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Neck Pain

Back Clinic Neck Treatment Team. Dr. Alex Jimenezs collection of neck pain articles contain a selection of medical conditions and/or injuries regarding symptoms surrounding the cervical spine. The neck is made up of various complex structures; bones, muscles, tendons, ligaments, nerves, and other types of tissues. When these structures are damaged or injured as a result of improper posture, osteoarthritis, or even whiplash, among other complications, the pain and discomfort an individual experiences can be impairing. Through chiropractic care, Dr. Jimenez explains how the use of spinal adjustments and manual manipulations focuses on the cervical spine can greatly help relieve the painful symptoms associated with neck issues. For more information, please feel free to contact us at (915) 850-0900 or text to call Dr. Jimenez personally at (915) 540-8444.


Disc Bulge & Herniation Chiropractic Care Overview

Disc Bulge & Herniation Chiropractic Care Overview

Disc bulge and disc herniation are some of the most common conditions affecting the spine of both young and middle-aged patients. It is estimated that approximately 2.6% of the US population annually visits a clinician to treat spinal disorders. Roughly $ 7.1 billion alone is lost due to the time away from work.

Disc herniation is when the whole or part of the nucleus pulposus is protruded through the torn or weakened outer annulus fibrosus of the intervertebral disc. This is also known as the slipped disc and frequently occurs in the lower back, sometimes also affecting the cervical region. Herniation of the intervertebral disc is defined as a localized displacement of disc material with 25% or less of the disc circumference on an MRI scan, according to the North American Spine Society 2014. The herniation may consist of nucleus pulposus, annulus fibrosus, apophyseal bone or osteophytes, and the vertebral endplate cartilage in contrast to disc bulge.

There are also mainly two types of disc herniation. Disc protrusion is when a focal or symmetrical extension of the disc comes out of its confines in the intervertebral space. It is situated at the intervertebral disc level, and its outer annular fibers are intact. A disc extrusion is when the intervertebral disc extends above or below the adjacent vertebrae or endplates with a complete annular tear. In this type of disc extrusion, a neck or base is narrower than the dome or the herniation.

A disc bulge is when the outer fibers of the annulus fibrosus are displaced from the margins of the adjacent vertebral bodies. Here, the displacement is more than 25% of the circumference of the intervertebral disc. It also does not extend below or above the margins of the disc because the annulus fibrosus attachment limits it. It differs from disc herniation because it involves less than 25% of the disc’s circumference. Usually, the disc bulge is a gradual process and is broad. The disc bulge can be divided into two types. In a circumferential bulge, the whole disc circumference is involved. More than 90 degrees of the rim is involved asymmetrically in asymmetrical bulging.

Normal Intervertebral Disc Anatomy

Before going into detail about the definition of disc herniation and disc bulge, we need to look at the standard intervertebral disc. According to spine guidelines in 2014, a standard disc is something that has a classic shape without any evidence of degenerative disc changes. Intervertebral discs are responsible for one-third to one-fourth of the height of the spinal column.

One intervertebral disc is about 7 -10 mm thick and measures 4 cm in anterior-posterior diameter in the lumbar region of the spine. These spinal discs are located between two adjacent vertebral bodies. However, no discs can be found between the atlas and axis and the coccyx. About 23 discs are found in the spine, with six in the cervical spine, 12 in the thoracic spine, and only five in the lumbar spine.

Intervertebral discs are made of fibro cartilages, forming a fibrocartilaginous joint. The outer ring of the intervertebral disc is known as the annulus fibrosus, while the inner gel-like structure in the center is known as the nucleus pulposus. The cartilage endplates sandwich the nucleus pulposus superiorly and inferiorly. The annulus fibrosus comprises concentric collagen fiber sheets arranged in a radial tire-like structure into lamellae. The fibers are attached to the vertebral endplates and oriented at different angles. With their cartilaginous part, the endplates anchor the discs in their proper place.

The nucleus pulposus is composed of water, collagen, and proteoglycans. Proteoglycans attract and retain moisture, giving the nucleus pulposus a hydrated gel-like consistency. Interestingly, throughout the day, the amount of water found in the nucleus pulposus varies according to the person’s level of activity. This feature in the intervertebral disc serves as a cushion or a spinal shock-absorbing system to protect the adjacent vertebra, spinal nerves, spinal cord, brain, and other structures against various forces. Although the individual movement of the intervertebral discs is limited, some form of vertebral motion like flexion and extension is still possible due to the features of the intervertebral disc.

Effect of Intervertebral Disc Morphology on Structure and Function

The type of components present in the intervertebral disc and how it is arranged determine the morphology of the intervertebral disc. This is important in how effectively the disc does its function. As the disc is the most important element which bears the load and allows movement in the otherwise rigid spine, the constituents it is made up of have a significant bearing.

The complexity of the lamellae increases with advancing age as a result of the synthetic response of the intervertebral disc cells to the variations in the mechanical load. These changes in lamellae with more bifurcations, interdigitation and irregular size and number of lamellar bands will lead to the altered bearing of weight. This in turn establishes a self-perpetuated disruption cycle leading to the destruction of the intervertebral discs. Once this process is started it is irreversible. As there is an increased number of cells, the amount of nutrition the disc requires is also increasingly changing the normal concentration gradient of both metabolites and nutrients. Due to this increased demand, the cells may also die increasingly by necrosis or apoptosis.

Human intervertebral discs are avascular and hence the nutrients are diffused from the nearby blood vessels in the margin of the disc. The main nutrients; oxygen and glucose reach the cells in the disc through diffusion according to the gradient determined by the rate of transport to the cells through the tissues and the rate of demand. Cells also increasingly produce lactic acid as a metabolic end product. This is also removed via the capillaries and venules back to the circulation.

Since diffusion depends on the distance, the cells lying far from the blood capillaries can have a reduced concentration of nutrients because of the reduced supply. With disease processes, the normally avascular intervertebral disc can become vascular and innervated in degeneration and in disease processes. Although this may increase the oxygen and nutrient supply to the cells in the disc, this can also give rise to many other types of cells that are normally not found in the disc with the introduction of cytokines and growth factors.

The morphology of the intervertebral disc in different parts of the spine also varies although many clinicians base the clinical theories based on the assumption that both cervical and lumbar intervertebral discs have the same structure. The height of the disc was the minimum in the T4-5 level of the thoracic column probably due to the fact that thoracic intervertebral discs are less wedge-shaped than those of cervical and lumbar spinal regions.

From the cranial to caudal direction, the cross-sectional area of the spine increased. Therefore, by the L5-S1 level, the nucleus pulposus was occupying a higher proportion of the intervertebral disc area. The cervical discs have an elliptical shape on cross-section while the thoracic discs had a more circular shape. The lumbar discs also have an elliptical shape though it is more flattened or re-entrant posteriorly.

What is a Disc Bulge?

The bulging disc is when the disc simply bulges outside the intervertebral disc space it normally occupies without the rupture of the outer annulus fibrosus. The bulging area is quite large when compared to a herniated disc. Moreover, in a herniated disc, the annulus fibrosus ruptures or cracks. Although disc bulging is more common than disc herniation, it causes little or no pain to the patient. In contrast, the herniated disc causes a lot of pain.

Causes for Disc Bulging

A bulging disc can be due to several causes. It can occur due to normal age-related changes such as those seen in degenerative disc disease. The aging process can lead to structural and biochemical changes in the intervertebral discs and lead to reduced water content in the nucleus pulposus. These changes can make the patient vulnerable to disc bulges with only minor trauma. Some unhealthy lifestyle habits such as a sedentary lifestyle and smoking can potentiate this process and give rise to more severe changes with the weakening of the disc.

General wear and tear due to repeated microtrauma can also weaken the disc and give rise to disc bulging. This is because when the discs are strained, the normal distribution of weight loading changes. Accumulated micro-trauma over a long period of time can occur in bad posture. Bad posture when sitting, standing, sleeping, and working can increase the pressure in the intervertebral discs.

When a person maintains a forward bending posture, it can lead to overstretching and eventually weakness of the posterior part of the annulus fibrosus. Over time, the intervertebral disc can bulge posteriorly. In occupations that require frequent and repetitive lifting, standing, driving, or bending, the bulging disc may be an occupational hazard. Improper lifting up of items, and improper carrying of heavy objects can also increase the pressure on the spine and lead to disc bulges eventually.

The bulging intervertebral discs usually occur over a long period of time. However, the discs can bulge due to acute trauma too. The unexpected sudden mechanical load can damage the disc resulting in micro-tears. After an accident, the disc can become weakened causing long-term microdamage ultimately leading to bulging of the disc. There may also be a genetic component to the disc bulging. The individual may have a reduced density of elastin in the annulus fibrosus with increased susceptibility to disc diseases. Other environmental facts may also play a part in this disease process.

Symptoms of Disc Bulging

As mentioned previously, bulging discs do not cause pain and even if they do the severity is mild. In the cervical region, the disease will cause pain running down the neck, deep pain in the shoulder region, pain radiating along the upper arm, and forearm up to the fingers.

This may give rise to a diagnostic dilemma as to whether the patient is suffering from a myocardial infarction as the site of referred pain and the radiation is similar. Tingling feeling on the neck may also occur due to the bulging disc.

In the thoracic region, there may be pain in the upper back that radiates to the chest or the upper abdominal region. This may also suggest upper gastrointestinal, lung, or cardiac pathology and hence need to be careful when analyzing these symptoms.

The bulging discs of the lumbar region may present as lower back pain and tingling feeling in the lower back region of the spine. This is the most common site for disc bulges since this area holds the weight of the upper body. The pain or the discomfort can spread through the gluteal area, thighs, and to the feet. There may also be muscle weakness, numbness or tingling sensation. When the disc presses on the spinal cord, the reflexes of both legs can increase leading to spasticity.

Some patients may even have paralysis from the waist down. When the bulging disc compresses on the cauda equine, the bladder and bowel functions can also change. The bulging disc can press on the sciatic nerve leading to sciatica where the pain radiates in one leg from the back down to the feet.

The pain from the bulging disc can get worse during some activities as the bulge can then compress on some of the nerves. Depending on what nerve is affected, the clinical features can also vary.

Diagnosis of Disc Bulging

The diagnosis may not be apparent from clinical history due to similar presentations in more serious problems. But the chronic nature of the disease may give some clues. Complete history and a physical examination need to be done to rule out myocardial infarction, gastritis, gastro-oesophageal reflux disease, and chronic lung pathology.

MRI of Disc Bulge

Investigations are necessary for the diagnosis. X-ray spine is performed to look for gross pathology although it may not show the bulging disc directly. There may be indirect findings of disk degeneration such as osteophytes in the endplates, gas in the disc due to the vacuum phenomenon, and the loss of height of the intervertebral disc. In the case of moderate bulges, it may sometimes appear as non-focal intervertebral disc material that is protruded beyond the borders of the vertebra which is broad-based, circumferential, and symmetrical.

Magnetic resonance imaging or MRI can exquisitely define the anatomy of the intervertebral discs especially the nucleus pulposus and its relationships. The early findings seen on MRI in disc bulging include the loss of normal concavity of the posterior disc. The bulges can be seen as broad-based, circumferential, and symmetrical areas. In moderate bulging, the disc material will protrude beyond the borders of the vertebrae in a non-focal manner. Ct myelogram may also give detailed disc anatomy and may be useful in the diagnosis.

Treatment of Disc Bulging

The treatment for the bulging disc can be conservative, but sometimes surgery is required.

Conservative Treatment

When the disc bulging is asymptomatic, the patient does not need any treatment since it does not pose an increased risk. However, if the patient is symptomatic, the management can be directed at relieving the symptoms. The pain is usually resolved with time. Till then, potent pain killers such as non-steroidal anti-inflammatory drugs like ibuprofen should be prescribed. In unresolved pain, steroid injections can also be given to the affected area and if it still does not work, the lumbar sympathetic block can be tried in most severe cases.

The patient can also be given the option of choosing alternative therapies such as professional massage, physical therapy, ice packs, and heating pads which may alleviate symptoms. Maintaining correct posture, tapes, or braces to support the spine are used with the aid of a physiotherapist. This may fasten the recovery process by avoiding further damage and keeping the damaged or torn fibers in the intervertebral disc without leakage of the fluid portion of the disc. This helps maintain the normal structure of the annulus and may increase the recovery rate. Usually, the painful symptoms which present initially get resolved over time and lead to no pain. However, if the symptoms get worse steadily, the patient may need surgery

If the symptoms are resolved, physiotherapy can be used to strengthen the muscles of the back with the use of exercises. Gradual exercises can be used for the return of function and for preventing recurrences.

Surgical Treatment

When conservative therapy does not work with a few months of treatment, surgical treatment can be considered. Most would prefer minimally invasive surgery which uses advanced technology to correct the intervertebral disc without having to grossly dissect the back. These procedures such as microdiscectomy have a lower recovery period and reduced risk of scar formation, major blood loss, and trauma to adjacent structures when compared to open surgery.

Previously, laminectomy and discectomy have been a mainstay of treatment. However, due to the invasiveness of the procedure and due to increased damage to the nerves these procedures are currently abandoned by many clinicians for disc bulging.

Disc bulging in the thoracic spine is being treated surgically with costotransversectomy where a section of the transverse process is resected to allow access to the intervertebral disc. The spinal cord and spinal nerves are decompressed by using thoracic decompression by removing a part of the vertebral body and making a small opening. The patient may also need a spinal fusion later on if the removed spinal body was significant.

Video-assisted thoracoscopic surgery can also be used where only a small incision is made and the surgeon can perform the surgery with the assistance of the camera. If the surgical procedure involved removing a large portion of the spinal bone and disc material, it may lead to spinal instability. This may need bone grafting to replace the lost portion with plates and screws to hold them in place.

What is a Disc Herniation?

As mentioned in the first section of this article, disc herniation occurs when there is disc material displaces beyond the limits of the intervertebral disc focally. The disc space consists of endplates of the vertebral bodies superiorly and inferiorly while the outer edges of the vertebral apophyses consist of the peripheral margin. The osteophytes are not considered a disc margin. There may be irritation or compression of the nerve roots and dural sac due to the volume of the herniated material leading to pain. When this occurs in the lumbar region, this is classically known as sciatica. This condition has been mentioned since ancient times although a connection between disc herniation and sciatica was made only in the 20th century. Disc herniation is one of the commonest diagnoses seen in the spine due to degenerative changes and is the commonest cause of spinal surgery.

