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Neck Pain Treatments

Back Clinic Chiropractic Neck Pain Treatment Team. Dr. Alex Jimenez’s collection of neck pain articles cover an assortment of medical conditions and/or injuries pertaining to pain and other symptoms surrounding the cervical spine. The neck consists of various complex structures; bones, muscles, tendons, ligaments, nerves, and other 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 individual experiences can be debilitating.

Depending on the underlying cause, neck pain symptoms can take on many different forms. They include:

Pain when holding your head in one place for long periods of time
Inability to move your head freely
Muscle tightness
Muscle spasms
Headache
Frequent cracking and crunching
Numbness and nerve pain radiating from the neck down to the upper arm and hand

Through chiropractic care, Dr. Jimenez explains how the use of manual adjustments to 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.


It Could Be More Than Shoulder Pain

It Could Be More Than Shoulder Pain

Introduction

The body is a functional machine that requires many muscles, organs, ligaments, joints, and tissues that provide everyday movements. In the upper extremities, the head, neck, and shoulders have many muscles, ligaments, and tissues that work together with the nerve roots from the nervous system that provides sensory-motor function to make the fingers move, the shoulders rotate, and the head turns from side to side. When injuries or common issues affect the muscles in the headneck, or shoulders, it can cause small nodules to form along the muscle fibers of the affected muscle area and cause referred pain in different locations of the body. Today’s article looks at the scalene muscles, how trigger points affect the scalene muscles while mimicking shoulder pain, and how to manage chronic pain associated with trigger points. We refer patients to certified providers who specialize in musculoskeletal treatments to aid individuals suffering from trigger points related to the shoulders affecting the scalene muscles. We also guide our patients by referring them to our associated medical providers based on their examination when appropriate. We ensure to find that education is the solution to asking our providers insightful questions. Dr. Jimenez DC observes this information as an educational service only. Disclaimer

11_Shah Role of Central Sensitization-compressed

What Are The Scalene Muscles?

Have you been experiencing tingling sensations running down your fingertips? Do you feel stiffness when rotating your neck or shoulders? Or do you feel muscle soreness in your shoulders? Many individuals who are feeling any of these symptoms affecting their neck or shoulders could be dealing with trigger point pain along the scalene muscles. The scalene muscles play a crucial part in the head and neck as they are deep muscles positioned laterally on the cervical tract of the spine. These muscles have three different branches: the anterior, medius, and posterior, which play the role of being accessory breathing muscles while being an important contributor to head and neck movement. To that point, it allows stability to the cervical spine. The scalene muscles even help support and elevate the upper rib cage when a person is lifting, pulling, or carrying heavy objects. However, like most muscles in the body, the scalene muscles can be prone to injury and can develop issues that can affect the upper extremities of the body.

 

Trigger Points Affects The Scalene Muscles Mimicking Shoulder Pain

When common injuries like pulling a muscle when carrying a heavy object or even a traumatic injury like being involved in an auto accident can cause pain in the affected area, over time, if not treated, can cause various symptoms to overlap and affect the muscles. When the scalene muscles are affected by injuries, they can develop tiny nodules along the taut muscle fibers and become hyperirritable to the surrounding areas of the upper half of the body. This is known as trigger point pain and can mimic other chronic issues that affect different body areas. To that point, trigger points affecting the scalene muscles may mimic shoulder pain in the upper half of the body. Studies reveal that scalene myofascial pain is a regional pain syndrome that originates pain in the neck area and radiates pain down to the arm. Since trigger points mimic other chronic issues, it is often misdiagnosed as another neck pain associated with radiculopathy when the scalene muscles are affected. When this happens, the muscles become stiff and weak, causing a reduction in the range of movement. 

 

 

Studies reveal that when individuals suffer from acute whiplash-associated disorders, the local and referred pain can be elicited from active trigger points to reproduce neck and shoulder pain. This causes a higher disability that exhibits widespread pressure causing the muscles to be hypersensitive and reducing the cervical range of motion. Many individuals often complain about shoulder pain while rubbing the upper parts of their arms. The scalene muscle is affected by active trigger points, thus mimicking shoulder pain.

 


Scalenes Trigger Points-Video

Have you been feeling muscle stiffness in your neck or shoulders? Have you been experiencing a numbing sensation along your arms? Have you felt tenderness along your shoulders when you touch them? Many of these pain symptoms are associated with trigger points along the scalene muscles. The video above explains where the trigger points are located along the scalene muscles and how they are causing referred pain in the neck and shoulder areas. Many factors can lead to the causation of trigger point pain and overlap with other chronic issues that can affect the upper extremities of the body, using sleep as an example. Studies reveal that poor sleeping posture can affect the neck and shoulders, leading to muscle stiffness along the scalene muscles and developing trigger points over time. Fortunately, various ways to manage referred shoulder pain are associated with trigger points.


Management Of Chronic Shoulder Pain Associated With Trigger Points

 

Many individuals are referred to pain specialists that can alleviate trigger points along the scalene muscle to reduce the effects of shoulder and neck pain. When referred pain along the scalene muscles causes chronic shoulder pain associated with trigger points, many people often do various movements to alleviate the pain. However, it can cause more pain in the affected area and prevent relief from the neck and shoulders. Studies reveal that various treatments like physiotherapy, trigger point injections, manipulation of the cervical spine, or acupuncture can help relax and lengthen the muscle fibers associated with the scalene muscle. To that point, this allows the neck to extend further without pain and reduces the overlapping symptoms that affect the upper extremities of the body. 

 

Conclusion

The scalene muscles play a crucial part in the head and neck area as deep muscles are positioned laterally on the cervical tract of the spine. These muscles help elevate the upper chest and laterally bend the neck from side to side. When injuries affect the scalene muscles and form tiny nodules known as trigger points, it can cause referred pain to the shoulders and the neck. To that point, symptoms like numbing or tingling sensations can travel down the arms and fingers. Fortunately, available treatments can reduce the symptoms and manage myofascial trigger pain along the shoulders and neck associated with the scalene muscles. This allows a better range of motion to the neck and shoulder and prevents future trigger points from forming in the scalene muscles.

 

References

Abd Jalil, Nizar, et al. “Scalene Myofascial Pain Syndrome Mimicking Cervical Disc Prolapse: A Report of Two Cases.” The Malaysian Journal of Medical Sciences : MJMS, Penerbit Universiti Sains Malaysia, Jan. 2010, www.ncbi.nlm.nih.gov/pmc/articles/PMC3216145/.

Bordoni, Bruno, and Matthew Varacallo. “Anatomy, Head and Neck, Scalenus Muscle.” In: StatPearls [Internet]. Treasure Island (FL), StatPearls Publishing, 16 Apr. 2022, www.ncbi.nlm.nih.gov/books/NBK519058/.

Fernández-Pérez, Antonio Manuel, et al. “Muscle Trigger Points, Pressure Pain Threshold, and Cervical Range of Motion in Patients with High Level of Disability Related to Acute Whiplash Injury.” The Journal of Orthopaedic and Sports Physical Therapy, U.S. National Library of Medicine, July 2012, pubmed.ncbi.nlm.nih.gov/22677576/.

Lee, Won-Hwee, and Min-Seok Ko. “Effect of Sleep Posture on Neck Muscle Activity.” Journal of Physical Therapy Science, The Society of Physical Therapy Science, June 2017, www.ncbi.nlm.nih.gov/pmc/articles/PMC5468189/.

Thapa, Deepak, et al. “Management of Chronic Shoulder Pain with Restricted Mobility – a Case Series.” Indian Journal of Anaesthesia, Medknow Publications & Media Pvt Ltd, Nov. 2016, www.ncbi.nlm.nih.gov/pmc/articles/PMC5125193/.

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Trigger Points Associated With Levator Scapulae

Trigger Points Associated With Levator Scapulae

Introduction

The muscles in the body help provide motion and protect the skeletal joints from harm. Each muscle group has ligaments, tissues, and muscle fibers that retract, stretch, and contract the body while helping the host to do everyday movements, breath, digest food, stabilize, and even rest. When a person is dealing with pain from a traumatic event or making repetitive motions, it can affect the muscles over time. Factors like not drinking enough water, constantly looking down on the phones, and being hunched over can cause strain on the muscles, causing overlapping pain on top of other chronic issues that may develop. When the muscles begin to cause pain along the shoulders and neck, it can become a risk of developing trigger points in the levator scapulae muscles. Today’s article examines the levator scapulae muscles, how trigger points affect these muscles, and how treatments can help manage the trigger points on the levator scapulae muscles. We refer patients to certified providers who specialize in musculoskeletal treatments to aid individuals suffering from trigger points associated with the neck and shoulders affecting the levator scapulae muscles. We also guide our patients by referring them to our associated medical providers based on their examination when appropriate. We ensure to find that education is the solution to asking our providers insightful questions. Dr. Jimenez DC observes this information as an educational service only. Disclaimer

11_Shah Role of Central Sensitization-compressed

What Is The Levator Scapulae?

Have you been dealing with pain along the neck or shoulders? Do you feel stiffness when turning your head from side to side? Or do you feel tenderness in the base of your neck and shoulders? Many individuals with shoulder and neck pain risk developing trigger points along the levator scapulae. The levator scapulae muscles originate from the posterior tubercles of the C1 through C4 vertebrae in the neck that is between the superior angle and the root of the scapulae spine. This superficial muscle’s primary function is to elevate the scapulae or the shoulder blades while working together with the trapezius and rhomboid muscles to assist the movement. The levator scapulae muscles also assist in providing neck extension, ipsilateral rotation, and lateral flexion. When pathologies like fibromyalgia, levator scapulae syndrome, or cervical myofascial pain begin to affect the levator scapulae muscles, the symptoms can potentially involve the shoulders and neck to cause referred pain to the upper extremities. 

 

How Trigger Points Affect The Levator Scapulae?

Many individuals with shoulder and neck pain have described radiating pain from their neck to their shoulders. Known as referred pain, the pain is located in one area of the body but in a different location. Studies reveal that when pain radiates from the neck and shoulders, any movements that are overstretching the levator scapulae can aggravate overlapping symptoms on the affected side. This allows small nodules to form along the levator scapulae muscle fibers, causing trigger points to affect the shoulder and neck muscles. 

 

 

Trigger point associated with the levator scapulae muscles causes the individual to have pain-like symptoms in the neck that causes muscle stiffness. This causes an emphasis on referred pain symptoms from the levator scapulae, like neck tension and restriction of range of motion on the neck. Studies reveal that pain over the superior angle of the levator scapulae is a common musculoskeletal disorder that is often accompanied by radiating pain on the neck, head, and shoulders. Some of the ways that trigger points form along the levator scapulae muscle can be due to ordinary factors like:

  • Stress
  • Posture
  • Over-exercising
  • Upper respiratory infections

Some of these factors above can shorten the levator scapulae muscle and restrict muscle movement to provide a full range of motion for the head and neck to turn. To that point, treatments are available to help loosen up and stretch the levator scapulae muscles to allow rotation and flexion on the neck and shoulders.


