ClickCease
+1-915-850-0900 spinedoctors@gmail.com
Select Page

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.


Achieve Relief: Spinal Decompression for Cervical Spinal Pain

Achieve Relief: Spinal Decompression for Cervical Spinal Pain

Can individuals with cervical spinal pain incorporate spinal decompression therapy to reduce neck pain and headaches?

Introduction

Many individuals deal with neck pain at some point, leading to many issues that can impact their daily lives. See, the neck is part of the cervical region of the musculoskeletal system. It is surrounded by muscles, soft tissues, and ligaments that protect the spinal cord while allowing the head to be mobile. Like back pain, neck pain is a common issue that causes pain and discomfort from associated environmental factors and traumatic injuries. When a person is dealing with neck pain, they are also coping with comorbidities that cause overlapping risk profiles like headaches and migraines. However, treatments like spinal decompression can help reduce cervical spinal pain affecting the neck and reduce the painful effects of headaches and migraines. Today’s article looks at the impact of cervical pain and headaches, how spinal decompression can reduce cervical spinal pain, and how it benefits from reducing headaches. We talk with certified medical providers who consolidate our patients’ information to assess how to mitigate cervical spinal pain from the neck. We also inform and guide patients on how spinal decompression can help reduce headaches caused by cervical spinal pain. We encourage our patients to ask their associated medical providers intricate and important questions about incorporating spinal decompression therapy as part of their routine to reduce headaches and migraines associated with the neck. Dr. Jimenez, D.C., includes this information as an academic service. Disclaimer.

 

The Effects Of Cervical Pain & Headaches

Do you feel stiffness on both sides of your neck that causes you limited mobility when you turn your neck? Have you experienced constant throbbing pain in your temples? Or do you feel muscle aches on your neck and shoulders from being hunched on the computer for an extended period? Many individuals dealing with these pain-like issues could be coping with cervical spinal pain. Various causes that can lead to the development of cervical spinal pain include herniated discs, pinched nerves, spinal stenosis, and muscle strain that originates from the neck region. This is because cervical spinal pain can be associated with environmental factors that can cause pain and discomfort, disability, and impaired quality of life as the surrounding neck muscles are overstretched and tight. (Ben Ayed et al., 2019) When people are dealing with cervical spinal pain, one of the symptoms it is associated with is headaches. This is because the intricated nerve pathways are connected to the neck and head. When cervical spinal pain is causing these issues, it can significantly impact a person’s daily body function as the pain is traveling upwards. 

 

 

At the same time, neck pain is a multifactorial disease that can become a major issue worldwide. Like back pain, numerous risk factors can contribute to its development. (Kazeminasab et al., 2022) Some risk factors, like excessive phone usage, cause prolonged neck flexion to the neck and shoulders, causing static muscular loading with a lack of support to the upper extremities. (Al-Hadidi et al., 2019) To this point, environmental risk factors like excessive phone usage can make individuals develop a hunched position in their necks that can compress the spinal disc in the cervical region and aggravate the nerve roots to produce headaches and pain. However, many individuals have found ways to reduce cervical spinal pain and find pain relief from their headaches.

 


Home Exercises for Pain Relief-Video


How Spinal Decompression Reduces Cervical Spinal Pain

When it comes to reducing cervical spinal pain, many individuals have experienced that spinal decompression can help mitigate the effects of cervical pain. Spinal decompression has increasingly been recognized as an effective non-surgical treatment when it comes to alleviating cervical spinal pain. What spinal decompression does is that it allows negative pressure on the cervical spine to relieve any herniated disc of the aggravated nerve roots and help improve neurological symptoms. (Kang et al., 2016) This is due to a person being strapped comfortably on a traction machine that gently stretches and decompresses the spinal vertebrae. Additionally, some of the benefits of spinal decompression for cervical spinal pain include:

  • Improved spinal alignment to reduce muscle strain on the neck muscles and joints.
  • Enhanced the body’s natural healing by increasing blood flow and nutrient exchange.
  • Increased neck mobility by decreasing muscle stiffness.
  • Reducing pain levels that are causing intense headaches. 

 

The Benefits of Spinal Decompression For Headaches

Additionally, spinal decompression can help reduce headaches associated with cervical spinal pain as spinal decompression can be combined with other therapies like acupuncture and physical therapy to relieve the protruding spinal dice and stabilize within the annulus by spinal elongation. (Van Der Heijden et al., 1995) This is due to gentle traction on the neck that is causing the prolapsed disc to reposition itself while restoring disc height to minimize the pressure on the nerves. (Amjad et al., 2022) When a person is doing spinal decompression therapy consecutively, the pain-like effects of cervical spinal pain and the associated headaches begin to reduce over time, and many people will start to notice how their habits are in correlation with their pain. By incorporating spinal decompression therapy as part of their treatment, many people can make small changes in their routine and be more mindful of their bodies to prevent the progression of cervical spinal pain from returning. 

 


References

Al-Hadidi, F., Bsisu, I., AlRyalat, S. A., Al-Zu’bi, B., Bsisu, R., Hamdan, M., Kanaan, T., Yasin, M., & Samarah, O. (2019). Association between mobile phone use and neck pain in university students: A cross-sectional study using numeric rating scale for evaluation of neck pain. PLOS ONE, 14(5), e0217231. doi.org/10.1371/journal.pone.0217231

Amjad, F., Mohseni-Bandpei, M. A., Gilani, S. A., Ahmad, A., & Hanif, A. (2022). Effects of non-surgical decompression therapy in addition to routine physical therapy on pain, range of motion, endurance, functional disability and quality of life versus routine physical therapy alone in patients with lumbar radiculopathy; a randomized controlled trial. BMC Musculoskelet Disord, 23(1), 255. doi.org/10.1186/s12891-022-05196-x

Ben Ayed, H., Yaich, S., Trigui, M., Ben Hmida, M., Ben Jemaa, M., Ammar, A., Jedidi, J., Karray, R., Feki, H., Mejdoub, Y., Kassis, M., & Damak, J. (2019). Prevalence, Risk Factors and Outcomes of Neck, Shoulders and Low-Back Pain in Secondary-School Children. J Res Health Sci, 19(1), e00440. www.ncbi.nlm.nih.gov/pubmed/31133629

www.ncbi.nlm.nih.gov/pmc/articles/PMC6941626/pdf/jrhs-19-e00440.pdf

Kang, J.-I., Jeong, D.-K., & Choi, H. (2016). Effect of spinal decompression on the lumbar muscle activity and disk height in patients with herniated intervertebral disk. Journal of Physical Therapy Science, 28(11), 3125-3130. doi.org/10.1589/jpts.28.3125

