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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.


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

 
   

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*
Head Down, Shoulders Hunched Forward = Phone Neck Pain

Head Down, Shoulders Hunched Forward = Phone Neck Pain

Being attached to a smartphone and looking down for a long can cause phone neck pain. We are all constantly connected to our family, friends, work, etc. When we keep our head down, shoulders hunched forward, neck straining from the uncomfortable angle for a long time a neck injury can develop. This has to do with knowing how to maintain proper posture while using a smartphone.

Most of us know this syndrome as tech neck, text neck, and is caused by straining the neck too far down and forward while talking/texting, etc. Holding this position for too long will cause neck muscle strain and pain. This also occurs with handheld devices with users hunching their shoulders forward. The awkward neck angel and rounded shoulders strain the entire upper body.

 

11860 Vista Del Sol, Ste. 128 Head Down, Shoulders Hunched Forward = Phone Neck Pain

Phone Neck Pain Stretches/Tips

Here are a few tips along with some light stretches/exercises to keep the neck muscles flexible and loose.

  • Try to bring the phone to eye level.
  • Check around and look up from the screen every few minutes so as not to remain in a downward position.
  • Incorporate light and easy neck stretches and exercises.

Chin Tuck

Move the chin towards the chest, and hold for 5 seconds as there will be a comfortable stretch from the neck to the base of the skull to the mid-back. Try doing a few up to 10 times until you feel thoroughly stretched.

Side Bend

Tilt the head to the right, bringing the ear close to the shoulder. Use your hand to pull your head farther into the stretch if possible. Hold for 20 seconds. Bring the head back to the center, and tilt to the left, and hold for 20 seconds. Repeat this motion 3-5 times on each side.

Head Rotation

Rotate the chin towards the right shoulder and hold for 20 seconds. Use your hand to push your head farther into the stretch if possible. Bring the head back to the center, and rotate to the left, and hold for 20 seconds. Repeat this motion 3-5 times on each side.

Neck pain can turn into a full injury or condition if an individual continues with this form of very poor posture. Taking care of our bodies needs to be a priority. Make proper posture a habit and it will help prevent neck and back pain from developing. This along with related posture and biomechanical issues. Proper posture means the head is upright, the ears are in line with the shoulders, and the shoulder blades are down.

Neck Pain Chiropractic Care

 

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*

What is Degenerative Disc Disease (DDD)?: An Overview

What is Degenerative Disc Disease (DDD)?: An Overview

Degenerative Disc Disease is a general term for a condition in which the damaged intervertebral disc causes chronic pain, which could be either low back pain in the lumbar spine or neck pain in the cervical spine. It is not a �disease� per se, but actually a breakdown of an intervertebral disc of the spine. The intervertebral disc is a structure that has a lot of attention being focused on recently, due to its clinical implications. The pathological changes that can occur in disc degeneration include fibrosis, narrowing, and disc desiccation. Various anatomical defects can also occur in the intervertebral disc such as sclerosis of the endplates, fissuring and mucinous degeneration of the annulus, and the formation of osteophytes.

 

Low back pain and neck pain are major epidemiological problems, which are thought to be related to degenerative changes in the disk. Back pain is the second leading cause of the visit to the clinician in the USA. It is estimated that about 80% of US adults suffer from low back pain at least once during their lifetime. (Modic, Michael T., and Jeffrey S. Ross) Therefore, a thorough understanding of degenerative disc disease is needed for managing this common condition.

 

Anatomy of Related Structures

 

Anatomy of the Spine

 

The spine is the main structure, which maintains the posture and gives rise to various problems with disease processes. The spine is composed of seven cervical vertebrae, twelve thoracic vertebrae, five lumbar vertebrae, and fused sacral and coccygeal vertebrae. The stability of the spine is maintained by three columns.

 

The anterior column is formed by anterior longitudinal ligament and the anterior part of the vertebral body. The middle column is formed by the posterior part of the vertebral body and the posterior longitudinal ligament. The posterior column consists of a posterior body arch that has transverse processes, laminae, facets, and spinous processes. (�Degenerative Disk Disease: Background, Anatomy, Pathophysiology�)

 

Anatomy of the Intervertebral Disc

 

Intervertebral disc lies between two adjacent vertebral bodies in the vertebral column. About one-quarter of the total length of the spinal column is formed by intervertebral discs. This disc forms a fibrocartilaginous joint, also called a symphysis joint. It allows a slight movement in the vertebrae and holds the vertebrae together. Intervertebral disc is characterized by its tension resisting and compression resisting qualities. An intervertebral disc is composed of mainly three parts; inner gelatinous nucleus pulposus, outer annulus fibrosus, and cartilage endplates that are located superiorly and inferiorly at the junction of vertebral bodies.

 

Nucleus pulposus is the inner part that is gelatinous. It consists of proteoglycan and water gel held together by type II Collagen and elastin fibers arranged loosely and irregularly. Aggrecan is the major proteoglycan found in the nucleus pulposus. It comprises approximately 70% of the nucleus pulposus and nearly 25% of the annulus fibrosus. It can retain water and provides the osmotic properties, which are needed to resist compression and act as a shock absorber. This high amount of aggrecan in a normal disc allows the tissue to support compressions without collapsing and the loads are distributed equally to annulus fibrosus and vertebral body during movements of the spine. (Wheater, Paul R, et al.)

 

The outer part is called annulus fibrosus, which has abundant type I collagen fibers arranged as a circular layer. The collagen fibers run in an oblique fashion between lamellae of the annulus in alternating directions giving it the ability to resist tensile strength. Circumferential ligaments reinforce the annulus fibrosus peripherally. On the anterior aspect, a thick ligament further reinforces annulus fibrosus and a thinner ligament reinforces the posterior side. (Choi, Yong-Soo)

 

Usually, there is one disc between every pair of vertebrae except between atlas and axis, which are first and second cervical vertebrae in the body. These discs can move about 6? in all the axes of movement and rotation around each axis. But this freedom of movement varies between different parts of the vertebral column. The cervical vertebrae have the greatest range of movement because the intervertebral discs are larger and there is a wide concave lower and convex upper vertebral body surfaces. They also have transversely aligned facet joints. Thoracic vertebrae have the minimum range of movement in flexion, extension, and rotation, but have free lateral flexion as they are attached to the rib cage. The lumbar vertebrae have good flexion and extension, again, because their intervertebral discs are large and spinous processes are posteriorly located. However, lateral lumbar rotation is limited because the facet joints are located sagittally. (�Degenerative Disk Disease: Background, Anatomy, Pathophysiology�)

 

Blood Supply

 

The intervertebral disc is one of the largest avascular structures in the body with capillaries terminating at the endplates. The tissues derive nutrients from vessels in the subchondral bone which lie adjacent to the hyaline cartilage at the endplate. These nutrients such as oxygen and glucose are carried to the intervertebral disc through simple diffusion. (�Intervertebral Disc � Spine � Orthobullets.Com�)

 

Nerve Supply

 

Sensory innervation of intervertebral discs is complex and varies according to the location in the spinal column. Sensory transmission is thought to be mediated by substance P, calcitonin, VIP, and CPON. Sinu vertebral nerve, which arises from the dorsal root ganglion, innervates the superficial fibers of the annulus. Nerve fibers don�t extend beyond the superficial fibers.

 

Lumbar intervertebral discs are additionally supplied on the posterolateral aspect with branches from ventral primary rami and from the grey rami communicantes near their junction with the ventral primary rami. The lateral aspects of the discs are supplied by branches from rami communicantes. Some of the rami communicantes may cross the intervertebral discs and become embedded in the connective tissue, which lies deep to the origin of the psoas. (Palmgren, Tove, et al.)