Classifications of Disc Herniation

There are many classifications regarding intervertebral disc herniation. In focal disc herniation, there is a localized displacement of the disc material in the horizontal or axial plane. In this type, only less than 25% of the circumference of the disc is involved. In broad-based disc herniation, about 25 – 50 % of the disc circumference is herniated. The disc bulge is when 50 – 100 % of the disc material is extended beyond the normal confines of the intervertebral space. This is not considered a form of disc herniation. Furthermore, the intervertebral disc deformities associated with severe cases of scoliosis and spondylolisthesis are not classified as a herniation but rather adaptive changes of the contour of the disc due to the adjacent deformity.

Depending on the contour of the displaced material, the herniated discs can be further classified as protrusions and extrusions. In disc protrusion, the distance measured in any plane involving the edges of the disc material beyond intervertebral disc space (the highest measure is taken) is lower than the distance measured in the same plane between the edges of the base.

Imaging can show the disc displacement as a protrusion on the horizontal section and as an extrusion on the sagittal section due to the fact that the posterior longitudinal ligament contains the disc material that is displaced posteriorly. Then the herniation should be considered an extrusion. Sometimes the intervertebral disc herniation can occur in the craniocaudal or vertical direction through a defect in the vertebral body endplates. This type of herniation is known as intravertebral herniation.

The disc protrusion can also be divided into two focal protrusion and broad-based protrusion. In focal protrusion, the herniation is less than 25% of the circumference of the disc whereas, in broad-based protrusion, the herniated disc consists of 25 – 50 % of the circumference of the disc.

In disc extrusion, it is diagnosed if any of the two following criteria are satisfied. The first one is; that the distance measured between the edges of the disc material that is beyond the intervertebral disc space is greater than the distance measured in the same plane between the edges of the base. The second one is; that the material in the intervertebral disc space and material beyond the intervertebral disc space is having a lack continuity.

This can be further characterized as sequestrated which is a subtype of the extruded disc. It is called disc migration when disk material is pushed away from the site of extrusion without considering whether there is continuity of disc or not. This term is useful in interpreting imaging modalities as it is often difficult to show continuity in imaging.

The intervertebral disc herniation can be further classified as contained discs and discs that are unconfined. The term contained disc is used to refer to the integrity of the peripheral annulus fibrosus which is covering the intervertebral disc herniation. When fluid is injected into the intervertebral disc, the fluid does not leak into the vertebral canal in herniations that are contained.

Sometimes there are displaced disc fragments that are characterized as free. However, there should be no continuity between disc material and the fragment and the original intervertebral disc for it to be called a free fragment or a sequestered one. In a migrated disc and in a migrated fragment, there is an extrusion of disc material through the opening in the annulus fibrosus with a displacement of the disc material away from the annulus.

Even though some fragments that are migrated can be sequestered the term migrated means just to the position and it is not referred to the continuity of the disc. The displaced intervertebral disc material can be further described with regard to the posterior longitudinal ligament as submembranous, subcapsular, subligamentous, extra ligamentous, transligamentous, subcapsular, and perforated.

The spinal canal can also get affected by an intervertebral disc herniation. This compromise of the canal can also be classified as mild, moderate, and severe depending on the area that is compromised. If the canal at that section is compromised only less than one third, it is called mild whereas if it is only compromised less than two-thirds and more than one third it is considered moderate. In a severe compromise, more than two-thirds of the spinal canal is affected. For the foraminal involvement, this same grading system can be applied.

The displaced material can be named according to the position that they are in the axial plane from the center to the right lateral region. They are termed as central, right central, right subarticular, right foraminal, and right extraforaminal. The displaced intervertebral disc material’s composition can be further classified as gaseous, liquefied, desiccated, scarred, calcified, ossified, bony, nuclear, and cartilaginous.

Before going into detail on how to diagnose and treat intervertebral disc herniation, let us differentiate how cervical disc herniation differs from lumbar herniation since they are the most common regions to undergo herniation.

Cervical Disc Herniation vs. Thoracic Disc Herniation vs Lumbar Disc Herniation

Lumbar disc herniation is the most commonest type of herniation found in the spine which is approximately 90% of the total. However, cervical disc herniation can also occur in about one-tenth of patients. This difference is mainly due to the fact that the lumbar spine has more pressure due to the increased load. Moreover, it has comparatively large intervertebral disc material. The most common sites of intervertebral disc herniation in the lumbar region are L 5 – 6, in the Cervical region between C7, and in the thoracic region T12.

Cervical disc herniation can occur relatively commonly because the cervical spine acts as a pivoting point for the head and it is a vulnerable area for trauma and therefore prone to damage in the disc. Thoracic disc herniation occurs more infrequently than any of the two. This is due to the fact that thoracic vertebrae are attached to the ribs and the thoracic cage which limits the range of movement in the thoracic spine when compared to the cervical and lumbar spinal discs. However, thoracic intervertebral disc herniation can still occur.

Cervical disc herniation gives rise to neck pain, shoulder pain, pain radiating from the neck to the arm, tingling, etc. Lumbar disc herniation can similarly cause lower back pain as well as pain, tingling, numbness, and muscle weakness seen in the lower limbs. Thoracic disc herniation can give rise to pain in the upper back radiating to the torso.

Epidemiology

Although disc herniation can occur in all age groups, it predominantly occurs between the fourth and fifth decade of life with the mean age of 37 years. There have been reports that estimate the prevalence of intervertebral disc herniation to be 2 – 3 % of the general population. It is more commonly seen in men over 35 years with a prevalence of 4.8% and while in women this figure is around 2.5%. Due to its high prevalence, it is considered a worldwide problem as it is also associated with significant disability.

Risk Factors

In most instances, a herniated disc occurs due to the natural aging process in the intervertebral disc. Due to the disc degeneration, the amount of water that was previously seen in the intervertebral disc gets dried out leading to the shrinking of the disc with the narrowing of the intervertebral space. These changes are markedly seen in degenerative disc disease. In addition to these gradual changes due to normal wear and tear, other factors may also contribute to increasing the risk of intervertebral disc herniation.

Being overweight can increase the load on the spine and increase the risk of herniation. A sedentary life can also increase the risk and therefore an active lifestyle is recommended in preventing this condition. Improper posture with prolonged standing, sitting, and especially driving can put a strain on the intervertebral discs due to the additional vibration from the vehicle engine leading to microtrauma and cracks in the disc. The occupations which require constant bending, twisting, pulling and lifting can put a strain on the back. Improper weight lifting techniques are one of the major reasons.

When back muscles are used in lifting heavy objects instead of lifting with the legs and twisting while lifting can make the lumbar discs more vulnerable to herniation. Therefore patients should always be advised to lift weights with their legs and not the back. Smoking has been thought to increase disc herniation by reducing the blood supply to the intervertebral disc leading to degenerative changes of the disc.

Although the above factors are frequently assumed to be the causes for disc herniation, some studies have shown that the difference in risk is very small when this particular population was compared with the control groups of the normal population.

There have been several types of research done on genetic predisposition and intervertebral disc herniation. Some of the genes that are implicated in this disease include vitamin D receptor (VDR) which is a gene that codes for the polypeptides of important collagen called collagen IX (COL9A2).

Another gene called the human aggrecan gene (AGC) is also implicated as it codes for proteoglycans which is the most important structural protein found in the cartilage. It supports the biochemical and mechanical function of the cartilage tissue and hence when this gene is defective, it can predispose an individual to intervertebral disc herniation.

Apart from these, there are many other genes that are being researched due to the association between disc herniation such as matrix metalloproteinase (MMP) cartilage intermediate layer protein, thrombospondin (THBS2), collagen 11A1, carbohydrate sulfotransferase, and asporin (ASPN). They may also be regarded as potential gene markers for lumbar disc disease.

Pathogenesis of Sciatica and Disc Herniation

The sciatic pain originated from the extruded nucleus pulposus inducing various phenomena. It can directly compress the nerve roots leading to ischemia or without it, mechanically stimulate the nerve endings of the outer portion of the fibrous ring and release inflammatory substances suggesting its multifactorial origin. When the disc herniation causes mechanical compression of the nerve roots, the nerve membrane is sensitized to pain and other stimuli due to ischemia. It has been shown that in sensitized and compromised nerve roots, the threshold for neuronal sensitization is around half of that of a normal and non-compromised nerve root.

The inflammatory cell infiltration is different in extruded discs and non-extruded discs. Usually, in non-extruded discs, the inflammation is less. The extruded disc herniation causes the posterior longitudinal ligament to rupture which exposes the herniated part to the vascular bed of the epidural space. It is believed that inflammatory cells are originating from these blood vessels situated in the outermost part of the intervertebral disc.

These cells may help secrete substances that cause inflammation and irritation of the nerve roots causing sciatic pain. Therefore, extruded herniations are more likely to cause pain and clinical impairment than those that are contained. In contained herniations, the mechanical effect is predominant while in the unconfined or the extruded discs the inflammatory effect is predominant.

Clinical Disc Herniation and What to Look for in the History

The symptoms of the disc herniation can vary a great deal depending on the location of the pain, the type of herniation, and the individual. Therefore, history should focus on the analysis of the main complaint among the many other symptoms.

The chief complaint can be neck pain in cervical disc herniation and there can be referred pain in the arms, shoulders, neck, head, face, and even the lower back region. However, it is most commonly referred to as the interscapular region. The radiation of pain can occur according to the level at the herniation is taking place. When the nerve roots of the cervical region are affected and compressed, there can be sensory, and motor changes with changes in the reflexes.

The pain that occurs due to nerve root compression is called radicular pain and it can be described as deep, aching, burning, dull, achy, and electric depending on whether there is mainly motor dysfunction or sensory dysfunction. In the upper limb, the radicular pain can follow a dermatomal or myotomal pattern. Radiculopathy usually does not accompany neck pain. There can be unilateral as well as bilateral symptoms. These symptoms can be aggravated by activities that increase the pressure inside the intervertebral discs such as the Valsalva maneuver and lifting.

Driving can also exacerbate pain due to disc herniation due to stress because of vibration. Some studies have shown that shock loading and stress from vibration can cause a mechanical force to exacerbate small herniations but flexed posture had no influence. Similarly, activities that decrease intradiscal pressure can reduce the symptoms such as lying down.

The main complaint in lumbar disc herniation is lower back pain. Other associated symptoms can be a pain in the thigh, buttocks, and anogenital region which can radiate to the foot and toe. The main nerve affected in this region is the sciatic nerve causing sciatica and its associated symptoms such as intense pain in the buttocks, leg pain, muscle weakness, numbness, impairment of sensation, hot and burning or tingling sensation in the legs, dysfunction of gait, impairment of reflexes, edema, dysesthesia or paresthesia in the lower limbs. However, sciatica can be caused by causes other than herniation such as tumors, infection, or instability which need to be ruled out before arriving at a diagnosis.

The herniated disc can also compress on the femoral nerve and can give rise to symptoms such as numbness, tingling sensation in one or both legs, and a burning sensation in the legs and hips. Usually, the nerve roots that are affected in herniation in the lumbar region are the ones exiting below the intervertebral disc. It is thought that the level of the nerve root irritation determines the distribution of leg pain. In herniations at the third and fourth lumbar vertebral levels, the pain may radiate to the anterior thigh or the groin. In radiculopathy at the level of the fifth lumbar vertebra, the pain may occur in the lateral and anterior thigh region. In herniations at the level of the first sacrum, the pain may occur in the bottom of the foot and the calf. There can also be numbness and tingling sensation occurring in the same area of distribution. The weakness in the muscles may not be able to be recognized if the pain is very severe.

When changing positions the patient is often relieved from pain. Maintaining a supine position with the legs raised can improve the pain. Short pain relief can be brought by having short walks while long walks, standing for prolonged periods, and sitting for extended periods of time such as in driving can worsen the pain.

The lateral disc herniation is seen in foraminal and extraforaminal herniations and they have different clinical features to that of medial disc herniation seen in subarticular and central herniations. The lateral intervertebral disc herniations can when compared to medial herniations more directly irritate and mechanically compress the nerve roots that are exiting and the dorsal root ganglions situated inside the narrowed spinal canal.

Therefore, lateral herniation is seen more frequently in older age with more radicular pain and neurological deficits. There is also more radiating leg pain and intervertebral disc herniations in multiple levels in the lateral groups when compared to medial disc herniations.

The herniated disc in the thoracic region may not present with back pain at all. Instead, there are predominant symptoms due to referred pain in the thorax due to irritation of nerves. There can also be predominant pain in the body that travels to the legs, tingling sensation and numbness in one or both legs, muscle weakness, and spasticity of one or both legs due to exaggerated reflexes.

The clinician should look out for atypical presentations as there could be other differential diagnoses. The onset of symptoms should be inquired about to determine whether the disease is acute, sub-acute, or chronic in onset. Past medical history has to be inquired about in detail to exclude red flag symptoms such as pain that occurs at night without activity which can be seen in pelvic vein compression, and non-mechanical pain which may be seen in tumors or infections.

If there is a progressive neurological deficit, with bowel and bladder involvement is there, it is considered a neurological emergency and urgently investigated because cauda equine syndrome may occur which if untreated, can lead to permanent neurological deficit.

Getting a detailed history is important including the occupation of the patient as some activities in the job may be exacerbating the patient’s symptoms. The patient should be assessed regarding which activities he can and cannot do.

Differential Diagnosis

  • Degenerative disc disease
  • Mechanical pain
  • Myofascial pain leading to sensory disturbances and local or referred pain
  • Hematoma
  • Cyst leading to occasional motor deficits and sensory disturbances
  • Spondylosis or spondylolisthesis
  • Discitis or osteomyelitis
  • Malignancy, neurinoma or mass lesion causing atrophy of thigh muscles, glutei
  • Spinal stenosis is seen mainly in the lumbar region with mild low back pain, motor deficits, and pain in one or both legs.
  • An epidural  abscess can cause symptoms similar to radicular pain involving spinal disc herniation
  • Aortic aneurysm which can cause low back pain and leg pain due to compression can also rupture and lead to hemorrhagic shock.
  • Hodgkin’s lymphoma in advanced stages can lead to space-occupying lesions in the spinal column leading to symptoms like that of intervertebral disc herniation
  • Tumors
  • Pelvic endometriosis
  • Facet hypertrophy
  • Lumbar nerve root schwannoma
  • Herpes zoster infection results in inflammation along with the sciatic or lumbosacral nerve roots

Examination in Disc Herniation

Complete physical examination is necessary to diagnose intervertebral disc herniation and exclude other important differential diagnoses. The range of motion has to be tested but may have a poor correlation with disc herniation as it is mainly reduced in elderly patients with a degenerative disease and due to disease of the joints.