Kazeminasab, S., Nejadghaderi, S. A., Amiri, P., Pourfathi, H., Araj-Khodaei, M., Sullman, M. J. M., Kolahi, A. A., & Safiri, S. (2022). Neck pain: global epidemiology, trends and risk factors. BMC Musculoskelet Disord, 23(1), 26. doi.org/10.1186/s12891-021-04957-4

Van Der Heijden, G. J., Beurskens, A. J., Koes, B. W., Assendelft, W. J., De Vet, H. C., & Bouter, L. M. (1995). The Efficacy of Traction for Back and Neck Pain: A Systematic, Blinded Review of Randomized Clinical Trial Methods. Physical Therapy, 75(2), 93-104. doi.org/10.1093/ptj/75.2.93

Disclaimer

Discover the Benefits of Electroacupuncture for Shoulder Pain

Discover the Benefits of Electroacupuncture for Shoulder Pain

Can individuals with shoulder pain, find pain relief from electroacupuncture therapy to reduce stiffness associated with the neck?

Introduction

When many individuals are dealing with pain-like symptoms that are caused by environmental factors, it can affect their daily performance or their routines. Some of the most common pain areas that people usually get are from the neck, shoulder, or back. Since the musculoskeletal system has various upper and lower quadrant muscles, they have an outstanding relationship with the nerve roots that spread out to the muscles to provide sensory-motor functions. When environmental factors or traumatic injuries start to affect the musculoskeletal system, it can lead to a life of disability, pain, and discomfort. So, when individuals are dealing with shoulder pain that is causing issues with their neck, it can lead to various pain-like symptoms in the upper quadrants and searching for treatments to reduce their pain. Treatments like electroacupuncture can provide a positive outlook on reducing shoulder pain associated with the neck. Today’s article focuses on how shoulder pain correlates with the neck, how electroacupuncture positively reduces shoulder pain, and how it can reduce neck and shoulder stiffness. We talk with certified medical providers who consolidate our patients’ information to assess how shoulder pain is correlated with neck issues. We also inform and guide patients on how non-surgical treatments like electroacupuncture can help reduce shoulder pain and relieve the neck. We encourage our patients to ask their associated medical providers intricate and important questions about how their neck and shoulder pain affects their daily routine. Dr. Jimenez, D.C., includes this information as an academic service. Disclaimer.

 

How Does Shoulder Pain Correlate With The Neck?

Have you been dealing with stiffness in your neck or shoulders that is causing your hands to feel numb? Do you feel muscle strain from the sides of your neck that rotating your shoulders causes temporary relief? Or do you feel muscle soreness in your shoulders after laying on one side for too long? Many of these pain-like issues are correlated with shoulder pain, which can become a frequent musculoskeletal condition that can evolve into chronic problems over time. (Suzuki et al., 2022) This can cause the upper body extremities that work with the shoulders to deal with muscular issues that cause the shoulder and neck muscles to become hypersensitive. Since shoulder pain can often correlate with neck issues or the cervical spine, various environmental and traumatic factors can cause musculoskeletal conditions like muscular tightness in the neck, disc degeneration, or even cervical spondylosis, which can cause referred pain to the shoulders.

 

 

Additionally, many working individuals at a desk job can experience shoulder pain associated with the neck as they are in a forward hunched position that causes significant stress on the soft tissues surrounding and supporting the cervical spine, which can risk the development of neck and shoulder pain. (Moon & Kim, 2023) This is due to the numerous nerve roots that run through the neck and shoulder region, causing the pain signals to invoke referred pain in the soft muscle tissues. At the same time, when people dealing with shoulder pain correlating with the neck are doing repetitive motions, compression, or staying in a fixed position for an extended period, it can become overlapping risk profiles, thus increasing the spread of neck and shoulder pain. (Elsiddig et al., 2022) To that point, when people are dealing with neck problems, it can influence the shoulders, leading to discomfort, reduced mobility, pain, stiffness, and decreased quality of life that can impact a person. (Onda et al., 2022) However, when the shoulder pain associated with the neck becomes too much, many people will seek treatment to reduce the pain.

 


The Science Of Motion- Video


The Positive Effects Of Electroacupuncture Reducing Shoulder Pain

 

When many people are looking for alternative and complementary non-surgical therapies, electroacupuncture is the answer for individuals suffering from shoulder pain correlating with the neck. Like traditional acupuncture, electroacupuncture involves electric stimulation and needle insertion into specific points or acupoints on the body by highly trained professionals to enhance therapeutic effects on the affected muscle area. For shoulder pain, electroacupuncture controls pain by activating the central nervous system and inducing the body’s natural biochemicals to promote healing. (Heo et al., 2022) While shoulder pain associated with the neck can arise from a variety of causes, electroacupuncture can target these issues by:

  • Reducing inflammation
  • Interrupting the pain signals
  • Enhancing muscle healing
  • Increasing range of motion

 

Electroacupuncture Reducing Neck & Shoulder Stiffness

Additionally, electroacupuncture can be combined with physical therapy to reduce neck and shoulder stiffness. When people incorporate exercises that target the neck and shoulders while combining electroacupuncture, they can see a long-term positive effect on pain reduction. (Duenas et al., 2021) The neck and shoulders will have improved flexibility and mobility from the exercises. At the same time, blood flow can help speed up the healing process, and the pain signals are blocked by electroacupuncture. For many individuals dealing with shoulder pain correlating with the neck, electroacupuncture can be an effective treatment to promote healing on the affected muscles and reduce pain.

