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Pregnancy back pain is very common. At least 50 percent of pregnant women and up to 80 percent will experience back pain at some point during their pregnancy. This is completely natural from the added weight of the baby. However, combined with all the other issues that arise during pregnancy ranging from: - Mood swings
- Morning sickness
- Fatigue
- Urinary issues
- Lower back pain
This can cause uncomfortable symptoms and take a serious toll on the body. Severe back pain during pregnancy is rare. We'll look at why you could develop pregnancy back pain, along with steps and proven ways to feel better. Back Pain Causes Pain can occur at any trimester, but it usually arises in the later months as the baby and belly grow. Pain can be mild to severe and usually happens in the lower back. There does not have to be pre-existing back problems. Pregnancy itself changes the body in ways that can lead to back pain. Example: As the uterus gets heavier, there is the added strain placed on the back muscles. This can alter proper posture and cause discomfort/pain. Pregnancy changes the center of gravity and accentuates the spine's curve in the lower back. When the abdominal muscles and core are weak and not strong enough, the changes of the curvature worsen since it is these muscles that stabilize the back. When pregnant, the body releases a hormone called relaxin that loosens ligaments, which is the tissue that connects the bones to each other inside the pelvis. The ligament loosening can affect back support and be a cause for pain. Other reasons women experience pregnancy back pain include: - Stress
- Poor posture
- Standing for too long
- Injury
- Trauma
Tips for Relief There are ways to ease pregnancy back pain without medical intervention. Here’s how: Pay Attention to Posture When standing up, make sure to stand straight with the shoulders held back. If you must remain standing for a long time, elevate one foot on a box, chair, or stool to relieve the pressure on the spine. Try to avoid standing for long periods. Remember to take regular breaks and get off your feet. Maintain proper posture when sitting, as well. Utilize an Ergonomic Chair Both at home and at work that offers plenty of support for the back. Also, a small cushion or pillow placed behind the lower back, along with a stool or footrest for elevating the feet can be highly beneficial. Proper Lifting Of course, do not lift heavy objects, and avoid bending at the waist to pick up items off the floor. Instead squat, bend the knees, and lift with the legs, not with the back. Exercise The best time to start an exercise regiment is before conception. Regular physical activity/exercise can help prevent and ease back pain, along with all of the other benefits. Doing simple exercises before getting pregnant can improve core strength, which can go a long way. Try to get as close as possible to a healthy weight before getting pregnant. This has the added benefit of reducing pregnancy risks and cesarean delivery. Once pregnant, mild or moderate exercise can help get a handle on back pain and prep the body for childbirth. Gentle workouts are the way to go. These will strengthen the back, core, and leg muscles. Recommended for pregnant women are: - Walking
- Swimming
- Prenatal yoga
- Stretches
Ask your provider which exercises, stretches are best for you. Remember movement is far better than resting too much. Also, working with a physical therapist or chiropractor in back strength will help immensely. Exercise Clothes Wear comfortable, spine supportive shoes. High heels should be removed altogether and take caution with flats, as these can and do often lack arch support. Shoe inserts/orthotics can help. Maternity support belts for back pain relief can also be an added tool. Currently, there is not a great deal of scientific proof that they work. But many women swear by them when they were pregnant. Sleep Adjustments Try sleeping on one side with the knees bent, along with a pillow between the knees or under the abdomen. Another possibility is using a firmer mattress. This can support the back better than a soft sinking mattress. If a firm mattress is not possible, consider placing a stiff board under the mattress for added firmness. Take naps, making sure to get the proper sleep that the body needs. This is especially true as the later weeks of pregnancy approach. This is easier said than done, but a warm bath can help the body relax before bed. Complementary practices Some women have found alternative medical approaches like acupuncture and prenatal massage to be quite helpful in easing pregnancy back pain. Before trying it out talk to your OB/GYN. Once discussed, you can decide if it’s a healthy choice. Make sure the masseuse or alternative practitioner has experience working with pregnant women. Pain Meds Pregnancy back pain is a leading cause of opioid prescriptions. When it comes to medication, a critical issue is potential for opioid abuse. There are some over-the-counter meds that can help ease back pain. However, Non-steroidal anti-inflammatory drugs or NSAIDs have been linked to pregnancy complications, and most doctors recommend not using them. Instead, try acetaminophen, which is just as effective and safe during pregnancy. Using hot and cold compresses and pain relief creams/ointments can also help. Pregnant women should always speak with a healthcare provider before starting any medication. Medical Help for Pregnancy Back Pain During pregnancy, some back pain is normal. When there is severe pain, sudden pain, or pain that lasts longer than two weeks this could be a sign of a more serious condition. It could be an indication of preterm labor, a urinary tract infection, or kidney stones. Call a doctor if you experience any of the following: - Back pain that does not get better/improve
- Back pain on one side of the body
- Back pain along with weakness in one or both legs
- Rhythmic back pain/s
- Accompanied back pain with vaginal bleeding, fever, urinary burning or change in vaginal discharge
- Suddenly unable to walk due to pain or weakness
- Lose feeling in the back, legs, buttocks, and pelvis
- Numbness could be the sign of a compressed nerve
Conclusion Pregnancy back pain usually fades away once the baby is born, these steps can be taken in the meantime to ease any discomfort. Don't forget to ask your OB/GYN for recommendations.
Reduce stress, reduce pain. Life creates stress, and while some stress can be good, too much causes health problems. Everyone experiences stress. However, now it is becoming a new normal in today’s hectic, fast-paced, high-pressure society. Most individuals equate stress with high blood pressure, heart attacks, or stroke. However, neck and back pain, insomnia, and weight gain can be stress-related, as well. And a lot of stress can make already-existing back/neck pain worse. 73% of individuals report experiencing stress-related psychological symptoms including anxiety and depression. These are not accurate numbers because most do not seek help for their stress issues. Stress symptoms should not be taken lightly. It is important to address the symptoms and find ways to reduce stress. Chiropractic is an effective stress reliever. Stress Financial pressures, kids, long work weeks, and medical problems are common anxieties. Prolonged stress can become chronic, which results in muscle tension that can feel stiff, achy and uncomfortable. Stress can develop into neck or back pain. Stress is the state of: - Emotional
- Mental
- Pressure
- Tension
That results from difficulties, adverse situations, or extremely demanding circumstances. The very nature of stress by definition makes it very subjective. A "stressful" situation for one person might not phase another. This makes it difficult to pin down a precise definition. More often, the term stress is more often used to describe the set of symptoms that are caused by stress and those symptoms can be as varied as the people who experience them. Symptoms Stress symptoms can affect the entire body physically and mentally. Common symptoms include: - Anxiety
- Chest pain
- Depression
- Fatigue
- Gastrointestinal problems
- Irritability
- Lower back pain
- Muscle tension
- Overeating
- Headache
- Restlessness
- Sleep problems
- Unable to focus
- Undereating
Health Technically, stress itself does not have a negative impact on health. Some individuals deal with situations that others would consider to be stressful, yet they never exhibit symptoms. This speaks to the subjective nature of stress. Different people experience different symptoms and are a combination of stress symptoms, how the person handles those symptoms that adversely affect health. Ultimately, stress symptoms can lead to some very serious conditions including: - Heart disease
- Hypertension
- Diabetes
- Obesity
- Cancer/s
Psychologically, it can lead to social withdrawal and social phobias and is directly linked to alcohol and drug abuse. Tips These can help you reduce stress, and reduce pain. Vital Signs - Get a medical checkup if possible through Telemedicine and talk to a doctor/therapist about your stress, along with medical history. Side effects from medications (prescription or over-the-counter), herbal products, or other supplements can cause restlessness, insomnia, and anxiety.
- Physical therapy combines pain-relieving non-invasive treatments with therapeutic exercise, posture correction, and preventive body mechanics.
- Consider conversational therapy with a stress counselor, psychologist, or support group online.
Get Moving - Yoga and relaxation movements help reduce stress and stretch muscles. Viniyoga blends breathing and movement together to quiet body and mind. These movements are less precise and adapted to a person's physical condition. Talk to a doctor about trying yoga or other stretches.
- Swimming combined with a sauna or steam bathing can relieve stress-induced pain.
- Take frequent stretch breaks to loosen up tight neck or back muscles.
- Go for short walks at break or lunchtime to get the circulation going.
Learn to Relax - Kick back, put your feet up, and empty your mind of everything.
- Wrap an ice pack and hot pack (or hot water bottle) individually in towels. Apply the ice pack for 10 minutes and then the hot pack for 5 minutes. Alternate several times.
- Massage, aromatherapy and spa treatments you can do at home.
- Aromatic massage oils containing eucalyptus can help ease muscle pain.
- Meditation or visualization therapy combines meditation practices that focus on breathing and calming the mind.
- Visualization techniques combine imagery with breathing exercises.
Take Control of the Little Things - Break up problems into smaller manageable pieces and work on resolving the easier parts first.
- Learn your limits, how to delegate responsibility and not take the entire load on your shoulders so as not to get overwhelmed.
- Allow yourself to fail, we all have to fail in order to learn in order to apply what was learned.
Eat and Drink for Life - Make mealtime less stressful. Pick nourishing foods, eat slowly, and savor each other's company.
- Caffeinated coffee, soda, and other drinks do not help reduce stress or promote restful sleep.
- Avoid drinking at night because it can make falling and staying asleep a challenge.
- Proper sleep or naps can help relieve stress.
Dealing with Stress Is Good for Your Back We may not be able to control life's stressors, but don't let everyday demands interfere with your health. Incorporate exercise, relaxation techniques, and healthy foods to reduce stress and pain and promote stress prevention. Reduce stress reduce pain with chiropractic Chiropractic cannot get rid of stress, but it can help relieve stress symptoms. The more stress the body endures, the more sensitive it becomes to pain and physical imbalances. Chiropractic helps by bringing the body back into balance, aligning the spine, and relieving pain. The simple act of aligning the spine helps relieve stress in the body that you may not even be aware of. The physical stress of a misaligned spine can exacerbate symptoms and make a person more susceptible to stressful stimuli in their environment. Chiropractic helps to improve circulation which is essential in relieving muscle tension and helps shuts down the fight or flight response allowing the body to rest and heal.
How RMD's affect the spine Most repetitive motion injuries or RMDs affect the arms and hands. However, they can also happen in the spine. The majority of back injuries, especially in the workplace, are often the result of long-term repetitive wear and tear on the: - Muscles
- Ligaments
- Tendons
- Spinal discs
Repetitive work motions like: - Pulling
- Reaching
- Twisting
- Bending
All of these movements can weaken and stress the spine and increase the risk of injury. Treatment for RMD's When first treating an RMD, the first step is to reduce or stop the motions that are causing the symptoms. Other therapies include: - Ice therapy reduces pain and swelling.
- Medications like cortisone and anti-inflammatory's also reduce pain and swelling.
- Chiropractic/Physical therapy relieves soreness and pain in the muscles and joints and strengthens the muscles to help prevent future injuries.
- Splints relieve pressure on the muscles and nerves.
- Surgery in rare cases can help relieve symptoms and prevent permanent damage.
Prevention RMDs can be prevented. Here are some important tips to reduce repetitive motion injury: - Take frequent breaks to avoid overuse of muscles with little rest breaks of whatever muscles/ligaments you are using.
- Regular exercise along with stretching and relaxation helps build strength, increase mobility, range of motion and prevent future injury.
- Look at your posture to make sure it is correct for the task at hand. This helps the elbows, wrists, hands, and spine maintain alignment during repetitive motions.
- Don't stay in a single position for too long. Change your posture frequently during any type of activity to relax one set of muscles and use another set, then switch and so on and so forth.
- Practicing correct form and technique will go a long way in preventing a repetitive injury.
- Avoid over-reaching, stretching and twisting.
- Use protective equipment and gear.
- Have a properly designed workstation with office or work equipment at the proper height, distance and allows you to work safely and comfortably.
Staying Healthy Staying healthy and avoiding RMD's is first priority if you work at a job or regularly participate in activities where repetitive motion/s and movement/s are used. Give yourself time to rest, exercise, and implement proper techniques. See a doctor or injury chiropractor if you are experiencing any of the symptoms listed. Ergonomically evaluating the causes is an important part of the diagnostic evaluation for patients with these conditions. Therefore, mapping out a customized treatment plan for changing the way you work/perform these motions is the ultimate goal. We focus on what works for you. We also strive to create fitness and better the body through researched methods and total wellness programs. These programs are natural and use the body’s own ability to achieve goals of improvement, rather than introducing harmful chemicals, controversial hormone replacement, surgery, or addictive drugs. We want you to live a life that is fulfilled with more energy, a positive attitude, better sleep, less pain, proper body weight and educated on how to maintain this way of life. I have made a life of taking care of every one of my patients.
We've all seen the commercials, web ads, emails, etc about the best pillow around. Getting a good night's sleep can be a struggle these days and any type of physical aid is welcome, specifically a pillow. This is especially true of people with chronic, acute cervical neck/back and neuropathic pain. Stores carry various lines of pillows that all claim to be the best pillow for neck pain. With all the different designs out there, choosing the right pillow for your way of sleeping can be a challenge. Dr. Jimenez takes a look at finding the right pillow that will help you sleep, stay asleep and wake up refreshed and with no neck/back pain. Cervical Support A pillow supports the: Throughout the sleep cycle, and therefore has a big responsibility. This guide will help you find the right one to meet your sleep needs. Sleeping position and the pillow can play a major role in comfort or pain. Example - Stomach sleepers usually have the most neck pain. This is because the neck is turned to the side and the spine is arched. For relief, try sleeping either on your back or on the side. This along with a pillow that supports the neck and the natural curve of the spine. Tips for Buying The Right One These guidelines apply to anyone looking for a pillow that can support the spine. It should: - Keeps your spine naturally aligned meaning the head should rest directly over your shoulders and should not be propped up or pushed back too much
- Can be adjusted for maximum support
- Supports your head
- Eliminates pressure on the cervical spine
- Increases sleep duration
- Hypoallergenic for those with allergies
Pillows come in all types and sizes, but don’t get it based on how it's going to look on your bed. Take into account your body size and match that to the size of the pillow. Picking Based On Your Sleep Position Picking the right one for you and understanding how you sleep is important, as your sleep position can lead the way. Stomach sleepers Thin pillows are the way to go and sometimes not using a pillow at all could be beneficial. Sleeping on your stomach puts more pressure on the lower back than any other sleeping position. Consider sleeping on your side/back or only sleep on your stomach for short periods then once comfortable switch to the side/back position. Back sleepers Thin pillows are also the way to go, but this pillow should have some lift at the bottom to help support your neck. Memory foam is an option for back sleepers because it adjusts to your head and neck shape. Side sleepers A firm pillow specifically one with a gusset or a piece of material that adds strength and thickness is more structured and can keep your spine aligned. Specialty With severe spine pain or if pregnant, standard pillows do not work. There are specialty pillows that can provide comfort and pain relief. Chiropractic Known also as a cervical pillow, these can help if you have chronic neck or back pain that’s not allowing sleep. These are molded to your neck and keep your spine aligned during sleep, and come in a variety of styles and materials. A chiropractor can help you choose the right type and instruct you on how to use it correctly. Pregnancy These also come in different types but the aim is to provide support to your growing abdomen. Pregnancy pillows also come with extra body pillows designed to fit under the abdomen and between the knees supporting the entire body. When To Replace Your Pillow - It is recommended that individuals should replace every 18 months to 2 years depending on how aggressively you sleep.
