Whiplash is MORE Than Just Neck Pain

Whiplash is MORE Than Just Neck Pain

Whiplash is MORE Than Just Neck Pain

When car accident victims are examined post-collision, many clinicians look to the neck since it is a commonly affected body part in cases of whiplash.  What often happens, though, is the clinician gets fixated on that part of the body and does not carefully look elsewhere.  This is why “eliciting” a patient history as opposed to “taking” one is critical.   In a recent article written by Hincapié, Cassidy, Côté, Carroll and Guzmán (2010), the authors sought to review the secondary pain patterns in accident victims.  This study was a “cross-sectional analysis of a population-based cohort of 6481…residents…” (p. 434).

The authors reported the pain complaints as follows, “Irrespective of pain in other areas, 86% of respondents reported posterior neck pain, 72% indicated head pain, and 60% noted lumbar back pain. Ninety-five percent of claimants reported some pain within the posterior trunk region, comprising the posterior neck, shoulder, mid-back, lumbar, and buttock areas.

Only 0.4% of respondents reported posterior neck pain only.

Four main patterns accounted for 60% of the variance in pain localization: 1) upper anterior trunk and upper extremity pain; 2) head, posterior neck, and upper posterior trunk pain; 3) low back pain; and 4) lower anterior trunk and lower extremity pain” (Hincapié et al., 2010, p. 434).

This is further evidence of the complexity of presenting complaints post motor vehicle accident.  Clinicians must be aware of these patterns when assessing bodily injury in order to accurately document causation.    Finally, the authors stated, “To the best of our knowledge, it is the first study in the literature to focus on the descriptive epidemiology of pain location after traffic injury. The vast majority of persons involved in MVCs have neck pain; however, this is but one area of pain localization that most commonly involves multiple areas of the body” (Hincapié et al., 2010, p. 438).

References:

Hincapié, C. A., Cassidy, J. D., Côté, P., Carroll, L. J., & Guzmán, J. (2010). Whiplash injury is more than neck pain: A population-based study of pain localization after traffic injury. Journal of Occupational and Environmental Medicine,52(4), 434-440.

 

 

Chiropractic Spinal Adjustments for Radiculopathy?

Chiropractic Spinal Adjustments for Radiculopathy?

Spinal manipulation (Chiropractic Adjustments) for Subacute and Chronic Lumbar Radiculopathy: A Randomized Controlled Trial

The American Journal of Medicine

January 2021; Vol. 134; No. 1; pp. 135−141

Seyedezahra Hosseini Ghasabmahaleh, MD, Zahra Rezasoltani, MD, Afsaneh Dadarkhah, MSc, Sanaz Hamidipanah, MD, Reza Kazempour Mofrad, Sharif Najafi, MD

This study cites 22 references.

The objective of this study was to evaluate the efficacy of Chiropractic Adjustments for the management of subacute and/or chronic lumbar radiculopathy.

44 patients, ages 25 to 60 years, with unilateral radicular low back pain lasting more than 4 weeks were randomly allocated to [manipulation + physiotherapy] and a control group [physiotherapy only].

The examination consisted of manual muscle testing, sensory testing, deep tendon reflexes, and Lasegue test. Participants were excluded if they had progressive neurological deficit causing weakness, incontinence, and any problem in heel and toe walking.

Patients were also excluded with bilateral or acute radiculopathy, spinal fracture, surgery, neoplasia, infection, significant malalignment or malformation, Cauda Equina, joint hypermobility, rheumatoid arthritis, inflammatory phase of ankylosing spondylitis, spondylolisthesis, severe osteoporosis, multiple myeloma, Paget disease, psoriatic arthritis, Reiter syndrome, current anticoagulation therapy or coagulation disorder, severe scoliosis, myopathy, diabetic neuropathy, a history of laminectomy, and spinal stenosis not attributable to a herniated disc.

The most common level of disc involvement was L4-L5 and L5-S1.

The outcome measures were:

  • The intensity of the low back pain on a visual analog scale
  • The Oswestry Disability Questionnaire score
  • Spinal ranges of motion
  • Straight-Leg-Raising test

All patients underwent physiotherapy, 5 sessions weekly for 2 weeks (10 sessions):

  • A hot pack for 20 minutes
  • Transcutaneous electrical stimulation for 20 minutes
  • Ultrasound treatment with intensity of 1 W/cm 2 for 5 minutes
  • Exercise for core stability, flexibility, strengthening, and aerobics

Manipulation was 3 sessions of 1 week apart using “high-velocity, low-amplitude thrust in the direction of freer permitted motion.”

