Can the Outcome of Back Pain Be Predicted?
Courtesy of:

Chad Abramson, D.C.
(425) 315-6262

Low Back Pain

Chiropractic Care for Soon-To-Be and New Moms

Low back pain (LBP) and pelvic girdle pain (PGP) are common complaints during pregnancy with some studies suggesting these conditions affect up to half of expecting mothers. In the postpartum period, it’s estimated that as many as one in-five women will continue to experience these forms of musculoskeletal pain up to three years following the birth of their child.

Typically, there isn’t one reason why an expectant mother develops LBP/PGP as there can be a number of contributing factors such as maternal weight gain, spinal biomechanical pregnancy-related changes, and abdominal muscle changes to accommodate the growing fetus. During pregnancy, the body also begins circulating a hormone called relaxin to relax the joints and ligaments in preparation for labor and delivery, which may be associated with an elevated risk for LBP/PGP.

While pregnancy and pregnancy-related LBP/PGP are very common, there is not a lot of published information on effective treatment options. With respect to the use of chiropractic care, there are a few randomized controlled trials, but most of the published literature involves small trials and case studies.

A 2016 systematic review and meta-analysis looked at ten studies with a total of 1,198 pregnant women and reported that chiropractic care can be effective for reducing pain intensity in women with LBP/PGP, though the authors recommended additional studies with larger patient populations.

Typically, doctors of chiropractic utilize a multimodal approach when managing expecting moms that can include a combination of manual therapies like spinal manipulation, mobilization (non-thrust), massage, and stretch/muscle release techniques, along with exercise training, patient education (such as ergonomic and activity modifications), diet and nutritional counseling, and the use of stabilizing belts. To accommodate for the growing fetus, the doctor may modify the patient’s positioning during treatment or adjust the table so that the patient can lay comfortably in a prone position. The chiropractor may also opt for low-force adjusting techniques instead of the high-velocity, low-amplitude adjustment most commonly associated with chiropractic care.

Neck Pain / Headaches

Manual Therapy for Cervicogenic Headaches

By some estimates, up to 20% of headaches are caused by a disorder of the cervical spine and its components (bone, disk, and soft tissue) usually accompanied by neck pain. It’s very common for patients with a cervicogenic headache to seek and receive manual therapies— like spinal manipulation and mobilization—from chiropractic care. Spinal manipulation is characterized by a high-velocity, low amplitude (HVLA) thrust accompanied by joint cavitation (release of gas causing a cracking sound) and spinal mobilization consists of slow, rhythmic, oscillating movements. Which approach is the most effective for this cervicogenic headaches?

In a 2016 randomized controlled study, researchers compared the effect of upper cervical and upper thoracic manipulation against mobilization plus exercises in a group of 110 patients with cervicogenic headache. Participants received six to eight treatments spread over four weeks, and researchers assessed headache intensity (0-100 scale), headache duration, disability, medication intake, and overall improvement at baseline, after one week of treatment, after four weeks of treatment, and after two months following the conclusion of care.

The data show that patients in the manipulation group experienced less frequent headaches and shorter headache duration at all follow-up points, greater overall improvement at the one-week and four-week time points, and greater reductions in headache intensity and disability at the final follow-up. Patients in each group reported improvements compared with their baseline readings, which suggests that both manual therapies can benefit the cervicogenic headache patient. It’s very common for chiropractors to incorporate both approaches into a treatment plan, depending on the patient’s unique case, as well as their own training and clinical preferences. This multimodal approach may also include other manual therapies, traction, physical therapy modalities, nutrition recommendations, and specific exercises targeting the neck and upper back.

It’s also important to note that while this study focused on cervicogenic headache patients, dysfunction in the cervical spine and associated tissues may also play some role in other forms of headache, such as migraines. In fact, studies have demonstrated that migraineurs often have an increased number of trigger points in their cervical muscles and that treatment aimed at reducing these trigger points is associated with reduced headache frequency and intensity.

For patients suffering from headaches of any type, it may be prudent to consult with a doctor of chiropractic to assess the cervical spine for any issues that may contribute to their headaches.

