Chiropractic Care for Neck Pain
Chiropractic care is a non-surgical treatment option that may help reduce your neck pain and related symptoms. Listed below are some of the different types of neck (cervical) conditions that Doctors of Chiropractic (DC) treat:
- Cervical intervertebral disc injuries that don’t require surgery
- Cervical sprain injuries
- Degenerative joint syndrome of the neck (eg, facet joints)
- Facet joint sprain
How Does a Chiropractor Diagnose Neck Pain? Your chiropractor will evaluate your spine as a whole because other regions of the neck (cervical), mid back (thoracic) and low back (lumbar) may be affected as well. Along with treating the spine as a whole, chiropractors treat the “whole person,” not just your specific symptoms. He or she may educate you on nutrition, stress management, and lifestyle goals in addition to treating your neck pain.
Before deciding which approach to try for your pain, the chiropractor will do a thorough examination to diagnose the specific cause of your neck pain.
He or she will determine any areas of restricted movement and will look at how you walk as well as your overall posture and spinal alignment. Doing these things can help your chiropractor understand your body mechanics.
In addition to the physical exam, you’ll also go through your past medical history with the chiropractor, and he or she may order imaging tests (eg, an x-ray or MRI) to help him or her diagnose the exact cause of your neck pain.
All these steps in the diagnostic process will give your chiropractor more information about your neck pain, which will help your chiropractor create a treatment plan customized for you.
Your chiropractor will also rule out a neck pain condition that will require surgery—if he or she believes your neck pain would be better treated by surgery, then you’ll be referred to a spine surgeon.
Chiropractic Treatments for Neck Pain Your chiropractor may use a combination of spinal manipulation, manual therapy, and other techniques as part of your treatment plan for neck pain.
Below are some spinal manipulation techniques your chiropractor may use.
- Flexion-distraction technique is a gentle, hands-on spinal manipulation that involves a pumping action on the intervertebral disc instead of direct force.
- Instrument-assisted manipulation uses a hand-held instrument to allow your chiropractor to apply force without thrusting into the spine.
- Specific spinal manipulation helps restore joint movement using a gentle thrusting technique.
Your chiropractor may also use manual therapies to treat your neck pain.
- Instrument-assisted soft tissue therapy uses special instruments to diagnose and treat muscle tension.
- Manual joint stretching and resistance techniques can help reduce neck pain and other symptoms.
- Therapeutic massage can help relax tense muscles.
- Trigger point therapy is used to relieve tight, painful points on a muscle.
Other therapies may also be used to ease neck pain symptoms.
- Inferential electrical stimulation uses a low frequency electrical current to stimulate neck muscles.
- Ultrasound sends sound waves into your muscle tissues to help stiffness and pain in your neck.
Therapeutic exercises may also be recommended—these can help improve overall range of motion in your neck and prevent neck pain from progressing.
The treatments listed above are simply examples of possible chiropractic treatments for neck pain; your actual treatment plan will depend on your diagnosis. Your chiropractor should thoroughly explain your treatment options so that you know what will happen.
Flexion Distraction to the Rescue for Chronic Back Pain
Everyday life can be a frustrating struggle for people who suffer from bulging discs, pinched nerves and spinal injuries. Not only can these spinal nerve compression issues trigger chronic pain, but they can also cause loss of sensation in the extremities and severe weakness that will impact quality of life.
The spine is made up of vertebrae and small joints, known as facet joints, which allows the spine to move easily. Fluid-filled cushions of cartilage, called discs, lay between the vertebrae to prevent bone-on-bone friction and absorb impacts. However, a wide range of unfortunate circumstances can affect this alignment. For instance, a car accident or sports accident can cause enough force to push the vertebrae out of position with each other, resulting in a disc to bulge or herniate. Besides undergoing risky and major surgery or using painkillers for the rest of your life, there is a safer, non-invasive, natural alternative – flexion distraction therapy.
Flexion distraction is a chiropractic technique used to treat conditions having to do with the lumbar spine. The technique is gentle and uses a non-forced procedure to take pressure off the spinal nerves that may be injured from a bulging or herniated disc. During the therapy, movements are usually slow, without any jerking or excessive pressure; therefore, patients are not subjected to increased pain or discomfort.
How Is Flexion Distraction Performed?
Flexion distraction involves using a special table that distracts and flexes the back in a gentle motion to allow the spine to move correctly so that pressure is taken off the disc bulge. The special treatment table moves in a smooth rhythmic fashion, allowing the chiropractor to gently stretch and bend the back in different directions while they add pressure to various parts of the spine. The painless non-invasive procedure essentially creates a negative pressure that pulls the disc bulge back into the spine, allowing movement of water, oxygen, and nutrients into the discs to keep them well articulated.
Over time and as we age, pressure on our spines may cause bulging or herniated discs. However, with the use of flexion & distraction, pressure is removed from the spinal discs, which helps widen the spinal canal, allowing motion to return to the spinal joints.