 


References

Duenas, L., Aguilar-Rodriguez, M., Voogt, L., Lluch, E., Struyf, F., Mertens, M., Meulemeester, K., & Meeus, M. (2021). Specific versus Non-Specific Exercises for Chronic Neck or Shoulder Pain: A Systematic Review. J Clin Med, 10(24). doi.org/10.3390/jcm10245946

Elsiddig, A. I., Altalhi, I. A., Althobaiti, M. E., Alwethainani, M. T., & Alzahrani, A. M. (2022). Prevalence of neck and shoulder pain among Saudi universities’ students who are using smartphones and computers. J Family Med Prim Care, 11(1), 194-200. doi.org/10.4103/jfmpc.jfmpc_1138_21

Heo, J. W., Jo, J. H., Lee, J. J., Kang, H., Choi, T. Y., Lee, M. S., & Kim, J. I. (2022). Electroacupuncture for the treatment of frozen shoulder: A systematic review and meta-analysis. Front Med (Lausanne), 9, 928823. doi.org/10.3389/fmed.2022.928823

Moon, S. E., & Kim, Y. K. (2023). Neck and Shoulder Pain with Scapular Dyskinesis in Computer Office Workers. Medicina (Kaunas, Lithuania), 59(12). doi.org/10.3390/medicina59122159

Onda, A., Onozato, K., & Kimura, M. (2022). Clinical features of neck and shoulder pain (Katakori) in Japanese hospital workers. Fukushima J Med Sci, 68(2), 79-87. doi.org/10.5387/fms.2022-02

Suzuki, H., Tahara, S., Mitsuda, M., Izumi, H., Ikeda, S., Seki, K., Nishida, N., Funaba, M., Imajo, Y., Yukata, K., & Sakai, T. (2022). Current Concept of Quantitative Sensory Testing and Pressure Pain Threshold in Neck/Shoulder and Low Back Pain. Healthcare (Basel), 10(8). doi.org/10.3390/healthcare10081485

Disclaimer

Electroacupuncture: The Miracle Treatment for Reducing Neck Pain

Electroacupuncture: The Miracle Treatment for Reducing Neck Pain

Can individuals dealing with neck pain find relief with electroacupuncture therapy while reducing pain symptoms to restore neck function?

Introduction

The cervical region of the body consists of the neck region, which allows the head to be mobile and stabilized from discomfort or pain. The neck has numerous muscles, ligaments, and tendons surrounding the cervical facet joints and spinal discs. However, when the neck muscles are overstretched or ached from environmental factors or traumatic injuries that cause the head and the neck muscles to whip back and forth rapidly, it can force individuals to deal with not only pain and discomfort from the neck but also the head and shoulders are affected as well. When this happens, many individuals try to find various relief methods to reduce the pain and its associated symptoms. Today’s articles look at how the pain symptoms are associated with the neck, how there are non-surgical treatments for neck pain, and how electroacupuncture can help restore neck function. We talk with certified medical providers who consolidate our patients’ information to understand better why they are experiencing neck pain. We also inform and guide patients on how non-surgical treatments like electroacupuncture can help restore neck function to the body. We encourage our patients to ask their associated medical providers intricate and important questions about reducing the impact of neck pain while trying to incorporate various therapeutic reliefs into their bodies. Dr. Jimenez, D.C., includes this information as an academic service. Disclaimer.

How Are Pain Symptoms Associated with the Neck?

Do you experience stiffness or pain on your neck’s left or right side? Do you constantly get headaches that you have to lie in a dark room to reduce the pain? Or do you experience numbness or tingling sensations on your shoulders and arms? Many of these pain-like scenarios are associated with neck pain. Now similar to back pain, neck pain is a multifactorial musculoskeletal condition that can lead to a socio-economic burden that causes many people to have reduced productivity and job-related problems that can be an issue. (Kazeminasab et al., 2022) Neck pain can be in acute or chronic stages as multiple factors can play the developmental part of neck pain. Some of the environmental factors and traumatic injuries associated with neck pain include:

  • Poor posture
  • Whiplash
  • Degenerative issues
  • Slouching/hunching position
  • Sprains or strains
  • Spinal fractures

When these environmental and traumatic injury factors start to cause issues in the neck region of the body, they can cause pain-like symptoms.

 

 

So, how is pain associated with the neck? Well, many individuals dealing with neck pain can either have specific or non-specific neck pain with various symptoms depending on the severity of the pain. While specific neck pain deals with the cervical spine, non-specific neck pain deals with the surrounding muscles and ligaments. To that point, many individuals who are dealing with neck pain are also experiencing somatic referred pain and radicular pain that is associated with neurological signs that make a diagnosis difficult to classify. (Misailidou et al., 2010) This can cause many individuals to experience referred pain in their shoulders and arms or have neurological issues like headaches and tension within their upper body regions, which then causes personal discomfort, disability, and impaired quality of life. (Ben Ayed et al., 2019) But all is not lost, as many individuals seek treatment to reduce the effects of neck pain. 

 


Movement As Medicine- Video


Non-Surgical Treatments For Neck Pain

When it comes to reducing neck pain from environmental factors or traumatic injuries, many people will seek treatments that are affordable and effective in not only decreasing neck pain but also its associated pain-like symptoms. Non-surgical treatments are an excellent way to reduce the effects of neck pain, and they can be combined with other therapies. Some of the non-surgical treatments that are suitable for neck pain include:

  • Chiropractic care
  • Acupuncture
  • Electroacupuncture
  • Spinal decompression
  • Massage therapy
  • Physical therapy

Many individuals dealing with acute neck pain can incorporate non-surgical treatments since they are not only effective through consecutive treatment but are affordable as well. (Chou et al., 2020) This allows many individuals to be more mindful of what factors affect the neck and make small changes to prevent them from returning.

 

Electroacupuncture Restoring Neck Function

One of the oldest forms of non-surgical treatment is through acupuncture, which originates from China and is performed by highly trained professionals. Depending on how severe the pain is in the neck, many individuals seek out acupuncture therapy or electroacupuncture to reduce the pain. The difference between the two is that acupuncture incorporates thin, solid needles to the specific acupoints in the body that involve the central nervous system. In contrast, electroacupuncture incorporates electric stimulation to become a transformation of energy to block the pain signals that are causing pain in the neck region. (Liu et al., 2022)

Additionally, when the cervical area of the spine has been affected by traumatic forces, it can cause the neck to lose functionality. So, when people incorporate electroacupuncture to restore neck functionality, it has analgesic and anti-inflammatory properties that regulate the endocannabinoid system. (Wang et al., 2021) This means that the pain receptors from the nerve roots are blocked, and relief forms in the neck. Depending on the severity, many people with neck pain can utilize electroacupuncture consecutively to regain neck mobility and reduce the pain-like effects that are causing them to be miserable. When people think about their health and wellness, they can make small changes to reduce their environmental factors and start living life to the fullest extent possible. 