 

The cervical intervertebral discs are additionally supplied on the lateral aspect by branches of the vertebral nerve. The cervical sinu vertebral nerves were also found to be having an upward course in the vertebral canal supplying the disc at their point of entry and the one above. (BOGDUK, NIKOLAI, et al.)

 

Pathophysiology of Degenerative Disc Disease

 

Approximately 25% of people before the age of 40 years show disc degenerative changes at some level. Over 40 years of age, MRI evidence shows changes in more than 60% of people. (Suthar, Pokhraj) Therefore, it is important to study the degenerative process of the intervertebral discs as it has been found to degenerate faster than any other connective tissue in the body, leading to back and neck pain. The changes in three intervertebral discs are associated with changes in the vertebral body and joints suggesting a progressive and dynamic process.

 

Degeneration Phase

 

The degenerative process of the intervertebral discs has been divided into three stages, according to Kirkaldy-Willis and Bernard, called ��degenerative cascade��. These stages can overlap and can occur over the course of decades. However, identifying these stages clinically is not possible due to the overlap of symptoms and signs.

 

Stage 1 (Degeneration Phase)

 

This stage is characterized by degeneration. There are histological changes, which show circumferential tears and fissures in the annulus fibrosus. These circumferential tears may turn into radial tears and because the annulus pulposus is well innervated, these tears can cause back pain or neck pain, which is localized and with painful movements. Due to repeated trauma in the discs, endplates can separate leading to disruption of the blood supply to the disc and therefore, depriving it of its nutrient supply and removal of waste. The annulus may contain micro-fractures in the collagen fibrils, which can be seen on electron microscopy and an MRI scan may reveal desiccation, bulging of the disc, and a high-intensity zone in the annulus. Facet joints may show a synovial reaction and it may cause severe pain with associated synovitis and inability to move the joint in the zygapophyseal joints. These changes may not necessarily occur in every person. (Gupta, Vijay Kumar, et al.)

 

The nucleus pulposus is also involved in this process as its water imbibing capacity is reduced due to the accumulation of biochemically changed proteoglycans. These changes are brought on mainly by two enzymes called matrix metalloproteinase-3 (MMP-3) and tissue inhibitor of metalloproteinase-1 (TIMP-1). (Bhatnagar, Sushma, and Maynak Gupta) Their imbalance leads to the destruction of proteoglycans. The reduced capacity to absorb water leads to a reduction of hydrostatic pressure in the nucleus pulposus and causes the annular lamellae to buckle. This can increase the mobility of that segment resulting in shear stress to the annular wall. All these changes can lead to a process called annular delamination and fissuring in the annulus fibrosus. These are two separate pathological processes and both can lead to pain, local tenderness, hypomobility, contracted muscles, painful joint movements. However, the neurological examination at this stage is usually normal.

 

Stage 2 (Phase of Instability)

 

The stage of dysfunction is followed by a stage of instability, which may result from the progressive deterioration of the mechanical integrity of the joint complex. There may be several changes encountered at this stage, including disc disruption and resorption, which can lead to a loss of disc space height. Multiple annular tears may also occur at this stage with concurrent changes in the zagopophyseal joints. They may include degeneration of the cartilage and facet capsular laxity leading to subluxation. These biomechanical changes result in instability of the affected segment.

 

The symptoms seen in this phase are similar to those seen in the dysfunction phase such as �giving way� of the back, pain when standing for prolonged periods, and a �catch� in the back with movements. They are accompanied by signs such as abnormal movements in the joints during palpation and observing that the spine sways or shifts to a side after standing erect for sometime after flexion. (Gupta, Vijay Kumar et al.)

 

Stage 3 (Re-Stabilization Phase)

 

In this third and final stage, the progressive degeneration leads to disc space narrowing with fibrosis and osteophyte formation and transdiscal bridging. The pain arising from these changes is severe compared to the previous two stages, but these can vary between individuals. This disc space narrowing can have several implications on the spine. This can cause the intervertebral canal to narrow in the superior-inferior direction with the approximation of the adjacent pedicles. Longitudinal ligaments, which support the vertebral column, may also become deficient in some areas leading to laxity and spinal instability. The spinal movements can cause the ligamentum flavum to bulge and can cause superior aricular process subluxation. This ultimately leads to a reduction of diameter in the anteroposterior direction of the intervertebral space and stenosis of upper nerve root canals.

 

Formation of osteophytes and hypertrophy of facets can occur due to the alteration in axial load on the spine and vertebral bodies. These can form on both superior and inferior articular processes and osteophytes can protrude to the intervertebral canal while the hypertrophied facets can protrude to the central canal. Osteophytes are thought to be made from the proliferation of articular cartilage at the periosteum after which they undergo endochondral calcification and ossification. The osteophytes are also formed due to the changes in oxygen tension and due to changes in fluid pressure in addition to load distribution defects. The osteophytes and periarticular fibrosis can result in stiff joints. The articular processes may also orient in an oblique direction causing retrospondylolisthesis leading to the narrowing of the intervertebral canal, nerve root canal, and the spinal canal. (KIRKALDY-WILLIS, W H et al.)

 

All of these changes lead to low back pain, which decreases with severity. Other symptoms like reduced movement, muscle tenderness, stiffness, and scoliosis can occur. The synovial stem cells and macrophages are involved in this process by releasing growth factors and extracellular matrix molecules, which act as mediators. The release of cytokines has been found to be associated with every stage and may have therapeutic implications in future treatment development.

 

Etiology of the Risk Factors of Degenerative Disc Disease

 

Aging and Degeneration

 

It is difficult to differentiate aging from degenerative changes. Pearce et al have suggested that aging and degeneration is representing successive stages within a single process that occur in all individuals but at different rates. Disc degeneration, however, occurs most often at a faster rate than aging. Therefore, it is encountered even in patients of working age.

 

There appears to be a relationship between aging and degeneration, but no distinct cause has yet been established. Many studies have been conducted regarding nutrition, cell death, and accumulation of degraded matrix products and the failure of the nucleus. The water content of the intervertebral disc decreases with the increasing age. Nucleus pulposus can get fissures that can extend into the annulus fibrosus. The start of this process is termed chondrosis inter vertebralis, which can mark the beginning of the degenerative destruction of the intervertebral disc, the endplates, and the vertebral bodies. This process causes complex changes in the molecular composition of the disc and has biomechanical and clinical sequelae that can often result in substantial impairment in the affected individual.

 

The cell concentration in the annulus decreases with increasing age. This is mainly because the cells in the disc are subjected to senescence and they lose the ability to proliferate. Other related causes of age-specific degeneration of intervertebral discs include cell loss, reduced nutrition, post-translational modification of matrix proteins, accumulation of products of degraded matrix molecules, and fatigue failure of the matrix. Decreasing nutrition to the central disc, which allows the accumulation of cell waste products and degraded matrix molecules seems to be the most important change out of all these changes. This impairs nutrition and causes a fall in the pH level, which can further compromise cell function and may lead to cell death. Increased catabolism and decreased anabolism of senescent cells may promote degeneration. (Buckwalter, Joseph A.) According to one study, there were more senescence cells in the nucleus pulposus compared to annulus fibrosus and herniated discs had a higher chance of cell senescence.� (Roberts, S. et al.)

 

When the aging process goes on for some time, the concentrations of chondroitin 4 sulfate and chondroitin 5 sulfate, which is strongly hydrophilic, gets decreased while the keratin sulfate to chondroitin sulfate ratio gets increased. Keratan sulfate is mildly hydrophilic and it also has a minor tendency to form stable aggregates with hyaluronic acid. As aggrecan is fragmented, and its molecular weight and numbers are decreased, the viscosity and hydrophilicity of the nucleus pulposus decrease. Degenerative changes to the intervertebral discs are accelerated by the reduced hydrostatic pressure of the nucleus pulposus and the decreased supply of nutrients by diffusion. When the water content of the extracellular matrix is decreased, intervertebral disc height will also be decreased. The resistance of the disc to an axial load will also be reduced. Because the axial load is then transferred directly to the annulus fibrosus, annulus clefts can get torn easily.

