MONTHLY HEALTH UPDATE
Can the Outcome of Back Pain Be Predicted?
Chad Abramson, D.C.
Low Back Pain
Groin Pain: The Low Back, Hips, and Pelvic Floor
In addition to neck pain and back pain, patients seek chiropractic care for many
musculoskeletal conditions, including groin pain. Pain in the groin area can emanate from a
myriad of causes from issues involving the reproductive organs, the renal/urinary system, the
lymph glands, a pelvic flood disorder, a hip joint condition, and even a lumbar disk
For a patient with groin pain, the first thing a doctor of chiropractic will likely do is review the patient’s history and conduct a thorough examination to rule out health issues that may be better suited for the patient’s medical physician. The examination will look for potential dysfunction in the pelvis, hip, and low back that can be addressed with chiropractic care.
While musculoskeletal issues in the lower back are typically localized to that area of the body, if a spinal disk herniates and places pressure on the spinal nerves, it can lead to symptoms down the leg and even into the torso and groin. Likewise, issues in the hip like osteoarthritis, labral tears, and hip bursitis can refer pain to the groin.
Chiropractic care for these conditions will include manual therapies to restore joint motion, specific exercises to strengthen/stretch the affected ligaments and muscles, and recommendations to address inflammation, such as supplements/vitamins or ice/heat instruction.
Pelvic floor disorder (PFD) is a common condition that describes the inability to correctly relax and coordinate the pelvic floor muscles, which can lead to issues with urination and defecation, among other things. The pelvic floor is like a sling of muscle holding the pelvic organs. Our pelvic floor muscles contract and relax when we go to the bathroom. Losing the ability to relax the muscles can lead to the inability to defecate or urinate, and losing the ability to contract the muscles can result in incontinence.
Fortunately, once more serious causes are ruled out, it’s possible to resolve PFD using biofeedback, pelvic flood exercises, and relaxation techniques, all of which may be provided by your doctor of chiropractic or in conjunction with a related healthcare professional.
There is the possibility that issues may be present in two or even all three areas that your doctor of chiropractic will address concurrently in order to reach a satisfactory treatment outcome.
Neck Pain / Headaches
Neck Pain and Upper-Crossed Syndrome
In normal head and neck posture, the center of the shoulder joints are located vertically in line
with the bottom of the mastoid processes (the bone just behind the bottom of the ear at the base of the
skull) while the muscles on the posterior (or back side) of the cervical spine (neck) act to maintain
balance and keep the head back.
Sitting at a computer or using a smartphone for long lengths of time can lead to a muscular imbalance—referred to as an “upper-crossed syndrome” (UCS)—where specific muscles in the upper back and neck (upper trapezius and levator scapulae) and the chest muscles (pectorals) are too tight. These hypertonic muscles “cross” with weakness of the deep neck flexors (in the front neck) and middle and lower trapezius (in the mid-back). This results in the classic forward head posture and rounded shoulders.
Fortunately, forward head posture can be remedied with exercises to strengthen the weak muscles and stretch the overly tight muscles. Here are a few:
1.Perform a standard push-up (from knees or toes) and when in the “up” position, push further toward the ceiling (feel your shoulder blades spread further apart).
2.Lie prone on a bench and raise your arms overhead to form a “Y”; follow with a “T” by lowering the arms to horizontal or 90°; move to a “W” (bend elbows 90° and lower arms to 45°); follow with an “L” (place arms at your sides keeping elbows bent at 90°, rotate outwards the forearms as far as possible). Squeeze your shoulder blades together, DON’T shrug the shoulders, HOLD each position for five to ten seconds and repeat the series two to three times.
3.Tuck your chin inward and nod; add some resistance—using your thumb/index grasping the chin—resist in BOTH directions (down and up nods). As a posture re-trainer, keep your chin-tucked during the day.
4.Lie on your side, elbow bend 90°; use a hand weight and raise it slowly toward the ceiling and lower it back down (five to ten slow reps); repeat on the other side.
5.Stand in a doorway and hook your elbow on (or grasp with your hand) the door jamb; slowly turn your body away from the door jamb until you feel a strong stretch in your chest muscles. Start low and move your elbow/hand higher and repeat; continue upwards until its overhead. Repeat several times on each side.
6.Look down and side bend RIGHT; reach over with your RIGHT hand and gently pull the head to a firm endpoint; reach with the LEFT hand toward the floor.
7.Look down, side bend, and rotate your head RIGHT; reach over with your RIGHT hand and gently pull the head to a firm endpoint; reach with the LEFT hand toward the floor. REPEAT on opposite side. Hold five to ten seconds and repeat two to three times.