A Natural Hands-On Relief
Originally developed by Dr. James M. Cox, flexion distraction is a well-researched technique that has been proven effective since the 1960s. Many chiropractors, including Dr. Roy Van Dyke at Steele Creek Chiropractic, PLLC, have been using this method on their patients for many years to manage the symptoms of disc herniation and many other conditions.
Flexion distraction can help with a number of conditions, including sciatica pain, arthritis, lower back stiffness, spondylolisthesis (a crack or stress fracture in one of the vertebrae), spinal stenosis (narrowing of the spinal canal), scoliosis, and sacroiliac syndrome. Flexion distraction has also been used to help manage conditions that age the spine, such as degenerative disc disease and osteoarthritis.
Flexion distraction therapy is a remarkable technique that can help with your back pain discomfort and possibly free you from the need for major surgery.
Chiropractic Treatment of Sciatica
Doctors of Chiropractic (DC) medicine regularly treat sciatica. Sciatica is characterized by pain that originates in the low back or buttock that travels into one or both legs. Sciatic nerve pain varies in intensity and frequency; minimal, moderate, severe and occasional, intermittent, frequent or constant.
Sciatic pain can be described as dull, achy, sharp, toothache-like, pins and needles or similar to electric shock-like shooting leg pain. Other sciatica symptoms may include burning, numbness and tingling sensations. Sciatica is also called radiating or referred pain, neuropathy, or neuralgia. A misconception is that sciatica is a disorder—however, sciatica is really a symptom of a disorder.
Sciatica Is Caused by Nerve Compression
Sciatica is generally caused by sciatic nerve compression. Spinal disorders known to cause sciatic nerve pain include lumbar spine subluxations (misaligned vertebral body/ies), herniated or bulging discs (slipped discs), pregnancy and childbirth, spinal tumors, and non-spinal disorders such as diabetes, constipation, or sitting on one's back pocket wallet.
One common cause of sciatica is piriformis syndrome. Piriformis syndrome is named after the piriformis muscle. The piriformis muscle is located in the lower part of the spine, connects to the thighbone, and assists in hip rotation. The sciatic nerve runs beneath the piriformis muscle. This muscle is susceptible to injury from a slip and fall, hip arthritis, or a difference in leg length. Such situations can cause piriformis muscle cramping and spasm to develop pinching the sciatic nerve and causing inflammation and pain.
Sciatic nerve compression may result in the loss of feeling (sensory loss), paralysis of a single limb or group of muscles (monoplegia), and insomnia.
Proper Diagnosis of Sciatica Is Essential
Since there are many disorders that cause sciatica, the chiropractor's first step is to determine what is causing sciatica. Forming a diagnosis involves a thoughtful review the patient's medical history, and a physical and neurological examination.
Diagnostic testing may include an x-ray, MRI, CT scan and/or electrodiagnostic tests (electromyography or EMG and nerve conduction velocity or NCV). These tests help to detect possible contraindications to spinal adjustments and other chiropractic therapies.
Chiropractic Treatment of Sciatica Symptoms
The purpose of chiropractic treatment is to help the body's potential to heal itself. It is based on the scientific principle that restricted spinal movement leads to pain and reduced function and performance. Chiropractic care is non-invasive (non-surgical) and drug-free.
The type of chiropractic therapy provided depends on the cause of the patient's sciatica. A sciatica treatment plan may include several different treatments such as ice/cold therapies, ultrasound, TENS, and spinal adjustments (sometimes called spinal manipulation). Below are more details on these chiropractic treatment modalities.
- Ice/Cold therapy reduces inflammation and helps to control sciatic pain.
- Ultrasound produces gentle heat created by sound waves that penetrate deep into soft tissues (eg, muscles). Ultrasound increases circulation and helps reduce muscle spasms, cramping, swelling, stiffness, and sciatic pain.
- TENS unit (transcutaneous electrical nerve stimulation) is a small box-like, battery-powered, portable muscle stimulating machine. Variable intensities of electrical current control acute pain and reduce muscle spasms. Larger versions of the home-use TENS units are used by chiropractors, physical therapists and other rehab professionals.
- Adjustments (Spinal Manipulation) At the core of chiropractic care are spinal adjustments. Manipulation frees restricted movement of the spine and helps restore misaligned vertebral bodies (subluxation) to their proper position in the spinal column. Spinal adjustment helps reduce nerve irritability responsible for inflammation, muscle spasm, pain, and other symptoms related to sciatica. Adjustments should not be painful. Spinal manipulation is proven to be safe and effective.
In college and during their training, students of chiropractic learn many different adjustment techniques enabling them to treat several types of subluxations and disorders. Techniques vary from a swift high velocity thrust to those that combine minimal force and gentle pressure. Mastery of each technique is an art that requires great skill and precision. Spinal manipulation is the treatment that differentiates chiropractic care from other medical disciplines.
