Monthly Pain Update – April 2025

The Gut Microbiome and Degenerative Disk Disease

Degenerative disk disease (DDD) is a condition where the intervertebral disks gradually break down leading to pain, stiffness, and reduced flexibility in the spine. While DDD is influenced by factors such as aging, mechanical stress, obesity, inflammation, trauma, and genetics, the exact mechanism that triggers the condition is not well understood. In recent years, scientists have begun looking toward the gut as a potential cause of DDD.

The gut microbiome is the diverse community of trillions of microorganisms, including bacteria and fungi, that live in the digestive tract and play a crucial role in our overall health. The types of bacteria that comprise the gut microbiome depend mainly on our lifestyle, particularly the food we eat. Bacteria that thrive on foods that are rich in vitamins, nutrients, and fiber tend to have a positive effect on the body. On the other hand, bacteria that rely on processed food and added sugars (and other “unhealthy” foods) are likely to have a negative impact. When there are too many “bad” bacteria present, it can lead to a host of problems with respect to digestion, mood, immune function, and more.

Some researchers propose that increased gut permeability (leaky gut), triggered by an imbalance of gut bacteria, may allow bacterial toxins to enter circulation, promoting systemic inflammation that could contribute to spinal disk degeneration. Over the long term, continual inflammatory responses can be detrimental to body tissues, including the intervertebral disks. A 2024 study analyzing stool samples from 60 adults (40 with DDD) found that individuals with DDD had a higher concentration of gut bacteria linked to systemic inflammation, suggesting a possible relationship between gut health and disk degeneration. Another study, also published in 2024, came to a similar finding for patients suffering from regional and chronic pain.

More research is needed before treatment guidelines for DDD can be updated to include addressing dysbiosis in the gut microbiome as part of a multimodal treatment plan for DDD. However, with the various positive benefits linked to improved gut health, it may be worth pursuing anyway. Strategies for improving gut health include adopting a Mediterranean-style diet, increasing dietary fiber intake, consuming fermented foods (e.g., yogurt, kimchi, sauerkraut), avoiding processed foods, regular exercise, staying hydrated, managing stress, avoiding excessive alcohol consumption, and getting quality sleep. Chiropractic care for DDD often includes spinal adjustments, mobilization techniques, and soft tissue therapies aimed at improving joint mobility, reducing muscle tension, and addressing biomechanical imbalances that may contribute to disk degeneration.

Decision-Making Factors for Carpal Tunnel Syndrome Care

While carpal tunnel syndrome (CTS) is a very common condition, controversy still exists among researchers and healthcare professionals regarding best practices for managing the condition. Most studies on musculoskeletal disorders, including CTS, focus on identifying treatments that provide symptom relief rather than exploring the factors influencing patients' decisions, particularly when choosing between surgical and non-surgical options.

A December 2024 meta-analysis reviewed six studies that examined CTS treatment from the patient's perspective, revealing four key decision-making themes:

• Return to Normalcy – Does this treatment effectively relieve symptoms and restore quality of life, allowing for uninterrupted sleep and daily activities?
• Patient-Centered Care – Is treatment information clear, specific, and accessible? Are patients given options, or are they simply told what their treatment will be?
• Work Considerations – Will treatment require time off work or job modifications? Will the doctor provide necessary documentation for the employer? Will the patient be able to return to their usual job, or must they consider a career change?
• Expectations – How quickly will relief occur? What is the likelihood of full recovery? If this treatment fails, what are the next steps?

The authors emphasized the importance of healthcare providers considering multiple decision-making factors and prioritizing clear communication and shared decision-making in CTS care. This approach enhances patient satisfaction and may lead to better treatment outcomes.

Chiropractic care provides CTS patients with a non-surgical treatment option that incorporates manual therapies to restore mobility to the median nerve, not only at the wrist but along its entire course from the neck to the hands. In addition, chiropractors may use complementary approaches such as night splinting, exercise training, physical therapy modalities, ergonomic assessment and modifications, and anti-inflammatory strategies. If necessary, care may be co-managed with other healthcare professionals who provide services beyond a doctor of chiropractic’s scope of practice.