- Using a pillow beyond its lifespan means there is no longer support for your spine which can exacerbate and create new injuries.
- How to tell when a pillow is done its duty, fold it in half. If the pillow stays and does not return to the original position is a good indicator that it’s time for a new pillow.
Sleep allows your body to heal and the spine to rejuvenate. It helps you handle stress better and manage pain more effectively. It is an essential part of good health so making sure that you get good quality sleep should be a priority – and it is possible.
Aracely Pisana visited Dr. Alex Jimenez, doctor of chiropractic in El Paso, Tx, for the first time after several other treatment attempts were unable to provide her with the back pain relief she deserved. Aracely Pisana describes how well Dr. Alex Jimenez and his staff have taken care of her and she adds that their services are what keeps her coming back for chiropractic care. Aracely Pisana has recovered her quality of life and she highly recommends Dr. Alex Jimeneaz as the non-surgical choice for back pain, among other health issues. We are blessed to present to you El Paso’s Premier Wellness & Injury Care Clinic. Our services are specialized and focused on injuries and the complete recovery process. Our areas of practice include Wellness & Nutrition, Chronic Pain, Personal Injury, Auto Accident Care, Work Injuries, Back Injury, Low Back Pain, Neck Pain, Migraine Treatment, Sports Injuries, Severe Sciatica, Scoliosis, Complex Herniated Discs, Fibromyalgia, Chronic Pain, Stress Management, and Complex Injuries. As El Paso’s Chiropractic Rehabilitation Clinic & Integrated Medicine Center, we passionately are focused on treating patients after frustrating injuries and chronic pain syndromes. We focus on improving your ability through flexibility, mobility and agility programs tailored for all age groups and disabilities. We want you to live a life that is fulfilled with more energy, positive attitude, better sleep, less pain, proper body weight and educated on how to maintain this way of life. I have made a life of taking care of every one of my patients. I assure you, I will only accept the best for you…
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Information: Dr. Alex Jimenez – Chiropractor
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Chiropractic treatment is dedicated to finding and correcting spinal misalignments. Many seek chiropractic care to alleviate pain and other health-related symptoms. One condition that is sought out constantly, is relief from lower back pain. 31 million Americans experience low back pain at any given time. This condition affects many, but finding the exact cause can be a challenge. Chiropractors are spinal specialists that are trained to not only alleviate pain but also find and help correct the cause of the problem. Prevention Is The Best Defense Prevention is the best cure for any condition/ailment. When a someone sees a chiropractor, they not only find relief for their condition, but they learn ways to prevent they symptoms in the future. Using proper exercise and ergonomics, they can ease the discomfort before it starts. Great results are gained by individuals that listen to instructions. Treatment Options Treatment options are plentiful. Based on the diagnosis they will suggest the ones that will benefit you the most. These treatments may include one or more of the following: - Spinal adjustments delivered either by hand or instrument like an Activator
- Hot or cold compresses
- Physical therapy modalities like Interferential Therapy or TENS
- Massage Therapy or some other form of soft tissue work
- Spinal decompression therapy
Relief Prescription medication could still be required to help reduce levels. The good news is that the meds can be decreased quicker than usual, as the spine misalignments are corrected, nerve compression is alleviated and the inflammation is reduced. This alone is well worth the investment of time and money to see a chiropractor. Exercise & Physical Rehabilitation As the treatment progresses from pain relief to rehabilitation, a chiropractor will recommend exercises to help strengthen the core muscles. These muscles help stabilize and protect the lower back. These exercises are performed at the office or specialized fitness center with certified physical therapists/trainers to make sure you understand how to do them without re-aggravating the original condition. Once educated on the purpose and how to perform them correctly, you’ll be able to continue at home in conjunction with spinal adjustments during maintenance care. Surgery Options Depending on the condition, surgery can be avoided if chiropractic treatment is implemented before injury/s or pain worsen. A chiropractor can help avoid surgery by correcting the problem. Make sure you follow the recommendations after a consultation and examination are performed. The examination may require X-rays or MRIs. A chiropractor is the ideal medical professional to consult with for any unexplained pain in the musculoskeletal system. They are highly qualified professionals that their specialty is treating conditions like lower back pain and they are very affordable. If you or a loved one have pain in the lower back, gives us a call. We’re here to help!
Why Chiropractic Combined With Glucosamine & Chondroitin Sulfates Are A Win-Win For Degenerative Disc Disease Sufferers. The most effective treatments are often found in the natural ones. The human body has this incredible ability to provide its own healing. Often we can aid that process through nutrition, exercise, and lifestyle changes. While there are some people who do reach for medications and invasive means of pain control, the truth is the best cure is the natural one. This is also true of degenerative disc disease. There are several natural treatments that help relieve the pain and even stop the progression of the disease. Common treatments include chiropractic, glucosamine, and chondroitin sulfates. What Is Degenerative Disc Disease (DDD)? In a healthy spine the discs that lie between the vertebrae and cushion them are filled with fluid. They allow the spine to move, flex, bend, and twist. Over time they may lose some of their cushion as part of the aging process. Degenerative disc disease occurs when the discs of the spine collapse and degrade. In extreme cases, the discs can completely collapse causing the vertebrae’s facet joints to rub against each other. This leads to osteoarthritis. The condition is accompanied by pain, inflammation, and loss of mobility. How Do Glucosamine & Chondroitin Sulfates Help Degenerative Disc Disease? Glucosamine and chondroitin sulfates are substances that occur naturally in the body. It is an essential element in cartilage maintenance and regeneration. They help to form new cartilage from within existing cartilage. They can actually help to rebuild the discs that have begun to degrade. Often they are taken as nutritional supplements. Studies show that long term use of glucosamine and chondroitin sulfate do indeed not just help arrest the development of spinal disc degeneration, they can also help to reverse the symptoms, especially if begun in the early stages of the disease. Treatment that incorporates these supplements result in decreased pain and improved range of motion. Patients may also notice strengthening of the back and increased flexibility. This is true even in patients who are older, in their 50’s and 60’s. Patients may start noticing a decrease in pain as early as six months after beginning to take the supplement. After taking it consistently, the other benefits present over time. What is also important to note is that neither glucosamine nor chondroitin sulfate cause any adverse side effects. These supplements are safe and effective. Chiropractic For Degenerative Disc Disease Chiropractic is a complementary treatment to combine with glucosamine and chondroitin sulfate for degenerative disc disease. Chiropractic alone is very effective for many spine and neck disorders, including degenerative disc disease. It is a natural, non-invasive treatment that does not use medications but instead incorporates lifestyle changes, diet, and exercise recommendations to provide whole body wellness. While chiropractic works very well to treat pain, improve mobility, and increase flexibility, it has actually been proven to stop the progression of degenerative disc disease and even reverse its effects. Using chiropractic for degenerative disc disease and combining it with supplements that include glucosamine and chondroitin sulfate is a very effective system for relieving the pain and other symptoms. In several studies, many patients saw improvement and decrease in symptoms faster than patients who used the supplements alone. Combining these treatments is usually the best course of action to help patients suffering from this devastating disease. When treating any condition, it is always best to go the most natural route possible. The fewer synthetic substances and manufactured toxins that are introduced into the body, the better chance the patient has of a more thorough and faster healing or at the very least a dramatic decrease in symptoms.
Physicians, neurologists, and other healthcare professionals may often run a cranial nerve examination as part of a neurological evaluation to analyze the operation of the cranial nerves. This involves a highly formalized series of tests that evaluate the status of each cranial nerve. A cranial nerve test begins with observation of the patient partly due to the fact that cranial nerve lesions may ultimately affect the symmetry of the face or eyes, among other signs and symptoms. The visual fields for neural lesions or nystagmus are tested via an evaluation of particular eye movements. The sensation of the face is tested by asking patients to execute different facial movements, like puffing out their cheeks. Hearing is tested through voice and tuning forks. The position of the individual’s uvula is also examined because asymmetry in its placement could indicate a lesion of the glossopharyngeal nerve. After the capability of the individual to use their shoulder to test the accessory nerve (XI), the patient’s tongue operation is generally assessed by detecting various tongue movements.
Daniel Alvarado, owner of PUSH Fitness, first met Dr. Alex Jimenez through the connection of a good friend and they became workout partners. Daniel Alvarado learned a lot regarding chiropractic alignment and physiology by training with Dr. Jimenez. After experiencing upper and mid back pain as well as shoulder pain, Daniel Alvarado began receiving regular chiropractic care with Dr. Alex Jimenez in order to restore the original alignment of his spine and improve the symptoms of his injury. Daniel Alvarado highly recommends Dr. Jimenez as the non surgical choice for sports injuries, as he discusses how Dr. Alex Jimenez's relationship with his patients can ensure a positive environment for a better, more improved treatment. Together with Dr. Alex Jimenez's chiropractic care and his own rehabilitation and sports therapy, Daniel Alvarado emphasizes the dynamic of their services. Sports injuries are injuries which occur in athletic activities or exercising. There are kids and approximately 30 million teens alone that participate in some form of sport. About 3 million sports athletes experience sports injuries annually, which causes some loss of time of participation in the sport. Prevention helps reduce sport injuries. It's crucial to set up participation in warm-ups and exercises which focus on primary muscle groups utilized in the game of interest. Also, establishing an accident prevention program as a staff, including education on rehydration, nutrition, tracking staff members "in danger", tracking behavior, skills, and techniques. Our team has takes great pride in bringing our families and injured patients only clinically proven treatments protocols. By teaching complete holistic wellness as a lifestyle, we also change not only our patients lives but their families as well. We do this so that we may reach as many El Pasoans who need us, no matter the affordability issues. Our uplifting southwest community surrounded by it limitless beauty is an amazing place to live and enjoy our families; it is therefore our mission to help each of our patients to live, to love, to matter and to thrive pain free in this wonderful special place. There is no reason we cannot help you. �� If you have enjoyed this video and/or we have helped you in any way please feel free to subscribe and share us. Thank You & God Bless. Dr. Alex Jimenez DC, C.C.S.T Facebook Clinical Page: https://www.facebook.com/dralexjimenez/ Facebook Sports Page: https://www.facebook.com/pushasrx/ Facebook Injuries Page: https://www.facebook.com/elpasochiropractor/ Facebook Neuropathy Page: https://www.facebook.com/ElPasoNeuropathyCenter/ Facebook Fitness Center Page: https://www.facebook.com/PUSHftinessathletictraining/ Yelp: El Paso Rehabilitation Center: http://goo.gl/pwY2n2 Yelp: El Paso Clinical Center: Treatment: https://goo.gl/r2QPuZ Clinical Testimonies: https://www.dralexjimenez.com/category/testimonies/ Information: LinkedIn: https://www.linkedin.com/in/dralexjimenez Clinical Site: https://www.dralexjimenez.com Injury Site: https://personalinjurydoctorgroup.com Sports Injury Site: https://chiropracticscientist.com Back Injury Site: https://www.elpasobackclinic.com Rehabilitation Center: https://www.pushasrx.com Fitness & Nutrition: http://www.push4fitness.com/team/ Pinterest: https://www.pinterest.com/dralexjimenez/ Twitter: https://twitter.com/dralexjimenez Twitter: https://twitter.com/crossfitdoctor
George Lara, now retired, found relief with Dr. Alex Jimenez, back pain specialist and chiropractor, for his degenerative disk disease following two back injuries he experienced several years ago. After using drugs/medications and experiencing constant symptoms due to his DDD, Mr. Lara describes how Dr. Jimenez's chiropractic treatment greatly helped restore his quality of life as well as promote his overall health and wellness. George Lara highly recommends Dr. Alex Jimenez as a non-surgical treatment choice for degenerative disc disease, and praises his dedication for treating his patients. Degenerative disk disease, or DDD, refers to the natural breakdown of an intervertebral disk of the spine. Despite its title, DDD isn't regarded as a disorder, nor is it degenerative. To the contrary, disk degeneration is frequently the consequence of ordinary daily stresses and minor accidents that cause spinal disks to slowly eliminate water in the anulus fibrosus, or even through the stiff outer layer of a disk. As water content decreases, they start to collapse. This could lead to pressure being placed on the nerves causing weakness and pain. While not necessarily symptomatic, DDD may lead to acute or chronic low back or neck pain in addition to nerve pain based on the positioning of the affected disk and the amount of strain it puts around the surrounding nerve roots. Please Recommend Us: If you have enjoyed this video and/or we have helped you in any way please feel free to recommend us. Thank You. Recommend: Dr. Alex Jimenez – Chiropractor Health Grades: http://www.healthgrades.com/review/3SDJ4 Facebook Clinical Page: https://www.facebook.com/dralexjimenez/reviews/ Facebook Sports Page: https://www.facebook.com/pushasrx/ Facebook Injuries Page: https://www.facebook.com/elpasochiropractor/ Facebook Neuropathy Page: https://www.facebook.com/ElPasoNeuropathyCenter/ Yelp: http://goo.gl/pwY2n2 Clinical Testimonies: https://www.dralexjimenez.com/category/testimonies/ Information: Dr. Alex Jimenez – Chiropractor Clinical Site: https://www.dralexjimenez.com Injury Site: https://personalinjurydoctorgroup.com Sports Injury Site: https://chiropracticscientist.com Back Injury Site: https://www.elpasobackclinic.com Linked In: https://www.linkedin.com/in/dralexjimenez Pinterest: https://www.pinterest.com/dralexjimenez/ Twitter: https://twitter.com/dralexjimenez Twitter: https://twitter.com/crossfitdoctor Recommend: PUSH-as-Rx ®™ Rehabilitation Center: https://www.pushasrx.com Facebook: https://www.facebook.com/PUSHftinessathletictraining/ PUSH-as-Rx: http://www.push4fitness.com/team/
Chiropractic care for spinal disc problems is steadily increasing in popularity. As more and more research proves the effectiveness for chiropractic for these types of problems, doctors and therapists are incorporating it into treatment plans for their patients. Spinal disc problems can be debilitating, causing significant pain and severely limiting mobility. Degenerative disc disease is one of the most common spinal problems, causing back pain that, like other spinal conditions, can extend into the hip and leg or even the arm and hand. It is caused by degeneration or thinning of the spinal joints or discs which can disrupt the mechanics of the spine and contribute to bulging discs that press on spinal nerves. Traditional treatment of this condition usually consists of strong pain medication and sometimes surgery. Patients who are dealing with pain from discs that are bulging or ruptured as well as herniated, or slipped discs, do respond well to chiropractic care. Where surgery has long been a primary medical answer to pain relief for these spinal conditions, chiropractic treatments offer a nonsurgical alternative that has been shown to be very effective. Most spinal or disc problems are marked by a specific set of symptoms including neck and back pain, stiffness, arm pain, leg pain, and tenderness in the spinal muscles or the spine itself. Other more serious symptoms can present at the onset of the condition or over a period of time. These symptoms indicate a dangerous problem that could even be life threatening; they include: - Back pain accompanied by fever
- Loss of control of bladder or bowel
- Severe weakness that inhibits the ability to use arms, legs, walk, etc.