Trigger Points Anatomy On The Levator Scapulae- Video

Have you been dealing with stress that is affecting your neck and shoulders? Have you been dealing with neck stiffness when turning your head? Or have you been feeling muscle tenderness between the neck and shoulders? Some of these symptoms are associated with trigger points affecting the levator scapulae muscles between the neck and shoulder. The video above overviews common trigger points and how they affect the levator scapulae, causing shoulder and neck pain. Since the levator scapulae muscles lay behind the trapezius muscle, studies reveal that trigger points or myofascial pain syndrome can cause hyperirritability in the muscle tissues and affect mobility functions in the nerve ends. Even though referred pain affects the neck and shoulder of the body, treatments are available to manage trigger points on the levator scapulae and relieve neck and shoulder pain.


Treatments To Manage Trigger Points On The Levator Scapulae

 

When there is trigger point pain affecting the levator scapulae, some common complaints that many individuals often complain about are neck and shoulder pain. However, various ways can alleviate the pain symptoms from the neck and shoulders while managing trigger points associated with the levator scapulae. Studies reveal that stretching the levator scapulae muscle in a seated position can improve muscle length along the levator scapulae and the cervical range of motion. Stretching the levator scapulae muscle can help reduce the pain along the levator muscle. To that point, it even helps reduce muscle imbalances and movement dysfunction along the cervical joints. Many individuals are referred to pain specialists like chiropractors by their doctors to reduce pain and functionality disability in the neck and realign the spine to loosen up the stiff muscles caused by subluxation. Realigning the cervical spine and stretching can reduce future trigger points and reduce pain symptoms from affecting the muscle.

 

Conclusion

The levator scapulae muscles in the body provide movement functionality to the neck and shoulders. The levator scapulae work together with the trapezius and rhomboid muscles to elevate the shoulder blades and assist with neck extension, ipsilateral rotation, and lateral flexion. When pathologies affect the levator scapulae muscles, they can develop trigger point pain along the muscle and cause neck and shoulder pain. The factors that cause trigger point pain can either be ordinary or traumatic and cause referred pain to the neck and shoulders. Fortunately, treatments like stretching and adjustments can help reduce the pain and loosen up stiff muscles along the levator scapulae. This will allow a cervical range of motion back to the neck and shoulder and elongate the levator scapulae.

 

References

Akamatsu, Flávia Emi, et al. “Trigger Points: An Anatomical Substratum.” BioMed Research International, Hindawi Publishing Corporation, 2015, www.ncbi.nlm.nih.gov/pmc/articles/PMC4355109/.

Henry, James P, and Sunil Munakomi. “Anatomy, Head and Neck, Levator Scapulae Muscles.” In: StatPearls [Internet]. Treasure Island (FL), StatPearls Publishing, 13 Aug. 2021, www.ncbi.nlm.nih.gov/books/NBK553120/.

Jeong , Hyo-Jung, et al. “Stretching Position Can Affect Levator Scapular Muscle Activity, Length, and Cervical Range of Motion in People with a Shortened Levator Scapulae.” Physical Therapy in Sport : Official Journal of the Association of Chartered Physiotherapists in Sports Medicine, U.S. National Library of Medicine, 4 Apr. 2017, pubmed.ncbi.nlm.nih.gov/28578252/.

Kulow, Charlotte, et al. “Levator Scapulae and Rhomboid Minor Are United.” Annals of Anatomy = Anatomischer Anzeiger : Official Organ of the Anatomische Gesellschaft, U.S. National Library of Medicine, Aug. 2022, pubmed.ncbi.nlm.nih.gov/35367623/.

Menachen, A, et al. “Levator Scapulae Syndrome: An Anatomic-Clinical Study.” Bulletin (Hospital for Joint Diseases (New York, N.Y.)), U.S. National Library of Medicine, 1993, pubmed.ncbi.nlm.nih.gov/8374486/.

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Trigger Points Affect Posterior Cervical Muscles

Trigger Points Affect Posterior Cervical Muscles

Introduction

The cervical spine has a casual relationship with the central nervous system as the brain and spinal cord works together to send neuron signals through the nerve pathways spread throughout the entire body. The cervical spine is part of the neck, where ligaments and muscles encompass the cervical joints to stabilize the head, neck, and shoulders. The neck has various muscles that support the head and can succumb to various injuries that can cause muscle strain and other associated symptoms that can affect the upper extremities of the body. Today’s article looks at the posterior cervical muscles, how trigger points affect the posterior cervical muscles, and how non-invasive treatments can help manage myofascial cervical pain. We refer patients to certified providers who specialize in musculoskeletal treatments to aid individuals suffering from myofascial trigger pain associated with the neck affecting the posterior cervical muscles. We also guide our patients by referring them to our associated medical providers based on their examination when appropriate. We ensure to find that education is the solution to asking our providers insightful questions. Dr. Jimenez DC observes this information as an educational service only. Disclaimer

11_Shah Role of Central Sensitization-compressed

What Are The Posterior Cervical Muscles?

 

Have you been experiencing random headaches that affect your day? Do you feel any tension in your neck? Or do you experience stiffness and limited mobility when turning your neck? Most of these symptoms are associated with trigger pain affecting the posterior cervical muscle on the neck. The posterior cervical muscles function in the neck’s anatomic region while protecting the cervical spine. The muscles in the cervical spine form a triangle on the neck while providing functionality and movement to the neck, the head, shoulder, and upper back. Some of the muscles that work together with the cervical spine include:

  • Levator scapulae
  • SCM (Sternocleidomastiod)
  • Trapezius
  • Erector spinae
  • Deep cervical flexors
  • Suboccipitals
  • Semispinalis
  • Splenius

These muscles and soft tissues provide stability to the neck and work together with the tendons and ligaments to rotate, extend, and retract the head, neck, shoulders, and upper back. To that point, if the neck muscles become strained, it can lead to various issues that can cause pain to the neck and cervical spine.

 

How Trigger Points Affect The Posterior Cervical Muscles

 

Studies reveal that a musculoskeletal disorder known as cervical myofascial pain causes the surrounding muscles in the neck and shoulder regions to become tender to the touch and evoke pain in different areas of the body. When the posterior cervical muscle has become strained from various issues like poor posture, over-exercising, getting involved in an auto accident, or have suffered from a degenerative condition, it can cause the muscles to be overused, hypersensitive, and stiff while potentially being at risk of developing trigger points along the neck and shoulder muscles. Trigger points are a bit problematic as they are associated with referred pain and can be either latent or active as they create tiny nodules along the taut muscle fibers in the area. Research studies reveal that referred pain from cervical myofascial pain can be elicited by active trigger points on the affected muscle. To that point, the active trigger points can mimic other pain symptoms along the upper extremities, making diagnosing myofascial pain challenging. Thankfully there are ways to manage trigger point pain associated with the posterior cervical muscles along the neck and cervical spine.


Exercises For Neck & Shoulder Pain-Video

Have you been experiencing stiffness along the sides of your neck or on your shoulders? Do headaches make it impossible to get through an entire day? Or have you been feeling tightness along your jawline? Many people with neck pain and its associated symptoms could risk developing myofascial trigger pain along the posterior cervical muscles. Having myofascial trigger pain associated with the posterior cervical muscle and affecting the neck and upper extremities can cause many people to be miserable; however, there are many ways that people can utilize to relieve the pain along the posterior cervical muscles and manage myofascial cervical pain associated with the neck. The video above provides various neck and shoulder pain exercises correlating with myofascial trigger points. To that point, finding non-invasive available treatments to manage myofascial cervical pain can help reduce the effects of pain along the neck and posterior cervical muscles.


Non-Invasive Treatments To Manage Myofascial Cervical Pain

 

Many people suffer from neck pain associated with myofascial cervical pain; many factors can contribute to developing tiny nodules along the posterior muscles. Studies reveal that activities, whether work-related or for entertainment, can yield repetitive stress on the muscle groups that cause chronic tension in the muscle fibers to form trigger points. To that point, myofascial trigger pain causes the taut muscle bands to be hyper-sensitive and affect the muscle area. Many people suffering from myofascial trigger pain can utilize non-invasive treatments to manage myofascial pain associated with the posterior cervical muscle. Some of the treatments that help manage myofascial cervical pain include:

  • Acupuncture
  • Trigger point release therapy
  • Chiropractic care
  • Heat therapy
  • Exercise/stretching

Many of these treatments help release the trigger points from the affected muscles and help prevent them from re-occurring on the affected muscles along the upper extremities.

Conclusion

The neck has many muscles, ligaments, and tissues that help support the upper extremities of the body. When issues begin to affect the functionality of the neck muscles, it can lead to the development of myofascial trigger pain in the posterior cervical muscles along the neck to cause painful symptoms. This can lead to overlapping chronic issues like stiffness and tenderness in the upper extremities. Non-invasive treatments can help alleviate the pain and manage the symptoms caused by myofascial cervical pain in the upper extremities of the body. This allows the affected muscle to return to its functionality and prevents future issues from affecting the body.

 

References

Alghadir, Ahmad H, et al. “Efficacy of Combination Therapies on Neck Pain and Muscle Tenderness in Male Patients with Upper Trapezius Active Myofascial Trigger Points.” BioMed Research International, Hindawi, 10 Mar. 2020, www.ncbi.nlm.nih.gov/pmc/articles/PMC7085833/.

Fernández-de-Las-Peñas, César, et al. “The Role of Myofascial Trigger Points in Musculoskeletal Pain Syndromes of the Head and Neck.” Current Pain and Headache Reports, U.S. National Library of Medicine, Oct. 2007, pubmed.ncbi.nlm.nih.gov/17894927/.

Stathakios, James, and Michael A Carron. “Anatomy, Head and Neck, Posterior Cervical Region.” In: StatPearls [Internet]. Treasure Island (FL), StatPearls Publishing, 27 July 2021, www.ncbi.nlm.nih.gov/books/NBK551521/.

Touma, Jeffrey, et al. “Cervical Myofascial Pain.” In: StatPearls [Internet]. Treasure Island (FL), StatPearls Publishing, 4 July 2022, www.ncbi.nlm.nih.gov/books/NBK507825/.

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Trigger Points Affecting The Neck & Splenius Muscles

Trigger Points Affecting The Neck & Splenius Muscles

Introduction

The neck is the connector to the head and shoulders, allowing mobility and functionality to stabilize the head from dropping down. The neck is also part of the cervical spine, where many neuron pathways, ligaments, and muscles work with the central nervous system to provide sensory-motor signals to the brain. The neck muscles also work together with the shoulder and upper back muscles to function for the upper extremities. These are known as the splenius muscles and help support the cervical spine. However, like all muscles in the body, the neck can succumb to traumatic injuries or common factors that can cause the neck muscles to be overused, injured, and strained to cause the nerves to send out disruptive signals to the brain and issues to develop. Today’s article looks at the splenius muscles on the neck, how trigger points affect the splenius muscles, and how to manage neck pain associated with trigger points. We refer patients to certified providers who specialize in musculoskeletal treatments to aid individuals suffering from myofascial trigger pain associated with neck pain affecting the splenius muscles. We also guide our patients by referring them to our associated medical providers based on their examination when appropriate. We ensure to find that education is the solution to asking our providers insightful questions. Dr. Jimenez DC observes this information as an educational service only. Disclaimer

11_Shah Role of Central Sensitization-compressed

The Splenius Muscles On The Neck

 

Have you been experiencing muscle pain in your neck? What about feeling tightness on the sides of your neck when you move your head from side to side? Or do random headaches seem to pop out of nowhere and affect your day? Most of these symptoms are associated with neck pain affecting the splenius muscles and can cause overlapping issues affecting the neck and the upper back. The splenius muscles are split into two muscle groups: the splenius capitis and the splenius cervicis. Both of the splenius muscles each have a job for neck functionality. The splenius capitis provides rotation and extension to the head, while the splenius cervicis provides rotation and extends to the cervical spine. The splenius capitis fibers are connected with the SCM (sternocleidomastoid) muscles that help move the head. The splenius cervicis encompasses the upper three cervical vertebrae and attach their muscle fibers to scapulae muscles. Even though these two muscles offer different functions, they could potentially be involved in injuries that can cause neck and upper back issues.

