Because the human head weighs between 12-15 pounds (5.44-6.80 kg), the neck and upper back muscles must constantly work to maintain an upright posture. Due to our use of computer and electronic devices, many people have forward head posture (FHP), meaning their head rests forwards on the neck more than it should. In fact, studies show that every inch of FHP places an additional 10 pound (4.53 kg) burden on the muscles in the upper back and neck to keep the head upright. It’s no wonder why a common complaint is, “My head feels so heavy and my neck feels compressed—I constantly have to rest my head on the back of the couch when I sit.” So, what can we do about this?

POSTURE: Reducing FHP is essential. To do this, tuck in your chin (creating a “double chin”) and speak as you do this. You will notice a change in your voice quality—HOLD for ten seconds and then release JUST ENOUGH for the voice to clear and try to KEEP this position throughout the day. It takes about three months to retrain old bad posture habits so be patient!

SLEEP: If your neck is narrower than your head (the case for most of us), your pillow needs to be thicker on the edge to support your cervical spine.

ACTIVITY: You may have to assess which activities (such as sports) are most important to you and either modify how you do it and/or change when and how long you engage in such actions. If your goal is to improve in an activity, gradually increase the frequency, intensity, and duration over time. If you hurt and can’t recover within a “reasonable” time frame (such as 24-48 hours), then you overdid it.

Chiropractic offers MANY therapeutic tools to help those with neck pain, which include spinal and extremity manipulation, soft tissue therapy, physical therapy modalities (like ultrasound), nutritional counseling, and exercise training. Your doctor of chiropractic can give you advice on sleeping posture and prescription pillows, home cervical traction options, and more. The goal is not only to manage your neck pain, but more importantly,  to teach you self-management strategies so YOU can control of this often disabling condition and reduce the need for prolonged care.

Many of us have had problems associated with dizziness from time to time and have not thought much about it. But when dizziness happens frequently, lasts a long time, or is severe, it definitely gets our attention and forces us to get it checked out.

BACKGROUND: To determine how common dizziness is and the personal burden it imposes on the population, a large-scale study examined 2,751 adults (aged 50+ years) using multiple measures for dizziness, hearing, tinnitus (ringing in the ears), and quality of life. An alarming 60% reported some type of vertigo. Interestingly, the researchers observed an association between tinnitus and vertigo. Also, the participants with vertigo reported lower quality of life scores than those without dizziness complaints. This study highlights the significant burden imposed by dizziness/vertigo stating that this is an “important public healthcare issue” that must be studied further.

CAUSES: The most common causes include benign paroxysmal positional vertigo (BPPV), acute vestibular neuronitis or labyrinthitis, Meniere’s disease, migraine headaches, and anxiety disorders. Less commonly, reduced blood flow to the brain/head (“vertebrobasilar ischemia”) and retrocochlear tumors can cause dizziness. The risk also increases with age.

TREATMENT OPTIONS: Most vertigo sufferers do not require extensive testing and can be treated in the clinic.  Benign paroxysmal positional vertigo and labyrinthitis are most often successfully managed by doctors of chiropractic with specific exercise to reposition the displaced “canaliths” or small stone-like material in the inner ear.

Treatment with a low-salt diet and diuretics (herbal options include: dandelion, ginger, parsley, hawthorn, and juniper) can also be helpful in resistant cases with fewer side effects than prescription vestibular suppressing medications. Consuming potassium-rich foods such as bananas, avocados, raisins, beans, squash, mushrooms, potatoes, yogurt, or fish is often wise when taking a diuretic. Chiropractors often provide nutritional counseling and can help guide you in this area as well.

 

Low back pain (LBP) can arise from a number of structures that comprise the lower back like the intervertebral disk, the facet joints, the muscles and/or tendon attachments, the ligaments that hold bone to bone, the hip, and the sacroiliac joint (SIJ). Though several of these can generate pain simultaneously, the focus of this month will center on the SIJ.

The role of the SIJ is quite unique, as it has a big job: it is the transition point between the flexible axial skeleton (our spine) and the pelvis, below which are the lower extremities or legs. The pelvis supports the weight of the torso, which usually accounts for about two-thirds of our body weight. The SIJ is shaped at an oblique angle that diverges or opens at the front and converges inwards at the back of the joint in order to support the weight on top of it. Because the sacrum/tailbone is “V” shaped, it fits like a wedge and is held together with very strong ligaments, making it an inflexible but sturdy joint.

Making a diagnosis of SIJ syndrome or identifying it as a pain generator can be a challenge. Your chiropractor may depend on several types of examinations in order to arrive at an SIJ syndrome diagnosis, such as palpation looking for pain directly over the SIJ; compression tests of the pelvis; front-to-back hip movements to stretch the joint; and imaging, such as x-ray, CT scans, and MRI.

