Monthly Archives: October 2013

The Headache Epidemic

Over the past few decades, chronic migraine headaches have increased dramatically among the U.S population. There has been an approximately 60% increase in rates over the years. Most of this increase has occurred in adults younger than 45 years, and women are slightly more affected than men.

One study showed that 80% of women and 70% of men reporting chronic migraine headaches had at least one physician contact per year because of migraine headaches; 8% and 7% of women and men, respectively, were hospitalized at least once a year because of the condition. In addition, chronic migraine headaches had a substantial impact on functional capacity: 4% of men and 3% of women reported a chronic limitation in normal activity because of migraine headaches and associated symptoms.

Clearly headaches are having a big impact on society today, with major dollars spent on disability payments, hospitalizations, doctor visits, and medication prescriptions. Most patients also self medicate with over-the-counter drugs. The use of these drugs has increased exponentially over the past ten years. All of this “treatment” has had little effect on the occurrence of headaches, or shown a healthy way to any sort of lasting cure.

The chiropractic approach to headaches is much different. The chiropractor looks at injuries to the spine (e.g. sprain/subluxation), which are affecting the nervous system. Headaches are just one of many symptoms than can occur when the spine is injured.

Rather than masking the symptom with ineffective and potentially unsafe medications, the chiropractor treats the cause of the problem. Scientific studies have shown this approach to have merit. The chiropractor will use specific adjustments and postural exercises to improve how your spine functions, which may in turn reduce your need for medications, lower the intensity of the pain, or even eliminate the headaches all together. Depending on how badly your spine is injured or how long you have suffered, will both affect how you may progress during care.

Only a comprehensive examination will determine if you are a good candidate for chiropractic care. The examination should include a detailed history of how the pain has affected your life, tests of your nervous system, and x-ray examination, to see how the vertebrae are positioned in your neck.

If you are a part of the headache epidemic, it can be a sign that you have a spinal condition the chiropractor may be able to help. Taking medications to cover-up the problem rarely makes the actual problem go away.  Visit for more information.

Does Neck Surgery Improve Long-Term Outcomes?

How many times have you heard, “I have a pinched nerve in my neck and have to have surgery.” Though there certainly are cases where surgical intervention is required, surgery should ONLY be considered after ALL non-surgical treatment approaches have been tried first (and failed). It is alarming how many cases of cervical radiculopathy (i.e., “pinched nerve”) end up being surgically treated with NO trial of non-surgical care. Hence, the focus of this month’s article will look at research (“MEDICAL EVIDENCE”) that clearly states neck surgery DOES NOT improve the long term outcomes of patients with chronic neck pain.

Chronic neck pain (CNP) is, by definition, neck pain that has been present for a minimum of three months. This category of neck pain is very well represented, as many neck pain sufferers have had neck pain, “…for years” or, at least longer than three months. Depending on the intensity of pain and it’s effect on daily function, many patients with CNP often ask their primary care provider, “…is there anything surgically that can be done?” The desire for a “quick fix” is often the focus of those suffering with neck pain. Unfortunately, according to recent studies, there may not be a “quick fix” or, at least surgery is NOT the answer. The December 2012 issue of The European Spine Journal reports that spine surgery did NOT improve outcomes for patients with CNP. Moreover, they pointed to other studies that showed some VERY STRONG REASONS NOT to have spine surgery unless everything else has failed. One of the reasons was a higher hospital readmission rate after spine surgery. Another reported that most studies on surgical vs. conservative [non-surgical] care showed a high risk of bias, suggesting the research on surgical intervention was biased in the research approach used. They further reported, “The benefit of surgery over conservative care is not clearly demonstrated.” It is important to point out that the research analyzed studies that included patients with and without radiculopathy (radiating arm pain from a pinched nerve), and myelopathy (those with pinching of the spinal cord creating pain, numbness, weakness in the legs, and/or bowel / bladder dysfunction).