- Loss of sensation in both arms and/or both buttocks
- Inability to defecate or urinate
More serious or life threatening symptoms may require medical intervention, but most spinal conditions can be helped or even corrected with chiropractic care. Through the careful, precise manipulation of the spine, a chiropractor can make adjustments to the body that help relieve the pain and pressure. This treatment can halt the debilitating progression of certain spinal problems while relieving pain and increasing mobility. Spinal problems are usually diagnosed by a combination of complete physical examination and a thorough patient history. During the examination the patient’s musculoskeletal and nervous systems are carefully assessed. A doctor of chiropractic will examine the patient by moving the patient into different positions using their legs, arms, and back while applying pressure to the joints. Other diagnostic tools include x-rays and magnetic resonance imaging (MRI). The preferable course of treatment for spinal problems is more conservative in nature. The earlier the problem can be diagnosed and treatment can begin, the better. There are several different treatments that a doctor of chiropractic may do to control and treat the pain. Modalities such as heat and ice applied to the affected area have been proven effective in controlling injury related pain in the lower back. Movement is also crucial to healing and the sooner the patient gets back on their feet, the better. For most injuries or back problems, those problems are exacerbated when the patient stays in bed or coddles their back instead of walking and moving. It can result in long term back problems. Spinal manipulation by a doctor of chiropractic has been proven to be an effective, safe treatment for disc problems and associated pain. In some cases therapeutic exercise may be added to the treatment and this too has been shown to be very effective. In most cases, chiropractic care is sufficient and surgery of the spine or injections are unnecessary to manage the problems. In fact, these more invasive therapies often create more problems than they cure. Chiropractic care should be the first course of action for spine related pain, injury, or problems. So if you or a loved one are suffering from spinal disc problems, make sure you give us a call. We’re here to help!
The autonomic concomitants of cervical pathomechanics
(the posterior cervical sympathetic syndrome) have been
widely reported. The literature documenting the autonomic
manifestations of thoracic and lumbar articular dysfunctions
has not been as extensive. The present study
attempts to determine the incidence and nosography of
vertebrogenic autonomic dysfunction (V.A.D.) in a sample
of 250 consecutive back pain subjects. Thirty-nine per cent
of all back pain subjects exhibited probable evidence of
V.A.D. The incidence of V.A.D. was distributed as follows:
cervicogenic cephalalgia - 60%76 (i.e., disturbed
vision, dysequilibrium, gastrointestinal upset); thoracalgia
- 54% (ie., nausea, flatus); and lumbalgia - 31% (i e.,
constipation, urinary frequency, menstrual disturbances). It is a well known clinical fact that diseases of the internal
organs may produce functional changes and symptoms
or signs in the musculoskeletal system of the body. These
somatic manifestations of visceral disease are fairly commonplace
and are considered to be of importance in the
diagnosis and localization of internal disease. All clinicians
have observed the conspicuous costovertebral angle muscle
spasm resulting from acute renal disorders (1). Abdominal
wall tension and tenderness are characteristic of certain
intra-abdominal and intrapelvic diseases (2-7). Coronary
disease is frequently accompanied by painful trigger areas
in the muscles of the chest and shoulder (8-9).
The premise that disorders of the musculoskeletal
system may reflexly cause autonomic dysfunction and
symptoms attributable to visceral malfunction is common
to both the chiropractic (10) and osteopathic schools (11),
but is not widely accepted by the medical profession. Physiologic
research, based primarily on animal experimentation,
has demonstrated that somatovisceral reflex activity
is indeed a physiologic fact (12-19); however, much remains
to be done to understand the importance of these
reflexes in normal and abnormal human physiology. The
literature of the osteopathic and chiropractic disciplines
has historically contained an abundance of anecdotal and
conceptual data in support of the somatovisceral reflex
hypothesis as a mechanism for symptom production in
man. Very little controlled clinical data has been presented
to support this hypothesis. Palmer in 1895 (20) was probably one of the first to
report a simple cause and effect relationship regarding
somatovisceral symptom production in a patient. His subject
had apparently been working in a cramped position
and felt something "give in his back." He claimed that he
simultaneously became deaf. Palmer examined the
patient's spine and found a "displaced fourth dorsal vertebra"
(sympathetic vasomotor nerves to the cranium) and
corrected it with a manipulation. The patient's hearing
was restored. Palmer thus deduced that the hearing loss
had been vertebrogenic in origin. Three decades later, the allopathic observers, Barre in
1925 and Lieou in 1928, reported similar series of cases in
which disorders of the cervical spine were accompanied by
dysfunction of the organs of the head (21,22). In addition
to hearing loss, the following cervicogenic symptoms have
been observed: vertigo, dysequilibrium, tinnitus, scotomata,
decreased vision, dysphagia, dysphonia, cough, anxiety
and asthenia. (23) The Barr6-Lieou syndrome (posterior cervical sympathetic
syndrome) has been repeatedly recorded in the literature
since 1928. This syndrome represents a generally
accepted classic example of somatovisceral reflex
pathology and is to be found in much of the authoritative
orthopaedic literature of today (24). Reports of somatically-induced visceral dysfunction have
not been confined to the cervical region, nor have they
been restricted to the literature of the chiropractic and
osteopathic schools. This is noteworthy, insofar as allopathic
training does not usually emphasize (or even include)
studies of somatovisceral reflex physiology. One
would therefore expect that allopathic observers would
approach their clinical observations with an absence of
bias and a low index of suspicion for somatovisceral
pathology. Nevertheless, such disorders have been obvious
enough to be noted and reported. Table 1 summarizes allopathic
observations in this regard as reported by Wills
(25), Ussher (26), Travell (27,28,29), Jackson (24), Cooper
(30), Lewit (31), Ushio et al (32), Love (33) and Ver Brugghen
(34). The literature cited here would tend to indicate that
somatically induced visceral dysfunction and symptom
production is indeed a clinical problem. The prevalence of
the problem is not known. The investigators reviewed in
Table 1 have for the most part, not attempted to discover
the percentile incidence of autonomic symptoms in musculoskeletal
disease, nor have they made it clear whether
their data was based on consecutive groups of first-contact
patients or on treatment-resistant subjects who were referred
to their departments for special care. The purpose of this investigation was to determine the frequency of symptoms attributable to vertebrogenic autonomic dysfunction in a consecutive group of first-contact chiropractic patients. MethodA pilot study, of the prospective-descriptive format, was designed. The focus of the study was on the anamnesis, with particular attention given to the sequence of clinical events. (For example, do patients with back pain simultaneously develop autonomic symptoms? If so, how often? 52 Do the autonomic symptoms disappear upon recovery from the spinal pain?) The emphasis then, was on seeking a parallelism between the development and disappearance of back pain with the development and disappearance of visceral symptoms. Inclusion/Exclusion and Data Gathering:The following guidelines for data gathering were adhered to throughout the study: 1. Two hundred and fifty consecutive first-contact patients who presented with back pain (cervical, thoracic or lumbar) comprised the sample for analysis. 2. After a thorough case-history was obtained from each subject, careful notation was made of associated symptoms. The phrasing of this latter aspect of the interview was as follows: "Have you, since the onset of your back pain, developed any other seemingly unrelated symptoms for example, have you felt generally ill? Have you been constipated? Have you had to empty your bladder more frequently - or less frequently?" Usually, four or five examples of known vertebrogenic symptoms were mentioned. See Table 1. A systems review followed. As additional symptoms were uncovered, it was determined whether or not their onset in any way paralleled the onset of back pain. 3. The patient was not given a r6sume prior to the beginning of treatment for his back pain. No further comment was made regarding the subject's visceral symptoms, if present. No mention was made of any relationship between the spinal pain and the visceral symptoms. A chart of the autonomic nervous system was removed from the office. The patient was not told that analytical data was being gathered. The attempt here was to limit, as much as possible, the introduction of accentuated placebogenic and/or Hawthorne effects (35) into the study. 4. The subjects who were accepted as chiropractic patients were treated with spinal manipulative therapy (primarily chiropractic high velocity, controlled amplitude adjustment). In some cases, ancillary physical therapeutic methods were utilized as indicated. Patients who were referred to other health disciplines for care (i.e. surgery) remained in the study providing that follow-up data were available. (This study was not designed to test the effectiveness of manipulative therapy its sole purpose was to investigate spinovisceral symptom parallelism see illustrative case 4.) 5. The subjects were re-evaluated when they became asymptomatic with respect to their back pain or were much improved (at least 80%o by mutual patient-examiner agreement). The patients were at this time questioned regarding the status of any associated visceral symptoms that had been previously reported. The observation that recovery from visceral symptoms paralleled recovery from the spinal pain was taken to be confirmatory evidence of vertebrogenic autonomic dysfunction in that subject. Subjects were excluded from the study for the following reasons: non-acceptance as a patient because of organic pathology or other contraindications, non-compliance, self-discharge from care, unsatisfactory recovery from the spinal complaint and incomplete admission or follow-up records. When a patient was dropped from the study, the next consecutive patient history was admitted to the data pool so that the target number of 250 subjects could be met. A survey of drug usage by patients in this study revealed the following: 52% of patients did not use drugs at all; 32% has self-administered approximately 1 to 6 non-prescription analgesic tablets (i.e. aspirin, codeine) and had subsequently sought professional care; 16% were on regular therapeutic dosages of physician prescribed or self-administered pharmaceuticals either for spinal pain or for other unrelated conditions. Most of the subjects who had used pharmaceuticals remained in the study. They were included or excluded after careful analysis of the individual data (see data analysis guidelines). Vertebrogenic Data Analysis:The presence or absence of vertebrogenic autonomic dysfunction (V.A.D.) was determined from the admission and follow-up records on each subject. The likelihood of vertebrogenicity was determined on the strength of the gathered data. The information on each case was then categorized as yielding probable, possible or negative evidence of vertebrogenic autonomic dysfunction. The guidelines for categorization were as follows: 1. Probable: Patients who exhibited an unequivocal parallelism between the onset and abatement of back pain with the onset and abatement of visceral symptoms were considered to have evidence of probable vertebrogenic autonomic dysfunction. 2. Possible: If there was any doubt regarding the accuracy of the gathered data (e.g. inconsistency of the subject's responses to questions) the findings were categorized as "possible V.A.D." If any discrepancies were noted in spinovisceral symptom parallelism, the data was considered to yield evidence of possible vertebrogenic autonomic dysfunction. For example, patients who fully recovered from spinal pains, but were left with vestiges of autonomic symptoms or patients who recovered from autonomic symptoms but were left with some spinal pain, were placed in the V.A.D. possible category. 3. Negative: Subjects who developed back pain but did not experience any symptoms attributable to autonomic dysfunction were classified as "V.A.D. negative". As stated in the previous section, data from patients who had used pharmaceuticals were individually scrutinized for inclusion or exclusion, and categorization. This analytical process would best be illustrated by the following examples: Case 1: This patient developed acute lumbalgia. He self-administered four 222 tablets® (total 32 mgs. codeine) on day 1 and presented here the next morning. He reported constipation as an associated symptom. The constipation resolved on day 3 although the lumbalgia continued. He remained in the study and was classified as "negative V.A.D." Case 2: This patient developed cervicalgia and self-administered 6 aspirin over day 1. She presented on day 2 and reported dizziness, gastric upset and flatus as associated symptoms. She discontinued her aspirin, but the autonomic symptoms persisted throughout the course of her treatment. All spinal and associated symptoms abated during the 3rd week. She remained in the study and was classified as "possible V.A.D." Case 3: This patient developed a severe cervical-brachial neuralgia. Her family physician prescribed Tylenol® and diazepam. She presented on day 10. She reported anorexia, nausea, flatus, blurred vision, dizziness and mental fogging as associated symptoms. On day 24 her cervicalgia and all associated symptoms had cleared, yet she remained on the prescribed medication. She was classified as "probable V.A.D." ResultsOf the original 250 subjects who met the criteria for admission to the study, 22 were subsequently lost (20 with self-discharges and/or poor results, 2 with organic disease found on continuing examination) and replaced by next consecutive patients. Ninety-eight (39%) of all subjects exhibited "probable" and thirty-three (13%) exhibited "possible" autonomic dysfunction. Also noteworthy was the observation that four (2%) of the subjects experienced reactivation (relapse) of previously quiescent visceral disease during their back pain episodes (2 duodenal ulcers, 2 lower genitourinary infections). The levels of spinal complaint fell into the following four categories: 1. cervicalgia with cephalalgia, 2. cervicalgia (with or without upper extremity pain), 3. thoracalgia, and 4. lumbalgia (with or without lower extremity pain). The frequency of autonomic dysfunction for each category is given in Table 2. The frequency distributions of the various autonomic manifestations observed are given in Tables 3 - 6. While Tables 3 - 6 give the frequency of symptoms observed in the present study, they do not give an accurate picture of vertebrogenic autonomic dysfunction as actually seen in clinical practice. Many of the subjects had multiple autonomic symptoms and these symptom complexes are not accurately portrayed by tables. The following case studies are instructive: Case 4: Mrs. F. presented with neck pain and headaches. She had sustained a whiplash injury 2 years previously and her symptoms had cleared with chiropractic therapy. Her present symptoms had recurred 2 months prior to her consultation here. She complained of a constant, moderate to severe upper cervical ache which radiated into the occipital-frontal regions. The cephalalgia occurred daily and intensified in the mid afternoon. She reported associated dizziness and difficulty in focusing her eyes. She could not clearly focus on close objects and stated that while driving, the windshield seemed to move back and forth in relation to her eyes. She was constantly squinting in an effort to see clearly. She had been seen by an optometrist 3 weeks previously with negative findings. On examination, cervical extension, right side-bending and left rotation were painful and limited. There was palpable paravertebral muscle spasm and restriction of motion in the upper cervical articulations. Trigger points were found here which reproduced the cephalalgia. Cervicogenic autonomic dysfunction was objectivated with the following manoeuvres: 1. Triggers: Firm pressure over the right lamina of C2 precipitated an immediate bout of blurred vision and diplopia. 2. Resisted Motion: Resisted cervical extension (with the head fixed so as to exclude vestibular motion) resulted in an episode of "swooning" and vertigo. 3. Cervical Torsion: The patient's head was fixed by an assistant (so as to exclude vestibular motion) and the torso was rotated, flexed, extended, side-bent and circumducted under the immobilized cranium. These maneuvers precipitated vertigo. Cervicogenic autonomic dysfunction was further confirmed by the therapeutic test. The patient was treated with the manual adjustment of the upper cervical spine. The results were as follows: 1. The initial manipulation caused a transitory aggravation of the dizziness and the visual symptoms. 2. This was quickly relieved by manual traction. 