Fibromyalgia (FM) is a condition that the medical community has long had difficulty defining. As stated last month, Fibromyalgia is often considered a “musculoskeletal disorder” (MSK) because of the aches and pains it produces in the muscles and joints. However, this is not really accurate since Fibromyalgia includes many other symptoms beyond just severe muscle pain, such as extreme fatigue, mental fog, sleep disorders, irritable bowel, and more. As such, “misdiagnosis” is more common than an accurate diagnosis when it comes the Fibromyalgia. Let’s take a closer look!
Neck pain is a very common condition that drives many patients to seek chiropractic care. Treatment planning typically includes four primary goals: 1) Pain Management; 2) Structural Realignment; 3) Functional Restoration; and 4) Maintenance / Prevention.
Last month, we addressed low back pain (LBP) in the younger patient (age 30-60), so it only seems appropriate to continue the discussion for those over the age of 60. As previously mentioned, back pain does NOT discriminate when it comes to age. In fact, chiropractors see many children and teenagers with low back pain as well as 90+ year-olds! Let’s take a look at the “usual” differences…
“Rest = rust” when it comes to whiplash: When we hurt, we often instinctively choose rest over activity, as we may be afraid that any activity will make the pain worse. But after just a few days of rest, both our injured AND healthy muscles become stiff and weak, which prolongs the healing process. Most studies show that returning to normal activity as soon as possible results in faster healing and resolution of pain. Also, the longer you remain inactive, the greater the chance for chronic pain to develop, which can result in permanent problems. We will guide you GRADUALLY back into normal, desired activities. DON’T LET PAIN OR THE FEAR OF PAIN keep you from getting on with life! This is both physically and mentally harmful!
You don’t have to be in a car to get whiplash: Even though car crashes account for the majority of whiplash injuries, a slip and fall or participating in a high-impact sport such as football, snowboarding, skiing, boxing, soccer, or gymnastics can result in head/neck trauma, which is more common than you think! With this said, other conditions, such as concussion, can occur in car crashes even if you don’t hit your head! The term, “mild traumatic brain injury” or MTBI is frequently used when it pertains to car crashes. Here, common symptoms include difficulty finding words to express yourself, losing your place when talking, and difficulty concentrating, focusing, and communicating. Many people are self-conscious about these types of problems and often do not discuss them with their doctor!
Aging increases the risk of whiplash injuries: The elderly are more likely to suffer from a whiplash injury compared with younger individuals. This is because as we age, we lose flexibility in the joints, muscles, and tendons in the neck. This REDUCES the ability for these tissues to stretch, making them MORE likely to be injured during the whiplash process. Also, the shock-absorbing cushions between our vertebrae (the intervertebral disks) lose their water content and literally dry up and crack as we age. This, along with the gradual onset of osteoarthritis in our joints, results in a reduced cervical range of motion.
Females are at greater risk of injury than males: This is because there is simply less neck muscle mass and strength among medium built females vs. males. This difference is even more dramatic in slender-necked females. Add the age component to this and the older slender female neck is particularly vulnerable to a cervical spine injury due to whiplash.
DO NOT ignore symptoms: Although most neck-injured crash victims experience immediate pain, some do not. This delay in symptom onset can be hours, days, and even sometimes weeks! Although it’s “human nature” to procrastinate and NOT seek immediate chiropractic care, you should! Studies show that the longer you wait, the longer it may take to help you! Also, in most cases, neck pain should gradually improve within the first month or two, but this does not always happen. The longer pain persists, the lower the odds for resolution, especially if the pain has lasted more than six months. Persisting symptoms may include (but are not limited to) headache, fatigue, shoulder pain, blurred vision, dizziness, difficulty concentrating, communicating, sleeping and/or swallowing. BOTTOM LINE: COME IN ASAP after the crash as prompt care yields the best results!
Low back pain (LBP) can arise from many causes. Nearly everyone has or will suffer from LBP at some point in time, though it is most common in the 30-year-old to 50-year-old group and it affects men and women equally. However, what about the elderly population and low back pain? Let’s discuss back pain unique to the geriatric population…
We’ve all heard of the “wear and tear” factor as it applies to clothing, automobiles, shoes, and tires, but it affects our bones and joints too! A condition that none of us can fully avoid is called osteoarthritis (OA). OA is the “wear and tear” factor on our joints, particularly the smooth covering called hyaline cartilage located on the surfaces of all moving joints. It’s the shiny, silky smooth surface that we’ve all seen at the end of a chicken leg when we separate it from the thigh. Osteoarthritis is the wearing away of that shiny, smooth surface and it can eventually progress to “bone-on-bone” contact where little to no movement is left in the affected joint. Bone spurs can also occur and be another potential generator of back pain. OA is NOT diagnosed by a blood or lab test but rather by an accurate history, physical examination, and ultimately, an x-ray. However, when the low back is affected by OA, it may not even hurt! Yes, in some cases, there may be a significant amount of OA on an x-ray and that patient may not have significant problems. Or the opposite can occur and some patients with very little arthritis can have a lot of back trouble. It’s FREQUENTLY very confusing. The “take-home” message with OA is that, in and of itself, it does not always generate pain. This is why the history, physical examination, and the response to treatment (chiropractic adjustments, exercise, and possibly some lifestyle changes in diet and activity) are MORE important than the amount of arthritis found on the x-rays. Ultimately, we will ALL get OA sooner or later. It’s usually a slow, gradual process that may slowly change our activity level. Ironically, KEEP MOVING is the best advice we can give to the patient with OA.