 

All these mechanisms lead to structural changes seen in degenerative disc disease. Due to the reduced water content in the annulus fibrosus and associated loss of compliance, the axial load can get redistributed to the posterior aspect of facets instead of the normal anterior and middle part of facets. This can cause facet arthritis, hypertrophy of the adjacent vertebral bodies, and bony spurs or bony overgrowths, known as osteophytes, as a result of degenerative discs. (Choi, Yong-Soo)

 

Genetics and Degeneration

 

The genetic component has been found to be a dominant factor in degenerative disc disease. Twin studies, and studies involving mice, have shown that genes play a role in disc degeneration. (Boyd, Lawrence M., et al.) Genes that code for collagen I, IX, and XI, interleukin 1, aggrecan, vitamin D receptor, matrix metalloproteinase 3 (MMP � 3), and other proteins are among the genes that are suggested to be involved in degenerative disc disease. Polymorphisms in 5 A and 6 A alleles occurring in the promoter region of genes that regulate MMP 3 production are found to be a major factor for the increased lumbar disc degeneration in the elderly population. Interactions among these various genes contribute significantly to intervertebral disc degeneration disease as a whole.

 

Nutrition and Degeneration

 

Disc degeneration is also believed to occur due to the failure of nutritional supply to the intervertebral disc cells. Apart from the normal aging process, the nutritional deficiency of the disc cells is adversely affected by endplate calcification, smoking, and the overall nutritional status. Nutritional deficiency can lead to the formation of lactic acid together with the associated low oxygen pressure. The resulting low pH can affect the ability of disc cells to form and maintain the extracellular matrix of the discs and causes intervertebral disc degeneration. The degenerated discs lack the ability to respond normally to the external force and may lead to disruptions even from the slightest back strain. (Taher, Fadi, et al.)

 

Growth factors stimulate the chondrocytes and fibroblasts to produce more amount of extracellular matrix. It also inhibits the synthesis of matrix metalloproteinases. Example of these growth factors includes transforming growth factor, insulin-like growth factor, and basic fibroblast growth factor. The degraded matrix is repaired by an increased level of transforming growth factor and basic fibroblast growth factor.

 

Environment and Degeneration

 

Even though all the discs are of the same age, discs found in the lower lumbar segments are more vulnerable to degenerative changes than the discs found in the upper segment. This suggests that not only aging but, also mechanical loading, is a causative factor. The association between degenerative disc disease and environmental factors has been defined in a comprehensive manner by Williams and Sambrook in 2011. (Williams, F.M.K., and P.N. Sambrook) The heavy physical loading associated with your occupation is a risk factor that has some contribution to disc degenerative disease. There is also a possibility of chemicals causing disc degeneration, such as smoking, according to some studies. (Batti�, Michele C.) Nicotine has been implicated in twin studies to cause impaired blood flow to the intervertebral disc, leading to disc degeneration. (BATTI�, MICHELE C., et al.) Moreover, an association has been found among atherosclerotic lesions in the aorta and the low back pain citing a link between atherosclerosis and degenerative disc disease. (Kauppila, L.I.) The disc degeneration severity was implicated in overweight, obesity, metabolic syndrome, and increased body mass index in some studies. (�A Population-Based Study Of Juvenile Disc Degeneration And Its Association With Overweight And Obesity, Low Back Pain, And Diminished Functional Status. Samartzis D, Karppinen J, Mok F, Fong DY, Luk KD, Cheung KM. J Bone Joint Surg Am 2011;93(7):662�70�)

 

Pain in Disc Degeneration (Discogenic Pain)

 

Discogenic pain, which is a type of nociceptive pain, arises from the nociceptors in the annulus fibrosus when the nervous system is affected by the degenerative disc disease. Annulus fibrosus contains immune reactive nerve fibers in the outer layer of the disc with other chemicals such as a vasoactive intestinal polypeptide, calcitonin gene-related peptide, and substance P. (KONTTINEN, YRJ� T., et al.) When degenerative changes in the intervertebral discs occur, normal structure and mechanical load are changed leading to abnormal movements. These disc nociceptors can get abnormally sensitized to mechanical stimuli. The pain can also be provoked by the low pH environment caused by the presence of lactic acid, causing increased production of pain mediators.

 

Pain from degenerative disc disease may arise from multiple origins. It may occur due to the structural damage, pressure, and irritation on the nerves in the spine. The disc itself contains only a few nerve fibers, but any injury can sensitize these nerves, or those in the posterior longitudinal ligament, to cause pain. Micro movements in the vertebrae can occur, which may cause painful reflex muscle spasms because the disc is damaged and worn down with the loss of tension and height. The painful movements arise because the nerves supplying the area are compressed or irritated by the facet joints and ligaments in the foramen leading to leg and back pain. This pain may be aggravated by the release of inflammatory proteins that act on nerves in the foramen or descending nerves in the spinal canal.

 

Pathological specimens of the degenerative discs, when observed under the microscope, reveals that there are vascularized granulation tissue and extensive innervations found in the fissures of the outer layer of the annulus fibrosus extending into the nucleus pulposus. The granulation tissue area is infiltrated by abundant mast cells and they invariably contribute to the pathological processes that ultimately lead to discogenic pain. These include neovascularisation, intervertebral disc degeneration, disc tissue inflammation, and the formation of fibrosis. Mast cells also release substances, such as tumor necrosis factor and interleukins, which might signal for the activation of some pathways which play a role in causing back pain. Other substances that can trigger these pathways include phospholipase A2, which is produced from the arachidonic acid cascade. It is found in increased concentrations in the outer third of the annulus of the degenerative disc and is thought to stimulate the nociceptors located there to release inflammatory substances to trigger pain. These substances bring about axonal injury, intraneural edema, and demyelination. (Brisby, Helena)

 

The back pain is thought to arise from the intervertebral disc itself. Hence why the pain will decrease gradually over time when the degenerating disc stops inflicting pain. However, the pain actually arises from the disc itself only in 11% of patients according to endoscopy studies. The actual cause of back pain seems to be due to the stimulation of the medial border of the nerve and referred pain along the arm or leg seems to arise due to the stimulation of the core of the nerve. The treatment for disc degeneration should mainly focus on pain relief to reduce the suffering of the patient because it is the most disabling symptom that disrupts a patient�s lives. Therefore, it is important to establish the mechanism of pain because it occurs not only due to the structural changes in the intervertebral discs but also due to other factors such as the release of chemicals and understanding these mechanisms can lead to effective pain relief. (Choi, Yong-Soo)

 

Clinical Presentation of Degenerative Disc Disease

 

Patients with degenerative disc disease face a myriad of symptoms depending on the site of the disease. Those who have lumbar disc degeneration get low back pain, radicular symptoms, and weakness. Those who have cervical disc degeneration have neck pain and shoulder pain.

 

Low back pain can get exacerbated by the movements and the position. Usually, the symptoms are worsened by the flexion, while the extension often relieves them. Minor twisting injuries, even from swinging a golf club, can trigger the symptoms. The pain is usually observed to be less when walking or running, when changing the position frequently and when lying down. However, the pain is usually subjective and in many cases, it varies considerably from person to person and most people will suffer from a low level of chronic pain of the lower back region continuously while occasionally suffering from the groin, hip, and leg pain. The intensity of the pain will increase from time to time and will last for a few days and then subside gradually. This �flare-up� is an acute episode and needs to be treated with potent analgesics. Worse pain is experienced in the seated position and is exacerbated while bending, lifting, and twisting movements frequently. The severity of the pain can vary considerably with some having occasional nagging pain to others having severe and disabling pain intermittently.� (Jason M. Highsmith, MD)

 

The localized pain and tenderness in the axial spine usually arises from the nociceptors found within the intervertebral discs, facet joints, sacroiliac joints, dura mater of the nerve roots, and the myofascial structures found within the axial spine. As mentioned in the previous sections, the degenerative anatomical changes may result in a narrowing of the spinal canal called spinal stenosis, overgrowth of spinal processes called osteophytes, hypertrophy of the inferior and superior articular processes, spondylolisthesis, bulging of the ligamentum flavum and disc herniation. These changes result in a collection of symptoms that is known as neurogenic claudication. There may be symptoms such as low back pain and leg pain together with numbness or tingling in the legs, muscle weakness, and foot drop. Loss of bowel or bladder control may suggest spinal cord impingement and prompt medical attention is needed to prevent permanent disabilities. These symptoms can vary in severity and may present to varying extents in different individuals.

