Monthly Pain Update – March 2025

Low Back Pain and Disability Among the Elderly

It’s estimated that 20-40% of older adults suffer from chronic low back pain. While low back pain can occur at any age, it is particularly challenging for the elderly, as it often interferes with daily activities, sleep, and exercise. Left unaddressed, chronic low back pain can increase the risk of depression, irritability, social isolation, and worsening overall health.

Several age-related factors contribute to chronic low back pain in seniors. These include degenerative changes in the spine, such as disk degeneration, arthritis, and spinal stenosis; muscle weakness and reduced flexibility; accumulated microtrauma from decades of repetitive movements or improper lifting; and chronic conditions like osteoporosis or metabolic disease, which weaken bones or increase inflammation. These factors not only make older adults more susceptible to chronic low back pain but also complicate recovery.

A November 2024 study followed 2,109 older adults with low back pain for two years and found that 77% still reported symptoms at the end of the study. While 41.7% experienced some improvement, the majority saw no change or worsening symptoms. Researchers identified four potentially modifiable risk factors for persistent low back pain: physical inactivity, neurogenic claudication (leg pain from nerve/spinal cord compression), multi-site pain, and low walking confidence. Addressing these factors could improve outcomes for older adults.

A systematic review conducted less than a decade ago highlights chiropractic care as a safe and effective treatment option for older adults. The review noted that chiropractic care improves pain and reduces disability, with users reporting high satisfaction. The review also emphasized that supportive, ongoing care—including periodic evaluations and treatment—is appropriate for seniors with musculoskeletal degeneration, as it helps them maintain functional goals and quality of life.

In summary, chronic low back pain can significantly affect an older adult’s quality of life if left unaddressed. However, conservative treatments, such as chiropractic care combined with positive lifestyle changes can improve outcomes, reduce disability, and lower the risk of recurrence. Early and proactive management is key to preserving mobility and independence.

Treating the Neck of the Carpal Tunnel Syndrome Patient

Carpal tunnel syndrome (CTS) is the most frequently diagnosed peripheral neuropathy and one of the most common conditions affecting the hand. The disorder typically results from compression of the median nerve on the palm side of the wrist, leading to numbness, tingling, and sometimes weakness in the thumb and fingers—except for the pinky and the pinky-side of the ring finger, which are innervated by the ulnar nerve. To avoid surgery, many CTS patients seek chiropractic care, which often includes manual therapies applied beyond the wrist and even to the neck due to the nature of the median nerve.

The median nerve originates from the C6-T1 spinal nerve roots in the neck and provides sensory and motor functions to the palm-side forearm and hand. It enables gripping, forming a fist, and detecting temperature and texture. If the mobility of the median nerve is restricted along its course, the resulting symptoms may mimic or overlap with traditional CTS. To complicate matters further, compression can occur at multiple sites, all of which need to be addressed for effective treatment.

In an October 2024 study, researchers divided 48 CTS patients into two groups. Both groups received wrist-focused treatment, including ten sessions of wrist mobilization, electrotherapy, and the use of a nocturnal wrist splint to maintain a neutral wrist posture overnight. However, one group also received manual therapies targeting the cervical spine. Patients underwent motor and sensory nerve conduction testing and completed questionnaires on CTS-related disability at baseline, immediately after treatment, and at six-month follow-ups.

Initially, both groups reported similar improvements in all outcome measures. However, at the six-month follow-up, the group that received cervical spine care showed greater improvements, suggesting that long-term benefits favor incorporating cervical spine treatment into CTS care.

Doctors of chiropractic are well-equipped to assess the entire course of the median nerve—from the neck to the hand—and identify all potential areas of restriction. They can provide conservative treatments to restore normal nerve function and help patients return to their daily activities. In more complex cases, chiropractors may coordinate care with specialists or medical physicians as needed.

Comprehensive Treatment for Subacromial Pain Syndrome

Shoulder pain is a common complaint that drives patients to a doctor’s office, including  chiropractic clinics. It’s estimated that about one-third of the population will experience shoulder pain at some point, with subacromial pain syndrome accounting for approximately two-thirds of these cases. Subacromial pain syndrome arises from issues in the subacromial space, located between the acromion (a bony prominence of the shoulder blade) and the rotator cuff tendons. This condition is often associated with inflammation, irritation, or damage to the tendons or bursa, leading to pain during lifting and overhead shoulder movements, reduced range of motion, and discomfort at night, especially when lying on the affected shoulder.