Chiropractic Limitations in Treating Sciatica
Sciatica can be caused by other disorders beyond the scope of chiropractic practice. If the doctor of chiropractic determines the patient's disorder requires treatment by another type of doctor, then the patient is referred to another specialty. In some cases, the referring chiropractor may continue to treat the patient and co-manage the patient's care with the other specialist.
Gentle Chiropractic Techniques for the Sacroiliac Joint
Some patients with low back or buttock pain resulting from sacroiliac joint dysfunction may favor a more gentle chiropractic treatment over the traditional spinal manipulation techniques.
Less forceful spinal manipulation involves slower (low-velocity) techniques that allow the joint to remain within its passive range of motion. Gentle chiropractic techniques include:
- Gravity traction using adjusting blocks: Padded "blocks" that vary in shape and size are strategically placed underneath the body. With the patient lying face down, the practitioner can gently reposition the sacroiliac joint and other areas, employing gravity from the block instead of relying solely on force.
- Respiratory-assisted adjusting, long-axis leg traction techniques: While the chiropractor gently pulls a leg at a specific angle, the patients takes deep breaths to facilitate the adjustment.
- A "drop" approach using a special chiropractic table: This table has sections that can be raised up to be dropped at the same time as the thrust, allowing gravity to assist the adjustment.
- A specialized adjusting tool or device called an Activator: The Activator is a spring-loaded instrument that is used during an adjustment to provide a low-force impulse directed at specific locations along the spine.
- Further reading: Activator Method Chiropractic Technique
- The "flexion distraction" technique: Flexion distraction involves the use of a specialized table that gently distracts, or stretches, the spine. The chiropractor is able to isolate the area of pain while slightly flexing the spine in a pumping rhythm.
Gentle Chiropractic Mobilization vs. Adjustment
Gentle chiropractic techniques typically do not involve twisting of the body. There are several reasons a chiropractor may recommend gentle chiropractic techniques over a traditional high-velocity, low-amplitude chiropractic adjustment, such as:
- Patient preference: Some patients simply do not feel comfortable with the traditional high-velocity thrust manipulation and prefer an approach that does not involve twisting or joint "popping."
- Contraindications: Some patients may not be able to tolerate traditional chiropractic manual manipulation, such as patients with certain types of spinal instability or advanced osteoporosis.
In addition to one or a combination of spinal manipulation techniques, the chiropractor may recommend various combinations of adjunctive therapy for sacroiliac joint pain.
Adjunctive Therapy for Sacroiliac Joint Pain
Chiropractors may utilize various adjunctive therapies for treating sacroiliac (SI) joint pain with the goals of reducing the patient's pain, improving function, and providing rehabilitation so the pain is less likely to return.
Pain is caused by either too much or too little movement of the sacroiliac joint. As a result, muscles surrounding the joint may benefit from chiropractic techniques to either relax the muscles or to strengthen them.
Muscle Relaxation Techniques
Muscle relaxation (muscle release) techniques are often applied during gentle chiropractic treatments to minimize excessive strain on the sacroiliac joint arising from an overly tight muscle.
Muscles that may require stretching as part of chiropractic care include (but are not limited to) the:
- Hamstrings (the muscles that run through the back of the thigh)
- Piriformis (the piriformis muscle is a pear-shaped muscle that runs from the back of the upper thigh bone (femur) to the sacrum)
- Adductors (four muscles from the pelvis to either the thigh bone or the knee that ultimately pull the legs together)
- TFL (tensor fascia lata muscle of the thigh, located on the outer aspect of the thigh)
- Overly tight, low back paraspinal muscles (the muscles next to the lumbar spine)
Other treatments for tight muscles, such as hot packs and massage, may also be employed by the chiropractor.
- Hot packs may be used to warm up/relax tight muscles prior to the chiropractic adjustment and/or for use at home.
- See Heat Therapy
- Therapeutic massage is a direct way to relax overly tight muscles. In addition, massage increases blood flow to the area, which in turn promotes healing.
- Abdominal muscles: pelvic tilt, trunk curl, exercise ball sit ups, sit backs, abdominal bracing
- Back muscles: kneeling or prone arm/leg raises, cat curls, exercise ball or floor extension
Muscle Strengthening Techniques
Strengthening the body's core muscles is important for stabilizing the sacroiliac joint. While some of the body's core muscles are exercised in everyday life, working most of the stomach/back muscles is more difficult and requires a conscious approach to targeting them for strengthening.
Specific home-based exercises designed to strengthen the phasic (weak) muscles are often prescribed treatments in chiropractic, for example:
An exercise ball is an excellent tool for strengthening core body muscles. The body responds to the instability of the ball to remain balanced, engaging many more muscles and neuropathways than when the body is exercised on a stable surface.