A complete neurological examination is often necessary. This should test muscle weakness and sensory weakness. In order to detect muscle weakness in small toe muscles, the patient can be asked to walk on tiptoe. The strength of muscle can also be tested by comparing the strength to that of the clinician. There may be dermatomal sensory loss suggesting the respective nerve root involvement. The reflexes may be exaggerated or sometimes maybe even absent.

There are many neurologic examination maneuvers described in relation to intervertebral disc herniation such as the Braggart sign, flip the sign, Lasegue rebound sign, Lasegue differential sign, Mendel Bechterew sign, Deyerle sign both legs or Milgram test, and well leg or Fajersztajin test. However, all these are based on testing the sciatic nerve root tension by using the same principles in the straight leg raising test. These tests are used for specific situations to detect subtle differences.

Nearly almost all of them depend on the pain radiating down the leg and if it occurs above the knee it is assumed to be due to a neuronal compressive lesion and if the pain goes below the knee, it is considered to be due to the compression of the sciatic nerve root. For lumbar disc herniation detection, the most sensitive test is considered to be radiating pain occurring down the leg due to provocation.

In the straight leg raising test also called the Lasegue’s sign, the patient stays on his or her back and keeps the legs straight. The clinician then lifts the legs by flexing the hip while keeping the knee straight. The angle at which the patient feels pain going down the leg below the knee is noted. In a normal healthy individual, the patient can flex the hip to 80- 90? without having any pain or difficulty.

However, if the angle is just 30 -70? degrees, it is suggestive of lumbar intervertebral disc herniation at the L4 to S1 nerve root levels. If the angle of hip flexion without pain is less than 30 degrees, it usually indicates some other causes such as tumor of the gluteal region, gluteal abscess, spondylolisthesis, disc extrusion, and protrusion, malingering patient, and acute inflammation of the dura mater. If pain with hip flexion occurs at more than 70 degrees, it may be due to tightness of the muscles such as gluteus maximus and hamstrings, tightness of the capsule of the hip joint, or pathology of sacroiliac or hip joints.

The reverse straight leg raising test or hip extension test can be used to test higher lumbar lesions by stretching the nerve roots of the femoral nerve which is similar to the straight leg raising test. In the cervical spine, in order to detect stenosis of the foramina, the Spurling test is done and is not specific to cervical intervertebral disc herniation or tension of the nerve roots. The Kemp test is the analogous test in the lumbar region to detect foraminal stenosis. Complications due to the disc herniation include careful examination of the hip region, digital rectal examination, and urogenital examination is needed.

Investigation of Disc Herniation

For the diagnosis of intervertebral disc herniation, diagnostic tests such as Magnetic resonance imaging (MRI), Computed tomography (CT), myelography, and plain radiography can be used either alone or in combination with other imaging modalities. Objective detection of disc herniation is important because only after such a finding the surgical intervention is even considered. Serum biochemical tests such as prostate-specific antigen (PSA) level, Alkaline phosphatize value, erythrocyte sedimentation rate (ESR), urine analysis for Bence Jones protein, serum glucose level, and serum protein electrophoresis may also be needed in specific circumstances guided by history.

Magnetic Resonance Imaging (MRI)

MRI is considered the best imaging modality in patients with history and physical examination findings suggestive of lumbar disc herniation associated with radiculopathy according to North American Spinal Society guidelines in 2014. The anatomy of the herniated nucleus pulposus and its associated relationships with soft tissue in the adjacent areas can be delineated exquisitely by MRI in cervical, thoracic, and lumbosacral areas. Beyond the confines of the annulus, the herniated nucleus can be seen as a focal, asymmetric disc material protrusion on MRI.

On sagittal T2 weighted images, the posterior annulus is usually seen as a high signal intensity area due to radial annular tear associated with the herniation of the disc although the herniated nucleus is itself hypointense. The relationship between the herniated nucleus and degenerated facets with the nerve roots which are exiting through the neural foramina are well-demarcated on sagittal images of MRI. Free fragments of the intervertebral disc can also be distinguished from MRI images.

There may be associated signs of intervertebral disc herniation on MRI such as radial tears on the annulus fibrosus which is also a sign of degenerative disc disease. There may be other telling signs such as loss of disc height, bulging annulus, and changes in the endplates. Atypical signs may also be seen with MRI such as abnormal disc locations, and lesions located completely outside the intervertebral disc space.

MRI can detect abnormalities in the intervertebral discs superiorly to other modalities although its bone imaging is a little less inferior. However, there are limitations with MRI in patients with metal implant devices such as pacemakers because the electromagnetic field can lead to abnormal functioning of the pacemakers. In patients with claustrophobia, it may become a problem to go to the narrow canal to be scanned by the MRI machine. Although some units contain open MRI, it has less magnetic power and hence delineates less superior quality imaging.

This is also a problem in children and anxious patients undergoing MRI because good image quality depends on the patient staying still. They may require sedation. The contrast used in MRI which is gadolinium can induce nephrogenic systemic fibrosis in patients who had pre-existing renal disease. MRI is also generally avoided in pregnancy especially during the first 12 weeks although it has not been clinically proven to be hazardous to the fetus. MRI is not very useful when a tumor contains calcium and in distinguishing edema fluid from tumor tissue.

Computed Tomography (CT)

CT scanning is also considered another good method to assess spinal disc herniation when MRI is not available. It is also recommended as a first-line investigation in unstable patients with severe bleeding. CT scanning is superior to myelography although when the two are combined, it is superior both of them. CT scans can show calcification more clearly and sometimes even gas in images. In order to achieve a superior imaging quality, the imaging should be focused on the site of pathology and thin sections taken to better determine the extent of the herniation.

However, a CT scan is difficult to be used in patients who have already undergone laminectomy surgical procedures because the presence of scar tissue and fibrosis causes the identification of the structures difficult although bony changes and deformity in nerve sheath are helpful in making a diagnosis.

The herniated intervertebral discs in the cervical disc can be identified by studying the uncinate process. It is usually projected posteriorly and laterally to the intervertebral discs and superiorly to the vertebral bodies. The uncinate process undergoes sclerosis, and hypertrophy when there is an abnormal relationship between the uncinate process and adjacent structures as seen in degenerative disc disease, intervertebral disc space narrowing, and general wear and tear.

Myelopathy can occur when the spinal canal is affected due to disc disease. Similarly, when neural foramina are involved, radiculopathy occurs. Even small herniated discs and protrusions can cause impingement of the dural sac because the cervical epidural space is narrowed naturally. The intervertebral discs have attenuation a little bit greater than the sac characterized in the CT scan.

In the thoracic region, a CT scan can diagnose an intervertebral disc herniation with ease due to the fact that there is an increased amount of calcium found in the thoracic discs. Lateral to the dural sac, the herniated disc material can be seen on CT as a clearly defined mass that is surrounded by epidural fat. When there is a lack of epidural fat, the disc appears as a higher attenuated mass compared to the surrounding.

Radiography

Plain radiography is not needed in diagnosing herniation of the intervertebral discs, because plain radiographs cannot detect the disc and therefore are used to exclude other conditions such as tumors, infections, and fractures.

In myelography, there may be deformity or displacement of the extradural contrast-filled thecal sac seen in herniation of the disc. There may also be features in the affected nerve such as edema, elevation, deviation, and amputation of the nerve root seen in the myelography image.

Diskography

In this imaging modality, the contrast medium is injected into the disc in order to assess the disc morphology. If pain occurs following injection that is similar to the discogenic pain, it suggests that that disc is the source of the pain. When a CT scan is also performed immediately after discography, it is helpful to differentiate the anatomy and pathological changes. However, since it is an invasive procedure, it is indicated only in special circumstances when MRI and CT have failed to reveal the etiology of back pain. It has several side effects such as headache, meningitis, damage to the disc, discitis, intrathecal hemorrhage, and increased pain.

Treatment of Herniated Disc

The treatment should be individualized according to the patient-guided through history, physical examination, and diagnostic investigation findings. In most cases, the patient gradually improves without needing further intervention in about 3 – 4 months. Therefore, the patient only needs conservative therapy during this time period. Because of this reason, there are many ineffective therapies that have emerged by attributing the natural resolution of symptoms to that therapy. Therefore, conservative therapy needs to be evidence-based.

Conservative Therapy

Since the herniation of the disc has a benign course, the aim of treatment is to stimulate the recovery of neurological function, reduce pain, and facilitate early return to work and activities of daily living. The most benefits of the conservative treatment are for younger patients with hernias that are sequestered and in patients with mild neurological deficits due to small disc hernias.

Bed rest has long been considered a treatment option in herniation of the disc. However, it has been shown that bed rest has no effect beyond the first 1 or 2 days. The bed rest is regarded as counterproductive after this period of time.

In order to reduce the pain, oral non-steroidal anti-inflammatory drugs such as ibuprofen and naproxen can be used. This can relieve the pain by reducing inflammation associated with the inflamed nerve. Analgesics such as acetaminophen can also be used although they lack the anti-inflammatory effect seen in NSAIDs. The doses and the drugs should be appropriate for the age and severity of the pain in the patient. If pain is not controlled by the current medication, the clinician has to go one step up on the WHO analgesics ladder. However, the long-term use of NSAIDs and analgesics can lead to gastric ulcers, liver, and kidney problems.

In order to reduce the inflammation, other alternative methods such as applying ice in the initial period and then switching to using heat, gels, and rubs may help with the pain as well as muscle spasms. Oral muscle relaxants can also be used in relieving muscle spasms. Some of the drugs include methocarbamol, carisoprodol, and cyclobenzaprine.

However, they act centrally and cause drowsiness and sedation in patients and it does not act directly to reduce muscle spasm. A short course of oral steroids such as prednisolone for a period of 5 days in a tapering regime can be given to reduce the swelling and inflammation in the nerves. It can provide immediate pain relief within a period of 24 hours.

When the pain is not resolved adequately with maximum effective doses, the patient can be considered for giving steroid injections into the epidural space. The major indication for the steroid injection into periradicular space is discal compression causing radicular pain that is resistant to conventional medical treatment. A careful evaluation with CT or MRI scanning is required to carefully exclude extra discal causes for pain. The contraindications for this therapy include patients with diabetes, pregnancy, and gastric ulcers. Epidural puncture is contraindicated in patients with coagulation disorders and therefore the foraminal approach is used carefully if needed.

This procedure is performed under the guidance of fluoroscopy and involves injecting steroids and an analgesic into the epidural space adjacent to the affected intervertebral disc to reduce the swelling and inflammation of the nerves directly in an outpatient setting. As much as 50% of the patients experience relief after the injection although it is temporary and they might need repeat injections at 2 weekly intervals to achieve the best results. If this treatment modality becomes successful, up to 3 epidural steroidal injections can be given per year.

Physical therapy can help the patient return to his previous life easily although it does not improve the herniated disc. The physical therapist can instruct the patient on how to maintain the correct posture, walking, and lifting techniques depending on the patient’s ability to work, mobility, and flexibility.

Stretching exercises can improve the flexibility of the spine while strengthening exercises can increase the strength of the back muscles. The activities which can aggravate the condition of the herniated disc are instructed to be avoided. Physical therapy makes the transition from intervertebral disc herniation to an active lifestyle smooth. The exercise regimes can be maintained for life to improve general well-being.

The most effective conservative treatment option that is evidence-based is observation and epidural steroid injection for the relief of pain in the short-term duration. However, if the patients so desire they can use holistic therapies of their choice with acupuncture, acupressure, nutritional supplements, and biofeedback although they are not evidence-based. There is also no evidence to justify the use of trans electrical nerve stimulation (TENS) as a pain relief method.

If there is no improvement in the pain after a few months, surgery can be contemplated and the patient must be selected carefully for the best possible outcome.

Surgical Therapy

The aim of surgical therapy is to decompress the nerve roots and relieve the tension. There are several indications for surgical treatment which are as follows.

Absolute indications include cauda equina syndrome or significant paresis. Other relative indications include motor deficits that are greater than grade 3, sciatica that is not responding to at least six months of conservative treatment, sciatica for more than six weeks, or nerve root pain due to foraminal bone stenosis.

There have been many discussions over the past few years regarding whether to treat herniation of intervertebral disc disease with prolonged conservative treatment or early surgical treatment. Much research has been conducted in this regard and most of them show that the final clinical outcome after 2 years is the same although the recovery is faster with early surgery. Therefore, it is suggested that early surgery may be appropriate as it enables the patient to return to work early and thereby is economically feasible.

Some surgeons may still use traditional discectomy although many are using minimally invasive surgical techniques over recent years. Microdiscectomy is considered to be the halfway between the two ends. There are two surgical approaches that are being used. Minimally invasive surgery and percutaneous procedures are the ones that are being used due to their relative advantage. There is no place for the traditional surgical procedure known as a laminectomy.

However, there are some studies suggesting microdiscectomy is more favorable because of its both short-term and long-term advantages. In the short term, there is a reduced length of operation, reduced bleeding, relief of symptoms, and reduced complication rate. This technique has been effective even after 10 years of follow-up and therefore is the most preferred technique even now. The studies that have been performed to compare the minimally invasive technique and microdiscectomy have resulted in different results. Some have failed to establish a significant difference while one randomized control study was able to determine that microdiscectomy was more favorable.

In microdiscectomy, only a small incision is made aided by an operating microscope and the part of the herniated intervertebral disc fragment which is impinging on the nerve is removed by hemilaminectomy. Some part of the bone is also removed to facilitate access to the nerve root and the intervertebral disc. The duration of the hospital stay is minimal with only an overnight stay and observation because the patient can be discharged with minimal soreness and complete relief of the symptoms.

However, some unstable patients may need more prolonged admission and sometimes they may need fusion and arthroplasty. It is estimated that about 80 – 85 % of the patients who undergo microdiscectomy recover successfully and many of them are able to return to their normal occupation in about 6 weeks.

There is a discussion on whether to remove a large portion of the disc fragment and curetting the disc space or to remove only the herniated fragment with minimal invasion of the intervertebral disc space. Many studies have suggested that the aggressive removal of large chunks of the disc could lead to more pain than when conservative therapy is used with 28% versus 11.5 %. It may lead to degenerative disc disease in the long term. However, with conservative therapy, there is a greater risk of recurrence of around 7 % in herniation of the disc. This may require additional surgery such as arthrodesis and arthroplasty to be performed in the future leading to significant distress and economic burden.

In the minimally invasive surgery, the surgeon usually makes a tiny incision in the back to put the dilators with increasing diameter to enlarge the tunnel until it reaches the vertebra. This technique causes lesser trauma to the muscles than when seen in traditional microdiscectomy. Only a small portion of the disc is removed in order to expose the nerve root and the intervertebral disc. Then the surgeon can remove the herniated disc by the use of an endoscope or a microscope.