3. The patient was fully recovered from all articular (pain) and non-articular (autonomic) symptoms by the tenth office visit. She remained asymptomatic over a 4 month follow-up period. Case 5: Mrs. J. presented with low cervical, right scapular and right mid-thoracic pain of several months duration. There was associated dizziness, staggering and blurred vision. She had been referred to an ENT specialist who was non-commital in regards to a diagnosis. On examination, a trigger point was located on the antero-lateral aspect of C6-7 which reproduced her pain. The cervical torsion test was strongly positive the patient requiring support because of the precipitated vertigo. The lower cervical segments were adjusted and all symptoms abated after 5 visits. The patient has had several relapses over the ensuing months. Dysequilibrium has been a constant concomitant of each attack. Case 6: Mr. R. Complained of a constant, dull mid-thoracic ache of 3 weeks duration. The symptoms had occurred after the patient spent several days working in the stooped forward position. The patient also complained of nausea and a feeling of a "lump" in the epigastric region. He stated that his food remained in his stomach for several hours after ingestion. He regurgitated frequently and was troubled with belching and flatus. He occasionally had crampy abdominal pains. On examination, the spinous processes and right costotransverse articulations of T4 to T7 were exquisitely tender. There was rhomboid. spasm on the right and mid-thoracic motion was restricted. A single adjustment to this level was followed by immediate pain relief together with several minutes of massive gaseous eructation. All other symptoms cleared over the next few hours and did not recur over a 3 month follow-up period. Case 7: Mr. V. presented with acute lumbo-sciatica of one week's duration. The pain had occurred after a straight-legged lift. Mr. V. reported that since the occurrence of his injury he had been troubled with alternating bouts of constipation and diarrhea, urinary frequency, nocturia, partial urinary retention, impotence and "retraction" of the testes. He exhibited sciatic kyphoscoliosis. All trunk movements were limited and painful. Straight-leg raising, foot dorsiflexion and Valsalva maneuvers were positive. Deep springing of the L4 vertebra aggravated his pain. Sphincter tone was normal. A trial of manipulation afforded only temporary (hours-days) relief. The left Achilles reflex became sluggish and the patient was referred for neurosurgery. An L4 discotomy resulted in complete recovery from all spinal and visceral symptoms. Case 8: Mrs. R. presented with an acute lumbalgia which referred to the left groin. The pain had occurred 4 days previously and since that time she had been troubled with constipation, flatus, urinary frequency and a burning dysuria. Her urinalysis was negative for abnormality. Lower lumbar and left sacroiliac dysfunctions were corrected with manipulation. All symptoms had cleared by the fourth office visit. At the time of discharge from care, Mrs. R. asked if her bowel and bladder symptoms could have anything to do with the lower back. She stated that every time she had a lower back episode she developed the same pelvic symptoms. She, had had several unremarkable bowel, gall bladder and urinary investigations in regards to these symptoms. Discussion: Vertebrogenic Autonomic DysfunctionThe exact mechanism of spinovisceral symptom production is not conclusively known. Several pathophysiologic hypotheses could be advanced to explain these clinical phenomena. It is also possible that different pathological processes are operant in different individuals. Postulated mechanisms of spinovisceral symptom production are summarized below: Pain: The autonomic concomitants of severe pain are well known. They are due to mass sympathetic stimulation and include such symptoms as agitation, hyperhidrosis, pupillary dilation and vomiting. Stress-Endocrine: Selye (36) has pointed out that many disease states are accompanied by two groups of symptoms - the symptoms produced by the stressor and another group of symptoms resulting from the body's endocrinal defense responses to the stressor. Using the eosinophil count as a stress indicator, I presented evidence which would suggest that 54% of severe lumbalgic episodes are accompanied by an alarm-endocrine reaction (37). It is possible that some of the symptoms observed in this study have an endocrine-chemical basis. Somato-Psycho-Visceral Reflexes: It is well known that certain patients look at their pains through a psychological magnifying glass and develop all manner of unrelated symptoms. Psychogenic symptom production, no doubt, introduces an artifact into this study. It is, however, very interesting to note that most of the symptoms observed here, bear a segmental relationship to the level of spinal lesion (only one patient in this series had any knowledge of the anatomy of the autonomic nervous system). These segmental spino-psycho-visceral relationships may be explained by osteopathic research. In a brilliant experiment, Korr et al have shown that when the psyche is stimulated, maximum sympathetic outflow occurs at hyperirritable cord levels which have been previously sensitized (facilitated) by proprioceptive input from preexisting spinal joint lesions (38). Somato-Visceral Reflexes: Somato-autonomic reflexes in the laboratory animal are a physiologic fact. They are observed under certain conditions in man. The postulated modus operandi in spinal lesions is as follows: the lesioned spinal joints trigger an increased afferent input (pain, proprioception) into the related cord segments. The lateral horn cells are facilitated via the internuncial neurons and impulses spill over into the sympathetic efferents causing activation (motor, vasomotor, secretory) of the target 56 viscera. Such sustained pathophysiologic activity could well be responsible for spinovisceral symptoms observed in back pain subjects. Nerve Compression: It is well known that discal lesions, vertebral exostoses and stenosis may compress nervous tissue and cause autonomic dysfunction or paresis. It is also possible that root compression may interfere with axoplasmic flow. If, for the purpose of survey, one considers paresthesia/anesthesia to be indicative of nerve-tissue compromise, then 30% of first-contact patients presenting at this office have nerve compression syndromes. This could be responsible for autonomic dysfunction in selected patients. Vascular Compromise: Cervical degenerative lesions may compromise the vertebral arteries and cause cranial symptoms. This mechanism could have been operative in aged patients; however, the slowly progressive cerebral dysfunction (39), which allegedly occurs with sustained neck torsion in this condition, was not observed in any of the subjects. Proprioceptive Cross-Talk: It is possible that unequal cervical muscle tensions might feed the central nervous system with confusing proprioceptive information so as to disturb normal righting reflexes. This mechanism could explain the high incidence of dysequilibrium in subjects with neck injuries. Other: The constipation observed in severe lumbalgic patients may be antalgic or due to lack of exercise. The spinovisceral syndromes described here are typical of the symptom complexes observed in the everyday clinical practices of all manipulative practitioners. Further studies, to more precisely explore these common clinical problems, are warranted. The present study represents a first-attempt prospective investigation and the presented statistics may be considered to be "ball-park" figures only. A much larger subject population is required. Analysis of the gathered data in a preliminary study such as this, almost invariably exposes deficiencies in the original prospective design which could be corrected to improve future investigations (40). The following recommendations should be considered: Investigator Artifact: Solo investigators who study their own patient populations may be subject to impaired objectivity. Future studies should utilize a multi-disciplinary team of investigators to design and carry out the project. Data Artifacts: All data gathering methods (verbal interviews and questionnaires) are subject to error (40,41). The interview method was used in the present study. Future studies should include both verbal interviews and written questionnaires to facilitate cross-checking of the accuracy of the gathered data. Psychologic Artifacts: Clinical studies are frequently criticized for failing to establish psychological base-lines for the studied subjects. Written questionnaires could incorporate standard psychological testing proforma. Pharmacologic Artifacts: Investigator judgement (bias) was used in categorizing data on drug users. Future studies should exclude these subjects, or at least analyze their data in a separate category. Statistical Artifacts: A much larger study population is required in order to establish accurate prevalence rates for vertebrogenic autonomic dysfunction. Formal statistical analysis is also required. Follow-Up: The foregoing study was designed to be an acute investigation of a common clinical syndrome. It asked simple, straight-forward questions regarding the sequence of events during back pain episodes. While many of the subjects were followed for months, and even years, it is debatable if long term follow-up would bring forth any additional answers to the questions asked. 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Golfers, does this sound familiar? It's a warm sunny day with a bit of a breeze, you are on the back nine about to sink a putt. When you swing, your back seizes up with severe pain. The beautiful day of golf turns into painfully riding in the golf cart back to the clubhouse, and you limping painfully to your car. If you have ever strained your back during a golf game, you are not alone. It's estimated of the 30 million golfers in the United States, 80% have experienced some sort of back pain. As fun as it is, swinging at golf balls puts an individual's body in an awkward position, opening up the opportunity for injury. While some golfers suffer through the pain by popping over-the-counter medications, others back away from playing as often, or stop altogether. There's another way to combat back injuries caused by golfing, without meds. It's not a magic wand, it's chiropractic care! Golfers are increasingly finding chiropractic care to be a valuable tool to help them deal with back injuries. Here are FORE! ways chiropractors can help injured golfers get off the couch and back on the green. Golfers: Consistent Adjustments Can Avoid Injuries In The First Place.Golfing, or any activity, is more enjoyable and causes less chance of injury if an individual's body is in top condition and operating normally. Periodic spinal adjustments keep the body functioning at maximum capacity, and reduce the chances of being injured. If the neck and back are aligned correctly, awkward positioning such as a golf swing will have a less negative impact. Chiropractic Treatment Can Reduce A Golfer's Pain.Back injuries can be extremely painful, and many turn to pain medications to gain relief and comfort. By treating the origin of the pain instead of just the symptoms, a chiropractor helps their patients manage the pain through manipulations, instead of drugs. Over the course of a few treatments, pain is often drastically diminished and much more manageable. A Golf Injury Can Heal Quicker With Chiropractic Care.Injuries to the back or neck can heal faster when chiropractors treat them than on their own. An experienced chiropractor can adjust the spine, and also work on the joints and surrounding tissue that can cause pain and hinder healing. Chiropractic evaluation considers the body as a whole. By treating the entire body, it promotes quicker healing of the injury. Increased Mobility Can Be Gained With Chiropractic Visits.Golfers who play often as well as those who only play a few times a year know mobility is essential to a good golf game. Stiff joints and a weak back not only mess with the golf game, but can be the very issues that end up causing an injury. A chiropractic treatment schedule keeps the body loose and strong, and working in optimum fashion. This prevents injuries and increases the chances of playing the game of your life. Golfers need to realize the sport can cause serious injuries just like "rougher" sports like football and rugby. It's a good idea to stretch before playing, stay hydrated, and avoid overexertion. If you are a golfer, chiropractic care is a valuable tool in staying healthy. Regular adjustments and manipulations keep your body on track and performing with maximum mobility at the top of your game. If you do suffer an injury, a chiropractor can help you manage your pain and decrease the time it takes to heal. Contact us today for more information on how we can help reduce the chance of injury for golfers, and promote healing.
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As we have transitioned to the spring season, especially with everything going on, most of us are taking on a DIY project or two along with spring cleaning around the house. You definitely want to avoid back pain and for sure back injury at any cost. The aim is to balance spring cleaning and spine safety while performing out-of-the-ordinary chores. Here is a little what to do's and don'ts. What to do - Stand up straight and learn to practice proper posture. Stand in a way where your back is less prone to injury.
- No matter what task you are performing, keep your spine in line and constantly check on how you're standing, reaching and lifting.
- Lift with your legs, not with your back. Avoid bending at the waist and straightening out, this is a bad habit and could be a set up for injury. You could slip a disc, tear a muscle, or sustain other injuries to the spine. No matter what you're lifting, bend your knees and keep your back straight to avoid injury.
- Maintain healthy body weight. While cleaning up the house, consider cleaning out the pantry and refrigerator. Carrying too much weight puts added and possibly dangerous pressure on the spine. This could mean that the added weight pulls your spine in all directions because of weak back/core muscles trying to keep the structure in line. Losing excess weight can help ease tension on the back and improve overall health.
- Strengthen the core muscles. Incorporate core-strengthening exercises into your day. With strong abdominal and back muscles, the core supports your spine, keeping it aligned and healthy.
- Get plenty of calcium-rich foods, like low-fat milk and cheese, almonds, black beans, and broccoli. Give your refrigerator a makeover with better foods for spine health. The spine needs healthy muscles to support it. Strong bones mean less risk of a spinal fracture if you suffer a slip and fall accident.
What not to do - Clear the air and stop smoking. Not only is smoking bad for the heart and lungs, but it is also bad for the spine. Nicotine decreases the discs ability to absorb nutrients to maintain the spine's proper function. Weakening the vertebrae increases the risk of a herniated disc or other spine injury/s. Nicotine interferes with the healing process, meaning that recovery time is slower.
- Over exert yourself. Taking on too much or trying to power through without proper breaks can lead to injury, as well as other health problems.
- Over-reaching. Trying to clean that out of reach spot overstrains your back, and can definitely lead to injury/strain/sprain.
- Use improper equipment. Using the wrong equipment/tool can be dangerous and raises the chance of injury.
- Don't take on large projects without warming up and stretching. When the body's spine muscles are not used to certain physical activities they can spasm and lead to sprain/strain and back pain.
- Don't put your body in awkward positions when cleaning, etc. Change your posture frequently to keep all the spinal muscles moving and active. If an awkward position presents, stop and find a comfortable position to work from, ensuring spine safety.
Back Pain All of these words can be used to describe back pain. - Achy
- Dull
- Excruciating
- Sharp
- Throbbing
Back pain is a common occurrence and when spring cleaning, if not using proper form and making wise decisions it can exacerbate the pain or create new injuries. The American Chiropractic Association says that back pain is the single leading cause of disability worldwide. Treatment Back pain usually heals on its own. A few days of over-the-counter pain meds, ice, and rest bring the back/spine to normal. For those that have to deal with the pain after a few weeks' might want to opt for other solutions. This is true for individuals who experience repeated flare-ups, or chronic lower back pain. One of the best options is chiropractic. Chiropractic doesn't focus only on the symptoms but helps kick in the body's natural healing abilities. Chiropractors understand the: - Bones
- Muscles
- Discs
- Nerves
They are able to determine the reason for the pain. Once diagnosed they can create a customized treatment plan that can range from compresses, spinal manipulation and exercises that helps heal the area and reduce the pain. Medication-free solution The natural healing, and restorative approach that chiropractic treatment offers instead of pain meds, which just dull the pain is one of the primary reasons individuals flock to chiropractic. Each individual's treatment varies according to Spine-Universe. As treatment progresses spinal alignment begins to balance the rest of the body and helps correct the issue causing the pain. Spinal manipulation improves mobility and function. Chiropractic for back pain Patients who experience lower back pain obviously never want to deal with it again, but it can flare up periodically. According to the National Institute of Neurological Disorders and Stroke, roughly 20% of those who suffer from low back pain will eventually deal with it chronically. This can cause frustration, especially when it affects mobility. Those who choose chiropractic are privy to treatment that: - Reduces pain
- Increases healing
- Shortens downtime
- Lessens chances of recurrence
If over the counter medication and ice packs haven't worked, it could be time to make an appointment with a licensed chiropractor. Spring is a great time to introduce yourself to new activities to keep you and your family busy and healthy. With some preparation and attention to detail, spring cleaning can be productive and safe.
Here are some tips to avoid stressing your back. Ergonomics breaks down how our work environment affects our work and body. Ergonomics looks for ways to improve our environment to decrease the risks of injury, ailments, enhance productivity, and improve the quality of our work. The profession of ergonomics focuses on two areas: - Industrial ergonomics also called occupational biomechanics focuses on the physical aspects of work like
- Force
- Posture
- Repetitive movement/s
- Human factor ergonomics looks at the psychological aspects of work like mental well-being and efficient decision-making.
Minimize Stress at the Desk - Try not to lean over the desk for extended amounts of time.
- Do not sit too far from the desk/workstation.
- Do not sit with your back unsupported.
- Adjust the chair to a proper height so the knees are bent at a 90-degree angle.
- Keep the elbows bent at a 90-degree angle but also rest the elbows on the work surface or chair armrests.
- Try not to bend or twist the neck while on the phone.
Maintaining a Neutral Spine While Standing The feet should be slightly apart with the knees straight and chin tucked in. Try not to stand in one or the same position for extended amounts of time. Change and shift the weight from one foot to the other regularly. Use a footstool to elevate the foot/feet off and on, shifting the weight and continually moving can be helpful. Proper Posture Proper posture means maintaining the natural curve of the spine known as a neutral spine. Proper posture should be incorporated into all activities of daily living, which minimizes the amount of added stress to the spine. Proper posture is so important it's what a chiropractor or physical therapist will first teach a patient. Proper posture looks like Imagine a plumb bob hanging from the ear lobe. With proper posture, the plumb bob will drop straight down the middle of the arm to the ankle. Why is this so important? Improper posture and incorrect body mechanics are two of the primary causes of neck and back pain. Lifting/Carrying Objects - Observe the object to be moved, if the object looks too heavy or too big then please get help!
- Before moving the object move any obstacles out of the path.
- Get as close to the object as possible and bend at the knees.
- Before lifting make sure the feet are slightly apart and flat. When turning, instead of twisting, pivot with the feet. This helps provide a stable base.
- Take a long breathe and tighten the stomach muscles.
- Smoothly lift the object using the arms and legs, not the back!
- Try to hold the object at the side and bottom and keep it close to the body.
- Keep your back straight.