Additional Support for the Sacroiliac Joint
When lower back pain arising from the sacroiliac joint is not responding to treatment, additional support and/or treatment may be necessary, such as:
- Sacroiliac belt/support: An elasticized belt tightened around the waist using Velcro can help support the sacroiliac joint
- Shoe insert: An anatomical short leg may require a heel lift, arch support or a combination of both
- TENS: A transcutaneous electrical nerve stimulation (TENS) device produces electrical stimulation using electrodes for pain treatment. It is believed that the electrical current directly blocks the transmission of pain signals along nerves
- Ice packs and rest: Ice packs are applied as needed to reduce inflammation in the area, along with short periods of rest to reduce irritation
- Physiological therapeutic modalities: Electrical stimulation, pulsed magnetic field, low level laser or class IV laser - may facilitate recovery by reducing inflammation and hence, pain
Weight loss management and diet: This approach is appropriate for treating sacroiliac joint dysfunction as is true for any chronic lower back condition. An anti-inflammatory diet, such as a gluten-free diet, is a good option for weight reduction in addition to other general health benefits of reducing the inflammatory markers in the body.
The chiropractor will perform a thorough physical examination and medical history to determine if there are any coexisting conditions that require treatment in addition to sacroiliac joint dysfunction. A whole-body approach is optimal when developing a treatment plan for each patient.
Flexion – Distraction Therapy
This powerful method is a technique used by chiropractors to treat many different conditions of the lumbar spine. This technique is aimed to increase spinal motion and fix disc bulges or herniations. The best part is this technique is a non-surgical method.
What is Flexion-Distraction Therapy?
Flexion - Distraction Therapy is a treatment often used for lumbar disc injuries (herniation, bulges, etc.) and for other low back and lower extremity radicular conditions.
How well does Flexion-Distraction Therapy work?
In a study published in European Spine Journal, researchers found that the use of flexion distraction is beneficial for people who suffer from chronic lower back pain (defined as back pain lasting more than three months). Performing a control study in which 235 individuals were recruited and qualified as having chronic lower back pain, 123 received flexion distraction and the remaining 112 engaged in standard therapeutic exercises with trained physical therapists.1
Based on their findings, researchers concluded that participants who engaged in flexion distraction treatment via chiropractic care “had significantly greater relief from perceived pain” when compared to subjects who completed physical therapy. Thus, flexion distraction tables can be used by chiropractic professionals as part of an effective pain-relieving treatment plan.1
1Guadavalli MR, et al. “A randomized clinical trial and subgroup analysis to compare flexion-distraction with active exercise for chronic low back pain.” Eur Spine J. 2006:15(7);1070-1082.
In many regards, a chiropractic examination is very similar to standard examination procedures administered by all health care providers. With that said, how chiropractors examine the structure and function of the spine and then determine specific chiropractic treatments separates chiropractic care from other disciplines.
Chiropractic Exam of Lower Back Pain
An initial chiropractic exam for back pain will typically have three parts: a consultation, case history, and physical examination.
- Consultation. The patient meets with the chiropractor and provides a brief synopsis of his or her lower back pain, such as:
- Duration and frequency of symptoms
- Description of the symptoms (e.g. burning, throbbing)
- Areas of pain
- What makes the pain feel better (e.g. sitting, stretching)
- What makes the pain feel worse (e.g. standing, lifting).
- Case history. The chiropractor identifies the area(s) of complaint and the nature of the back pain by asking questions and learning more about different areas of the patient's history, including:
- Family history
- Dietary habits
- Past history of other treatments (chiropractic, osteopathic, medical and other)
- Occupational history
- Psychosocial history
- Other areas to probe, often based on responses to above questions.
- Physical examination. A chiropractor may utilize a variety of methods to determine the spinal segments that require chiropractic treatments, including but not limited to static and motion palpation techniques determining spinal segments that are hypo mobile (restricted in their movement) or fixated. Depending on the results of the above examination, a chiropractor may use additional diagnostic tests, such as:
- X-ray to locate subluxations (the altered position of the vertebra)
- A device that detects the temperature of the skin in the paraspinal region to identify spinal areas with a significant temperature variance that requires manipulation.
Many chiropractors utilize a holistic, biomechanical concept of treating the bipedal structure in its entirety, in an attempt to balance the structure from the feet upward.
Chiropractors are typically trained in multiple methods of assessing lower back pain, including:
- Evaluation and management services.1 Chiropractors are trained in examining the joints, bones, muscles and tendons of the spine, head, extremities and other areas of the body with the purpose of noting any misalignment, tenderness, asymmetry, defects or other problems.
- Neurologic and other common physical examination procedures.1 Chiropractors are trained to perform a variety of neurologic tests (nerve root compression/tension, motor strength, coordination, deep tendon and pathological reflexes, etc.) and are skilled in performing orthopedic, cardiovascular and many other common examinations.
- Specialized assessment.1 Chiropractors are trained to assess range of motion, stability, muscle strength, muscle tone and other assessments with the lower back.
- Common diagnostic studies.1 Chiropractors are trained in use of diagnostic studies and tools such as radiography (X-rays), laboratory diagnostics and neurodiagnostics.