 

How Trigger Points Affect The Splenius Muscles

 

One of the most common complaints many people seem to be impacted is shoulder and neck pain. Various factors can cause an impact on the shoulders and neck due to overusing the splenius muscles connected to the neck and shoulders and developing trigger points associated with the splenius muscles. Studies reveal that trigger points or myofascial pain can make the splenius muscles hypersensitive and tender along the taut band of the splenius muscles. To that point, the splenius muscles become palpable and produce localized pain to other structures along the neck, shoulders, and head. Trigger points are a bit complex to diagnose because they mimic other chronic issues that affect the body and potentially involve many common symptoms that could happen daily. Studies reveal that common symptoms like headaches are associated with trigger points along the head, neck, and shoulder muscles. Since trigger points are challenging to diagnose, they can make the taut band of the musculoskeletal fibers and become either active or latent when pressure is on the affected area. To that point, causes tension occurs in the body’s head, neck, and shoulders. Fortunately, various ways to manage trigger point pain are associated with neck pain along the splenius muscles.


Trigger Points & Splenius Muscles- Video

Have you been dealing with random headaches that randomly occur throughout the day? What about experiencing muscle stiffness and tenderness located on your neck and shoulders? Or have you been experiencing poor sleep throughout the night? Most of these symptoms are associated with trigger point pain associated with neck pain along the splenius muscles. The video above explains how trigger points affect the splenius muscles and some of the causes that lead to the development of trigger point pain along the splenius muscles. Many people dealing with trigger points associated with neck pain often explain to their doctors that they have been feeling muscle stiffness along their neck, causing limited mobility. Studies reveal that active myofascial trigger points along the neck and shoulder muscles elicited referred pain to contribute to symptoms of pain intensity, disability, and poor sleep quality to mechanical neck pain. To that point, many individuals try to incorporate various treatments to alleviate the symptoms and manage neck pain associated with trigger points.


Managing Neck Pain Associated With Trigger Points

 

Many people dealing with neck pain associated with trigger points along the splenius muscles often don’t realize that some causes affect how the muscles are used. Ordinary factors like poor posture, looking down at the phones, or leaning closer to any screens can cause strain on the splenius muscles. In contrast, traumatic factors like whiplash or auto accidents can inflict pain on the muscle fibers. Various ways to manage neck pain associated with trigger points are non-invasive unless the pain is severe. When a person goes to their primary doctor for a routine check-up, they describe the symptoms of pain affecting their bodies while the doctor examines them. Once the issue is diagnosed, many doctors will refer their patients to a pain specialist specializing in the matter. So say if a person is dealing with neck pain associated with trigger point pain along their splenius muscles that is causing them headaches, would be referred to a pain specialist like a chiropractor to relieve myofascial trigger pain along the splenius muscles that are suffering from spinal subluxation in the musculoskeletal system. Spinal adjustments allow the stiff muscles to become loose and even break up the adhesion of the trigger points on the muscle. Incorporating chiropractic care to treat neck pain associated with trigger points can bring back functionality to the body.

Conclusion

The neck allows the head to be mobile and help keeps it stable. As part of the cervical spine, the neck has many neuron pathways, ligaments, and muscles that work with the central nervous system to provide sensory-motor function. The muscles that provide functionality to the shoulders, neck, and upper back are called the splenius muscles. The splenius muscles consist of two groups: the capitis and cervicis, which have different jobs for neck functionality. However, like any muscle in the body may potentially be impacted by various issues that can cause neck and upper back issues. Common and traumatic issues can lead to the development of myofascial trigger pain along the neck muscles. To that point causes neck pain and disability to the neck. When this happens, various treatments are available to manage neck pain associated with myofascial pain and alleviate the symptoms, causing relief to the neck.

 

References

Chatchawan, Uraiwan, et al. “Characteristics and Distributions of Myofascial Trigger Points in Individuals with Chronic Tension-Type Headaches.” Journal of Physical Therapy Science, The Society of Physical Therapy Science, Apr. 2019, www.ncbi.nlm.nih.gov/pmc/articles/PMC6451952/.

Henson, Brandi, et al. “Anatomy, Back, Muscles – StatPearls – NCBI Bookshelf.” In: StatPearls [Internet]. Treasure Island (FL), StatPearls Publishing, 10 Aug. 2021, www.ncbi.nlm.nih.gov/books/NBK537074/.

Muñoz-Muñoz , Sonsoles, et al. “Myofascial Trigger Points, Pain, Disability, and Sleep Quality in Individuals with Mechanical Neck Pain.” Journal of Manipulative and Physiological Therapeutics, U.S. National Library of Medicine, Oct. 2012, pubmed.ncbi.nlm.nih.gov/23158466/.

Ribeiro, Daniel Cury, et al. “The Prevalence of Myofascial Trigger Points in Neck and Shoulder-Related Disorders: A Systematic Review of the Literature.” BMC Musculoskeletal Disorders, BioMed Central, 25 July 2018, www.ncbi.nlm.nih.gov/pmc/articles/PMC6060458/.

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Trigger Pain Affecting The Sternocleidomastoid Muscle

Trigger Pain Affecting The Sternocleidomastoid Muscle

Introduction

The neck is vital in keeping the head upright in a casual relationship with the cervical spine. The neck is home to the thyroid organ and the surrounding muscles that help support the neck to the rest of the body. One of the muscles that help support the neck is the sternocleidomastoid muscle. When traumatic forces begin to affect the neck, over time can lead to the development of chronic conditions associated with pain. When individuals start to feel pain affecting their neck, it can cause them to be miserable and find ways to relieve the pain they are experiencing. Today’s article focuses on the sternocleidomastoid muscle, how trigger pain affects this muscle, and ways to relieve SCM pain. We refer patients to certified providers who specialize in musculoskeletal treatments to aid individuals suffering from SCM associated with trigger pain along the neck. We also guide our patients by referring them to our associated medical providers based on their examination when appropriate. We ensure to find that education is the solution to asking our providers insightful questions. Dr. Jimenez DC observes this information as an educational service only. Disclaimer

11_Shah Role of Central Sensitization-compressed

What Is The Sternocleidomastoid Muscle?

Have you been experiencing pain along the sides of your neck? What about limited mobility when you turn your neck from side to side? Or do headaches seem to worsen throughout the entire day? Some of these symptoms are associated with pain along the neck and could affect the surrounding muscles that are connected. One of the surrounding muscles that sit behind the thyroid is known as SCM or sternocleidomastoid muscle. The sternocleidomastoid muscle is a long muscle with dual innervation and multiple functions in the neck. The SCM is connected to the trapezius muscle that helps flex the neck, pulling the head forward while bringing the chin down to the chest. The SCM and the trapezius muscle work together to help stabilize and fix the head position while the host is talking or eating. When factors affect the neck over time, the SCM also gets involved.

 

How Does Trigger Pain Affect The Sternocleidomastoid?

 

When factors affect SCM associated with the neck, many issues will start to affect the neck and overlap pain near the eyes, ears, sides of the cheeks, and forehead. Studies reveal that SCM may develop myofascial trigger points in the head, causing referred pain. Trigger points are usually formed when traumatic forces affect certain areas in the body. For SCM to be affected by trigger pain, tiny knots along the taut band of the SCM muscle fibers become sensitive to pressure when compressed, and many people often describe the pain as deep and dull. To that point, the symptoms associated with SCM trigger pain may appear in numerous combinations or together depending on how severe the pain is on the person. Some of the symptoms related to SCM trigger pain include:

  • Headaches (sinus, cluster, or tension)
  • Sore throat
  • Ear pain (popping sounds in the ears)
  • Blurred vision
  • Vertigo
  • Dizzyness
  • Balance issues
  • Muscle soreness

 


SCM Pain & Trigger Points- Video

Have you been dealing with headaches throughout the entire day? What about muscle tenderness in certain areas near your neck or shoulders? Or have you been feeling dizzy that it is affecting your daily activities? Many people with these symptoms may be dealing with SCM pain associated with trigger pain. The video above offers an insightful overview of how does trigger pain may be involved with SCM pain. SCM or sternocleidomastoid muscle is a long muscle that surrounds the sides of the neck and is connected to the trapezius muscle. When factors begin to affect the SCM, the muscle is at risk of developing trigger pain along the muscle fibers. Studies reveal that trigger pain along the SCM may affect SCM’s normal muscle functions, like chewing due to hyperactivity. Fortunately, there are ways to relieve SCM pain associated with trigger pain affecting the neck.


Ways To Relieve SCM Pain In The Neck

 

When it comes to SCM pain associated with trigger pain along the neck, many individuals find ways to relieve the related symptoms that are causing the pain. Some individuals will take over-the-counter medication to relieve their neck, shoulders, and head pain. At the same time, others do stretches to release the tension on their head, neck, and shoulders. However, trigger pain is a bit complex and challenging to diagnose since it mimics other conditions that affect the body. As luck would have it, many doctors will refer musculoskeletal specialists like massage therapists, physical therapists, and chiropractors who can help relieve SCM pain in the neck. Studies reveal that a combination of physiotherapy, classical massages, and stretching exercises can be applied to alleviate SCM pain in the neck. By stretching and massaging the SCM, many individuals can begin to feel pain relief in their neck, increase their range of motion, and have endurance in their neck. Integrating these various treatments for the SCM (sternocleidomastoid muscle) pain in the neck can help revitalize a person’s sense of well-being without being in pain.

 

Conclusion

The SCM, or sternocleidomastoid muscle, is a long muscle that sits behind the thyroid organ and is connected with the trapezius muscle. This muscle helps stabilize and holds the head position while flexing the neck and bringing the chin down to the chest. When environmental or traumatic factors affect the neck muscles, it can lead to chronic conditions over time, thus inflicting pain and tenderness along the SCM. These are known as trigger points and can be hard to diagnose due to them mimicking other chronic symptoms associated with the neck, head, and shoulders. Thankfully, various treatments like physiotherapy, stretching exercises, and classical massages can help relieve the trigger points along the SCM and relieve the neck and surrounding muscles.

 

References

Bordoni, Bruno, and Matthew Varacallo. “Anatomy, Head and Neck, Sternocleidomastoid Muscle.” In: StatPearls [Internet]. Treasure Island (FL), StatPearls Publishing, 5 Apr. 2022, www.ncbi.nlm.nih.gov/books/NBK532881/.