Rather than resulting from a single injury, subacromial pain syndrome is often caused by the accumulation of microinjuries and degenerative changes due to factors such as aging, repetitive activities, poor posture, improper mechanics, and shoulder muscle imbalances. While surgical intervention may be an option in severe cases, treatment guidelines emphasize prioritizing non-surgical approaches, as these may achieve similar results without the risks, costs, and recovery time associated with surgery. A combination of manual therapies and shoulder-specific exercises is well-supported in the literature, though a recent study found that a more comprehensive approach may yield additional benefits.

In an October 2024 study, researchers divided patients with subacromial pain syndrome into two groups. Both groups received treatment that included manual therapies and exercises aimed at improving the motion of the glenohumeral joint (the ball-and-socket joint of the shoulder complex). However, the second group also received scapular muscle stretching and strengthening exercises, scapular motor control retraining, thoracic spine mobilization, and postural correction. While both groups showed similar improvements immediately after treatment, the comprehensive group demonstrated faster and more significant progress at a six-month follow-up. These findings suggest that incorporating mid-back and scapular-focused care may be essential for achieving long-lasting relief in patients with subacromial pain syndrome.

The good news is that doctors of chiropractic are trained to evaluate the whole patient rather than focusing solely on the area of chief complaint. Addressing contributing factors in adjacent areas, such as the scapula and thoracic spine, can significantly enhance treatment outcomes and help patients achieve lasting relief.

Cranio-Cervical Flexion Exercises for Chronic Neck Pain

Chronic neck pain is defined as pain persisting for longer than three months in the area between the base of the skull (occiput) and the upper thoracic region, specifically up to the T3 level of the thoracic spine. For many patients, chronic neck pain arises from the accumulation of microtraumas to the tissues in the neck and surrounding regions, often coupled with postural faults. Over time, these issues can lead to muscle imbalances and increased strain on the soft tissues that support the head.

When examining patients with chronic neck pain, chiropractors often observe weakness in the deep neck flexor muscles, which are critical for stabilizing the cervical spine. Strengthening these deep muscles is often a key goal for recovery. Unlike the superficial neck flexor muscles, the deep neck flexors cannot be voluntarily contracted in the same way. Instead, we must inhibit the superficial muscles to engage the deeper ones.

Here's a simple exercise to strengthen the deep neck flexors: lie on your back, tuck your chin slightly, and lift your head while keeping your eyes forward. Hold this position for ten seconds. Initially, this may be challenging, but with consistent practice, it becomes easier. Once you can hold the position for ten seconds, you can progress by increasing the duration, adding sets with brief rest periods, or applying resistance by pressing your hands against the front of your head. Your chiropractor may recommend additional or alternative exercises tailored to your specific needs. To make this routine easier to incorporate into your day, consider doing these exercises before bed or in the morning.

Your doctor of chiropractic may also have you perform these exercises during office visits as part of your treatment plan. In one study involving 58 chronic neck pain patients, researchers found that cranio-cervical flexion exercises led to greater improvements in neck range of motion and pain intensity if they were performed immediately following the application of manual therapies to improve the mobility of the upper cervical spine. This suggests that restoring cervical spine mobility may be a necessary first step to maximize the benefits of cranio-cervical flexion exercises.

This finding highlights the advantages of a multimodal treatment approach for managing chronic neck pain. By combining the strengths of different therapies, such as manual therapy and targeted exercises, patients can benefit from their synergistic effects, potentially achieving faster and more effective relief.

The Effect of Whiplash on the Autonomic Nervous System

The sudden acceleration and deceleration of the head and neck during a whiplash event is most commonly associated with mechanical injury to the soft tissues that support the cervical spine, leading to symptoms like neck pain. Over time, researchers have identified additional whiplash-related symptoms such as dizziness, stress reactivity, heart rate variability issues, visual disturbances, and digestive dysfunction. But how does injury to the neck lead to these diverse symptoms? The answer lies in understanding the autonomic nervous system.