In the assessment of lower back pain, differential diagnosis utilizing a "triage" concept of classifying low back injuries into one of three categories helps to guide the doctor of chiropractic. These categories of chiropractic diagnosis include:
- Potentially serious: tumor, infection, fracture, major neurological problem (cauda equina), local open wound or burn, prolonged bleeding (hemophilia), artificial joint implant problems, pacemaker problems, joint infection
- Nerve problem: when the nerve root in the low back is pinched or compressed, causing a radiculopathy (sciatica). Typical causes of nerve root pinching include a lumbar herniated disc, spondylolisthesis, spinal stenosis
- Non-specific: mechanical back pain in the lumbar spine. This type of lower back pain is the most common presentation, and includes pain for which there is no identifiable cause.
With chiropractic diagnosis of potentially serious injuries, the chiropractor will typically refer the patient to a relevant medical specialist and possibly a surgeon, and as appropriate the chiropractor may co-manage the patient's care with other back pain specialists.1 With this classification, chiropractic manipulation is typically avoided over the relevant anatomy.
With chiropractic diagnosis of a nerve root problem causing sciatica and/or non-specific causes of low back pain, chiropractors typically describe the symptoms experienced on the following scale:
- Acute (symptoms lasting less than 6 weeks)
- Subacute (symptoms lasting between 6 and 12 weeks)
- Chronic (symptoms lasting for 12 weeks or more)
- Recurrent/flare up (symptoms are similar to original symptoms and return sporadically or as result of exacerbating circumstances).1
A chiropractic adjustment refers to a chiropractor applying manipulation to the vertebrae that have abnormal movement patterns or fail to function normally.
The objective of this chiropractic treatment is to reduce the subluxation, with the goals of increasing range of motion, reducing nerve irritability and improving function.
Chiropractic Adjustment Description
A chiropractic adjustment typically involves:
- A high velocity, short lever arm thrust applied to a vertebra
- An accompanying, audible release of gas (joint cavitation) that is caused by the release of oxygen, nitrogen, and carbon dioxide, which releases joint pressure (cavitation)2
- A relieving sensation most of the time, although minor discomfort has been reported (that usually lasts for a short time duration) if the surrounding muscles are in spasm or the patient tenses up during this chiropractic care.
It should be known that joint cavitation or cracking does not occur at times, typically as a result of significant muscle splinting or the patient not being adequately relaxed during the chiropractic manipulation. At times like this, it is sometimes best for the chiropractor to apply ice, have the patient rest, or do electrical stimulation and massage prior to attempting the chiropractic adjustment.
Chiropractic Adjustment Techniques
There are many different manipulative techniques that can be utilized in chiropractic, and there is a certain skill level and "art" involved with high velocity, low amplitude adjustment or manipulation. It is perhaps more important for the chiropractor to determine when not to apply the adjustment.
Chiropractic Adjustment Side Effects
The most common reaction to a chiropractic adjustment is aching or soreness in the spinal joints or muscles. If this aching or soreness occurs, it is usually within the first few hours post-treatment and does not last longer than 24 hours after the chiropractic adjustment. Application of an ice pack often reduces the symptoms relatively quickly.
Chiropractic Services Beyond Adjustments
The focus on spinal adjustment is what makes doctors of chiropractic unique in their approach to treating patients with spinal complaints. The chiropractic adjustment, however, may not be the only procedure a chiropractor may employ in managing a patient's care. For example, chiropractic care has utilized drugless therapeutics (natural therapies) since as early as 1912.1
Natural agents such as heat, cold, water, massage, light, and exercise are some of the physiological therapeutic measures that are often utilized by chiropractors. When controlled, these and other elements exert a beneficial influence on body functions and can help a number of common lower back pain problems.
Common Forms of Chiropractic Therapy
Some physiological therapeutic measures that are often utilized in chiropractic care include:
- Heat and cold. Chiropractors may alternate between heat and ice therapy to help patients treat back pain. Ice packs may be used to numb the back for a 10 to 15 minute period and then switched with a heating pad, heat wrap or hot water bottle to restore blood flow to the area and promote faster healing.
- Exercise. Chiropractors may provide patients with instructions for an exercise program focusing on stretching and strengthening the back. For more information, see Exercise and Chiropractic Therapy.
- Massage. Chiropractors may massage the soft tissues to improve circulation, reduce swelling and inflammation associated with the back pain, and encourage quicker healing. See Massage Therapy for Lower Back Pain.
- Dietary management. Many chiropractors will provide patients with tips on how an improved diet may help with their back pain, and some may recommend dietary supplements after spinal manipulation.
- Ultrasound. With ultrasound, sound waves create deep heat therapy that is applied to the soft tissues and joints. Basically micro-massaging the soft tissues and joints, ultrasound therapy can not only help reduce back pain, stiffness, and spasms, but increase blood flow and accelerate the healing process.