- Carry the object with the elbows slightly bent.
- When carrying try to keep a balanced amount of weight in each hand. For example, shopping bags or luggage should have the loads divided in two.
- Keep the shoulders held slightly back and level.
- The ears should line up with the shoulders.
- Keep the chin tucked in slightly.
- Keep the pelvis shifted forward so that the hips are lined up with the ankles.
Reaching - Consider the size, weight, and location of the object.
- Use a heavy-duty step ladder.
- Directly face the object and get as close to it as possible.
- One hand should be used for additional support.
- Try not to look overhead for extended periods as this causes unnecessary stress to the neck.
- Store items that are used all the time easy to reach. This could mean rearranging shelves etc.
There are almost as many causes of back pain as there are words to describe the pain and symptoms. Muscle spasms are the most common cause, the spine is susceptible to the same problems as other parts of your body. Poor posture and incorrect body mechanics are two of the leading causes of neck and back pain. Through Dr.Alex Jimenez’s unique approach to healing, he continues being voted the best Chiropractor in El Paso by the El Paso reviewing sites, clinical specialists, researchers and readers. This is in part because he passionately accepts patients he feels are candidates for care. If he feels you need other treatment, then you will be referred to a clinic or Physician that is best suited for you. Dr. Jimenez has teamed with the top surgeons, clinical specialists, medical researchers and premiere rehabilitation providers to bring El Paso the top clinical treatments to our community. Providing high non-invasive protocols is our priority.
Understanding your spine, the way it works and moves is critical to finding the right back pain treatment when back pain or injury creeps in. People don't really think about their spines until back pain rears its ugly head. The spine is not one continuous structure that extends from the neck to the tailbone. It is an intricate, complex group of several structures. Some understanding of the spine can help individuals make informed decisions before getting involved in activities that can cause a spinal injury. Anatomy The spine is made up of 24 vertebrae, these are the bones stacked on top of each other and forms the spinal column. The spinal cord passes through the vertebrae that acts as a protective frame. The spinal column surrounds the spinal cord like an electrical cord. It protects the nerves that run from the brain, through the spinal column and out to the rest of the body. The spinal cord is the highway of nerves that carry the brain's signals to the rest of the body, allowing the ability to move the arms and legs, etc. The soft, spongy shock absorbers in between the vertebrae are the intervertebral discs. They keep the vertebrae separated so smooth function and movement is possible. Because the spine is such a complicated network of bones, discs, muscles, nerves, and ligaments, getting to the bottom of exactly what’s wrong when back pain sets in can be a complicated process. This is where having some knowledge of your spine can help a doctor or chiropractor figure out what's going on and then developing the best treatment plan possible. Time Dealing with time can be a tricky issue when suffering from back pain. When only soreness, stiffness and muscle stress occur every so often then time can be the best medicine, as rest is all that is needed for the swelling to go down. But when the pain does not go away with rest and is getting worse, waiting for evaluation is not an option. Imagine all of those complex structures in the spine as dominos in a row. If one domino/disc falls or slips pressure is placed on all the other dominos/discs to work harder to support the failing structure. But they can only do this for so long until the other discs or other areas of the body begin to fail. Left untreated will eventually cause the failure of other structures of the body. Strong Spine It was designed to support the entire body combined with the additional weight that we carry. It deserves care and respect. Unfortunately, it is not made of titanium and is susceptible to injury. Spinal Nerve Compression When a spinal nerve gets compressed, entrapped, or pinched it becomes inflamed and pain sets in. In the illustration of a neck spine segment, many different disorders are causing the nerve compression in this instance: - Herniated disc
- Thickened ligament
- Bone spurs called osteophytes
Making sure to pay close attention to your spine will safeguard it. So spend some time to understand how your spine operates. Looking at some basic yoga for back poses can be a great start to understand how your spine functions. What is Yoga? In its purest form, it is an ascetic and spiritual discipline that comes from Hindu culture. It involves simple meditation, breath control, and performing body postures. While an ancient practice long used for spiritual and emotional healing as well as physical wellness, yoga has been adopted in western culture and widely accepted as a form of fitness as well as a therapeutic practice used for relaxation and overall good health. It focuses on inward healing with outward results. People who practice regularly find they are: - More centered
- Handle stress better
- More flexible
- Have better mobility
- Have stronger leaner bodies
Kent S. Greenawalt, President, and CEO of Foot Levelers discuss how custom foot orthotics can help reduce back pain, low back pain, and sciatica. In a recent research study published by the American Congress of Rehabilitation Medicine (ACRM), researchers demonstrated that Foot Levelers custom foot orthotics help considerably reduce back pain and several of its associated health issues. The research study also demonstrated that Foot Levelers custom foot orthotics and chiropractic care help tremendously reduce low back pain and sciatica. Foot Levelers custom foot orthotics and chiropractic care helped improve the patient's overall health and wellness. Dr. Jimenez is a chiropractor in El Paso, TX who can help provide these benefits through the utilization of chiropractic care and Foot Levelers custom foot orthotics, among other treatments.
Teachers go through a lot in a day. They spend hours on their feet. They bend, stoop, and lift, hunching over students’ desks helping them and carrying heavy books. They sit at a desk, grading papers. It’s no wonder so many of our educators complain of neck and back pain! The good news is, regular chiropractic care can help alleviate those symptoms so that teachers can keep doing what they do best – sculpting young minds. Research shows that back pain is a common complaint for teachers. When you factor in the mental stress as well as the physical demands, it is easy to see how they could have problems with aches and pains. Chiropractic care offers a proactive approach to health care and overall wellness to keep teachers pain free. Why Teachers should Seek Chiropractic Care When you are juggling home, family, and career, it is easy to put your health on the back burner. You may start out ignoring that twinge of pain in your lower back, or those headaches that you get now and then. But if left untreated, these problems can worsen. That occasional back pain could turn into a full-time ordeal, affecting your arms, legs, even your feet. The occasional headaches could steadily increase in intensity and frequency until it seems you can’t go a day without one. When your body is bombarded with pain it affects every aspect of your life. Even low-level pain that is constant can lower your performance on the job and at home. It can cause irritability, difficulty concentrating, and fatigue. Your students suffer; your family suffers. It is really worth it? Chiropractic care is a proactive approach to better health both mentally and physically. It will help you stay on top of your game so that you function better in the classroom as well as at home. When you feel better you will have more energy to do the things you enjoy. Even once a week or once every two weeks in a chiropractor’s office can make a world of difference in how you feel and how you function. What Chiropractic won’t do for Teachers Chiropractic is a natural approach to health care. It provides patients with a non-invasive, medication-free way to manage their pain. The teacher who seeks out chiropractic care will not be prescribed mind-numbing medications that upset the stomach and inhibit your performance in the classroom. It won’t prescribe invasive procedures that require time off work and out of the class while you recuperate. Medical doctors often just treat just the symptoms without ever addressing the root of the problem. This is an almost sure-fire guarantee that your problems will return because they were never resolved. Chiropractic seeks to find the cause of the problem so that the pain can be managed, not just temporarily relieved. How Chiropractic Benefits Teachers When you visit a chiropractor, he or she will do much more than just adjust your neck and back. They may discuss with you the activities you enjoy, what your schedule is like, and how you spend your day. While they will realign your spine and bring your body back into alignment, they will also help you in other areas as well. This translates to fewer sick days, less pain, and increased effectiveness in the classroom. Chiropractic provides a whole-body approach to wellness. It sees the patient, treating the underlying causes, not just the symptoms. Your chiropractor may offer nutrition and dietary advice, advising you to lose weight, eliminate certain foods from your diet, or add certain foods. They may recommend lifestyle changes like quitting smoking or incorporating exercise into your daily routine. You may be given supplements that support your immunity, joints, or overall health. By treating the whole patient, chiropractic is more effective and will greatly improve the patient’s quality of life.
Back pain can be debilitating. A patient can find they have trouble moving or engaging in regular activities like lifting their children or even walking. Pain in the mid to upper back can be caused by a variety of issues, and it can have a significant impact on a person’s quality of life. Many people see chiropractors to get relief from their back pain, but there are some things that chiropractic patients should know so that they can get the most out of their treatments. What is the Thoracic Spine? 12 vertebrae make up the thoracic spine which is located just above the lumbar spine and just below the cervical spine. It is often referred to as the upper back. This part of the spine has several essential functions. The ribs connect with this portion of the spine, and it also is responsible for protecting the spinal cord. The thoracic spine also differs from the lumbar spine and cervical spine. Instead of curving inward (lordosis) as those areas do, it curves outward (kyphosis). This provides the freedom of movement that allows a person to bend forward and touch their toes. It does not allow for much bending backward; that typically comes from the lower back. Many nerves extend from the thoracic spine. They control organ function for the major organs, including: T1 to T4 - Heart
- Esophagus
- Upper body muscles
- Lungs
- Larynx
- Part of the arms
- Trachea
- Esophagus
T5 to T10 - Gallbladder
- Diaphragm
- Small intestine
- Appendix
- Liver
- Kidneys
- Suprarenal gland
- Stomach
- Spleen
- Adrenal gland
- Pancreas
T11 to T12 - Small intestines
- Mid to upper body muscles
- Lymph circulation
- Colon
- Solar plexus
- Uterus
Mid to Upper Back Pain Pain in the thoracic area of the spine is often caused by muscle strain, overuse, and injury to the discs, ligaments, and muscles that surround the spine and support it. Poor posture can also cause pain in that area. It is also very common for myofascial pain to affect the connective tissue of` muscle groups and individual muscles. These problems can occur due to a variety of causes: - Slouching or slumping while standing or sitting
- Getting in a car accident where the patient is lurched forward or jolted
- Lifting something that is too heavy
- Yard work
- Getting struck or hit in the back
- Playing sports
Osteoarthritis can also occur in this area. It is caused by torn cartilage brought about by the everyday wear and teas and even the simple process of aging. Fractured vertebrae can also cause back pain in the thoracic area, as can a herniated disc, and a spine that is oddly shaped or misshapen. Degenerative disc disease and spinal stenosis can also be culprits. Chiropractic Care for the Thoracic Spine The goal of the chiropractor treating a patient for thoracic back pain will usually focus on reducing the pain and inflammation in the area. The treatments may include: - Spinal adjustments
- Specialized exercise recommendations
- Ergonomic training
- Distraction
- Heat or ice
- Traction
- Electrical stimulation
The chiropractor may also recommend nutritional supplements like proteolytic enzymes to aid in managing the swelling and pain that may be caused by disc herniation and some other back injuries. They may also recommend dietary changes or weight loss to help the patient manage their pain. Chiropractic is a safe, effective, non-invasive treatment for mid to upper back pain. Many patients experience results immediately which is another draw for people. Most patients with back problems will be advised to maintain regular chiropractic visits to effectively manage the pain and keep it at bay.
The spine is made of bones called vertebrae, with the spinal cord running through the spinal canal in the center. The cord is made up of nerves. These nerve roots split from the cord and travel between the vertebrae into various areas of the body. When these nerve roots become pinched or damaged, the symptoms that follow are known as, radiculopathy. El Paso, TX. Chiropractor, Dr. Alexander Jimenez breaks down radiculopathies, along with their causes, symptoms and treatment. The entire length of the spine, at each level, nerves exit through holes in the bone of the spine (foramen) on each side of the spinal column. These nerves are called nerve roots, or radicular nerves and branch out from the spine and supply different parts of the body. Nerves exiting the cervical spine travel down through the arms, hands, and fingers. This is where neck problems affecting a cervical nerve root can cause pain, as well as, other symptoms through the arms and hands, one form of (radiculopathy). Another is low back problems that affect a lumbar nerve root. This can radiate through the leg and into the foot, another form of (radiculopathy, or sciatica), which creates leg pain and/or foot pain. The spinal cord does not go into the lumbar spine and because the spinal canal has space in the lower back, problems in the lumbosacral region often cause nerve root problems and not a spinal cord injury. Serious conditions i.e. disc herniation or fracture in the lower back are also not likely to cause permanent loss of motor function in the legs. - Cervical Spine - This nerve root is named according to the Lower spinal segment that the nerve root runs between.
- Example - The nerve at C5-C6 level is called the C6 nerve root.
- It's named like this because as it exits the spine, it passes Over the C6 pedicle (a piece of bone part of the spinal segment).
- Lumbar Spine - These nerve roots are named according to the Upper spinal segment that the nerve runs between.
- Example - The nerve at L4-L5 level is called the L4 nerve root.
- The nerve root is named this way because as it exits the spine it passes Under the L4 pedicle.
Two Nerve Roots Two nerves cross each disc level Only one exits the spine (through the foramen) at that level Exiting Nerve Root - This is the nerve root exiting the spine at a certain level Example: L4 nerve root exits the spine at L4-L5 level. Traversing Nerve Root - This nerve root goes across the disc and exits the spine at the level below. Example: L5 nerve is the traversing nerve root at L4-L5 level, and is the exiting nerve root at L5-S1 level. There is some confusion when a nerve root is compressed by disc herniation or other cause to refer both to the intervertebral level (where the disc is) and to the nerve root that is affected. This depends on where the disc herniation or protrusion is happening. It could impinge upon either the exiting nerve or the traversing nerve. If The Traversing Nerve Is Affected Lumbar Radiculopathy In the lumbar spine, there is a weak area in the disc space right in front of the traversing nerve root, so lumbar discs tend to herniate or leak out and impinge on the traversing nerve. If The Exiting Nerve Is Affected Cervical Radiculopathy The opposite is true in the neck. In the cervical spine, the disc tends to herniate to the side, rather than toward the back and the side. If the disc material herniates to the side, it will compress or impinge the exiting nerve root. Radiculopathy & Sciatica Nerve root goes by another name Radicular Nerve, and when a herniated or prolapsed disc presses on a radicular nerve, this is referred to as a radiculopathy. A medical physician might say there is herniated disc at L4-L5, which creates an L5 radiculopathy or an L4 radiculopathy. It all depends on where the disc herniation occurs (the side or the back of the disc) and which nerve is affected. And the term for radiculopathy in the low back is the ever famous Sciatica. Radiculopathy - A pinched nerve can occur at different areas of the spine (cervical, thoracic or lumbar).
- Common causes are narrowing of the hole where the nerve roots exit, which can result from stenosis, bone spurs, disc herniation and other conditions.
- Symptoms vary but often include pain, weakness, numbness and tingling.
- Symptoms can be managed with nonsurgical treatment, but minimal surgery can also help.
Prevalence & Pathogenesis - A herniated disc can be defined as herniation of the nucleus pulposus through the fibers of the annulus fibrosus.
- Most disc ruptures occur during the third and fourth decades of life while the nucleus pulposus is still gelatinous.
- The most likely time of day associated with increased force on the disc is the morning.
- In the lumbar region, perforations usually arise through a defect just lateral to the posterior midline, where the posterior longitudinal ligament is weakest.
Epidemology Lumbar Spine: - Symptomatic lumbar disc herniation occurs during the lifetime of approximately 2% of the general population.
- Approximately 80% of the population will experience significant back pain during the course of a herniated disc.
- The groups at greatest risk for herniation of intervertebral discs are younger individuals (mean age of 35 years)
- True sciatica actually develops in only 35% of patients with disc herniation.
- Not infrequently, sciatica develops 6 to 10 years after the onset of low back pain.
- The period of localized back pain may correspond to repeated damage to annular fibers that irritates the sinuvertebral nerve but does not result in disc herniation.
Epidemology Cervical Spine: - The average annual incidence of cervical radiculopathies is less than 0.1 per 1000 individuals.