The autonomic nervous system regulates involuntary functions like heart rate, digestion, breathing (even when it's automatic), and hormone release. It accomplishes this through nerve impulses sent between the brainstem, diencephalon, spinal cord, and target organs or tissues. When this communication is disrupted, a whiplash patient may experience one or more of the autonomic symptoms mentioned. Several mechanisms may explain this:

• Proprioceptive dysfunction: Injury to the mechanoreceptors housed in the cervical spine that provide sensory input crucial for balance, coordination, and proprioception.
• Vagal nerve dysfunction: The vagus nerve, which exits the skull and runs along the neck, can be affected by injury, potentially disrupting resting heart rate and digestive processes.
• Sympathetic chain irritation: Damage or irritation to the clusters of nerves running along the spine can alter how the body responds to stress, contributing to autonomic imbalances.
• Brainstem dysregulation: Microtrauma to the brainstem can disrupt its role as the autonomic nervous system's control center, causing dizziness, orthostatic hypotension, and difficulty regulating body temperature.
• Cervical arterial dysfunction: Damage to the arteries supplying blood to the brainstem can impair oxygen and nutrient delivery, disrupting autonomic regulation.
• Chronic pain and stress: Prolonged pain and stress signals can overwhelm the nervous system, reducing its ability to effectively regulate autonomic functions.

This is why providing a detailed history when seeking chiropractic care for whiplash-associated disorders (WAD) is so important. Even symptoms you might not associate with whiplash could help your chiropractor develop a comprehensive treatment plan tailored to your needs. Fortunately, whiplash injuries often respond well to conservative treatments like chiropractic care. Scheduling your initial appointment as soon as possible may increase the likelihood of achieving an optimal recovery outcome.

Spotting the Signs of Stroke

Stroke is a leading cause of death and long-term disability globally. While 1-in-10 stroke patients may achieve a full recovery, the majority will experience varying degrees of impairment, ranging from minor to severe, that can hinder their ability to perform pre-stroke activities of daily living. Additionally, without proactive measures, stroke survivors face an elevated risk of a recurrent stroke, which can have catastrophic consequences.

A stroke occurs when blood vessels fail to deliver oxygen and nutrients to the brain, either due to a blood clot (ischemic stroke) or a ruptured blood vessel (hemorrhagic stroke). Approximately 80% of strokes are ischemic. When oxygen and nutrients cannot reach brain tissue, the affected area may lose function, with consequences varying based on the region of the brain involved. Here’s a comprehensive list of symptoms based on the side of the brain in which a stroke occurs:

• LEFT BRAIN: Paralysis on the right side of the body, sensory changes on the right side of the body, speech/language problems, abstract thinking loss, problems with thinking and memory, and slow, cautious behavioral style.
• RIGHT BRAIN: Paralysis on the left side of the body, sensory changes on the left side of the body, vision problems, spatial thinking or imagery issues, problems with thinking and memory, and loss of quick, inquisitive behavioral style.
• BRAIN STEM: When a stroke occurs in the brain step, it can affect both sides of the body. The most severe damage could leave someone in a ‘locked-in’ state. Locked-in state is a condition in which the patient is generally unable to speak and can’t move because of the paralysis of muscles except for vertical eye movements and blinking. The person remains conscious, they can hear, think, reason and comprehend. In these cases, communication is established through eye movements.

In the event of a stroke, prompt treatment to address the cause of blood flow restriction is essential for both saving the patient’s life as well as reducing the risk for functional losses. Researchers have create the BE FAST acronym to help spot the signs of stroke: Balance (loss of), Eyes (blurred, double or total visual loss in one or both eyes), Face (droops on one side), Arms (loss of function), Speech (slurred or lost), and Time (you have a short window of time where medication can dissolve the clot and restore function). According to Cleveland Clinic, 52% of individuals suffering an ischemic stroke caused by a very large clot had better long-term outcomes if they received the IV-administered tissue plasgminogen activator (IV tPA) meds within 60 minutes of symptom onset. This can also be highly effective if administered within three-to-four hours of symptom onset.

The good news is that up to 80% of strokes are preventable by addressing modifiable risk factors such as maintaining a healthy weight, not smoking, eating a heart-healthy diet, exercising regularly, sleeping seven-to-eight hours per night, managing chronic conditions (e.g., diabetes, heart disease), controlling cholesterol levels, avoiding excessive alcohol intake, and refraining from illicit drug use (especially cocaine and methamphetamines).

This information should not be substituted for medical or chiropractic advice. Any and all healthcare concerns, decisions, and actions must be done through the advice and counsel of a healthcare professional who is familiar with your updated medical history.