keeps you from bending your neck (i.e., Bluetooth, speakerphones, headsets).

Keep your shoulders relaxed and elbows bent to 90 degrees.

Wrists should not be bent while at the keyboard. Forearms and wrists should not be leaning on a hard edge.

Keep frequently used objects, like your telephone, close to your body to prevent excessive reaching.

Take a 10-second break every 20 minutes: Micro activities include: walking, stretching, or moving your head in a “plus sign” fashion.

Do a micro break.

Another video about the desk set and suggestion on how a workstation should.

Have a question about your workstation? Dr. Steve can help with that! Contact our office so you can make sure you’re workstation isn’t contributing to pain.

Tools for Migraines

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!

Evaluate, Fix, Prevent

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.  

Dose-response Relationship Between Physical Exercise and Risk of Physician-Diagnosed Dementia

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

What is Upper Cross Syndrome?

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.

Tips While Working at a Desk part 2

  • 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!

Tips While Working at a Desk Part 1

  • 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!

Managing Neck Pain and Headaches Part 2

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

Neck Strain/Sprains

Cervical strains and sprains are some of the most common injuries sustained to the cervical spine. A cervical strain is when an injury occurs to the muscles of the cervical spine. A sprain, on the other hand, is an injury to the ligaments or joints; both, however, have similar pain and symptom patterns. Patients suffering from this diagnosis often have pain when attempting to move the head and neck, especially at end ranges of motion. Another symptom that sufferers’ may experience is frequent headaches, which may not seem directly evident to the patient that the source of the headaches may be caused by their cervical strain or sprain.

The main physical causes of this condition are:

  • Automobile accidents
  • Whiplash
  • Contact sports injuries
  • Repetitive overuse injury
  • Prolonged poor posture

Obviously some of the time these injuries are impossible to avoid, such as traumatic automobile accidents and whiplash injuries. At this point there are no steps for prevention and your next course of action is to seek treatment, usually with ice in the days immediately following the injury as well as therapeutic modalities such as interferential electrical stimulation, Active Release Technique, and massage.

In cases where the injury stems from a problem related to overuse, poor posture or improper exercise, there are steps that can be taken to help avoid these injuries from happening. Proper instruction on ergonomics in the workplace, fixing posture and instilling healthy habits, as well as receiving the proper knowledge in exercising can help build a better foundation for a healthy spine for life.

Neck Disc Pain

Discogenic Pain Syndrome is a condition that results from soft tissue damage and associated irritation of the fibers of intervertebral discs. Intervertebral discs are cushions found between each vertebra of the spine that work as shock absorbers to protect the vertebrae by helping dissipate the forces applied to the spine and to help facilitate movement. The cervical discs are found between the vertebrae of the spine in the area we think of like the neck. Intervertebral discs consist of an outer annulus fibrous, made up of tough, fibrous connective tissue, which surrounds a gel-like center called the nucleus pulposus. The outer third of the annulus fibrous is innervated by nerves and contain pain and mechanical receptors which mediate pain transmission from structural damage to the intervertebral discs or indirectly through chemically mediated inflammation.

Cervical disc pain can arise from a variety of reasons, whether by injury or a degenerative condition. In most cases, the condition can be treated to allow the person to continue his/hers active lifestyle.

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.

Dr. Steve is always here to help your neck pain and headaches. If you are suffering from either please set up an appointment to start the healing process!