The “Aging” Lower Back – Part 2

back-painLast month, we started a series on low back pain (LBP) in the geriatric population, and we discussed osteoarthritis (OA) and degenerative disk disease (DDD). As reported last month, this group of conditions often co-exist in this population, so we will continue this discussion this month…

A unique condition associated with OA and DDD is called “spinal stenosis” (SS).  Stenosis means “narrowing,” and it applies to two locations in the spine: 1) The holes through which the nerves in our neck and back exit out of the sides of the spine (called “intervertebral foramen” or, IVF); and, 2) The “spinal canal” through which the spinal cord travels. When narrowing occurs on the sides of the spine where the nerves exit, it’s called, “lateral spinal stenosis.” When the spinal canal narrows, it’s called “central spinal stenosis.” Our spinal cord starts up in the neck as an extension off the brain stem and usually ends at the junction between the middle and lower back (around T12/L1) with the “cauda equina” (which literally means, “horses tail”) and extends downward. The cauda equina is made up of many nerves that travel down and exit out the sides of the lumbar spine (through the IVFs) and sacrum (tail bone) and transfer information (motor and sensory) to and from our legs and brain. When the size of the canal through which these nerves travel close down or narrow enough, sufferers will initially start feeling vague symptoms of leg heaviness or fatigue after walking for 30 or more minutes. As years pass and the IVFs or central canal become gradually more narrow, it may get to the point where a person can only walk a short distance because their legs, “…just won’t move.” A classic complaint of SS is only being able to walk for four to five minutes prior to needing to sit down for 30 seconds to a few minutes (usually five minutes at the most) after which time the leg complaints resolve and the process repeats itself. When the nerves are compressed in these tight canals and the legs become heavy and hard to move, the term, “neurogenic claudication” is used. Another “classic” finding of SS is that RELIEF occurs when the patient bends forward, such as on a grocery cart or, simply stopping and bending over can be immediately relieving in many cases.

Chiropractic adjustments and other techniques are often very helpful in these cases if it is not too far advanced. The good news is that it usually helps, so prior to considering surgery or injections for this, give chiropractic a try – it’s less invasive and safer. We can always refer you to the next step if the condition becomes too advanced and/or if the results become less satisfying.

Compression fractures are another common cause of back pain in the elderly population. They’re often caused by minor trauma in the presence of poor bone density (osteoporosis) which accounts for about 700,000 of the 1.5 million osteoporotic fractures. Interestingly, many patients do not know what they did to cause these fractures so only 25-30% actually go to doctors and have this positively diagnosed (by x-ray). Treatment varies depending on what the percentage of fracture occurred (a little vs. a lot), and in unstable cases, a procedure called kyphoplasty (where cement is injected into the collapsed vertebral body) may be appropriate. As chiropractors, we can help this population by offering nutritional counseling to improve bone density and often provide symptomatic relief with adjustments (low force types) and other modalities.

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 back pain, we would be honored to render our services.


Headaches: How Does Chiropractic Help?

headacheHeadaches (HA) can be tremendously disabling, forcing sufferers away from work or play into a dark, quiet room to minimize any noise and light that intensifies the pain. According to the National Headache Foundation, there are over 45 million Americans who suffer from chronic, re-occurring headaches, of which 28 million are of the migraine variety. Also, approximately 20% of children and adolescents deal with headaches that can interfere significantly with their daily routines. There are many different types of headaches and many sub-types within the main categories. Here are a few: Tension HA (also, called cervicogenic HA), migraine, mixed headache syndrome (a mixture of migraine and tension HAs), cluster (less common but the most severe), sinus headaches, acute headaches, hormone headaches, chronic progressive headaches (traction or inflammatory HAs), and MANY more! Just “GOOGLE” “headache classification” for the daunting list! Let’s take a look at how chiropractic manages these headaches!

According to a study completed in 2005, a review of the published literature revealed good evidence that intensity and frequency of HAs are indeed helped by chiropractic intervention. They limited their review to cervicogenic headaches and spinal manipulation and noted the need for larger scale studies. The well-respected Cochrane database reported spinal manipulation (SM) as an effective treatment option with short-term benefits similar to amitriptyline, a commonly prescribed medication for migraine HA patients.