These minimally invasive surgical techniques have a higher advantage of lower surgical site infections and shorter hospital stays. The disc is centrally decompressed either chemically or enzymatically with the use of chymopapain, laser, or plasma (ionized gas) ablation and vaporization. It can also be decompressed mechanically by using percutaneous lateral decompression or by aspirating and sucking with a shaver such as a nucleosome. Chemopapin was shown to have adverse effects and was eventually withdrawn. Most of the above techniques have shown to be less effective than a placebo. Directed segmentectomy is the one that has shown some promise in being effective similar to microdiscectomy.

In the cervical spine, the herniated intervertebral discs are treated anteriorly. This is because the herniation occurs anteriorly and the manipulation of the cervical cord is not tolerated by the patient. The disc herniation that is due to foraminal stenosis and that is confined to the foramen are the only instances where a posterior approach is contemplated.

The minimal disc excision is an alternative to the anterior cervical spine approach. However, the intervertebral disc stability after the procedure is dependent on the residual disc. The neck pain can be significantly reduced following the procedure due to the removal of neuronal compression although significant impairment can occur with residual axial neck pain. Another intervention for cervical disc herniation includes anterior cervical interbody fusion. It is more suitable for patients with severe myelopathy with degenerative disc disease.

Complications of the Surgery

Although the risk of surgery is very low, complications can still occur. Post-operative infection is one of the commonest complications and therefore needs more vigorous infection control procedures in the theatre and in the ward. During the surgery, due to poor surgical technique, nerve damage can occur. A dural leak may occur when an opening in the lining of the nerve root causes leakage of cerebrospinal fluid which is bathing the nerve roots. The lining can be repaired during the surgery. However, headache can occur due to loss of cerebrospinal fluid but it usually improves with time without any residual damage. If blood around the nerve roots clots after the surgery, that blood clot may lead to compression of the nerve root leading to radicular pain which was experienced by the patient previously. Recurrent herniation of the intervertebral disc due to herniation of disc material at the same site is a devastating complication that can occur long term. This can be managed conservatively but surgery may be necessary ultimately.

Outcomes of the Surgery

There has been extensive research done regarding the outcome of lumbar disc herniation surgery. Generally, the results from the microdiscectomy surgery are good. There is more improvement of leg pain than back pain and therefore this surgery is not recommended for those who have only back pain. Many patients improve clinically over the first week but they may improve over the following several months. Typically, the pain disappears in the initial recovery period and it is followed by an improvement in the strength of the leg. Finally, the improvement of the sensation occurs. However, patients may complain of feeling numbness although there is no pain. The normal activities and work can be resumed over a few weeks after the surgery.

Novel Therapies

Although conservative therapy is the most appropriate therapy in treating patients, the current standard of care does not address the underlying pathology of herniation of the intervertebral discs. There are various pathways that are involved in the pathogenesis such as inflammatory, immune-mediated, and proteolytic pathways.

The role of inflammatory mediators is currently under research and it has led to the development of new therapies that are directed at these inflammatory mediators causing damage to the nerve roots. The cytokines such as TNF ? are mainly involved in regulating these processes. The pain sensitivity is mediated by serotonin receptor antagonists and ?2 adrenergic receptor antagonists.

Therefore, pharmacological therapies that target these receptors and mediators may influence the disease process and lead to a reduction in symptoms. Currently, cytokine antagonists against TNF ? and IL 1? have been tested. Neuronal receptor blockers such as sarpogrelate hydrochloride etc have been tested in both animal models and in clinical studies for the treatment of sciatica. Cell cycle modifiers that target the microglia that are thought to initiate the inflammatory cascade have been tested with the neuroprotective antibiotic minocycline.

There is also research on inhibiting the NF- kB or protein kinase pathway recently. In the future, the treatment of herniation of the intervertebral disc will be much more improved thanks to the ongoing research. (Haro, Hirotaka)

 

El Paso Chiropractor Near Me

Dr. Alex Jimenez DC, MSACP, RN, CCST

 

A disc bulge and/or a herniated disc is a health issue that affects the intervertebral discs found in between each vertebra of the spine. Although these can occur as a natural part of degeneration with age, trauma or injury as well as repetitive overuse can also cause a disc bulge or a herniated disc. According to healthcare professionals, a disc bulge and/or a herniated disc is one of the most common health issues affecting the spine. A disc bulge is when the outer fibers of the annulus fibrosus are displaced from the margins of the adjacent vertebral bodies. A herniated disc is when a part of or the whole nucleus pulposus is protruded through the torn or weakened outer annulus fibrosus of the intervertebral disc. Treatment of these health issues focuses on reducing symptoms. Alternative treatment options, such as chiropractic care and/or physical therapy, can help relieve symptoms. Surgery may be utilized in cases of severe symptoms. – Dr. Alex Jimenez D.C., C.C.S.T. Insight

Curated by Dr. Alex Jimenez D.C., C.C.S.T.

 

References

  • Anderson, Paul A. et al. Randomized Controlled Trials Of The Treatment Of Lumbar Disk Herniation: 1983-2007. Journal Of The American Academy Of Orthopaedic Surgeons, vol 16, no. 10, 2008, pp. 566-573. American Academy Of Orthopaedic Surgeons, doi:10.5435/00124635-200810000-00002.
  • Fraser I (2009) Statistics on hospital-based care in the United States. Agency for Healthcare Research and Quality, Rockville
  • Ricci, Judith A. et al. Back Pain Exacerbations And Lost Productive Time Costs In United States Workers. Spine, vol 31, no. 26, 2006, pp. 3052-3060. Ovid Technologies (Wolters Kluwer Health), doi:10.1097/01.brs.0000249521.61813.aa.
  • Fardon, D.F., et al., Lumbar disc nomenclature: version 2.0: Recommendations of the combined task forces of the North American Spine Society, the American Society of Spine Radiology,  and the American Society of Neuroradiology. Spine J, 2014. 14(11): p. 2525-45.
  • Costello RF, Beall DP. Nomenclature and standard reporting terminology of intervertebral disk herniation. Magn Reson Imaging Clin N Am. 2007;15 (2): 167-74, v-vi.
  • Roberts, S. Disc Morphology In Health And Disease. Biochemical Society Transactions, vol 30, no. 5, 2002, pp. A112.4-A112. Portland Press Ltd., doi:10.1042/bst030a112c.
  • Johnson, W. E. B., and S. Roberts. Human Intervertebral Disc Cell Morphology And Cytoskeletal Composition: A Preliminary Study Of Regional Variations In Health And Disease. Journal Of Anatomy, vol 203, no. 6, 2003, pp. 605-612. Wiley-Blackwell, doi:10.1046/j.1469-7580.2003.00249.x.
  • Gruenhagen, Thijs. Nutrient Supply And Intervertebral Disc Metabolism. The Journal Of Bone And Joint Surgery (American), vol 88, no. suppl_2, 2006, p. 30. Ovid Technologies (Wolters Kluwer Health), doi:10.2106/jbjs.e.01290.
  • Mercer, S.R., and G.A. Jull. Morphology Of The Cervical Intervertebral Disc: Implications For Mckenzies Model Of The Disc Derangement Syndrome. Manual Therapy, vol 1, no. 2, 1996, pp. 76-81. Elsevier BV, doi:10.1054/math.1996.0253.
  • KOELLER, W et al. Biomechanical Properties Of Human Intervertebral Discs Subjected To Axial Dynamic Compression. Spine, vol 9, no. 7, 1984, pp. 725-733. Ovid Technologies (Wolters Kluwer Health), doi:10.1097/00007632-198410000-00013.
  • Lieberman, Isador H. Disc Bulge Bubble: Spine Economics 101. The Spine Journal, vol 4, no. 6, 2004, pp. 609-613. Elsevier BV, doi:10.1016/j.spinee.2004.09.001.
  • Lappalainen, Anu K et al. Intervertebral Disc Disease In Dachshunds Radiographically Screened For Intervertebral Disc Calcifications. Acta Veterinaria Scandinavica, vol 56, no. 1, 2014, Springer Nature, doi:10.1186/s13028-014-0089-4.
  • Moazzaz, Payam et al. 80. Positional MRI: A Valuable Tool In The Assessment Of Cervical Disc Bulge. The Spine Journal, vol 7, no. 5, 2007, p. 39S. Elsevier BV, doi:10.1016/j.spinee.2007.07.097.
  • Lumbar Disc Disease: Background, History Of The Procedure, Problem. Emedicine.Medscape.Com, 2017, http://emedicine.medscape.com/article/249113-overview.
  • Vialle, Luis Roberto et al. LUMBAR DISC HERNIATION. Revista Brasileira de Ortopedia 45.1 (2010): 1722. PMC. Web. 1 Oct. 2017.
  • Herniated Nucleus Pulposus: Background, Anatomy, Pathophysiology. http://emedicine.medscape.com/article/1263961-overview.
  • Vialle, Luis Roberto et al. LUMBAR DISC HERNIATION. Revista Brasileira De Ortopedia (English Edition), vol 45, no. 1, 2010, pp. 17-22. Elsevier BV, doi:10.1016/s2255-4971(15)30211-1.
  • Mullen, Denis et al. Pathophysiology Of Disk-Related Sciatica. I. Evidence Supporting A Chemical Component. Joint Bone Spine, vol 73, no. 2, 2006, pp. 151-158. Elsevier BV, doi:10.1016/j.jbspin.2005.03.003.
  • Jacobs, Wilco C. H. et al. Surgical Techniques For Sciatica Due To Herniated Disc, A Systematic Review. European Spine Journal, vol 21, no. 11, 2012, pp. 2232-2251. Springer Nature, doi:10.1007/s00586-012-2422-9.
  • Rutkowski, B. Combined Practice Of Electrical Stimulation For Lumbar Intervertebral Disc Herniation.Pain, vol 11, 1981, p. S226. Ovid Technologies (Wolters Kluwer Health), doi:10.1016/0304-3959(81)90487-5.
  • Weber, Henrik. Spine Update The Natural History Of Disc Herniation And The Influence Of Intervention.Spine, vol 19, no. 19, 1994, pp. 2234-2238. Ovid Technologies (Wolters Kluwer Health), doi:10.1097/00007632-199410000-00022.
  • Disk Herniation Imaging: Overview, Radiography, Computed Tomography.Emedicine.Medscape.Com, 2017,
  • Carvalho, Lilian Braighi et al. Hrnia De Disco Lombar: Tratamento. Acta Fisitrica, vol 20, no. 2, 2013, pp. 75-82. GN1 Genesis Network, doi:10.5935/0104-7795.20130013.
  • Kerr, Dana et al. What Are Long-Term Predictors Of Outcomes For Lumbar Disc Herniation? A Randomized And Observational Study. Clinical Orthopaedics And Related Research, vol 473, no. 6, 2014, pp. 1920-1930. Springer Nature, doi:10.1007/s11999-014-3803-7.
  • Buy, Xavier, and Afshin Gangi. Percutaneous Treatment Of Intervertebral Disc Herniation. Seminars In Interventional Radiology, vol 27, no. 02, 2010, pp. 148-159. Thieme Publishing Group, doi:10.1055/s-0030-1253513.
  • Haro, Hirotaka. Translational Research Of Herniated Discs: Current Status Of Diagnosis And Treatment. Journal Of Orthopaedic Science, vol 19, no. 4, 2014, pp. 515-520. Elsevier BV, doi:10.1007/s00776-014-0571-x.

 

 

Neck Adjustment Techniques

Neck Adjustment Techniques

Individuals turn to chiropractic care neck adjustments to help ease neck problems and alleviate pain. Some of the different types of neck-cervical conditions that chiropractic treats include:

  • Cervical intervertebral disc injuries
  • Cervical sprain injuries
  • Degenerative joint syndrome of the neck
  • Facet joint sprain
  • Whiplash

A chiropractor will evaluate the whole spine because other regions may be affected and/or contribute to the problems. They will determine areas of restricted movement and will look at walking gait, overall posture, and spinal alignment. Before deciding which approach to use, the chiropractor will thoroughly examine the specific cause of the problems. Neck adjustments consist of various techniques and methods.

Neck Adjustment Techniques

Neck Adjustments

Cervical Mobilization

  • Cervical mobilization focuses on using gentle motions around the neck.
  • It incorporates the high-velocity low-amplitude technique, which uses quick pressure to release an area.
  • This adjustment is best for reducing pain and increasing the neck’s range of motion.

Cervical Drop

  • The cervical drop technique requires the individual to lie on their stomach or side as the chiropractor adjusts the neck, and to prevent any added pressure around the neck, the headrest drops.
  • After the chiropractor prepares the neck for the adjustment, they will work on specific points, release the headrest, and quickly twist the neck.
  • All of this is done within seconds.
  • A standard cervical drop is flexion-distraction.
  • This will release tension in the spine.
  • This technique improves spinal flexibility by placing the vertebrae in their correct position.

Manual Traction

  • The patient sits in a chair for this neck adjustment.
  • Manual traction allows the chiropractor to move the neck at different angles and helps them determine the right amount of force during the adjustment.
  • A chiropractor will cradle the head in the palms of their hands and quickly move it from side to side.

Soft Tissue Massage

  • This technique is often used after a complete adjustment.
  • A chiropractor will gently massage the neck and apply pressure to any inflamed areas.
  • This increases blood circulation and prevents muscles from tensing and contracting.

Chiropractic Benefits

The benefits that come with using chiropractic neck adjustments include.

Improves Flexibility

  • One benefit of chiropractic neck adjustments is that they improve your flexibility.
  • Tight muscles or joints out of place make it harder for the neck to move, limiting its range of motion.
  • Chiropractic works to reduce poor flexibility by ensuring the bones and muscles are in their proper position.

Prevents Tension

  • Individuals that deal with severe tension often notice their neck and upper back feeling sore.
  • Tension tightens the muscles and can cause them to press on nerves.
  • If too much pressure is on them, the nerves can send out painful pulses.
  • A chiropractor will feel around the neck and shoulders to identify areas of concern. After the examination, they will make the proper adjustments to reduce pressure on the nerves and calm inflamed muscles.

Prevents Arthritis

  • Arthritis causes inflammation throughout the body. If not treated, this inflammation can increase the wearing down of bones.
  • Worn-down bones reduce strength and can irritate nerves.
  • Chronic neck pain could indicate that the joints in the neck are misplaced.
  • If these joints are not correctly realigned, the constant friction can begin to break down the bones leading to arthritis.
  • Chiropractic neck adjustments prevent this by ensuring the joints are in place and maintaining joint health by flushing toxins in and around them.

