Monthly Pain Update – September 2025

Dynamic Stabilization Exercises for Chronic Low Back Pain

In addition to persistent pain, individuals with chronic low back pain often exhibit impaired postural control, which is linked to core muscle atrophy, weakness, and dysfunctional motor control. One effective method for addressing these deficits is dynamic stabilization exercises—a functional approach based on developmental movement patterns modeled after infant motor learning. This strategy aims to restore optimal body function by aligning the head and spine and integrating postural awareness, breathing mechanics, and motor control. The primary goal of dynamic stabilization training is to activate the appropriate respiratory and core muscles to maintain core stability during static positions and locomotor tasks. Common exercises include:

• Supine Diaphragmatic Breathing: Lie on your back with your knees bent and feet flat. Place one hand on your chest and the other on your stomach. Inhale slowly through your nose, allowing your stomach to rise while keeping your chest still. Exhale gently through your mouth, letting your belly fall. Repeat for eight to ten breaths.
• Supine “Dead Bug”: Lie on your back with arms extended toward the ceiling and knees bent at 90 degrees. Brace your core and press your lower back into the floor. Slowly lower your right arm and left leg toward the floor without touching down. Return to the starting position and repeat on the opposite side. Perform five to ten reps per side.
• Side-Lying Rolling: Lie on your back with arms and legs extended. Reach your right arm across your body to initiate a roll to your left side while keeping your legs still. Return to start, then initiate a roll by reaching your right leg across while keeping the upper body relaxed. Alternate sides for four to six reps each.
• Bear Crawl: Start on all fours with your hands under your shoulders and your knees under your hips. Lift your knees 1–2 inches off the floor. Step your right hand and left foot forward together, followed by your left hand and right foot. Keep your back flat and hips steady. Crawl forward six to ten steps, then reverse.
• High Side Plank: Lie on your side with legs straight and feet stacked. Place your lower hand under your shoulder and press into the floor to lift your hips, forming a straight line from head to feet. Hold for 15–30 seconds while breathing steadily. Switch sides and repeat.
• Kneeling-to-Sitting Transfer: Begin in a tall kneeling position with your torso upright. Slowly sit back onto your heels while maintaining posture. Return to tall kneeling using hip and core control. Repeat for eight to ten reps.

In a March 2025 study, researchers assigned 30 chronic low back pain patients to perform these dynamic stabilization exercises three times per week for four weeks. Another 30 patients followed a traditional core strengthening routine (e.g., crunches, planks, bird-dogs). While both groups reported similar reductions in pain and disability, the dynamic stabilization group experienced greater improvements in core muscle contractility and standing postural control.

Despite these benefits, adherence remains a challenge—many patients simply don’t follow through with prescribed exercises. If you find it difficult to stay motivated between visits, speak with your doctor of chiropractic. They can recommend an alternative that better suits your preferences and increases your likelihood of sticking with it.

When Surgery Is Needed for Carpal Tunnel Syndrome

Carpal tunnel syndrome (CTS) is a condition that occurs when the median nerve is compressed as it passes through the wrist. The carpal tunnel is a narrow passage in the wrist that also contains several tendons and blood vessels. Any factor that reduces the cross-sectional area of the tunnel or increases the volume of its contents—such as inflammation, swelling, or structural changes—can compress the median nerve and trigger the hallmark symptoms of CTS, including pain, numbness, tingling, and weakness in the hand and fingers. Clinical guidelines generally recommend conservative care as the first line of treatment for CTS. Chiropractic care, which may include manual therapy, nerve gliding techniques, exercise, and ergonomic advice, is a well-supported conservative approach. However, in some cases, more invasive interventions such as surgery may be necessary.

The clearest indication for surgical intervention is in an emergency situation. While CTS is most often caused by repetitive microtrauma over time (such assembly line work), it can also result from acute trauma. In cases involving a distal radius fracture, crush injury, or rapid-onset swelling from hematoma, abscess, or infection, urgent surgical decompression may be needed to prevent permanent nerve damage.

Surgery may also be necessary in non-emergency cases when conservative care fails. Most patients with mild-to-moderate CTS respond well to conservative management. However, in more advanced or prolonged cases, scar tissue, chronic inflammation, or direct nerve damage may make recovery slower—or unlikely—without surgical intervention. Unfortunately, many patients wait until symptoms significantly impair daily function before seeking care, which can reduce the effectiveness of conservative treatments.

Unfortunately, research shows that best-practice guidelines are not consistently followed. For example, a study of 782,717 patient records found that only 88 patients received all recommended conservative treatments within the first year after diagnosis. Similarly, a 2021 Finnish study reported that 17% of patients who underwent carpal tunnel release surgery had received no conservative care beforehand.