Joint Pain

5 Exercises to Fight Forward Head Posture

Even though poor posture can impair physical function and affect one’s health, it’s very common to see people with a slouched, forward head posture. Aside from advice to sit up straight, limit phone use, or hold devices at eye level, are there any exercises that can help reverse forward head posture? The answer: “YES!” Let’s look at five easy-to-perform exercises you can start right away…

EXERCISE #1Pectoral Stretch: Grasp a door jam and rotate your body outward, allowing your arm to pull back until you feel a firm stretch in the chest wall muscles (hold for three-to-ten seconds until the muscle loosens). Move your hand upward and downward and repeat to stretch the different muscle fibers of the pectorals. Repeat on the other side.

EXERCISE #2External Rotation: Use a light weight (2.5-10 lbs./1.13- 4.5 kg, judge by fatigue without pain after ten to fifteen reps); lie on your side with the upside elbow bent 90 degrees, slowly raise the weight toward the ceiling, and then slowly lower it. As an alternative, use Thera Band or Thera-Tubing from a sitting or standing position and perform bilaterally at the same time.

EXERCISE #3Scapular Abd-/Add-uction: Assume a push-up position (from feet or knees) and rather than bending the elbows (like in a “normal” push-up), keep the elbows locked straight and drop the chest to bring the shoulder blades together and then reverse the motion, raising the chest to spread the shoulder blades out as far as possible. Repeat to fatigue, adding more reps as able. This retracts the shoulders by strengthening the interscapular muscles.

EXERCISE #4Chin Retractions: From a sitting, standing, or supine position, tuck in the chin while looking straight ahead and then nod the chin down and up. This will strengthen the deep neck flexor muscles that help stabilize the cervical spine. You can add resistance by pushing the chin into your fist while in the up/down directions.

EXERCISE #5Neck Stretch: With the left hand, reach over the side of the head and pull the right side of the head/neck sideways to the left first while looking upward (pull sideways and back) and then slowly rotate the head left and right feeling for the stretch in the front and side of the neck. Alternative: with the same set-up, drop the head forward (in flexion, pull sideways and forward) while slowly rotating the head left and right feeling for the stretch in the back and side of the neck.

In addition to these exercises, your doctor of chiropractic can utilize manual therapies, like manipulation and mobilization, to help restore normal motion to the neck, shoulders, and upper back, which can help speed your progress to a more normal, healthy, and attractive posture.

Carpal Tunnel Syndrome

Testing for Suspected Carpal Tunnel Syndrome

When an individual’s hands and fingers start tingling, they will most often suspect carpal tunnel syndrome (CTS). However, pressure on the median nerve anywhere along its course from the neck to the hand can produce similar symptoms in the hand and fingers. So what is the best way to diagnose CTS and differentiate it from other conditions?

A 2021 study reported that a Timed Phalen’s Test (TPT) could predict abnormal nerve findings on diagnostics like electromyography (EMG). In the TPT, a patient pushes the back of their hands together with the wrists bent at 90 degrees and the doctor uses a stopwatch to time how long it takes for numbness to occur. In 403 patients with confirmed CTS, 69% had a positive TPT in less than ten seconds, thus supporting TPT as a VERY accurate test to clinically help diagnose CTS.

In 2000, a systematic review of twelve studies concluded that the following clinical in-office tests are also predictive of a positive CTS diagnosis: 1) Hand dysesthesias (numbness/tingling) that follow the median nerve distribution (thumb, index, middle, and thumb-half of the ring finger). 2) A Katz hand diagram (a drawing of where symptoms are located) that matches the areas of the hand innervated by the median nerve. 3) Weak thumb abduction strength.

Typically, a doctor is more secure in their diagnosis when several tests are positive. Researchers refer to multiple positive tests as “clusters”, while others use the term “clinical prediction rule”.

If compression of the median nerve at the carpal tunnel is confirmed, it’s important to examine the other likely places for median nerve compression because it’s common for issues to be present at two or more locations. Each of these conditions will need to be addressed for the patient to have a satisfactory treatment outcome. Doctors of chiropractic are trained to examine the whole patient and not just the area of chief complaint because dysfunction in one part of the body can affect other regions.

The good news is that CTS patients often respond favorably to the non-surgical treatments provided in the chiropractic clinical setting, especially when a diagnosis is made early in the course of the disease. This is why it’s important to consult your doctor of chiropractic when symptoms first begin as they may be resolved quickly with in-office treatment, home-based exercises, and work modifications before more serious and activity-limiting symptoms develop.


The Chiropractic Diagnosis and Treatment Process for Whiplash

Following a car accident, slip and fall, or sports collision, many whiplash associated disorder (WAD) patients are advised by friends, family, co-workers, or an attorney to see a doctor of chiropractic. For many WAD patients, this may be their first experience with chiropractic. What can they expect?