Büyükturan, Buket, et al. “The Effects of Combined Sternocleidomastoid Muscle Stretching and Massage on Pain, Disability, Endurance, Kinesiophobia, and Range of Motion in Individuals with Chronic Neck Pain: A Randomized, Single-Blind Study.” Musculoskeletal Science & Practice, U.S. National Library of Medicine, 12 June 2021, pubmed.ncbi.nlm.nih.gov/34147954/.

Kohno, S, et al. “Pain in the Sternocleidomastoid Muscle and Occlusal Interferences.” Journal of Oral Rehabilitation, U.S. National Library of Medicine, July 1988, pubmed.ncbi.nlm.nih.gov/3171759/.

Missaghi, Babak. “Sternocleidomastoid Syndrome: A Case Study.” The Journal of the Canadian Chiropractic Association, Canadian Chiropractic Association, Sept. 2004, www.ncbi.nlm.nih.gov/pmc/articles/PMC1769463/.

Disclaimer

Myofascial Trigger Pain Affecting The Trapezius Muscle

Myofascial Trigger Pain Affecting The Trapezius Muscle

Introduction

The body incorporates different muscles that have specific jobs to help mobilize the skeletal joints while providing function to the arms, neck, legs, and back. Many individuals use their muscles for everyday uses like lifting and carrying objects, moving from one place to another, and protecting vital organs from damage. To that point, issues like traumatic events, injuries, and environmental factors can affect the body and cause damage to the muscles. When the muscles are affected by these factors, tiny knots can form along the taut muscle band that can cause painful symptoms that affect specific areas in the body. One of the muscles affected by pain is the trapezius muscle, known as the “coat hanger” muscle, which can be associated with chronic symptoms of myofascial pain syndrome. Today’s article examines the trapezius muscle, how myofascial pain affects the trapezius muscle, and how to manage myofascial trapezius pain. We refer patients to certified providers specializing in musculoskeletal treatments to aid individuals suffering from trapezius muscle pain associated with myofascial pain. We also guide our patients by referring them to our associated medical providers based on their examination when it’s appropriate. We find that education is the solution to asking our providers insightful questions. Dr. Jimenez DC provides this information as an educational service only. Disclaimer

11_Shah Role of Central Sensitization-compressed

What Is The Trapezius Muscle?

 

Have you experienced pain in your neck, shoulders, or mid-upper back? Do you feel headaches occurring near your temples? What about tenderness in certain areas of your body? Some of these symptoms may appear in your trapezius muscles. The trapezius muscle is located across the back that looks like a simple trapezoid with upper, middle, and lower muscle fibers that have different functions for the upper-middle back, shoulders, and neck. While the entire trapezius muscle helps rotates, elevate, and retract the scapula while extending the head and neck, and turning the chin by itself. At the same time, the entire muscle can help with assisting the extension of the cervical and thoracic spine.

  • Upper Trapezius muscles: allow the shoulders to rise, bend the head and neck, and help support the weight of the upper extremities of the body, including the arms.
  • Middle Trapezius muscles: assist with flexion and abduction of the arms around the shoulders at a nearly full range.
  • Lower Trapezius muscles: Helps retract the scapula while rotating the glenoid fossa upwards by decompressing the vertebral borders of the scapula. These fibers help assist the flexion and abduction of the arms.

When traumatic forces or injuries affect the trapezius muscles, painful symptoms begin to affect the muscles, causing them to be tender to the touch and affecting different areas in the body.

 

How Does Myofascial Pain Affect The Trapezius Muscle?

 

When traumatic forces or injuries affect the trapezius muscles, certain parts of the shoulders, neck, and upper-mid back will experience pain-related symptoms. When people experience headaches and shoulder and neck pain in their bodies while feeling tenderness in their trapezius muscles, this is known as referred pain associated with myofascial pain. Myofascial pain is when tiny knots along the taut muscle bands begin to make the muscle area tender to the touch. Individuals who suffer from myofascial pain in their trapezius muscles might experience hyperirritable spots that inflict pain and motor dysfunction. Studies reveal that individuals who work in food services may have symptoms of shoulder pain associated with myofascial pain due to repetitive motions on the upper trapezius muscles affecting their upper bodies. Myofascial trigger pain is a bit challenging to diagnose since the pain can be in different locations and mimic various ailments in the body. To that point, when the trapezius muscles are affected by trigger pain may potentially be involved with cervical myofascial pain. Cervical myofascial pain is a disorder that causes pain from muscle overuse or trauma in the neck. When the pain affects the neck muscles, it can travel down to the trapezius muscles causing tenderness and sensitivity in the affected muscle area. Stress, postural mechanics, or repetitive movements can develop myofascial pain syndrome and affect the surrounding muscles.


Trapezius Trigger Points- Video

Have you felt sore around your shoulders, neck, and upper-mid back? What about muscle tenderness in certain areas of your body? Do you feel tension along your neck or near the temples of your head? If you have been dealing with any of these symptoms, then you might be experiencing myofascial trapezius pain. The video above explains how trigger points from traumatic events can affect the trapezius muscle and cause referred pain that overlaps other conditions that may affect the body. Studies reveal that trigger points in the head and neck muscles of many suffering individuals have tension-type headaches. Tension-type headaches are one of the symptoms associated with myofascial trapezius pain. Some of the other symptoms related to myofascial pain affecting the trapezius muscle include:

  • Deep aching pain
  • Stiffness
  • Muscle spasms
  • Tightness around the shoulder and neck
  • Tenderness along the shoulders, neck, and upper back
  • Occipital headaches

 


How To Manage Myofascial Trapezius Pain

 

When many individuals suffer from myofascial trapezius pain, many would go to their primary doctor and explain to them that they are experiencing tension headaches constantly. Since myofascial pain is associated with the trapezius muscle is a bit complex and challenging for doctors to diagnose since every person’s pain is different. Many doctors will refer their patients to associated specialists like physical therapists, massage therapists, or chiropractors to determine where the pain is located along the trapezius muscle. Different treatments can help alleviate stiff muscles, and studies reveal that spinal manipulative therapy can help manage chronic pain from myofascial origins. Spinal subluxations or misalignment could potentially involve the corresponding spinal nerve root causing antinociceptive effects to the tender muscle, thus causing pain to the trapezius muscle. Utilizing various treatments to treat myofascial trapezius pain can provide individuals with beneficial relief from their pain along with managing their associated symptoms.

 

Conclusion

The trapezius muscle is a large superficial trapezoid-shaped muscle located in the back. The upper, middle, and lower muscle fibers have different functions in the head, neck, shoulders, and arms. The trapezius muscle also helps with assisting the extension of the cervical and thoracic spine. When traumatic events or injuries affect the trapezius muscle, it can be developed over time to create trigger points along the taut muscle band of the trapezius muscle and cause referred pain to the upper extremities of the body. Luckily various treatments can help manage the associated pain symptoms from myofascial trapezius pain and can help many individuals get back on their health and wellness journey.

 

References

Fernández-de-Las-Peñas, César, et al. “Myofascial Trigger Points and Their Relationship to Headache Clinical Parameters in Chronic Tension-Type Headache.” Headache, U.S. National Library of Medicine, Sept. 2006, pubmed.ncbi.nlm.nih.gov/16942471/.

Hwang, Ui-Jae, et al. “Predictors of Upper Trapezius Pain with Myofascial Trigger Points in Food Service Workers: The Strobe Study.” Medicine, Wolters Kluwer Health, June 2017, www.ncbi.nlm.nih.gov/pmc/articles/PMC5500039.

Laframboise, Michelle A, et al. “Effect of Two Consecutive Spinal Manipulations in a Single Session on Myofascial Pain Pressure Sensitivity: A Randomized Controlled Trial.” The Journal of the Canadian Chiropractic Association, Canadian Chiropractic Association, June 2016, www.ncbi.nlm.nih.gov/pmc/articles/PMC4915475/.

Ourieff, Jared, et al. “Anatomy, Back, Trapezius – StatPearls – NCBI Bookshelf.” In: StatPearls [Internet]. Treasure Island (FL), StatPearls Publishing, 26 July 2021, www.ncbi.nlm.nih.gov/books/NBK518994/.

Touma, Jeffrey, et al. “Cervical Myofascial Pain – Statpearls – NCBI Bookshelf.” In: StatPearls [Internet]. Treasure Island (FL), StatPearls Publishing, 4 July 2022, www.ncbi.nlm.nih.gov/books/NBK507825/.

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Neck Pain Associated With Myofascial Trigger Pain

Neck Pain Associated With Myofascial Trigger Pain

Introduction

The neck ensures that the head is upright in the body while providing mobility to rotate, bend, and tilt in various directions. The neck is part of the cervical spine and provides sensory-motor functions from the nerve pathways spread out along the shoulders and upper back. When traumatic events or injuries affect the cervical spine and cause pain to the neck over time, however, if not treated, it can lead to problematic symptoms associated with muscle pain. Neck pain can lead to muscle stiffness and cause myofascial trigger pain associated with referred pain along the rest of the upper body. Today’s article looks at the effects of neck pain, how it is associated with myofascial trigger pain, and ways to manage neck pain associated with myofascial trigger pain. We refer patients to certified providers specializing in musculoskeletal treatments to aid individuals suffering from neck pain associated with myofascial trigger pain. We also guide our patients by referring them to our associated medical providers based on their examination when it’s appropriate. We find that education is the solution to asking our providers insightful questions. Dr. Jimenez DC provides this information as an educational service only. Disclaimer

11 Trindade Endocrine Disruption-compressed

The Effects Of Neck Pain

 

Have you been feeling muscle stiffness around your neck and shoulders? Do you experience random headaches that affect your day? What about feeling tingling sensations along your arms and hands? These symptoms are associated with neck pain and can affect many individuals if not treated over time. Many people who suffer from neck pain will feel muscle stiffness that affects not only the sides of the neck but around the shoulders and their upper back. Studies reveal that neck pain is a multifactorial musculoskeletal disorder that affects the worldwide population and can become a chronic problem. Risk factors associated with the contributing development of neck pain include:

  • Stress
  • Poor posture
  • Anxiety
  • Sleep position
  • Neuromusculoskeletal disorders
  • Auto accidents
  • Traumatic events

Many of these risk factors associated with neck pain can cause pain symptoms and cause pain in different locations of the body, making diagnosing the pain source problematic for doctors.

