Back Clinic Treatments. There are various treatments for all types of injuries and conditions here at Injury Medical & Chiropractic Clinic. The main goal is to correct any misalignments in the spine through manual manipulation and placing misaligned vertebrae back in their proper place. Patients will be given a series of treatments, which are based on the diagnosis. This can include spinal manipulation, as well as other supportive treatments. And as chiropractic treatment has developed, so have its methods and techniques.
Why do chiropractors use one method/technique over another?
A common method of spinal adjustment is the toggle drop method. With this method, a chiropractor crosses their hands and pressed down firmly on an area of the spine. They will then adjust the area with a quick and precise thrust. This method has been used for years and is often used to help increase a patient’s mobility.
Another popular method takes place on a special drop table. The table has different sections, which can be moved up or down based on the body’s position. Patients lie face down on their back or side while the chiropractor applies quick thrusts throughout the spinal area as the table section drops. Many prefer this table adjustment, as this method is lighter and does not include twisting motions used in other methods.
Chiropractors also use specialized tools to assist in their adjustments, i.e., the activator. A chiropractor uses this spring-loaded tool to perform the adjustment/s instead of their hands. Many consider the activator method to be the most gentle of all.
Whichever adjustment method a chiropractor uses, they all offer great benefits to the spine and overall health and wellness. If there is a certain method that is preferred, talk to a chiropractor about it. If they do not perform a certain technique, they may recommend a colleague that does.
It has been compared to the worst possible type of pain anyone can imagine. Other people say it’s even worse than labor because the pain doesn’t seem to have an end to it. These are some of the most common descriptions of sciatica, where a severe case of this excruciating nerve pain can bring anyone to their knees. That’s why lots of patients don’t simply say they have sciatica, they’re victims of its symptoms.
Sciatic nerve pain, or sciatica, is associated with many well-known symptoms, however, is sciatica really that common? What type of treatments are available to help alleviate sciatic nerve pain?And does a person’s everyday activities play a part in whether they will develop sciatica in the first place? Dwight Tyndall, MD, FAAOS answers several of the most commonly asked questions patients need to know regarding their sciatica.�Dr. Tyndall is a pioneer in the area of outpatient spine surgery, however, he is also a strong proponent of non-surgical treatment methods, including chiropractic care, to manage back pain and sciatica. Dr. Tyndall shares his perspectives on sciatic nerve pain and discusses what may indicate a need for surgery in severe cases of sciatica.
What is Sciatica?
According to Dr. Tyndall, sciatica is both a spinal disorder and a catch-all term for a group of symptoms. Sciatic nerve pain, best referred to as sciatica, is a spinal condition characterized by nerve pain which radiates down the length of the sciatic nerve. The sciatic nerve is the largest nerve in the entire human body, and it’s made up of spinal nerves from the vertebrae level L4 in the lumbar spine down to the vertebrae level S1 in the sacrum. Anything which impacts those nerves can lead to sciatica. Moreover, sciatica’s symptoms may be grouped under the medical term dysesthesia, meaning any sort of abnormal sensation. Most patients describe sciatica as an odd feeling radiating out of their lower back into their buttocks and down to their thigh and calf, often radiating as far down into the foot.
What are the Symptoms of Sciatica?
Dr. Tyndall explains that sciatica’s hallmark symptom include pain in the low back or buttocks which radiates down one or both legs. Signs and symptoms which shouldn’t be ignored include pain which doesn’t respond to non-surgical treatment options and/or pain which greatly restricts an individuals activity level and quality of life. Some red flags which may signal the need for surgical interventions associated with sciatic nerve pain include: reduced motor function in one part of the leg, usually a drop foot at which the patient can’t lift thei foot off the ground, weakness in one or both legs and bladder or bowel changes.
Is Sciatica the Same as Lumbar Radiculopathy?
“Most people see sciatica to be more severe than lumbar radiculopathy, but radiculopathy, which comes from the Latin radix significance origin, is a condition that affects the nerve during its origin as it exits the spinal cord. Sciatica and lumbar radiculopathy can be brought on by a pinched nerve from the spinal column due to a disc herniation or stenosis, but kidney problems or a sinus issue, like endometriosis, may also pose sciatica-like symptoms,” states Dr. Dwight Tyndall.
Who’s at Risk of Developing Sciatica?
“By my clinical experience, men and women have exactly the same identical risk of developing sciatica. Obesity also doesn’t play a role, either. Concerning age classes, however, sciatica has been estimated to peak during the ages of 30 and 40, and the risk usually declines as people begin reach their 50’s,” added Dr. Tyndall.
How Common is Sciatica?
As mentioned by Dr. Dwight Tyndall, sciatica and low back pain frequently occur together, but sciatica is much less common. While 80 percent of individuals experience low back pain at any point in their lives, just 2 to 3 percent will actually develop sciatica.
When Should a Person with Sciatica See a Healthcare Professional?
According to Dr. Tyndall, an individual with symptoms of sciatic nerve pain will need to see a healthcare professional if their pain is not reacting to over-the-counter (OTC) medications, or if these create weakness in the leg. Also, a person ought to see a doctor if their pain is so severe that their well-being is affected. Should the sciatica include bladder or bowel changes, the individual must seek immediate medical attention for their health issues. Furthermore, it’s important for a person with sciatica to seek the help of a healthcare professional to rule out any possible underlying causes which may be responsible for their symptoms.
What Type of Healthcare Professional Can Help Treat Sciatica?
According to Dr. Tyndall, any healthcare professional qualified and experienced in spine health issues, such as a chiropractor, can help diagnose, treat and even prevent sciatica. A doctor of chiropractic, or chiropractor, is a healthcare professional who utilizes spinal adjustments and manual manipulations, among other non-invasive treatment methods, to help correct any spinal misalignments, or subluxations, which may be causing sciatic nerve pain. A chiropractor may also recommend a series of stretches and exercises, as well as lifestyle modifications, to help speed up the patient’s recovery process. Chiropractic care is often the preferred alternative treatment option to help alleviate sciatica without the need for drugs and/or medications or surgery. However, if a patient is experiencing any of the red flag symptoms mentioned above, it may be necessary to visit a spine surgeon in order to discuss the treatment options. Always make sure to consider surgical interventions as a final alternative if your sciatica doesn’t respond to non-surgical treatment methods.
What are the Causes of Sciatica?
“There are many external factors, but among the greatest is your occupation. Someone who operates in a manual labor industry, like construction, has a higher likelihood of developing sciatica since they put more wear and tear on their back. Tiger Woods is an example of this. He acquired sciatica because his career as a golfer placed significant stress on his spine. There is a genetic element as well, as a few young men and women who do not operate in a strenuous job develop sciatica, however, the genetic tie is not clearly defined. Lastly, pregnancy may also result in sciatica. As the infant develops, it can put pressure on the lumbar spine, pelvis, and sciatic nerve. However, delivering the infant is usually enough to eliminate sciatica caused by pregnancy,” says Dr. Tyndall.
How Often is Sciatica Likely to Re-Occur?
“This question isn’t easy to answer because many factors contribute to whether a person will develop sciatica more than once. Sciatica is likely to re-occur if the spinal disc that led to sciatica the very first time is severely damaged. The more damaged the disk, the more likely it is to re-herniate and lead to sciatica again. Also, if the patient continues to work in a high-physical stress environment, the risk of re-ocurrence increases.