There are a number of conditions associated with OA that affect the spine and respond well to chiropractic treatment. Degenerative disk disease (DDD) is one of those conditions found in association with OA. In fact, another name for OA is “degenerative joint disease” (DJD)! The normal anatomy of the intervertebral disk (IVD) consists of a thick, tough outer layer of fibroelastic cartilage and a central “nucleus” that is more liquid-like and allows the IVD to function like a shock absorber. As we age, the water content gradually “dries up” and the shock absorbing quality is lost.
As chiropractors, we address OA (DJD) and DDD with a number of HIGHLY EFFECTIVE treatments but most important (in many cases) is the use of spinal manipulation or adjustments. “Exercising the joint” with manipulation and mobilization reduces the tightness and stiffness associated with OA and DDD. Exercises are also important and can give the OA/DDD patient a way of controlling this condition on their own. Diet, activity modification/encouragement, and periodic adjustments help a lot! Next month, we will continue this discussion!
We realize you have a choice in whom you consider for your health care provision and we sincerely appreciate your trust in choosing our service for those needs. If you, a friend, or family member requires care for back pain, we would be honored to render our services.
Children have been treated by chiropractors for spinal problems ever since chiropractic was founded in 1895, and neck pain is no exception. Neck pain is surprisingly common in kids, though not quite as common as it is in adults, reaching a similar occurrence rate by age 18. Studies conducted in the United States and in other countries report similar findings, leaving one to conclude there is a high prevalence of neck pain in kids all over the world. There are many causes of neck pain with a few being unique to children and some that could be a warning sign of something dangerous, such as meningitis. But far more commonly, neck pain in kids is NOT dangerous. Let’s take a look!
Looking at neck and shoulder pain in high-school-aged students, 931 males between 16 and 19 years of age were surveyed. More than two out of five students (44.3%) had recurrent neck and shoulder pain more than once a week with an overall prevalence of 79.1%. THAT’S A LOT! The study reported the student’s average sitting time was 10.2 hours a day, 59% did NOT sit up straight, and 11.9% reported that they stretched their neck and shoulders regularly throughout the day. Students with recurrent neck and shoulder pain also reported frequent fatigue and depressed moods. Looking specifically at 1,122 backpack-using adolescents, 74.4% were classified as having back or neck pain. When compared to non- or low use backpackers, there was nearly a two times greater likelihood of having back/neck pain! Also, females and those with a large body mass index (overweight) were also significantly associated with back/neck pain. Lastly, they found when compared to adolescents with no back/neck pain, those with pain carried significantly heavier backpacks.
Another common cause of neck pain in adolescents is a condition called torticollis or, “wry neck.” This is basically a muscle spasm of certain neck muscles that rotate and extend the head from the neutral/normal position, often described as being “stuck” in this position. Though there are several types of torticollis, it can be triggered by almost anything including a change in weather, sleeping in a draft, following an infection like a cold or flu, maintaining a faulty prolonged posture, certain types of medications, and many others. Some studies describe torticollis as usually improving within one to four weeks, but in the hands of a chiropractor, it usually takes two to three days for the acute pain to subside and one week to completely finish the job! Of course, this varies depending on the case. Infants can be born with “congenital torticollis,” which occurs in 0.3 to 2.0% of newborns. Here too, chiropractic is VERY effective.
We realize you have a choice in whom you consider for your health care provision and we sincerely appreciate your trust in choosing our service for those needs. If you, a friend, or family member requires care for neck pain, we would be honored to render our services.
Whiplash usually occurs as a result of a car crash when the head moves in a fast, uncontrolled way in many possible directions. The forwards-backwards movement is described in a classic “whiplash” injury but side-to-side, rotational, or a combination of movements often occur, especially if we add in the factor of the head being turned or rotated when the impact occurs, regardless of how the car is hit. This month, let’s talk treatment!
