Category Archives: Neck Pain

Yankton Chiropractor discusses neck pain in children and chiropractic

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.  Visit http://www.olsonchiropracticcenter.com for more information.

Why Does My Neck Hurt So Much But My Car Only Go a Dent? | Yankton Chiropractor | Brian Olson DC

Whiplash pain can be much different from other types of injuries. When a car accident is severe, the pain will come on right away. If the injury produces a mild or moderate sprain, sometimes it takes a few days for the pain and inflammation to reach its maximum. Sometimes it is stiffness that is the prominent symptom and the patient notices this in the first few weeks after the accident. The delay in pain is often seen in low speed collisions where typically there is very less damage to the vehicles. There are a lot of factors that determine the extent of injury following a low speed whiplash. One of these is the neck posture prior to impact. Was the head turned? This can occur if the patient was looking at the rear view mirror during the collision. Low speed collisions can occur in parking lots. If the patient was turned to see if a space was clear, this can make a simple trauma result in a significant injury. Besides the position of the patient prior to the collision, the speed and amount of vehicle damage are sometimes good criteria for the severity of the trauma. However, it may not be in many cases because of crumple zones. Cars are built with crumple zones. These areas are crushed during the collision and absorb the energy of impact. In some low speed collisions, there is less crumple and more of the force is transmitted to the occupants. This is but one reason why vehicle damage won’t always equate with the spinal damage. Another factor in whiplash is whether the head-rest was properly positioned. A proper headrest should be close to the back of the head and its high point slightly above the top of the head. The reason for the high position is that in a rear-end collision, the patient who is being hit will rise slightly with impact. If the headrest is too low, then the neck will bend around it like a fulcrum causing even more injury. The same thing happens if the seat is reclined too far and the head whips backwards before hitting the headrest. Because symptoms can come on slowly and minor vehicle damage is not a good indicator of injury, a thorough examination is required. It is important to be checked by a competent health care provider after any motor vehicle collision.  Visit http://www.olsonchiropracticcenter.com for more information.

Is It My Neck or Thoracic Outlet Syndrome?

 

Neck pain can arise from many different sources, and the patient’s clinical presentation can be quite similar making it a challenge to diagnose. One of those related, and sometimes co-existing conditions, is called thoracic outlet syndrome, or TOS. Let’s first discuss the anatomy of the neck and the thoracic outlet so we all have a good “picture” in mind of what we’re talking about.

TOS can arise from either blood vessel compression, nerve compression or both, making the ease of diagnosis difficult. Adding to the challenge, the “pinch” of the structure can occur at more than one place! The nerves and blood vessels can get pinched at the exiting holes in the spine (“neuroforamen”), by tight “scalene” muscles, under the collar bone (clavicle) and/or by a tight pectoralis minor muscle near the arm pit. Hence, the symptoms usually include pain and numbness in the shoulder, arm and hand (usually affecting the 4th & 5th fingers). It’s our job to run different tests to figure out where the primary pinch or pinches are located so we can treat the right area.

The causes of TOS can be many, with one of the obvious being a fractured collar bone or clavicle. Another is from having an extra rib. As there is not a lot of room for an extra structure, this can be a point of compression for some (but doesn’t create TOS in everyone). An overly tight scalene muscle, scar tissue, an extra large muscle and so on can also result in pinching of the nerves and/or blood vessels.

Purses, backpacks, carrying golf clubs, a mailbag and the like can also cause a pinch. A seat belt injury in a car accident is yet another cause, either from the direct trauma, or later when scar tissue forms in the area.

Our posture alone (without trauma), such as a slouchy, slumped posture where the shoulders roll forwards can cause TOS and, large breasts and obesity also add to the list of risk factors. Women are affected 3x more than men. Certain jobs where reaching overhead or outwards such as waitresses, carpenters, electricians, increase TOS risk.

You can depend on us to identify, locate and treat the areas that need attending as chiropractic includes many effective TOS treatment methods. The surgical outcomes are less than impressive so do EVERYTHING else first (a good surgeon will tell you that).

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.

Neck Pain: Manipulation vs. Mobilization – What’s Better?

 

 

Does mobilization (MOB) get less, the same, or better results when compared to spinal manipulative therapy (SMT)? To answer this question, let’s first discuss the difference between the two treatment approaches.

 

Mobilization (MOB) of the spine can be “technically” defined as a “low velocity, low amplitude” force applied to the tissues of the cervical spine (or any joint of the body, but we’ll focus on the cervical region). This means a slow, rhythmic movement is applied to a joint using various methods such as figure 8, side to side, front to back and /or combinations of any of these movements. In the neck, gentle to firm manual traction or pulling, when applied to the cervical spine, stretches the joint and disk spaces and can be included during MOB.