 

The pain can also radiate to other parts of the body due to the fact that the spinal cord gives off several branches to two different sites of the body. Therefore, when the degenerated disc presses on a spinal nerve root, the pain can also be experienced in the leg to which the nerve ultimately innervates. This phenomenon, called radiculopathy, can occur from many sources arising, due to the process of degeneration. The bulging disc, if protrudes centrally, can affect descending rootlets of the cauda equina, if it bulges posterolaterally, it might affect the nerve roots exiting at the next lower intervertebral canal and the spinal nerve within its ventral ramus can get affected when the disc protrudes laterally. Similarly, the osteophytes protruding along the upper and lower margins of the posterior aspect of vertebral bodies can impinge on the same nervous tissues causing the same symptoms. Superior articular process hypertrophy may also impinge upon nerve roots depending on their projection. The nerves may include nerve roots prior to exiting from the next lower intervertebral canal and nerve roots within the upper nerve root canal and dural sac. These symptoms, due to the nerve impingement, have been proven by cadaver studies. Neural compromise is thought to occur when the neuro foraminal diameter is critically occluded with a 70% reduction. Furthermore, neural compromise can be produced when the posterior disc is compressed less than 4 millimeters in height, or when the foraminal height is reduced to less than 15 millimeters leading to foraminal stenosis and nerve impingement. (Taher, Fadi, et al.)

 

Diagnostic Approach

 

Patients are initially evaluated with an accurate history and thorough physical examination and appropriate investigations and provocative testing. However, history is often vague due to the chronic pain which cannot be localized properly and the difficulty in determining the exact anatomical location during provocative testing due to the influence of the neighboring anatomical structures.

 

Through the patient�s history, the cause of low back pain can be identified as arising from the nociceptors in the intervertebral discs. Patients may also give a history of the chronic nature of the symptoms and associated gluteal region numbness, tingling as well as stiffness in the spine which usually worsens with activity. Tenderness may be elicited by palpating over the spine. Due to the nature of the disease being chronic and painful, most patients may be suffering from mood and anxiety disorders. Depression is thought to be contributing negatively to the disease burden. However, no clear relationship between disease severity and mood or anxiety disorders. It is good to be vigilant about these mental health conditions as well. In order to exclude other serious pathologies, questions must be asked regarding fatigue, weight loss, fever, and chills, which might indicate some other diseases. (Jason M. Highsmith, MD)

 

Another etiology for the low back pain has to be excluded when examining the patient for degenerative disc disease. Abdominal pathologies, which can give rise to back pain such as aortic aneurysm, renal calculi, and pancreatic disease, have to be excluded.

 

Degenerative disc disease has several differential diagnoses to be considered when a patient presents with back pain. These include; idiopathic low back pain, zygapophyseal joint degeneration, myelopathy, lumbar stenosis, spondylosis, osteoarthritis, and lumbar radiculopathy. (�Degenerative Disc Disease � Physiopedia�)

 

Investigations

 

Investigations are used to confirm the diagnosis of degenerative disc disease. These can be divided into laboratory studies, imaging studies, nerve conduction tests, and diagnostic procedures.

 

Imaging Studies

 

The imaging in degenerative disc disease is mainly used to describe anatomical relations and morphological features of the affected discs, which has a great therapeutic value in future decision making for treatment options. Any imaging method, like plain radiography, CT, or MRI, can provide useful information. However, an underlying cause can only be found in 15% of the patients as no clear radiological changes are visible in degenerative disc disease in the absence of disc herniation and neurological deficit. Moreover, there is no correlation between the anatomical changes seen on imaging and the severity of the symptoms, although there are correlations between the number of osteophytes and the severity of back pain. Degenerative changes in radiography can also be seen in asymptomatic people leading to difficulty in conforming clinical relevance and when to start treatment. (�Degenerative Disc Disease � Physiopedia�)

 

Plain Radiography

 

This inexpensive and widely available plain cervical radiography can give important information on deformities, alignment, and degenerative bony changes. In order to determine the presence of spinal instability and sagittal balance, dynamic flexion, or extension studies have to be performed.

 

Magnetic Resonance Imaging (MRI)

 

MRI is the most commonly used method to diagnose degenerative changes in the intervertebral disc accurately, reliably, and most comprehensively. It is used in the initial evaluation of patients with neck pain after plain radiography. It can provide non-invasive images in multiple plains and gives excellent quality images of the disc. MRI can show disc hydration and morphology-based on the proton density, chemical environment, and the water content. Clinical picture and history of the patient have to be considered when interpreting MRI reports as it has been shown that as much as 25% of radiologists change their report when the clinical data are available. Fonar produced the first open MRI scanner with the ability of the patient to be scanned in different positions such as standing, sitting, and bending. Because of these unique features, this open MRI scanner can be used for scanning patients in weight-bearing postures and stand up postures to detect underlying pathological changes which are usually overlooked in conventional MRI scan such as lumbar degenerative disc disease with herniation. This machine is also good for claustrophobic patients, as they get to watch a large television screen during the scanning process. (�Degenerative Disk Disease: Background, Anatomy, Pathophysiology.�)

 

Nucleus pulposus and annulus fibrosus of the disc can usually be identified on MRI, leading to the detection of disc herniation as contained and non contained. As MRI can also show annular tears and the posterior longitudinal ligament, it can be used to classify herniation. This can be simple annular bulging to free fragment disc herniations. This information can describe the pathologic discs such as extruded disc, protruded discs, and migrated discs.

 

There are several grading systems based on MRI signal intensity, disc height, the distinction between nucleus and annulus, and the disc structure. The method, by Pfirrmann et al, has been widely applied and clinically accepted. According to the modified system, there are 8 grades for lumbar disc degenerative disease. Grade 1 represents normal intervertebral disc and grade 8 corresponds to the end stage of degeneration, depicting the progression of the disc disease. There are corresponding images to aid the diagnosis. As they provide good tissue differentiation and detailed description of the disc structure, sagittal T2 weighted images are used for the classification purpose. (Pfirrmann, Christian W. A., et al.)

 

Modic has described the changes occurring in the vertebral bodies adjacent to the degenerating discs as Type 1 and Type 2 changes. In Modic 1 changes, there is decreased intensity of T1 weighted images and increased intensity T2 weighted images. This is thought to occur because the end plates have undergone sclerosis and the adjacent bone marrow is showing inflammatory response as the diffusion coefficient increases. This increase of diffusion coefficient and the ultimate resistance to diffusion is brought about by the chemical substances released through an autoimmune mechanism. Modic type 2 changes include the destruction of the bone marrow of adjacent vertebral endplates due to an inflammatory response and the infiltration of fat in the marrow. These changes may lead to increased signal density on T1 weighted images. (Modic, M T et al.)

 

Computed Tomography (CT)

 

When MRI is not available, Computed tomography is considered a diagnostic test that can detect disc herniation because it has a better contrast between posterolateral margins of the adjacent bony vertebrae, perineal fat, and the herniated disc material. Even so, when diagnosing lateral herniations, MRI remains the imaging modality of choice.