The assessments were carried out at the baseline, immediately after intervention, and at 3 months’ follow-up.

“We hypothesized that manipulation would affect the intensity of pain and disability in patients with subacute or chronic radiculopathy.”

Key Points about Chiropractic Adjustments from this Article:

1) The prevalence of lumbar radiculopathy is 3%-5% of the general population.

  • Radicular pain is “accompanied by the neurological manifestations of a compressive force along a particular nerve route.”
  • “The force is commonly exerted by a bulging or herniating disc, a hypertrophied facet or ligament, spondylolisthesis, neoplastic disease, or an infectious process.”
  • “A large number of lumbar radiculopathies persist for more than 4 weeks.”
  • “If nonoperative treatment measures fail, surgical treatment is indicated.”

2) “The safety of spinal manipulation (Chiropractic Adjustments), especially when compared with medical treatments, encourages its use for conservative treatment of lumbar disc herniation.”

3) “spinal manipulation (Chiropractic Adjustments) has been reported to have a desirable effect on pain, straight leg raise test, range of motion, size of disc herniation, and neurological symptoms in lumbar radiculopathy.” [Important]

  • A 2019 study showed that patients with subacute lumbar radiculopathy benefit from manipulation.
  • Manual therapy is more “effective for managing spondylosis with or without radicular pain than conventional physical therapy.”

4) “spinal manipulation (Chiropractic Adjustments) for the treatment of lumbar disc herniation has been reported to be safe.”

  • “The risk of manipulation causing a clinically worsened status of the properly selected patient has been estimated to be less than 1 in 3.7 million manipulations.” [Important]
  • “Patient satisfaction has been demonstrated to increase in patients who receive spinal manipulation (Chiropractic Adjustments).”
  • Manipulation may reduce a second lumbar spine surgery by two-thirds.

5) OUTCOMES:

  • “There were significant differences in the patterns of pain and disability reduction between the manipulation and control groups during the study.”
  • Patients receiving physiotherapy alone did not experience the decrease in the Oswestry disability scores as in the manipulation group.
  • “For the disability indices, the outcomes were better in the manipulation group post-intervention and at 3 months’ follow-up.”
  • “Manipulation was better than non-manipulation strategy in increasing range of motion in all directions and maneuvers.”
  • The manipulation group sustained favorable outcomes in pain control.
  • “There were statistically significant differences in the results of straight leg raise test in the manipulation group.”
  • The manipulation group benefited from the treatment more than the control.”
  • “Manipulation was more successful in yielding favorable clinical outcomes and restoring function.”
  • “We did not find any important adverse effect or worsening of the manifestations in our patients receiving physiotherapy, exercise, or manipulation.”
  • “Our results showed that manipulation was more successful in pain palliation and disability reduction than non-manipulation strategy.”
  • “The manipulation group experienced better outcomes in increasing range of motion and improving the results of the straight leg raise test.”
  • “The favorable outcomes remained for at least 3 months following the conclusion of the treatment.”
  • “Our results are consistent with previous findings in the literature regarding the advantages of manual therapy for musculoskeletal disorders.”

6) Mechanisms:

  • “spinal manipulation (Chiropractic Adjustments) promotes separation between the joint surfaces, improves smooth joint gliding, and increases joint gapping.”
  • “Pain decreases because of cytokine release, mechanoreceptor stimulation, and increase in blood flow.”

7) “At the end of the study, it was evident that the intervention group had significantly greater improvement in pain, disability, and range of motion.”

  • “Some patients in the control group [physiotherapy only] informed us that they had not experienced a favorable improvement in the intensity of their symptoms.”

8) “spinal manipulation (Chiropractic Adjustments) leads to more success in pain control and disability reduction for the management of subacute or chronic lumbar radiculopathy.” [Key Point]

  • “We conclude that manipulation improved the results of physiotherapy over a period of 3 months for patients with subacute or chronic lumbar radiculopathy.”
  • Results “showed significantly better outcomes for manipulation in all measurements.”

9) “spinal manipulation (Chiropractic Adjustments) improves the results of physiotherapy over a period of 3 months for patients with subacute or chronic lumbar radiculopathy.” [Key Point]

10) “Minimum side effects, ease of administration, and patient satisfaction are the expected benefits of manipulation.” [Important]

11) “It would be a good idea to prescribe manipulation combined with other treatments for patients with nonacute lumbar radiculopathy.”