Anti-Inflammatory Food

Most neck pain is the result of inflammation. Individuals can take synthetic medications to reduce inflammation, but they have side effects. It is recommended to add natural anti-inflammatory foods to one’s diet. These won’t only reduce inflammation but can increase energy levels and help the body heal quicker. A few recommended foods include:

  • Avocados
  • Peppers
  • Strawberries
  • Blueberries
  • Turmeric
  • Salmon

Body Composition


Heart Disease

Heart disease is the leading cause of death of adults in the United States. Many factors can contribute to heart disease, and research has pointed to inflammation caused by obesity as one of the most significant factors contributing to the development. The main culprits are cytokines produced by excess fat in the body. These cytokines cause inflammation of the walls of the arteries, causing damage and increasing blood pressure. Blood pressure is the force of blood pushing against the walls of the blood vessels. When high blood pressure is present, the heart does not pump blood effectively, causing the heart to enlarge. An enlarged heart is a significant risk factor for heart failure if steps are not taken to remedy it.

References

Bradley S. Polkinghorn, Christopher J. Colloca, Chiropractic treatment of postsurgical neck syndrome with mechanical force manually assisted short-lever spinal adjustments, Journal of Manipulative and Physiological Therapeutics, Volume 24, Issue 9,
2001, Pages 589-595, ISSN 0161-4754, https://doi.org/10.1067/mmt.2001.118985. (https://www.sciencedirect.com/science/article/pii/S0161475401836915)

Haldeman S. Principles and Practice of Chiropractic. York, PA: McGraw-Hill; 2005.

Hawk, Cheryl et al. “Best Practices for Chiropractic Management of Patients with Chronic Musculoskeletal Pain: A Clinical Practice Guideline.” Journal of alternative and complementary medicine (New York, N.Y.) vol. 26,10 (2020): 884-901. doi:10.1089/acm.2020.0181

Eric L. Hurwitz, Hal Morgenstern, Philip Harber, Gerald F. Kominski, Fei Yu, and Alan H. Adams, 2002: A Randomized Trial of Chiropractic Manipulation and Mobilization for Patients With Neck Pain: Clinical Outcomes From the UCLA Neck-Pain Study American Journal of Public Health 92, 1634_1641, https://doi.org/10.2105/AJPH.92.10.1634

Wang, Zhaoxia, and Tomohiro Nakayama. “Inflammation, a link between obesity and cardiovascular disease.” Mediators of inflammation vol. 2010 (2010): 535918. doi:10.1155/2010/535918

Waking Up With Neck Pain

Waking Up With Neck Pain

Waking up with neck soreness, stiffness, achiness, and pain can take a toll throughout the day. Individuals, that experience this regularly wonder what happened while laying down in bed? Individuals can wake up with one or a combination of these symptoms after sleeping. A few ways to prevent neck pain after sleeping and self-care to relieve any symptoms.

Waking Up With Neck Pain

What Is Happening?

The spine keeps the body upright and moving and regularly resists gravity and other forces acting upon it. The neck, aka the cervical spine, is a little more delicate. The neck has the important job of holding up the head. The human head weighs around 10 to 12 lbs, and that’s using proper posture.  According to a study, the head’s weight can increase up to 60 lbs. with a 60-degree tilt. This can happen from looking down at a phone for too long. All that weight makes the muscles that support the head and neck work overtime contributing to fatigued muscles.

Then when sleeping, cervical spinal misalignment starts to set in, producing torticollis. Torticollis, aka wry neck, is a condition where the neck gets twisted or tilted at an awkward angle. Babies can be born with it, known as congenital torticollis, and individuals can develop it from various sources. It can be temporary, chronic, and it can be caused by acute trauma. Torticollis is not considered a condition like ankylosing spondylitis but more like a symptom with overlapping sources.

  • The neck’s ligaments can become irritated and inflamed.
  • Neck muscle spasms can cause soreness and inflammation.
  • Either of these can be caused by sleeping in an awkward position or by using the wrong pillow.

Waking With Neck Pain

When waking up with neck pain, it could be that the pillow no longer provides sufficient support, the pillow is too thick, placing the neck in an awkward position, the individual’s sleeping position strains the muscles and ligaments, or a combination. It is usually a pillow that is too soft with no support that causes neck pain. Maintaining spinal alignment when sleeping is just as crucial as during the day, as it helps to prevent overly taxing the muscles and ligaments.

How to control posture when sleeping?

The pillow could be the answer. A firm pillow will keep the spine in a straight line from the atlas, which is the first cervical vertebra/C1, down to the coccyx or the tailbone. The way an individual sleeps also affects how they wake up. The most recommended sleeping position for individuals with morning neck pain is on the back. Back sleeping might not work for everyone as it can aggravate conditions like sleep apnea. If that is the case, sleeping on the side is the next recommended position. It is recommended to avoid sleeping on the stomach. The head could slip down the pillow edge causing the head to be in a tilted position. This can place added pressure on the nerves that start in the neck, leading to further neck pain or radiculopathy pain that spreads out to the arms or legs.

What To Do?

If neck pain presents after waking, get some ice or a cold pack on it. Try 20 minutes on, 20 minutes off. This will reduce inflammation. Also, over-the-counter nonsteroidal anti-inflammatory medications like ibuprofen can help. If neck pain continues, switch from ice to heat also 20 minutes on, 20 off. If the pain is caused by spasming muscle/s, heat can relax the area and increase blood circulation. A gentle massage on and around the area can help spread the circulation and ease the spasm.

Stretching the neck

Stretching the neck will keep the muscles loose and reduce the risk of ligament, muscle and tendon strains, and torticollis.

  • Try to touch the right ear to the right shoulder.
  • Push gently on the left side of the head.
  • Return to the starting position.
  • Repeat on the left side.
  • Repeat on each side ten times.
  • Look up to the ceiling as far as possible.
  • Return to the starting position.
  • Look down as far as possible.
  • Do ten reps up and down.
  • Turn the head to the right.
  • Push the chin gently with the left hand.
  • Return to starting position.
  • Repeat on the left side.
  • Do ten reps right and left.

Body Composition


Sleep and Fat Loss

Body composition change and losing fat mass are also related to sleep. Losing fat requires the body to be in a caloric deficit. This means having the body use more energy than the body takes in. This is accomplished by restricting calories through diet or increasing calories used through physical activity/exercise. However, most individuals utilize a combination. This can be referred to as calories in/calories out. Losing sleep can sabotage fat loss goals by stealing both the calories in and calories out.

References

Hansraj, Kenneth K. “Assessment of stresses in the cervical spine caused by posture and position of the head.” Surgical technology international vol. 25 (2014): 277-9.

Preventing Neck Pain from Sleeping: National Sleep Foundation. (n.d.) “How to Prevent Neck Pain While Sleeping.” sleep.org/articles/prevent-neck-pain-while-sleeping/

Neck Crepitus Cracking, Grinding Sounds

Neck Crepitus Cracking, Grinding Sounds

Neck crepitus is a grinding sound that comes from moving or rotating the neck. Usually, it is not something to worry about, as the body is a sound system that generates various noises. For example, when hungry, the stomach rumbles. After digestion, the body releases the gasses through a burp. The bones can also generate neck cracking or popping sounds with regular movements. This unusual sensation is known as crepitus.

Neck Crepitus Cracking, Grinding Sounds

Crepitus

Crepitus or crepitation is a scientific term that describes joint movements sounds. Sounds can include:

  • Popping
  • Cracking
  • Snapping
  • Grinding

However, crepitus can happen in any moveable joints in the body. An example could be a neck cracking or popping sound when looking over the shoulder.

Why the Neck So Susceptible

The cervical spine consists of seven segments, and each segment has multiple joints that interact with the segments above and below it. The cervical spine is a flexible system that protects the neurologic structures while maintaining head and neck stability. This flexibility and the multiple joints at each level can wear down, leading to arthritis and neck crepitus.

Other Symptoms

Neck crepitus can present without other symptoms. But it can also be associated with other severe symptoms that include:

  • Neck pain
  • Instability
  • Weakness
  • Numbness
  • Diminished manual dexterity
  • Difficulty walking

Risk Increases With Age

Neck crepitus can present at any age; however, the risk increases as the body ages. Some individuals may have neck crepitus symptoms more often. For example, the neck cracking or popping sounds could present just a few times a month. However, other individuals could have cracking, popping sounds daily or even throughout the day. Neck crepitus can increase or decrease in frequency. Symptoms could present for several days before the sensations stop entirely.

Possible Causes

Neck crepitus can have various causes, and multiple factors can also overlap to generate these sensations.

Articular Pressure Changes

Natural lubricating lining and fluid are found within the body’s joints. Small gas bubbles can form within the synovial joints, including the facet joints. When the bubbles collapse, they are released, creating cracking noises in the joints. The sounds can happen with regular everyday movements. This also occurs when a chiropractor or physical therapist performs spinal manipulations.

Tendon or Ligament Movement

Tendons are the tissue that connects the muscles to the bones, and Ligaments connect the bones. A tendon in motion can also make noises when sliding around a bone or over another tendon or ligament. The cracking can be caused by tight tissues and muscles from aging or muscles that have become weak/deconditioned.

Bones Grinding

Osteoarthritis, known as spondylosis in the spine, can cause the facet joints that connect the vertebrae to degenerate. The protective cartilage wears down, and the vertebral bones start to rub against each other. This can produce a grinding noise. However, the grinding can result from disc degeneration, which reduces the cushioning between the vertebrae.

When to Consult A Physician

If neck crepitus presents without other symptoms, it’s usually not serious. When neck crepitus presents with other symptoms, it is recommended to contact a doctor. These symptoms include:

If pain spreads out and runs down the arm or there is difficulty completing fine motor tasks like writing your name or getting dressed, consult a doctor. These symptoms can be caused by spinal cord or nerve root compression. Sometimes, neck crepitus can show up after a different health issue. For example, if an individual notices neck sounds weeks after cervical spine surgery, the spine surgeon can determine if the two are connected. A recent fall or car accident could also cause symptoms to present. If the crepitus presents almost every time with joint movement, there could be compromised joint function.

Treatment and Prevention

There are various treatment options for neck crepitus. It is recommended to start with conservative treatment like physical therapy and chiropractic pain management. Imaging scans are necessary to see if there are signs of compression on the spinal cord or nerves. Treatment objectives are to remove the pressure from the neural structures and restore the spine’s stability. Cervical traction is another form of treatment. Consult a physician, spine specialist, or chiropractor to properly diagnose the issues, figure out what is going on, and develop a personalized treatment plan if necessary.


Body Composition


Sugar Replacements

Sugar substitutes can help with weight control and diabetes by allowing individuals to eat sweets without raising blood sugar levels. Sugar replacements are additives that add sweetness to food without the calories of sugar. Some sugar substitutes are synthetically made, while others are natural. Sugar replacements include:

Sucralose

  • This artificial sweetener comes from sucrose and contains no calories. It is highly sweeter than sugar and can be found in grocery stores.

Fructose

  • This sweetener comes in crystalline form or high-fructose corn syrup, which is often used for baking. Fructose is sweeter than sugar and has been linked to early diabetes.

Stevia

  • This sweetener is extracted from the stevia rebaudiana plant species. It is calorie-free and can help manage and improve cholesterol levels.

Aspartame

  •  Only a tiny amount is necessary, as this artificial sweetener is 200 times sweeter than sugar. It contains four calories per gram.
  • Aspartame has been associated with cancer, dementia, and depression. But research has not found a direct correlation, and currently, recommended amounts are safe to consume.
References

Mohamad, I et al. “Swollen neck and crepitus after bouts of cough.” Malaysian family physician: the official journal of the Academy of Family Physicians of Malaysia vol. 8,3 49-50. 31 Dec. 2013

Nguyen, Andrew B et al. “Crepitus: an uncommon complication of a common procedure.” The Annals of thoracic surgery vol. 91,4 (2011): e63. doi:10.1016/j.athoracsur.2011.01.031

Tension In The Neck, Relief and Motion Restored With Chiropractic

Tension In The Neck, Relief and Motion Restored With Chiropractic

Muscle tension in the neck is a common musculoskeletal disorder.  The neck is made up of flexible muscles that support the weight of the head. The muscles can experience injury and irritation from overuse and poor posture habits. Worn joints or compressed nerves can cause neck pain, but muscle spasms or soft tissue injuries commonly cause neck tension. Neck tension can present suddenly or progress slowly. Sleeping in an awkward position or straining the neck while engaged/involved in some activity can cause muscles to tense up. Chronic neck tension that comes and goes over the course of weeks or months could have a cause that goes unnoticed, like teeth grinding or being in a hunched position for extended periods.

Tension In The Neck, Relief and Motion Restored With Chiropractic

Symptoms of neck tension

Symptoms can come on suddenly or progressively. These include:

  • Stiffness
  • Tightness
  • Spasms
  • Turning the head is difficult
  • Discomfort and/or pain worsens with certain positions

Causes

Because the neck can move in many directions, there are various causes of tension in the neck. These include:

Repetitive motion or overuse injuries

Individuals whose work requires repetitive movements like scanning objects, looking up and behind constantly can strain the muscles.

Improper posture

An adult’s head weighs 10 to 11 pounds. If the weight is not properly distributed and supported with a healthy posture, the neck muscles have to work harder, causing strain.

Computer workstation habits

Individuals that sit at a desk or workstation for most of the day or night can develop hunching habits that they may overlook. This can definitely cause neck muscles to strain.

Phone habits

Constantly looking down at the phone is a common cause of tension in the neck and text neck.

Grinding teeth

When individuals grind or clench their teeth, pressure is placed on the muscles in the neck and jaw. This pressure strains the muscles, causing pain. There are exercises to promote more relaxed jaw muscles.

Physical activities and sports

Working out in a way that engages the neck muscles or whipping the head around during a game or some physical activity can cause minor neck injury and strain.

Sleep position habits

When sleeping, the head and neck should be aligned with the rest of the body. Using large pillows that elevate the neck too much can cause tension to build up while sleeping.

Heavy purses, backpacks, shoulder bags

Lifting and carrying any heavy object can throw the body out of alignment. This can cause strain on one side of the neck, building tension.

Stress

Psychological stress impacts the whole body. When stressed, individuals can inadvertently tense up and strain their muscles.

Tension headaches

These are mild to moderate headaches that typically affect the forehead. However, these types of headaches can cause neck tension and tenderness.

Prevention

Making simple adjustments can help relieve, manage, and prevent tension in the neck and shoulders. These include:

Ergonomics

Consider a standing desk. Adjust the workstation so that proper posture along with comfort is maintained. Try different adjustments like the height of the chair, desk, and computer.

Be aware of body posture.