 

CT scan has several advantages over MRI such as it has a less claustrophobic environment, low cost, and better detection of bonny changes that are subtle and may be missed on other modalities. CT can detect early degenerative changes of the facet joints and spondylosis with more accuracy. Bony integrity after fusion is also best assessed by CT.

 

Disc herniation and associated nerve impingement can be diagnosed by using the criteria developed by Gundry and Heithoff. It is important for the disc protrusion to lie directly over the nerve roots traversing the disc and to be focal and asymmetrical with a dorsolateral position. There should be demonstrable nerve root compression or displacement. Lastly, the nerve distal to the impingement (site of herniation) often enlarges and bulges with resulting edema, prominence of adjacent epidural veins, and inflammatory exudates resulting in blurring the margin.

 

Lumbar Discography

 

This procedure is controversial and, whether knowing the site of the pain has any value regarding surgery or not, has not been proven. False positives can occur due to central hyperalgesia in patients with chronic pain (neurophysiologic finding) and due to psychosocial factors. It is questionable to establish exactly when discogenic pain becomes clinically significant. Those who support this investigation advocates strict criteria for selection of the patients and when interpreting results and believe this is the only test that can diagnose discogenic pain. Lumbar discography can be used in several situations, although it is not scientifically established. These include; diagnosis of lateral herniation, diagnosing a symptomatic disc among multiple abnormalities, assessing similar abnormalities seen on CT or MRI, evaluation of the spine after surgery, selection of fusion level, and the suggestive features of discogenic pain existence.

 

The discography is more concerned about eliciting pathophysiology rather than determining the anatomy of the disc. Therefore, discogenic pain evaluation is the aim of discography. MRI may reveal an abnormally looking disc with no pain, while severe pain may be seen on discography where MRI findings are few. During the injection of normal saline or the contrast material, a spongy endpoint can occur with abnormal discs accepting more amounts of contrast. The contrast material can extend into the nucleus pulposus through tears and fissures in the annulus fibrosus in the abnormal discs. The pressure of this contrast material can provoke pain due to the innervations by recurrent meningeal nerve, mixed spinal nerve, anterior primary rami, and gray rami communicantes supplying the outer annulus fibrosus. Radicular pain can be provoked when the contrast material reaches the site of nerve root impingement by the abnormal disc. However, this discography test has several complications such as nerve root injury, chemical or bacterial diskitis, contrast allergy, and the exacerbation of pain. (Bartynski, Walter S., and A. Orlando Ortiz)

 

Imaging Modality Combination

 

In order to evaluate the nerve root compression and cervical stenosis adequately, a combination of imaging methods may be needed.

 

CT Discography

 

After performing initial discography, CT discography is performed within 4 hours. It can be used in determining the status of the disc such as herniated, protruded, extruded, contained or sequestered. It can also be used in the spine to differentiate the mass effects of scar tissue or disc material after spinal surgery.

 

CT Myelography

 

This test is considered the best method for evaluating nerve root compression. When CT is performed in combination or after myelography, details about bony anatomy different planes can be obtained with relative ease.

 

Diagnostic Procedures

 

Transforaminal Selective Nerve Root Blocks (SNRBs)

 

When multilevel degenerative disc disease is suspected on an MRI scan, this test can be used to determine the specific nerve root that has been affected. SNRB is both a diagnostic and therapeutic test that can be used for lumbar spinal stenosis. The test creates a demotomal level area of hypoesthesia by injecting an anesthetic and a contrast material under fluoroscopic guidance to the interested nerve root level. There is a correlation between multilevel cervical degenerative disc disease clinical symptoms and findings on MRI and findings of SNRB according to Anderberg et al. There is a 28% correlation with SNRB results and with dermatomal radicular pain and areas of neurologic deficit. Most severe cases of degeneration on MRI are found to be correlated with 60%. Although not used routinely, SNRB is a useful test in evaluating patients before surgery in multilevel degenerative disc disease especially on the spine together with clinical features and findings on MRI. (Narouze, Samer, and Amaresh Vydyanathan)

 

Electro Myographic Studies

 

Distal motor and sensory nerve conduction tests, called electromyographic studies, that are normal with abnormal needle exam may reveal nerve compression symptoms that are elicited in the clinical history. Irritated nerve roots can be localized by using injections to anesthetize the affected nerves or pain receptors in the disc space, sacroiliac joint, or the facet joints by discography. (�Journal Of Electromyography & Kinesiology Calendar�)

 

Laboratory Studies

 

Laboratory tests are usually done to exclude other differential diagnoses.

 

As seronegative spondyloarthropathies, such as ankylosing spondylitis, are common causes of back pain, HLA B27 immuno-histocompatibility has to be tested. Estimated 350,000 persons in the US and 600,000 in Europe have been affected by this inflammatory disease of unknown etiology. But HLA B27 is extremely rarely found in African Americans. Other seronegative spondyloarthropathies that can be tested using this gene include psoriatic arthritis, inflammatory bowel disease, and reactive arthritis or Reiter syndrome. Serum immunoglobulin A (IgA) can be increased in some patients.

 

Tests like the erythrocyte sedimentation rate (ESR) and C- reactive protein (CRP) level test for the acute phase reactants seen in inflammatory causes of lower back pain such as osteoarthritis and malignancy. The full blood count is also required, including differential counts to ascertain the disease etiology. Autoimmune diseases are suspected when Rheumatoid factor (RF) and anti-nuclear antibody (ANA) tests become positive. Serum uric acid and synovial fluid analysis for crystals may be needed in rare cases to exclude gout and pyrophosphate dihydrate deposition.

 

Treatment

 

There is no definitive treatment method agreed by all physicians regarding the treatment of degenerative disc disease because the cause of the pain can differ in different individuals and so is the severity of pain and the wide variations in clinical presentation. The treatment options can be discussed broadly under; conservative treatment, medical treatment, and surgical treatment.

 

Conservative Treatment

 

This treatment method includes exercise therapy with behavioral interventions, physical modalities, injections, back education, and back school methods.

 

Exercise-Based Therapy with Behavioral Interventions

 

Depending on the diagnosis of the patient, different types of exercises can be prescribed. It is considered one of the main methods of conservative management to treat chronic low back pain. The exercises can be modified to include stretching exercises, aerobic exercises, and muscle strengthening exercises. One of the major challenges of this therapy includes its inability to assess the efficacy among patients due to wide variations in the exercise regimens, frequency, and intensity. According to studies, most effectiveness for sub-acute low back pain with varying duration of symptoms was obtained by performing graded exercise programs within the occupational setting of the patient. Significant improvements were observed among patients suffering from chronic symptoms with this therapy with regard to functional improvement and pain reduction. Individual therapies designed for each patient under close supervision and compliance of the patient also seems to be the most effective in chronic back pain sufferers. Other conservative approaches can be used in combination to improve this approach. (Hayden, Jill A., et al.)

 

Aerobic exercises, if performed regularly, can improve endurance. For relieving muscle tension, relaxation methods can be used. Swimming is also considered an exercise for back pain. Floor exercises can include extension exercises, hamstring stretches, low back stretches, double knee to chin stretches, seat lifts, modified sit-ups, abdominal bracing, and mountain and sag exercises.

 

Physical Modalities

 

This method includes the use of electrical nerve stimulation, relaxation, ice packs, biofeedback, heating pads, phonophoresis, and iontophoresis.

