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.

Wrist splints are often a beneficial form of CTS self-care, as they can assist in relieving the pressure within the carpal tunnel by restricting wrist flexion and extension. Because we cannot control the position of our wrist during sleep and the pressure on the nerve worsens the more it bends forward or backward, splints are most commonly used during sleep.

There are literally hundreds of options of splints available online that range from simple glove-like splints (some with and without the fingers covered) to full arm splints. The majority block wrist motion and use Velcro closures with metal bars on the bottom and/or top of the splint. Your doctor of chiropractic can help you choose the best splint for your particular case.

There are studies that have attempted to isolate one form of treatment from others for conditions like CTS, but as noted in a 2012 Cochrane report, many of these studies involve small sample sizes, making it difficult to draw firm or hard conclusions. Moreover, healthcare providers typically utilize MANY approaches simultaneously to achieve the best, most prompt results, keeping surgery as the last resort.

Typically, the non-surgical management of carpal tunnel syndrome (CTS) includes several approaches such as splints; rest; job modifications; anti-inflammatory measures like ice, drugs, vitamins, and herbs; physical modalities, such as ultrasound and laser; and manual therapies, such as manipulation and mobilization.

Care may also focus on relieving pressure on the median nerve in other anatomical locations (the neck or shoulder, for example) as dysfunction elsewhere on the course of the nerve can contribute to a patient’s CTS symptoms. Furthermore, a treatment plan may also address other conditions that can contribute to the build-up of pressure in the carpal tunnel such as diabetes or hypothyroidism. Generally, it’s more challenging to manage the condition when a patient has waiting years or even decades to seek care. Thus, for the best possible outcome, please have a doctor of chiropractic evaluate your wrist and hand symptoms sooner rather than later.

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

If you suffer from shoulder pain, here are some exercises you can do at home that really work to improve flexibility and strength. Just remember to ALWAYS stay within reasonable pain boundaries and work BOTH sides of your body, NOT just the injured shoulder!

For flexibility, start with the “Codman” Pendulum exercise. Stand or sit and lean forward so that your arm can swing like the pendulum of a clock while holding a light weight (2-5 lbs, or .9-2.26 kg initially). Move the weight in a clockwise, counter-clockwise, left-to-right, and/or forward-backward ALLOWING the shoulder to RELAX. DO NOT shrug your shoulder upward—let the shoulder go. This is usually comfortable and therefore can be done MANY times a day!

Another great beginning exercise is the Finger Wall-Walk. Stand in front of a wall and slowly walk your fingers up a wall staying within a comfortable range. Go slow and repeat several times. As you improve, rotate your trunk or stand with your body 45º, 60º, and later, 90º to the wall.

To perform the Crossover Arm Stretch, relax your shoulders and gently pull your arm across your chest using the uninvolved arm/hand to assist in the movement. Hold for up to 30 seconds and repeat with the other arm.

The Passive Internal Rotation (stick behind the back) and External Rotation (stick in front) requires a broomstick held parallel to the floor. Grip the stick with both hands held shoulder width apart and allow one arm to move the relaxed arm inward and outward. Do this as two separate exercises. Hold the end-range for up to 30 seconds each, repeat one to three times, as tolerated.

For Strengthening, the use of Thera-Tube or Band works well when anchored into the hinged side of a door. Pretend you are standing on a clock (12, 3, 6, and 9 o’clock positions) and SLOWLY pull and release the tubing three times in each of the four “clock positions,” ALWAYS staying in the pain-free range.

Your “ultimate guide” for advancing in reps, sets, and type of exercise is the comfort factor – AVOID sharp, lancinating painful movements/exercises or those that leave you sore for more than 24-48 hours afterwards. Track your recovery time after exercising to determine safety.

Primarily, chiropractic focuses on the diagnosis and treatment of neuromuscular disorders with an emphasis on treatment utilizing manual adjustments and other types of manipulation and/or mobilization of the spine. Chiropractic is classified as a form of primary care, as anyone can choose to see a doctor of chiropractic without a referral.

A 2010 meta analysis reviewed a number of published studies to determine the strength of scientific evidence regarding the effectiveness of manual treatment for both musculoskeletal (MSK) and non-musculoskeletal (non-MSK) conditions.

Lead author Dr. Gert Bronfort reviewed 49 relevant systematic reviews and 16 evidence-based clinical guidelines and concluded that he and the other authors of the analysis found SMT/mobilization to be effective in adults for the following: acute, subacute, and chronic low back pain; migraine and cervicogenic headache; cervicogenic dizziness; and several extremity joint conditions. Interestingly, Dr. Bronfort and his team noted thoracic manipulation/mobilization as effective for acute and subacute neck pain, but the evidence available at the time was inconclusive for cervical manipulation/mobilization alone for neck pain of any duration.

The evidence was also inconclusive for SMT/mobilization for mid back pain, sciatica, tension-type headache, coccydynia, temporomandibular joint disorders, fibromyalgia, premenstrual syndrome, and pneumonia in older adults. Additionally, they found SMT/mobilization was not effective for asthma, dysmenorrhea (when compared to sham SMT), or stage 1 hypertension when added to an antihypertensive diet. In children, the evidence was inconclusive regarding the effectiveness of SMT/mobilization for otitis media and enuresis, and they also noted SMT/mobilization was not effective for infantile colic and asthma when compared with sham SMT.

In a 2014 follow-up study, lead author Dr. Christine Clar confirmed most of the previously “inconclusive” or “moderate” evidence ratings of the 2010 evidence report. However, the availability of new research motivated Dr. Clar to note moderate evidence for these conditions: manipulation/mobilization (with exercise) for rotator cuff disorders, spinal mobilization for cervicogenic headache, and mobilization for miscellaneous headache.

These two meta-analyses are significantly helpful for those considering chiropractic care for specific conditions. Reviews like this are planned for the future, and the list of conditions that respond well to chiropractic care should expand as areas that need further study are determined and more research is published.