Stay aware of the body’s posture when sitting and standing. Keep the ears, shoulders, and hips in a straight line. Consider phone posture reminders and devices to check in with how you’re holding yourself throughout the day.

Take breaks throughout the day.

Take breaks that will move the body and stretch the neck and upper body. This benefits the muscles, eyes, and mental health.

Sleep position

Improve sleeping positions with a smaller, flatter, firmer pillow.

Reduce weight from the shoulders

Utilize a rolling bag instead of carrying heavy bags and backpacks, and only carry what is necessary.

Movement

Try to get 30 minutes of moderate exercise/physical activity a day to keep the body in healthy condition.

Meditation and stretching

Practicing yoga or meditation along with stretching out helps reduce psychological and physical stress. Yoga can count as daily exercise.

Doctor or Dentist

If chronic neck tension is presenting, see a doctor or chiropractor. Consult a dentist about teeth grinding or temporomandibular joint TMJ disorder treatments.

Neck stretches

To relieve tension in the neck, try some neck stretches.

Chin to chest stretch

  • Sitting or standing.
  • Clasp the hands on top of the head, elbows pointing outward.
  • Gently pull down the chin to the chest
  • Hold for 30 seconds.

Seated neck stretch

  • Sit with the feet touching the ground.
  • Hold the seat with the left hand
  • With the right hand on top of the head.
  • Gently pull your head to the right, so the ear almost touches the shoulder.
  • Hold for 30 seconds
  • Repeat on the opposite side.

Body Composition


The Immune System

The Immune System is essential in maintaining health. Its objective is to:

  • Neutralize pathogenic microorganisms like bacteria that enter the body and threaten homeostasis.
  • Eliminate harmful substances from the environment.
  • Fight against cells that cause illnesses like cancer.

Innate and adaptive immune processes.

  • The innate system includes exterior defenses, like the skin, proteins, and white blood cells.
  • Any organisms that escape the first line of defense have to then face the adaptive system. This is made up of T and B cells.
  • The adaptive immune system is constantly adapting and evolving to identify changes in pathogens change over time.
  • These systems work together to provide resistance and the elimination of long-term survival of infectious agents in the body.
References

Chaplin, David D. “Overview of the immune response.” The Journal of allergy and clinical immunology vol. 125,2 Suppl 2 (2010): S3-23. doi:10.1016/j.jaci.2009.12.980

Hawk, Cheryl et al. “Best Practices for Chiropractic Management of Patients with Chronic Musculoskeletal Pain: A Clinical Practice Guideline.” Journal of alternative and complementary medicine (New York, N.Y.) vol. 26,10 (2020): 884-901. doi:10.1089/acm.2020.0181

Hughes, Stephen Fôn et al. “The role of phagocytic leukocytes following flexible ureterorenoscopy, for the treatment of kidney stones: an observational, clinical pilots-study.” European journal of medical research vol. 25,1 68. 11 Dec. 2020, doi:10.1186/s40001-020-00466-7

Levoska, S. “Jännitysniska” [Tension neck]. Duodecim; laaketieteellinen aikakauskirja vol. 107,12 (1991): 1003-8.

Keeping The Neck In One Position For Too Long

Keeping The Neck In One Position For Too Long

Many individuals will be looking up at the fireworks this 4th of July weekend. A word of caution when keeping the neck in one position for too long can cause neck discomfort and/or pain. Neck discomfort and pain can cause significant disruption with everyday activities. The neck is an area that is constantly in motion. Keeping it in one position for an extended period can cause damage/injury and spinal misalignment. Although neck pain often resolves on its own in a few days. However, it can lead to headaches or an inability to concentrate, affecting an individual’s quality of life. Here are some potential causes and remedies for decreasing neck discomfort and pain.

Keeping The Neck In One Position For Too Long

Keeping The Neck In One Position For Too Long Can Cause

  • Mechanical issues and imbalances in the upper spine, known as the cervical spine
  • Muscle tension
  • Muscle strain
  • Spinal misalignment
  • Poor posture
  • Sleeping problems
  • Injury or trauma to the neck from the force and weight
  • Chronic neck misalignment

If symptoms come on suddenly, are severe, or result in neurological issues like severe shooting pain, tingling, numbness, or sudden loss of arm strength, seek medical attention immediately.

Treatment

When the neck is strained or out of alignment, it disrupts nerve circulation integrity. Spinal misalignment is subtle in nature and can be difficult to detect without a professional examination. A chiropractor is trained to recognize any underlying issues to reset/realign the entire spine to optimal form. They will assess, guide, and treat the issue/s specific to the individual’s needs. Once the nerves are working uninhibited, a chiropractor can recommend neck exercises, stretches, and more to strengthen and prevent neck problems. When spinal alignment is restored, the body will begin to operate at full potential.


Healthy Body Composition


Meal Prep to Success

For individuals that want to eat less and change eating habits, change up the approach.

Meal prepping is a healthy habit that many have had success with because it helps achieve sustainable outcomes in weight loss. Every meal plan will vary for everyone.

  1. First, individuals have different health goals.
  2. Second, everyone has a different approach to their diet choices. For example, an individual might want to go low-carb and goes with the ketogenic diet. In comparison, some individuals are comfortable planning a week in advance and freezing labeled plastic containers.

Regardless of goals, dietary, or fitness preferences, a workable meal plan is recommended. The ultimate goal is to prevent feeling overwhelmed about planning the next healthy meal and resort to a junk food meal. To steer clear of unhealthy food choices and achieve a healthy body composition, here is a real-world tip to create and stick to a healthy meal plan.

Have a well-stocked fridge and pantry

Keeping to a meal plan is easier with a well-stocked fridge and pantry. Ensure to keep a list of essential groceries whenever going to the store to ensure plenty. This list of staples includes:

  • Eggs
  • A favorite protein
  • Whole grains
  • Yogurt
  • Healthy oils
  • Herbs and spices
  • Butter
  • Leafy greens
  • Beans

Having these ingredients ready to go means a healthy meal can be quickly put together when short on time.

Be realistic and make room for crazy days

You don’t have to come up with a seven-day weekly meal plan. It is important to change up the routine, so boredom doesn’t set in. Before planning and prepping several meals, double-check the calendar. Allow yourself some slack. This could be one or two lunches or dinners in a week just in case something comes up. If batch cooking, even schedule days for leftovers for that extra flexibility.

References

BMJ. 2017 Advances in the diagnosis and management of neck pain. Available at: https://pubmed.ncbi.nlm.nih.gov/28807894/

Mayo Clin Proc. 2015. Epidemiology, diagnosis, and treatment of neck pain. Available at: https://pubmed.ncbi.nlm.nih.gov/25659245/

Open Orthop J. 2016. A Qualitative Description of Chronic Neck Pain has Implications for Outcome Assessment and Classification. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5301418/

Phys Ther. 2018. A Mechanism-Based Approach to Physical Therapist Management of Pain. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6256939/

Chiropractic Mobilization For Cervical Joints With Radiculopathy

Chiropractic Mobilization For Cervical Joints With Radiculopathy

Individuals experiencing radiculopathy in and around the neck notice it immediately often driving them to the medicine cabinet. This condition presents with:

  • Acute pain
  • Numbness
  • Muscle spasms

However, medication will only help relieve the pain temporarily but it won’t alleviate what is causing the radiculopathy. This is because pain medication/s can exacerbate the condition by blocking the pain signals with the root nerve issue never being resolved. Chiropractic is a complete solution that specifically mobilizes the cervical joints where nerve impingement is happening. The objective is to help individuals understand the underlying cause of the acute pain induced by radiculopathy and provide long-term pain relief through cervical joint mobilization.

11860 Vista Del Sol, Ste. 128 Chiropractic Mobilization For Cervical Joints With Radiculopathy

Radiculopathy Pain

 

To determine what cervical nerve bundles are being affected by a subluxation or vertebral compression a chiropractor needs to isolate the pain. This is accomplished through a description of symptoms, radiological imaging to provide visual confirmation, and an examination of the affected area. Isolating the pain allows the chiropractor to determine the extent of misalignment and how much the nerve is being compressed. This will help in the development of a customized treatment plan. A chiropractor will be able to see and feel the degree of pressure being placed on the nerve or bundle of nerves.

Mobilizing The Cervical Joints

Chiropractors approach this directly based on the individual and the severity of the case. The most common joint mobilizations include:

  • Low-impact adjusting will shift the misaligned vertebrae back into place
  • Traction to decompress cervical vertebrae
  • Adjustments to the opposite non-painful area will help counterbalance stress in the spine

Radiculopathy improvement consists of:

  • The cervical spine is stabilized through bracing and posture supports
  • Isometric exercises will recondition the neck, shoulders, and upper back
  • Range of motion exercises will prevent any subtle compression/s
  • Corrective restoration of the cervical spine’s curve

The spine returns to normal during cervical joint mobilization and alleviates radiculopathy immediately and long term.

Proper chiropractic care will correct the affected nerve bundle, and stabilize the cervical spine to prevent/resist:

  • Compression
  • Translation
  • Subluxation
  • Other shifts that can occur

Chiropractic Mobilization Long Term Relief

A pinched nerve should not be treated with over-the-counter medications for long-term health. Corrective chiropractic mobilization is a recommended course of action for alleviating this and other musculoskeletal conditions. Chiropractic understands the nature and severity of radiculopathy as well as developing the proper customized treatment plan that will bring optimal results.


Body Composition


 

DASH Diet Example

Breakfast

  • 3/4 cup bran flakes cereal with 1 banana and 1 cup low-fat milk
  • 1 slice whole-wheat bread with 1 tsp. unsalted butter
  • 1 orange
  • 1 cup coffee

Lunch

  • Sandwich 2 slices of whole-wheat bread
  • 3 oz. grilled thin chicken breast
  • 2 slices low-fat cheese
  • 1 tbsp. mustard

Salad

  • 1/2 cup chopped/diced cucumbers
  • 1/2 cup chopped/diced tomatoes
  • 1 tablespoon sunflower seeds
  • 1 teaspoon low-calorie non-cream dressing
  • 1/2 cup fruit cocktail with no sugar

Snack

  • 1/3 cup unsalted almonds

Dinner

  • 3 oz. lean beef with 2 tbsp. fat-free, low sodium gravy
  • 1 cup broccoli sauteed with 1/2 tsp. olive oil
  • 1 small baked potato topped with:
  • 1 tbsp. fat-free sour cream or plain Greek yogurt
  • 1 tbsp. shredded, reduced-fat, natural low-sodium cheddar cheese
  • 1 tbsp. chopped scallions
  • 1 small apple

Dessert

  • 1/2 cup low-fat plain Greek yogurt topped with:
  • 1/2 cup berries
  • Cocoa powder light dusting

Disclaimer

The information herein is not intended to replace a one-on-one relationship with a qualified health care professional, licensed physician, and is not medical advice. We encourage you to make your own health care decisions based on your research and partnership with a qualified health care professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from a wide array of disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the musculoskeletal system’s injuries or disorders. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and support, directly or indirectly, our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request. We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900.

Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, CTG*
email: coach@elpasofunctionalmedicine.com
phone: 915-850-0900
Licensed in Texas & New Mexico

References

BMJ. 2017 Advances in the diagnosis and management of neck pain. Available at: https://pubmed.ncbi.nlm.nih.gov/28807894/

Mayo Clin Proc. 2015. Epidemiology, diagnosis, and treatment of neck pain. Available at: https://pubmed.ncbi.nlm.nih.gov/25659245/

Open Orthop J. 2016. A Qualitative Description of Chronic Neck Pain has Implications for Outcome Assessment and Classification. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5301418/

Evid Based Complement Alternat Med. 2015. Complementary and Alternative Medicine for the Management of Cervical Radiculopathy: An Overview of Systematic Reviews. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4541004/

Texas Supreme Court’s Decision in “Texas Board of Chiropractic Examiners et al v. Texas Medical Association” Case

Texas Supreme Court’s Decision in “Texas Board of Chiropractic Examiners et al v. Texas Medical Association” Case

After all of these years, I am happy to announce that the Texas Supreme Court has finally made a decision regarding the Texas Board of Chiropractic Examiners et al v. Texas Medical Association case on January 29th, 2021. With great honor and gratitude, I’d like to continue to extend sincere thanks to everyone who worked hard on this case and whose tremendous efforts resulted in the decision. Thanks to the Supreme Court’s decision, chiropractors in Texas can now carry on their jobs accordingly. Below, I have provided a letter from Board President, Mark R. Bronson, D.C., F.I.A.N.M. on behalf of the Texas Board of Chiropractic Examiners stating the Texas Supreme Court’s decision in the Texas Board of Chiropractic Examiners et al v. Texas Medical Association case on January 29th, 2021. – Dr. Alex Jimenez D.C., C.C.S.T.

 


 

February 1, 2021

 

On behalf of the Texas Board of Chiropractic Examiners, I extend our sincere thanks and appreciation to everyone whose efforts resulted in the Texas Supreme Court’s decision in Texas Board of Chiropractic Examiners et al v. Texas Medical Association on January 29, 2021. Special thanks are due to all the attorneys at the Office of the Attorney General who worked on this case over these years.

 

The decision properly affirmed the validity of the Board’s scope of practice rule, which the court clearly said does not exceed our statutory scope of chiropractic practice. The court unequivocally held that the Board�s rules do not violate Occupations Code Chapter 201 or run counter to the chapter’s objectives set by the Texas Legislature, and in fact, carefully observe the statutory boundary between the medical and chiropractic professions. This decision, which recognizes the common sense and long-standing inclusion of associated nerves in chiropractic diagnosis and treatment, preserves and strengthens the essence of chiropractic.

 

Thanks to the court’s decision, our licensees can now fulfill their duties as vital portal-of-entry healthcare providers in Texas without fear. The court’s decision reaffirms the principles of economic freedom that have made Texas the best state in the nation to be a chiropractor.

 

Sincerely,

 

Mark R. Bronson, D.C., F.I.A.N.M. Board President
Texas Board of Chiropractic Examiners

 

Supreme-Court-Decision

 


 

The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.*

 

Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas & New Mexico*

 

The Atlas Vertebra Key To Maintaining Head Balance And Alignment

The Atlas Vertebra Key To Maintaining Head Balance And Alignment

The Atlas vertebra is named for the mythological figure who held the world on their back/neck. The vertebrae are located at the top of the spine, where the cranium and spine connect. More than just a foundation for support, the vertebrae could be the most important vertebrae of the body. It consists of a complex bundle of nerves, vertebral arteries, and is the point where the entire weight of the cranium makes contact.  
 