- Pure soft disc herniations are less common than hard disc abnormalities (spondylosis) as a cause of radicular arm pain.
- In a study of 395 patients with nerve root abnormalities, radiculopathies occurred in the cervical and lumbar spine in 93 (24%) and 302 (76%), respectively.
Pathogenesis - Alterations in intervertebral disc biomechanics and biochemistry over time have a detrimental effect on disc function.
- The disc is less able to work as a spacer between vertebral bodies or as a universal joint.
Pathogenesis - LUMBAR SPINE - The two most common levels for disc herniation are L4-L5 and L5-S1, which account for 98% of lesions; pathology can occur at L2-L3 and L3-L4 but is relatively uncommon.
Overall, 90% of disc herniations are at the L4-L5 and L5-S1 levels. - Disc herniations at L5-S1 will usually compromise the first sacral nerve root, a lesion at the L4-L5 level will most often compress the fifth lumbar root, and herniation at L3-L4 more frequently involves the fourth lumbar root.
- Disc herniation may also develop in older patients.
- Disc tissue that causes compression in elderly patients is composed of the annulus fibrosus and and portions of the cartilaginous endplate (hard disc.)
The cartilage is avulsed from the vertebral body. - Resolution of some of the compressive effects on neural structures requires resorption of the nucleus pulposus.
- Disc resorption is part of the natural healing process associated with disc herniation.
- The enhanced ability to resorb discs has the potential for resolving clinical symptoms more rapidly.
- Resorption of herniated disc material is associated with a marked increase in infiltrating macrophages and the production of matrix metalloproteinases (MMPs) 3 and 7.
- Nerlich and associates identified the origins of phagocytic cells in degenerated intervertebral discs.
- The investigation identified cells that are transformed local cells rather than invaded macrophages.
- Degenerative discs contain the cells that add to their continued dissolution.
Pathogenesis - CERVICAL SPINE - In the early 1940s, a number of reports appeared in which cervical intervertebral disc herniation with radiculopathies was described.
- There is a direct correlation between the anatomy of the cervical spine and the location and pathophysiology of disc lesion.
- The eight cervical nerve roots exit via intervertebral foramina that are bordered anteromedially by the intervertebral disc and posterolaterally by the zygapophyseal joint.
- The foramina are largest at C2-C3 and decrease in size until C6-C7.
- The nerve root occupies 25% to 33% of the volume of the foramen.
- The C1 root exits between the occiput and the atlas (C1)
- All lower roots exit above their corresponding cervical vertebrae (the C6 root at the C5-C6 interspace), except C8, which exits between C7 and T1.
- A differential growth rate affects the relationship of the spinal cord and nerve roots and the cervical spine.
- Most acute disc herniations occur posterolaterally and in patients around the forth decade of life, when the nucleus is still gelatinous.
- The most common areas of disc herniations are C6-C7 and C5-C6.
- C7-T1 and C3-C4 disc herniations are infrequent ( less than 15 %).
- Disc herniation of C2-C3 is rare.
- Patients with upper cervical disc protrusions in the C2-C3 region have symptoms that include suboccipital pain, loss of hand dexterity, and paresthesias over the face and unilateral arm.
- Unlike lumbar herniated discs, cervical herniated discs may cause myelopathy in addition to radicular pain because of the anatomy of the spinal cord in the cervical region.
- The uncovertebral prominences play a role in the location of ruptured discs material.
- The uncovertebral joint tends to guide extruded disc material medially, where cord compression may also occur.
- Disc herniations usually affect the nerve root numbered most caudally for the given disc level; for example, the C3 – C4 disc affects the fourth cervical nerve root; C4- C5, the fifth cervical nerve root; C5 – C6, the sixth cervical nerve root; C6 – C7, the seventh cervical nerve root; and C7 – T1, the eighth cervical nerve root.
- Not every herniated disc is symptomatic.
- The development of symptoms depends on the reserve capacity of the spinal canal, the presence of inflammation, the size of the herniation, and the presence of concomitant disease such as osteophyte formation.
- In disc rupture, protrusion of nuclear material results in tension on the annular fibers and compressıon of the dura or nerve root causing pain.
- Also important is the smaller size of the sagittal diameter, the bony cervical spinal canal.
- Individuals in whom a cervical herniated disc causes motor dysfunction have a complication of cervical disc herniation if the spinal canal is stenotic.
Clinical History - LUMBAR SPINE - Clinically, the patient’s major complaint is a sharp, lancinating pain.
- In many cases there may be a previous history of intermittent episodes of localized low back pain.
- The pain not only in the back but also radiates down the leg in the anatomic distribution of the affected nerve root.
- It will usually be described as deep and sharp and progressing from above downward in the involved leg.
- Its onset may be insidious or sudden and associated with a tearing or snapping sensations of the spine.
- Occasionally, when sciatica develops, the back pain may resolve because once the annulus has ruptured, it may no longer be under tension.
- Disc herniation occurs with sudden physical effort when the trunk is flexed or rotated.
- On occasion, patients with L4-L5 disc herniation have groin pain. In a study of 512 lumbar disc patients, 4.1% had groin pain.
- Finally, the sciatica may vary in intensity; it may be so severe that patients will be unable to ambulate and they will feel that their back is "locked".
- On the other hand, the pain may be limited to a dull ache that increases in intensity with ambulation.
- Pain is worsened in the flexed position and relieved by extension of the lumbar spine.
- Characteristically, patients with herniated discs have increased pain with sitting, driving, walking, couching, sneezing, or straining.
Clinical History - CERVICAL SPINE - Arm pain, not neck pain, is the patient’ s major complaint.
- The pain is often perceived as starting in the neck area and then radiating from this point down to shoulder, arm and forearm and usually into the hand.
- The onset of the radicular pain is often gradual, although it can be sudden and occur in association with a tearing or snapping sensation.
- As time passes, the magnitude of the arm pain clearly exceeds that of the neck or shoulder pain.
- The arm pain may also be variable in intensity and preclude any use of the arm; it may range from severe pain to a dull, cramping ache in the arm muscles.
- The pain is usually severe enough to awaken the patient at night.
- Additionally, a patient may complain of associated headaches as well as muscle spasm, which can radiate from the cervical spine to below the scapulae.
- The pain may also radiate to the chest and mimic angina (pseudoangina) or to the breast.
- Symptoms such as back pain, leg pain, leg weakness, gait disturbance, or incontinence suggest compression of the spinal cord (Myelopathy).
Physical Examination - LUMBAR SPINE - Physical examination will demonstrated a decrease in range of motion of the lumbosacral spine, and patients may list to one side as they try to bend forward.
- The side of the disc herniation typically corresponds to the location of the scoliotic list.
- However, the specific level or degree of herniation does not correlate with the degree of list.
- On ambulation, patients walk with an antalgic gait in which they hold the involved leg flexed so that they put as little weight as possible on the extremity.
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Neurologic Examination: - The neurologic examination is very important and may yield objective evidence of nerve root compression (We should evaluate of reflex testing, muscle power, and sensation examination of the patient).
- In addition, a nerve deficit may have little temporal relevance because it may be related to a previous attack at a different level.
- Compression of individual spinal nerve roots results in alterations in motor, sensory, and reflex function.
- When the first sacral root is compressed, the patient may have gastrocnemius-soleus weakness and be unable to repeatedly raise up on the toes of that foot.
- Atrophy of the calf may be apperent, and the ankle (Achilles) reflex is often diminished or absent.
- Sensory loss, if present, is usually confined to the posterior aspect of the calf and the lateral side of the foot.
- Involvement of the fifth lumbar nerve root can lead to weakness in extension of the great toe and, in a few cases, weakness of the everters and dorsiflexors of the foot.
- A sensory deficit can appear over the anterior of the leg and the dorsomedial aspect of the foot down to the big toe
- With compression of the fourth lumbar nerve root, the quadriceps muscle is affected; the patient may note weakness in knee extension, which is often associated with instability.
- Atrophy of the thigh musculature can be marked. Sensory loss may be apparent over the anteromedial aspect of the thigh, and the patellar tendon reflex can be diminished.
- Nerve root sensitivity can be elicited by any method that creates tension.
- The straight leg-raising (SLR)test is the one most commonly used.
- This test is performed with the patient supine.
Physical Examination - CERVICAL SPINE Neurologic Examination: - A neurologic examination that shows abnormalities is the most helpful aspect of the diagnostic work-up, although the examination may remain normal despite a chronic radicular pattern.
- The presence of atrophy helps document the location of the lesion, as well as its chronicity.
- The presence of subjective sensory changes is often difficult to interpret and requires a coherent and cooperative patient to be of clinical value.
- When the third cervical root is compressed, no reflex change and motor weakness can be identified.
- The pain radiates to the back of the neck and toward the mastoid process and pinna of the ear.
- Involvement of the fourth cervical nerve root leads to no readily detectable reflex changes or motor weakness.
- The pain radiates to the back of the neck and superior aspect of the scapula.
- Occasionally, the pain radiates to the anterior chest wall.
- The pain is often exacerbated by neck extension.
- Unlike the third and the fourth cervical nerve roots, the fifth through eighth cervical nerve roots have motor functions.
- Compression of the fifth cervical nerve root is characterized by weakness of shoulder abduction, usually above 90 degree, and weakness of shoulder extension.
- The biceps reflexes are often depressed and the pain radiates from the side of the neck to the top of the shoulder.
- Decreased sensation is often noted in the lateral aspect of the deltoid, which represents the autonomous area of the axillary nerve.
- Involvement of the sixth cervical nerve root produces biceps muscles weakness as well as diminished brachioradial reflex.
- The pain again radiates from the neck down the lateral aspect of the arm and forearm to the radial side of hand (index finger, long finger, and thumb).
- Numbness occurs occasionally in the tip of the index finger, the autonomous area of the sixth cervical nerve root.
- Compression of the seventh cervical nerve root produces reflex changes in the triceps jerk test with associated loss of strength in the triceps muscles, which extend the elbow.
- The pain from this lesion radiates from the lateral aspect of the neck down the middle of the area to the middle finger.
- Sensory changes occur often in the tip of the middle finger, the autonomous area for the seventh nerve.
- Patients should also be tested for scapular winging, which may occur with C6 or C7 radiculopathies.
- Finally, involvement of the eighth cervical nerve root by a herniated C7-T1 disc produces significant weakness of the intrinsic musculature of the hand.
- Such involvement can lead to rapid atrophy of the interosseous muscles because of the small size of these muscles.
- Loss of the interossei leads to significant loss of fine hand motion.
- No reflexes are easily found, although the flexor carpi ulnaris reflex may be decreased.
- The radicular pain from the eighth cervical nerve root radiates to the ulnar border the hand and the ring and little fingers.
- The tip of the little finger often demonstrates diminished sensation.
- Radicular pain secondary to a herniated cervical disc may be relieved by abduction of the affected arm.
- Although these signs are helpful when present, their absence alone does not rule out a nerve root lesion.
Laboratory Data - Medical screening laboratory test (blood counts, chemistry panels erythrocyte sedimentation rate [ESR]) are normal in patients with a herniated disc.
-
Electro diagnostic Testing - Electromyography(EMG)is an electronic extension of the physical examination.
- The primary use of EMG is to diagnose radiculopathies in cases of questionable neurologic origin.
- EMG findings may be positive in patients with nerve root impingement.
Radiographic Evaluation - LUMBAR SPINE - Plain x-rays may be entirely normal in a patient with signs and symptoms of nerve root impingement.
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Computed Tomography - Radigraphic evaluation by CT scan may demonstrate disc bulging but may not correlate with the level of nerve damage.
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Magnetic Resonance Imaging - MR imaging also allows visualization of soft tissues, including discs in the lumbar spine.
- Herniated discs are easily detected with MR evaluation.
- MR imaging is a sensitive technique for the detection of far lateral and anterior disc herniations.
Radiographic Evaluation - CERVICAL SPINE -
X-rays - Plain x-rays may be entirely normal in patients wit han acute herniated cervical disc.
- Conversely, 70% of asymptomatic women and 95% of asymptomatic men between the ages of 60 and 65 years have evidence of degenerative disc disease on plain roentgenograms.
- Views to be obtained include anteroposterior, lateral, flexion, and extension.
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Computed Tomography - CT permits direct visualization of compression of neural structures and is therefore more precise than myelography.
- Advantages of CT over myelography include better visualization of lateral abnormalities such as foraminal stenosis and abnormalities caudal to the myelographic block, less radiation exposure, and no hospitalization.
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Magnetic Resonance - MRI allows excellent visualization of soft tissues, including herniated discs in the cervical spine.
- The test is noninvasive.
- In a study of 34 patients with cervical lesions, MRI predicted 88% of the surgically proven lesions versus 81% for myelography-CT, 58% for myelography, and 50% for CT alone.
Differential Diagnosis - LUMBAR SPINE - The initial diagnosis of a herniated disc is ordinarily made on the basis of the history and physical examination.
- Plain radiographs of the lumbosacral spine will rarely add to the diagnosis but should be obtained to help rule out other causes of pain such as infection or tumor.
- Other tests such as MR, CT, and myelography are confirmatory by nature and can be misleading when used as screening tests.
Spinal Stenosis - Patient with spinal stenosis may also suffer from back pain that radiates to the lower extremities.
- Patients with spinal stenosis tend to be older than those in whom herniated discs develop.
- Characteristically, patients with spinal stenosis experience lower extremity pain (pseudoclaudication=neurogenic claudication) after walking for an unspecified distance.
- They also complain of pain that is exacerbated by standing or extending the spine.
- Radiographic evaluation is usually helpful in differentiating individuals with disc herniation from those with bony hypertrophy associated with spinal stenosis.
- In a study of 1,293 patients, lateral spinal stenosis and herniated intervertebral discs coexisted in 17.7% of individuals.
- Radicular pain may be caused by more than one pathologic process in an individual.
Facet Syndrome - Facet syndrome is another cause of low back pain that may be associated with radiation of pain to structures outside the confines of the lumbosacral spine.
- Degeneration of articular structures in the facet joint causes pain to develop.
- In most circumstances, the pain is localized over the area of the affected joint and is aggravated by extension of the spine (standing).
- A deep , ill-defined, aching discomfort may also be noted in the sacroiliac joint, the buttocks, and the legs.
- The areas of sclerotome affected show the same embryonic origin as the degenerated facet joint.
- Patients with pain secondary to facet joint disease may have relief of symptoms with apophyseal injection of a long-acting local anesthetic.
- The true role of facet joint disease in the production of back and leg pain remains to be determined.
- Other mechanical causes of sciatica include congentenial abnormalites of the lumbar nerve roots, external compression of the sciatic nerve (wallet in a back pants pocket), and muscular compression of the nerve (piriformis syndrome).
- In rare circumstances, cervical or thoracic lesion should be considered if the lumbar spine is clear of abnormalities.
- Medical causes of sciatica (neural tumors or infections, for example) are usually associated with systemic symptoms in addition to nerve pain in a sciatic distribution.
Differential Diagnosis - CERVICAL SPINE - No diagnostic criteria exist for the clinical diagnosis of a herniated cervical disc.
- The provisional diagnosis of a herniated cervical disc is made by the history and physical examination.
- The plain x-ray is usually nondiagnostic, although occasionally disc space narrowing at the suspected interspace or foraminal narrowing on oblique films is seen.
- The value of x-rays is to exclude other causes of neck and arm pain, such as infection and tumor.
- MR imaging and CT-myelography are the best confirmatory examinations for disc herniation.