The good news is that chiropractic care is not only a highly effective conservative treatment for CTS, but chiropractors are also trained to assess the entire course of the median nerve, not just the wrist. This is crucial, as nerve compression can occur anywhere along the nerve’s path—from the neck and shoulder to the elbow and forearm. In fact, many patients with carpal tunnel syndrome also have multiple sites of nerve entrapment, a condition known as double crush syndrome. For long-term success, all contributing factors must be identified and addressed.

Four Reasons Shoulder Injuries Heal So Slowly

 Shoulder injuries are a common complaint, affecting approximately 40 out of every 1,000 people each year. While the causes of shoulder pain and dysfunction vary, they all share one frustrating trait: they tend to heal slowly. In fact, many clinical guidelines published around the world recommend longer treatment durations for shoulder complaints compared to other soft tissue injuries. That raises the question—why does the shoulder take so long to recover?

 The first reason is structural complexity. The shoulder isn’t just one joint; it’s four interconnected joints that make up what’s known as the shoulder girdle. These include the sternoclavicular joint, located near the breastbone where the clavicle connects; the glenohumeral joint, which is the main ball-and-socket joint that allows for overhead movements and throwing; the acromioclavicular joint, where the clavicle joins the acromion of the scapula; and the scapulothoracic articulation, where the shoulder blade glides along the rib cage. Because these joints share soft tissues and must move in harmony, it’s difficult to rehabilitate one joint in isolation. When one joint is injured, compensatory movement patterns often develop in the others, raising the risk of additional injury. To make matters more challenging, certain regions of the shoulder have limited blood supply, which slows the delivery of oxygen and nutrients essential for tissue healing.

 The second reason involves the shoulder’s incredible range of motion. It is the most mobile joint in the human body, capable of complex, multidirectional movement. However, that mobility comes at a price—reduced stability. Unlike more stable joints like the hip, the shoulder relies almost entirely on soft tissue structures such as muscles, ligaments, and tendons to maintain its position during activity. When these stabilizing structures are injured, restoring their strength and coordination takes time, especially if pain inhibits normal use.

 A third factor is that the shoulder is more prone to severe or high-impact injuries than many other joints. Its structural design favors flexibility over durability, leaving it more vulnerable during forceful or repetitive movements—particularly in sports or jobs that involve overhead motions. Because it lacks strong bony architecture to protect it, and because many activities push the joint to the end of its range of motion, even minor injuries can cause significant tissue disruption. This is especially true for athletes who throw, swim, or play racket sports.

 Finally, healing is influenced by the age and injury history of the shoulder. As we age, our body’s ability to heal declines. This is due to reduced collagen production, fewer blood vessels, slower stem cell activity, hormonal changes, and increased oxidative stress. Chronic illnesses such as diabetes or cardiovascular disease further impair healing capacity. And if someone has injured their shoulder in the past, the presence of scar tissue, structural irregularities, or residual instability can make recovery from a new injury even more difficult.

 Doctors of chiropractic are well-trained in using manual therapies and customized rehabilitation exercises to restore shoulder function. However, as outlined above, recovery is typically not quick or straightforward. Improvement usually requires more than just a few visits, especially if patients do not consistently follow self-care and home exercise recommendations.

Lifestyle Risk Factors for Headaches

Years Lived with Disability (YLD) is a public health metric that estimates the number of years individuals live with a disease or health condition, adjusted for the severity of the disability. According to the 2021 Global Burden of Disease Study, headaches account for 5.2% of global YLDs, ranking just behind low back pain and depression. This burden is particularly significant among working-age adults, as headaches are a major contributor to both absenteeism (missing work) and presenteeism (working while impaired).

In an effort to reduce the impact of headaches in the workforce, a May 2025 study examined data from 63,071 employees of the Fujitsu Group, a Japanese IT company. Participants completed questionnaires on general health, lifestyle, and headache history. Results showed that half of men and two-thirds of women experienced headaches on at least three days per month, and 17% of men and 26.5% of women reported headaches on ten or more days per month.

Further analysis identified high stress levels as the strongest risk factor for headaches—increasing the risk 7.13 times in men and 8.79 times in women. Other contributing factors included workplace conditions such as prolonged sitting and eye strain; mood disorders such as depression and anxiety; musculoskeletal problems like back pain and stiff shoulders; physical inactivity; and insomnia.

These findings highlight opportunities for employers to mitigate headache-related disability, which could improve both productivity and employee retention. Potential strategies include: improving communication across individuals, teams, and departments; encouraging frequent breaks to reduce eye strain and physical fatigue; offering wellness services such as massage therapy, yoga, or calm spaces; recognizing and rewarding employee efforts; and providing benefits that support better sleep, mental health, and physical well-being.

Of course, individuals should also take proactive steps to manage stress and improve their overall health. Doing so can reduce the risk not only of headaches, but also other musculoskeletal and chronic health conditions. While there are more than 150 types of headaches, many of the most common forms respond well to chiropractic care, leading to reductions in headache frequency, duration, and intensity. If headaches are interfering with your ability to function at work or in daily life, consider chiropractic care as part of a conservative treatment approach.