 


References

Ben Ayed, H., Yaich, S., Trigui, M., Ben Hmida, M., Ben Jemaa, M., Ammar, A., Jedidi, J., Karray, R., Feki, H., Mejdoub, Y., Kassis, M., & Damak, J. (2019). Prevalence, Risk Factors and Outcomes of Neck, Shoulders and Low-Back Pain in Secondary-School Children. J Res Health Sci, 19(1), e00440. www.ncbi.nlm.nih.gov/pubmed/31133629

www.ncbi.nlm.nih.gov/pmc/articles/PMC6941626/pdf/jrhs-19-e00440.pdf

Chou, R., Wagner, J., Ahmed, A. Y., Blazina, I., Brodt, E., Buckley, D. I., Cheney, T. P., Choo, E., Dana, T., Gordon, D., Khandelwal, S., Kantner, S., McDonagh, M. S., Sedgley, C., & Skelly, A. C. (2020). In Treatments for Acute Pain: A Systematic Review. www.ncbi.nlm.nih.gov/pubmed/33411426

Kazeminasab, S., Nejadghaderi, S. A., Amiri, P., Pourfathi, H., Araj-Khodaei, M., Sullman, M. J. M., Kolahi, A. A., & Safiri, S. (2022). Neck pain: global epidemiology, trends and risk factors. BMC Musculoskelet Disord, 23(1), 26. doi.org/10.1186/s12891-021-04957-4

Liu, R., Li, S., Liu, Y., He, M., Cao, J., Sun, M., Duan, C., & Li, T. (2022). Acupuncture Analgesia in Patients with Postoperative Neck Pain: A Protocol for Systematic Review and Meta-Analysis. Evid Based Complement Alternat Med, 2022, 1226702. doi.org/10.1155/2022/1226702

Misailidou, V., Malliou, P., Beneka, A., Karagiannidis, A., & Godolias, G. (2010). Assessment of patients with neck pain: a review of definitions, selection criteria, and measurement tools. J Chiropr Med, 9(2), 49-59. doi.org/10.1016/j.jcm.2010.03.002

Wang, J., Zhang, J., Gao, Y., Chen, Y., Duanmu, C., & Liu, J. (2021). Electroacupuncture Alleviates Hyperalgesia by Regulating CB1 Receptor of Spinal Cord in Incisional Neck Pain Rats. Evid Based Complement Alternat Med, 2021, 5880690. doi.org/10.1155/2021/5880690

Disclaimer

Say Goodbye to Headaches with Acupuncture

Say Goodbye to Headaches with Acupuncture

Can individuals dealing with headaches find the relief they are looking for from acupuncture to reduce pain-like symptoms?

Introduction

As part of the musculoskeletal system, the neck is part of the upper body portions and allows the head to be mobile through full rotations without pain and discomfort. The surrounding muscles, ligaments, and tendons help protect the cervical spinal region and have a fantastic relationship with the shoulders. However, the neck area can succumb to injuries, leading to pain-like symptoms that can cause pain and discomfort in the upper regions. One of the pain-like symptoms that correlates with neck pain is headaches. Headaches can vary in acute to chronic stages as they affect many individuals and the various factors that correlate with them. When headaches start to form, many individuals will look at multiple treatments to reduce the pain-like symptoms that correlate with headaches and have the relief they deserve. Today’s article looks at the various factors that correlate with headaches, how headaches cause overlapping risk profiles with neck pain, and how treatments like acupuncture can reduce headaches. We talk with certified medical providers who consolidate our patients’ information to provide treatments like acupuncture to minimize headaches. We also inform and guide patients on how acupuncture can benefit many individuals dealing with neck pain associated with headaches. We encourage our patients to ask their associated medical providers intricated and important questions about their pain-like symptoms that correlate with headaches and neck pain. Dr. Jimenez, D.C., includes this information as an academic service. Disclaimer.

 

The Various Factors Correlating Headaches

 

Have you been experiencing tension around the back of your neck after a long day? Do you feel a dull ache after staring at the computer or phone screen? Or do you feel a pounding sensation that you must lie down for a few minutes? Many of these pain-like scenarios are associated with headaches that affect many individuals from time to time. Headaches are correlated with various biochemical and metabolic risk profiles or changes that cause central sensitization and neuronal dysfunction. (Walling, 2020) This causes many individuals to develop acute or chronic pain-like symptoms that affect their heads and various locations around the face and the neck area. Some of the multiple factors that can lead to the development of headaches include:

  • Stress
  • Allergies
  • Tension
  • Inability to sleep
  • Lack of water and food
  • Traumatic injuries
  • Bright strobing lights

Additionally, other factors like obesity can become a strong risk factor for secondary headaches like migraines to have symptoms of intracranial hypertension impact the body. (Fortini & Felsenfeld Junior, 2022) This could lead to the development of neck pain caused by headaches.

 

Headaches & Neck Pain

When it comes to headaches associated with neck pain, many individuals will experience tension and pain in the surrounding muscles and the ongoing symptoms. Neck pain can cause overlapping risk profiles to muscles, ligaments, facet joints, and visceral structures of the neck that can trigger the development of a headache or become a symptom that co-exists with a neck disorder. (Vicente et al., 2023) Additionally, neck pain and headaches are strongly associated as muscular pain plays a role in headache development as they provide negative consequences within their social lives. Headaches can hinder a person’s ability to concentrate, while neck pain causes limited mobility and stiffness. (Rodriguez-Almagro et al., 2020

 


Tension Headaches Overview- Video


Acupuncture Reducing Headaches

When individuals are dealing with headaches, many will incorporate home remedies to reduce the tension they are experiencing from the various factors. This can provide temporary relief to mitigate the effects of the pain-like symptoms associated with headaches. However, when the pain from headaches becomes unbearable with neck pain in the mix, that is where non-surgical treatments could be the answer. Non-surgical treatments are effective on pain caused by headaches and customized to the person’s pain. For example, acupuncture could help with headaches and neck pain. Acupuncture is one of the oldest forms of non-surgical treatments; highly trained professionals use solid thin needles to be placed in various acupoints in the body to restore energy flow and reducing pain associated with headaches. (Turkistani et al., 2021)

 

 

Acupuncture can even help reduce the frequency and duration of headaches while disrupting the pain signals and help provide insight into the positive effects of pain reduction. (Li et al., 2020) When people start incorporating acupuncture as part of their health and wellness treatment plan, they will feel their headaches reduced and their neck mobility back to normal. Through consecutive treatment, they will feel much better and become more aware of the various factors pertaining to headache production while making small changes to reduce their chances of returning. 