How is Sciatica Diagnosed?
“The physical examination is essential to a sciatica diagnosis. The straight-leg raise test is the traditional diagnostic tool during a physical examination. In this test, a patient be asked to lift up their leg when lying down. If that induces pain down their leg, the patient could have sciatica. Other physical tests healthcare professionals frequently utilize are knee extension tests, where the patient expands their knee to a straight position, like a straight-leg lift. Additionally, healthcare professionals will as patients to walk on their tip toes or on their heel to measure their potency. Other healthcare professionals will also observe how strong they are going down stairs or simply walking. Many doctors can determine a sciatica analysis from a physical examination, but if imaging studies are needed to learn more, the physician may recommend a magnetic resonance imaging (MRI) scan.
What Treatments are Effective for Sciatica?
As mentioned before by Dr. Dwight Tyndall, there is a variety of treatment options available to help alleviate the symptoms of sciatica. Approximately 80 percent of patients will improve with non-surgical treatment options. Several OTC medications, such as NSAIDs (eg, ibuprofen), are also effective in the management of sciatic nerve pain. If the sciatica does not subside, the doctor may prescribe a low-dose steroid pack (to be obtained over one week). If this doesn’t manage the sciatic nerve pain, then the patient may receive an epidural steroid injection (you will first need an MRI to pin-point the injection region).
Other non-surgical treatment options which are commonly utilized to help alleviate the symptoms of sciatica, include, acupuncture, chiropractic care and physical therapy, and needless to say, time normally works wonders such as pain. Chiropractic care is the most commonly used alternative treatment option for the treatment of sciatica. Chiropractic care focuses on the diagnosis, treatment and prevention of a variety of injuries and/or conditions associated with the musculoskeletal and nervous system. Through spinal adjustments and manual manipulations, a doctor of chiropractic, or chiropractor, can help reduce unnecessary pressure in the structures surrounding the spine, improving strength, mobility and flexibility. Chiropractic care and physical therapy alike, can also help improve a patient’s overall health and wellness, aside from improving their sciatica, through physical activities and nutritional advice.
Is Surgery Ever Necessary to Treat Sciatica?
“It may certainly be so, however, the good thing is that the vast majority of people with sciatica don’t need surgery. And, your doctor may ask you to explore non-surgical treatment options, however, your tolerance for pain is the real predictor as to when you have to consider another option for treatment. Surgery may be necessary if symptoms worsen despite trying non-surgical alternatives, if you have weakness in your leg, or if you experience bladder and/or bowel changes,” explained Dr. Dwight Tyndall.
“The surgical procedure to treat sciatica is also called a lumbar microdiscectomy. It is a normal procedure with very positive individual outcomes when used accordingly. A lumbar microdiscectomy is similar to a traditional lumbar discectomy. Technological advances, like the advent of surgical microscopes, allow surgeons to create smaller incisions that are minimally traumatic to the body and result in a much quicker recovery for the patient”, added Dr. Tyndall.
Can Surgery be Performed in an Outpatient Setting?
“Yes, lumbar microdiscectomy can surely be carried out in an outpatient setting. Many patients like the cozy environment and are able to go home the exact same day of operation,” concluded�Dwight Tyndall, MD, FAAOS.
Is Sciatica Preventable?
As thoroughly explained by Dr. Dwight Tyndall, sciatica can be preventable if the individual doesn’t put significant and repeated stress in their back, which will reduce the chance of damaging or injuring a nerve. Nonetheless, in the present society, through our tasks and daily stresses of modern life, it’s difficult to accomplish that. Fortunately, with the abundance of treatment choices available, people can get relief from sciatic nerve pain with the appropriate healthcare professional’s help.
Dr. Alex Jimenez’s Insight
Many people will experience symptoms of low back pain at least once throughout their lifetime, however, only a few individuals will develop true sciatica symptoms. Sciatica is medically referred to as a collection of symptoms, rather than a single condition, and it’s generally characterized by pain and discomfort, followed by tingling or burning sensations and numbness along the length of the sciatic nerve. The sciatic nerve is the largest nerve in the human body and it travels from the lower back down the buttocks and thighs into the legs and feet. Sciatic nerve pain, or sciatica, has become a common health issue for many people, therefore, its important to be educated regarding this prevalent complaint in order to follow up with the most appropriate treatment.
The scope of our information is limited to chiropractic as well as to spinal injuries and conditions. To discuss the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .
Curated by Dr. Alex Jimenez
Additional Topics: Sciatica
Sciatica is medically referred to as a collection of symptoms, rather than a single injury and/or condition. Symptoms of sciatic nerve pain, or sciatica, can vary in frequency and intensity, however, it is most commonly described as a sudden, sharp (knife-like) or electrical pain that radiates from the low back down the buttocks, hips, thighs and legs into the foot. Other symptoms of sciatica may include, tingling or burning sensations, numbness and weakness along the length of the sciatic nerve. Sciatica most frequently affects individuals between the ages of 30 and 50 years. It may often develop as a result of the degeneration of the spine due to age, however, the compression and irritation of the sciatic nerve caused by a bulging or herniated disc, among other spinal health issues, may also cause sciatic nerve pain.
Active release therapy, more specifically referred to as the active release technique, is a patented system designed by Dr. P. Michael Leahy which focuses on the treatment of developed scar tissue in damaged muscles all across the human body. When Dr. Leahy first developed the technique about two decades ago, he realized that the damage in the complex soft tissues of the muscles might perhaps be able to be sensed as well as addressed directly through movement in the form of specialized techniques. With its proven ability to cure pain, its own acronym, ART, provides the active release therapy with some ironical link to being a true art form in chiropractic care.
When athletes overwork their muscles from playing sports or even through just everyday activities, many individuals don’t understand how scar tissue can develop on our muscles in the first place. The scar issue forms in order to help heal damaged muscles, however, it can ultimately create painful symptoms which may last long after these have healed. Scar tissue most commonly develops as a result of pulled muscles or muscle tears, or even from a lack of oxygen, called hypoxia.
As the scar tissue builds in the damaged or injured muscles, if the individual does not maintain a proper level of mobility in the affected area, it can progressively cause muscles to become stiff or tight and weak, eventually leading to health issues such as tendonitis or nerve problems. This explains why some people with pain or limited range of motion, often will need to visit a healthcare professional immediately. Fortunately, many doctors are certified to treat these type of problems using active release therapy.
Using the Active Release Technique to Relieve Pain
Together with providing tension to the targeted sore muscle and utilizing specific body motions, the painful symptoms associated with scar tissue improves through active release therapy. As of now, there are approximately 500 different active release techniques designed to alleviate the tightness or stiffness and weakness in all of the body’s soft tissues, from the muscles to the nerves. Many of these movements are particularly chosen for each individual based on the specific muscle issue and location.
Active release techniques can also be helpful for small traumatic injuries caused by accumulative trauma or repetitive strain. More specifically, ART functions to break up fibrous tissues called adhesions. These adhesions result from a tear onto a tendon, ligament or muscle. Adhesions commonly develop in different ways, including from trauma as a result of acute injury or from repetitive motion injury caused by overuse, most commonly from sports injuries. It may also be a result of poor posture which has been aggravated by continuous pressure in addition to tension produced in the soft tissues for extended amounts of time.