12) Clinical Signigance from the Authors

  • “spinal manipulation (Chiropractic Adjustments) is effective in pain control and disability reduction in patients with subacute or chronic lumbar radiculopathy.”
  • “spinal manipulation (Chiropractic Adjustments) improves the outcome of the straight leg raise test.”
  • “Benefits from spinal manipulation (Chiropractic Adjustments) remain at least for 3 months.”
  • “spinal manipulation (Chiropractic Adjustments) is a relatively safe and easily administered therapeutic measure for nonacute lumbar radiculopathy.”

If you think that this is a problem that you might have and need help, give us a call at 541-343-4343 to have an evaluation to see if this treatment is right for you.

3 Breathing Exercises to Master Your Sleep

 

3 Breathing Exercises To Master Your Sleep

After a long day of work, house chores, and playing with our children, we long for a good night’s sleep. But when this is not possible many problems arise:

  • Lack of alertness
  • Daytime sleepiness
  • Inability to think, remember and process information
  • Relationship stress
  • Low-quality life
  • More chance to have an accident

Not to mention that lack of sleep can lead to poor health. It can cause high blood pressure, diabetes, heart attack, heart failure or stroke, depression, impairment in immunity, and lower sex drive.

Now, finding a solution for sleeping can be quite challenging. Most people tend to medicate, drink herbal teas, even drink alcohol to solve their sleep deficiency. But have you thought of practicing breathing exercises? Conscious breathing has countless benefits, and accomplishing a good night’s sleep is one of them.

Breathing Exercises That Will Have You Sleeping Like A Baby

Practicing breathing exercises before going to bed will improve your sleep, reduce stress, and boost overall health. Breathing consciously will help you control your mind and body, releasing it from any external distraction or unwanted thoughts. Let’s go over some breathing techniques that’ll seduce you to a sweet slumber.

Counting While Breathing

Counting is very effective in helping you fall asleep. Lie down on your bed, finding a position that will contribute to your conscious breathing. Feel relaxed and start counting; it can be from one to ten and then backward from ten to one. Sync up every count with your exhales. Repeat until you fall asleep.

Focus in Your Breathing

While lying on your bed, feel relaxed with every exhalation. You can center your attention on your nose, and feel the cold air as you inhale and warm air as you exhale. You can start noticing other sensations as you sink into the bed, feeling things slow down, and feeling your body heavy. You won’t even notice how much time it took you until falling deeply asleep.

Breathing Through Each Nostril

You can do this breathing exercise while sitting or lying on your bed. Use your thumb to cover up your right nostril, breathe deeply through your left nostril, counting to six. Pause for a count of two. Use your index finger to cover your left nostril and release your thumb from the right nostril, exhaling entirely for a count of six. Repeat from ten to fifteen times.

Breathing Center In Eugene

Learning the magic of breathing consciously can be challenging for some people, and that’s fine. Breathing takes quite a lot of concentration. If you find yourself struggling with breathing techniques, at Cascade Health Center, in Eugene, we can guide you through countless breathing exercises to help you sleep better and improve your overall health.

REACH OUT TO US AND START BREATHING

Move it or Lose it!

Joint Health: Move it or Lose It

As a chiropractor, I commonly see people with complaints of neck and back pain. Usually I’ll take a set of x-rays to assess what their spine looks like, and sadly, I often have to tell them that they have some degree of spinal degeneration. Spinal degeneration presents as thinning of the cartilaginous disc between the vertebrae (called “degenerative disc disease”) as well as the formation of osteophytes, or bone spurs, along the edges of the bones. This process can occur at any joint but is particularly troublesome in the spine, due to all of the neurological structures it can interfere with. While we don’t want degeneration anywhere in our bodies, joints like hips, knees, and shoulders can be replaced, if necessary. However, we only get one spine and we haven’t figured out a good replacement for it yet, so we must take extra care of it throughout our lives.

 

The spine consists of 24 vertebral bones (plus the sacrum and coccyx) connected by 48 separate “facet” joints. These are the joints where Degenerative Joint Disease (DJD) is most commonly found. DJD is a gradual process that involves the wearing down of structures that make up a joint. This can happen anywhere in the skeletal system that has suffered a trauma or undergone too much “wear and tear.” This is why it is frequently found on one side of the body or at only 1 spinal level. For instance, if someone tends to put more weight on their right leg, the right hip and knee will likely degenerate faster. This is unlike an inflammatory joint disease, like Rheumatoid Arthritis (RA), that will occur on both sides of the body to multiple joints.