 


References

Fortini, I., & Felsenfeld Junior, B. D. (2022). Headaches and obesity. Arq Neuropsiquiatr, 80(5 Suppl 1), 204-213. doi.org/10.1590/0004-282X-ANP-2022-S106

Li, Y. X., Xiao, X. L., Zhong, D. L., Luo, L. J., Yang, H., Zhou, J., He, M. X., Shi, L. H., Li, J., Zheng, H., & Jin, R. J. (2020). Effectiveness and Safety of Acupuncture for Migraine: An Overview of Systematic Reviews. Pain Res Manag, 2020, 3825617. doi.org/10.1155/2020/3825617

Rodriguez-Almagro, D., Achalandabaso-Ochoa, A., Molina-Ortega, F. J., Obrero-Gaitan, E., Ibanez-Vera, A. J., & Lomas-Vega, R. (2020). Neck Pain- and Unsteadiness-Inducing Activities and their Relationship to the Presence, Intensity, Frequency, and Disability of Headaches. Brain Sci, 10(7). doi.org/10.3390/brainsci10070425

Turkistani, A., Shah, A., Jose, A. M., Melo, J. P., Luenam, K., Ananias, P., Yaqub, S., & Mohammed, L. (2021). Effectiveness of Manual Therapy and Acupuncture in Tension-Type Headache: A Systematic Review. Cureus, 13(8), e17601. doi.org/10.7759/cureus.17601

Vicente, B. N., Oliveira, R., Martins, I. P., & Gil-Gouveia, R. (2023). Cranial Autonomic Symptoms and Neck Pain in Differential Diagnosis of Migraine. Diagnostics (Basel), 13(4). doi.org/10.3390/diagnostics13040590

Walling, A. (2020). Frequent Headaches: Evaluation and Management. American Family Physician, 101(7), 419-428. www.ncbi.nlm.nih.gov/pubmed/32227826

www.aafp.org/pubs/afp/issues/2020/0401/p419.pdf

Disclaimer

Treating Neck Pain with Acupuncture: A Guide

Treating Neck Pain with Acupuncture: A Guide

Can individuals dealing with neck pain incorporate acupuncture as part of their health and wellness treatment to relieve headaches?

Introduction

As part of the musculoskeletal system, the neck allows the head to go into full rotation without feeling discomfort or pain. The neck is part of the cervical spine region and is surrounded by numerous ligaments, muscles, and tissues that help protect the spinal cord and the spinal column. However, the neck is also the most susceptible to injury neck to back pain as it is one the top three complaints many individuals suffer from at some point in their lives. When people experience neck pain, numerous causes can contribute to developing neck pain, while pain-like symptoms like headaches contribute to the body. This causes many individuals to seek treatment and find the relief they are looking for to reduce neck pain while continuing their daily routine. Today’s article looks at how neck pain is associated with headaches and how treatments like acupuncture can help with neck pain and reduce the painful effects of headaches. We talk with certified medical providers who utilize our patients’ information to provide acupuncture treatments to lessen the impact of headaches caused by neck pain. We also inform patients how multiple non-surgical treatments can help reduce headaches and pain-like symptoms associated with neck pain. We encourage our patients to ask their associated medical providers intricated and important questions about the pain-like symptoms they are experiencing from neck pain. Dr. Jimenez, D.C., incorporates this information as an academic service. Disclaimer.

 

Neck Pain & Headaches

Have you been experiencing unexplained stiffness along the sides of your neck? Do you feel a dull ache at the base of your neck or skull after looking down at your phone for an extended period? Or do you experience frequent headaches that are constant throughout the day? Many people dealing with these pain-like issues are associated with neck pain that is affecting their quality of life. Neck pain is amongst the top three complaints many people have experienced at some point. Neck pain has common presenting symptoms that are diagnosed, and the prevalence is much higher in older adults due to degenerative spinal changes in the facet joints and spinal discs. (Childress & Stuek, 2020) Many individuals experience common musculoskeletal pain conditions like muscle strains and stiffness when this happens. At the same time, neck pain can also be associated with neurological conditions that cause overlapping risk profiles, forcing many individuals to miss out on important events. Neck pain is a multifactorial musculoskeletal condition affecting many individuals as it induces them to miss work. This is because various modifiable and non-modifiable risk factors contribute to developing neck pain. (Kazeminasab et al., 2022) These risk factors can range from physical inactivity to poor posture, causing overlapping risk profiles that can trigger neck pain to advance over time. 

 

 

So, how are headaches associated with neck pain? When a person is experiencing a headache, many would often think that the headaches are caused by not eating enough food or drinking enough water. Those are some of the factors that contribute to headaches, but they can also be due to the stress and comorbidities that are associated with neck pain. This is due to the risk factors many individuals don’t realize contribute to neck pain. Factors like the forward head position from smartphone usage cause tension on the cervical structures, generating potential degeneration and tearing of the neck structures. (Maayah et al., 2023) As repetitive motions affect the neck structure more over time, the nerve roots that surround the spine and spread through the upper extremities can become aggravated, and cause referred pain to different areas of the body, leading to headaches. When dealing with headaches associated with neck pain, they will feel stress, affecting their productivity. The headaches can range from acute to chronic, depending on the severity. Fortunately, many individuals dealing with headaches associated with neck pain will seek treatment to reduce the pain-like symptoms and feel the relief to return to their daily routine.


Healing After Trauma- Video

Many individuals who are dealing with neck pain often deal with headaches as a sign that risk factors are in play, like poor posture, slouching, or traumatic injuries that can affect their ability to work or participate in activities. This can cause many people to feel miserable and decrease their quality of life, thus causing them to seek out treatment for their pain, hence why many individuals opt for non-surgical treatments due to them being affordable and personalized. Non-surgical treatments range from chiropractic care to acupuncture, depending on the severity and location of where the pain is in the body. The video above shows how non-surgical treatments can help many individuals positively influence healing after a traumatic injury and restore a person’s well-being.