Active Vs. Passive Treatment for Hip Pain

Patients frequently seek chiropractic care for hip-related conditions—such as femoroacetabular impingement, developmental dysplasia of the hip, labral tears, and cartilage injuries—often in hopes of preventing or delaying surgery. Fortunately, treatment guidelines for these and many musculoskeletal conditions typically recommend non-surgical approaches as the first line of treatment. But which manual therapies provided by chiropractors are most effective for painful and disabling hip conditions?

Active therapies involve patient participation, requiring movement or resistance to movement. Examples include stretching and strengthening exercises to correct muscle imbalances, resistance training through a full range of motion, and movement pattern exercises to enhance proprioception. In contrast, passive therapies are administered solely by the chiropractor. These include spinal manipulation and mobilization to restore joint function, myofascial release to alleviate muscle tension, massage to promote relaxation and circulation, and trigger point therapy to relieve muscle knots.

A November 2023 study recruited 33 young adults with hip-related groin pain and divided them into two treatment groups. The passive treatment group underwent joint mobilization therapy aimed at reducing pain and improving mobility. The active treatment group engaged in exercises aimed at correcting abnormal movement patterns while performing various tasks. Assessments completed by patients in both groups at the conclusion of the treatment period revealed both experienced significant improvement in hip-related pain and disability. Another study compared two active treatments—the approach used in the prior study and a more general strength training and stretching regimen. Both methods led to improvements in hip strength, muscle volume, and reduced fat infiltration in the muscle.

These findings suggest that both active and passive therapies benefit patients with hip conditions. Chiropractors often utilize one or more of each type as part of a comprehensive treatment plan. Of course, the specific therapies used will depend on several factors including patient history, examination findings, patient preference, and their chiropractor’s training and clinical experience. If a patient does not respond to treatment, adjustments can be made to optimize outcomes.

Poor Neck Posture’s Effect on Balance and Breathing

Ideally, the head should rest on the neck with the external auditory meatus (ear opening) aligning with the acromion process (bony end of the shoulder) when viewed from the side. When we have good neck posture, it’s hard to believe the head weighs the same as a recreational bowling ball. Unfortunately, most people don’t have ideal posture. Studies estimate that a significant portion of the population—especially those who spend prolonged hours on screens—exhibits forward head posture. Research suggests that for every one inch the head shifts forward, the load on the cervical spine increases by approximately 10 lbs., placing excessive strain on the neck muscles and joints, which can result in neck pain. Forward head posture can also affect balance and breathing. Here’s how…

Our body maintains balance through the careful coordination of three systems. Most people are familiar with the vestibular system in the inner ear and our visual system as being important for balance, but many are less familiar with the proprioceptive system. Proprioceptors are special nerve cells in tendons, muscles, and joints that provide feedback about where the various parts of the body are in relation to one another. The soft tissues in the neck are particularly rich in proprioceptors, and the excess stress and strain caused by forward head posture can impair their function, which in turn can affect balance, coordination, and spatial awareness.

Forward-head posture leads to a rounded upper back (thoracic kyphosis), restricting lower rib mobility and diaphragm efficiency. This may reduce forced vital capacity, inspiratory reserve volume, and peak expiratory flow, leading to shallower breathing and decreased oxygen intake. Essentially, forward head posture means you can’t breathe as deeply and have less lung capacity and oxygen intake, potentially leading to lower fitness, less vitality, brain fog, and difficulty maintaining focus. Patients with forward head posture also tend to overuse the chest and neck muscles when breathing, which can affect the ability of these muscles to contribute to other activities.

Chiropractic care for forward head posture typically involves a multimodal approach, including spinal adjustments to improve cervical mobility, myofascial release to relieve muscle tension, postural retraining exercises to strengthen stabilizing muscles, and ergonomic recommendations to help patients maintain proper head positioning throughout daily activities. If proprioception or breathing deficits are observed, additional strategies will be employed both in the office and at home to help restore normal function as quickly as possible.