In February of 2008, the Neck Pain Task Force published overwhelming evidence that research supports the use of cervical spinal manipulation in the treatment of both acute and chronic neck pain with or without radiculopathy. Bronfort published similar findings in 2010 in a large UK based study that looked at the published evidence supporting different types of treatment for various conditions. They found cervical spine manipulation was effective for neck pain of ANY duration (acute or chronic). Chiropractic utilizes manipulation, manual traction, mobilization, muscle release techniques, home cervical traction, exercise, as well as a multitude of physiotherapy modalities when managing patients with CNP. Given the overwhelming research evidence that surgical intervention for CNP is NOT any better than non-surgical care, the greater amount of negative side-effects, and the obviously long recovery time post-surgically, chiropractic treatment of anyone suffering from CNP should be tried FIRST.

We realize that you have a choice in where you choose your healthcare services.  If you, a friend or family member requires care for neck pain, we sincerely appreciate the trust and confidence shown by choosing our services and look forward in serving you and your family presently and, in the future.

Tension – Type Headaches


At some point, everyone will have a headache, whether it’s from stress, lack of sleep, hormonal related or even self-induced after having way too much fun the night before! In fact, 9 out of 10 Americans suffer from headaches.  For the most part, headaches are not indicative of a dangerous underlying condition, but they can be (…a topic for a future “Health Update”).  The focus of this Health Update is to discuss the most common form of headache – the tension-type headache or, TTHA.


Tension-type headaches (TTHA) are defined by the Mayo Clinic as “a diffuse, mild to moderate pain that’s often described as feeling like a tight band around your head.” Ironically, even though this is the most common form of headache, the causes of TTHA are not well understood. These are sometimes described as muscle contraction headaches but many experts no longer think muscle contractions are the cause.  They now feel that “mixed signals” coming from nerve pathways to the brain are the cause and may be the result of “overactive pain receptors.”


Regardless of the cause, the triggers of tension headaches are well known and include stress, depression/anxiety, poor posture, faulty awkward work station set-ups, jaw clenching and many others. Risk factors for TTHA include being a woman (studies show that almost 90% of woman experience tension headaches at some point in life) and being middle aged (TTHA’s appear to peak in our 40s, though TTHA’s are not limited to any one age group). Complications associated with TTHA’s may include job productivity loss, family and social interaction disruption, and relationship strain.  The diagnosis is typically made by excluding other dangerous causes of headaches and when all the test results return “normal,” the diagnosis of TTHA is made.


Treatment utilizing over the counter medications are often effective so long as side effects of stomach irritation and/or liver and kidney issues don’t arise. The use of heat and/or cold is often helpful as some prefer one over the other. Alternating between ice and heat is sometimes most effective. Controlling stress by trimming out less important duties or “…taking on less” can help.  Yoga, meditation, biofeedback and relaxation therapy are also great! An “ergonomic” assessment of a workstation and how it “fits” the headache patient can also yield great results.  Other highly effective therapies include acupuncture, massage therapy, behavior and/or cognitive therapy as well as of course, chiropractic! Chiropractic is a GREAT choice compared to standard medical care, especially when side effects to medications exist.  This is because manipulation of the cervical spine addresses the cause of the headache and doesn’t just try to “cover up” the pain.  In 2001, Duke University reported compelling evidence that spinal manipulation resulted in almost immediate improvement for those with headaches that originate in the neck with significantly fewer side effects and longer-lasting relief compared to commonly prescribed medication. Chiropractic treatment approaches include (partial list): spinal manipulation, trigger point therapy, mobilization techniques, exercise training, physical therapy modality use, dietary and supplementation education / advice, lifestyle coaching and ergonomic assessments.


We realize you have a choice in where you choose your healthcare services.  If you, a friend or family member requires care for headaches, we sincerely appreciate the trust and confidence shown by choosing our services and look forward in serving you and your family presently and, in the future.

Whiplash “Basics”

Whiplash is a non-medical term typically describing what happens to the head and
neck when a person is struck from behind in a motor vehicle collision. Let’s
look at some basic facts about whiplash:
  Before cars, trains were the main source of whiplash and was called “railroad
  Better terms for whiplash injuries include “cervical
  acceleration-deceleration” (CAD) which describes the mechanism of the injury,
  and/or the term “whiplash associated disorders” (WAD), which describes the
  residual injury symptoms.
  Whiplash is one of the most common non-fatal injuries involved in car crashes.