STEP 1: IMMEDIATELY seek chiropractic attention following a whiplash injury: This is important as studies show delayed treatment is associated with worse outcomes after the dust settles. To avoid long-term disability, DON’T WAIT! Pain usually scares people into a guarded, protective way of thinking. The longer you wait, the greater the muscle tightness, spasm, weakening, and your increased fear of activity because of the pain!
STEP 2: REDUCE INFLAMMATION: The words “pain” and “inflammation” are quite synonymous. If you feel “hurt,” you are “inflamed.” We must begin anti-swelling/inflammation measures ASAP after an injury like whiplash. The BEST/safest approach is an ICE PACK – rotate it on/off/on/off/on every 15 minutes (1.25 hours/session) three times a day OR, CONTRAST ice with heat (10 min. ice/5 min. heat x3, ending with ice = 40 min.). BOTH methods produce a PUMP-like effect to quickly get rid of the inflammation. You also have the option of OTC medications (Aspirin, ibuprofen, and naproxen) but these NSAIDs (non-steroidal anti-inflammatory drugs) carry significant side-effects for some people, the most evident early on being stomach upset/irritation (later, liver and kidney damage) so be careful! You don’t want to have to treat an ulcer on top of your whiplash! Consider anti-inflammatory nutrients, herbs, vitamins, and food – they’re safe and effective (we’ve discussed these previously – SEARCH the web for more information).
STEP 3: AVOID INACTIVITY: This is important since the “natural” thing to do is nothing, “…because it hurts!” WE will guide you in this process as you need to know how much and what type of activity is safe and appropriate. You have to “interpret” the pain as being either safe or harmful and then you react accordingly. You MUST tell us the type of pain (sharp, knife-like is harmful vs. a “good” stretch type of hurt is safe), how much pain there is (7-10 on a 0-10 scale is potentially harmful), how constant it is, and what helps/hurt (what have you tried and learned so far). THEN, we will guide you appropriately (with your help)!
STEP 4: DO NORMAL ACTIVITY: This dovetails our last point. Get on with your normal activities as avoiding work and other ADLs (activities of daily living) leads to “disability thinking” or thinking you’re worse than you are. DON’T LET THAT HAPPEN. Talk to us!!!
STEP 5: AVOID prolonged faulty postures: Whether it’s a conversation with a person who is NOT directly in front of you, a faulty computer screen position, talking in a car without turning your body (look straight ahead), or talking on the phone, CHANGE IT!
STEP 6: COMPLY with a home-based exercise program: This is HUGE! We will guide you in this process. We will start with ice and then possibly a home traction device, isometrics followed by Theratube or band (isotonic) exercises, posture training, and much more. You NEED guidance in this area – let us HELP YOU!
Whiplash, or WAD (whiplash associated disorders) results from the rapid movement of the neck and head resulting in injury. This is the net result of the “classic” motor vehicle collision, though other injury models (like slips and falls) can result in similar injuries. Better results (less long-term pain and disability) tend to occur with initial active treatment of the neck with mobilization/manipulation, exercise, and encouraging movement vs. placing a collar on the patient and “resting” the injured neck. Though there are a few studies that suggest there is no difference in results, the majority state that it is BEST to actively treat the patient and encourage movement (of course, assuming no unstable fractures have occurred) rather than to place the patient into a collar and limit activities. The first question that we’ll address this month is, why is this important?
The simple answer is that you, as an advocate for an injured friend, family member or as a patient yourself, may NOT be offered “the best” treatment approach by the ER or primary care physician. In fact, one study cited a survey regarding the management of whiplash injuries in an ER and reported that between 23-47% of physicians prescribed a soft cervical collar for acute whiplash rather than promoting immediate active treatment. By knowing this information, the knowledgeable patient can refuse the collar method of care and seek care that emphasizes the use of early mobilization and manipulation, like chiropractic! Though referrals to chiropractors are increasing as more research becomes available, chiropractic care is still significantly ignored or not considered by many practicing ER and primary care physicians. As always, you need to be your own “best advocate,” and the only way to do that is to be informed, hence the intention of this Health Update! Some studies even report that the use of a collar may have deleterious or “bad” side effects and can actually make you WORSE (this was reported by the Quebec Task Force)! The majority of studies on the subject of whiplash report that encouraging “normal activity,” as opposed to immobilization, IS the best approach. We will certainly help steer you in the right direction!
Next, let’s talk about WHY does this method works better? The research supports that soft tissues injuries heal better and with less scar tissue formation when patients receive active treatment/early activity types of care (like manipulation/chiropractic). In general, any treatment approach that reduces patient suffering sooner, encourages one to return to “normal activities” faster, and promotes independence and self-care methods earlier is the best approach!
We realize you have a choice in whom you consider for your health care provision and we sincerely appreciate your trust in choosing our service for those needs. If you, a friend, or family member requires care for whiplash, we would be honored to render our services.