The myth requires Atlas to be careful while holding the world carefully and confidently at all times, otherwise it will come crashing down. The key is being able to balance it perfectly. The vertebra has the same job to hold the head up properly and maintain posture. If not problems with balance and alignment will begin to develop, and affect the entire spine.  
11860 Vista Del Sol, Ste. 128 The Atlas Vertebra Key To Maintaining Head Balance And Alignment
 

The Atlas Vertebra

 

Balance

The Atlas vertebrae’s role in maintaining balance is based on its ability to adjust to the weight of the head. The actual vertebra is wider than the other cervical vertebrae. This creates a center of gravity that is reinforced through proper posture. It distributes the weight of the head (10-12lb) evenly to centralize the weight and is supported by the natural curvature of the spine. If the center of gravity shifts, the Atlas vertebra will tilt in that direction as well. This creates instability in the cervical spine and can increase the amount of weight the spine is taking and trying to redistribute. This creates spinal issues and leads to everything from poor posture, overcompensation that leads to injury.  

Shifting Causes

Disruption to the vertebra and its ability to balance can come from a variety of causes and can occur as a result of chronic and acute conditions. Some include:
  • Auto accidents, sports, work injuries can cause cervical soft tissue damage
  • Dislocation of cervical vertebrae below the Atlas results in instability
  • Poor posture/s make individuals overcompensate to one side of the body straining muscles, ligaments, tendons causing pain and other issues
  • Herniated, bulging, and slipped discs
11860 Vista Del Sol, Ste. 128 The Atlas Vertebra Key To Maintaining Head Balance And Alignment
 

Unbalanced effects

Spinal issues range from simple neck pain and soreness to full-on chronic pain. Because the Atlas can alter the balance of the entire spine, combined with cranium support, issues can be localized and referred creating further complications. Addressing the root problems requires a comprehensive chiropractic approach. Chiropractic will assess the position of the spine and determine the degree to which Atlas has shifted out of place. An adjustment treatment plan makes it possible to undo the widespread damage.

Body Composition


 

Muscle Loss

Individuals do not realize that muscle loss occurs throughout their lifetime. This is because muscles, like other tissues in the body, must go through cell turnover and protein synthesis. This means that the body is constantly breaking down protein in the muscles and rebuilding them. Skeletal muscle can be developed with proper nutrition and includes consuming a proper amount of protein to provide the necessary amino acids and from physical activity. The reverse is also true, if an individual becomes less physically active and/or their diet no longer supports the development of increased muscle tissue, the body enters a catabolic/tissue-reducing state known as muscle atrophy.

Dr. Alex Jimenez�s Blog Post Disclaimer

The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas& New Mexico*
References
Woodfield, H Charles 3rd et al. �Craniocervical chiropractic procedures – a pr�cis of upper cervical chiropractic.��The Journal of the Canadian Chiropractic Association�vol. 59,2 (2015): 173-92.
Mechanical Vs. Manual Cervical Traction The Chiropractic Difference

Mechanical Vs. Manual Cervical Traction The Chiropractic Difference

Spinal traction, both mechanical and manual are treatment options that are based on the application of force to the axis of the spinal column. A region of the spinal column is pulled in opposite directions to stabilize or change the position of herniated, slipped, bulging, discs, and/or nerve injury/damage to the spine. Traction treatment is crucial to spinal adjustments, especially with disc or nerve compression.  
11860 Vista Del Sol, Ste. 128 Mechanical Vs. Manual Cervical Traction The Chiropractic Difference
 
It allows the chiropractor to alleviate any stress that could lead to disc problems like herniation, rupture, or displacement. However, traction is a general term. The concepts can apply to all forms of traction, but the application itself can be drastically different in terms of static positioning and inverse force.  

Mechanical vs. Manual Cervical Traction

Mechanical force is typically applied through a series of weights or a fixation device and requires the patient to stay in bed or is placed in a halo vest. The techniques and methodologies can vary, but the objectives/results are the same. The utilization is developed on a case-by-case basis and the chiropractor’s diagnosis/recommendations. Many chiropractors implement both mechanical and manual traction approaches. Choosing the right traction plan comes from a thorough examination, medical history, and understanding of each method’s strengths.  

Traction approach

The difference between mechanical and manual traction is simple. Mechanical traction is directed by the use of machines, weights, and pulleys, while manual traction is performed by a professional chiropractor. With mechanical traction, an individual’s head is cradled into a sling, then positioned at the optimal position for the adjustment. The sling is counterweighted to hold the head/neck in that position, leveraging mechanical pressure and affecting change.  
11860 Vista Del Sol, Ste. 128 Mechanical Vs. Manual Cervical Traction The Chiropractic Difference
 
Manual traction has the individual lie down on a table, with the chiropractor pulling the head away from the neck to decompress the cervical spine. The adjustment/s can be a continuous pull, or a series of low-force pulls in different directions. Again these depend on the individual’s condition and nature of the adjustment.  

Techniques and methodologies

Mechanical and manual traction can have similar results, but both offer different benefits based on the individual. Mechanical traction is a hands-free technique for decompression that allows chiropractors to focus on the patient’s needs when working on complex cases. This method is more applicable for severe cases, where the traction could last for 20-30 minutes. Mechanical traction is helpful when teaching healthy posturing. Manual traction benefits come from the control that a chiropractor has over the technique. With the manual pulling, the chiropractor can increase or decrease the countering force. A hands-on approach enables chiropractors to feel the spinal adjustments, and understand the effects of the traction.  
 

The proper form of traction

The overall ability of traction to decompress the spine makes it a valuable approach to treat various conditions. The exact nature of the condition determines whether mechanical or manual traction will be used along with the recommendation/treatment plan of the chiropractor. Injury Medical Chiropractic Clinic is committed to implementing the best approach for spinal correction for every patient. Mechanical and manual traction are just two adjustment modalities.

Body Composition Health

 
 

Resistance Training For Everyone

Even if not an athlete resistance training is important for functional fitness. Functional strength training attempts to emulate the physiological demands of real day-to-day activities. Traditional strength training focuses on specific muscle groups during the exercise, while functional training focuses on whole muscle groups to train the body for daily responsibilities. Individuals might believe they are too old for resistance training. But research shows the benefits of improving an individual’s functional fitness level, specifically for older adults. Functional training resistance exercises and bodyweight movements can help the body become stronger, more flexible, more agile, and better equipped to handle day-to-day responsibilities. Plus, it can help with injury prevention.
Reference
Afzal, Rabia et al. �Comparison between Manual Traction, Manual Opening technique, and Combination in Patients with cervical radiculopathy: Randomized Control Trial.� JPMA. The Journal of the Pakistan Medical Association�vol. 69,9 (2019): 1237-1241.
Back and Neck Pain Therapeutic Tools for Wish List

Back and Neck Pain Therapeutic Tools for Wish List

Individuals with neck and back pain should consider adding a few pain-relieving therapeutic tools to the holiday wish list. Spine specialists/experts have some tools for their patients and others who are dealing with back and neck pain. Looking at various points, these therapeutic tools offer the gift of helping to reduce neck and back pain, when unable to see a chiropractor or physical therapist.  
11860 Vista Del Sol, Ste. 128 Back and Neck Pain Therapeutic Tools for Wish List
 

Foam Rollers

Foam rolling is effective for different types of aches and pains, especially backaches. Foam rolling benefits include:
  • Releasing muscle knots and tension
  • Reduces inflammation
  • Decreases pain
  • Improves range of motion
  • Returns flexibility
 

Wedge Pillow

A wedge pillow for the back is a necessity. A wedge pillow removes the stress from the spine and neck when lying down. Flipped around will take the tension off the legs also bringing back pain relief.  
 

Deep Percussive Massager

Percussive massagers can provide a deep massage to various areas of the body especially the lower back. There are a variety of brands available with different levels of technology. However, careful use of these instruments must be exercised. This is because the massage can be intense and can exacerbate or cause further injury, and individuals can develop a tolerance making the massage no longer effective.  
 

Seat Cushion

If sitting at a desk throughout the day or working from home a proper seat cushion is mandatory. Many individuals who sit the majority of their day utilize a combination cushion that includes the seat cushion with lower back support. Individual cushions are great because they can be moved easily and adjusted to fit where needed. Therapeutic seat cushions come with various features available, here are a few to keep in mind. Memory foam and air cells offer the most pressure relief. If there is tailbone pain, focus on a seat cushion with the tailbone cut out for extra relief. An office chair with these features should also be considered.  
 

Inversion Table

Inversion tables are available at reasonable prices, starting around $100. Used correctly this therapeutic tool can successfully help relieve back pain. Inversion tables and cervical traction provide decompression and postural alignment for the spine helping with pain relief. These devices offer gentle decompression through the angle used. Wider angles or full inversion provides more decompression on the back. Individual spinal needs should be discussed with a chiropractor, physical therapist, or physician before using this therapeutic tool.  
11860 Vista Del Sol, Ste. 128 Back and Neck Pain Therapeutic Tools for Wish List
 

Pain Patches and Topical Agents

Pain-relieving patches like Lidocaine, IcyHot, and Salonpas patches are widely recommended for tight and sore areas of the body.  
 

Sitting Standing Desk

A sitting and standing desk can be highly beneficial to back pain. In addition to burning off bonus calories throughout the day, Changing positions and postures throughout the day are recommended. This is to keep the muscles, ligaments, tendons moving, and not in a static position for too long. Changing every 20 to 30 minutes is the recommended time. Sitting and standing desks can provide positional changes that will help with posture, core stability, and circulation. This will help reduce and alleviate pain in the low back, neck, and shoulders. However, the desk needs to be stable and adjusted to the proper height.  
 

Lower Back Sitting Support

These therapeutic tools help reinforce the low back region when seated. Most of us start to slouch forward with the head and shoulders hunched forward after some time at the computer. This strains the whole body, specifically the low back. Lower back supports can help maintain proper alignment of the spine when seated.  
11860 Vista Del Sol, Ste. 128 Back and Neck Pain Therapeutic Tools for Wish List
 

Knee, Thigh, Pelvis Pillow

These pillows have different names but are used in the same way. This is a pillow that can be placed between the legs while sleeping takes the pressure off the pelvis and spine. These types of pillows are great for individuals that sleep on their side. This is because the top leg often shifts down, leading to increased stress on the hips and low back. These pillows help keep the legs aligned during sleep relieving pressure on the low back.  
 

How To Self-Care for Back Pain Books

There are a variety of books that offer tips, and therapies for self-care. These products are not a cure-all. They are intended to help in combination with proper treatment, especially for certain spinal conditions. If pain is limiting daily function, consult a chiropractor, physical therapist, or physician about using the above therapeutic tools.

Doctor of Chiropractic Near Me

 

Dr. Alex Jimenez�s Blog Post Disclaimer

The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas& New Mexico*
References
Furlan, Andrea D et al. �Massage for low-back pain.��The Cochrane database of systematic reviews,9 CD001929. 1 Sep. 2015, doi:10.1002/14651858.CD001929.pub3
Enjoy the Hobbies You Love Without Back and Neck Pain

Enjoy the Hobbies You Love Without Back and Neck Pain

We all have our hobbies that we are passionate about, love doing, and could see turning into a second career. However, certain hobbies can generate stress on the spine. This often leads to a decrease in being able to participate in these activities, which can lead to various health issues. Maintaining the body’s physical fitness and keeping the spine healthy is key to being able to continue without neck or back pain. Hobbies are an important part of life. Individuals need to enjoy what they love from sports activities to music to arts and craft projects. Having activities/hobbies help:
  • Boost mental health
  • Relieve stress
  • Lower blood pressure
  • Promotes weight loss
  • Meditative qualities
Here�s how to make sure the hobbies/activities are fun and safe.  
11860 Vista Del Sol, Ste. 128 Enjoying the Hobbies You Love Without Back and Neck Pain
 

Protecting the Neck

Poor posture is one of the leading causes of neck and back pain. Looking down or being in a standing/sitting hunched position regularly increases the load/stress on the neck increasing the chances for strain, injury, headaches, and chronic pain. In the neutral position, the skull weighs around 10-12 pounds. When leaning the head forward weight increases from let’s say 27 pounds at a 15-degree angle to 60 pounds at a 60-degree angle. The strain on the cervical vertebrae, joints, and muscles can be immense. A good example is text-neck. This has become a normal thing when using a smartphone, gaming, or other similar activities. Studies suggest that the average individual spends three to five hours a day on a smartphone or tablet. This means three to five hours of extra weight on the cervical spine. Engaging in a hobby that requires an individual to look down constantly in a similar fashion can lead to serious and chronic neck pain along with other cervical issues.  
 
Individuals are spending more time at home and getting more serious about their hobbies. This is fantastic, however, these individuals need to take time to stretch out, and get some physical activity into their hobby routine. Just like taking frequent walk-around, stretch out at work breaks, so to do hobbyists need to step back from their projects to keep a healthy balance. The position of the neck and the way it is held for activities like:
  • Sewing
  • Carpentry
  • Gardening
  • Painting
  • Pottery
  • Knitting
  • Music
Hobbies like this can increase the risk of neck pain, so the key is prevention, paying attention to head posture every now and again, and taking stretching breaks.

Proper Posture Makes a Difference

11860 Vista Del Sol, Ste. 128 Enjoying the Hobbies You Love Without Back and Neck Pain
 
Many individuals stand and sit when working on their hobbies. This is quite common and is encouraged when doing these absorbing activities. But being immersed in these activities, most forget to check their posture when doing so. This is what leads to problems that at first are shrugged off as just soreness. Eventually, the individual begins to engage in bad/awkward posture habits that avoid the pain and think this will help. This worsens the problems and promotes further strain/injury. Leaning, bending, reaching, and twisting curves the spine increasing the load and stress. Performing these actions over and over for extended periods means:
  • Strain
  • Low back pain
  • Muscle spasms
  • Sciatica
  • Leg pain
  • Foot pain
Slouching is another posture problem that increases the likelihood of lower back pain. Slouching causes gaps between the lower back vertebrae. This stresses the facet joints or the connections between the vertebrae. The soft tissues elongate/stretch and lengthen like muscles and connective tissue. What elongation does is:
  • Cause the tissues to attempt to snap back to the original shape. This can cause painful spasms.
  • Muscles that are constantly elongated become weaker with time.
The longer an individual sits, stands, and slouches impacts the body’s health negatively, leading to a chain of health problems. Maintaining proper posture and keeping the spine straight minimizes the strain on muscles and the vertebrae. Prevent pain and discomfort.  
 