- Diathermy. A form of shortwave, electro-magnetic therapy that passes the softer tissues and provides heat to denser tissues, diathermy relaxes the muscles and connective tissues, decreases muscle spasms, and accelerates the healing process by increasing circulation. In chiropractic treatment utilizing diathermy, the treated area will typically feel pleasantly warm.
- Hydrotherapy. Using water and varying its temperature and pressure via hot baths, whirlpools, saunas or wraps, hydrotherapy focuses on the body's reaction to hot and cold stimuli. In chiropractic, hydrotherapy may be used to reduce the sensitivity of back pain through cold stimuli that numb the pain and the use of hot stimuli to promote blood flow and faster healing.
- Electrical muscle stimulation. During this chiropractic therapy, electrodes are placed on the skin that send light electrical pulses to different areas of the body with the purpose of reducing inflammation, curtailing muscle spasms and relieving back pain.
- Transcutaneous electrical nerve stimulators (TENS). The most common form of electrical stimulation, TENS units feature electrodes that are placed over the painful area with the user having the power to control the intensity of electrical stimulation. It is believed that TENS help block the transmission of pain signals along the nerves and also release the body’s natural painkillers, endorphins.
- Traction. A chiropractic traction massage may include the patient lying face up as a system of rollers move about the back, all the while stretching and massaging the muscles in the back. Chiropractors may use other traction devices that stretch the spine, decompress the discs and reduce the pressure on the nerve roots (a procedure known as non-surgical spinal decompression).
- Infrared radiation. In chiropractic, a thermal camera may be used to image colored hues indicating the blood flow in the back. For example, red hues would indicate higher IR radiation and more blood flow in the back. Infrared radiation may be used by chiropractors to differentiate normal temperature changes from abnormal differences and to assess underlying conditions that are causing back pain.
- Cold laser therapy. With cold laser therapy, particles of energy are carried in a laser and absorbed by the cell membrane’s photo receptors after penetrating the skin surface. The cells and tissues then convert this light energy into biochemical energy, fueling a biological process that is believed to decrease swelling, reduce back pain and inflammation, and improve circulation.
- Ergonomics. During the course of chiropractic care, the chiropractor may recommend some modification such as a work station change that is applied at home and/or at work. The success or failure of obtaining patient satisfying outcome may be directly related to applying an ergonomic/job-related modification or a hobby-related irritating activity.
- Pelvic stabilization. When leg-length deficiency, flat feet and/or subtalar instability are present, the chiropractor may place a small heel lift in the shoe on the short leg side and/or prescribe corrective arch supports to help stabilize the pelvis.
- Patient education. A chiropractor may advise a variety of lifestyle modifications, including diet and nutritional programs, self-care and coping strategies, to the patient experiencing lower back pain.
These methods may or may not be utilized by the chiropractor in the course of a patient's case management depending upon their specific needs.
Frozen Shoulder and Chiropractic Treatment
In our chiropractic clinics we often find the term 'frozen shoulder' misused.
The term is commonly used to describe any persistent shoulder pain and restricted movement.
Shoulder problems can be complex and require a thorough assessment to be accurately diagnosed and as with any other joint problem.
The success of any treatment depends on correct diagnosis and cooperation between patient and practitioner.
What is a Frozen shoulder?
Frozen shoulder, or “adhesive capsulitis” to give it the medical term, refers to loss of arm movement at the shoulder joint combined with inflammation of the tissues within the joint capsule that surrounds the shoulder and is often accompanied by a great degree of pain during even the slightest movements.
These tissues become thickened and shortened and eventually 'stick' together, hence the medical term - adhesive capsulitis.
What are the symptoms?
There are three stages:
- “Freezing Phase” Initially, there is progressive limitation of all movements of the shoulder. This may follow a recent minor trauma, dislocation, prolonged immobilisation, heart attack (myocardial infarction) and sometimes neck problems (cervical radiculitis). Pain may or may not accompany this, although pain will be felt if you try to exceed the limited movement. This phase can last anywhere between 2 and 9 months.
- “Frozen Phase” As the fluid in the joint becomes thickened there may be more pain and eventually, the condition progresses until all movement is greatly restricted. This phase can last from 4 to 12 months.
- “Thawing Phase” As the inflammation begins to subside so does any pain experienced. During this phase movement in the shoulder begins to gradually return but may or may not recover 100% if left untreated. This phase characteristically lasts between 6 to 9 months.
Early diagnosis is vital because the condition is reversible.
Once it has progressed into the adhesive/frozen stage, some persistent restriction may remain.
The recovery period varies depending on how long the problem has been there and the severity of it. It is not uncommon for it to take up to 6 months to recover with treatment and up to 12-24 months without treatment.
Rotator Cuff Tendinitis/Tear
The rotator cuff muscles play an important role in the movement of the shoulder.
They consist of the supraspinatus, infraspinatus and teres minor muscles. The rotator cuff tendon is a major source of pain and disability.
