Monthly Pain Update – May 2025

X-Rays for Seniors with Chronic Low Back Pain

Chronic low back pain is a common condition that becomes even more prevalent with age. By some estimates, it may affect nearly 3 in 4 older adults each year. As individuals aged 65 and older continue to make up a growing share of the global population, chronic low back pain will remain a significant healthcare concern. Given the risks associated with surgery and medication side effects, many seniors prefer a non-surgical, non-pharmacologic approach to managing their pain—leading them to seek chiropractic care.

X-rays may or may not be used during an examination, which can sometimes cause confusion for patients. Many are surprised to learn that one of the primary uses of X-ray in chiropractic care is not to help decide if a patient may not be a candidate for chiropractic treatment. If a patient's history or symptoms include significant trauma, a history of cancer, osteoporosis, prolonged corticosteroid use, infection, high fever, worsening pain at rest, neurological symptoms, sudden deformity, or a palpable mass, an X-ray may be warranted. In such cases, imaging helps identify fractures, severe osteoporosis, tumors, infections, or other serious conditions that require referral to a specialist or emergency care.

Absent red flags, most clinical guidelines do not recommend X-rays for uncomplicated chronic low back pain in older adults. Not only can this avoid unnecessary radiation exposure, but many older adults have incidental findings on X-ray—such as disk degeneration, disk herniation, or scoliosis—that may not be the primary cause of their pain. Focusing on these findings could lead to unnecessary and ineffective treatment with the patient continuing to experience ongoing pain and disability.

Interestingly, many spine-related complaints in older adults do not have a clear structural cause, meaning the pain may not be visible on X-ray. This underscores the importance of chiropractors performing movement-based assessments to identify soft tissue dysfunction that may be contributing to the patient's pain. By replicating the motions that provoke discomfort, chiropractors can gain valuable insights into muscular, ligamentous, and fascial contributions to the patient’s chief complaint, allowing for a more targeted care plan.

Fortunately, many cases of chronic low back pain in older adults respond well to a multimodal treatment plan that incorporates manual therapies, targeted exercises, therapeutic modalities, patient education, and nutritional support. This approach not only helps reduce pain but also improves mobility, function, and overall quality of life.

Truck Driving and Carpal Tunnel Syndrome

When we think of carpal tunnel syndrome, we often picture people whose jobs or leisure activities involve rapid hand movements—like typing, playing an instrument, or line work; heavy tool usage—like construction work; or prolonged time spent in awkward hand positions—like dentists and surgeons. One profession we don’t typically consider is professional drivers, especially those behind the wheel of big rigs traveling long distances. So why are truckers at an elevated risk for carpal tunnel syndrome?

The carpal tunnel itself is a very small structure through which tendons, blood vessels, and the median nerve all pass. Any activity that either reduces the size of the tunnel or increases the volume of its contents can restrict movement of the median nerve. This can lead to pain, numbness, tingling, and other symptoms associated with carpal tunnel syndrome. The muscles located on the palm side of the forearm attach to the tendons that allow us to grip a steering wheel—often in a non-neutral posture—which can reduce the cross-sectional area of the carpal tunnel while prolonged static muscle contractions can overload the tendons, leading to inflammation and increased pressure on the median nerve. The low-frequency vibrations from the engine and roadway can also irritate the median nerve.

Beyond these factors that directly affect the wrist, truck drivers often maintain static postures for several hours at a time. This can contribute to postural imbalances that place stress on the median nerve at other locations—such as the neck, shoulder, elbow, or forearm. Nerve compression at these sites can not only generate symptoms commonly mistaken for carpal tunnel syndrome but also increase the risk of median nerve entrapment at the wrist. To complicate matters further, metabolic conditions like diabetes—and even some medications used to manage chronic illness—are linked to an increased risk of developing carpal tunnel syndrome due to potential effects on nerve health, water retention, inflammation, and more.

All of this underscores the importance of seeking care early in the course of the condition when symptoms are mild. Early intervention increases the chance for a successful outcome and can prevent symptoms from escalating to the point they affect work performance. A doctor of chiropractic can provide in-office treatment to help restore mobility to the median nerve—at the wrist or other compression points—and can also demonstrate exercises that can be performed on the go, as well as offer ergonomic advice to help maintain a neutral wrist position while driving.

A Common Cause of Kneecap Pain

Patellofemoral pain syndrome (PFPS) is characterized by pain in the front region of the knee, around the patella (kneecap), and is often described as stabbing, aching, and/or burning—especially during movements that increase pressure between the femur and patella. Common aggravating activities include prolonged sitting, transitioning from sitting to standing, climbing or descending stairs, kneeling, squatting, running on hills or uneven surfaces, and jumping or other high-impact movements. In moderate to severe cases, PFPS can make even simple tasks painful and frustrating, potentially leading to increased sedentary behavior, muscle deconditioning, and secondary mental health concerns.

Although PFPS can occasionally arise from a specific incident—such as a fall, jump, or direct trauma to the kneecap—it often develops gradually. The prevailing theory is that most cases stem from repetitive stress combined with faulty movement patterns, which over time overload the patellofemoral joint. These abnormal mechanics may result from misalignments, imbalances, or injuries affecting the bones, muscles, joints, or soft tissues of the knee. Over time, poor biomechanics increase localized stress and may lead to irritation or pain around the kneecap.

Importantly, PFPS may also originate from dysfunction elsewhere in the kinetic chain. Contributing factors include improper running mechanics (such as over-striding or heel striking), foot and ankle issues like pes planus (flat feet), or excessive pronation, as well as weakness or imbalances in the hips. Pelvic instability or tilt and core weakness can also alter lower limb alignment, further increasing stress on the patellofemoral joint. Even a slight increase in tissue load over time—especially in the context of repetitive movements and insufficient recovery—can lead to microtrauma and eventual pain.