- Cervical disc herniations may affect structures other than nerve roots.
- Disc herniation may cause vessel compression (vertebral artery) associated with vertebrobasilar artery insufficiency and be manifested as blurred vision and dizziness.
- Other mechanical causes of arm pain should be excluded.
- The most common is some form of compression on a peripheral nerve.
- Such compression can occur at the elbow, forearm, or wrist. An example is compression of the median nerve by the carpal ligament leading to carpal tunnel syndrome.
- The best diagnostic test to rule out these peripheral neuropathies is EMG.
- Excessive traction on the arm secondary to heavy weights may cause radicular pain without disc compression of nerve roots.
- Spinal cord abnormalities must be considered if signs of myelopathy are present in conjunction with radiculopathies.
- Spinal cord lesions such as syringomyelia are identified by MRI, and motor neuron disease is identified by EMG.
- Multiple sclerosis should be considered in a patient with radiculopathies if the physical signs indicate lesions above the foramen magnum (optic neuritis).
- In very rare circumstances, lesions of the parietal lobe corresponding to the arm can mimic the findings of cervical radiculopathies.
Origin: The most common cause of migraines/headaches can relate to neck complications. From spending excessive time looking down at a laptop, desktop, iPad, and even from constant texting, an incorrect posture for extended periods of time can begin to place pressure on the neck and upper back leading to problems that can cause headaches. The majority of these type of headaches occurs as a result of tightness between the shoulder blades, which in turn causes the muscles on the top of the shoulders to also tighten and radiate pain into the head. Origin Of Head Pain - Arises from pain sensitive structures in the head
- Small diameter fibers (pain/temp) innervate
- Meninges
- Blood vessels
- Extracranial structures
- TMJ
- Eyes
- Sinuses
- Neck muscles and ligaments
- Dental structures
- The brain has no pain receptors
Spinal Trigeminal Nucleus - Trigeminal nerve
- Facial nerve
- Glossopharyngeal nerve
- Vagus nerve
- C2 nerve (Greater occipital nerve)
Occipital Nerves http://dailymedfact.com/neck-anatomy-the-suboccipital-triangle/ Sensitization Of Nociceptors - Results in allodynia and hyperalgesia
http://slideplayer.com/9003592/27/images/4/Mechanisms+associated+with+peripheral+sensitization+ to+pain.jpg Headache Types Sinister: - Meningeal irritation
- Intracranial mass lesions
- Vascular headaches
- Cervical fracture or malformation
- Metabolic
- Glaucoma
Benign: - Migraine
- Cluster headaches
- Neuralgias
- Tension headache
- Secondary headaches
- Post-traumatic/post-concussion
- "Analgesic rebound" headache
- Psychiatric
HA Due To Extracranial Lesions - Sinuses (infection, tumor)
- Cervical spine disease
- Dental problems
- Temporomandibular joint
- Ear infections, etc.
- Eye (glaucoma, uveitis)
- Extracranial arteries
- Nerve lesions
HA Red Flags Screen for red flags and consider dangerous HA types if present Systemic symptoms: - Weight loss
- Pain wakes them from sleep
- Fever
Neurologic symptoms or abnormal signs: - Sudden or explosive onset
- New or Worsening HA type especially in older patients
- HA pain that is always in the same location
Previous headache history - Is this the first HA you’ve ever had?
Is this the worst HA you’ve ever had? Secondary risk factors: - History of cancer, immunocompromised, etc.
Dangerous/Sinister Headaches Meningeal irritation - Subarachnoid hemorrhage
- Meningitis and meningoencephalitis
Intracranial mass lesions - Neoplasms
- Intracerebral hemorrhage
- Subdural or epidural hemorrhage
- Abscess
- Acute hydrocephalus
Vascular headaches - Temporal arteritis
- Hypertensive encephalopathy (e.g., malignant hypertension, pheochromocytoma)
- Arteriovenous malformations and expanding aneurysms
- Lupus cerebritis
- Venous sinus thrombosis
Cervical fracture or malformation - Fracture or dislocation
- Occipital neuralgia
- Vertebral artery dissection
- Chiari malformation
Metabolic - Hypoglycemia
- Hypercapnea
- Carbon monoxide
- Anoxia
- Anemia
- Vitamin A toxicity
Glaucoma Subarachnoid Hemorrhage - Usually due to ruptured aneurysm
- Sudden onset of severe pain
- Often vomiting
- Patient appears ill
- Often nuchal rigidity
- Refer for CT and possibly lumbar puncture
Meningitis - Patient appears ill
- Fever
- Nuchal rigidity (except in elderly and young children)
- Refer for lumbar puncture - diagnostic
Neoplasms - Unlikely cause of HA in average patient population
- Mild and nonspecific head pain
- Worse in the morning
- May be elicited by vigorous head shaking
- If focal symptoms, seizures, focal neurologic signs, or evidence of increased intracranial pressure are present rule our neoplasm
Subdural Or Epidural Hemorrhage - Due to hypertension, trauma or defects in coagulation
- Most often occurs in the context of acute head trauma
- Onset of symptoms may be weeks or months after an injury
- Differentiate from the common post-concussion headache
- Post-Concussive HA may persist for weeks or months after an injury and be accompanied by dizziness or vertigo and mild mental changes, which will all subside
Increase Intracranial Pressure - Papilledema
- May cause visual changes
https://openi.nlm.nih.gov/detailedresult.php?img=2859586_AIAN-13-37- g001&query=papilledema&it=xg&req=4&npos=2 Temporal (Giant-Cell) Arteritis - >50 years old
- Polymyalgia rheumatic
- Malaise
- Proximal joint pains
- Myalgia
- Nonspecific headaches
- Exquisite tenderness and/or swelling over the temporal or occipital arteries
- Evidence of arterial insufficiency in the distribution of branches of the cranial vessels
- High ESR
Cervical Region HA - Neck trauma or with symptoms or signs of cervical root or cord compression
- Order MR or CT cord compression due to fracture or dislocation
- Cervical instability
- Order cervical spine x-rays lateral flexion and extension views
Ruling Out Dangerous HA - Rule our history of serious head or neck injury, seizures or focal neurologic symptoms, and infections that may predispose to meningitis or brain abscess
- Check for fever
- Measure blood pressure (concern if diastolic >120)
- Ophthalmoscopic exam
- Check neck for rigidity
- Auscultate for cranial bruits.
- Complete neurologic examination
- If needed order complete blood cell count, ESR, cranial or cervical imaging
Episodic Or Chronic? <15 days per month = Episodic >15 days per month = Chronic Migraine HA Generally due to dilation or distension of cerebral vasculature Serotonin In Migraine - AKA 5-hydroxytryptamine (5-HT)
- Serotonin becomes depleted in migraine episodes
- IV 5-HT can stop or reduce severity
Migraine With Aura History of at least 2 attacks fulfilling the following criteria One of the following fully reversible aura symptoms: - Visual
- Somatic sensory
- Speech or language difficulty
- Motor
- Brain stem
2 of the following 4 characteristics: - 1 aura symptom spreads gradually over ≥5 min, and/or 2 symptoms occur in succession
- Each individual aura symptom lasts 5-60 min
- 1 aura symptom is unilateral
- Aura accompanied or followed in <60 min by headache
- Not better accounted for by another ICHD-3 diagnosis, and TIA excluded
Migraine Without Aura History of at least 5 attacks fulfilling the following criteria: - Headache attacks lasting 4-72 h (untreated or unsuccessfully treated)
- Unilateral pain
- Pulsing/pounding quality
- Moderate to severe pain intensity
- Aggravation by or causing avoidance of routine physical activity
- During headache nausea and/or sensitivity to light and sound
- Not better accounted for by another ICHD-3 diagnosis
Cluster Headache - Severe unilateral orbital, supraorbital and/or temporal pain
- “Like an ice pick stabbing me the eye”
- Pain lasts 15-180 minutes
At least one of the following on the side of headache: - Conjunctival injection
- Facial sweating
- Lacrimation
- Miosis
- Nasal congestion
- Ptosis
- Rhinorrhea
- Eyelid edema
- History of similar headaches in the past
Tension Headache Headache pain accompanied by two of the following: - Pressing/tightening (non-pulsing) quality
- “Feels like a band around my head”
- Bilateral location
- Not aggravated by routine physical activity
Headache should be lacking: - Nausea or vomiting
- Photophobia and phonophobia (one or the other may be present)
- History of similar headaches in the past
Rebound Headache - Headache occurring on ≥15 days a month in a patient with a pre-existing headache disorder
- Regular overuse for >3 months of one or more drugs that can be taken for acute and/or symptomatic treatment of headache
- Due to medication overuse/withdrawal
- Not better accounted for by another ICHD-3 diagnosis
Sources Alexander G. Reeves, A. & Swenson, R. Disorders of the Nervous System. Dartmouth, 2004. Share Free Ebook: Pain - Psychological Perspectives
Ataxia is a degenerative disease of the nervous system. Symptoms can mimic those of being inebriated/intoxicated, with slurred speech, stumbling, falling, and unable to maintain coordination. This comes from degeneration of the cerebellum, which is the part of the brain responsible for coordinating movement. It is a disease that affects people of all ages. However, age of symptom onset can vary, from childhood to late adulthood. Complications from the disease can be serious, even debilitating and life shortening. Symptoms can vary from person to person, as well as, the type of Ataxia. Symptom onset and progression can vary as well. Symptoms can worsen slowly, over decades or quickly, over a few months. The common symptoms are lack of coordination, slurred speech, trouble eating, swallowing, eye movement abnormalities, motor skill deterioration, difficulty walking, gait abnormalities, tremors, and heart problems. People with Ataxia usually require wheelchairs, walkers, and/or scooters to aid in mobility. Ataxia The Loss Of Full Control Of Bodily Movements, Especially Gait History Of Ataxia - How long has it been present?
- Slow onset ➔ Degenerative disease?
- Acute onset ➔ Stroke?
- When does it occur?
- If worsened by walking on uneven surfaces, or with limited vision ➔ Sensory ataxia?
- Are there any coexisting symptoms?
- Vertigo, weakness, stiffness, cognitive changes, etc.
- Have others noticed this gait disturbance?
- If no, consider psychogenic cause
- Is the gait change explainable by physical problems such as pain or weakness?
- Antalgic gait, limp, etc.
-
Weakness - Proximal muscle weakness ➔ Myopathy?
- Distal muscle weakness ➔ Neuropathy?
- UMN signs?
- LMN signs?
- Has the patient fallen? Or at risk for fall?
- Is ataxia limiting ADLs?
Balance - Utilizes
- Vestibular system
- Cerebellar system
- Conscious proprioceptive information (joint position sense)
- Visual information
- Motor strength and coordination
Vestibular System - Generally, if the problem lies in the vestibular system the patient will experience dizziness, possibly having vertigo or nystagmus
- Unable to walk a straight line
- When walking, will tend to veer to one side
Testing The Vestibular System -
- Patient marches in place with eyes closed and arms raised to 90 degrees in front of them
- If they rotate more than 30 degrees = positive
- Patient will rotate toward the side of vestibular dysfunction
-
Rhomberg Test - If patient sways a different direction every time their eyes are closed, this may indicate vestibular dysfunction
Cerebellar System - Cerebellar gaits present with a wide-base and generally involve staggering and titubation
- Patient will have difficulty doing Rhomberg’s test with eyes open or closed, because they cannot stand with their feet together
- Afferent information helps make assessments about where the body is in space
- Ventral spinocerebellar tract
- Dorsal spinocerebellar tract
- Cuneocerebellar tract
- Olivocerebellar tract
- Efferent tracts carry responsive information to make adjustments to muscle tone and position to maintain balance
Testing The Cerebellar System -
Piano-playing test & hand-patting test - Both assess for dysdiadochokinesia
- Both tests, patient will have more difficulty moving the limb on the side of cerebellar dysfunction
-
Finger-to-nose test - Patient may be hyper/hypo metric in movement
- Intention tremor may be reveled
Joint Position Sense - Conscious proprioception may be diminished, especially in elderly patients and patients with neuropathy
Visual Information - Patients with joint position sense losses often rely on visual information to help compensate.
- When visual input is removed or diminished these patient’s have exaggerated ataxia.
Motor Strength & Coordination - If patient has reduced frontal lobe control they may end up with an apraxia of gait, where they have difficult with the volitional control of movement
- Extrapyramidal disorders such as Parkinson disease result in inability to control motor coordination
- Pelvic girdle muscle weakness due to a myopathy will produce an abnormal gait pattern
Commonly Seen Abnormal Gait Patterns -
Circumduction gait - Hemiplegia
- Often due to stroke
- Bilaterally (Diplegic gait), causes toe walking
- Typical gait of cerebral palsy patients
-
Festinating gait - Small steps due to spasticity
- Often seen in Parkinson Disease
-
Myopathicgait(waddling) - Seen in disorders of proximal muscle weakness
-
Steppage gait/Neuropathic gait - Leg is lifted from the hip, without dorsiflexion at the ankle
- Often seen in patients with foot-drop due to a LMN lesion
- Wide-BasedCerebellargait
Gait Deviation/Examination Videos Gait Deviations 2012 Gait Examination (Stanford Medicine 25) Dizziness The Sensation Of Loss Of Balance -
4 Main Types - Vertigo
- Peripheral
- Central
- Pre-Syncope/Light-headedness
- Disequilibrium
- Other/Floating type
Peripheral Vertigo - More common than central vertigo
- Due to damage to the inner ear or CN VIII
- Usually produces abnormal eye movements
- Nystagmus – May be horizontal or rotary
- Usually jerky in nature, with a fast and slow phase
- Named for the direction of the fast phase
- Vertigo usually worsens when patient looks to the side of the fast phase of nystagmus
- Severity of nystagmus usually correlates with severity of vertigo
- No other symptoms/signs of CNS dysfunction
- Patient may have nausea or difficulty walking, but only because of vestibular dysfunction
- Patient may also have hearing loss or tinnitus due if CN VIII or auditory mechanism function is damaged
- Typically the causes are benign, including
- Benign paroxysmal positional vertigo (BPPV)
- Cervicogenic vertigo
- Acute labyrinthitis/Vestibular neuronitis
- Meniere’s Disease
- Perilymph fistula
- Acoustic Neuroma
Narrowing It Down - If movement, particularly of the head/neck exacerbate vertigo, consider:
- BPPV
- Vertebrobasilar artery insufficiency
- Cervicogenic vertigo
- If noise brings on episodes, consider:
- Meniere’s disease
- Perilymph fistula
Vertigo Hx Questions - Does your dizziness feel like you’re on an amusement park ride?
- Do you get nauseous when you’re dizzy?
- Are you spinning?
- Or is the world spinning?