 

Neck Pain Associated With Myofascial Trigger Pain

Since neck pain is common for many individuals, one of the symptoms associated with muscle stiffness and tenderness is myofascial trigger pain overlapping neck pain. Studies reveal that the formation of trigger points is caused when various physical activities begin to yield repetitive stress or cause micro-tears in the definite muscle groups that can cause tension within the muscle fibers. To that point, knots in the taut band of the muscles become hypersensitive and produce referred pain, tenderness, motor dysfunction, and autonomic phenomena. When the neck suffers from a traumatic event that affects the spine, over time can create trigger points or myofascial pain. It is difficult to diagnose where the pain is located in the body because myofascial trigger pain often mimics other pain conditions. It can confuse many individuals as they think they are suffering from one pain, but it’s a different pain that affects their body. Other studies reveal that individuals with myofascial pain syndrome associated with neck pain have a tender point within the tight muscular band, causing local discomfort. To that point, myofascial pain can cause referral pain in remote areas like cervical spine disorders like herniation can often be confused with myofascial pain when there is referral pain in the upper extremities of the body. Some of the symptoms associated with myofascial trigger pain that affects the neck include:

  • Deep, aching pain
  • Headaches
  • Muscle tenderness in the neck or shoulders
  • Tingling sensation or numbness down the arms and hands
  • Muscle stiffness

 


Neck Pain & Trigger Points- Video

Are you experiencing numbness that is running down your shoulders to your hands? What about muscle stiffness along the sides of the neck or shoulders? Or do headaches seem to pop out of nowhere and affect your day? You could risk suffering from neck pain associated with myofascial trigger pain. The video above explains how neck pain is associated with trigger points and how to trigger pain can be primary or secondary to neck pain. Studies reveal that myofascial pain syndrome is a common muscular pain disorder that is misunderstood and involves referred pain to form minor, tender trigger points within the muscles. To that point, myofascial pain associated with neck pain may be consistent with specific patterns of pain associated with each trigger point, contributing factors like emotional, postural, and behavioral factors that cause tension in the neck and frequently related symptoms from various conditions make diagnosing difficult. Since myofascial trigger points are complex and mimic other conditions that affect a different body part, many believe that different ailments affect their body than the actual ailment itself. Thankfully there are ways to manage neck pain associated with myofascial trigger pain and relieve muscle pain.


Ways To Manage Neck Pain Associated With Myofascial Trigger Pain

 

Since myofascial trigger pain associated with the neck can be a bit complex and challenging to diagnose, many doctors will refer patients to a physical therapist, a chiropractor, or another spine specialist to examine the trigger points causing neck pain. Various treatments can range from home remedies to severe muscle injections, depending on how severe the injuries are since everyone’s pain is different. Some of the available treatments that can reduce and manage myofascial neck pain include:

  • Exercising (helps stretch and strengthen neck and upper back muscles)
  • Massage (helps loosen stiff muscles in the neck and shoulders)
  • Heat therapy (helps relax and increase blood flow to the affected area)
  • Chiropractic care (uses spinal manipulation to prevent further pain issues from happening)
  • Acupuncture (helps to relax the trigger point and relieve pain)

Incorporating these various treatments can provide beneficial relief to those suffering from myofascial neck pain and help manage the symptoms associated with the body.

 

Conclusion

The neck provides mobility to the head as it can rotate, bend, and tilt in various directions while providing sensory-motor functions to the shoulders and upper back from the nerve roots in the cervical spine. When traumatic forces impact the neck, myofascial trigger pain can lead to neck pain. Myofascial trigger pain associated with neck pain is where tiny knots in the affected neck muscles become tender and stiff, which causes referred pain to different locations in the body. Myofascial neck pain is challenging to diagnose but manageable to treat with various treatments and techniques that can release the knots from the affected muscle and prevent future symptoms from happening. This allows many individuals to feel relief from their neck pain and continue their wellness journey.

 

References

Alghadir, Ahmad H, et al. “Efficacy of Combination Therapies on Neck Pain and Muscle Tenderness in Male Patients with Upper Trapezius Active Myofascial Trigger Points.” BioMed Research International, Hindawi, 10 Mar. 2020, www.ncbi.nlm.nih.gov/pmc/articles/PMC7085833/.

Ezzati, Kamran, et al. “Prevalence of Cervical Myofascial Pain Syndrome and Its Correlation with the Severity of Pain and Disability in Patients with Chronic Non-Specific Neck Pain.” The Archives of Bone and Joint Surgery, Mashhad University of Medical Sciences, Mar. 2021, www.ncbi.nlm.nih.gov/pmc/articles/PMC8121028/.

Fricton, J R, et al. “Myofascial Pain Syndrome of the Head and Neck: A Review of Clinical Characteristics of 164 Patients.” Oral Surgery, Oral Medicine, and Oral Pathology, U.S. National Library of Medicine, Dec. 1985, pubmed.ncbi.nlm.nih.gov/3865133/.

Kazeminasab, Somaye, et al. “Neck Pain: Global Epidemiology, Trends and Risk Factors.” BMC Musculoskeletal Disorders, BioMed Central, 3 Jan. 2022, www.ncbi.nlm.nih.gov/pmc/articles/PMC8725362/.

Disclaimer

Chiropractor Recommendations Neck Pain and Cervical Spinal Stenosis

Chiropractor Recommendations Neck Pain and Cervical Spinal Stenosis

Cervical spinal stenosis is a condition that causes narrowing of the neck region of the spine. This narrowing can compress the nerves causing pain and discomfort. The symptoms are caused by the misalignment/subluxation of the neck, which is usually the c1 and c2 vertebrae. Misalignments can be caused by daily wear and tear; injuries and tumors can cause or worsen the condition. Cervical spinal stenosis is a severe condition that worsens as time progresses and can cause permanent damage and paralysis. Chiropractor recommendations and non-invasive techniques can alleviate the symptoms, along with therapeutic stretches and exercises, and diet is all part of a personalized treatment plan.

Chiropractor Recommendations: Cervical Spinal Stenosis

Stenosis Symptoms

The most common symptom is neck pain. Doctors recommend avoiding all activities that worsen the pain; however, chiropractors suggest remaining as active as possible to keep the muscles strong. This is because inactivity over time can lead to muscular deterioration around the neck. Other symptoms besides neck pain include:

  • Neck discomfort and pain
  • Headaches
  • Numbness, tingling in the shoulder, arm, hand
  • Difficulty maintaining balance
  • Walking problems

Chiropractor Recommendations

Pain Or Stiffness In The Neck Should Not Be Ignored

  • Pain or stiffness in the neck that worsens rapidly or does not ease up or go away after two weeks requires medical attention.
  • Ignoring or dismissing the pain or stiffness can worsen the condition.

Looking Down At A Phone Too Long

  • Looking down too long increases the strain on the neck.
  • Keeping the head forward for extended periods increases the chances of pinching/compressing nerves and causing radiculopathy.

Exercises That Roll The Neck Around

  • Exercises that roll or pull the neck are not advised as they can exacerbate the condition.
  • A chiropractor will recommend specific neck stretches and exercises on a case-by-case basis.

Heavy Bag, Purse, BackPack On One Shoulder

  • It is recommended to carry a backpack with both shoulders to distribute the weight evenly.
  • Over time, a backpack, bag, or purse on the same shoulder will disrupt the walk cycle and pull down on one side of the neck, exacerbating cervical spinal stenosis.
  • For bags and purses with one strap, it is recommended to alternate shoulders or use a crossbody strap.

Sleeping On The Stomach

  • Sleeping on the stomach means having to turn the neck to one side.
  • This stresses and aggravates cervical stenosis.
  • It is recommended to sleep on the side or back.

Treatment, Therapy, and Rehabilitation

  • Chiropractic is recommended for spinal stenosis because it corrects and re-aligns dislocated and herniated discs and decompresses the spine.
  • Treatment reduces pressure on the spinal cord and its joints and nerve networks.
  • Various techniques include physiotherapeutic massage, spinal adjustments, cervical traction, spinal decompression, and flexion-distraction, which will address stenosis symptoms, treat pain, reduce inflammation, numbness, and restore muscle function.

Non-Surgical Cervical Decompression


References

Clark, Aaron J et al. “Cervical spinal stenosis and sports-related cervical cord neurapraxia.” Neurosurgical focus vol. 31,5 (2011): E7. doi:10.3171/2011.7.FOCUS11173

Kukurin, George W. “The amelioration of symptoms in cervical spinal stenosis with spinal cord deformation through specific chiropractic manipulation: a case report with long-term follow-up.” Journal of manipulative and physiological therapeutics vol. 27,5 (2004): e7. doi:10.1016/j.jmpt.2004.04.009

Isaac Z. Evaluation of the patient with neck pain and cervical spine disorders. UpToDate. www.uptodate.com/contents/evaluation-of-the-patient-with-neck-pain-and-cervical-spine-disorders. Last updated May 2, 2016. Accessed February 25, 2018.

Headaches As A Somatovisceral Problem

Headaches As A Somatovisceral Problem

Introduction

Everyone has headaches at some point throughout their lives, which can be excruciating, depending on the severity. Whether it is a heavy workload that causes a person to have severe tension on their foreheads, allergies that cause immense pressure in between the sinus cavity in the middle of the face, or common factors that seem to cause a pounding sensation in the head, headaches are no joke. Often, headaches seem to go away when it’s in their acute form but can become chronic when the pain doesn’t go away, causing issues to the eyes and muscles. Today’s article looks at how headaches affect the body and how they can become a somatovisceral problem for many individuals. We refer patients to certified, skilled providers specializing in neurological treatments that help those individuals that are suffering from headaches. We also guide our patients by referring to our associated medical providers based on their examination when it’s appropriate. We find that education is critical for asking insightful questions to our providers. Dr. Alex Jimenez DC provides this information as an educational service only. Disclaimer

 

Can my insurance cover it? Yes, it may. If you are uncertain, here is the link to all the insurance providers we cover. If you have any questions or concerns, please call Dr. Jimenez at 915-850-0900.

05 - Cooper A4M Headache - 1 Slide-compressed

How Headaches Affect The Body

 

Do you feel a pounding sensation in your forehead? Do your eyes seem to become dilated and sensitive to light? Do both arms or hands seem to lock up and have a pins-and-needles sensation that feels uncomfortable? These signs and symptoms are various forms of headaches affecting the head. The head helps protect the brain from damage as the neuron signals from the central nervous system are connected to the cervical regions of the spine. When factors like lifestyle habits, dietary food intake, and stress affect the central nervous system, they begin to co-mingle to form various forms of headaches. Each form of headache continuously shifts in many suffering individuals to never sit still for their clinicians to capture their specific profile. Some of the multiple headaches include:

  • Tension headaches
  • Migraines
  • Stress headaches
  • Sinus pressure
  • Clustered headaches

When headaches begin to affect the neck and head, research shows that these headaches cause a convergence between the cervical sections of the spine and the skull base. This becomes a mediator for the neck and head to develop referred pain. Referred pain is known as pain that occurs in one section of the body than where it is located. For example, say someone has been through a traumatic injury that causes them to have whiplash in their neck; that pain in their neck muscles can mimic a headache affecting one side of their head. Additional information has mentioned that migraine headaches can cause chronic inflammatory issues in the gut-brain axis, causing dysfunctional autonomic and enteric nervous systems and affecting the body. 


How The Body Deals With  Migraines-Video

Have you experienced throbbing in various sections of your face? Do you feel your muscles tense up around your neck or shoulders? Or does your body feel exhausted that noise seems to cause immense pain? The various forms of headaches can cause many problems not only in the neck but in the body as well. The video above shows what happens to the body when a person is suffering from a migraine. Research studies have noticed that individuals suffering from migraines will develop associated somatic comorbid symptoms like anxiety and depression, making migraine headaches more frequent. At the same time, being the top three of the most common forms of headaches, migraines may share a common underlying mechanism involving the overlapping profiles of the cerebrovascular system that is equivalent to a repetitive stress disorder affecting the central nervous system.


How Headaches Are A Somatovisceral Problem

 

Research studies have found that the severity of the headache in a person, especially in women, causes a synergetic relationship that causes somatic symptoms and depression to be so high. This is due to the overlapping risk profiles that affect the mechanisms of the sympathetic nervous system, causing the production of cervicogenic headaches and chronic migraines to form. This is because the junction of the brain stem and the spinal cord is called the trigeminocervical nucleus and overlaps the nociceptive cells. When this happens, The close anatomic pain fibers from the cervical spine and the trigeminal system start to be aggravated; it creates pain impulses from the neck to the head, causing headaches to be interpreted. 