Upper crossed syndrome and forward head posture can also lead to joint fixations in the cervical and thoracic spine, which can be addressed by a doctor of chiropractic using spinal manipulative therapy. Your chiropractor can also walk you through these and other exercises to restore normal posture, depending on your unique case.
Non-Surgical Care for Shoulder Instability in Young Adults
Shoulder instability (SI) occurs when the soft tissues (joint capsule, ligaments, and
labrum) that hold the humerus in the shallow ball-and-socket glenohumeral joint become
stretched, torn, or detached. When these tissues are damaged, the resulting shoulder
instability is characterized as structural. If instability is caused by abnormal muscle activity
that places too much or too little stress on the shoulder joint, the condition is described as
In teenagers and young adults, shoulder instability is typically the functional variety, and it can affect up to 2.6% of this population. The most common variety of functional SI among these individuals is posterior positional functional shoulder instability (PP-FSI).
Patients with PP-FSI experience disabling shoulder pain during mid-range movement of the shoulder joint, caused by a muscle imbalance where the external rotator cuff muscles and the posterior deltoid are under-active and the internal rotator muscles are hyperactive. There is also an altered balance of the periscapular muscles. Using functional MRI, researchers have observed that the brain of a PP-FSI patient may send abnormal signals to the shoulder muscles during movement, similar to an infant who hasn’t developed fine motor skills or a recovering stroke or brain injury patient.
The conservative treatment approach to PP-FSI involves manual therapies to help restore proper motion to the shoulder joint, specific exercises to strengthen the muscles that have become inactive, ice and nutritional recommendations to address inflammation, modalities like electronic muscle stimulation to retrain the muscles, and activity modifications to reduce the risk of re-injury during the initial phase of the healing process. Over time, the patient can begin to resume their normal activities, provided movement doesn’t lead to sharp, lancinating pain in the shoulder.
Other musculoskeletal injuries in the shoulder, arm, neck, or upper back that may have preceding or developed following the PP-FSI injury will also need to be addressed in order to return the patient to their normal activities.
While surgical intervention may be advised as a first course of treatment for some PP-FSI patients, treatment guidelines typically recommend utilizing non-surgical methods first, of which chiropractic care is an excellent choice.
Carpal Tunnel Syndrome
Short-Term Care for Carpal Tunnel Syndrome
While the primary driver for carpal tunnel syndrome (CTS) may sometimes be
hormonal changes (hypothyroid, pregnancy, or birth control use), type 2 diabetes, or an
inflammatory condition (rheumatoid arthritis, psoriatic arthritis, or gout), many patients’
hand and wrist symptoms are caused by musculoskeletal issues that place pressure on the
median nerve or restrict its motion. The good news is that chiropractic care is a great fit for
the CTS patient, but how much care is needed before the numbness, tingling, weakness, and
pain starts to resolve?
In one study that included 22 CTS patients, 19 of whom had CTS in both hands and wrists, researchers observed that the application of only manual therapy techniques to the hand, wrist, and forearm three times a week for two weeks led to significant improvements in pain, function, numbness, sensation, strength, and night awakening. The patients also performed better on the Phalen’s maneuver—a common clinical test used to stimulate CTS symptoms. Best of all, the participants continued to experience these improvements up to twelve weeks after their final treatment!
In addition to the manual therapies involved in the aforementioned study, doctors of chiropractic utilize additional non-surgical techniques such as nocturnal wrist splinting, at-home exercises/stretching, nutritional counseling, and job/ergonomic modifications. Dysfunction elsewhere along the course of the median nerve (such as the neck, shoulder, elbow, and forearm) may also need to be addressed.
If non-musculoskeletal causes are suspected, co-management with the patient’s medical doctor may be necessary. Though several studies have shown that surgical intervention may not be superior to non-surgical care over the long-term, a referral to a surgeon may be warranted if non-surgical treatment fails to produce a satisfying result.
For CTS and other musculoskeletal conditions, many doctors of chiropractic will commence care with a short-term approach (such as six visits spread over two weeks, as used in the study discussed above) to evaluate how the patient responds to care and to adjust treatment recommendations from there. In mild cases, the patient may be released from care and advised to return on an as-needed basis. For chronic or severe cases of CTS, additional treatment may be required, though if the condition is too advanced, a full resolution of symptoms may not be possible. Hence, the importance of visiting your doctor of chiropractic for hand and wrist symptoms sooner rather than later!