 

Transcutaneous Electrical Nerve Stimulation (TENS)

 

In this non-invasive method, electrical stimulation is delivered to the skin in order to stimulate the peripheral nerves in the area to relieve the pain to some extent. This method relieves pain immediately following application but its long term effectiveness is doubtful. With some studies, it has been found that there is no significant improvement in pain and functional status when compared with placebo. The devices performing these TENS can be easily accessible from the outpatient department. The only side effect seems to be a mild skin irritation experienced in a third of patients. (Johnson, Mark I)

 

Back School

 

This method was introduced with the aim of reducing the pain symptoms and their recurrences. It was first introduced in Sweden and takes into account the posture, ergonomics, appropriate back exercises, and the anatomy of the lumbar region. Patients are taught the correct posture to sit, stand, lift weights, sleep, wash face, and brush teeth avoiding pain. When compared with other treatment modalities, back school therapy has been proven to be effective in both immediate and intermediate periods for improving back pain and functional status.

 

Patient Education

 

In this method, the provider instructs the patient on how to manage their back pain symptoms. Normal spinal anatomy and biomechanics involving mechanisms of injury is taught at first. Next, using the spinal models, the degenerative disc disease diagnosis is explained to the patient. For the individual patient, the balanced position is determined and then asked to maintain that position to avoid getting symptoms.

 

Bio-Psychosocial Approach to Multidisciplinary Back Therapy

 

Chronic back pain can cause a lot of distress to the patient, leading to psychological disturbances and low mood. This can adversely affect the therapeutic outcomes rendering most treatment strategies futile. Therefore, patients must be educated on learned cognitive strategies called �behavioral� and �bio-psychosocial� strategies to get relief from pain. In addition to treating the biological causes of pain, psychological, and social causes should also be addressed in this method. In order to reduce the patient�s perception of pain and disability, methods like modified expectations, relaxation techniques, control of physiological responses by learned behavior, and reinforcement are used.

 

Massage Therapy

 

For chronic low back pain, this therapy seems to be beneficial. Over a 1 year period, massage therapy has been found to be moderately effective for some patients when compared to acupuncture and other relaxation methods. However, it is less efficacious than TENS and exercise therapy although individual patients may prefer one over the other. (Furlan, Andrea D., et al.)

 

Spinal Manipulation

 

This therapy involves the manipulation of a joint beyond its normal range of movement, but not exceeding that of the normal anatomical range. This is a manual therapy that involves long lever manipulation with a low velocity. It is thought to improve low back pain through several mechanisms like the release of entrapped nerves, destruction of articular and peri-articular adhesions, and through manipulating segments of the spine that had undergone displacement. It can also reduce the bulging of the disc, relax the hypertonic muscles, stimulate the nociceptive fibers via changing the neurophysiological function and reposition the menisci on the articular surface.

 

Spinal manipulation is thought to be superior in efficacy when compared to most methods such as TENS, exercise therapy, NSAID drugs, and back school therapy. The currently available research is positive regarding its effectiveness in both the long and short term. It is also very safe to administer under-trained therapists with cases of disc herniation and cauda equina being reported only in lower than 1 in 3.7 million people. (Bronfort, Gert, et al.)

 

Lumbar Supports

 

Patients suffering from chronic low back pain due to degenerative processes at multiple levels with several causes may benefit from lumbar support. There is conflicting evidence with regards to its effectiveness with some studies claiming moderate improvement in immediate and long term relief while others suggesting no such improvement when compared to other treatment methods. Lumbar supports can stabilize, correct deformity, reduce mechanical forces, and limit the movements of the spine. It may also act as a placebo and reduce the pain by massaging the affected areas and applying heat.

 

Lumbar Traction

 

This method uses a harness attached to the iliac crest and lower rib cage and applies a longitudinal force along the axial spine to relieve chronic low back pain. The level and duration of the force are adjusted according to the patient and it can be measured by using devices both while walking and lying down. Lumbar traction acts by opening the intervertebral disc spaces and by reducing the lumbar lordosis. The symptoms of degenerative disc disease are reduced through this method due to temporary spine realignment and its associated benefits. It relieves nerve compression and mechanical stress, disrupts the adhesions in the facet and annulus, and also nociceptive pain signals. However, there is not much evidence with regard to its effectiveness in reducing back pain or improving daily function. Furthermore, the risks associated with lumbar traction are still under research and some case reports are available where it has caused a nerve impingement, respiratory difficulties, and blood pressure changes due to heavy force and incorrect placement of the harness. (Harte, A et al.)

 

Medical Treatment

 

Medical therapy involves drug treatment with muscle relaxants, steroid injections, NSAIDs, opioids, and other analgesics. This is needed, in addition to conservative treatment, in most patients with degenerative disc disease. Pharmacotherapy is aimed to control disability, reduce pain and swelling while improving the quality of life. It is catered according to the individual patient as there is no consensus regarding the treatment.

 

Muscle Relaxants

 

Degenerative disc disease may benefit from muscle relaxants by reducing the spasm of muscles and thereby relieving pain. The efficacy of muscle relaxants in improving pain and functional status has been established through several types of research. Benzodiazepine is the most common muscle relaxant currently in use.

 

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

 

These drugs are commonly used as the first step in disc degenerative disease providing analgesia, as well as anti-inflammatory effects. There is strong evidence that it reduces chronic low back pain. However, its use is limited by gastrointestinal disturbances, like acute gastritis. Selective COX2 inhibitors, like celecoxib, can overcome this problem by only targeting COX2 receptors. Their use is not widely accepted due to its potential side effects in increasing cardiovascular disease with prolonged use.

 

Opioid Medications

 

This is a step higher up in the WHO pain ladder. It is reserved for patients suffering from severe pain not responding to NSAIDs and those with unbearable GI disturbances with NSAID therapy. However, the prescription of narcotics for treating back pain varies considerably between clinicians. According to literature, 3 to 66% of patients may be taking some form of the opioid to relieve their back pain. Even though the short term reduction in symptoms is marked, there is a risk of long term narcotic abuse, a high rate of tolerance, and respiratory distress in the older population. Nausea and vomiting are some of the short term side effects encountered. (�Systematic Review: Opioid Treatment For Chronic Back Pain: Prevalence, Efficacy, And Association With Addiction�)

 

Anti-Depressants

 

Anti-depressants, in low doses, have analgesic value and may be beneficial in chronic low back pain patients who may present with associated depression symptoms. The pain and suffering may be disrupting the sleep of the patient and reducing the pain threshold. These can be addressed by using anti-depressants in low doses even though there is no evidence that it improves the function.

 

Injection Therapy

 

Epidural Steroid Injections

 

Epidural steroid injections are the most widely used injection type for the treatment of chronic degenerative disc disease and associated radiculopathy. There is a variation between the type of steroid used and its dose. 8- 10 mL of a mixture of methylprednisolone and normal saline is considered an effective and safe dose. The injections can be given through interlaminar, caudal, or trans foramina routes. A needle can be inserted under the guidance of fluoroscopy. First contrast, then local anesthesia and lastly, the steroid is injected into the epidural space at the affected level via this method. The pain relief is achieved due to the combination of effects from both local anesthesia and the steroid. Immediate pain relief can be achieved through the local anesthetic by blocking the pain signal transmission and while also confirming the diagnosis. Inflammation is also reduced due to the action of steroids in blocking pro-inflammatory cascade.

 

During the recent decade, the use of epidural steroid injection has increased by 121%. However, there is controversy regarding its use due to the variation in response levels and potentially serious adverse effects. Usually, these injections are believed to cause only short term relief of symptoms. Some clinicians may inject 2 to 3 injections within a one-week duration, although the long term results are the same for that of a patient given only a single injection. For a one year period, more than 4 injections shouldn�t be given. For more immediate and effective pain relief, preservative-free morphine can also be added to the injection. Even local anesthetics, like lidocaine and bupivacaine, are added for this purpose. Evidence for long term pain relief is limited. (�A Placebo-Controlled Trial To Evaluate Effectivity Of Pain Relief Using Ketamine With Epidural Steroids For Chronic Low Back Pain�)

 

There are potential side effects due to this therapy, in addition to its high cost and efficacy concerns. Needles can get misplaced if fluoroscopy is not used in as much as 25% of cases, even with the presence of experienced staff. The epidural placement can be identified by pruritus reliably. Respiratory depression or urinary retention can occur following injection with morphine and so the patient needs to be monitored for 24 hours following the injection.