 

Conclusion

Overall, headaches are no joke when they start to affect the body and cause mimic pain in different parts of the body. When various factors begin to cause somatic issues that tense the muscles but also affect the surrounding nerves, it can cause headaches to form and become excruciating. Different forms of headaches can affect other regions of the face and can go away for a short period in their acute form. However, in its chronic condition, it can cause the body to be in so much pain. Finding ways to prevent headaches from progressing further can benefit the individual.

 

References

Castien, René, and Willem De Hertogh. “A Neuroscience Perspective of Physical Treatment of Headache and Neck Pain.” Frontiers in Neurology, Frontiers Media S.A., 26 Mar. 2019, www.ncbi.nlm.nih.gov/pmc/articles/PMC6443880/.

Cámara-Lemarroy, Carlos R, et al. “Gastrointestinal Disorders Associated with Migraine: A Comprehensive Review.” World Journal of Gastroenterology, Baishideng Publishing Group Inc, 28 Sept. 2016, www.ncbi.nlm.nih.gov/pmc/articles/PMC5037083/.

Maizels, Morris, and Raoul Burchette. “Somatic Symptoms in Headache Patients: The Influence of Headache Diagnosis, Frequency, and Comorbidity.” Headache, U.S. National Library of Medicine, 2004, pubmed.ncbi.nlm.nih.gov/15546261/.

Tietjen;Brandes JL;Digre KB;Baggaley S;Martin V;Recober A;Geweke LO;Hafeez F;Aurora SK;Herial NA;Utley C;Khuder SA;, G E. “High Prevalence of Somatic Symptoms and Depression in Women with Disabling Chronic Headache.” Neurology, U.S. National Library of Medicine, 9 Jan. 2007, pubmed.ncbi.nlm.nih.gov/17210894/.

Disclaimer

Decompression For Alleviating Myelopathy Neck Pain

Decompression For Alleviating Myelopathy Neck Pain

Introduction

The neck has two functions that allow the body to make sure that it holds the head up. The motor functions enable the neck to be mobile with the head as it can turn, twist and rotate without any discomfort or pain affecting it. For the sensory functions, the neck can feel when it has been stretched or adjusted or feel pain when it is injured. These two functions ensure that the neck is working correctly, but when injuries or unwanted events occur and affect the neck, it can cause unwanted problems. Neck injuries have a wide range of painful symptoms that can affect the spine’s head, neck, and cervical region. Today’s article will focus on myelopathy neck pain, its causes and symptoms, and how decompression therapy can help alleviate myelopathy neck pain for many individuals. Referring patients to qualified and skilled providers who specialize in spinal decompression therapy. We guide our patients by referring to our associated medical providers based on their examination when it’s appropriate. We find that education is essential for asking insightful questions to our providers. Dr. Alex Jimenez DC provides this information as an educational service only. Disclaimer

 

Can my insurance cover it? Yes, it may. If you are uncertain, here is the link to all the insurance providers we cover. If you have any questions or concerns, please call Dr. Jimenez at 915-850-0900.

G-11 - Decompression and Sensory nerves

What Is Myelopathy Pain?

 

Have you been experiencing upper back or neck pain? Do you feel a tingling sensation running from your neck down to your hands? Or have you experienced difficulty in simple tasks like writing or putting on clothes? Experiencing these symptoms might show that you are suffering from myelopathy pain in the neck and cervical area of the spine. Research studies have defined myelopathy pain as when the neck suffers from a traumatic injury that causes severe compression on the spinal cord in the cervical area. The spinal cord in the spine has nerve roots that are branched out in the cervical region and allow the signals to be transported from the brain to the rest of the body. When traumatic injuries cause an impact on the spine, the blunt force will compress the spinal cord causing unwanted symptoms that affects either the cervical or lumbar portions of the spine. When the spinal cord becomes compressed, it can cause issues to the cervical part of the spine’s sensory and motor neck functions. 

 

The Symptoms & Causes

When a person is suffering from myelopathy pain in the cervical regions of their spine, research studies have shown that the symptoms that myelopathy pain causes are motor dysfunction, where a person is having difficulty doing ordinary activities like getting ready for the day. Other symptoms that cervical myelopathy can cause to the neck are sensory dysfunctions, where the arms and hands feel numb to the touch. This tingling sensation gives off a pins and needles feeling to the body, and it can become uncomfortable for many individuals experiencing this sensation. This could be due to the cervical nerves and the spinal cord nerves being in pain. Additional research has mentioned that cervical myelopathy is caused when osteoarthritic changes in the spinal column that causes the spinal canal to be reduced. Myelopathy cervical pain can also be caused by cervical herniation in the neck, where the spinal discs aggravate the nerve roots. Other causes for the development of myelopathy are:

 

 


Cervical Traction/Decompression Treatment-Video

Feeling a tingling sensation running down from your shoulders to your hands? How about muscle stiffness from your neck turning it side to side? Is it difficult to do simple tasks like brushing your hair or buttoning up a shirt? Perhaps you are experiencing cervical myelopathy in the neck that is causing these symptoms, and decompression/traction treatments could be the relief you need. The video above shows how to assemble the Chatanooga decompression machine for cervical decompression/traction treatments. This treatment allows the individual to lay their head on the traction table and be secured. The device enables moderate pulling to release the pinched nerves from causing more pain to the neck and upper half of the body. Cervical decompression/traction can also help with neck and spinal issues like cervical herniation, radicular pain, and muscle stiffness. Cervical decompression/traction therapy has many beneficial factors in a person’s wellness treatment. This link will explain how cervical decompression offers impressive relief for many people who suffer from neck pain and cervical myelopathy.


How Decompression Therapy Helps Alleviate Myelopathy Neck Pain

 

With myelopathy, neck pain causing not only neck pain but also upper body pain that hinders a person’s ability to do simple tasks. Research studies have shown that decompression surgery can help alleviate myelopathy neck pain by restoring the neurological motor function back in the spinal cord and providing relief to the cervical nerve roots. Other research studies have found that decompression treatments for myelopathy neck pain can help improve neck functionality, reduce neck disability, and even help restore a person’s quality of life by bringing back their motor function for the upper extremities that are associated with the neck. 

 

Conclusion

Overall, having myelopathy neck pain can cause a person to lose their motor and sensory functions in their upper body. The factors like herniation, spinal spondylolysis, and spinal injuries are some of the causes of the development of myelopathy. It can make a person deal with constant neck pain without finding relief. Decompression treatments help many suffering individuals dealing with myelopathy neck pain by relieving the tension from the cervical nerve root that is causing the pain signals in the cervical area. By reducing the inflamed cervical nerve, people can feel the relief they desire when incorporating decompression treatments into their wellness journey.

 

References

Cheung, W Y, et al. “Neurological Recovery after Surgical Decompression in Patients with Cervical Spondylotic Myelopathy – a Prospective Study.” International Orthopaedics, Springer-Verlag, Apr. 2008, www.ncbi.nlm.nih.gov/pmc/articles/PMC2269013/.

Donnally, Chester J, et al. “Cervical Myelopathy.” In: StatPearls [Internet]. Treasure Island (FL), StatPearls Publishing, 6 Mar. 2022, www.ncbi.nlm.nih.gov/books/NBK482312/.

Fehlings;Wilson JR;Kopjar B;Yoon ST;Arnold PM;Massicotte EM;Vaccaro AR;Brodke DS;Shaffrey CI;Smith JS;Woodard EJ;Banco RJ;Chapman JR;Janssen ME;Bono CM;Sasso RC;Dekutoski MB;Gokaslan ZL;, Michael G. “Efficacy and Safety of Surgical Decompression in Patients with Cervical Spondylotic Myelopathy: Results of the Aospine North America Prospective Multi-Center Study.” The Journal of Bone and Joint Surgery. American Volume, U.S. National Library of Medicine, 18 Sept. 2013, pubmed.ncbi.nlm.nih.gov/24048552/.

Medical Professionals, Cleveland Clinic. “Myelopathy: Symptoms, Causes and Treatments.” Cleveland Clinic, 2 Oct. 2021, my.clevelandclinic.org/health/diseases/21966-myelopathy.

Milligan, James, et al. “Degenerative Cervical Myelopathy: Diagnosis and Management in Primary Care.” Canadian Family Physician Medecin De Famille Canadien, College of Family Physicians of Canada, Sept. 2019, www.ncbi.nlm.nih.gov/pmc/articles/PMC6741789/.

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Decompression Therapy For Relieving Cervical Herniation

Decompression Therapy For Relieving Cervical Herniation

Introduction

As part of the upper body, the neck’s job is to keep the head upright while providing motor functions to turn up, down, left, and right while rotating it counter and clock-wise without any issues or pain. Like the lower back, the neck is enveloped by the spinal cord, ligaments, and soft muscle tissues that protect the cervical area of the spinal column from unwanted factors and injuries. When undesirable factors or injuries cause neck issues, it can affect a person’s ability to keep their head upright. Many injuries or natural factors cause a person to look down constantly and cause tension in the neck and shoulder muscle areas that makes them hunched over. Luckily, treatments are available to help restore neck function back to the individual. Today’s article discusses cervical herniation, how it affects the neck, and how decompression treatments can help relieve the cervical area on the spine. Referring patients to qualified and skilled providers who specialize in spinal decompression therapy. We guide our patients by referring to our associated medical providers based on their examination when it’s appropriate. We find that education is essential for asking insightful questions to our providers. Dr. Alex Jimenez DC provides this information as an educational service only. Disclaimer

 

Can my insurance cover it? Yes, it may. If you are uncertain, here is the link to all the insurance providers we cover. If you have any questions or concerns, please call Dr. Jimenez at 915-850-0900.

FreeReport-Herniations

What Is Cervical Herniation?

 

Have you been feeling stiffness around your neck and shoulder areas? Does your neck ache after hunching over the computer after work? How about the crick in your neck that seems to be irritating? All of these symptoms are due to herniation in the cervical area of the spine. Research studies have defined cervical disc herniation as one of the most common causes of neck pain in individuals. When the body starts to naturally age, the spine does as well. The cervical area of the spine protects the spinal cord through ligaments, soft tissues, nerves, and spinal discs, just like the lower back in the lumbar regions. When there are issues that cause pain in the cervical area, additional research shows that nerve root irritation can cause a wide range of pain in the neck. The pain can be mild to severe depending on the herniated disc’s impact and the severity of the neck’s injury.

 

How Does It Affect The Neck?

Research studies have found that cervical herniation can affect the neck due to the variety of symptoms that it causes. In the upper and lower segments of the spine, disc herniation symptoms are mainly caused due to compression along the spinal nerves, causing them to become aggravated in these two regions. Some of the progressing pain that the neck suffers from cervical herniation can affect one area of the neck, which is axial pain, or it can affect the cervical nerve root that travels down from the shoulders to the hands, which is known as radicular pain. These types of neck pain can be due to cervical herniation and cause a person to be miserable. Additional research studies have shown that when cervical disc herniation starts to progress further, individuals with a sedentary lifestyle haven’t found ways to alleviate the progressing pain that the neck is suffering from. Fortunately, there are treatments for relieving not only neck pain but can restore the cervical spinal discs back in the spine.