Whiplash and Weakened Neck Muscles
The whiplash process can lead to a number of concurrent symptoms (neck pain,
headaches, limited cervical range of motion, etc.) referred to as whiplash associated disorders, or
WAD. It’s estimated that about one in five WAD patients will also develop potentially chronic,
concussion-like symptoms like brain fog, difficulty concentrating, and other cognitive
impairments. A 2020 study shed light on a way to help identify such patients early on so targeted
treatment could help keep their WAD from becoming chronic and persistent.
In the study, researchers used resting-state-fMRI (rs-fMRI) to image 23 patients with chronic WAD and compared their findings with assessments used to objectively measure neck disability, traumatic distress, depression, and pain. The research team identified an association between fat infiltration into the cervical muscles and abnormalities in the brain network structure associated with WAD-related neuropsychological issues. That is, the patients with more fatty tissue in their neck muscles were also those with more signs of brain injury or altered brain function.
When deep muscles and associated soft tissue in the neck are injured in a whiplash event, the body may recruit superficial muscles to help stabilize the body and maintain posture. While this can protect the deep muscles from further injury in the short term, it can decondition these muscles over time and allow fatty deposits to infiltrate its tissue.
In another study that followed 141 WAD patients and 40 non-injured subjects for one year, researchers observed that the WAD patients demonstrated a loss in neck muscle strength throughout the year, even if their neck pain resolved and their cervical range of motion returned to normal. Additionally, the patients who had not recovered enough to return to work after a year had an average of 50% loss of strength in their neck muscles.
The findings of these studies suggest that when the whiplash process is forceful enough to injure the soft tissues of the neck in a manner that leads to abnormal muscle activity that allows important muscles to weaken and for fatty deposits to develop, then the same event can also lead to a potential brain injury, with resulting cognitive symptoms. If so, then identifying WAD patients with cervical muscle weakness early may help doctors uncover which patients may need more substantive care to reduce their risk for ongoing WAD issues.
Several treatment guidelines indicate that chiropractic care is a great first-choice treatment option for the WAD patient, which may involve a multimodal approach to restore motion in the affected joints and strength in the deep and superficial cervical muscles.
Whole Body Health
Health Optimization Strategies
Though some element of our overall wellbeing is defined by our genetics, there is a lot
you can do to live a long and healthy life. Here’s a short list:
1.Get enough sleep. While the average adult needs only seven to nine hours of sleep a night to feel rested, younger age groups usually require much more: infants (0-3 months): 14- 17 hours/day; 4-11 months: 12-15 hours/day; toddlers: (1-2 years old) 11-14 hours/day; pre-school (3-5 years old): 10-13 hours/day; school age (6-13 years old): 9-11 hours/day; and teenagers (14-17 years old): 8-10 hours/day. An expectant mother may need additional sleep, especially early in the pregnancy.
2.Exercise at moderate intensity for at least 30 minutes a day (brisk walk, bike ride, jog, yoga, tai chi, etc.). Federal guidelines also recommend strength training the major muscle groups twice a week.
3.Avoid added sugars, sugary drinks, and processed foods. Eat more whole grains, fruits, and vegetables. Not only will it help you maintain a healthier body weight, but you’ll also improve the make-up of your gut microbiota, which can bolster your immune system.
4.Consider supplementation if your diet is deficient in important vitamins and minerals. For example, a 2017 study published in the journal Nutrients reported that vitamin C can enhance the production of B- and T-cells, which are related to the body’s ability to fight off infections. Moreover, the study noted that vitamin C deficiency is associated with impaired immunity resulting in higher susceptibility to infection.
5.When (not if) stress hits, take five slow, deep breaths (in your nose and out of your mouth). Consider mindful meditation or schedule relaxing activities into your day.
6.Engage in social networks (senior centers, church, and book clubs or go to plays, music events, and art galleries with a friend), preferably in person but virtually (phone or video chat) if that’s not feasible.
7.Laughing reduces stress hormones, boosts white blood cells, and keeps you healthy.
8.Wash your hands with soap and water regularly, use hand sanitizer regularly (if it’s not possible to wash your hands), don’t touch your eyes, nose, and mouth; cover your mouth with your arm when you sneeze, and stay home when you’re ill.
9.Spend time in the sun or take a vitamin D supplement. Studies show that individuals with poor vitamin D status may be at an increased risk for upper respiratory infection and impaired immune response.
Of course, if you experience musculoskeletal pain, like neck or back pain, schedule an appointment with your doctor of chiropractic. Typically, the sooner you seek care, the faster you’ll be able to return to your daily activities without pain.
FOR YOUR FREE NO-OBLIGATION CONSULTATION CALL
Abramson Family Chiropractic
10222 19 th Ave SE, Suite 103, Everett, WA 98208
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.