Monthly Pain Update – December 2025
Risk Factors for Postpartum Low Back Pain
It’s estimated that as many as 50–70% of new mothers experience low back pain and related disability, which can hinder their ability to carry out daily activities such as household chores, self-care, and meeting the physical demands of infant care—including feeding, lifting, and carrying. When severe enough, these physical limitations can contribute to stress, anxiety, and postpartum depression, further interfering with the mother’s ability to bond with her newborn and diminishing her overall quality of life. What are the underlying causes of postpartum low back pain?
Interestingly, some risk factors may be present even before conception. Research suggests that being overweight or obese, physically inactive, or exposed to occupational risk factors such as whole-body vibration, poor ergonomics, and frequent lifting can set the stage for low back pain both during pregnancy and after delivery. Women with a prior history of low back pain are also at elevated risk for symptoms during and following pregnancy.
As the baby grows, the center of mass shifts forward in the body. To compensate, the pelvis tilts anteriorly and the lumbar spine increases in lordosis, placing added stress on the lumbar intervertebral disks and facet joints. The stretching of the abdominal muscles can reduce spinal stability, while hormonal changes that prepare the pelvis for childbirth can increase joint laxity, further affecting stability in the lower spine and pelvic region. To compound these effects, expectant mothers may experience fluid retention, deconditioning from reduced activity, sleep positions that strain the lower back, and psychosocial factors such as stress and anxiety that heighten pain perception.
Childbirth itself can also contribute to postpartum low back pain. The physical effort of pushing during delivery can strain the lower back, and the hormonal changes that allow for ligamentous laxity during pregnancy may persist afterward, leaving the spine more susceptible to mechanical stress. In cases of cesarean delivery, factors such as spinal anesthesia, post-surgical immobilization, and prolonged bedrest can further delay recovery and exacerbate pain.
Unfortunately, it’s a common misconception that postpartum low back pain will simply resolve on its own. In reality, studies suggest that up to 1 in 5 new mothers with low back pain will develop chronic symptoms lasting a year or longer. While some risk factors for postpartum low back pain are beyond a woman’s control, others—such as maintaining an active lifestyle, avoiding prolonged inactivity, and seeking chiropractic care to help restore proper joint motion and function in the lumbar spine during and after pregnancy—can play a key role in prevention and recovery.
Midlife Carpal Tunnel Syndrome
Carpal tunnel syndrome (CTS) occurs when the median nerve becomes compressed or restricted as it passes through the wrist. Early on, this may cause mild, intermittent tingling, numbness, or pain in parts of the hand, but over time, symptoms can become more frequent and activity-limiting. While CTS can develop at any age, it’s most common during midlife due to the convergence of three key factors: occupational stress, hormonal and metabolic changes, and age-related anatomy.
When we perform frequent, repetitive hand movements, the tendons that run through the carpal tunnel glide back and forth against one another. Over time, the lubricating sheaths surrounding these tendons can become inflamed and sustain micro-injuries that need time to recover. However, occupations or hobbies that involve non-neutral wrist positions, high gripping forces, or vibration exposure often provide little opportunity for rest. After years—or decades—of repetitive stress, minor irritation can progress into chronic inflammation that’s difficult to ignore or manage with over-the-counter remedies.
In addition to repetitive movement, hormonal changes and worsening metabolic health during midlife increase CTS risk. Chronically elevated blood sugar can thicken connective tissue (including the transverse carpal ligament) and increase fluid retention, both of which reduce space inside the carpal tunnel and place pressure on the median nerve. Poor metabolic health also damages the microvessels that supply the nerve and fuel systemic inflammation that can narrow the tunnel even further. Women face an added risk during this stage of life, as changes in estrogen and thyroid hormones can make tissues less elastic and more vulnerable to shear forces.
Age-related changes compound the problem. As we grow older, damaged tissues heal and regenerate more slowly. Tendons thicken, ligaments stiffen, and the myelin sheath that insulates nerves can begin to thin, leaving the median nerve more susceptible to compression at the carpal tunnel. Muscle mass naturally declines as well, reducing the stabilizing forces around the wrist. These changes affect not only the carpal tunnel itself but the entire course of the median nerve—from the neck and shoulder down through the elbow and forearm—meaning that restriction anywhere along its path can heighten sensitivity to compression at the wrist.
Fortunately, all is not lost. Although we can’t stop the aging process, we can control occupational and metabolic risk factors. Adjusting tools to maintain a neutral wrist position, scheduling regular micro-breaks, and performing nerve-gliding or wrist-mobility exercises can help reduce pressure in the tunnel. Supporting overall metabolic health is equally important: limit sugary drinks and ultra-processed foods, increase fruit and vegetable intake, take daily walks, and aim for 150 minutes of moderate activity plus two resistance-training sessions per week.
Finally, chiropractic care can help restore normal motion to the wrist and surrounding joints, reducing strain on the median nerve along its entire pathway. Your chiropractor can also teach you the most effective exercises for symptom management and guide you on ergonomic adjustments to keep your wrists healthy long-term.