Treatment for Whiplash-Injured Cervical Facet Joints

The sudden acceleration and deceleration of the head and neck during a whiplash injury commonly damages soft tissues such as muscles, tendons, and ligaments. However, among the most frequently injured structures are the facet joints. In fact, research suggests that approximately half of neck pain cases—including those unrelated to whiplash—involve the facet joints. Why are these joints so vulnerable during whiplash?

Except for the C1 vertebra (the atlas), each cervical vertebra from C2 to C7 features paired superior and inferior facet joints that articulate with the vertebrae above and below. These joints allow for controlled movement in flexion and extension (forward/backward), lateral flexion (side bending), and—though limited—rotation. Each facet joint is richly innervated with mechanoreceptors and nociceptors (sensory fibers that detect motion and pain), making them highly sensitive to injury. Clinical studies have shown that the C2-3 and C5-6 levels are most often associated with facet joint-related neck pain.

Diagnosis of facet joint injury typically relies on clinical history and physical examination. In select cases, diagnosis can be confirmed with a diagnostic nerve block, which involves injecting a local anesthetic near the medial branch nerves that supply the affected facet joint. Diagnostic imaging like X-ray, MRI, or CT may not confirm the source of pain but can be useful for excluding other conditions or guiding interventional procedures.

Unless emergency surgery is required, treatment guidelines favor conservative care. Recommended options include neck-specific exercises, graded activity, range-of-motion training, and manual therapies such as joint mobilization and manipulation. Studies support a multimodal approach—combining several therapies—which often leads to quicker and more effective recovery. Of note, a January 2025 literature review discouraged the use of treatments such as Botox injections, intra-articular steroid injections, and surgery due to insufficient supporting evidence.

The good news is that doctors of chiropractic offer many of the conservative therapies recommended for managing facet joint injuries. In addition to relieving pain, chiropractic care helps restore normal joint motion, improving function and quality of life. If needed, your chiropractor can coordinate care with other healthcare providers to help you achieve the best possible outcome.

Lifestyle Strategies to Manage Hypertension

High blood pressure, or hypertension, is a chronic medical condition in which the force of blood pushing against the walls of the arteries is consistently too high. Over time, this sustained pressure places excessive strain on the cardiovascular system, significantly increasing the risk of complications such as stroke, heart attack, heart failure, and kidney disease. While medications are available to lower blood pressure, they are not a “magic pill.” In some cases, medications may not lower blood pressure enough on their own, lose effectiveness over time, and cause side effects that lead to additional health concerns. Because of these limitations, lifestyle modification is a core component of hypertension management, which may include:

• Diet: A diet high in sodium and low in potassium can cause the body to retain fluid and impair sodium regulation, leading to increased blood pressure. High intake of saturated fats and processed foods can also stiffen blood vessels. Health experts recommend diets rich in fruits, vegetables, lean proteins, whole grains, and healthy fats. The DASH (Dietary Approaches to Stop Hypertension) and Mediterranean diets are both supported by strong clinical evidence for lowering blood pressure.
• Exercise: Regular physical activity helps the heart pump more efficiently and supports flexible, responsive blood vessels. It also reduces inflammation and stress hormone levels. Even a single session of moderate exercise can produce short-term reductions in blood pressure.
• Avoid tobacco: Smoking damages the endothelium (the inner lining of blood vessels), promotes inflammation, and narrows arteries, all of which contribute to higher blood pressure. Second-hand smoke exposure has similar effects.
• Limit alcohol: Chronic heavy drinking raises blood pressure by impairing kidney function, increasing stress hormone release, and negatively impacting central blood pressure regulation. Even moderate alcohol intake may contribute to hypertension in some individuals.
• Maintain a healthy weight: Excess body weight increases the workload on the heart and contributes to hormonal, metabolic, and inflammatory changes that elevate blood pressure. Weight loss—especially abdominal fat—can significantly improve blood pressure.
• Manage stress: Chronic stress activates the sympathetic nervous system and increases circulating levels of cortisol and adrenaline, which raise blood pressure. Stress also encourages unhealthy coping behaviors like overeating, alcohol use, and smoking.
• Improve sleep quality: Getting between seven and nine hours of restorative sleep each night is essential for blood pressure regulation. Conditions like obstructive sleep apnea (OSA)—which causes repeated interruptions in breathing during sleep—are strongly linked to resistant hypertension. Poor sleep also increases stress and reduces the body’s ability to recover.

Believe it or not, chiropractic care may also support blood pressure regulation. Some studies suggest that chiropractic adjustments can influence autonomic nervous system function, reduce muscle tension, and relieve mechanical compression on blood vessels. These changes may lead to short-term reductions in blood pressure, particularly in patients with cervical spine dysfunction. While chiropractic is not a standalone treatment for hypertension, it may serve as a complementary strategy, especially when paired with a healthy lifestyle.

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.