Monthly Pain Update June 2025

Low Back Pain and the Thoracolumbar Fascia

It’s estimated that approximately 7.5% of the global population experiences at least one episode of low back pain each year, contributing significantly to healthcare costs and lost productivity. Most cases of low back pain are classified as non-specific, meaning there is no identifiable underlying pathology such as an infection, tumor, osteoporosis, or inflammatory disorder. Rather, non-specific low back pain results primarily from mechanical issues involving joints, muscles, and soft tissues in the lower back due to strains, muscular imbalances, deconditioning, stiffness, or poor movement patterns. One anatomical structure in the lower back that can significantly contribute to non-specific low back pain is the thoracolumbar fascia.

The thoracolumbar fascia comprises of several layers of richly innervated fibrous connective tissue in the lower back. These layers connect critical postural and core muscles to provide spinal stability and efficiently transfer forces between the spine, pelvis, and limbs. In a healthy individual, these fascial layers glide smoothly over each other during everyday movements, such as walking, bending, and twisting. However, excessive strain on the thoracolumbar fascia—due to repetitive motions without adequate rest, scar tissue from previous injuries, or loss of elasticity from aging or immobilization—can increase shear strain between these fibrous layers. Increased shear strain restricts normal fascial movement, making basic daily activities more challenging. Consequently, the body compensates by recruiting other muscles and joints, potentially placing additional strain on these tissues and resulting in inflammation, microtraumas, and eventually pain and functional disability.

A January 2025 study using ultrasound elastography compared thoracolumbar fascia shear strain between 32 patients with non-specific low back pain and 32 pain-free individuals. The researchers observed distinct differences in shear strain between groups. Specifically, the low back pain group demonstrated significantly reduced fascial gliding between layers, correlating directly with increased disability scores.

Findings during a physical examination that may suggest issues with the thoracolumbar fascia include contralateral arm-leg swing during walking, limited or uneven trunk rotation, altered movement sequencing during lumbopelvic flexion and extension, and positive findings during palpation, muscle activation testing, and myofascial shear testing. Some clinicians may also utilize ultrasound elastography either directly in-office or via specialist referral to quantify fascial dysfunction.

If restrictions or reduced mobility of the thoracolumbar fascia are identified, restoring fascial mobility through targeted treatment may be highly important in low back pain management. Chiropractors commonly utilize interventions such as manual therapy, myofascial release techniques, foam rolling, and targeted therapeutic exercises designed specifically to enhance movement, reduce fascial strain, and alleviate pain.

Non-Surgical Management of Carpal Tunnel Syndrome

Carpal tunnel syndrome (CTS) is a common condition caused by compression of the median nerve as it passes through the carpal tunnel in the wrist. This can lead to pain, numbness, tingling, and eventually weakness in the hand, particularly affecting the thumb, index finger, middle finger, and the thumb-side of the ring finger. In mild-to-moderate cases, research has shown that non-surgical approaches can be as effective as surgery, without the added costs or risks of surgical intervention. One area of conservative management includes manual therapies commonly used by doctors of chiropractic.

Manual therapies are hands-on (or instrument-assisted) techniques designed to restore musculoskeletal function by addressing joint, muscle, and soft tissue mobility. Here are some manual therapy techniques a chiropractor may employ when managing CTS:

• Neurodynamic mobilization: Gentle, controlled movements to restore median nerve mobility along its path through the wrist and forearm.
• Carpal bone mobilization: Subtle gliding or distraction movements between the carpal bones to enhance joint motion and alignment.
• Soft tissue mobilization: The application of manual pressure to release adhesions within muscles, fascia, and tendons.
• Transverse friction massage: Repetitive, cross-fiber strokes to promote circulation, reduce adhesions, and encourage tissue remodeling in tendons and ligaments.
• Myofascial release: Sustained pressure, stretching, or gliding movements applied to the fascia to restore normal tissue mobility and reduce inflammation or irritation around the median nerve.
• Trigger point therapy: Pressure or massage to deactivate hyperirritable spots in muscles such as the pronator teres or flexor carpi radialis, which may refer pain or mimic CTS symptoms.

These techniques are often combined based on physical examination findings. Research supports the use of multimodal care, which tends to produce better outcomes than isolated techniques alone. Additionally, manual therapies may be applied along the entire course of the median nerve—including the neck, shoulder, elbow, and forearm—since compressions at multiple sites (a concept known as double crush syndrome) may contribute to CTS symptoms. Chiropractors may also incorporate physiotherapy modalities, prescribe home exercises, recommend workplace or activity modifications, suggest nighttime wrist splinting, and provide nutritional guidance to support the rehabilitative process.

It’s important to note that non-surgical methods may be less effective in severe cases, particularly when there is significant muscle atrophy or constant numbness. That’s why individuals experiencing symptoms of CTS should seek care early to improve the likelihood of recovery and potentially avoid surgery.