Acupuncture For Neck Pain

Non-surgical treatments are excellent for individuals trying to find the relief they seek in their neck pain. As stated earlier, non-surgical treatments are cost-effective and tailored to the person’s pain. Acupuncture is a form of non-surgical treatment that can help reduce the comorbidities associated with neck pain. Acupuncture is a medical practice in which highly trained, licensed, and certified professionals use solid, super-thin needles to be placed at specific points to treat the body. What this does is that when the needles are penetrating the points, it will begin to open any blockage or excess energy to flow correctly, restore balance to the body, and relieve the individual’s symptoms. (Berger et al., 2021) Some of the beneficial results that acupuncture can provide individuals with neck pain is a reduction of pain and disability to the neck while treating referred pain that is causing overlapping risk profiles to induce headaches. (Peron et al., 2022

 

Acupuncture Relieving Headaches

Since headaches are associated with neck pain, acupuncture can help relieve the headaches from progressing further and enable many individuals to get back to their routine. Some overlapping risk profiles contributing to headaches include trigger points on the neck muscles that can cause non-dermatomal referral pain and discomfort. (Pourahmadi et al., 2019) When an acupuncturist is treating individuals for their headaches, many individuals will begin to feel the relief after a few consecutive sessions, and, combined with physical therapy to strengthen neck and shoulder muscles, will notice that the pain has been reduced significantly. Acupuncture is a safe, helpful, and available alternative treatment that is beneficial for many individuals dealing with headaches associated with neck pain. (Urits et al., 2020) By incorporating acupuncture as part of a person’s treatment plan, they can begin to feel the relief they deserve while also being more mindful of how they are treating their bodies to prevent pain-like symptoms from returning.


References

Berger, A. A., Liu, Y., Mosel, L., Champagne, K. A., Ruoff, M. T., Cornett, E. M., Kaye, A. D., Imani, F., Shakeri, A., Varrassi, G., Viswanath, O., & Urits, I. (2021). Efficacy of Dry Needling and Acupuncture in the Treatment of Neck Pain. Anesth Pain Med, 11(2), e113627. doi.org/10.5812/aapm.113627

Childress, M. A., & Stuek, S. J. (2020). Neck Pain: Initial Evaluation and Management. American Family Physician, 102(3), 150-156. www.ncbi.nlm.nih.gov/pubmed/32735440

www.aafp.org/pubs/afp/issues/2020/0801/p150.pdf

Kazeminasab, S., Nejadghaderi, S. A., Amiri, P., Pourfathi, H., Araj-Khodaei, M., Sullman, M. J. M., Kolahi, A. A., & Safiri, S. (2022). Neck pain: global epidemiology, trends and risk factors. BMC Musculoskelet Disord, 23(1), 26. doi.org/10.1186/s12891-021-04957-4

Maayah, M. F., Nawasreh, Z. H., Gaowgzeh, R. A. M., Neamatallah, Z., Alfawaz, S. S., & Alabasi, U. M. (2023). Neck pain associated with smartphone usage among university students. PLOS ONE, 18(6), e0285451. doi.org/10.1371/journal.pone.0285451

Peron, R., Rampazo, E. P., & Liebano, R. E. (2022). Traditional acupuncture and laser acupuncture in chronic nonspecific neck pain: study protocol for a randomized controlled trial. Trials, 23(1), 408. doi.org/10.1186/s13063-022-06349-y

Pourahmadi, M., Mohseni-Bandpei, M. A., Keshtkar, A., Koes, B. W., Fernandez-de-Las-Penas, C., Dommerholt, J., & Bahramian, M. (2019). Effectiveness of dry needling for improving pain and disability in adults with tension-type, cervicogenic, or migraine headaches: protocol for a systematic review. Chiropr Man Therap, 27, 43. doi.org/10.1186/s12998-019-0266-7

Urits, I., Patel, M., Putz, M. E., Monteferrante, N. R., Nguyen, D., An, D., Cornett, E. M., Hasoon, J., Kaye, A. D., & Viswanath, O. (2020). Acupuncture and Its Role in the Treatment of Migraine Headaches. Neurol Ther, 9(2), 375-394. doi.org/10.1007/s40120-020-00216-1

Disclaimer

Therapeutic Solutions for Upper Crossed Syndrome: What You Need to Know

Therapeutic Solutions for Upper Crossed Syndrome: What You Need to Know

Can various therapeutic options provide relief for individuals with upper crossed syndrome to restore muscle strength?

Introduction

Many individuals often suffer neck and shoulder pain from poor posture, improper heavy lifting, musculoskeletal conditions, auto accidents, whiplash, etc. The surrounding muscles that connect the neck and shoulders help protect the cervical and thoracic region of the spine and can succumb to injuries that can cause pain-like symptoms causing discomfort to the individual. Neck, shoulder, and back pain are the three most common issues many individuals have experienced. These musculoskeletal disorders can also correlate with pre-existing conditions; many people will feel pain and discomfort while trying to find the relief they seek. One of the most common issues people often experience is upper crossed syndrome, which can be associated with neck and shoulder pain. Today’s article explains what upper cross syndrome is and how it affects the neck and shoulders while also diving into how different therapeutic options like spinal decompression and chiropractic care can reduce the effects of upper cross syndrome. We speak with certified medical providers who incorporate our patients’ information to provide numerous treatment plans to mitigate upper-crossed syndrome in the neck and shoulders. We also inform our patients that there are many therapeutic options, like chiropractic care and spinal decompression, to minimize muscle pain in the neck and shoulders. We encourage our patients to ask intricated and educational questions to our associated medical providers about the pain-like symptoms they are experiencing correlating with upper-crossed syndrome. Dr. Alex Jimenez, D.C., utilizes this information as an academic service. Disclaimer

 

What Is Upper Crossed Syndrome?