Internal vs. External Shoulder Impingement Syndrome
Most adults will experience shoulder pain at some point during their lifetime, and it’s estimated that nearly one-third of adults are affected each year. Among the many possible diagnoses, shoulder impingement syndrome accounts for roughly half of all shoulder pain cases. However, current understanding indicates that shoulder impingement syndrome is not a single diagnosis, but rather a cluster of symptoms that can arise from multiple anatomical and biomechanical factors. The condition is typically classified as either internal or external, depending on where and how the impingement occurs.
The shoulder complex functions as an integrated system of four joints that together allow for an exceptional range of motion. The glenohumeral joint that joins the humerus (upper arm bone) with the glenoid fossa of the scapula is the primary joint responsible for most shoulder movement. It is stabilized by the rotator cuff muscles, labrum, and surrounding ligaments. Under ideal conditions, this joint moves freely to perform tasks like lifting, throwing, or reaching overhead. But when mechanical forces, either within the joint itself or external to it, disrupt that motion, the result may be pain, inflammation, and limited movement. Over time, chronic irritation may lead to scar tissue formation and even degenerative changes.
External impingement occurs when the acromion or coracoacromial ligament compress the rotator cuff during arm elevation. While anatomical variations such as a hooked acromion can predispose some individuals to impingement, the most common contributors are poor scapular control, forward shoulder posture, rotator cuff weakness, or degenerative changes from repetitive overhead activity or aging.
Internal impingement, on the other hand, occurs when the humeral head pinches the rear portion of the rotator cuff between the greater tuberosity and the posterior glenoid rim during high-velocity overhead movements such as throwing or serving. Contributing factors often include posterior capsule tightness, shoulder instability, scapular dyskinesis, excessive external rotation, and repetitive overuse. Internal impingement is more common among younger, athletic, or physically active individuals.
While surgery is occasionally indicated as a first-line intervention in specific cases (such as significant structural damage or full-thickness rotator cuff tears), clinical guidelines overwhelmingly recommend conservative management as the initial approach, with chiropractic care serving an excellent choice! Treatment typically aims to restore normal movement patterns within the shoulder complex through a multimodal approach that may include manual therapies, joint mobilization, specific exercises, physiotherapy modalities, traction, and postural retraining. The goal is to reduce inflammation, restore joint motion, release adhesions, address trigger points, and strengthen weakened muscles.
Chiropractic Treatment for Chronic Rhinosinusitis?
Chronic rhinosinusitis is a long-term inflammation of the nasal and paranasal sinus mucosa lasting twelve weeks or more, characterized by at least two of the following symptoms: nasal congestion, facial pressure or pain, reduced sense of smell, and/or nasal discharge. It’s estimated that about 1 in 10 adults worldwide are affected, though prevalence may be higher in some regions due to genetic, cultural, and environmental factors that contribute to persistent inflammation of the nasal and sinus lining.
Contributing factors can include allergic or environmental irritants—from household allergens to air pollution—structural issues such as a deviated nasal septum, enlarged turbinates, or nasal polyps that obstruct sinus drainage, recurrent infections, immune dysfunction, asthma, and even gastroesophageal reflux. It’s highly likely that two or more of these are present in a patient, making each case somewhat unique and often requiring a tailored, multidisciplinary approach to resolve symptoms.
Standard treatment usually starts with intranasal corticosteroids and nasal saline irrigation, with the option of adding antibiotics, systemic steroids, antihistamines, decongestants, or leukotriene modifiers. The data show that up to 90% of chronic rhinosinusitis patients without nasal polyps respond to this approach, though the success rate falls to 50–70% in the presence of nasal polyps. For the 10–20% who don’t respond to conventional treatment, the patient may receive referral to see if they are a candidate for functional endoscopic sinus surgery aimed at enlarging the sinuses to restore proper drainage and ventilation.
For patients who don’t tolerate certain medications, wish to avoid surgery, or continue to experience symptoms even after undergoing functional endoscopic sinus surgery, there is limited evidence that some hands-on therapies provided by chiropractors may be of benefit. A 2024 systematic review reported that manual therapies—including cervical soft tissue manipulation, cervical myofascial release, cervical high-velocity/low-amplitude thrust manipulation (HVLA-TM), thoracic muscle energy, scapular release, thoracic HVLA-TM, cranial techniques, and lymphatic drainage—may help reduce head and neck congestion, improve lymphatic and venous outflow, normalize autonomic tone, enhance respiratory mechanics and immune function, and decrease perceived facial pressure and headache.
While chiropractors in most jurisdictions are recognized as portal-of-entry healthcare providers—meaning patients can see them directly without referral—chronic rhinosinusitis may, in some regions, fall outside the direct chiropractic scope of practice. In such cases, co-management with the patient’s physician is advised, and chiropractic care should be provided on an adjunctive basis consistent with local regulations.
The good news is that conservative care has a high success rate for both internal and external impingement—especially when treatment begins early—helping most patients recover without the need for surgery.
The Four Grades of Whiplash Associated Disorders
Whiplash occurs when the head suddenly accelerates and then rapidly decelerates, placing excessive strain on the soft tissues that support the neck. In addition to neck pain and stiffness, this motion can produce a variety of symptoms collectively known as whiplash-associated disorders (WAD). To better define and manage these injuries, the Quebec Task Force on Whiplash-Associated Disorders (1995) developed a classification system that grades whiplash severity from I to IV.
