Can Chiropractic Care Help Headaches?

     I have had many chiropractic patients in the Mandeville and Covington areas who have come to me for relief of their headaches, so I get this question a lot.  The answer I usually give is that it depends, but the chances are good that chiropractic care can help.  The most common cause of chronic, recurring headaches is upper neck dysfunction.  These types of headaches are known as cervicogenic headaches, meaning that the headaches source originates in the neck.  It has been estimated that 80% of chronic headaches fall into this category, so you can see how chiropractic care would be a really good choice for treatment.  Other types of headaches also respond chiropractic, which addresses the structure an function of the cervical spine. This is because the cervicogenic headache can trigger other types of headaches such as migraines or tension headaches.  Self treating with over the counter medications has been shown to actually increase the frequency and duration of headaches long-term.  Isn't it ironic that the very medication that people take for their headaches actually makes their problem worse in the long run?  A Duke University study in 2001 concluded "Manipulation appeared to result in immediate improvement in headache severity when used to treat episodes of cervicogenic control...a course of manipulation treatments resulted in sustained improvement in headache frequency and severity."   What this means is that chiropractic care results in long term improvement with less headaches and less severe headaches.  If you are suffering from chronic headaches then this is some really good news!  If you are a patient who has recurrent headaches and the medications do not offer any long-term relief, then you should see a good chiropractor in your area.

Home Care for Low Back Pain

     Patients ask me all the time what they can do at home to manage their low back pain.  This is a very important question.  Patients get relief when they come to the office for treatment, but can cause their pain to resurface or worsen by doing the wrong things at home in an attempt to self-treat.  One of the most common mistakes is using a heating pad on an already inflamed lower back.  The signs of inflammation are pain, heat, redness, and swelling.  That's right - pain is a sign that you have inflammation!  Putting heat on an area that is already inflamed will make the inflammation worse and your pain worse.  I'm not saying that heat should never be used, but in this case, where you are having acute lower back pain, heat is not indicated.  Ice should be used instead of heat if you are experiencing lower back pain that has recently started.  20 minutes on and then 40 minutes off is the proper duration.  This can be repeated every hour.  If you are diabetic or have sensory impairment, then you should consult your doctor before attempting this.  Another common mistake is to stretch too vigorously in an attempt to loosen tight muscles.  Stretching should always be done according to the patient's tolerance.  If it causes pain to stretch, then you are stretching too far.  No pain, no gain does not apply here!  A little soreness is expected during a stretch, but not pain.  There is a difference.  Another mistake is to bounce or repeatedly jerk on a muscle while stretching.  A muscle reacts to a sudden stretch by suddenly contracting.  By stretching, you are trying to relax the muscles, not trying to make them contract.  for this reason, you should perform steady stretches for at least 10 seconds according to your tolerance.  These two tips for caring for your lower back pain, using ice properly and stretching properly at home, can really help you get better faster and can help you manage your pain between visits.  For more information about chiropractic care and our office visit nschiro.com
 

I Believe in Chiropractic

    It never ceases to amaze me when I hear a patient say that they know someone who says that they "don't believe in chiropractic".  I understand that people might not understand what it is and how it works, but that doesn't stop these same people from believing in other things that have a whole lot less research and evidence supporting its existence.  I guess those people are not saying that they do not believe it exists, they just don't believe that it works.  Quite often, the very people that say such things end up trying chiropractic care because they see first-hand the results that their friends are getting.  Results that are natural, with no risky surgery or drugs.  I recently had the pleasure of treating someone who tried the medical treatment approach for his back pain and sciatic pain.  He had drugs, injections, and 50 visits to a PT clinic with no results. His next stop was going to be surgery, but he decided to try chiropractic as a last resort.  After just a few visits here his pain is already reduced by 50%.  I can tell you that this man, who was quite skeptical when he came in for his first visit, now believes in chiropractic.  Maybe he should have tried chiropractic first instead of last.  Quoting research statistics does little to sway the opinion of a skeptic, but results speak for themselves.  Days like today make me thank God that he lead me to this profession.

Treatment for Sciatic Pain

     I recently came across an article about the use of epidural steroid injections for sciatic pain.  The study analyzed the results from two dozen clinical trials on thousands of patients.  The study concluded that "epidural injections (into the spine) of corticosteroids had no long- or short-term effect on sciatica back pain, and such a small short-term effect on leg pain it would make no difference to the patient." A link to this article can be found here.

     To be honest, I have mixed feelings about this one.  I have been using pain management doctors for many years to help my patients who can not seem to get their inflammation under control.  Like any procedure, the effectiveness is dependent on many different factors.  Better candidates experience better results.  I understand that the injection itself does nothing to correct the physical problem that is the cause of the sciatic pain.  Instead, the steroid simply extinguishes the inflammation temporarily.  This explains why there seems to be some good short-term relief but no real gains in the long run.  For this reason, in my practice, I tend to utilize epidural injections for that short-term pain reduction so that I can get some work done in an effort to make some structural changes that will treat the cause of the irritation to the sciatic nerve, rather than just treating the outcome.  This can be achieved through spinal manipulation, spinal decompression, physical therapy modalities, and rehabilitation.  I have had really great results co-managing patients this way.  The pain management doctor helps the patient with their pain in the short-term while I offer non-surgical treatment that addresses the cause of the patient's sciatic pain.

     I hope that other physicians who read the article continue to educate themselves on the treatments available for their patients who suffer with sciatic pain.  I sincerely believe that all treatment options should be utilized before surgery is considered.  Given the high success rate of spinal decompression and chiropractic care for patients with back pain and sciatic pain, I think that these treatment methods should always be considered before more invasive procedures are carried out.  