If it becomes inflamed (tendonitis) or torn; voluntary abduction, elevation and rotation of the shoulder is lost.
However, the chiropractor will be able to move the shoulder noting only a slight loss in movement due to pain.
WhKorthals-de Bos et al (2003), British Medical Journalereas with frozen shoulder, the chiropractor will not be able to move the joint. Rotator cuff muscle pain is usually due to trauma or overuse movements.
Bursas are fluid filled sacs that surround certain joints of the body and act to prevent excess friction between tissues and/or bony surfaces.
In the shoulder, you will find the sub-deltoid bursa that lies underneath the deltoid muscles. (These muscles make the rounded shape of the shoulder/arm).
The bursa can become inflamed (bursitis) or pinched which in turn will produce pain and some limited movement of the shoulder. Slight swelling and heat production may be felt.
Referred pain from the Neck
It is one of the most common co-existing causes of shoulder pain seen in chiropractic practice.
When the spinal joints are sprained and become inflamed and irritated in the neck, it automatically triggers muscle spasm. It affects the muscles with the same nerve supply relating to the level that has been injured. Pressure may also occur on the surrounding nerve fibres, but that is less common.
The nerves supply information to the muscles of the shoulder and if these nerves become inflamed, the muscles go into spasm and weaken, and subsequently movement will be affected.
Even low-grade increase of muscle tension, due to neck problems, makes you more likely to develop shoulder pain and problems.
Chiropractic treatment can help this.
FROM: J Manipulative Physiol Ther 1998 (May); 21 (4): 288—294 Bergmann TF, Jongeward BV Methods Department, Northwestern College of Chiropractic, Bloomington, MN 55431, USA
OBJECTIVE: To discuss a case of sciatica associated with lower back pain that originates in a disc. We discuss the use of manipulative therapy as a conservative approach and compare it with other conservative methods and with surgery. CLINICAL FEATURES: The patient suffered from lower back and left leg pain that had increased in severity over a 6-day period. There was decreased sensation in the dorsum of the left foot and toes. Computed tomography demonstrated the presence of a small, contained disc herniation. INTERVENTION AND OUTCOME: The patient was initially treated with ice followed by flexion-distraction therapy. This was used over the course of her first three visits. Once she was in less pain, side posture manipulation was added to her care. Nine treatments were required before she was released from care. CONCLUSION: We need a nonsurgical, conservative approach to treat lower back pain with sciatica as an alternative to and before beginning the more aggressive, and potentially hazardous, surgical treatment. There is some support for the idea that lumbar disc herniation with neurological deficit and radicular pain does not contraindicate the judicious use of manipulation. Although significant questions remain for the evaluation and treatment of lumbar radiculopathy (sciatica) with disc herniations, there is ample evidence to suggest that a course of conservative care, including spinal manipulation, should be completed before surgical consult is considered.
Typical Cervical Problems Treated by Chiropractic
Chiropractic manipulation can address a number of causes of neck pain. It is not a treatment for every type of neck problem, but on the other hand is also considered a first line of treatment for many.
Two typical causes of pain that originate in the neck and may be treated by manipulation include mechanical neck pain and disc problems.
Mechanical Neck Pain
Mechanical neck pain includes pain generated from muscle, tendons, joint capsules, ligaments and/or the fascia. This type of problem is a common cause of neck pain and stiffness. Most of the time, many of these tissues are simultaneously injured and can cause pain both locally as well as at a distance away from the injury site.
Facet joint problems are a good example of mechanical neck pain. The facets are located in the back of the neck, about 1 inch from each side of the midline. When a facet joint is sprained or injured, pain may be localized and/or referred pain a distance away from the neck injury, such as into the shoulder blade, upper back and even into the arm. The referred pain pattern is unique and depends on the specific spinal level of the cervical spine that is involved.
Cervical Disc Problems
Tears can develop in the cervical disc and/or the inside of the disc (the nucleus) can herniate through the outer part (the annulus) and trap or pinch the nerve root as it exits the spine.
Cervical nerve root irritation can frequently refer pain down the arm and into the hand, usually affecting specific regions such as the 4th and 5th digits, the palm side thumb to 3rd fingers and/or the back of the hand on the thumb, index finger side of the hand, depending on which nerve root is irritated.
On rare occasions, if the nucleus of the disc herniates straight backwards, it can compress the spinal cord and create symptoms in the legs and even affect the function of the bowels and/or bladder. On these rare occasions, the patient needs to be referred to a spine surgeon for immediate medical attention.
The above are two broad examples of types of cervical spine problems that may be treated with cervical spinal manipulation. The patient needs to receive a complete exam prior to cervical manipulation.
Korthals-de Bos et al (2003), British Medical Journal
In a Randomized controlled trial, 183 patients with neck pain were randomly allocated to manual therapy (spinal mobilization), physiotherapy (mainly exercise) or general practitioner care (counseling, education and drugs) in a 52-week study. The clinical outcomes measures showed that manual therapy resulted in faster recovery than physiotherapy and general practitioner care. Moreover, total costs of the manual therapy-treated patients were about one-third of the costs of physiotherapy or general practitioner care.