WAD I is characterized by neck pain and stiffness without any objective findings on physical examination. In other words, there is no loss of range of motion; no muscle spasm or guarding; no swelling, bruising, or deformity; no neurological deficit; and no imaging abnormalities. Approximately 15–25% of whiplash patients fall into this category.
In WAD II, neck symptoms are accompanied by physical examination findings such as decreased range of motion, localized tenderness in neck muscles, muscle spasm, and sometimes headache. However, there are no neurological deficits or abnormalities visible on diagnostic imaging. About two-thirds of whiplash patients are graded WAD II.
At the WAD III level, patients present with both musculoskeletal findings (as seen in WAD II) and neurological signs, which may include sensory loss (numbness or tingling), motor weakness (reduced strength in muscles supplied by affected cervical nerves), altered reflexes, or radiating arm pain. As with WAD I and II, the injury still involves soft tissues that typically do not appear on X-ray or advanced imaging. Approximately 5–10% of whiplash patients fall into this grade of WAD.
The classification of WAD IV is utilized when there is structural damage to the cervical spine that is present on diagnostic imaging and is usually associated with severe symptoms. Patients with WAD IV typically require emergency treatment to stabilize the spine. Fortunately, fewer than 1–2% of whiplash patients meet this criterion.
The good news is that WAD I, II, and III typically respond well to a multimodal chiropractic approach aimed at reducing pain and restoring function as quickly as possible. Manual therapies may include gentle, low-velocity, low-amplitude techniques; thrust manipulation (high-velocity, low-amplitude); facet gliding; long-axis cervical traction; passive range-of-motion exercises; massage; trigger-point therapy; dry needling; or acupuncture. Adjunctive physical therapy modalities such as electrical stimulation, therapeutic ultrasound, laser therapy, pulsed electromagnetic field (PEMF) therapy, in-office or home cervical traction, and others are also frequently utilized. Exercise training is a crucial component of care, as long-term improvement depends on patient self-management and reduces provider dependency that can sometimes arise. In the event a patient does not respond to care or if additional issues are present that fall outside the chiropractic scope, the case may be co-managed with an allied healthcare provider.
Sleep Is Essential for Good Health
Sleep is a fundamental biological necessity that supports vital processes such as brain waste clearance, immune regulation, and nutrient metabolism. While the body can recover from an occasional night of poor rest, frequent sleep disruption can set the stage for chronic disease. Experts estimate that about ten percent of adults meet the criteria for insomnia, while another twenty percent experience occasional insomnia symptoms, highlighting just how widespread sleep problems are.
There are three key ingredients for healthy sleep: quantity, quality, and consistency. Adults generally need seven to nine hours of rest each night, with the required amount gradually decreasing with age. If you find yourself sleeping in on weekends or relying on naps to catch up, that’s a clear sign you’re not getting enough sleep during the week. But the number of hours alone doesn’t tell the whole story. The body cycles through several stages of sleep—from light to deep to rapid eye movement—and waking repeatedly during the night can interrupt these cycles, leaving you feeling tired even after spending sufficient time in bed. Equally important is maintaining a regular sleep schedule. Going to bed and waking up at the same time each day, even on weekends, helps regulate the body’s circadian rhythm, the internal clock that governs hormone release, body temperature, and alertness. When this rhythm is stable, it becomes easier to fall asleep, stay asleep, and wake feeling refreshed.
And no, that morning cup of coffee can’t make up for poor sleep. In fact, an analysis of data concerning more than 88,000 adults in the UK Biobank study found that inadequate or irregular sleep is associated with 172 diseases, including dementia, Parkinson’s disease, and diabetes. For 42 of these conditions—among them liver cirrhosis, fibrosis, and age-related frailty—poor sleep more than doubles disease risk. Remarkably, the researchers estimate that insufficient or irregular sleep accounts for roughly 20% of the overall risk profile in 92 of these conditions, suggesting that sleep regularity may play an even greater role in long-term health than sleep duration alone.
To set the stage for better sleep, experts emphasize lifestyle and environmental factors that support the body’s natural rhythms. A nutrient-rich diet, regular physical activity, limited alcohol and caffeine intake, and effective stress management all contribute to more restful sleep. Exposure to natural light during the day and minimizing blue light from screens in the evening help reinforce the body’s natural light–dark cycle. Keeping the bedroom dark, quiet, and cool promotes deeper rest, while maintaining a consistent bedtime strengthens the brain’s expectation of when to release sleep-related hormones. If snoring, gasping, or frequent awakenings are a problem, a sleep specialist can evaluate for conditions such as sleep apnea.
Finally, when pain interferes with sleep, addressing the source is essential. Research shows a bidirectional relationship between poor sleep and musculoskeletal pain—particularly low back pain—meaning that inadequate rest can worsen discomfort, and discomfort can further erode sleep quality. In such cases, consulting a doctor of chiropractic can be an important step toward breaking this cycle and restoring both comfort and healthy sleep.
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.