Benign Paroxysmal Positional Vertigo (BPPV/BPV) - May develop spontaneously, especially in the elderly
- May arise due to head trauma
- Vertiginous episodes associated with specific movements:
- Looking at a high shelf (“top-shelf vertigo”)
- Bending over
- Rolling over in bed
- Onset of vertigo begins a few seconds after the movement, and resolves within about a minute
- Diagnostic test
- Dix-Hallpike Maneuver
- Treatment procedure
- Epley Maneuver
- Brandt-Daroff Exercises
- Can self resolve as crystals dissolve, but it may take months and new otoliths can become displaced
Cervicogenic Vertigo - Occurs after head/neck injuries, but is not very common
- Usually accompanied by pain and/or joint restriction
- Usually vertigo and nystagmus will be less severe than in BPPV
- Vertigo begins with change in head position but does not subside as quickly as it does in BPPV
Vertebrobasilar Artery Insufficiency - Occurs if the vertebral artery is compressed during head rotation/extension
- Onset of vertigo is delayed more than in BPPV or cervigogenic vertigo, because ischemia will take up to 15 seconds to occur
- Orthopedic test may help in evaluation
- Barré-Liéou Sign
- DeKlyn Test/Hallpike Maneuver
- Hautant test
- Underberg Test
- Vertebrobasilar After Functional Maneuver
Acute Labyrinthitis/ Vestibular Neuronitis - Not well understood, but believed to be inflammatory in origin
- Follows viral infection or arise seemingly without cause
- Single, monophasic attack of vertigo
- Resolves in days to a few weeks and generally does not reoccur
Meniere’s Disease - Increased pressure in the endolymph causes membrane ruptures and sudden mixture of endolymph and perilymph
- Episodes last 30 minutes to several hours, until equilibrium between the fluids is reached
- Over time, episodes damage vestibular and cochlear hair cells
- Low-pitch buzzing tinnitus
- Loss of hearing of low tones
Meniere’s Disease vs. Syndrome - Meniere’s syndrome is when then symptoms of Meniere’s disease are found to be secondary to another condition, such as:
- Hypothyroidism
- Acoustic neuroma
- Superior semicircular canal dehiscence (SCDS)
- Perilymph fistula
- True Meniere’s disease is idiopathic
Perilymph Fistula - Small leak due to trauma, especially barotrauma
- Can look very similar symptomatically to Meniere’s disease/syndrome
- Exacerbated by changes in pressure
- Airplane rides
- Driving uphill
- Hennebert’s sign
- Vertigo or nystagmus episode brought on by sealing pressure of the ear (such as by inserting an otoscope)
Central Vertigo - Less common than peripheral vertigo
- Caused by damage to the processing centers of vestibular information in the brain stem and the cerebral cortex
- Typically “dizziness” is less severe than with peripheral vertigo
- Nystagmus
- Usually more severe than the description/patient’s complaint
- May go in multiple directions, including vertical
- May or may not have other CNS findings on examination
- No change in hearing expected
Causes Include: - Cerebrovascular disease (such as transient ischemic attacks)
- Multiple Sclerosis
- Arnold-Chiari Malformation
- Damage to caudal brainstem or vestibulocerebellum
- Migraine condition
Pre-Syncope Hx Qustions - Does it feel like you’re going to pass out?
- Does the dizziness feel similar to when you stand up too fast?
Pre-Syncope - “Light-headedness”
- CardiacOrigin
- Output disorders
- Arrhythmias
- Holter monitor testing
- Postural/Orthostatic hypotension
- May be secondary to other problems (diabetic neuropathy, adrenal hypofunction, Parkinsons, certain medications, etc.)
- Vasovagal episodes
- Slow heart rate with low blood pressure
- Often brought on by stress, anxiety or hyperventilation
- Migraine
- Due to cerebrovascular instability
- Blood sugar dysregulation
Disequilibrium Hx Questions - Does the dizziness only occur when you’re on your feet?
- Does it get better if you touch/hold onto something?
Disequilibrium - Common in the elderly
- Due to sensory deficits
- Gradual onset
- Worsened by reduced vision
- Dark
- Eyes closed
- Visual acuity losses
- Improved by touching a stationary object
- Subjective of dizziness often improves with a gait assistive device (cane, walker, etc.)
Other Causes - Psychological stress
- Often patient will describe dizziness as “floating”
- Rule out hyperventilation and other types of dizziness
Sources Blumenfeld, Hal. Neuroanatomy through Clinical Cases. Sinauer, 2002.
Alexander G. Reeves, A. & Swenson, R. Disorders of the Nervous System. Dartmouth, 2004.
Allergy Sufferers! As winter gives way to spring, seasonal allergies can really get you down. Whether you get a few sniffles and some sneezing or you are down for the count with every terrible allergy symptom known to man, it can make spring pretty unbearable. There is no shortage of allergy medications on the market, but they come with their own issues. The majority of them cause drowsiness and other unpleasant side effects, leaving you barely able to function. Those that are made from a “non drowsy” formula sound great, but if you have certain health conditions, like high blood pressure, you are out of luck – and stuck either taking the ones that make you sleep sucking it up and dealing with your allergies sans medication. That’s no way to live. What Are Allergies?When your immune produces histamines in response to an allergen that you encounter the physiological reaction that you experience is broadly referred to as allergies or hay fever. The allergens may be simple substances that normally do not affect people, but when your body is out of balance, it can cause a variety of problems. Symptoms of allergies include: - Runny nose
- Stuffy nose
- Headache
- Sneezing
- Itchy eyes
- Coughing or scratchy throat
- Skin Rash or Hives
- Swelling
- Diarrhea
- Nausea
- Fatigue
Anaphylaxis, severe, life threatening allergies can include swelling of the airways, tongue, and throat, inability to breathe due to blocked airway, and other dangerous symptoms. The allergens can be something you come in contact with, like poison ivy, something you breathe in, like mold or dust, or it can be something you ingest, like strawberries or peanuts. Different people will have different allergies, but those who are allergic to the same things may not have the same reaction. Often a doctor or allergist will diagnose your allergies. Chiropractic Care For Allergy SufferersChiropractic treatments have been found to be very effective for relieving allergy symptoms and even stopping allergies at their source. It reduces the severity of allergy symptoms as well as the frequency of occurrence. It does not work like allergy medications which have an anti-histamine effect and only work as a short term fix for your allergy symptoms. Chiropractic treatments help your body become more balanced so that it is better equipped for combating allergies at the source. When your spine is not aligned it can impact your nervous system leading to a variety of problems – including allergies. Your immune system can be affected, causing it to malfunction. A chiropractor can help relieve the stress on your nervous system by aligning your spine. This takes the pressure off of nerves, allowing your immune system to function at a more optimal level. This makes it easier for your body to ward off infections while recognizing allergens as harmless. When your immune system encounters allergens it doesn’t overreact to them. Instead, the reaction is much more subdued, or even nonexistent. Chiropractic has also been found to help asthma patients breathe easier. Asthma symptoms are diminished. Chiropractic care is more than just spinal manipulation, though. It promotes whole body wellness. Patients are taught exercise, stress relief, and nutrition so that the entire system is treated. The whole body treatment plan for chiropractic patients will help you be allergy free in a short time. It is important to follow your chiropractic plan thoroughly and consistently. Get plenty of rest and take time to destress. The more you can relax and take care of yourself, the healthier you will be overall. Chiropractic care can help so many health conditions; it can actually make you healthier. Allergy sufferers or if you are struggling with allergies for the first time, give chiropractic care a try you just might be surprised.
Hydration: There is no denying that a healthy diet is integral to overall wellness and staying hydrated is absolutely vital. Every organ, every cell in your body contains water. In fact, when you don’t drink enough water and keep your body properly hydrated, it does not function as it should. The health of your spine and back depends heavily on whether you are properly hydrated. In fact, if you don’t drink enough water plain, pure water, it could affect your back, causing pain and limiting mobility. HydrationOverview Of Spinal ConstructionTo understand water’s role in spinal health, you first need to understand how the spine is constructed. The row of bones that make up the spine are called vertebrae. Between each vertebrae is a disc. This disc works like a shock absorber so as you bend, flex, and move about the disc provides a buffer so the bones do not rub together. Each disc is comprised of two parts. The center of the disc is the nucleus pulposis. It is made up mostly of water. The nucleus pulposis is surrounded by a tough, flexible ring that contains a gelatinous substance. It protects the inner area which is the cushion for the vertebrae. Two factors that further complicate the rehydration of the discs are aging and sedentary lifestyles. How Water Is Good For Your BackAs you go about your daily activities, each time you move, the spine compresses the disc, squeezing out the water within. Even walking or sitting upright can cause this as gravity causes the spine to compress. When the disc does not have adequate water, the result is pain and lack of mobility as well as increased risk of spinal injury. When you are not properly hydrated your body cannot replenish the water in the discs, causing them to remain compressed. Beverages like soda are not adequate for effective hydration. You need to make sure that you drink enough water every day. For years we were told that 8 eight ounce glasses of water a day was the rule for proper hydration, and that works for many people. However, an article in the Harvard Health Letter suggests that the body can be properly hydrated with 30 to 50 ounces of water a day. The article goes on to suggest that water can also be found in foods like spinach, watermelon, soups, and lettuce are also good sources for hydration. Spinal Problems Caused By DehydrationWhen the body is dehydrated the discs remain compressed instead of refilling. When that happens the overall function of the spine is compromised. Your constant back pain may actually be caused by dehydration. When the discs cannot refill they can’t do their job. This leads to immobility and a compromised range of motion. Hydration also plays an important role in how the cerebrospinal fluid moves and works. While it does require more than water to function properly, water does play an important role. When the body is dehydrated this fluid cannot move as it should which can even affect brain function. On a larger scale, when the body is dehydrated it begins to retrieve water from other parts of the body so it can reroute it to the vital organs and sustain life. The extremities are the first places it pulls water from and the spine is another. When it deprives the spine of water in order to supply the organs then you remain in a constant deficit which can cause pain and mobility problems. How The Spine RehydratesAs the body rehydrates itself, it does not assign the spine as a priority. The vital organs take precedence so the spine basically gets what is left over. If there is already a deficiency present, then there is nothing left over to rehydrate the spine. When there is adequate water in the body, normal activity and movement aids in the rehydration of the discs. The most significant rehydration occurs while you sleep though. When you lie down and rest your body is best able to initiate the process of rehydrating your spinal discs via osmosis. Chiropractic care is another way to adjust the spine and encourage the refilling of the discs. That depends, of course, on proper water intake. Be good to your spine; it’s the only one you have.
Back pain is a daily issue for millions of Americans, with a variety of medial issues being the culprit. The results of lower back pain on the economy as a whole are far reaching, from tons of lost work time to enormous medical costs. Maignes Syndrome is estimated to be the cause of a great deal of the instances of lower back pain. Never heard of it? Lucky you because those who are diagnosed with Maignes Syndrome suffer pain that sometimes lasts for weeks or even months, and can become quite severe. Discomfort is increased sometimes when the patient twists his torso, or lifts a heavy object. What Is Maignes Syndrome?Also called Thoracolumbar Junction Syndrome, Maignes Syndrome is a spinal disorder that is located in the nerves in the upper lumbar region of the back, causing pain to radiate along the nerves from the site. This spinal condition creates difficult to diagnose symptoms, since it often results in pain in a different part of the body than the actual source. It is believed this "condition exists because of the facet joint issues at the junction between the middle spine and lower spine.". The pain from Maignes Syndrome usually shows up in the hip, lower back, or groin. If you are experiencing lower back pain, you may suffer from Maignes Syndrome. Schedule a chiropractic visit as soon as possible, because a chiropractor benefits Maignes Syndrome sufferers in four important ways. Doctor Of Chiropractic Can……Help Correctly Diagnose ItUnfortunately, the nature of the pain and location of the condition frequently cause Maignes Syndrome to be misdiagnosed. Sacroiliac joint pain is sometimes the diagnosis they receive, which hinders proper treatment. For this reason, the patient needs to make certain they are working with an experienced chiropractor who understands the subtle differences of the two conditions. …Adjust The Area Where The Issue OriginatesIn order to minimize the symptoms of the condition, a chiropractor can administer adjustments on and around the area causing the issue, the thoracolumbar facet joints. Aligning this area correctly, and loosening the area that may have become tight from overcompensation, assists in relieving pain from Maignes Syndrome. …Offer At Home Exercises To Help With HealingFortunately, there are exercises that can aid Maignes Syndrome, both in loosening the tightness of the afflicted area, and building up the surrounding muscle strength so the body can compensate for the issue. A chiropractor who understands this spinal condition can walk you through a step-by-step exercise regimen of the types of exercises that will help your body adapt to and heal from Maignes Syndrome. …Promote Your Body's Ability To Heal ItselfChiropractic care is a broad-based approach to the body's inner function and balance. Experienced chiropractors understand that all parts fit together for overall health. A patient with Maignes Syndrome benefits from chiropractic care because of this. Your chiropractor will make a series of adjustments that help the nervous system work at optimum capacity, which promotes healing to the entire body. Attacking Maignes Syndrome directly at the site and through the body as a whole promotes faster healing and increased mobility. Individuals with Maignes Syndrome unfortunately face an uphill battle that begins with being correctly diagnosed. The complexity of the spinal condition is the primary reason to seek a professional chiropractor's opinion at the first sign of ongoing lower back pain. Once Maignes Syndrome is correctly pinpointed, the chiropractor will be able to design an in-house and at-home blend of treatment options to minimize your healing time and achieve a pain-free, fully functioning back.
"Mom, it hurts. It hurts!" Parents of children suffering from ear infections are all too familiar with this cry. Tugging at their ears, crying, and trouble sleeping are all signs of an ear infection in your little one. Children are more susceptible to ear infections than adults because of their smaller Eustachian tubes, and their less effective immune systems. Unfortunately, chronic ear infections can quickly become a painful, ongoing problem. Parents have a variety of options at their disposal to treat their child's ear infections. Drops, antibiotics, and ventilation tubes placed by surgical procedure are all commonly used treatments for chronic infections. Chiropractic care is another option available and is rapidly gaining acceptance and popularity for the effective treatment of ear infections. According to HealthyChild.com, ear infections are the reason for 35% of pediatrician visits, and ear pain is the number one reason a child visits a chiropractor. Children who suffer from recurring ear infections benefit from chiropractic care in several ways that are not available through other, more traditional forms of treatment. Here are a few of the benefits chiropractic care offer for ear infections are: Ear Infections: It Is Non-InvasiveUnlike the surgical procedure that is often used to combat ear infections by inserting tubes in the child's ears, chiropractic adjustments provide a non-invasive form of treatment. This treatment option works well because a little one's spine may be moved out of alignment from the birthing process, or from any number of spills he or she makes learning to walk, run, or navigate stairs. An experienced chiropractor can map out a treatment plan that includes gentle adjustments of the child's neck and spine. The goal is to decrease fluid build up within the ear canals that bring on ear infections and pain. It Is A Painless Option Of TreatmentThe last thing parents want in any medical treatment is to cause their child more pain. A negative experience at a doctor's office can create a fear that lasts for years to come. Children with ear infections have nothing to fear from visiting a chiropractor. During a chiropractic visit, the child will participate in adjustments that are pain free. The treatments will be able to reduce the pain in a short amount of time in many instances, and reduce the chance of dealing with another ear infection down the road. It Treats The Underlying CauseOther options of treatment may decrease the symptoms of an ear infection, but never get to the actual root issue. Chiropractic care strives to return the body in its entirety to its normal function. This is the main building block concept for chiropractic in general. By re-aligning the spine, the body as a whole can be healthier and more resistant to infection and disease. Chiropractic care helps adjust the child's body back to a normal state, thus providing a way for it to heal itself and fight off future ear (and other) infections better than simply using drops and antibiotics. If your child is susceptible to ear infections, there are steps you can take to minimize the chances of an occurrence in the first place. Frequent hand washing to prevent the spread of germs and avoiding cigarette smoke are two simple ways to combat ear infections. Chiropractic treatment continues to show promise in treating the underlying issues that cause a child to suffer from ear infections. If you are looking for a treatment that is pain free, not intimidating to the child, and an alternative to invasive surgery, enlisting the help of a chiropractor is a fantastic option. So if your child is experiencing chronic ear infections, give us a call. Our Doctor of Chiropractic is here to help!
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