 


Cervical Traction For Neck Herniation-Video

Have you been experiencing muscle stiffness in the cervical portion of your neck? How about traveling pain from your shoulders to your hands? Do you feel any pain from stretching your neck from side to side to try and relieve it? Experiencing cervical herniation is no joke regarding your neck and spinal health. Why not give cervical decompression or traction a try? The video above shows what cervical traction does for individuals suffering from neck herniation. Cervical traction can provide beneficial results for people who need relief from neck pain, tension headaches, and migraines impacting their lives. Cervical traction allows the cervical herniated discs to lay off on the irritated cervical nerve and relieve the neck through gentle pulling. Cervical decompression/traction therapy has many beneficial factors in a person’s wellness treatment. This link will explain how cervical decompression offers impressive comfort for many people who suffer from neck pain and cervical herniation.


How Does Decompression Therapy Help With Cervical Herniation

 

Since the neck helps make sure that the head is kept upright and unwanted circumstances and injuries occur on the neck, many treatments are there to help many individuals who suffer from cervical herniation or neck pain. Research studies have found that spinal decompression treatments for the cervical spine can help improve cervical disc herniation symptoms in the neck. What cervical decompression does to the neck is that it helps promote inflammatory absorption in the neuromuscular tissues while also enhancing and restoring the natural curvature of the cervical spine. When individuals utilize cervical decompression therapy for their neck pain, it helps them rebuild the lost biomechanical balance in the cervical vertebrae and promotes healing of the neck. 

 

Conclusion

The neck’s primary function in the body is to make sure that the head is upright and can move around without feeling any pain or issues. However, just like the lower back, the neck can suffer from injuries like disc herniation, neck pain, and neck-related problems that can cause a person to be miserable. Cervical decompression/traction therapy has been a promising non-surgical treatment for neck pain by gently pulling on the cervical area, allowing the cervical disc herniation to be back in the spine and cause relief to the person. This treatment can be a part of a person’s wellness journey in finding ways to relieve pain one section at a time.

 

References

Curtis, Scott. “All about Neck Pain.” Spine, Spine-Health, 9 Dec. 2019, www.spine-health.com/conditions/neck-pain/all-about-neck-pain.

Dydyk, Alexander M, et al. “Disc Herniation – Statpearls – NCBI Bookshelf.” In: StatPearls [Internet]. Treasure Island (FL), StatPearls Publishing, 18 Jan. 2022, www.ncbi.nlm.nih.gov/books/NBK441822/.

Sharrak, Samir, and Yasir Al Khalili. “Cervical Disc Herniation – Statpearls – NCBI Bookshelf.” In: StatPearls [Internet]. Treasure Island (FL), StatPearls Publishing, 20 Jan. 2022, www.ncbi.nlm.nih.gov/books/NBK546618/.

Turk, Okan, and Can Yaldiz. “Spontaneous Regression of Cervical Discs: Retrospective Analysis of 14 Cases.” Medicine, Wolters Kluwer Health, Feb. 2019, www.ncbi.nlm.nih.gov/pmc/articles/PMC6407963/.

Xu, Qing, et al. “Nonsurgical Spinal Decompression System Traction Combined with Electroacupuncture in the Treatment of Multi-Segmental Cervical Disc Herniation: A Case Report.” Medicine, Lippincott Williams & Wilkins, 21 Jan. 2022, www.ncbi.nlm.nih.gov/pmc/articles/PMC8772752/.

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Disc Bulge & Herniation Chiropractic Care Overview

Disc Bulge & Herniation Chiropractic Care Overview

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

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

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

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

Normal Intervertebral Disc Anatomy

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

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

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

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

Effect of Intervertebral Disc Morphology on Structure and Function

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

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

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

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

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

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

What is a Disc Bulge?

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

Causes for Disc Bulging

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

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

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

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

Symptoms of Disc Bulging

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

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

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

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

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

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

Diagnosis of Disc Bulging

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

MRI of Disc Bulge

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

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

Treatment of Disc Bulging

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

Conservative Treatment

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

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

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

Surgical Treatment

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

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

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

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

What is a Disc Herniation?

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

Classifications of Disc Herniation

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Epidemiology

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

Risk Factors

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

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

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

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

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

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

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

Pathogenesis of Sciatica and Disc Herniation

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

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

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

Clinical Disc Herniation and What to Look for in the History

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

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

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

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

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

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

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

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

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

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

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

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

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

Differential Diagnosis

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

Examination in Disc Herniation

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

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

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

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

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

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

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

Investigation of Disc Herniation

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

Magnetic Resonance Imaging (MRI)

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

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

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

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

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

Computed Tomography (CT)

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

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

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

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

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

Radiography

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

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

Diskography

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

Treatment of Herniated Disc

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

Conservative Therapy

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

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

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

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

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

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

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

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

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

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

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

Surgical Therapy

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

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

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

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

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

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

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

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

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

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

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

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

Complications of the Surgery

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

Outcomes of the Surgery

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

Novel Therapies

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

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

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

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

 

El Paso Chiropractor Near Me

Dr. Alex Jimenez DC, MSACP, RN, CCST

 

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

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

 

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  • Moazzaz, Payam et al. 80. Positional MRI: A Valuable Tool In The Assessment Of Cervical Disc Bulge. The Spine Journal, vol 7, no. 5, 2007, p. 39S. Elsevier BV, doi:10.1016/j.spinee.2007.07.097.
  • Lumbar Disc Disease: Background, History Of The Procedure, Problem. Emedicine.Medscape.Com, 2017, emedicine.medscape.com/article/249113-overview.
  • Vialle, Luis Roberto et al. LUMBAR DISC HERNIATION. Revista Brasileira de Ortopedia 45.1 (2010): 1722. PMC. Web. 1 Oct. 2017.
  • Herniated Nucleus Pulposus: Background, Anatomy, Pathophysiology. emedicine.medscape.com/article/1263961-overview.
  • Vialle, Luis Roberto et al. LUMBAR DISC HERNIATION. Revista Brasileira De Ortopedia (English Edition), vol 45, no. 1, 2010, pp. 17-22. Elsevier BV, doi:10.1016/s2255-4971(15)30211-1.
  • Mullen, Denis et al. Pathophysiology Of Disk-Related Sciatica. I. Evidence Supporting A Chemical Component. Joint Bone Spine, vol 73, no. 2, 2006, pp. 151-158. Elsevier BV, doi:10.1016/j.jbspin.2005.03.003.
  • Jacobs, Wilco C. H. et al. Surgical Techniques For Sciatica Due To Herniated Disc, A Systematic Review. European Spine Journal, vol 21, no. 11, 2012, pp. 2232-2251. Springer Nature, doi:10.1007/s00586-012-2422-9.
  • Rutkowski, B. Combined Practice Of Electrical Stimulation For Lumbar Intervertebral Disc Herniation.Pain, vol 11, 1981, p. S226. Ovid Technologies (Wolters Kluwer Health), doi:10.1016/0304-3959(81)90487-5.
  • Weber, Henrik. Spine Update The Natural History Of Disc Herniation And The Influence Of Intervention.Spine, vol 19, no. 19, 1994, pp. 2234-2238. Ovid Technologies (Wolters Kluwer Health), doi:10.1097/00007632-199410000-00022.
  • Disk Herniation Imaging: Overview, Radiography, Computed Tomography.Emedicine.Medscape.Com, 2017,
  • Carvalho, Lilian Braighi et al. Hrnia De Disco Lombar: Tratamento. Acta Fisitrica, vol 20, no. 2, 2013, pp. 75-82. GN1 Genesis Network, doi:10.5935/0104-7795.20130013.
  • Kerr, Dana et al. What Are Long-Term Predictors Of Outcomes For Lumbar Disc Herniation? A Randomized And Observational Study. Clinical Orthopaedics And Related Research, vol 473, no. 6, 2014, pp. 1920-1930. Springer Nature, doi:10.1007/s11999-014-3803-7.
  • Buy, Xavier, and Afshin Gangi. Percutaneous Treatment Of Intervertebral Disc Herniation. Seminars In Interventional Radiology, vol 27, no. 02, 2010, pp. 148-159. Thieme Publishing Group, doi:10.1055/s-0030-1253513.
  • Haro, Hirotaka. Translational Research Of Herniated Discs: Current Status Of Diagnosis And Treatment. Journal Of Orthopaedic Science, vol 19, no. 4, 2014, pp. 515-520. Elsevier BV, doi:10.1007/s00776-014-0571-x.

 

 

Baastrup’s Syndrome aka Kissing Spine Syndrome

Baastrup’s Syndrome aka Kissing Spine Syndrome

Baastrup’s syndrome is named after Christian Ingerslev Baastrup. He discovered and described the condition in 1933. In this syndrome, pain and inflammation are triggered when the spinous processes of two adjacent vertebrae begin to touch each other. This is where the term kissing spine came from. Most back and neck pain is attributed to inflammation or degeneration of the spinal vertebrae, discs, muscles, and nerves. This is a spinal condition that can cause problems with age. If experiencing pain that worsens when arching the back, consult a professional chiropractor. A physical examination and imaging could reveal the spine is going through this underdiagnosed condition.

11860 Vista Del Sol, Ste. 128 Baastrup's Syndrome aka Kissing Spine Syndrome

Kissing Spine

Spine problems mostly involve the vertebrae and the discs. However, the spine has other components, which include spinous processes. These are thin segments of bone that protrude off the back of each vertebra. Kissing spine syndrome, also known as Baastrup’s disease, or interspinous bursitis, happens when these spinous processes begin to move close together and touch/kiss. Pain and inflammation can be triggered by this.

It is believed to develop as a result of degeneration in the spine that comes with age. As vertebral discs break down from all the wear and tear of life, this can cause the spinous processes to move closer together and touch. This typically develops in the lumbar spine/lower back, but can also affect the cervical spine/neck. The most common symptom of kissing spine syndrome is back pain that worsens when touched or arching the back. For some individuals slumping forward or rounding the back, can help diminish the pain.

When the spinous processes touch, they begin abrasively rubbing against each other. This wears them down and can lead to other types of spinal degeneration. Over time secondary problems can begin to present including neurological conditions caused by compressed nerves. The condition is common in older adults from the natural wear and tear on their spines. But young individuals specifically athletes, can develop the syndrome.

  • Poor posture
  • Obesity
  • Spinal injury/s are additional risk factors.

Diagnosing the condition involves a physical exam and imaging scans to confirm that the spinous processes are in fact touching.

Chiropractic Care

A chiropractor can help manage the pain caused by degenerative disc disease and kissing spine syndrome. Treatment protocols for kissing spine syndrome include:

  • Spinal adjustments
  • Physical therapy massage
  • Spinal manipulation
  • Stretches
  • Exercises
  • Anti-inflammatory diet

Spinal decompression techniques can open the spinal segments so that the spinous processes don’t touch. Manipulations can facilitate proper joint mobility and alleviate inflammation. Physical therapy exercises and stretches will help stretch the spine and the supportive tissues. If experiencing neck or low back pain, contact Injury Medical Chiropractic and Functional Medicine Clinic. Our spine specialists will listen, discuss, and develop a personalized treatment plan. We provide non-invasive approaches for long-term pain management and spinal correction for lasting comfort.