Since the SIJ is NOT a flat and smooth oblique joint, x-ray has many limitations. However, the pubic bone called the “symphysis pubis” (SP), which is located in the front of the pelvis, can be easily seen on x-ray. Because the pelvis is a ring-like structure, an SP that is out of alignment may indicate SIJ dysfunction.

In a recent study, two independent orthopedic surgeons analyzed the x-rays of 20 consecutive patients (17 women and 3 men) with proven SIJ dysfunction and LBP (confirmed by SIJ injection testing), which resulted in the findings of osteoarthritic degeneration and subluxation (misalignment) in 18 of the 20 subjects.

When they assessed the SP in 20 non-SIJ LBP control subjects (16 women and 4 men), 7 had abnormal SP findings (35%) versus 18 of 20 with SIJ-LBP mentioned above (90%). A review of the patients’ past radiology reports found that only three reports mentioned this in the SIJ-LBP group and none reported this in the control group. The authors concluded that SP findings are underreported by radiologists, and because SP is much easier to “read” or assess than the SIJ itself, it NEEDS to be looked at!

Content Courtesy of Chiro-Trust.org. All Rights Reserved.

 

Traumatic brain injury (TBI) is also becoming a “hot topic” as it relates to motor vehicle collisions (MVC). The question is: how often is TBI missed?

The simple answer is: FREQUENTLY! This is due to the fact that attention is often drawn toward other injuries such as a neck injury or a limb injury. One study found that doctors were more likely to miss an mTBI diagnosis in patients who had sustained an arm or leg fracture. Among a total of 251 trauma patients, only 8.8% were diagnosed with mTBI at the time of injury vs. 23.5% who were eventually diagnosed at a later date. The authors of the study note the importance for healthcare providers to not be overly focused on the most obvious injury, as it may result in missing an mTBI diagnosis and the opportunity for early management of the condition—potentially leading to greater pain, suffering, and long-term disability.

But how “good” is our ability to assess mTBI? In a recent study on the ability of sideline assessments to predict subsequent problems after a sport-related concussion, researchers concluded that although sideline measures are useful for diagnosing concussion, they are not suitable for determining the extent of injury one to two weeks post-injury.

Part of the problem associated with concussion, regardless of cause, is an overall lack of knowledge about the condition on the part of athletes, parents, coaches, and medical professionals. In a Canadian survey of members of these groups, “predictors” of better concussion knowledge included prior personal experience or history of concussion. Factors affecting knowledge included language, age, educational level, annual household income, and TBI history.

Yet another issue is the “under reporting” of concussion. Looking at gender differences in a total of 288 athletes across 7 sports (198 males, 90 females), in spite of having similar knowledge about concussion, female athletes were more likely to report their concussive symptoms than males.

Sobering facts: 1) About 1.7 million cases of TBI occur in the US annually, and approximately 5.3 million live with a disability caused by TBI; 2) Annual direct and indirect TBI costs are estimated at $48-56 billion; 3) Among children under fourteen years of age, TBI results in 2,685 deaths and 37,000 hospitalizations; 4) Between 50-70% of TBI accidents are the result of a motor vehicle crash.

Though there are many different type of headache, many involve both the upper cervical region (the neck) and the head. Between the muscles that attach to the head and neck, the ligaments that hold the vertebrae together, the blood vessels that allow blood to flow to and from the head, and the nerves that allow us to smell, taste, see, smile, wink, stick out our tongue, and so much more, it’s no wonder that the neck is intimately related to the head and therefore headaches.

One structure that sheds additional light on this close relationship between the neck and headaches is called the “myodural bridge” (MDB), which spans between a muscle in the back of the neck called the rectus capitus posterior minor and the protective covering of the spinal cord called the dura mater. This connection sits in close proximity to the vertebral artery, veins, and the first cervical nerve or C1 (the occipital nerve).

So how does this MDB cause headaches? Normally when we move our head and neck, the muscle contraction puts tension on the MDB, transmitting its force to tense up the dura, stabilizing the spinal cord. This prevents infolding of the dura, which can generate pain in the form of a headache.

When an injury such as whiplash occurs, cervical vertebral joint dysfunction and overly tight muscles in this area transmit abnormal tension to the dura mater via the MDB, which (like infolding) can result in headaches. If the injured muscle/s weaken or atrophy, this can further compromise the function of the MDB, leading to chronic (long-term) headaches.

A common symptom of an MDB headache is a throbbing pain, usually on one side of head near the ear/temple area and possibly behind the eye. The headache may last from several minutes to several days and the base of the head is tender to the touch. Typically, head movements intensify the pain/headache and neck pain may or may not be present.

Research shows that chiropractic manipulation, soft tissue therapy, and exercise can significantly benefit patients with headaches, regardless of the cause. But it is easy to understand that treatment directed to this region is necessary to restore function, and discovery of this MDB may play an important role as to why chiropractic care is so effective for headache patients.