 

Spinal Manipulative Therapy (SMT) can be defined as a “high velocity, low amplitude” type of force applied to joint which is often accompanied by a audible release or “crack,” which is the release of gas (nitrogen, oxygen, and carbon dioxide). Some joints “cavitate” or “crack” while others are less likely to release the gas. Studies that date back to the 1940s report an immediate improvement in a joint’s range of motion occurs when the joint cavitates. Many people instinctively stretch their own neck to the point of gas release, which typically, “…feels good.” This can become a habit and usually is not a big problem. However, in some cases, it can lead to joint hypermobility and ligament laxity.  As a rule, if only a gentle stretch is required to produce the cavitation/crack, it’s typically “safe” verses the person who uses higher levels of force by grabbing their own head and twisting it beyond the normal tissue stretch boundaries. The later is more likely to result in damage to the ligaments (tissue that strongly holds bone to bone) and therefore, should be avoided.  Since SMT is usually applied in a very specific location (where the joint is fixated or “stuck”, or, partially displaced), it’s obviously BEST to utilize chiropractic, as we chiropractors do this many times a day (for years or even decades) and we know where to apply it and can judge the amount of force to utilize, especially the neck where there are many delicate structures.

 

Back to the question: Which is better, MOB or SMT? Or, are they equals in the quest of rid of neck pain? A recent study of over 100 patients with “mechanical neck pain” (strain/sprain)  showed that those who received SMT had a significantly better response than the MOB group as measured by a pain scale, a disability scale and 2 tests that measure function! So, the next time you ask the question, “….do you have to crack my neck?,” the answer should be “yes, if you want to achieve the quickest response.” However, if there is sharp pain during the “set-up” of the manipulation or adjustment, modifications in the technique are appropriate or, a different method should be considered.

 

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.

Cervical Traction – Does It Help With Neck Pain and Headaches

Traction is defined as, “…the act of pulling a body part.” Therefore, it is commonly used in many regions including legs, arms, low back, mid-back, and the neck. We will be limiting this discussion to cervical or neck traction, and the question of the month is, “…does it help patients with neck pain and headaches?” Though I’m assuming you already know, the answer is YES! You may want a little “proof,” so here it goes! REDUCES DISK PROTRUSIONS: In 2002, a medically based study found traction to be very effective in the treatment of cervical radiculopathies (pinched nerves in the neck that radiate pain into the arms). A 2008 study using MRI (images) described the effect traction had on the disk protrusions in the neck reporting 25 of 35 (or 71%) were reduced while in traction with a 19% increase in the spacing (disk height) and improved neck range of motion after the traction was applied. They postulated that by pulling the vertebrae in the neck apart, there was a suction-like effect pulling the disk material back in place. RECOMMENDED BY GUIDELINES: Around the world, guidelines have been published giving doctors information that allows us to know how well certain forms of treatment work for different conditions. In a 2008 publication, it was reported that, “Clinicians should consider the use of mechanical intermittent cervical traction, combined with other interventions such as manual therapy and strengthening exercises, for reducing pain and disability in patients with neck and neck-related arm pain.” CLINICAL PREDICTION RULES: These help us determine who is most likely to benefit from a certain type of treatment (in this case cervical traction and exercise). If 3 of 5 variables are found, the likelihood of success with traction & exercise was reported to be 79%, and if 4 of the 5 are found, 90%. The 5 variables are: 1. Radiating neck to arm pain in certain positions; 2. Positive shoulder abduction sign; 3. Age >55years old; 4. Positive limb tension test; 5. Relief of symptoms using manual distraction test (if pain is relieved while the neck is being pulled). INTERMITTENT AND CONTINUOUS TRACTION: Either way, significant improvement in neck and arm pain, neck mobility, and nerve function occurred with both approaches. TRACTION VS. SURGERY: In this study, patients with radiating arm pain and positive neurological findings on exam were offered a course of traction before surgical options. They reported 63 of 81, or 78%, of the patients experienced significant or total relief, 3 could not tolerate traction and 15 simply didn’t respond. They concluded that when neck and arm symptoms with neurological deficits were present for 6 weeks, that 75% will respond to neck traction over the next 6 weeks. There are MANY additional studies available that show well beyond doubt that cervical traction is a GREAT option in the management of neck and arm pain and sometimes headaches. Next month, we will discuss “HOW TO” apply cervical traction. 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.

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.

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
  spine.”
  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
  alone.
  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,
  females>males.
  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:
  300msec)
  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
(lordosis).
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 www.olsonchiropracticcenter.com 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 www.olsonchiropracticcenter.com for more information.