Such adhesions, when left untreated, can also limit blood flow as well as shorten muscles, causing the well-known symptoms. Worsened symptoms can also result in pain, discomfort or weakness and at times numbness, most notably when scar tissue applies pressure on the nerves. When adhesions occur, the patient will surely complain of distress much more due to the simple fact that they will not be able to engage in the physical activities they were used to performing in before.
The active release technique, or ART,� works by implementing a couple of movements and motions on the affected muscle, tendon or fascia. In comparison to other soft tissue therapies, it’s said to achieve better end results. Primarily, ART aims to help improve the symptoms of the damaged or injured area by applying pressure and force on it. From there, the individual will be tasked to perform a technique which will help release the tension from the treatment. This can essentially improve motion for the treated region.
The combination of this tension out of the active release technique and that of the movement of muscles and its soft tissues will loosen and break up the adhesions. Because of this, there’ll be lesser pain felt on the injured region. This technique works well with active strengthening in addition to biomechanics training. The combination of these therapies will make patients feel improved body awareness, strength, flexibility and mobility even after a few ART sessions.
How Different is ART from Traditional Soft Tissue Treatments?
When compared with traditional manners of soft tissue therapy, ART boasts of a very comprehensive strategy. The active release technique is performed by certified healthcare practitioners who’ve underwent a very rigorous training procedure. Healthcare professionals must participate in sit-in classes and they must also have hands-on testing. Their certificate doesn’t stop after they pass the 90 percent mark on the hands on test though. They’ll also have to maintain their ART certification by getting annual recertification. This may work by honing the healthcare professional’s abilities and at the exact time, this will boil to the benefit of patients undergoing the therapy.
How Successful is ART as a Treatment?
Current research has demonstrated how effective the procedure is when it comes to treating hamstring pain and dysfunction in addition to hip pain, turf toe and lymph nodes. While the efficacy of ART has been demonstrated along these areas, several studies are still being made to check into its potential for treating disorders for other body components.
Using the Active Release Technique for Sciatica
Sciatica is an issue which affects a large number of people. It is essentially a pain syndrome, characterized by a collection of common symptoms which are caused when the sciatic nerve, the largest and most important nerve supplying the lower spine and the lower extremities, is compressed by the small muscles in the pelvis. The piriformis muscle is the one most implicated in the compression of the sciatic nerve, particularly because it moves through this muscle when emerging from the pelvis and entering the lower limbs. The active release technique, or ART, may be used in the treatment of sciatica brought on by piriformis syndrome.
Pathophysiology of Sciatica
When sciatica is caused by the compression of the sciatic nerve by the piriformis muscle, the latter generally goes into a spasm for an extended period of time, leading to the compression of this fundamental nerve. The spasm may result in a compromise in the blood supply to the muscle itself as well as the nerve, which will further complicate the issue. Nerve communications are important in order for the human body to maintain its outmost efficiency. Sciatica often can also be caused by disc injuries and herniations, as generally is a differential diagnosis to piriformis syndrome. Specific orthopedic tests can help, doctors of chiropractic, or chiropractors, evaluate the source of the patient’s sciatica prior to commencing any type treatment.
Consequences of Sciatic Nerve Pain
There are a number of effects that could arise as a result of sciatica. Reduction in overall body ranges of movement can be anticipated, accompanied by searing or sharp pain that can be excruciating. This can make it very difficult for an individual’s quality of life, especially when carrying out daily tasks like going to school and work, might become impossible due to the seriousness of the health issue. When the issue isn’t treated on time, it might cause permanent damage to the sciatic nerve.
Conventional Treatments for Sciatic Nerve Pain
There are a range of conventional treatments that may be utilized based on the intensity of the sciatic nerve pain, or sciatica. One of these is an injection of a drug/medication that can relax the muscle so that it stops compressing the nerve. Additionally, it has been proven that drugs and/or medications, such as steroids, may also have an impact on reducing the pain and impairment related to the symptoms. When the pharmacological methods don’t result in any progress, surgical ones can be attempted. The most usual of these is a surgery to release the nerve from the muscle by cutting away a portion of it. Although these have been listed as conventional treatments which may be used to treat sciatica, alternative treatment options and secondary opinions should be considered before considering surgical interventions. Only when no other treatment has demonstrated any improvements, should surgery be considered by a patient.
The Role of Active Release Techniques for Sciatica
The active release technique, or ART, is a form of therapy that focuses on the manipulation of soft tissues, including nerves, fascia and muscles, so as to achieve relief of painful symptoms, in this case for sciatica. For sciatic nerve pain, ART is utilized to reduce spasm and remove adhesions of the muscle that may be entrapping the sciatic nerve. Since the adhesions are removed through specific manual methods, the nerve can slide under the soft tissues, and sciatica symptoms can solve relatively quickly. There are a range of things that a patient can do in order to increase the efficacy of the active release technique. Early start to treatment assists in long-term resolution of sciatica symptoms.
Dr. Alex Jimenez’s Insight
The active release technique, also known as active release therapy or ART, is a soft tissue treatment based on a series of movement and motion techniques utilized to relieve pain and discomfort as well as promote the healing of muscles, joints and nerves, among other soft tissues. When performed by a certified healthcare professional, including a chiropractor, ART can help break down adhesions which may have developed following scar tissue formation after a damaged or injured muscle has healed. The active release technique has become one of the most common therapy for soft tissue treatment.
ART therapy is usually provided by skilled therapists like chiropractors, who have to keep their accreditation through continuing education on a yearly suface. This treatment is a specialized procedure that needs quite a bit of expertise and skill so as to work and supply rapid results. The scope of our information is limited to chiropractic as well as to spinal injuries and conditions. To discuss the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .
Curated by Dr. Alex Jimenez
Additional Topics: Sciatica
Sciatica is medically referred to as a collection of symptoms, rather than a single injury and/or condition. Symptoms of sciatic nerve pain, or sciatica, can vary in frequency and intensity, however, it is most commonly described as a sudden, sharp (knife-like) or electrical pain that radiates from the low back down the buttocks, hips, thighs and legs into the foot. Other symptoms of sciatica may include, tingling or burning sensations, numbness and weakness along the length of the sciatic nerve. Sciatica most frequently affects individuals between the ages of 30 and 50 years. It may often develop as a result of the degeneration of the spine due to age, however, the compression and irritation of the sciatic nerve caused by a bulging or herniated disc, among other spinal health issues, may also cause sciatic nerve pain.
Whiplash Injuries: If you have ever had to deal with the pain of whiplash, you know how it can impact every aspect of your life. Whiplash can cause chronic pain and keep you from doing many activities you enjoy. Daily tasks can be painful or even impossible to carry out. Even milder cases can make turning your head from side to side complex.
Chiropractic is a very effective treatment for whiplash injuries that helps with pain management and enables you to heal faster. Your chiropractor can recommend exercises you can do at home between treatments and other lifestyle changes that will facilitate your healing and improve flexibility.
Whiplash Injuries
What Is Whiplash?
Whiplash is a term that describes an injury that is typically focused on the neck and spine. It is caused when the head and neck are thrown in one direction unexpectedly and quickly, then thrust in the opposite direction. The head is rapidly whipped, usually front to back. It can be whipped from side to side, though.