 

Have you been dealing with muscle pain in your shoulders or neck after being on the computer for a while? Do you feel stiffness in your shoulders that rotating them causes temporary relief? Or does it hurt when you turn your head from side to side? Many of these pain-like scenarios are often associated with upper-cross syndrome. Many people don’t often realize that upper crossed syndrome is a musculoskeletal condition that affects the neck, shoulder, and chest muscles and causes them to be weak and tight due to poor posture. The upper crossed syndrome can cause referred pain to the upper extremities, leading to cervicogenic headaches, limited range of motion, trigger points in the muscles, and muscle imbalance. (Moore, 2004) When many people are dealing with upper crossed syndrome due to poor posture, it can lead to many issues in the neck and shoulders.

 

How Does It Affect The Neck & Shoulders?

Now, why does upper crossed syndrome affect the neck and shoulders? Many people unintentionally hunched over when looking at their phones, being on the computer, or relaxing at home. This causes specific muscles in the neck and shoulder region, like the serratus and lower trapezius muscles, to become weak while the pectoral and neck muscles are tight. (Chu & Butler, 2021) This, in turn, causes the shoulders to be more rounded and hunched, causing the neck and head to crane forward. When people are dealing with upper crossed syndrome, many would often complain about pain-like symptoms like:

  • Headaches
  • Neck Strain
  • Muscle tightness
  • Upper back pain
  • Restricted range of motion
  • Numbness/Tingling sensations in the arms

The upper crossed syndrome can also occur gradually over time and cause nerve compression to the upper extremities. When the upper neck and shoulder muscles start to affect the surrounding nerve roots, which then leads to nerve dysfunction in the sensory and motor skills when a person picks up an object. (Lee & Lim, 2019) However, many individuals dealing with upper-crossed syndrome can seek treatment to relieve muscle pain in their neck and shoulders.

 


An Overview Of Upper Crossed Syndrome- Video

Since upper cross syndrome is a musculoskeletal condition that affects the neck and shoulders, it can result in muscle imbalance and pain in the individual. Many people, especially in the working field, develop this syndrome by being hunched over for an extended period. (Mujawar & Sagar, 2019) This causes the head to be more forward, the neck posture to be curved and hunched, and the shoulders to be rounded. The video above explains upper-crossing syndrome, its causes, and how it is treated. 


Spinal Decompression Reducing Upper Crossed Syndrome

 

Numerous treatments can help restore muscle strength and reduce muscle pain in the neck and shoulders. Treatments like spinal decompression can help reduce upper crossed syndrome by slowly using gentle traction to the cervical spine region and gently stretching the neck muscles to provide relief. Spinal decompression is one of the non-surgical treatments that many individuals with headaches associated with upper crossed syndrome can find the comfort they seek through pain reduction and improve their quality of life. (Eskilsson et al., 2021) At the same time, spinal decompression can be part of a personalized treatment plan that many individuals can add to their daily routine to prevent the pain from returning. (Saunders, 1983)

 

Chiropractic Care Restoring Muscle Strength

Just like spinal decompression, chiropractic care is a non-surgical treatment that can be combined with various stretching techniques to restore the neck’s range of motion and reduce pain associated with upper-crossed syndrome. (Mahmood et al., 2021) Chiropractic care incorporates manual and mechanical techniques like MET (muscle energy techniques) and spinal manipulation to realign the spine out of subluxation. When chiropractors integrate MET to manage upper crossed syndrome, many individuals find that their pain has decreased, their cervical range of motion is improved, and their neck disability is reduced. (Gillani et al., 2020) When many individuals start thinking about their health and wellness, they can make small changes to improve their posture and be more mindful of their bodies to reduce the chances of upper-cross syndrome returning.

 


References

Chu, E. C., & Butler, K. R. (2021). Resolution of Gastroesophageal Reflux Disease Following Correction for Upper Cross Syndrome-A Case Study and Brief Review. Clin Pract, 11(2), 322-326. doi.org/10.3390/clinpract11020045

Eskilsson, A., Ageberg, E., Ericson, H., Marklund, N., & Anderberg, L. (2021). Decompression of the greater occipital nerve improves outcome in patients with chronic headache and neck pain – a retrospective cohort study. Acta Neurochir (Wien), 163(9), 2425-2433. doi.org/10.1007/s00701-021-04913-0

Gillani, S. N., Ain, Q., Rehman, S. U., & Masood, T. (2020). Effects of eccentric muscle energy technique versus static stretching exercises in the management of cervical dysfunction in upper cross syndrome: a randomized control trial. J Pak Med Assoc, 70(3), 394-398. doi.org/10.5455/JPMA.300417

Lee, E. Y., & Lim, A. Y. T. (2019). Nerve Compression in the Upper Limb. Clin Plast Surg, 46(3), 285-293. doi.org/10.1016/j.cps.2019.03.001

Mahmood, T., Afzal, W., Ahmad, U., Arif, M. A., & Ahmad, A. (2021). Comparative effectiveness of routine physical therapy with and without instrument assisted soft tissue mobilization in patients with neck pain due to upper crossed syndrome. J Pak Med Assoc, 71(10), 2304-2308. doi.org/10.47391/JPMA.03-415

Moore, M. K. (2004). Upper crossed syndrome and its relationship to cervicogenic headache. J Manipulative Physiol Ther, 27(6), 414-420. doi.org/10.1016/j.jmpt.2004.05.007

Mujawar, J. C., & Sagar, J. H. (2019). Prevalence of Upper Cross Syndrome in Laundry Workers. Indian J Occup Environ Med, 23(1), 54-56. doi.org/10.4103/ijoem.IJOEM_169_18

Saunders, H. D. (1983). Use of spinal traction in the treatment of neck and back conditions. Clin Orthop Relat Res(179), 31-38. www.ncbi.nlm.nih.gov/pubmed/6617030

 

Disclaimer

Innovated Non-Surgical Treatment For Cervical Spinal Pain

Innovated Non-Surgical Treatment For Cervical Spinal Pain

How does innovated non-surgical treatment help assist individuals with cervical spinal pain to reduce headaches?