Common Sense Treatment Progression

     I am seeing a disturbing pattern starting to emerge in regard to the treatment that a typical lower back pain patient goes through prior to seeing a surgeon.  The norm now goes something like this:  The patient goes to his primary care doctor with lower back pain.  His doctor prescribes some medications and orders a MRI.  Sometimes a the patient is referred for some PT, which usually consists of some stretching, massage, and maybe some ball or balance exercises.   If there is any sign of a disc bulge on the MRI, then the patient is referred to pain management for a series of epidural injections.  The next step, should the injections fail to give the patient relief, is referral to a neurosurgeon.  
     When I think about the logical sequence of treatment, it should progress from the least invasive, least expensive care to the most invasive, most expensive care without skipping any steps in between.  Lower back surgery is statistically the least effective and the most expensive care for lower back pain and should be the last resort unless certain red-flag signs are present.  It is generally accepted that the rate of success is about 50%, and a recent study indicates that only 1 in 100 back surgeries are medically necessary.  Injections are not very cost effective either, somewhere around $1500 per injection with most cases requiring a series of three for a total of around $4500.  Injections like these should be used in conjunction with some form of physical treatment because they do not actually fix anything.  The steroids used simply turn off the inflammatory process temporarily.  Don't get me wrong, I have nothing against medical doctors who perform these procedures - I refer many cases to pain management and to neurosurgery every year and they do a fantastic job.  The patients that I refer, will however, never look back and say that they should have tried something else prior to surgery.
     At Northshore Chiropractic, we offer non-surgical treatment for patients suffering from lower back pain and other musculoskeletal conditions.  We take a logical approach that is problem focused and does not skip any of the steps that can potentially save a patient from going through a surgery before it is absolutely needed.  We are happy to co-manage our patients with their medical doctor in order to achieve the best results utilizing the least invasive procedures.  One of the procedures we use is spinal decompression therapy.  It is a non-surgical treatment for bulging and herniated discs that has been shown to be up to 86% effective.  This, coupled with its relatively low cost when compared to injections or surgery, make it a logical step that should be added before these other more invasive and expensive procedures are utilized.

Functional Rehab for Low Back Pain

     There is a problem in traditional rehabilitation for lower back pain.  I see patients every day who, despite the fact that they have had extensive treatment and rehabilitation, still exhibit instability in functional positions.  They almost always describe to me exercises that they were taught that include ball exercises, abdomen strengthening, and the like.  Lumbar core stabilization is, unfortunately, not equal to abdomen strength.  It is all about coordination and co-contraction of the abdominal  muscles and the main lumbar stabilizing muscles that include the multifidus, quadratus lumborum, and pelvic floor muscles.

     Strength does not equal stability.  I have seen some really big and strong athletes who are completely unstable in positions needed for normal daily activities.  Think about some activities that require stability and balance, like riding a bike.  Do you have to be strong to do that?  No! Four year old children can learn to ride a bike pretty easily.  They just  have to develop the coordination needed to perform that action first.

     One thing that I have noticed is that patients have been given a lot of abdominal strength exercises and lumbar strength exercises, but nothing that facilitates the co-contraction patterns that are needed to truly be stable in functional positions such as sitting and standing.  This is the missing element in a great deal of lumbar rehab protocols.  I see no point in performing strength exercises for lower back pain until unstable muscle patterns are corrected.  Otherwise you would just be reinforcing these unstable patterns, making it more difficult later on to address.  

     In my practice, I see many patients who have had disc problems for extended periods of time who have had multiple episodes.  I utilize chiropractic care, spinal decompression , and functional rehabilitation designed to address the instability patterns that develop in response to pain.  Strengthening comes after instability is addressed.  The great thing about this approach is that stability exercises are less strenuous and can be started earlier in care when they can not tolerate strength exercises.  This approach is "phase of care friendly" for that reason and the progression from stability to strength becomes a logical process that progresses as the patient's pain level decreases.  This helps to prevent future episodes from happening over and over due to bad muscle patterns that, if left untreated, continue to cause pain and interfere with normal function.  

Structure and Function

What is chiropractic and what to doctors of chiropractic do?  That is a really good question.  Chiropractors believe that the structure of your body greatly effects how it functions.  Not just how you move around or how fast you can run and those types of things but how you function overall.  We are talking joints, muscles, nerves, ligaments, organs, and everything else.  Your brain controls every cell and organ in your body.  Its nerve signals are sent downward from the brain to the spinal cord and then out to the nerve roots which eventually branch out to innervate everything.  The spinal cord is housed within the bones of your neck and back called the spine and the nerve roots exit from the spine through little holes called IVF's.  When the structure of your spine is altered, bad things start to happen.  First of all, because the structure is altered, joints start to have dysfunction.  They don't move correctly and become restricted.  This in itself is enough to cause cellular breakage, inflammation, and pain.  A recent study showed that joint restriction and immobilization caused joint surfaces to start degenerating within just 72 hours!  Altering structure causes stresses to be taken up unevenly.  Bones form according to the stresses placed on them and uneven stress leads to uneven bone growth.  Whenever I see a bone spur on a X-ray I know right away that there is a structural problem.  I always think of the car alignment analogy here - If the alignment on your car went out one day you might not really even notice anything at first.  Drive another couple of thousand miles with a bad alignment and I can guarantee that you will start noticing that things are not right.  What might start as just an irritating wobble at first could end up becoming a big problem later when you start to mess up tie rods, ball joint, and other expensive parts.  Your spine structure is like this.  Bad alignment left untreated will eventually lead to much worse problems later on such as arthritis, disc problems, nerve problems, joint problems...the list goes on and on.  Structure effects function.  It is as simple as that.  Chiropractors are the very best healthcare professionals that address the structure of your body without invasive procedures or drugs.