Most people associate whiplash with car accidents, but even turning one way while a child tugs your arm in another direction can cause it. Anything that jerks your head suddenly can cause whiplash.
What Damage Does Whiplash Cause?
The damage that is caused by whiplash is called vertebral subluxation. This type of subluxation is caused by injury, and a chiropractor can diagnose the injury and treat it. It is the most common source of discomfort and pain caused by injuries due to whiplash. There are different kinds caused by tension and emotional stress, poor sleeping, lousy posture, weak muscles, and inadequate diet.
The injury from whiplash is in the neck and spine, but the pain can extend to the head, arms, shoulders, hips, and legs. You can experience frequent headaches, numbness, and tingling in your hands and have difficulty walking or moving about. The pain can range from stiffness and soreness to stabbing and sharpness. The injury can affect various nerves, causing blurred vision, dizziness, low back pain, ear ringing, and even problems with your internal organs.
Chiropractic Treatment For Whiplash
Chiropractors will use different techniques to relieve the pain of whiplash and help with healing.
Chiropractic Adjustment The chiropractor performs spinal manipulation to move the joints into alignment gently. This will help to align the body to relieve pain and encourage healing.
Muscle Stimulation and Relaxation This involves stretching the affected muscles, relieving tension, and helping them relax. Finger pressure techniques may also be combined with trying to alleviate pain.
McKenzie Exercises These exercises help with disc derangement that whiplash causes. They are first performed in the chiropractor’s office, but the patient can be taught how to do them at home. This helps the patient have some degree of control in their healing.
Each whiplash case is different. Instances of varying whiplash have various symptoms. A chiropractor will evaluate the patient and determine the appropriate treatment case-by-case basis. The chiropractor will determine the best course of treatment that will relieve your pain and restore your mobility and flexibility.
Whiplash can be far more severe than you may realize. Any accident that causes whiplash injuries can result in the vertebrae moving out of alignment. This can damage and irritate the spinal nerves. Even whiplash from years ago can still affect you if you never saw a chiropractor. Your spine can still be out of alignment, and injury or trauma from years ago can cause problems that seem unrelated.
Injury Medical Clinic: Accident Treatment & Recovery
Physicians, neurologists, and other healthcare professionals may often run a cranial nerve examination as part of a neurological evaluation to analyze the operation of the cranial nerves. This involves a highly formalized series of tests that evaluate the status of each cranial nerve. A cranial nerve test begins with observation of the patient partly due to the fact that cranial nerve lesions may ultimately affect the symmetry of the face or eyes, among other signs and symptoms.
The visual fields for neural lesions or nystagmus�are tested via an evaluation of particular eye movements. The sensation of the face is tested by asking patients to execute different facial movements, like puffing out their cheeks. Hearing is tested through voice and tuning forks. The position of the individual’s uvula is also examined because asymmetry in its placement could indicate a lesion of the glossopharyngeal nerve. After the capability of the individual to use their shoulder to test the accessory nerve (XI), the patient’s tongue operation is generally assessed by detecting various tongue movements.
Damage or Injury of the Cranial Nerves
Compression
Cranial nerves may be compressed due to increased intracranial pressure, a profound effect of an intracerebral haemorrhage, or tumour which presses against the cranial nerves and interferes with the communication of impulses along the length of a nerve. In some instances, a loss of functionality of one cranial nerve may on occasion be the first symptom of an intracranial or skull base cancer.
An increase in intracranial pressure can lead to dysfunction of the optic nerves (II) because of the compression of the surrounding veins and capillaries, resulting in swelling of the eyeball, known as papilloedema. A cancer, such as an optic glioma, can also affect the optic nerve (II). A pituitary tumour can compress the optic tracts or the optic chiasm of the optic nerve (II), causing visual field loss. A pituitary tumour may also extend into the cavernous sinus, compressing the oculuomotor nerve (III), the trochlear nerve (IV) and the abducens nerve (VI), often leading to double-vision and strabismus. These cranial nerves may also be impacted by herniation of the temporal lobes of the brain via the falx cerebri.
The cause of trigeminal neuralgia, where one side of the face experiences painful signs and symptoms, is believed to be due to the compression of a cranial nerve by an artery as the nerve exits from the brain stem. An acoustic neuroma, especially at the junction between the pons and medulla, may compress the facial nerve (VII) and the vestibulocochlear nerve (VIII), resulting in hearing and sensory loss on the affected side.
Stroke
Occlusion of blood vessels which supply the cranial nerves or their nuclei, or an ischemic stroke, might cause specific signs and symptoms which could localize where the occlusion happened. A clot in a blood vessel draining the cavernous sinus, also known as the cavernous sinus thrombosis, may affect the oculomotor (III), the trochlear (IV), and the opthalamic branch of the trigeminal nerve (V1) and the abducens nerve (VI).
Inflammation
Inflammation caused by an infection may impair the operation of any of the cranial nerves. Infection of the facial nerve (VII), for instance, can result in Bell’s palsy. Multiple sclerosis, an inflammatory process which can produce a loss of the myelin sheathes that encircle the cranial nerves, may cause a variety of shifting signs and symptoms which can ultimately affect multiple cranial nerves.
Other
Trauma to the skull, bone disease like Paget’s disease, and damage or injury to the cranial nerves through neurosurgery, by way of instance, through tumor removal, are other potential causes of cranial nerve health issues.
Dr. Alex Jimenez’s Insight
There are 12 pairs of cranial nerves which exit the brain, one in each side. These cranial nerves are named and numbered (I-XII) according to their location in the brain as well as their specific function in the body. Common conditions, such as multiple sclerosis, may affect one or more of the cranial nerves, resulting in dysfunction of the specific regions innervated by them. Signs and symptoms associated with health issues affecting specific cranial nerves can help healthcare professionals determine the source of the problem. Testing the cranial nerves involves a number of steps in order to be certain which function of the human body has been ultimately affected.
Clinical Significance of the Cranial Nerves
Most commonly, humans are believed to have twelve pairs of cranial nerves which have been assigned Roman numerals I-XII for identification. The numbering of the cranial nerves is based on the order in which they emerge from the brain, or from the front to the back of the brainstem. These include: the olfactory nerve (I), the optic nerve (II), the oculomotor nerve (III), the trochlear nerve (IV), the trigeminal nerve (V), the abducens nerve (VI), the facial nerve (VII), the vestibulocochlear nerve (VIII), the glossopharyngeal nerve (IX), the vagus nerve (X), the accessory nerve (XI), and the hypoglossal nerve (XII). Below we will narrow down the clinical significance of the cranial nerves.
Olfactory Nerve (I)
The olfactory nerve (I) communicates the sensation of smell to the brain. Lesions resulting in anosmia, or loss of the sense of smell, have been previously described to occur through trauma, damage or injury to the head, especially in the instance that a patient hits the back of their head. In addition, frontal lobe masses, tumors, and SOL have also been associated with the loss of the sense of smell. Healthcare professionals have previously identified that the loss of the sense of smell is one of the first symptoms seen in Alzheimer’s and early dementia patients.