Introduction

Do you or your loved ones often experience headaches that don’t disappear? Do you often feel your shoulder and neck muscles ache after looking down at your cell phone? Or do you feel aches after being slouched for an extended period? Many of these scenarios correlate with referred pain in the cervical spinal region, which can develop into neck pain. The neck region is located in the upper body portion and provides mobility for the head without pain and discomfort. The neck region also has surrounding muscles and ligaments that support the spine and protects the thyroid and spinal cord. However, just like the back region, it is susceptible to pain as many individuals can overstretch the neck muscles, and it can cause referred pain to the shoulders and head, leading to pain-like symptoms that can lead to a life of disability. However, non-surgical treatments can minimize the pain and help strengthen the surrounding muscles in the neck region. Today’s article focuses on how cervical spinal pain connects with headaches and how decompression can reduce headaches while relieving neck pain. Additionally, we communicate with certified medical providers who incorporate our patients’ information to reduce cervical spinal pain associated with headaches, causing many musculoskeletal issues in the upper body portion. We also inform them that non-surgical treatments can help relieve headaches and provide relief to the neck region. We encourage our patients to ask amazing educational questions for our associated medical providers about their symptoms correlating with cervical spinal pain. Dr. Jimenez, D.C., incorporates this information as an academic service. Disclaimer

 

Cervical Spinal Pain & Headache Connection

Throughout the world, neck pain (cervical spinal pain) is the second most common problem that can affect many individuals throughout their lives. It can lead to a life of disability and pain if not treated immediately. Many individuals often experience non-specific neck pain, as it can be through a postural or mechanical basis that can cause muscle strain in the surrounding muscles or compress the spinal canal to cause headaches that can last throughout the entire day. (Binder, 2008) Additionally, neck pain, like back pain, is a multifactorial disease with common risk factors like lack of physical activity, duration of computer usage, and perceived stress. (Kazeminasab et al., 2022) Many of these risk factors are normal as they can also affect the surrounding muscles in the lower back region and shoulder region, as many people often do repetitive motions that can naturally be overstretched and cause pain-like issues to the neck region. With neck pain connected with headaches, it can cause overlapping risk profiles and be costly. Neck pain associated with headaches can be a frequent and expensive occupational health problem as symptoms of pain, disability, reduced life quality, and, for adults, time lost for work. (Ben Ayed et al., 2019)

 

 

The correlation between headaches and neck pain is that the spinal canal is compressed from traumatic forces that can lead to cervicogenic headaches. Cervicogenic headaches usually aggravate neck mobility, thus reducing the ROM of the neck. (Verma, Tripathi, & Chandra, 2021) This can lead to many individuals suffering from migraine-like headaches and muscle stiffness in the upper regions of the body. When many individuals are dealing with headaches associated with cervical spinal pain, many will find treatments to mitigate the pain-like symptoms affecting the upper body region.

 


The Benefits Of Stretching-Video

When it comes to neck pain, it can be either acute or chronic depending the factors that cause it or the severity of the pain. Many individuals sought treatment that can alleviate the pain in the upper regions that are non-surgical and beneficial to their health and well-being. Non-surgical treatments can help stretch the tight and short muscles in the neck region and can reduce headaches affecting the person. Additionally, having the neck muscles professionally stretched by a massage therapist can relieve the neck and reduce headaches. The video above explains the benefits of stretching and describes how many people don’t stretch their bodies often to prevent pain-like issues from reoccurring in the future.


Spinal Decompression For Cervical Pain

 

Non-surgical treatments are excellent when it comes to reducing neck pain. When relieving neck pain, healthcare professionals must use the best available evidence to enhance clinical decision-making and improve the quality of care for people with neck pain. (Misailidou et al., 2010) Spinal decompression can help many people with neck pain by reducing the issues through gentle spinal traction. What spinal decompression does for the cervical spine is that it can realign the disc that is aggravating the neck region and causing headaches by stretching the surrounding muscles. This causes muscle improvement for the neck as it can change the patient’s pain outcome. (Youssef et al., 2019) Additionally, spinal decompression is safe, cost-effective, and gentle on the spine as it can be combined with other therapies to mitigate any residual pain that can relieve the neck and back. (Flynn, 2020) Many people who incorporate spinal decompression as part of their routine can benefit from their outcome as they return to their routine.

 


References

Ben Ayed, H., Yaich, S., Trigui, M., Ben Hmida, M., Ben Jemaa, M., Ammar, A., Jedidi, J., Karray, R., Feki, H., Mejdoub, Y., Kassis, M., & Damak, J. (2019). Prevalence, Risk Factors and Outcomes of Neck, Shoulders and Low-Back Pain in Secondary-School Children. J Res Health Sci, 19(1), e00440. www.ncbi.nlm.nih.gov/pubmed/31133629

www.ncbi.nlm.nih.gov/pmc/articles/PMC6941626/pdf/jrhs-19-e00440.pdf

 

Binder, A. I. (2008). Neck pain. BMJ Clin Evid, 2008. www.ncbi.nlm.nih.gov/pubmed/19445809

www.ncbi.nlm.nih.gov/pmc/articles/PMC2907992/pdf/2008-1103.pdf

 

Flynn, D. M. (2020). Chronic Musculoskeletal Pain: Nonpharmacologic, Noninvasive Treatments. American Family Physician, 102(8), 465-477. www.ncbi.nlm.nih.gov/pubmed/33064421

www.aafp.org/dam/brand/aafp/pubs/afp/issues/2020/1015/p465.pdf

 

Kazeminasab, S., Nejadghaderi, S. A., Amiri, P., Pourfathi, H., Araj-Khodaei, M., Sullman, M. J. M., Kolahi, A. A., & Safiri, S. (2022). Neck pain: global epidemiology, trends and risk factors. BMC Musculoskelet Disord, 23(1), 26. doi.org/10.1186/s12891-021-04957-4

 

Misailidou, V., Malliou, P., Beneka, A., Karagiannidis, A., & Godolias, G. (2010). Assessment of patients with neck pain: a review of definitions, selection criteria, and measurement tools. J Chiropr Med, 9(2), 49-59. doi.org/10.1016/j.jcm.2010.03.002

 

Verma, S., Tripathi, M., & Chandra, P. S. (2021). Cervicogenic Headache: Current Perspectives. Neurol India, 69(Supplement), S194-S198. doi.org/10.4103/0028-3886.315992

 

Youssef, J. A., Heiner, A. D., Montgomery, J. R., Tender, G. C., Lorio, M. P., Morreale, J. M., & Phillips, F. M. (2019). Outcomes of posterior cervical fusion and decompression: a systematic review and meta-analysis. Spine J, 19(10), 1714-1729. doi.org/10.1016/j.spinee.2019.04.019

 

Disclaimer