  There are over one million whiplash injuries per year due to car crashes
  An estimated 3.8 per 1,000 people per year have a whiplash injury.
  In the United States alone, 6.2% of the population has “late whiplash
  syndrome” (symptoms that do not resolve at one year).
  1 in 5 cases (20%) remain symptomatic at one year post-injury of which only
  11.5% returned to work and only 35.4% of that number returned to the same
  level of work after 20 years.
  The majority of whiplash cases occur in the fourth decade of life,
  Whiplash can occur from slips, falls, and brawls, as well as from
  horse-riding, cycling injuries, and contact sports.
  Injury from whiplash can occur at speeds of 15 mph or less.
  In the “classic” rear end collision, there are four phases of injury (time:
  1.) Initial (0msec) – before the collision (the neck is stable)
  2.) Retraction (1-150msec) – “whiplash” starts where the head/neck stay in the
  original position but the trunk is moving forwards by the car seat. This is
  where the “S” shaped curve occurs (viewing the spine from the side).
  3.) Extension (150-200msec) – the whole neck bends backwards (hopefully
  stopped by a properly placed head rest).
  4.) Rebound (200-300msec) – the tight, stretched muscles in the front of the
  neck propels the head forward immediately after the extension phase.
  We simply cannot voluntarily contract our neck muscles fast enough to avoid
  injury, as injury to the neck occurs within 500msec. and voluntary contraction
  or bracing takes 800msec or longer.
  Injury is worse when the seat is reclined as our body can “ramp” up and over
  the seat and headrest. Also, a springy seat back increases the rebound affect.

  Prompt treatment is better than waiting for a long time. Manipulation is a
  highly effective (i.e., COME SEE US!) treatment option.
We realize you have a choice in where you choose your healthcare services.  If
you, a friend or family member requires care for whiplash, we sincerely
appreciate the trust and confidence shown by choosing our services and look
forward in serving you and your family both presently and in the future.

Neck Pain and Our Pillow!

The relationship between neck pain and our pillow is more important than most of
us realize! Though we all may have at one time or another slept on a variety of
surfaces, and used any number of pillows (flat, medium, bulky) made of different
materials (foam, feather, air, water, or memory foam), it’s usually not until
neck pain and/or headaches start to become an issue that we start to think,
“…how important is my pillow?” Thankfully, the question has been addressed in a
randomized peer-reviewed study. So, what did they find out?
The goal of a pillow is to support the neck more so than the head. In a study
headed by Dr. Liselott Persson, MD, of the department of neurosurgery at the
University of Lund in Sweden, researchers tested whether specific neck pillows
have any effect on neck pain, headache and sleep quality in people suffering
with chronic (>3months), non-specific neck pain. They also researched whether
there was an optimum or “best” type of pillow that was preferred by their 52
patient group. They used 4 different pillows, 1 “normal” pillow and 3 of which
were specially designed, each having a different shape and consistency. Over a
4-10 week time frame, the pillows were randomly distributed to the neck pain
group who then graded them according to comfort, the effects on neck pain, sleep
quality and headache using a questionnaire, and also described the
characteristics of an “ideal pillow.” Researchers and participants concluded the
“ideal pillow” (for reducing neck pain and headaches and improving quality of
sleep) includes a soft pillow with good support under the neck’s curve
There are many styles of contoured cervical or neck pillows that vary
considerably. This study supports the use of a specially designed style over a
normal pillow. So what are some of the things to look for? First, consider your
neck’s length and girth.  When you look in a mirror, do you have a neck that is
short vs. long or, narrow vs. wide? This will direct you to a pillow that has a
larger “hump” for your neck to be cradled in if it’s a long neck and, the height
of the hump – taller for the slender neck or, shorter for the wide neck. Some
pillows have 2 options of “hump” sizes (located on the long edges of the pillow)
– one short and flat and the other side taller and wider. Others recommend lying
in the middle of the pillow if you’re a back sleeper vs. lying on the edge of
pillow when sleeping on your sides. A measurement taken from the neck to the
point of the shoulder determines if the pillow should be a small, medium, or
large. Water filled and/or air filled pillows can be varied by the amount of
water or air added. The bottom line of which is “best” is based on comfort and
support. Regardless of which you choose, it can take several days to get used to
the new pillow, so we recommend using the pillow for at least 1 week. By then,
you’ll know if you chose the right style.
We realize that you have a choice in where you choose your healthcare services.
If you, a friend or family member requires care for neck pain, we sincerely
appreciate the trust and confidence shown by choosing our services and look
forward in serving you and your family presently and, in the future.  Go to for more information.