Healthcare professionals may test the function of the olfactory nerve (I) by having the patient close their eyes and cover one nostril at a time in order to have them breathe out through their nose while placing a scent under the nostril and having them breathe in. The doctor will ask the patient, “do you smell anything?”, and record the findings. This tests whether the nerve is operating appropriately. If the patient says yes, the doctor will then ask the patient to identify the scent. This tests whether the processing pathway, known as the temporal lobe, is functioning accordingly.
Optic Nerve (II)
The optic nerve (I) communicates visual information to the retina. Lesions to this cranial nerve can be the result of CNS disease, such as MS, or CNS tumors and SOL. Most health issues associated with the visual system emerge from direct trauma, metabolic or vascular diseases. FOV lost in the periphery can also indicate that SOL may be affecting the optic chiasm, including a pituitary tumor.
A healthcare professional will often test the function of the optic nerve (II) by asking whether the patient can see. If the patient describes having vision in each eye, the optic nerve is functional. Doctors may also perform visual acuity testing using the Snellen chart, first one eye at a time, then the two eyes together, or they may perform distance vision testing. Near vision testing will often involve the Rosenbaum chart, first one eye at a time, then the two eyes together. Additional associated testing for the visual system can include, the ophthalmoscopic or funduscopic exam, which assess the A/V ratio and vein/artery health as well as assess cup to disc ratio of the visual system. Other testing methods include field of vision testing, intraoccular pressure testing and the iris shadow test.
Oculomotor Nerve (III), Trochlear Nerve (IV), and Abducens Nerve (VI)
The oculomotor nerve (III), the trochlear nerve (IV), the abducens nerve (VI) and the ophthalmic division of the trigeminal nerve (V1) travel through the cavernous sinus to the superior orbital fissure, passing out of the skull into the orbit. These cranial nerves control the tiny muscles that move the eye and also offer sensory innervation to the eye and orbit.
The clinical significance of the oculomotor nerve (III) includes diplopia, lateral strabismus (unopposed lateral rectus m.), head rotation away from the side of the lesion, a dilated pupil (unopposed dilator pupillae m.), and ptosis of the eyelid (loss of function of the levator palpebrae superioris m.). Lesions to the oculomotor nerve (III) can occur due to inflammatory diseases, such as syphilitic and tuberculous meningitis, aneurysms of the posterior cerebral or superior cebellar aa., and SOL in the cavernous sinus or displacing the cerebral peduncle to the opposite side. Testing this cranial nerve is performed by moving a light in front of the patient’s pupil from the lateral side and hold for 6 seconds. The doctor should watch for direct (ispilateral eye) and consensual (contralateral eye) pupillary constriction in order to distinguish dysfunction of the oculomotor nerve (III).
The clinical significance of the trochlear nerve (IV) is characterized where the patient presents diplopia and difficulty while maintaining a downward gaze, often complaining of having difficulties when walking down stairs, resulting in more frequent tripping and/or falling, followed by extortion of the affected eye (unopposed inferior oblique m.) and a head tilt to the unaffected side. Lesions to the trochlear nerve (IV) can commonly be the result of inflammatory diseases, aneurysms of the posterior cerebral or superior cerebellar aa., SOL in the cavernous sinus or superior orbital fissure and surgical damage during mesencephalon procedures. Head tilts in superior oblique palsy (CN IV failure) may also be identified.
The clinical significance of the abducens nerve (VI) includes diplopia, medial strabismus (unopposed medial rectus m.), and head rotation towards the side of the lesion. Lesions to this cranial nerve can be the result of aneurysms of the posterior inferior cerebellar or basilar aa., SOL in the cavernous sinus or 4th ventricle, such as a cerebellar tumor, fractures of the posterior cranial fossa, and increased intracranial pressure. Testing this cranial nerve is performed through the H-Pattern testing, where the healthcare professional will have the patient follow an object no bigger than 2 inches. It’s essential for the doctor to follow these specific guidelines as patient’s can have difficulties focusing on items that are too large, and it’s also important for the doctor not to hold the object too close to the patient. Convergence and accommodation testing is performed by bringing the object close to the bridge of the patient’s nose and back out at least 2 times. The physician must look for pupillary constriction response as well as convergence of the eyes.
Trigeminal Nerve (V)
The trigeminal nerve (V) is made up of three different parts: The . When put together, these nerves provide sensation to the skin of the face and also controls the muscles of mastication, or chewing. Cranial nerve dysfunction along any of the separate sections of the trigeminal nerve (V) can manifest as decreased bite strength on the ipsilateral side of the lesion, loss of sensation along the distribution of V1, V2, and V3, and loss of corneal reflex. Lesions to the trigeminal nerve (V) can be the result of aneurysms or SOL affecting the pons, particularly tumors at the cerebellopontine angle, skull fractures on the facial bones or damage to the foramen ovale, and Tic doloureux, most frequently referred to as trigeminal neuralgia, characterized by sharp pain along the distributions of the different parts of the trigeminal nerve (V). Physicians may utilize analgesic, anti-inflammatory or contralateral stimulation to control the signs and symptoms.
Testing the trigeminal nerve (V) includes pain & light touch testing along the ophthalmic (V1), the maxillary (V2), as well as the Mandibular (V3) nerves of the cranial nerve.�Testing is best done toward the more medial or proximal areas of
the face, where the V1, the V2 and the V3 are better delineated. A healthcare professional may also assess dysfunction along this cranial nerve using the blink/corneal reflex testing, performed by puffing air or doing a small tissue tap from the lateral side of the eye on the cornea. If normal, the patient blinks. The CN V provides the sensory (afferent) arc of this reflex. Bite strength may also be tested by having the patient bite down on a tongue depressor while the doctor tries to remove it. The jaw jerk/Masseter reflex may also be performed with the patient�s mouth slightly open, by placing the thumb on a patient�s chin and tapping the own thumb with a reflex hammer. Strong closure of the mouth indicates UMN lesion. CN V provides both the motor and sensory of this reflex.
Facial Nerve (VII) and Vestibulocochlear Nerve (VIII)
The facial nerve (VII) and the vestibulocochlear nerve (VIII) both input the inner auditory canal in the temporal bone. The facial nerve subsequently extends to the side of the face then distributes to control and reach all of the muscles in charge of facial expressions. The vestibulocochlear nerve reaches the organs which control equilibrium and hearing in the temporal bone.
As with all cranial nerves, signs and symptoms along the facial nerve (VII) describe the location of the lesion. Lesion in the lingual nerve will manifest as loss of taste, general sensation in the tongue and salivary secretion. Lesion proximal to the branching of the chorda tympani, such as in the facial canal, will result in the same signs and symptoms, without the loss of general sensation of the tongue, partly due because the V3 has not yet joined the facial nerve (VII). Corticobulbar innervation is asymmetric to the upper and lower parts of the facial motor nucleus. In the instance of an UMN lesion, or a lesion to the corticobulbar fibers, the patient will experience paralysis of the muscles in charge of facial expression in the contralateral lower quadrant. If there is an LMN lesion, or a lesion to the facial nerve itself, the patient will experience paralysis of the muscles of facial expression in the ipsilateral half of the face, otherwise known as Bell’s palsy.
A healthcare professional will test the facial nerve (VII) initially by asking the patient to mimic or follow specific instructions to make certain facial expressions. The doctor should make sure to evaluate all four quadrants of the face by asking the patient to raise their eyebrows, puff their cheeks, smile and then close their eyes tightly. Subsequently, the doctor will test the facial nerve (VII) by checking the strength of the buccinator muscle against resistance. The healthcare professional will achieve this by asking the patient to hold air in their cheeks as they press gently from the outside. The patient should be able to hold air in against the resistance.