Body Composition


The Paleo Diet

The Paleo diet consists of eating foods that would have been available to humans before modern agriculture was established. If the food was not available to these human ancestors and they did not eat it, then it is not part of the Paleo diet. This includes eating:

  • Lean meats
  • Fish
  • Vegetables
  • Fruits
  • Eggs
  • Nuts

The Paleo cuts out foods like:

  • Grains
  • Legumes
  • Dairy
  • Sugars
  • Processed oils

One study published in the American Journal of Clinical Nutrition compared the Paleo diet to other control diets based on United States nutritional guidelines. The researchers found that the Paleo diet generated improvements in waist circumference, triglyceride levels, and blood pressure.

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

Philipp LR, Baum GR, Grossberg JA, Ahmad FU. Baastrup’s Disease: An Often Missed Etiology for Back Pain. Cureus 8(1): e465. Published January 22, 2016. www.cureus.com/articles/3982-baastrups-disease-an-often-missed-etiology-for-back-pain. Accessed December 20, 2018.

Filippiadis DK, Mazioti A, Argentos S, et al. Baastrup’s disease (kissing spines syndrome): a pictorial review. Insights Imaging. 2015 Feb; 6(1): 123–128. Published online January 13, 2015. link.springer.com/article/10.1007/s13244-014-0376-7 Accessed December 20, 2018.

Axial Neck Pain and Whiplash

Axial Neck Pain and Whiplash

Axial neck pain is also known as uncomplicated neck pain, whiplash, and cervical/neck strain. They refer to pain and discomfort running along the back or posterior of the neck. Axial is defined as forming or around an axis. This type of pain stays around the neck and immediate surrounding structures. It does not spread/radiate out to the arms, hands, fingers, and other areas of the body. Axial neck pain differs from two other neck conditions. They are:

Cervical radiculopathy describes irritation or compression/pinching of the nerve as it exits the spinal cord. The nerves of the cervical spine are known as the peripheral nerves. They are responsible for relaying signals to and from the brain to specific areas of the arms and hands. The signals sent from the brain are for muscle movement, while signals going to the brain are for sensation.

CervicalMusculatureDiagram ChiropractorElPaso
11860 Vista Del Sol, Ste. 128 Axial Neck Pain and Whiplash

When one of these nerve/s gets irritated, inflamed, or injured, it can result in:

  • Muscle pain
  • Weakness
  • Numbness
  • Tingling sensation
  • Burning pain
  • Other types of abnormal sensations in the arms, hands, or fingers.

Cervical myelopathy describes compression of the spinal cord itself. The spinal cord is the information highway/pipeline to all parts of the body. There is a range of symptoms that can include:

  • Same symptoms as cervical radiculopathy
  • Balance problems
  • Coordination problems
  • Loss of fine motor skills
  • Bowel and bladder incontinence

Axial neck pain

Axial neck pain is a quite common type of neck pain. It affects around 10% of the population. However, the majority of these cases do not involve severe symptoms that limit daily activity.

Symptoms

Pain in the back of the neck is the primary and most common symptom. Sometimes the pain travels to the base of the skull, shoulder, or shoulder blade. Other symptoms include:

  • Neck stiffness
  • Headaches
  • Localized muscle pain
  • Warmth
  • Tingling
11860 Vista Del Sol, Ste. 128 Axial Neck Pain and Whiplash

Developmental Risk factors

Poor posture, lack of ergonomics, and muscle weakness increase the chances of developing axial neck pain. Risk factors for development include:

  • Age
  • Trauma – Auto accident, sports, personal, work injury
  • Headaches
  • Depression
  • Chronic neck pain
  • Sleep problems

Diagnosis

Based on symptoms and physical exam findings are how a diagnosis is usually achieved. A doctor will typically order an x-ray, CT, or MRI of the cervical spine. This calls for an immediate visit to a hospital/clinic for evaluation. There could be severe symptoms that could indicate something more dangerous, causing pain like infection, cancer, or fracture. These symptoms include:

  • Prior trauma/injury from a fall, automobile accident, sports, work injury
  • Fever
  • Weight loss
  • Night sweats
  • Constant night pain

Rheumatic conditions/diseases that cause neck pain can include morning stiffness and immobility that gets better as the day progresses. If symptoms continue for more than 6 weeks, imaging of the spine could be recommended, especially for individuals that have had previous neck or spine surgery or if it could be cervical radiculopathy or myelopathy.

Treatment

There is a wide range of treatment options. Surgery is rarely required except for severe cases. Returning to normal activities almost right away is one of the most important things to prevent the pain from becoming chronic. First-line treatments typically begin with:

  • Physical therapy
  • Chiropractic
  • Stretching routine
  • Strengthening exercises
  • Acetaminophen
  • Anti-inflammatory medication/s
  • Muscle relaxants are sometimes prescribed

If a cervical spine fracture has been diagnosed, a neck brace could be recommended for short-term use. A soft collar could be utilized if the pain is severe, but a doctor usually discontinues use after 3 days. Other non-invasive treatment options include:

  • TENS – transcutaneous electrical nerve stimulation
  • Electromagnetic therapy
  • Qigong
  • Acupuncture
  • Low-level laser therapy
  • Cognitive-behavioral therapy

Invasive treatments like injections, nerve ablation, and surgery are rarely required. But if necessary, it can be beneficial for those cases.

el paso, tx doctor

Causes

A variety of the neck’s anatomical structures can contribute to the pain. Common causes include:

  • Poor posture
  • Age
  • Degeneration
  • Ergonomics
  • Injury to muscles or ligaments
  • Arthritis

All of these can affect vertebral bodies, discs, and facet joints. Shoulder arthritis or a rotator cuff tear can imitate axial neck pain. Dysfunction of the temporomandibular jaw joint or the blood vessels of the neck can cause axial pain, but it is rare.

Prognosis

Symptoms are usually alleviated within 4-6 weeks from when the pain started. Pain that continues beyond this should encourage a visit to a chiropractic physician.

Prevention

  • Keep neck muscles strong with exercise.
  • Stretch the neck regularly.
  • A healthy diet specifically for bone support.
  • Proper sleep posture, for example, sleeping on the back or side with a pillow that supports the natural curve of the neck.
  • If on a computer for work or a long period, align the eyes with the top third of the screen.
  • Avoid looking down when on the phone, reading, etc., for a long time by keeping the arms supported on an armrest.
  • Glasses should be pushed up on the nose bridge; if they slide down, there is a tendency for the head to follow.
  • Don’t forget to look up frequently.

Optimizing posture, ergonomics, and muscle strengthening can help prevent the onset of pain and help alleviate the symptoms.


 

Whiplash Neck Pain Treatment


 

Analgesics Pain Symptom Relieving Medications

Analgesics Pain Symptom Relieving Medications

Analgesics are pain-relieving medications, also known as painkillers. These can be over-the-counter and prescription medications. Either could be part of a treatment plan for spine-related pain. Individuals dealing with back or neck conditions, typically take analgesics to reduce symptoms.
  • Analgesics are available over-the-counter/OTC and with a prescription
  • Prescription analgesics usually include the more powerful form of over-the-counter medications
  • Various analgesics are available in topical form
  • Analgesics can be specialized with some to relieve pain, with others reducing inflammation/pain
11860 Vista Del Sol, Ste. 128 Analgesics Pain Symptom Relieving Medications
 

Over-the-counter

Acetaminophen, Non-steroidal anti-inflammatory drugs, and topical analgesics are the most commonly used medications for various pain symptoms. Over-the-counter analgesics are most effective when taken at the first sign/presentation of acute pain. Whiplash, along with muscle sprains and strains are common injuries known to cause short term pain that can be mild to severe. Follow the medication’s instructions on dosage recommendations and precautions. If the medication does not work or helps manage the pain, and/or pain symptoms worsen, contact your healthcare provider. This could be an indicator that a more powerful prescription analgesic is needed to help manage the pain, along with added therapy like physical therapy, and chiropractic to help avoid dependence on the prescription meds.

Acetaminophen

Tylenol is one form of medication taken for different types of pain and is one of the most popular over-the-counter analgesics. Acetaminophen’s purpose is exclusively to relieve pain. It does not reduce inflammation.

Non-steroidal anti-inflammatory drugs – NSAIDs

Non-steroidal anti-inflammatory drugs work to reduce inflammation and pain. Types of over-the-counter These include:
  • Aspirin
  • Ibuprofen
  • Naproxen

Topical analgesics

Topical analgesics like capsaicin cream and salicylates are an alternative to analgesics taken by mouth. These creams, balms, gels, and sprays are applied to the painful area. It is a very common application and is widely used for joint, muscle, and back pain. Salicylates are plant-based chemicals that operate to decrease the body’s production of prostaglandins. These are lipids that let the body know that there is a problem causing inflammation and pain.  
 

Prescription

A doctor could prescribe an analgesic as part of a treatment plan to help manage short-term and chronic pain. It is extremely important to precisely follow the doctor’s instructions on how much and when to take the medication. Remember that any of these medications have the potential for side effects, which includes the risk of negative interactions when taken with other meds. Be sure to talk with a doctor about potential risks, and keep them informed about all medications like blood pressure and diabetes meds and natural herbs/vitamins/supplements taken for other medical conditions.

COX-2 Inhibitors

Cyclo-oxygenase-2 or COX-2 inhibitors are a prescription NSAID medication type that is formulated to target specific enzymes that trigger inflammation. Inflammation is not just a symptom but can also be a cause of pain related to many different spinal disorders. COX-2 inhibitors have a lower risk of causing/contributing to gastrointestinal problems. There are other potential side effects and risks associated with COX-2 inhibitors. Potential side effects include an increased risk of cardiovascular problems, like a heart attack or blood clots. COX-2 inhibitors reduce the risk of stomach problems than classic NSAIDs but if gastrointestinal conditions exist to talk with a doctor before taking these medications.  
11860 Vista Del Sol, Ste. 128 Analgesics Pain Symptom Relieving Medications
 

Opioids

These are highly potent analgesics and are no longer the first type of pain-relieving medication that a doctor prescribes. They are now to be the last resort for reducing moderate to severe pain symptoms. These medications work by decreasing the perception and reaction to the pain. Opioids are prescribed for short-term use following surgical procedures and trauma. However, there are different situations where use is appropriate. When opioids are recommended, the doctor will begin with the lowest strength/dosage to manage the pain. Types of opioids include:
  • Codeine
  • Hydrocodone
  • Hydromorphone
  • Oxycodone
  • Meperidine
  • Tramadol
Opioids have an increased risk for addiction and abuse. If an opioid-based medication is prescribed the medication is safe and effective as long as it is used exactly as the doctor instructs. Side effects can include:
  • Drowsiness
  • Constipation
  • Nausea
  • Euphoria
  • Slowed breathing

A Pain Helper

Analgesic medications are commonly used for various types of pain-causing conditions. When they are used properly with a doctor�s supervision they are safe and effective at managing pain and discomfort. If new symptoms present and/or the pain worsens or becomes different contact your doctor on appropriate instructions.

Chiropractic Neck 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*