Ergonomics at the House

Ergonomic stressors include:
  • The force/s required to perform and complete a physical chore/task.
  • Adopted static and awkward working postures to complete task/s
  • The repetitiveness of the task/s
Any of these factors or combination places a higher risk for discomfort, pain, and injury. The immediate surroundings like the bench, work area, craft room, etc. and how the individual moves or does not move, and interacts in these areas is the focus of ergonomics. Proper ergonomics will help protect the spine, as well as the rest of the body. Improper ergonomics can cause damage like muscle strain, repetitive movements, and incorrect posture. Taking a look at the hobby workspace the ergonomics, and making any necessary adjustments can help prevent strain/injury.

Proper seating

Make sure the right type of chair, stool, bench, etc is being utilized. Adjustable types that have neck and lower back support are the way to go. Make sure the base is stable, the seat is comfortable and adjustable. Backrests and armrests can help maintain proper posture.

Correct table/desk/workstation height

Various drafting tables and lap desks have adjustable surfaces to adjust the height for working with a proper ergonomic posture. If the work surface is not adjustable adjust the chair or make adjustments as needed. The hips should be higher than the knees to take the strain off the sacrum and lower back. The upper back should be straight, with the shoulder blades together creating a supportive platform for the neck and head.

Tools

Using the best tools for working and organization will help avoid injuries and constant awkward positions like leaning/reaching over and around the workspace. Look for tools that can be adjusted to different heights, resistance levels, etc. depending on what is needed and what will reduce any strain.

Vision

If an individual needs to lean in to get a closer look then vision could be the problem. If an individual wears glasses it could be time for a check-up. Or if an individual does not wear glasses, it could be time to see an optometrist. Non-prescription magnifiers could be the answer.  
mobility flexibility el paso tx.
 

Stretching Regularly

Working too long in one position can be detrimental to overall health. It is very understandable when individuals get into the zone, working on something creative, and not wanting to stop the flow. However, frequent breaks are vital. Stretching regularly and getting up to move around is key to staying healthy.

Neck Stretch

  • Stretch the neck by turning the head from side to side in a gentle fashion.
  • Tip the head to each side so the ear almost touches the shoulder.
  • Lower the head so that the chin almost touches the chest.
  • Turn the to look diagonally down at the armpit. This stretches the trapezius and levator scapulae muscles.
  • Hold the stretches for 10-15 seconds.
  • Always perform slowly and gently.

Lower Back Stretch

15 minutes a day of stretches will maintain the health of the spine. If pain or discomfort becomes frequent or unmanageable, seek professional help. Physical therapists and chiropractors are trained in orthopedic issues and ergonomics without prescription. Call a doctor or physical therapist to find out if treatment is necessary. Following these guidelines can help keep hobbies fun and without pain.

Lower Back Pain Skate Boarding Injury Treatment


 

Dr. Alex Jimenez�s Blog Post Disclaimer

The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas& New Mexico*
Acetaminophen Usually the First Choice When Back and Neck Pain Strike

Acetaminophen Usually the First Choice When Back and Neck Pain Strike

Acetaminophen, best known as Tylenol, is one of the most common medications for headaches and general pain. More than likely the most common back, neck, and overall pain medication around. However, it is only a pain reducer, and will not reduce inflammation. Doctors often recommend this medicine before moving on to prescription medication. A member of the analgesic pain reliever class of medications. These can vary in strength along with side effects, but their purpose is to reduce pain. Acetaminophen can be found in over 600 prescriptions and over-the-counter medicines, including certain opioids. Other acetaminophen brand names include:
  • Tylophen
  • Tempra
  • FeverAll
  • Mapap
  • Pharbetol
  • Panadol
 

Strength and Weakness

When neck or back pain presents, over-the-counter medicines fall into two categories. These are acetaminophen or non-steroid anti-inflammatory drugs also known as NSAIDs. Acetaminophen and NSAIDs like Advil, aspirin both relieve pain. However, non-steroid anti-inflammatories also help in reducing inflammation. Although non-steroid anti-inflammatories have this added benefit, they can also present potential side effects like stomach and gastrointestinal problems. A spinal sprain or strain can cause acute back pain. Acetaminophen is typically recommended for acute back or neck pain and for pain that comes and goes quickly. Individuals that experience periodic pain usually take acetaminophen when the pain flares up. Individuals with chronic spinal pain report acetaminophen help to alleviate/reduce the pain. Many with chronic pain use acetaminophen regularly and not only when the pain presents. This helps manage before pain strikes.

Safety

Acetaminophen is gentle on the stomach, making some individuals preferring it over the non-steroid anti-inflammatories. But just like any other medication acetaminophen has its risks and can cause severe damage if used improperly. Taking acetaminophen in large doses can cause severe liver damage. The Food and Drug Administration reports that acetaminophen overdoses send over fifty-thousand individuals to the emergency room every year. And over one-hundred Americans die yearly from accidental overdoses. Using acetaminophen safely means taking no more than 3,000 milligrams a day and no more than 1,000 milligrams at a time. Take extra precautions when taking extra-strength. These can include as much as 650 mg per pill/capsule. Before taking acetaminophen for back and neck pain, talk to a doctor or pharmacist about the proper dosage. And tell the doctor about all the medications being taken including natural herbs and holistic. Another reason for telling the doctor is that many other medications have acetaminophen included without you knowing it. Part of the discussion should include alcohol consumption. This can elevate the risk of negative reactions.  
11860 Vista Del Sol, Ste. 128 Acetaminophen Usually the First Choice When Back and Neck Pain Strike

Resources

If non-pharmacological treatments/therapies done for at least 4 months prove ineffective then an acetaminophen regimen could be a safe and effective part of a back and neck pain treatment plan. While this medicine is one of the most common treatments, it is not without risks and side effects. Talk to a doctor or pharmacist about all the medications and supplements to ensure the regimen supports health for the long-term. To learn more along with safety information go to Acetaminophen Patient Guide.
 

Severe Back Pain Chiropractic Treatment


 

Dr. Alex Jimenez�s Blog Post Disclaimer

The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas& New Mexico*
Radiofrequency Ablation Non-Surgical Minimally Invasive Treatment

Radiofrequency Ablation Non-Surgical Minimally Invasive Treatment

Radiofrequency ablation, also known as RFA is a minimally invasive procedure performed in an outpatient clinic to treat neck, back, facet joints, and sacroiliac joint pain. It involves the use of radio waves pulsing at a high frequency that temporarily disable the nerves from transmitting pain signals to the brain. Relief can last three to six months. Radiofrequency ablation treatment could be an option to manage chronic back and neck pain. There are other names, but the radio frequency concept is the same. They are:
11860 Vista Del Sol, Ste. 128 Radiofrequency Ablation Non-Surgical Minimally Invasive Treatment
  Chronic neck, back, and hip pain take a significant toll on the body. Finding the right treatment can make all the difference. However, it does not work for everyone. For those that might have tried other non-surgical treatments to manage the pain, including physical therapy and steroid injections, that did not bring relief then radiofrequency ablation could be another treatment option.

Radiofrequency Ablation Benefits

  • Pain relief compared to steroid injections lasts longer
  • Relief exceeds that of injections
  • It is a non-surgical procedure
  • Complication risks are low
  • Opioid or other analgesic medication is reduced
  • Quick recovery
  • Improved quality of life
  • Relief can last six months to a year, and longer
 

Pain Reduction

Before undergoing radiofrequency ablation, a doctor must pinpoint the nerves causing the neck, back, or sacroiliac joint pain. They will perform a nerve block injection to determine if there is temporary relief from the pain. If there is temporary relief it means that the origin of the pain was found. This could qualify to become a candidate for radiofrequency ablation.
  • A Medial branch block is performed to diagnose the facet joint/s that are causing the pain.
  • A sacroiliac joint block is performed to determine if and which sacroiliac joint is causing the pain.

Preparation

The doctor will give instructions on how to prepare for the procedure. Instructions can vary from those listed, as every patient’s case is unique.
  • Do not eat 6 hours prior to your procedure
  • Wear loose, comfortable clothing
  • Easy to put on shoes
  • Have a designated driver for after the procedure
  • Make sure the doctor knows about all medications, vitamins, supplements, and herbs being taken
  • Follow the doctor�s instructions when taking prescribed and over-the-counter medications. This includes vitamins, supplements, and herbs
  • Bring all medications on the day of the procedure to be taken with minimal interruption
Radiofrequency ablation usually takes an hour or longer depending on the extent of the treatment. One example could be the number of facet joints being treated.

The Procedure

The patient will be positioned face down on the treatment table. Pillows are offered and positioned for optimal comfort. The area where the treatment will be administered is sterilized. The areas of the body not undergoing the treatment are covered with a sterile covering. Sedation could be utilized but not heavy sedation. More than likely it will be what is known as twilight sedation. A local anesthetic is injected into and around the area/s being treated. Because radiofrequency ablation involves electricity a grounding pad is attached to the calf of one of the legs. The treatment table is adjusted for the precise placement of the needles and electrodes. The doctor will use fluoroscopy or a real-time x-ray as a guide.  
11860 Vista Del Sol, Ste. 128 Radiofrequency Ablation Non-Surgical Minimally Invasive Treatment
 
Once the needle/s and electrode/s placement is confirmed, a low electrical current is sent through the electrodes. This creates waves of pulsating energy that stimulate and change the nerve/s sensory tissue so it does not send pain signals. Some individuals report a warm or mild pulsing sensation. When finished, the electrodes and needles are removed. The treated area is cleaned up, sterilized and bandages are applied.

After the Procedure

After the procedure, the patient is sent home with a set of recovery instructions. An example could be:
  • Keep the bandages in place
  • Don’t take a bath or shower
  • A shower can be taken the following day and the bandages removed
  • Do not perform any strenuous activity for up to two days
When the anesthetic wears off, the individual will have soreness and some mild pain around the treatment area. As long as everything is fine individuals can return to work and normal routine within three days. Full recovery can take up to two weeks for the treated/ablated nerves to stop sending pain signals. Although the nerves no longer conduct pain, it is temporary and not a permanent fix. This is because the nerves grow back. If the cycle starts over, talk with the doctor about another session.
 

Peripheral Neuropathy Relief & Treatment

 
 

Dr. Alex Jimenez�s Blog Post Disclaimer

The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas& New Mexico*
Neck Brace or Collar for Neck Pain Disorders

Neck Brace or Collar for Neck Pain Disorders

Using a neck brace or collar can be part of a treatment option for individuals dealing with a neck injury, pain, and recovery. Cervical-neck spinal conditions can go from mild to debilitating if left untreated and could progress to chronic pain. Whiplash and abnormal cervical lordosis, which is an unnatural curvature of the spine, can happen from looking down at a phone too long, known as text-neck. These are common but different neck disorders that can be helped with a neck brace. Being prescribed a neck brace depends on the severity of the pain symptoms. Does it present with or without upper back pain, radiate into the shoulders, cause headaches/migraine? These details will help a doctor or chiropractor figure out the best treatment option. If the patient can benefit then a neck brace, also called a cervical collar or cervical orthosis could be used.  
11860 Vista Del Sol, Ste. 128 Neck Brace or Collar for Neck Pain Disorders
 

Neck Brace

Fortunately, spinal surgery is rarely necessary. There are plenty of non-surgical treatment options that can help manage and reduce neck pain. A neck brace or collar could be part of a treatment plan that includes:
  • Chiropractic
  • Physical therapy
  • Massage
  • Acupuncture
  • Medications – over-the-counter and prescription if necessary
The treatment plan will be based on the outcome of:
  • Physical examination
  • Neurological examination
  • X-rays
  • Other imaging tests
  • Severity of symptoms
These combined will confirm a diagnosis with the treatment focusing on:
  • Neck stabilization
  • Pain management
  • Advanced healing
  • Early mobilization

Brace Basics

There are a variety of soft and rigid neck braces available to help manage different cervical spine conditions. The type of brace prescribed is based on the diagnosis and treatment plan. Soft neck braces are flexible and offer the greatest range of motion. Rigid collars are for stricter immobilization/stabilization. Stabilization refers to immobilizing the head and neck. Limiting or preventing motion helps to support the head while reducing weight from the cervical spine. Two of the most common neck pain disorders are whiplash and poor posture.  
 

Soft Collar

Whiplash is a hyperflexion and hyperextension neck injury. It is caused when the neck quickly, forcefully and swiftly whips forward and backward. Whiplash injuries most commonly happen from auto accidents, work, personal, and sports injuries. Whiplash symptoms are considered sprains and strains. This is when ligaments, in this case, those of the neck, and the muscles are stretched or torn. These include:
  • Neck pain
  • Stiffness
  • Muscle spasms
  • Headaches that start in the neck
However, all of the symptoms can radiate into the head and upper back. This is where a doctor could recommend a soft cervical collar as part of a treatment plan. This could be in conjunction with muscle relaxants and physical therapy. Soft collars provide neck support to help reduce soft tissue inflammation and the pain forty-eight to seventy-two hours after the injury. Soft neck braces are usually made of foam and covered with cotton or other easily washable, comfortable wearable material. The brace wraps around the neck and is secured with Velcro straps. Be aware that over-using a neck brace can happen. A doctor will explain further and will prescribe/encourage performing daily motion exercises, and stretching exercises, as soon as the patient is able after a whiplash injury.

Rigid Collar

Lordosis means the normal forward curve in the neck. However, the normal curve can change negatively with time when the head regularly bends forward past the shoulders. An example is looking down at your phone. Most of us spend hours a day looking down at a phone pad, etc. This causes significant strain on the neck. The human head weighs around 12 pounds. This weight increases to about 60 pounds when the head and neck are extended forward and bent down. A constantly increased load on the spine can lead to massive stress to the bones, ligaments, and muscles with the potential change in the normal curve and chronic neck pain. Text neck is another spinal disorder that a neck brace can help treat. Depending on the severity of the pain and injury a rigid neck brace or collar could be used.  
11860 Vista Del Sol, Ste. 128 Neck Brace or Collar for Neck Pain Disorders
 
All neck braces offer some degree of head and neck support. Another type of rigid neck brace has adjustable features that were developed to treat forward head posture caused by poor posture. This brace is called the Cervigard Forward Head Posture Neck Collar. It supports while correcting the alignment of the head and neck. Regular use can gradually restore the normal curvature by correcting head and neck posture.  
 
Doctors recommend the brace be worn for 20 minutes a day or several hours, depending on the severity of pain and injury. The process of correcting the deformation can be compared to straightening teeth with braces, aligners, etc. This retrains the muscles and corrects the abnormal soft tissue tightness that develops from the condition.  
 

Instructions

If a doctor prescribes a brace, follow their instructions for how to wear the neck brace. This will ensure the pain reduces and alleviates, while at the same time reducing the risk of the negative effects of overuse. Ask the doctor or chiropractor how to care for the brace.
 

Neck & Low Back Pain Treatment

 
   

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