Signs and symptoms of dysfunction in the vestibulocochlear nerve (VIII) often involve changes in hearing alone, most commonly as a result of infections in the otitis media and/or as a result of skull fractures. The most common lesion to this nerve is caused by an acoustic neuroma which affects the CN VII and the CN VIII, particularly the cochlear and vestibular divisions, as a result of proximity in the internal auditory meatus. Signs and symptoms of the health issue include nausea, vomiting, dizziness, hearing loss, tinnitus, and Bell’s palsy, etc.
Testing the vestibulocochlear nerve (VIII) for dysfunction commonly involves an otoscopic exam, the scratch test, which determines whether a patient can hear equally on both sides, the Weber test, tests for lateralization, a 256 Hz tuning fork placed on top of the patient�s head in the center, which can help point out whether a patient hears it louder on one side than the other, and finally the Rinne test, which compares air conduction to bone conduction. Normally, air conduction should last twice as long as bone conduction.
Glossopharyngeal Nerve (IX), Vagus Nerve (X) and Accessory Nerve (XI)
The glossopharyngeal (IX), the vagus nerve (X) and the accessory nerve (XI) all emerge from the skull to enter the neck. The glossopharyngeal nerve (IX) provides innervation to the upper throat and the back of the tongue, the vagus nerve (X) offers innervation to the muscles at the voicebox, and proceeds down to provide parasympathetic innervation to the chest and abdomen. The accessory nerve (XI) controls the trapezius and sternocleidomastoid muscles at the neck and shoulder.
The glossopharyngeal nerve (IX) is rarely damaged alone, due to it�s proximity to the CN X and XI. A healthcare professional should perform a test to look for signs of CN X & XI damage as well if CN IX involvement is suspected.
Patients with clinical signs and symptoms caused by vagus nerve (X) dysfunction may experience dysarthria, or difficulty speaking clearly, as well as dysphagia, or difficulty swallowing. These may present as food or liquid coming out of their nose or frequent chocking or coughing when eating and/or drinking. Further clinical presentations include hyperactivity of a visceral motor component, leading to the hypersecretion of gastric acid and resulting in ulcers. Hyper-stimulation of the general sensory component can cause coughing, fainting, vomiting and reflex visceral motor activity. The visceral sensory component of this nerve only provides general feelings of un-wellness but visceral pain may transfer on to the sympathetic nerves.
Testing for the glossopharyngeal nerve (IX) and the vagus nerve (X) can include the gag reflex, where the�CN IX provides the afferent (sensory) arc and the�CN X provides the efferent (motor) arc. Approximately 20 percent�of patients have a minimal or absent gag reflex. Other tests may include wwallowing, gargling, etc., as it requires CN X function. Healthcare professionals may also test palatal elevation because it requires CN X function. Furthermore, the doctor will see whether the palate elevates and uvula deviates
contralateral to damaged side. Finally, the healthcare professional will test the auscultation of the heart, since the R CN X innervates SA node (more rate regulation) and the L CN X the AV node (more rhythm regulation).
Lesions in the accessory nerve (XI)�may occur due to radical surgeries in the neck area, such as the removal of the laryngeal carcinomas. Testing for the accessory nerve (XI) may include the strength test SCM m. Patients with clinical signs and symptoms due to lesions in the accessory nerve (XI) will experience difficulties turning their head against the resistance of a healthcare professional, particularly toward the side opposite of the lesion. Testing for the accessory nerve (XI) may also include the strength test trapezius m. Patients with clinical signs and symptoms due to lesions in the accessory nerve (XI) will experience difficulties with shoulder elevation on the side of the lesion.
Hypoglossal Nerve (XII)
The hypoglossal nerve (XII) originates from the skull to reach the tongue in order to control essentially all of the muscles involved in the movements of the tongue. The clinical significance of health issues associated to the hypoglossal nerve (XII) can manifest as a deviating tongue towards the side of an inactive genioglossus m. upon tongue protrusion. This may often be contralateral to a corticobulbar, or UMN, lesion or from an ipsilateral to a hypoglossal n., or LMN, lesion.
Testing for the hypoglossal nerve (XII) involves the healthcare professional asking a patient to stick out their tongue. The doctor will look for any deviation which may signal a health issue along the length of the hypoglossal nerve (XII). Another test the doctor may perform as a part of the evaluation may include the physician asking the patient to place their tongue inside their cheek and apply light resistance, one side at a time. The patient should be able to resist moving their tongue with pressure.
The clinical significance of the signs and symptoms which manifest as a result of cranial nerve dysfunction are essential in order for the healthcare professional to properly diagnose the patient’s specific health issue. The clinical findings described above are often unique to the affected cranial nerve and the tests and evaluations for each can help confirm a diagnosis. Proper diagnosis is fundamental in order for the doctor to continue with the patient’s appropriate treatment. The scope of our information is limited to chiropractic as well as to spinal injuries and conditions. To discuss the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .
Curated by Dr. Alex Jimenez
Additional Topics: Sciatica
Sciatica is medically referred to as a collection of symptoms, rather than a single injury and/or condition. Symptoms of sciatic nerve pain, or sciatica, can vary in frequency and intensity, however, it is most commonly described as a sudden, sharp (knife-like) or electrical pain that radiates from the low back down the buttocks, hips, thighs and legs into the foot. Other symptoms of sciatica may include, tingling or burning sensations, numbness and weakness along the length of the sciatic nerve. Sciatica most frequently affects individuals between the ages of 30 and 50 years. It may often develop as a result of the degeneration of the spine due to age, however, the compression and irritation of the sciatic nerve caused by a bulging or herniated disc, among other spinal health issues, may also cause sciatic nerve pain.
Back Pain Specialist: Mike Melgoza is a very active person who is always engaging in physical activity, as a result, he occasionally suffers from debilitating back pain symptoms. Mike Melgoza was struggling to sleep properly due to his symptoms of back pain before receiving chiropractic care with Dr. Alex Jimenez. Mike Melgoza has already started experiencing tremendous relief from his back pain and he highly recommends Dr. Alex Jimenez as the non-surgical choice for back pain.
Back Pain Specialist
Back pain is one of the most common reasons people visit the doctor or miss work and it is also a leading cause of disability globally. The majority of people have back pain at least once throughout their lifetimes. Luckily, you can take steps to prevent or relieve back pain. If prevention fails, easy treatment and appropriate body mechanics frequently will heal your back in a few weeks and keep it operational for the long haul. Surgery is rarely required to treat back pain.
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Patellofemoral Syndrome: As the weather warms and spring is in full swing, more and more runners are heading outside, hitting the pavement to train for upcoming races or to just step up their game after a long winter. While there are some die hard runners who don�t let even the most brutal winter stop them, most tend to retreat indoors, waiting for warmer days and a more pleasant environment. Unfortunately, increased activity can also lead to an increased risk of injury, particularly patellofemoral pain syndrome (PFPS), also known as runner�s knee.
What Is Patellofemoral Pain Syndrome?