Chiropractic care for pain relief Spinal manipulation primary therapy, but treatment options are expanding Updated: June 6, 2018Published: February, 2015 Chiropractic is a system of therapy focused on the structure of the body, particularly the spine. Chiropractors manipulate the body's alignment to relieve pain and improve function and to help the body heal itself. While the mainstay of chiropractic is spinal manipulation, chiropractic care may also include other treatments, including manual or manipulative therapies, postural and exercise education, and ergonomic training (how to walk, sit, and stand to limit back strain). Chiropractors today often work in conjunction with primary care doctors, pain experts, and surgeons to treat patients with pain. The most positive research on chiropractic therapy has focused on spinal manipulation for low back pain. As one of the alternatives to pain-relieving drugs, the American College of Physicians low back pain guideline recommends spinal manipulation along with heat, massage and acupuncture. Chiropractic treatment may also help people with other musculoskeletal related pains. "Spinal manipulation" is a generic term used for any kind of therapeutic movement of the spine. Most often it involves the application of quick but strong pressure on a joint between two vertebrae of the spine. In addition to spinal manipulation, a chiropractor may advise you about changing your biomechanics and posture and suggest other treatments and techniques. The ultimate goal of chiropractic is to help relieve pain and help patients better manage their condition at home.
Headaches and Chiropractic
If you have a headache, you’re not alone. Nine out of 10 Americans suffer from headaches. Some are occasional, some frequent, some are dull and throbbing, and some cause debilitating pain and nausea. What do you do when you suffer from a pounding headache? Do you grit your teeth and carry on? Lie down? Pop a pill and hope the pain goes away? There is a better alternative.
Research shows that spinal manipulation – one of the primary treatments provided by doctors of chiropractic – may be an effective treatment option for tension headaches and headaches that originate in the neck. A 2014 report in the Journal of Manipulative and Physiological Therapeutics (JMPT) found that interventions commonly used in chiropractic care improved outcomes for the treatment of acute and chronic neck pain and increased benefit was shown in several instances where a multimodal approach to neck pain had been used1. Also, a 2011 JMPT study found that chiropractic care, including spinal manipulation, improves migraine and cervicogenic headaches2.
Headaches have many causes, or “triggers.” These may include foods, environmental stimuli (noises, lights, stress, etc.) and/or behaviors (insomnia, excessive exercise, blood sugar changes, etc.). About 5 percent of all headaches are warning signals caused by physical problems. The remaining 95 percent of headaches are primary headaches, such as tension, migraine, or cluster headaches. These types of headaches are not caused by disease; the headache itself is the primary concern.
The greatest majority of primary headaches are associated with muscle tension in the neck. Today, Americans engage in more sedentary activities than in the past, and more hours are spent in one fixed position or posture (such as sitting in front of a computer). This can increase joint irritation and muscle tension in the neck, upper back and scalp, causing your head to ache.
What Can You Do?
The American Chiropractic Association (ACA) offers the following suggestions to prevent headaches: If you spend a large amount of time in one fixed position, such as in front of a computer, on a sewing machine, typing or reading, take a break and stretch every 30 minutes to one hour. The stretches should take your head and neck through a comfortable range of motion. Low-impact exercise may help relieve the pain associated with primary headaches. However, if you are prone to dull, throbbing headaches, avoid heavy exercise. Engage in such activities as walking and low-impact aerobics. Avoid teeth clenching. The upper teeth should never touch the lowers, except when swallowing. This results in stress at the temporomandibular joints (TMJ) – the two joints that connect your jaw to your skull – leading to TMJ irritation and a form of tension headaches. Drink at least eight 8-ounce glasses of water a day to help avoid dehydration, which can lead to headaches.
What Can a Doctor of Chiropractic Do?
- Your doctor of chiropractic may do one or more of the following if you suffer from a primary headache:
- Perform spinal manipulation or chiropractic adjustments to improve spinal function and alleviate the stress on your system.
- Provide nutritional advice, recommending a change in diet and perhaps the addition of B complex vitamins. Offer advice on posture, ergonomics (work postures), exercises and relaxation techniques. This advice should help to relieve the recurring joint irritation and tension in the muscles of the neck and upper back.
Doctors of chiropractic undergo extensive training to help their patients in many ways beyond just treatment for low-back pain. They know how tension in the spine relates to problems in other parts of the body, and they can take steps to relieve those problems.
1. Bryans R, Descarreaux M, Duranleau M, et al. Evidence based guidelines for the chiropractic treatment of adults with neck pain. J Manipulative Physiol Ther 2014; 37: 42-63. 2. Bryans R, Descarreaux M, Duranleau M, et al. Evidence based guidelines for the chiropractic treatment of adults with headache. J Manipulative Physiol Ther 2011; 34: 274-89.