For cervicogenic HA, the combination of neck exercises and SM was found to be effective in both the short- and long-term, and SM was superior to massage or placebo (sham or “fake” manipulation). Regarding the question of treatment frequency of SM plus up to two modalities (heat and soft tissue therapy), a preliminary study found that when comparing patients receiving one, three, or four visits per week for three weeks, those receiving 9-12 treatments during the three weeks had the most benefit. Regarding the questions, “what is affected by SM” and, “why does SM work” for cervicogenic HA patients, a study describes the intimate relationship between the upper cervical nerve roots (C1-3), the trigeminal (cranial nerve V), the spinal accessory (cranial nerve XI), and the vascular system. Inflammation within these structures and their relationship with the trapezius and SCM muscles help us understand the “why” and “how” of SM and referred pain pattern to the face and head in those with cervicogenic HAs. Realizing this is a bit “technical”, feel free to GOOGLE these structures and you’ll appreciate the close proximity they have to each other and how adjustments, or SM, applied to the upper cervical spine can affect this region. It has also been reported that SM and strengthening of the deep neck flexor muscles benefits the cervicogenic HA patient. Many HA sufferers have combinations of symptoms including dizziness, neck pain, concentration “fog”, fatigue, and others, which were found to also respond to SM applied to the upper cervical spine. One study reported a 36% reduction in pain killer medication use in a group of cervicogenic headache patients receiving SM but no reduction in the patient group receiving soft-tissue therapy. The list of research studies goes on and on! So WHAT are you waiting for? TRY CHIROPRACTIC for your headache management!!!

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 headaches, we would be honored to render our services.

Carpal Tunnel Syndrome – What Is It?


Carpal Tunnel Syndrome (CTS) basically occurs when pressure is applied to the median nerve as it travels through the wrist on the palm side resulting in numbness, tingling, pain, and later, weakness of the grip and pinch functions. But, the median nerve can be pinched at many other locations as it courses down from the neck to the hand, which is why we examine and treat the CTS patient from the neck down! The median nerve has been described as the “eye of the hand,” as it is one of the three major nerves formed from the brachial plexus—that “highway” of nerves made up of the C5-T2 roots leaving the neck, merging together to eventually form the three main nerves of the arm. Because the median nerve function regulates pinch and grip strength, buttoning a shirt, writing a note, driving a car, and even sleeping are ALL affected by a median nerve pinch. But WHAT is CTS? Let’s take an “inside” look!

We know that fast, repetitive motion-related jobs like meat or fish packing plants, assembly line work, sewing occupations, and the like can cause CTS over time. Look at the palm side of your wrist and wiggle your fingers. Do you see ALL THE MOVEMENT that is occurring just before the wrist in the forearm? That motion is coming from the tendons, which like shoe strings, attach the forearm muscles to the fingers. Notice ALL the movement in your forearm muscles closer to the elbow – that’s a lot of motion! There are nine tendons that are covered by a lubricating sheath that help the fast moving tendons reduce friction, thus decreasing the chances for heat build up, swelling (inflammation), and subsequent pain and loss of function. But, there is a limit or threshold that the tendons and sheaths can withstand before they just can’t keep up. These nine tendons and sheaths are quite tightly packed together as they leave the forearm and enter the carpal tunnel.

The carpal tunnel is made up of eight small wrist bones called the “carpal bones,” and ANYTHING that makes that tunnel more narrow can effectively cause CTS. If we look at what happens INSIDE the tunnel in the CTS patient, the venous blood flow and nerve flow (called “axonal transport”) is blocked when the PRESSURE inside the tunnel occurs. We all know what it feels like when a blood pressure cuff is inflated on our arm – if it’s pumped up too high or left on too long, the arm REALLY HURTS! That’s because the blood can’t get past the inflated cuff and oxygen can’t get to our muscles and tissues past the cuff and IT CAUSES PAIN!