 

Facet Injections

 

These injections are given to facet joints, also called zygapophysial joints, which are situated between two adjacent vertebrae. Anesthesia can be directly injected to the joint space or to the associated medial branch of the dorsal rami, which innervates it. There is evidence that this method improves the functional ability, quality of life, and relieves pain. They are thought to provide both short and long term benefits, although studies have shown both facet injections and epidural steroid injections are similar in efficacy. (Wynne, Kelly A)

 

SI Joint Injections

 

This is a diarthrodial synovial joint with nerve supply from both myelinated and non-myelin nerve axons. The injection can effectively treat degenerative disc disease involving sacroiliac joint leading to both long and short term relief from symptoms such as low back pain and referred pain at legs, thigh, and buttocks. The injections can be repeated every 2 to 3 months but should be performed only if clinically necessary. (MAUGARS, Y. et al.)

 

Intradiscal Non-Operative Therapies for Discogenic Pain

 

As described under the investigations, discography can be used both as a diagnostic and therapeutic method. After the diseased disc is identified, several minimally invasive methods can be tried before embarking on surgery. Electrical current and its heat can be used to coagulate the posterior annulus thereby strengthening the collagen fibers, denaturing and destroying inflammatory mediators and nociceptors, and sealing figures. The methods used in this are called intradiscal electrothermal therapy (IDET) or radiofrequency posterior annuloplasty (RPA), in which an electrode is passed to the disc. IDET has moderate evidence in relief of symptoms for disc degenerative disease patients, while RPA has limited support regarding its short term and long term efficacy. Both these procedures can lead to complications such as nerve root injury, catheter malfunction, infection, and post-procedure disc herniation.

 

Surgical Treatment

 

Surgical treatment is reserved for patients with failed conservative therapy taking into account the disease severity, age, other comorbidities, socio-economic condition, and the level of outcome expected. It is estimated that around 5% of patients with degenerative disc disease undergo surgery, either for their lumbar disease or cervical disease. (Rydevik, Bj�rn L.)

 

Lumbar Spine Procedures

 

Lumbar surgery is indicated in patients with severe pain, with a duration of 6 to 12 months of ineffective drug therapy, who have critical spinal stenosis. The surgery is usually an elective procedure except in the case of cauda equina syndrome. There are two procedure types that aim to involve spinal fusion or decompression or both. (�Degenerative Disk Disease: Background, Anatomy, Pathophysiology.�)

 

Spinal fusion involves stopping movements at a painful vertebral segment in order to reduce the pain by fusing several vertebrae together by using a bone graft. It is considered effective in the long term for patients with degenerative disc disease having spinal malalignment or excessive movement. There are several approaches to fusion surgery. (Gupta, Vijay Kumar, et al)

 

  • Lumbar spinal posterolateral guttur fusion

 

This method involves placing a bone graft in the posterolateral part of the spine. A bone graft can be harvested from the posterior iliac crest. The bones are stripped off from its periosteum for successful grafting. A back brace is needed in the post-operative period and patients may need to stay in the hospital for about 5 to 10 days. Limited motion and cessation of smoking are needed for successful fusion. However, several risks such as non-union, infection, bleeding, and solid union with back pain may occur.

 

  • Posterior lumbar interbody fusion

 

In this method, decompression or diskectomy methods can also be performed via the same approach. The bone grafts are directly applied to the disc space and ligamentum flavum is excised completely. For the degenerative disc disease, interlaminar space is widened additionally by performing a partial medial facetectomy. Back braces are optional with this method. It has several disadvantages when compared to anterior approach such as only small grafts can be inserted, the reduced surface area available for fusion, and difficulty when performing surgery on spinal deformity patients. The major risk involved is non-union.

 

  • Anterior lumbar interbody fusion

 

This procedure is similar to the posterior one except that it is approached through the abdomen instead of the back. It has the advantage of not disrupting the back muscles and the nerve supply. It is contraindicated in patients with osteoporosis and has the risk of bleeding, retrograde ejaculation in men, non-union, and infection.

 

  • Transforaminal lumbar interbody fusion

 

This is a modified version of the posterior approach which is becoming popular. It offers low risk with good exposure and it is shown to have an excellent outcome with a few complications such as CSF leak, transient neurological impairment, and wound infection.

 

Total Disc Arthroplasty

 

This is an alternative to disc fusion and it has been used to treat lumbar degenerative disc disease using an artificial disc to replace the affected disc. Total prosthesis or nuclear prosthesis can be used depending on the clinical situation.

 

Decompression involves removing part of the disc of the vertebral body, which is impinging on a nerve to release that and provide room for its recovery via procedures called diskectomy and laminectomy. The efficacy of the procedure is questionable although it is a commonly performed surgery. Complications are very few with a low chance of recurrence of symptoms with higher patient satisfaction. (Gupta, Vijay Kumar, et al)

 

  • Lumbar discectomy

 

The surgery is performed through a posterior midline approach by dividing the ligamentum flavum. The nerve root that is affected is identified and bulging annulus is cut to release it. Full neurological examination should be performed afterward and patients are usually fit to go home 1 � 5 days later. Low back exercises should be started soon followed by light work and then heavy work at 2 and 12 weeks respectively.

 

  • Lumbar laminectomy

 

This procedure can be performed thorough one level, as well as through multiple levels. Laminectomy should be as short as possible to avoid spinal instability. Patients have marked relief of symptoms and reduction in radiculopathy following the procedure. The risks may include bowel and bladder incontinence, CSF leakage, nerve root damage, and infection.

 

Cervical Spine Procedures

 

Cervical degenerative disc disease is indicated for surgery when there is unbearable pain associated with progressive motor and sensory deficits. Surgery has a more than 90% favorable outcome when there is radiographic evidence of nerve root compression. There are several options including anterior cervical diskectomy (ACD), ACD, and fusion (ACDF), ACDF with internal fixation, and posterior foraminotomy. (�Degenerative Disk Disease: Background, Anatomy, Pathophysiology.�)

 

Cell-Based Therapy

 

Stem cell transplantation has emerged as a novel therapy for degenerative disc disease with promising results. The introduction of autologous chondrocytes has been found to reduce discogenic pain over a 2 year period. These therapies are currently undergoing human trials. (Jeong, Je Hoon, et al.)

 

Gene Therapy

 

Gene transduction in order to halt the disc degenerative process and even inducing disc regeneration is currently under research. For this, beneficial genes have to be identified while demoting the activity of degeneration promoting genes. These novel treatment options give hope for future treatment to be directed at regenerating intervertebral discs. (Nishida, Kotaro, et al.)

 

 

Degenerative disc disease is a health issue characterized by chronic back pain due to a damaged intervertebral disc, such as low back pain in the lumbar spine or neck pain in the cervical spine. It is a breakdown of an intervertebral disc of the spine. Several pathological changes can occur in disc degeneration. Various anatomical defects can also occur in the intervertebral disc. Low back pain and neck pain are major epidemiological problems, which are thought to be related to degenerative disc disease. Back pain is the second leading cause of doctor office visits in the United States. It is estimated that about 80% of US adults suffer from low back pain at least once during their lifetime. Therefore, a thorough understanding of degenerative disc disease is needed for managing this common condition. – Dr. Alex Jimenez D.C., C.C.S.T. Insight

 

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*�

 

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

 

References

 

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Spinal Injection or Nerve Block For Neck and Back Pain

Spinal Injection or Nerve Block For Neck and Back Pain

Spinal injections are exactly what the name says. They are administered direct injections of medicine/s in a specific location of the spine. These are used to treat various conditions affecting the spine when non-invasive treatment/s are not working.