When a patient presents for chiropractic care with suspected PFPS, a thorough history and physical examination are essential to rule out other causes of anterior knee pain, such as chondromalacia patella, runner’s knee, jumper’s knee, bursitis, or osteoarthritis. These conditions may co-occur with PFPS and require concurrent management to ensure the best clinical outcome. Assessment of the entire kinetic chain—including the feet, ankles, hips, pelvis, and core—is crucial to identify biomechanical contributors that may place undue stress on the knee.

Once contributing factors are identified, treatment is typically multimodal, incorporating manual therapies to restore normal joint motion (especially in the knee, hip, and ankle); in-office physiotherapy modalities; therapeutic exercises to strengthen weak muscle groups and/or stretch tight muscles; and activity modification to reduce load on the patellofemoral joint during recovery. A comprehensive, individualized approach is key to reducing symptoms, restoring function, and preventing recurrence.

Neck Pain in Young Adults

Neck pain is a common complaint at all age levels, but it can be particularly problematic in the young adult population as it can limit their ability to carry out daily life and work activities and negatively affect their quality of life as they start their careers and build their lives. In fact, a 2020 study found that 58.3% of young adults experienced at least one episode of neck pain in the previous year. As you might expect, a key driver of neck pain among this age group is their screentime habits.

In an August 2024 study, researchers examined 62 university students who had experienced at least two episodes of neck pain in the previous year. The study found that students who spent four or more hours a day on their smartphones reported significantly higher levels of neck pain. These students also demonstrated reduced endurance in the deep neck flexor muscles—key stabilizers of the cervical spine that support the head.

But why would prolonged device use lead to weakness in these muscles? The answer lies in forward head posture. Ideally, the head should rest on the cervical spine so that the ear aligns with the end of the shoulder when viewed from the side. However, when the head tilts forward and downward toward a screen, the deep neck flexor muscles become inactive. Over time, this inactivity can lead to deconditioning. To compensate, superficial muscles—typically responsible for voluntary head and neck movement—take over, becoming fatigued and overworked. This imbalance increases the risk of musculoskeletal pain and dysfunction.

The good news is that a few simple lifestyle adjustments can help reverse this process and reduce the risk of chronic neck pain. First, try to spend less time on your phone. If avoiding prolonged phone use isn’t possible, set reminders to take breaks every 20-30 minutes to stretch and move around. Holding your phone at eye level can also help maintain better posture and prevent excessive downward tilting of the head. Additionally, limiting sedentary time and engaging in more physical activity can not only reduce the risk of musculoskeletal pain but also support better cognitive function and mental health.

To strengthen the deep neck flexors, try this simple exercise: retract your chin and head (as if creating a "double chin"); keeping the chin tucked, slowly nod your head up and down by about two to three inches; repeat 5-10 times, several times a day. As you build strength, add resistance by pressing your hand gently against the front or back of your head during the movement.

If neck pain persists despite these efforts, consider consulting a chiropractor who can provide hands-on treatment, assess your posture, and recommend additional corrective exercises tailored to your specific needs.

Whiplash and Injury to the Facet Joints

The facet joints are located in the posterior (back) part of the vertebrae and are typically symmetrical, with four per vertebra—a left and right superior facet and an inferior facet set. The superior and inferior facets articulate with the corresponding facets of the adjacent vertebrae, contributing to spinal stability, mechanical load distribution, and controlled movement. The rapid acceleration-deceleration mechanism of a whiplash injury can overstretch the muscles, ligaments, and synovial capsules surrounding the facet joints, and since these structures are highly pain-sensitive, facet joint damage can result in various pain presentations.

The most common pain pattern for facet joint injuries involves localized pain and stiffness at the site of inflammation, often exacerbated by neck movements such as looking over the shoulder. Patients may also experience referred pain to the shoulder blade region in the mid-back. If the injury irritates nearby spinal nerves, the patient may also report numbness, tingling, or radiating pain extending into the shoulder, arm, and hand on the affected side.

During the examination, a chiropractor will assess pain response to movement, particularly if pain worsens with extension (bending backward) and rotation, range of motion limitations and whether movement reproduces symptoms, and localized tenderness or joint stiffness upon palpation. They will also perform orthopedic and neurological tests to provoke facet joint pain, rule out nerve root involvement, and to differentiate facet joint dysfunction from other potential causes of pain, such as disk herniation, muscle strain, or spinal stenosis. If necessary, X-rays may be taken to rule out fractures or other red flags that would contraindicate chiropractic treatment, such as severe degenerative changes or spinal instability.

Like other joints in the body, the facet joints can wear down over time, leading to degenerative joint disease (DJD) or osteoarthritis, which are very common in older adults. However, facet joint injuries sustained earlier in life (such as from a car accident) can accelerate degenerative changes, leading to early-onset DJD or osteoarthritis. This underscores the importance of timely and appropriate care during the acute injury phase to reduce long-term complications.

Chiropractors utilize a multimodal approach to managing whiplash-associated disorder (WAD) and facet joint dysfunction, incorporating manual therapy (spinal adjustments, mobilization techniques); therapeutic exercises to restore mobility and strength; general fitness guidance to improve posture and spinal health; in-office physiotherapy modalities (e.g., ultrasound, electrical stimulation); anti-inflammatory strategies, including ice therapy and nutritional support; and more. In complex cases, co-management with the patient’s primary care physician or a specialist may be necessary to achieve the best possible outcome.