Non-Surgical Management of Frozen Shoulder

Adhesive capsulitis, commonly known as frozen shoulder, is a condition characterized by painful and restricted shoulder movement. It affects approximately 2-5% of the United States population, most frequently in adults aged 40 to 60. The condition develops gradually, beginning with a “freezing” phase in which movement becomes increasingly painful and limited. This stage can last two to nine months. It is followed by a “frozen” phase, lasting four to twelve months, where the pain may lessen but stiffness persists. Finally, the “thawing” phase occurs as range of motion gradually returns, though some residual stiffness or functional limitation may remain. Many individuals seek chiropractic care to help manage symptoms and accelerate recovery—especially those who do not respond well to, or prefer to avoid, conventional treatments such as non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroid injections, capsular distension, or surgery.

 During an initial visit, the chiropractor will take a thorough history and assess symptoms, followed by a physical examination that may include active and passive range of motion testing, orthopedic assessments, and neurological screenings. This evaluation helps to both confirm the diagnosis of adhesive capsulitis and rule out other possible causes of shoulder pain and restricted movement, such as rotator cuff tears, impingement syndrome, calcific tendonitis, osteoarthritis, cervical radiculopathy, biceps tendinopathy or rupture, and labral tears.

 In-office care often includes various manual therapies aimed at improving shoulder mobility. During the acute “freezing” phase, chiropractors may use low-grade mobilizations—gentle, passive movements within the joint's available range—to reduce pain and muscular guarding. As inflammation subsides, high-grade mobilizations may be introduced to stretch the joint capsule and improve range of motion, often by moving into resistance at or near the joint’s end range. In some cases, manipulative therapy may be applied to address capsular restrictions. If mechanical dysfunctions in surrounding regions—such as the cervical spine or thoracic spine—are contributing to symptoms, chiropractors may apply treatment to these areas as well.

 In addition to in-office care, home exercise is critical for optimal recovery. Chiropractors may recommend wand exercises, which involve using the unaffected arm to assist the affected shoulder through various ranges of motion using a cane or broomstick. These may be performed in both standing and lying positions and are customized based on the individual’s stage of recovery. 

Chiropractors may also encourage patients to reduce sedentary behavior, engage in regular aerobic activity, eat an anti-inflammatory diet, and use heat and/or ice therapy depending on their stage of healing. In more complex or non-responsive cases, chiropractors may co-manage with a medical doctor or orthopedic specialist to ensure the best possible outcome.

When Headaches Arise from the Neck

Cervicogenic headache is a secondary type of headache resulting from dysfunction in the neck region. Currently, the prevailing theory in research on how this form of headache occurs is that mechanical problems—such as sprains or strains, disc herniations, or degenerative arthritis—irritate one or more of the upper cervical spinal nerves (typically C1–C3), and this irritation can cause referred pain that is perceived in the occipital (back of head), frontal (forehead), temporal (sides), or orbital (eye) regions. It is estimated that cervicogenic headaches account for approximately 4% of all headache cases and represent a common reason why adults, particularly those approaching middle age, seek chiropractic care.

When patients present to a chiropractic clinic with headaches, chiropractors will rely on patient history, clinical examination findings, and provocative orthopedic tests to determine if the headache is cervicogenic or another type (such as migraine or tension-type). Diagnosis can be complicated because some patients experience multiple headache types simultaneously.

To accurately diagnose cervicogenic headaches, chiropractors specifically look for these hallmark characteristics: unilateral pain (on one side of the head only) that does not shift sides in subsequent episodes; pain that typically originates in the neck and then radiates upward to the occipital, temporal, frontal, or orbital areas; pain that’s described as non-throbbing and non-lancinating (steady, dull, or aching rather than sharp or pulsing); episodes that vary significantly in duration, from hours to days, or even months; headache pain that’s frequently triggered or aggravated by neck movements or applying external pressure to the cervico-occipital junction (base of skull and upper neck); and pain that’s commonly accompanied by restricted neck range of motion and vague pain or stiffness in the shoulder or upper trapezius area.

Once the diagnosis is confirmed and underlying musculoskeletal dysfunction is identified, treatment can commence. Chiropractors typically employ a multimodal approach, combining in-office manual therapies (such as spinal adjustments, mobilizations, soft-tissue therapies, and muscle-energy techniques) with targeted therapeutic exercises for the patient to perform at home. Treatment for cervicogenic headache may also include intermittent cervical traction, administered either in-office or with an at-home traction device. Cervical traction helps relieve nerve root irritation or compression, decrease muscle spasms, enhance joint mobility, reduce vascular constriction, and promote healthier postural alignment.

Standard treatment guidelines for cervicogenic headaches often recommend an initial course of approximately eight to ten chiropractic visits over four to six weeks. However, exact treatment frequency and duration may vary based on individual patient factors and the chiropractor’s clinical judgment.