Neck Pain and Cervical Disk Herniation

Neck Pain and Cervical Disk Herniation

Neck Pain and Cervical Disk Herniation

Neck pain can arise from many sources. There are ligaments that hold bones to
other bones that are non-elastic and very strong. When injured, the term,
“sprain” is applied. The muscle and/or its attachment (the tendon) can tear as
well, which is called a “strain.” But, what is it that people refer to when they
say, “…I slipped a disk in my neck!”?
The disks lay between the vertebrae in the front of the spine, and they are part
of the primary support and shock absorbing system of our neck and back. There
are 6 disks in the neck, 12 in the mid-back and 5 in the low back for a total of
23. The disks in the low back are big, like the vertebral bodies they lie
between, and get progressively smaller as they go up the spine towards the head.
When we bend our neck forwards, the disk compresses, and opens wider when we
look up. It forms a wedge shape when we side bend left or right, and it twists
when we rotate or turn the head.
The terms, “…a slipped disk, a herniated disk, a ruptured disk, a bulging disk”
(and more), all mean something similar, if not exactly the same thing. A central
part of the disk is liquid-like and can herniate in any direction. When it does,
it can create pain IF it pinches something, or it may be painless if it doesn’t.
In fact, since the invention of the CAT scan and MRI, many (“normal”) people
have been found on the scan to have some type of disk “derangement” (alteration
of the normal integrity of the disk), with 50%+ showing bulging disk(s) and 21%
showing frank herniations WITH NO PAIN AT ALL! So, in the absence of shooting
pain down an arm from the neck, or when there is no numbness or weakness in the
arm, why order an MRI? It may show bulges or herniations that are not
“clinically” important, and may falsely lead a doctor to recommend surgery when
it’s not needed.
There are “KEY” findings in the history and examination that leads us to the
diagnosis of a cervical disk injury. From the history, the disk patient often
has arm pain, numbness, and/or muscle weakness that follows a specific pathway,
such as numbness to the thumb/index finger (C6 nerve), middle of the hand & 3rd
finger (C7) or to the pinky & ring finger (C8). Certain positions, such as
looking up, usually irritate the neck and arm, and bending the head forward
relieves it. Another unique history and exam finding is if the patient finds
relief by putting the arm up and over their head. Similarly, letting the arm
hang down is often associated with irritation. Other examination findings unique
to a cervical disk injury include reproducing the arm pain by placing the head
in certain positions such as bending the head back and to the side
simultaneously. Another is compressing the head into the shoulders. When lifting
up on the head (traction), relief of arm pain is common. The neurological exam
will usually show a reduction of sensation when we gently poke them with a sharp
object, and/or they may have weakness when compared to the opposite side.
Chiropractic treatments can be very successful in resolving cervical disk
herniation signs and symptoms, and should CERTAINLY be tried before agreeing to
a surgical correction. Often, the surgeon will recommend a fusion of 2 or more
neck vertebrae, sometimes with a metal plate in the front of the spine. This
increases the load on either side of the fusion and can create problems above
and below the fusion. Trust me, try chiropractic first. You’ll be glad you did!
We realize that you have a choice in where you choose your healthcare services.
If you, a friend or family member requires care for neck pain, we sincerely
appreciate the trust and confidence shown by choosing our services and look
forward in serving you and your family presently and, in the future.  Visit for more information.

Low Back Pain and Common Mistakes

We often read about what to do for low back pain (LBP), but do we look at LBP from the perspective of “what NOT to do!”