Fatty Infiltration and Chronic Whiplash Associated Disorders

Whiplash-associated disorders (WAD) refer to a range of symptoms—including neck pain, stiffness, headaches, dizziness, and reduced mobility—that arise from a hyperextension-flexion injury of the cervical spine. This commonly occurs due to sudden acceleration and deceleration forces, most often seen in motor vehicle collisions. Research suggests that up to 50% of the 3 million Americans who develop WAD each year will continue to experience persistent pain and disability for months or even years post-injury. In order to reduce the risk of chronic WAD and its accompanying impact on the individual and society in general, several studies in the last decade have sought to identify why some patients recover and others don’t. It appears one piece to this puzzle may be what happens within the injured muscles.

In a July 2023 study, researchers recruited 97 adults who visited an emergency room following a motor vehicle collision that did not result in hospitalization. The research team monitored the participants for the following year with the aid of magnetic resonance imaging (MRI), functional examinations, and patient outcome questionnaires. The study found that individuals with greater fat infiltration in their neck muscles had a higher likelihood of developing moderate-to-severe chronic WAD symptoms, including persistent neck pain and disability. While this does not establish causation, it suggests that muscle degeneration may play a role in long-term recovery outcomes.

When muscles become underused or damaged, they atrophy (shrink), and as a compensatory process, the body gradually replaces lost muscle fibers with fat and fibrotic tissue. The deep neck muscles, which are important for maintaining balance and spinal stability, are particularly susceptible to injury during a whiplash event. If these muscles become injured, the superficial muscles used to consciously move the head and neck will be forced to take on these added functions. In the short term, this may not be a problem but over time, the deep muscles can weaken and atrophy allowing fat infiltration to occur.

This finding supports the importance of early chiropractic intervention and staying active to reduce the risk of WAD progressing to a chronic condition. Chiropractic care for WAD typically includes spinal mobilization, myofascial release, and neuromuscular retraining to improve joint mobility and restore proper muscle function. Additionally, chiropractors encourage patients to gradually return to normal activities within pain tolerances, avoiding excessive restriction of movement to help maintain muscle function, prevent stiffness, and promote recovery while minimizing the risk of re-injury.

Maintaining Physical Function in Older Adults

By 2050, the population of adults over age 65 in the United States is expected to grow by more than 40%, reaching over 83.7 million and making up nearly a quarter of the American population. From a societal standpoint, helping older adults stay healthy and independent is crucial not only for maintaining their quality of life but also for reducing the economic burden associated with aging-related care. According to the World Health Organization, healthy aging largely depends on “the ability to preserve intrinsic capacity,” which refers to an individual's combined physical and mental abilities. Let’s look at how we can maintain our physical capacity as we age.

Aging naturally leads to a decline in physical function, and unfortunately, there is no drug available to prevent this process. However, research has demonstrated that engaging in structured, repetitive physical activity improves function and slows aging-related decline in older adults. This is critical because balance impairments and difficulty with daily activities increase fall risk, potentially leading to serious injuries that compromise independence. Additionally, exercise helps keep us metabolically healthy, which can reduce the risk for chronic disease, another issue that can make independent living difficult.

Research highlights how quickly inactivity leads to functional decline. Many seniors in long-term care facilities spend most of their day sedentary, engaging in exercise only once or twice a week. Within two years of admission, half of these residents lose the ability to independently perform at least one daily living activity. A systematic review of 147 studies found that exercise significantly improves physical function in older adults, with optimal benefits seen at around 170 minutes per week. This falls closely in line with fitness guidelines for seniors recommending at least 150 minutes of moderate-to-vigorous physical activity a week, accompanied by two-to-three sessions of strength training and balance-focused exercises.

Even older adults with sarcopenia (loss of muscle mass) and frailty can benefit from exercise. An analysis of 11 randomized clinical trials found that supervised tai chi classes—an ancient Chinese practice combining slow, deliberate movements with deep breathing—led to significant improvements in physical function, walking ability, fear of falling (kinesiophobia), balance, blood pressure, mood, and overall quality of life. Interestingly, a 2019 study found that adults in their 70s and 80s—regardless of their exercise history—have a similar ability to build muscle in response to strength training.

Pain and the fear of worsening it are among the biggest barriers to exercise. However, research shows that exercise often helps manage pain and plays a key role in treatment plans. If pain is keeping you from staying active, consult a chiropractor. A few treatments might be all it takes to get you back to (or started on) a great workout routine!

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.