This could be an area along the upper cervical/neck spine all the way down to the sacrum. Injections are also utilized in helping to diagnose neck or back pain that radiates or spreads into an individual�s arms and legs. These are known as:

  • Cervical radiculopathy
  • Lumbar radiculopathy

Spinal injection/s for diagnostic or treatment purposes could be a part of an overall treatment plan along with chiropractic/physical therapy and possible medication.

11860 Vista Del Sol, Ste. 128 Spinal Injection or Nerve Block For Neck and Back Pain

The medicine in the injection

The medicine could be comprised of a local anesthetic on its own, steroid on its own, or a combination of the two. Steroids are short for corticosteroid, which is a strong anti-inflammatory medication. A contrast dye like an x-ray dye could be added to the injection mix. This dye acts as a guide for precise placement of the needle using image guidance.

Spinal disorders that could benefit

Proceeding with an injection treatment plan is based on an individual’s unique factors that apply to their condition/state. This decision will be made after consultation, and diagnosis with your doctor, spine specialist, or chiropractor.

Healthcare providers recommend conservative treatment first. A treatment plan typically runs around 4-6 weeks. If there is no change or improvement in the individual’s condition from the conservative therapy then injection treatment/s could be recommended. Conditions, where injection/s are used, include:

  • Disc herniation
  • Facet joint pain
  • Failed back syndrome
  • Sacroiliac joint pain
  • Sciatica
  • Spinal stenosis

Spinal injection and nerve block difference

Spinal injections are a general term that could mean any type of injection involving the spine. Nerve blocks are a precise type of injection that targets a specific nerve. As the medicine is injected into the target nerve/s, it blocks or creates a blockade of the pain signals being sent from the area (ex. neck, low back, etc.) that is generating the pain.

Injection types

Epidural

An epidural means an injection on the dura. The dura is the outermost layer that encloses the spinal cord. �

11860 Vista Del Sol, Ste. 128 Spinal Injection or Nerve Block For Neck and Back Pain

3 types of epidurals. They are named according to the direction and angle the needle takes to get to the dura.

  • Caudal epidural:

The spinal canal ends at an opening at the end of the sacrum called the spinal hiatus. The medicine is injected into the epidural space through the sacral hiatus. This is the method that is used to provide anesthesia to pregnant women when they’re in labor. �

StructureoftheSacrumDiagram ElPasoChiropractor
  • Transforaminal epidural:

There are nerve roots that come out of the spinal canal at each level through a bony opening called the intervertebral foramen or neuroforamen. The medicine is injected into the epidural space in these areas.

  • Interlaminar epidural:

The lamina is a section that forms the arch of each level and forms the spinal canal. The lamina at each level lays on top of the lamina right below. The needle is inserted between the lamina for delivery of the medicine into the epidural space. �

third and fourth lumbar vertebrae lumbar vertebra lumbar spine vertebral bone

Selective Nerve Root Block – SNRB

These involve the injection of a local anesthetic onto a targeted nerve. They are typically used for diagnostic purposes. For individuals with multi-spinal compression/s, these combined with:

  • Medical history
  • Physical exam
  • MRI

These can help identify the pain generator such as spinal stenosis.

Medial Branch Block – MBB

The facet joints are bony projections that connect a vertebral level to the levels above and below. These can become arthritic and is responsible for different forms of back pain.

This type of spinal injection is local anesthetic injected on the medial branch nerves. These are the nerves that send pain signals from the facet joint/s. They are useful in determining if the facet joint is the pain generator. �

Facet Joint

These are injections directly into the facet joint itself. Much like injecting anti-inflammatory and pain meds into a knee with arthritis.

Sacroiliac Joint

The two sacroiliac joints help connect either side of the sacrum to the hip joint. Like other joints, these can get inflamed and cause painful symptoms. This is an injection directly into one or both of the sacroiliac joints.

Administration of the spinal injection or nerve block

Injections are only to be performed by doctors trained specifically in spinal injections. Injections are usually performed by an:

  • Anesthesiologist
  • Neurologist
  • Neurosurgeon
  • Orthopedic surgeon
  • Physiatrist
  • Radiologist

Role of these procedures

Reasons why an injection could be used:

  • Help as a diagnostic to identify the pain generator
  • Therapeutically to provide pain relief
  • As a prognostic pain predictor of the relief, an individual could expect from a more invasive procedure like nerve ablation.

How often

A maximum of 6 injections for one year is the recommended treatment protocol. Each injection should be based on the effect/s of the previous injection.

Potential benefits

The main benefit is to bring pain relief and the ability to function.

Potential risks

Spinal injections are considered safe with a low rate of complications. The most common include:

  • Bleeding
  • Headache
  • Facial flushing

Major complications include:

  • Puncture of the dura
  • Infection
  • Nerve damage

Major complications happen in less than one percent of those undergoing the treatment. Individuals with diabetes could see a temporary elevation of their blood sugar.

Lasting effects

How long the medicine lasts is different for everyone and comes with variables like:

  • Type of injection
  • Type of pathology
  • Diagnosis
  • Cause
  • How long the symptoms last

Most can expect to have one and a half to three months of relief. However, with some, they may only provide minimal relief, while others may see improvements for up to a year.


Treating Severe & Complex Sciatica Syndromes


 

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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*

Alternative Treatments for Neck Pain

Alternative Treatments for Neck Pain

A doctor could recommend alternative treatments, as part of a plan for neck pain like acupuncture, herbal compounds, and yoga. You may want to try them out yourself. Many have reported that these have really helped. Please consult a doctor before trying any alternative therapies. These are safe but should be set-up by a professional to make sure they are done safely. For example, there could be negative interactions between herbs, supplements, and other medications being used.

11860 Vista Del Sol, Ste. 128 Alternative Treatments for Neck Pain El Paso, Texas

Acupuncture

This is an eastern approach to healing. Acupuncture focuses on the body’s energy force known as Qi or Chi. When the energy is blocked from flowing this is when physical illnesses develop. Acupuncture restores the healthy energy flow. It isn’t better or worse it is just different.

Herbal Medicine

There are herbal compounds that have proven to be useful for neck pain.

 

Capsaicin Cream

Capsaicin is a chili pepper extract and can help relieve neck pain. It temporarily reduces pain. Capsaicin cream can help with osteoarthritis and muscle pain, which both cause neck pain.

Devil’s Claw

Devil’s claw comes from southern Africa, where it has been used for centuries to treat fever, arthritis, and gastrointestinal problems. It is used for conditions that cause inflammation and pain, like cervical osteoarthritis.

White Willow Bark

White willow bark is how aspirin in Europe was developed. Synthetic versions like aspirin can irritate the stomach, which is why the natural white willow bark is used instead. It helps with conditions that cause pain and inflammation like osteoarthritis.

 

11860 Vista Del Sol, Ste. 126 Passive/Active Physical Therapy for Whiplash El Paso, TX.

 

Massage

Neck pain can be caused by stress, overuse, and misuse. Misuse means like sitting hunched over a computer for too long every day will take its toll. Massage helps to release tension, relieve muscle inflammation, and pain. Regular massages could help as a preventative measure.

 

11860 Vista Del Sol, Ste. 128 Alternative Treatments for Neck Pain El Paso, Texas

Yoga/Pilates

Yoga and Pilates can increase core strength, improve balance, posture, and reduce stress. These can all help deal with neck pain/ prevent neck pain when done correctly and safely. Neck pain relief can be found with these treatments. Treatments that focus on relieving tension or stress can prove especially helpful if the pain is related to tight muscles and the physical effects of stress.

These alternative treatments could work at their optimal in combination with other therapies. This is to fully address the underlying spinal condition/root cause, along with any other neck-related symptoms.


 

Neck Pain Chiropractic Care


 

NCBI Resources