Runner�s knee is often used to describe PFPS, but runner�s knee is actually a broader term describing several different knee injuries or ailments. PFPS is a painful condition that is caused when the tissue that is between the femur (thigh bone) and the patella (kneecap) becomes inflamed or irritated.
Most people will notice pain in the front portion or anterior part of the knee, but pain can be experienced in other parts of the knee and even back pain may occur. Running increases the discomfort, as does sitting for long periods and going up or down stairs.
The causes of PFPS can also vary widely. Overuse is often the first thing that people think, but a problem with the way the knee is aligned is actually the most common reason.
If the patella is not properly aligned, when it moves through the groove that is at the end of the femur, it causes irritation to the surrounding tissues. This usually happens because the muscles and joints are out of balance.
For instance, if the quad muscle on one side is weaker than the other side it throws the entire system out of balance, causing the knee to become misaligned. This leads to knee pain and discomfort.
Treatment For Patellofemoral Syndrome – Runner�s Knee
When treating PFPS, rest is usually first on the list, followed by icing the area to reduce inflammation. Once the pain is under control, the next step is to determine what is causing the problem. It is important to rule out more serious conditions or injuries first in order to determine the best course of treatment.
If it is indeed PFPS, strengthening the muscles in and around the knee is generally the first step in treatment. It is important that the muscle strength is balanced so that the knee can be properly aligned. Getting a good pair of running shoes is also recommended so that future injury can be prevented.
Chiropractic For Runner�s Knee
Runner�s knee, or PFPS, responds very well to chiropractic treatment. The chiropractor is able to do a complete exam and find the cause of the problem, then tailor the treatment accordingly. This is typically done on a case by case basis with treatment that is based on the individual�s unique needs. The chiropractor may do various chiropractic alignments and manipulations on the spine, hip, ankle, and knee in order to bring the body back into proper balance.
The chiropractor may also recommend other complimentary treatments including special supplements, dietary adjustments, and an exercise plan. The chiropractor may also recommend certain stretching exercises to aid in healing. Kinesio taping is another common treatment that may be used in conjunction with chiropractic care. It is particularly beneficial when there is a muscular strength imbalance. The tape can help support the weaker muscle group.
Chiropractic care is a very effective treatment for patellofemoral syndrome and the associated knee pain. It works to correct the problem by bringing the body back into proper alignment, allowing it to function as it should.
Almost everyone can say that they’ve experienced a feeling of unsteadiness or a spinning/whirling sensation in their heads at one point in their lifetimes. Usually it’s narrowed down to dizziness, however, dizziness is a broad term that can mean different things to different individuals. It is a prevalent complaint which can also be serious. Dizziness has no specific medical definition, but there are four common conditions which can be considered types of dizziness:
Vertigo. The feeling of motion where there is no movement, as if you were spinning or your environment is whirling. Spinning/whirling yourself around and around, then abruptly stopping, can produce temporary vertigo. However, when it occurs throughout an individual’s regular course of living, it could mean that there’s an underlying health issue in the vestibular system of the inner ear, the body’s equilibrium system which tells you which way is up or down and senses the position of your head. About half of all dizziness complaints are diagnosed as vertigo.
Lightheadedness. Also referred to as near syncope or pre-syncope, lightheadedness is the feeling that you’re about to faint. It is commonly believed to occur from standing up too fast or by breathing deeply enough times to generate the sensation.
Disequilibrium. A problem with walking. People with disequilibrium feel unsteady on their feet or feel as if they will fall.
Anxiety. Individuals who are scared, worried, depressed, or fearful of open spaces can use the term “dizzy” to imply feeling frightened, depressed, or anxious.
Individuals who frequently suffer from dizziness may also ultimately complain of more than one type of dizziness. For instance, people with vertigo may also feel anxious. Dizziness may be a one-time event, or it can be a chronic, long-lasting issue. Nearly everyone who experiences some form of dizziness will recover over time. This is because an individual’s sense of balance is an intricate interaction between the brain, each ear’s different vestibular system, sensors in the muscles, and sense of vision. When one component experiences dysfunction, others can generally learn how to compensate. Below, we will be narrowing down the four common types of dizziness.
Vertigo, the sensation of spinning or whirling, can be divided into two different categories: peripheral vertigo and central vertigo. Peripheral vertigo is more common than central vertigo and it typically develops due to damage to the inner ear or CN VIII. This type of vertigo produces abnormal eye movements, referred to as nystagmus, which may be horizontal or rotary.
Nystagmus is usually jerky in nature with a fast and slow phase, however it is often named for the direction of the fast phase. Peripheral vertigo may worsen when the patient looks to the side of the fast phase of nystagmus. Furthermore, the severity of nystagmus can correlate with the severity of the patient’s vertigo. Peripheral vertigo is also characterized as having no other signs and/or symptoms of CNS dysfunction. Patient may describe having symptoms of nausea or may present difficulty when walking, but only due to vestibular dysfunction. The patient may also have hearing loss or tinnitus if the CN VIII or auditory mechanism function is damaged.
The causes of peripheral vertigo are typically benign, including: benign paroxysmal positional vertigo, or BPPV, cervicogenic vertigo, acute labyrinthitis/vestibular neuronitis, Meniere’s disease, perilymph fistula, and acoustic neuroma. Identifying a patient’s cause of vertigo can be determined by narrowing down the symptoms through proper diagnosis from a healthcare professional. If movements, especially of the neck and head, aggravate vertigo, it may be attributed to BPPV, vertebrobasilar artery insufficiency or cervicogenic vertigo. If noise manifests episodes of vertigo, it may be attributed to Meniere’s disease or perilymph fistula.
Common Causes of Dizziness
Vertigo can be Brought on by many things:
Infections, such as the ones which cause the frequent cold or diarrhea, can lead to temporary vertigo through an ear infection. This inner ear disease is generally viral, benign, and usually goes away in one to six weeks, however, drugs and/or medications are readily available if these become too severe.
Benign paroxysmal positional vertigo, or BPPV, is caused by the motion of a misplaced otolith, a tiny calcium particle the size of a grain of sand, from the component of the inner ear which senses gravity into the part that senses head position. The individual feels as if their head is turning when it isn’t. After diagnosis of BPPV using a special methods known as the Dix-Hallpike test, treatment done right in the doctor’s office can help move the otolith back where it belongs and fix the health issue. This therapy, known as the Epley maneuver, has been accounted to cure vertigo 80 percent of the time.
Meniere’s disease is a disorder characterized by long-lasting episodes of severe vertigo. Other symptoms of Meniere’s disease are tinnitus, or ringing in the ears, hearing loss, and fullness or pressure in the ear.
Dandy’s syndrome is a feeling of everything bouncing up and down. It may occur to individuals who take an antibiotic that is toxic to the ear. However, it usually improves over time.
Less frequent, deadly diseases may also result in vertigo, like tumors or stroke.
Below, we will be narrowing down some of the common causes of vertigo, described above, in further detail.