 

While conditions like RA tend to be genetically inherited, structural degeneration can happen to anyone, which is why it’s the leading cause of joint pain in adults. Since DJD tends to get worse as people age, it is generally thought that this is just a normal aging process. However, after learning about joint structure and function through school, research, and clinical experiences, I believe that aging is more correlated than causative, and that to an extent, degeneration is common but not normal.

 

When told “getting old” or “it’s due to aging” is to blame, people are lead to believe they have no control. After all, we can’t do anything about aging. As a practitioner who mainly works with joints, hearing that joints degenerate because of aging is like telling a dentist that people get cavities due to old age. Of course there are some genetic conditions that cause people to have weaker joint structures. Certain things truly are out of our control, such as the fact that the more years we live, the more likely our joints will be subjected to stressors, traumatic forces and wear. Yet there are some things we can do to keep our joints healthier. My next blog post will address step 1 of 5 things you can do to defy aging and keep your joints young!

Concussion and Kids in Sports

Concussions discussion has becoming increasingly common, especially with the discussion about football, particularly among school-age athletes. It has been estimated that there are up to 3.8 million sports-related concussions in the United States each year. Concussions are a problem. By definition, a concussion is trauma to the brain. A concussion injury literally jolts the brain, either by a direct or indirect blow, causing one’s brain to bounce against the bony inside walls of the skull. The force of the blow directly determines the degree and extent of brain cell damage. Importantly, any person can experience a concussion from having sustained a blow to the head, even a blow to the head that doesn’t seem to cause concussion symptoms.

Recent research has shown that children playing tackle football, for every one year younger the individual started playing tackle football, it predicted the early onset of behavioral and mood problems by 2.5 years and cognitive problems by 2.4 years. This means they experienced earlier problems with memory and planning and organizing skills, they had emotional problems, and they struggled with depression and aggression much earlier in life than those players that started tackle football later.

In 2013, the American Academy of Neurology (AAN) issued its latest update on the Evaluation and Management of Concussion in Sports. The update, representing a summary of evidence-based guidelines, referenced several standardized symptom checklists including the Standardized Assessment of Concussion and the Post-Concussion Symptom Scale/Graded Symptom Checklist, both of which had moderate to high sensitivity and specificity in identifying sports-related concussions when administered soon after a suspected concussion. In 2013, the AAN also published Concussion During Sports Activities, a summary of evidence-based guidelines for patients and their families. The AAN documents note that concussion symptoms include headaches, dizziness, double vision, confusion, sensitivity to light or sound, and nausea and vomiting. Signs of a concussion that others can observe include slurred speech, changes in balance and coordination, a blank stare, and behavior and personality changes.

Concussion resolution may be evaluated by use of standardized checklists and return to age-matched normative values regarding cognitive performance and physiological function, as well as neurocognitive testing. An athlete who has sustained a concussion should not return to play/practice until her or his physician has assessed that the athlete is asymptomatic, the concussion has resolved, and the athlete is off medication.

Even before one’s concussion has resolved, chiropractic care can provide substantial assistance. A blow to the head involves trauma to the neck vertebras (cervical spine) and regional muscles, tendons, and ligaments. As well, an injury significant enough to cause a concussion can also cause damage to the spinal nerves in the neck. Such trauma can cause nerve irritation and interfere with the normal motion of the cervical spine. Spinal dysfunction and nerve irritation/interference can then cause a range of pain symptoms and altered physiological function, not only in the neck and shoulder region but also in other locations and other systems such as the gastrointestinal, immune, and endocrine systems.

By beginning or continuing regular chiropractic care once concussion symptoms have resolved, a post-concussion patient can obtain treatment that will help ensure that her or his spinal column and nerve system are functioning at peak capacity. In this way, regular chiropractic care helps post-concussion patients achieve and maintain optimal levels of health and well-being. Call us today for your appointment at 541-343-4343 with Eugene Chiropractor Dr. Garreth MacDonald.

References:

 

  1. Alosco ML, et. al. Age of first exposure to tackle football and Chronic Traumatic Encephalopathy. Ann Neurol. 2018 Apr 30. doi: 10.1002/ana.25245. [Epub ahead of print]
  2. Broglio SP, et al: National Athletic Trainers’ Association Position Statement: Management of Sport Concussion. J Athletic Train 49(2):245-265, 2014
  3. American Academy of Neurology: Update: Evaluation and Management of Concussion in Sports, 2013 — https://www.aan.com/Guidelines/Home/GetGuidelineCo…
  4. American Academy of Neurology: Concussion During Sports Activities: Summary of Evidence-based Guidelines to Patients and Their Families, 2013 — https://www.aan.com/Guidelines/Home/GetGuidelineCo…