ICE vs. HEAT:  If you ask your doctor, “what’s better for my back, ice or heat?” the answer is either one or the other or, “…whichever you like better.”  This leaves the LBP at a loss of who or what to believe.  So, let’s settle this once and for all.  Ice should be tried first because it will rarely make the LBP worse, whereas head can.  Ice is an “anti-inflammatory” agent, meaning it reduces swelling.  Ice reduces congestion or pushes painful chemicals and fluids that accumulate out of the injured area when there is inflammation and usually feels good (once it’s numb), maybe not initially because it is cold.  Head does the opposite of ice.  It’s a vasodilator meaning it pulls fluid INTO the area.  Sure, it feels “good” initially, but often people will say it makes them worse later.  That’s because the additional fluid build up in an already inflamed area is kink of like throwing gasoline on a fire.  When LBP is chronic (it’s been there > 3 months), heal MAY be preferred.  Contrast therapy or, alternating between the two can work as an effective “pump” pushing out fluids (with ice) and pulling in fluids (with heat).  Here, start and end with ice so the first and last things done are “anti-inflammatory.”


IGNORE YOUR LBP:  The comment, “I was just hoping it would go away,” has been used by all of us at some point.  Though LBP can get better over time, it’s simply impossible to know when or if it will.  If you have suffered from back pain previously, then you already know that getting in quickly for a chiropractic adjustment BEFORE the reflex muscle spasm sets up can stop the progression, often before it reaches a disabling level.  If you want to reduce the chances of missing work or a golf game due to LBP, come in immediately when the “warning signs” occur – you know, the ‘little twinge’ in your back that’s telling you, “…be careful!”


BED REST:  There is a time for rest and a time for exercise, but knowing what to do when is tricky.  Another “tru-ism” is the best exercise when done too soon may harm you, but when done at the right time will really help.  So, here are some general guidelines: a) no more than 24-48 hours of mostly bed rest; b) walking is usually a great, safe starting activity after or even during the first 48 hours; c) avoid activities that create sharp pain (like bend, lift, twist combinations); d) use ice or contrast therapies a lot during that initial 48 hours; e) follow our exercise instructions and treatment plan – we’ll guide you through this process.


FOCUS ON X-RAY OR MRI FINDINGS: Did you know that about 50% of us have bulging disks, and 20% of us have herniated disks in our low back and yet have NO pain?  That’s right!  Many of us have “disk derangement” but no symptoms whatsoever.  Similarly, the presence of arthritis on x-rays may have no relationship to an episode of LBP.  It’s easy to blame an obvious finding on an image for our current trouble, but it may be misleading.  In fact, it can even make a person fearful of doing future activities that may be just fine or even good for us.  The WORST thing for some types of arthritis is to do nothing.  That will just lead to more stiffness and pain! More later!


We realize you have a choice in who you choose to provide your healthcare services.  If you, a friend or family member requires care for low back pain, we sincerely appreciate the trust and confidence shown by choosing our services and look forward in serving you and your family presently and, in the future. Visit for more information.


Side Effects of Chiropractic vs. Medications for Headaches

Have you ever stopped and wondered, “…which type of doctor should I go to for treatment of my headaches?” In order to make an informed decision, it is appropriate to look at the side effects each treatment option carries and then consider the pros and cons of each treatment.

It has been reported that 45 million Americans suffer from headaches, many on a daily basis. Though some just put up with the pain, others become totally disabled during the headache. Most people initially turn to an over the counter drug such as a non-steroidal anti-inflammatory drug (NSAID) of which there are 3 types: 1) salicylates, such as aspirin; 2) traditional NSAIDS, such as Advil (ibuprofen), Aleve (naproxen); and, 3) COX –2 inhibitors, such as Celebrex.

According to the medical review board of, complications of NSAID drugs include stomach irritation (gastritis, ulcer), bleeding tendencies, kidney failure, and liver dysfunction. Some NSAIDs (particularly indomethacin) can interfere with other medications used to control high blood pressure and cardiac failure and long term use of NSAIDs may actually hasten joint cartilage loss, leading to premature arthritis. Another over the counter commonly used drug is Tylenol (Aceteaminophen) in which liver toxicity can be a potential side effect (particularly with long term use).