The Boundary Between Whiplash and Concussion

Whiplash associated disorders (WAD) is a term used to describe the constellation of symptoms resulting from the sudden acceleration and deceleration of the head, most commonly during motor vehicle collisions. This can include physical symptoms like neck pain and stiffness; pain that gets worse with neck movement; loss of neck motion; headaches that start at the base of the skull; tenderness/pain in the shoulder, upper back or arms; and tingling or numbness in the arms. However, WAD patients may also experience non-musculoskeletal symptoms that are also commonly associated with concussions like dizziness, fatigue, brain fog, blurred vision, ringing in the ears (tinnitus), sleep interruptions, memory problems, depression and anxiety. Let’s explore why this may be the case even if the skull may not strike anything during a car crash.

A 2021 systematic review of eight studies concluded that there are no clear boundaries between mild traumatic brain injury (mTBI) and whiplash-associated disorder (WAD), as they share many overlapping features — including similar symptoms, trauma biomechanics, cognitive impairments, diffuse axonal lesions visible on functional MRI (fMRI), cervical spine joint dysfunction, weakness in the deep cervical flexor muscles, and both tightness and weakness in the cervical extensor muscles, which can contribute to headaches. Additionally, researchers point out that examinations of patients suffering from persistent concussive syndrome often reveal cervical joint dysfunction and symptoms like neck pain and stiffness. Likewise, chronic WAD patients may experience many ongoing concussion-like symptoms.

During whiplash events, particularly rear-end collisions, the head undergoes rapid and forceful movement occurring in milliseconds—far too quickly for individuals to brace or prepare for the impact. The brain, suspended inside the skull by delicate ligaments, rapidly moves back and forth, striking the inner surfaces of the skull. Additionally, the diagonal shoulder-chest seatbelt used in vehicles can create a rotational force or torque on the torso and neck, introducing a twisting motion at impact. These rotational forces can cause shearing or tearing of delicate nerve fibers (axons) and may result in bruising or contusions to brain tissue, thus generating neurological symptoms characteristic of concussions. Thus, even in the absence of external trauma to the skull, the brain can become injured when it comes into forceful contact with the inside of the skull.

Chiropractors play a uniquely beneficial role in the management of WAD due to their holistic approach to patient care. Chiropractic treatment typically includes manual spinal manipulation and mobilization techniques aimed at restoring joint function, improving posture, and relieving pain. Doctors of chiropractic may also use various in-office physical modalities, such as electrical stimulation, therapeutic ultrasound, laser therapy, and pulsed electromagnetic field therapy, to reduce inflammation, accelerate healing, and manage acute or chronic pain. Patients commonly receive instruction on therapeutic exercises designed to strengthen weak muscle groups, stretch overly tight tissues, and correct abnormal posture patterns—particularly forward head posture. Additionally, chiropractors frequently provide dietary advice and recommend nutritional supplements aimed at reducing inflammation and supporting tissue healing, along with home-based pain management strategies involving ice, heat, and gentle movements.

Try Pickleball!

Chiropractors and other healthcare providers often encourage patients to sit less and move more, as an active lifestyle not only reduces the risk of early death and chronic disease but also helps seniors maintain their independence longer. Many aging adults are drawn to accessible forms of physical activity such as yoga, golf, Pilates, tai chi, and walking, but one that’s rapidly growing in popularity is pickleball.

Pickleball combines elements of tennis, badminton, and ping-pong using special paddles and a perforated plastic ball. With unique rules for underhanded serves, mandatory bounces after serving, and a non-volley zone near the net (known as "the kitchen"), the game fosters fun rally exchanges and is typically played in single or double formats. According to USA Pickleball, over 18,000 new courts were installed in the United States in 2023 alone, bringing the total to 68,458—clearly demonstrating the sport’s growing popularity.

A recreational match can last anywhere from 15 to 25 minutes, which means playing six to ten matches a week may be enough to meet general physical activity guidelines of 150 minutes of moderate-to-vigorous exercise a week. Beyond its physical benefits—including improved balance, which is especially important for older adults—pickleball is also a great way to relieve stress and socialize. A systematic review of 63 studies found that pickleball can positively impact personal well-being, life satisfaction, and mood in older adults. Researchers even suggest it could serve as a new tool to support both mental and physical health.

Of course, as pickleball is a physical activity that may result in fast movements and sudden changes in direction, there is a risk for injury. This is especially true for those who are new to exercise or have been sedentary. It's best to start at a lower intensity and gradually increase your activity level as your body adapts. Be sure to wear proper footwear, stretch before playing, stay hydrated, and wear sunscreen, a hat, and/or sunglasses when playing outdoors.

Regardless of age, if you’re looking for a fun way to stay active, pickleball might be a great option. And if aches or pains are holding you back, visit your chiropractor. A few targeted adjustments and some personalized home exercise recommendations could be all you need to get out on the court and enjoy the game.

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.