To give you an appreciation of the pressure difference between the normal vs. CTS wrist, normally, the pressure ranges between 2 and 10 mmHg. We pump up a blood pressure cuff to about 150-200 mmHg when we take blood pressure, so this is NOT MUCH! This 2-10 mmHg pressure increases when we change the position of our fingers, wrist and forearm with wrist extension (bending the hand backwards), causing the greatest pressure increase. This is why we fit the CTS patient with a wrist “cock-up” splint to be worn at night since you can’t control your wrist position when you sleep and any bent position increases the pressure and can wake you up due to numbness, tingling, pain prompting you to shake and flick your hands and fingers until they, “…wake up.” When CTS is present, the pressure inside the tunnel goes up exponentially, meaning NOT 2 or 3 times, but 6, 12, 24 times what is normal and even higher! Now, if you add wrist bending (extension > flexion), the pressure REALLY gets high and it doesn’t take long for the nerve pinch and blood loss to wake us up. We’ve previously talked about other conditions that can make developing CTS more common or make it worse like hypothyroid, diabetes, arthritis, kidney disease, and more. AGAIN, this is because an increase is pressure results from these conditions (increased swelling = increased pressure = increased symptoms). As chiropractors, we will guide and manage your care through the healing process of CTS using a conservative, NON-SURGICAL treatment approach – TRY THIS FIRST!

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 Carpal Tunnel Syndrome, we would be honored to render our services.

Fibromyalgia “(More) Facts”

FibromyalgiaFibromyalgia Facts (FM) has been described as being a “myth” as well as “real” (and probably everything in between the two). This is a VERY controversial disorder that some doctors push under the rug by saying, “….there is no such thing,” while others stake their reputation on it. So with this wide variance in attitude and beliefs about FM, what ARE the facts?

Fibromyalgia has been defined as, “…a complex chronic pain disorder that affects an estimated 10 million Americans” (ref: National Fibromyalgia Association). Women are affected the greatest, but it can affect men and children as well. This condition can be subtle, hardly interfering with life and all of its activities to being totally disabling, disallowing participation in work and the most desired aspects of daily living.

DIAGNOSIS: In 1990, the American College of Rheumatology (ACR) introduced the diagnostic criteria for FM. This includes a patients history of “wide spread pain” for at least three months, AND pain in 11 or more of the 18 specifiic tender points using 4 kg of pressure. Due to the significant controversy about the reality of the disease (as stated in the opening paragraph), ONLY a physician knowledgable about FM should make the diagnosis. Along with this diagnostic responsibility, ALL other conditions having similar presenting symptoms as FM, “…must be ruled out” BEFORE making the diagnosis of FM.

SYMPTOMS: Though the hallmark of FM is widespread, generalized pain (in all four body quadrants), a number of other symptoms are common amongst FM sufferers. Some of these include fatigue (moderate to severe), sleep disorders, brain fog, irritable bowel syndrome (IBS), headaches (including migraine), anxiety, depression, and environmental sensitivities. Studies suggest that there is a “neuroendocrine” (nerves and hormones) abnormality that may contribute to the FM symptoms.

CAUSES: Research has found a genetic link, as FM is OFTEN seen in several family members (among siblings and/or mothers and their children). “Secondary fibromyalgia” arises AFTER other health-related issues occur such as physical trauma (like an acute injury or illness), which can act as a “trigger” for initiating FM. Recently, more attention has been directed to the central nervous system as the “underlying mechanism” for developing FM. Here, the threshold or level of a stimulus that triggers a painful response is found to be much lower in FM patients compared to a healthy group of people (this is called “central sensitization”). Thus, a pain response is amplified in the FM patient due to this lowered threshold of pain tolerance.

TREATMENT: As there is NO KNOWN cure for FM, symptomatic support and functional improvement are two important primary goals when treating patients with FM. In the medical world, there are MANY drugs that have been utilized for FM (such as sleep aids, muscle relaxers, anti-inflammatory, analgesics, and anti-depressants / -anxiety meds). ALTERNATIVE therapies include massage therapy, chiropractic, myofascial release, acupuncture, herbal supplements, yoga, and other exercise approaches such as swimming and/or simply walking are popular care options for many FM patients. Increasing rest, pacing daily activities (to avoid “over-use”), stress management (relaxation tapes, exercise, and nutritional support can ALL HELP reduce FM symptoms and improve quality of life!

If you, a friend or family member requires care for Fibromyalgia, we sincerely appreciate the trust and confidence shown by choosing our services!