Benign Paroxysmal Positional Vertigo (BPPV)
Benign paroxysmal positional vertigo, or BPPV, may develop spontaneously, particularly in the elderly. It may also commonly develop as a result of head trauma or head injury, such as that resulting from an automobile accident. Vertiginous episodes associated with BPPV may manifest through specific movements, including, looking at a high shelf, referred to as top-shelf vertigo, bending over, and rolling over in bed at night. The onset of vertigo with BPPV can begin a few seconds after movement and often resolves within a minute. As mentioned above, the diagnostic test commonly utilized to diagnose BPPV is the Dix-Hallpike maneuver. Treatment procedures to treat BPPV include the Epley maneuver and Brandt-Daroff Exercises. Furthermore, benign paroxysmal positional vertigo may also resolve on its own as the loose crystals in the inner ear dissolve, however, it may take months and new otoliths can also become displaced.
Cervicogenic vertigo occurs after a neck or head injury, however, it is not very common. It’s generally accompanied by pain and/or joint restriction where vertigo and nystagmus are less severe than that in BPPV. Cervicogenic vertigo manifests with changes in head position but does not subside as quickly as it does with benign paroxysmal positional vertigo.
Vertebrobasilar Artery Insufficiency
Vertebrobasilar artery insufficiency occurs if the vertebral artery is compressed during head rotation or extension. In this instance, the onset of vertigo is delayed more than in BPPV or cervicogenic vertigo due to the fact that ischemia often takes up to 15 seconds to occur. Orthopedic tests for vertebrobasilar artery insufficiency may help in its diagnosis. Diagnostic tests include the�Barre?-Lie?ou sign, DeKlyn Test or Dix-Hallpike Maneuver, Hautant test, Underberg test and the vertebrobasilar after functional maneuver.
Acute Labyrinthitis and Vestibular Neuronitis
Acute labyrinthitis and vestibular neuronitis are not well understood, however, they’re believed to develop as a result of inflammation. These conditions generally follow after a viral infection or may occur seemingly without a cause.�Acute labyrinthitis and vestibular neuronitis are characterized by a single, monophasic attack of vertigo which typically resolves in days to a few weeks and generally does not reoccur.
Meniere’s Disease
Meniere’s disease is characterized by increased pressure in the endolymph which causes membrane ruptures and a sudden mixture of endolymph and perilymph. With Meniere’s disease, episodes of vertigo can last from 30 minutes to several hours, or until equilibrium between the fluids in the inner ears to be reached. Over time, these episodes can damage vestibular and cochlear hair cells, resulting in low-pitch buzzing tinnitus and the loss of hearing of low tones. In comparison to Meniere’s disease, Meniere’s syndrome is when the symptoms of Meniere’s disease are found to be secondary to another condition, such as: hypothyroidism, acoustic neuroma, superior semicircular canal dehiscence or SCDS, or perilymph fistula. True Meniere’s disease is idiopathic.
Perilymph Fistula
Perilymph fistula is an abnormal connection, or tear, which causes a small leak within the inner ear due to trauma or injury, especially barotrauma. Perilymph fistula can look very similar symptomatically to Meniere’s disease/syndrome and it’s often aggravated by changes in pressure causes by airplane rides or driving uphill. Another symptom of perilymph fistula includes Hennebert’s sign, where a vertigo or nystagmus episode is brought on by sealing pressure of the ear, such as by inserting an otoscope.
Central vertigo, another category of vertigo, is less common than peripheral vertigo, as described above. It is caused by damage to the processing center of vestibular information in the brain stem and the cerebral cortex. However, episodes of dizziness are considered to be less severe than with peripheral vertigo while episodes of nystagmus are more severe than the patient’s complaint or description. This specific nystagmus associated with central vertigo may go in multiple directions, including vertical. Central vertigo may or may not have other CNS findings upon diagnosis or examination and no changes in hearing can be expected with this form of vertigo. The most common causes of central vertigo include: cerebrovascular disease, such as transient ischemic attacks, multiple sclerosis, Arnold-Chiari malformation, damage to caudal brainstem or vestibulocerebellum and/or migraine condition.
Lightheadedness, or pre-syncope dizziness, is generally caused by some surrounding circumstance impairing blood flow into the brain when an individual is standing up. Blame this problem on our ancestors who learned to walk upright, placing our brain above our heart. It is a challenge for your heart to keep the brain supplied with blood and it is easy for this system to break down. When blood vessels in the brain become dilated, or enlarged, as a result of elevated fever, excitement or hyperventilation, alcohol ingestion, or prescription drugs and/or medications, such as antidepressants, it’s no wonder someone may commonly get lightheaded. There can also be serious causes, however, such as a stroke and cardiovascular disease.
Pre-syncope dizziness is specifically from cardiac origin, such as output disorders, arrhythmias, Holter monitor testing. It may also be caused by postural/orthostatic hypotension, which may be secondary to other health issues like diabetic neuropathy, adrenal hypofunction, Parkinsons, certain drugs and/or medications, etc. Light-headedness can involve vasovagal episodes accompanied by slow heart rate with low blood pressure often caused by stress, anxiety or hyperventilation. Finally, pre-syncope dizziness can be caused by migraine headaches due to cerebrovascular instability and blood sugar dysregulation.
Disequlibrium, can be caused by:
A type of arthritis in the neck called cervical spondylosis, which puts stress on the spinal cord.
Parkinson’s disease or related disorders that cause an individual to stoop forward.
Disorders involving part of the brain known as the cerebellum. The cerebellum is the part of the brain responsible for coordination and balance.
Diseases like diabetes that can lead to lack of sensation in the legs.
Disequilibrium is most common in the elderly and it generally occurs due to sensory deficits. In addition, disequilibrium has a gradual onset which worsens with reduced vision, darkness, eyes closed and visual acuity losses. However, it is improved by touching a stationary object which is often subjective as dizziness improves with a gait assistive device like a cane, walker, etc.
Dr. Alex Jimenez’s Insights
If you’ve ever experienced a sudden spinning or whirling sensation or even felt faint, woozy or unsteady, you’re not alone. Dizziness is a term used to describe a range of sensations and it is one of the most common reasons why many adults visit their healthcare professionals. While these false sensations can rarely signal a life-threatening condition, frequent episodes can significantly affect an individual’s quality of life. Diagnosis and treatment of dizziness can depend largely on the cause of the symptoms. Fortunately, many treatment methods used to treat dizziness are considered safe and effective.
Other causes of dizziness can be attributed to psychological stress. In this instance, the patient will describe their dizziness as a “floating” sensation.�Dizziness in the kind of anxiety is frequently, but not always, caused by depression. In addition, it can be attributed to an anxiety disorder or anxiety. Various medications can also cause dizziness as a side effect. It’s essential for a healthcare professional to rule out this type of dizziness caused by hyperventilation as well as other types of dizziness. The scope of our information is limited to chiropractic as well as to spinal injuries and conditions. To discuss the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .
Curated by Dr. Alex Jimenez
Additional Topics: Sciatica
Sciatica is medically referred to as a collection of symptoms, rather than a single injury and/or condition. Symptoms of sciatic nerve pain, or sciatica, can vary in frequency and intensity, however, it is most commonly described as a sudden, sharp (knife-like) or electrical pain that radiates from the low back down the buttocks, hips, thighs and legs into the foot. Other symptoms of sciatica may include, tingling or burning sensations, numbness and weakness along the length of the sciatic nerve. Sciatica most frequently affects individuals between the ages of 30 and 50 years. It may often develop as a result of the degeneration of the spine due to age, however, the compression and irritation of the sciatic nerve caused by a bulging or herniated disc, among other spinal health issues, may also cause sciatic nerve pain.
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