During the initial visit, the patient will first complete paperwork to document details about their accident, the onset of symptoms, the initial self-management strategies utilized and their effects, the initial healthcare assessment and its effects, and the current presenting complaints. The patient will also be asked about their medical and family history as this may be important when making a diagnosis. The doctor of chiropractic will review the history and ask the patient questions to clarify some of the answers.

Then the patient will undergo a physical examination that may include observation; palpation; orthopedic tests; neurological tests (including cranial nerve and brain/coordination tests); x-ray (often including stress views); posture and gait assessment; and static and motion palpation of the cervical (neck), thoracic (mid-back), lumbar (low back), and pelvis/hips. Not only will these testing procedures help to determine the diagnosis, but they will also give the doctor of chiropractic clarification on which specific therapies to administer to reduce pain and disability in the patient.

Treatment will usually include a multimodal approach that includes manual therapies such as spinal manipulation, mobilization, and soft tissue work, among others. There are a variety of techniques that fall under each of these general categories. For example, chiropractors are trained in several adjusting techniques like diversified, Gonstead, drop-table, instrument, etc. The same goes for soft tissue therapies, which can include trigger-point therapy (TPT) using superficial and/or deep tissue pressure, longitudinal and/or cross fiber friction massage, active release techniques (ART)— which combines deep pressure into a tight muscle with simultaneous stretching of the muscles— multiple types of massage therapy, and more. Treatment may also include physical therapy modalities like electric stim, laser, ultrasound, and more, all depending on the patient’s unique case and the chiropractor’s training and treatment preferences. In some instances, a patient may be referred to an allied healthcare provider or specialist for services that cannot be provided in a chiropractic setting. The goal of treatment is for the patient to achieve maximum possible improvement, and how many visits it will take to get there will vary from patient to patient based on their general health, past history, and the extent of their current injuries.

To achieve a satisfying long-term outcome, the patient may also receive instruction on dietary modifications to aid the healing process, as well as exercises to perform at home to reduce the risk for recurrence.

Whole Body Health

High-Intensity Interval Training: How Much Time is Needed?

We all know we need to regularly exercise as part of a healthy lifestyle, but many don’t because they feel that they don’t have enough time in the day to work out. In recent years, a form of exercise called high-intensity interval training (HIIT) has gained attention in both gyms and the scientific literature as a great way to get fit. Essentially, an individual will engage in aerobic exercise at high intensity for short bursts of time between intervals of lighter intensity physical activity. So, how much HIIT is needed to see results?

The answer: four seconds! Yes, a mere four seconds of all-out, maximum exertion exercise when repeated two to three dozen times per session might be all that is needed to maintain or even improve fitness, strength, and power. At least, that’s what a study published in July 2021 in the journal Medicine & Science in Sports & Exercise claims.
The researchers point out that different methods of HIIT have been studied, but the effects of repeated maximal effort power cycling (PC) with very short exercise time— specifically four seconds coupled with short recovery times of 15-30 seconds—might best suit individuals with limited time to exercise. The study group consisted of eleven healthy young adults who trained three times a week for eight weeks using a PC program that included 30 PC sets at four seconds maximum intensity followed by 30 seconds of rest, with rest times progressively shortened to fifteen seconds as the study progressed. By week eight, the PC sessions had fallen to less than ten minutes.
The participants experienced a 13.2% increase in VO2 peak (maximum oxygen intake), a 7.6% increase in total blood volume, and a 17.2% increase in maximal anaerobic power. While further research with larger and more varied study groups is needed, the findings from this study suggest that this HIIT routine may offer a great way to squeeze an effective workout into a busy day.
Of course, consult with your healthcare provider before starting any exercise program to assess your current fitness level and to identify any issues that may indicate a different form of physical activity may work better for your unique situation. If you have aches and pains, your doctor of chiropractic can also provide treatment to help restore normal joint motion and show you stretches you can do at home before and after your workout to reduce the risk of injury as you engage in a new fitness routine.



Abramson Family Chiropractic

10222 19 th Ave SE, Suite 103, Everett, WA 98208

(425) 315-6262

This information should not be substituted for medical or chiropractic advice. Any and all health care concerns, decisions, and actions must be done through the advice and counsel of a health care professional who is familiar with your updated medical history.