Here’s the kicker – only about 60% of patients respond to a 3 week trial of an NSAID, NSAIDs can mask signs and symptoms of infection, it cannot be predicted which NSAID will work best, and no single NSAID has been proven to be superior over others for pain relief. Moreover, estimates of death associated with NSAID (mostly gastrointestinal causes) range between 3200 on the low side to higher than 16,500 deaths per year in the United States. Another BIG concern is that low daily doses of aspirin, “…clearly have the potential to cause GI injury as 10mg of aspirin daily causes gastric ulcers.

Others may turn to prescription medication for hopeful pain relief. One of the more frequently prescribed medication for headaches is amitriptyline (commonly known as Elavil, Endep, or Amitrol). This is actually an antidepressant but was found to work quite well for some headache sufferers. The potential side effects include blurred vision, change in sexual desire or ability, constipation or diarrhea, dizziness, drowsiness, dry mouth, headache (ironically), appetite loss, nausea, tiredness, trouble sleeping, tremors and weakness. Allergic reactions such as rash, hives, itching, difficulty breathing, tightness in the chest, swelling of the mouth, face, lips or tongue, chest pain, rapid and/or irregular heart rate, confusion, delusions, suicidal thoughts or actions AND MORE are reported.

The pros and cons of chiropractic include a report on children under 3 years of age, where only one reaction for every 749 adjustments (manipulations) occurred (it was crying, NO serious side effects were reported). In adults, transient soreness may occur. Though stroke has been reported as a cause of headache, it was concluded that stroke “…is a very rare event…”, and that, “…we found no evidence of excess risk of VBA stroke associated chiropractic care compared to primary care.” Another convincing study reported that chiropractic was 57% more effective than drug therapy in reducing headache and migraine pain! They concluded – chiropractic first, drugs second and surgery last.

We realize that you have a choice in where you choose your healthcare services. If you, a friend or family member requires care for headaches, we sincerely appreciate the trust and confidence shown by choosing your services and look forward in serving you and your family presently and, in the future. For more information visit


Where Does Low Back Pain Come From?

“Where does the pain come from?” is probably the most common asked question we hear as chiropractors and frequently, the patient is not told the answer to simple question.  The problem is, the question is not simple.  This is because there are many structures in the low back that share a common nerve supply and hence, the pain arising from those structures is located in the same area of the back.  For example, the back portion of the disk, the facet capsule and some of the deep muscles in the spine are all innervated by the same nerve and therefore hurt is a similar location.  In all honesty, the only way to try to isolate the pain generator is to inject a local anesthetic to block the pain for a short while.  This is like when you go to the dentist and they “numb” your tooth so you don’t feel the pain when they work on it.  After a few hours, you start to feel some “life” coming back to your mouth and soon it regains its full feeling.  Of course, no one would consider “numbing” the back just to figure out exactly where the pain is arising as really, it’s not that important.  This is because the chiropractic treatment approach is similar regardless of the exact tissue that is involved.  However, it DOES matter in cases where a nerve root is shooting pain down the leg caused by a herniated disk vs. a localized pain in the back that doesn’t radiate.  Hence, we doctors of chiropractic will work hard to differentiate these two distinct types of conditions as the treatment is definitely different.


In 1995, the Quebec Task Force recognized the importance of this distinction and recommended all health care providers concentrate on differentiating the nerve root/herniated disk case from what is called “mechanical low back pain.  The common structures that cause nerve root pain are herniated disks and mechanical low back pain usually comes from the facet joints.


The facet joint, when sprained/injured, hurts worse when bending backwards and feels good bending forwards.  This is exactly the opposite for the herniated disk where bending backwards helps reduce pain and often reduces the shooting leg pain as well, while bending over even a little can create a sharp stabling pain in the back that may shoot down the leg.  Of course, there are variations of this and, to make matters more complicated, BOTH disk and the facet can generate pain at the same time, so it’s not always this cut and dry.


We realize you have a choice in who you choose to provide your healthcare services.  If you, a friend or family member requires care for low back pain, we sincerely appreciate the trust and confidence shown by choosing our services and look forward in serving you and your family presently and, in the future. Visit for more information.