Tag Archive for: neck pain

Not All Neck Injuries Are the Same

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Not All Neck Injuries Are the Same

Neck injuries are really common and they can cause a variety of different symptoms. The most obvious is neck pain, but it can also be associated with headache, dizziness, visual problems, and autonomic problems as well.⁣
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Neck pain can come from a variety of injuries, and no two injuries are the same, even if it got injured the same way.⁣
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The tissues that are injured depend on how the neck was injured, how strong the neck was at baseline, genetic predisposition to inflammation degeneration, age, and history of previous injuries.⁣
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Because of that, different tissues can be injured even if the mechanism of injury is the same. These can include:⁣
• Muscles⁣
• Ligaments ⁣
• Discs⁣
• Joint capsule or joint cartilage ⁣
• Arthritis⁣
• Nerves⁣


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This isn’t even mentioning factors like psychological and social factors that contribute to persistent pain responses.⁣
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Patients frequently bring in test results from MRI or other imaging hoping that we might be able to help their specific case with upper cervical chiropractic care.⁣
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But many of these injuries may not even show up on an a standard MRI.⁣


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That’s why we should never take for granted how important it is to actually examine a patient thoroughly with our own eyes and hands.⁣
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While imaging may be an important piece of how we take care of someone, we always perform a thorough physical exam of the neck and assess for different neck injuries so we can treat it appropriately, but also know when to refer out.⁣

 


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#protecttheneck #neuroplasticity #neuroscience

Hidden Drivers of Chronic Pain – We Have Been Thinking About Pain All Wrong

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What if what we always knew about chronic pain was wrong? 🤔

We are conditioned to think about pain as a direct product of injury. Because of this, we have strong, but incorrect assumption that the severity of pain correlates with the severity of injury.

These beliefs may be true for acute pain or injury, but they have poor carry over to chronic pain conditions. In fact, taking these beliefs into a chronic pain condition likely promotes nocebo and likely worsens outcomes in painful conditions.

As patients and health providers, we put most of our collective energy into the biological factors in pain.

  • structural issues
  • Inflammation

But we have a strong tendency to discount the psychological and social factors that contribute to pain.
– Fear and avoidance of movement
– False beliefs about the nature of pain
– The role of depression and anxiety in magnifying pain conditions
– How our friends and family deal with pain (walk it off vs rest till it’s better)


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While addressing the biological factors is important, the psychological and social factors behind pain might be most important in having enduring results.

Without addressing the psycho and social aspects of pain, patients are often in a roller coaster of temporary relief going from doctor to doctor or treatment to treatment never satisfied.

This starts in our office with a change in belief. A belief that your body is strong and anti-fragile. A belief that the body is self-healing and is always striving to maintain homeostasis.

 

In a perfect world, we hope that our patients start feeling better before we even put our hands on them because they are starting to embrace a stronger, brain-centric view of life and health.

Working on Your Curves: Long Term Outcomes From Fixing Military Neck

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I’ll admit that I’ve gone back and forth on the importance of cervical curves in my career. When I was in chiropractic school I was adamant about the importance of cervical curves and how the loss of a curve could affect the progression of spinal arthritis.

Then once I was in practice for a few years, I saw that most neck curves wouldn’t really change very much. Despite the fact that it didn’t change, I’d see really great changes and improvements of many of my patients, so I assumed that it is a nice feature, but probably not necessary to resolving a complaint. You can read some of my previous thoughts on cervical curves here:

I Have Military Neck: Now What?

So What Has Changed my Mind?

I still stand by my previous writings and say that having a proper neck curvature is a really good and positive thing, but you can still get really great results with most secondary conditions even if the neck curve doesn’t come back.

However, I have started to come around on the importance of having a proper neck curvature for the health of the human brain and nervous system. So what changed my mind?

Here are three pretty recent studies looking at the impact that cervical curve changes have on dizziness and cerebral blood flow.

Increase in cerebral blood flow indicated by increased cerebral arterial area and pixel intensity on brain magnetic resonance angiogram following correction of cervical lordosis

The first paper is a study that looked at consecutive patients getting imaging of the arteries going into the brain. Magnetic resonance angiography (MRA) measured the intensity of blood flow with the neck in patients with a straight or military neck pattern. The patients were then placed on a foam orthotic to produce a curve in the neck and a new MRA was taken with the neck in a curved position.

Before and after changes in blood flow to the brain using a device to improve cervical curve.

The patients’ MRA scans showed significant improvements in blood flow in the brain when they were lying on the orthotic with an improved cervical curve! The interesting thing is that it’s been known for years that a loss of cervical curve was associated with decreased blood flow in the brain, but there was no evidence showing that improving the curve would change blood flow. Now there is.

The effect of normalizing the sagittal cervical configuration on dizziness, neck pain, and cervicocephalic kinesthetic sensibility: a 1-year randomized controlled study.

While the previous paper is interesting, it’s limited by the small sample size and lack of controls. It was also a proof of concept study, and not one where an intervention was performed and tested to see if it made a difference long term. However, it may help explain why patients can get significant improvement in pain and dizziness.

This next paper features a randomized clinical trial of cervical curve correction along with cervical manual therapies compared to manual therapy alone for cervical dizziness.

The study looked at the results for patients with neck pain and dizziness for short term improvement at 10 weeks, and to see if they sustained improvement at a 1 year follow-up. The results are below.

Differences in patients with cervical dizziness at 10 weeks and 1 year. Changes after 10 weeks were similar to regular physical therapy, but the changes were hugely different at 1 year when there was an improved curve in the neck

The chart shows that the patients who were in the cervical curve correction group had significant improvements in head posture and curvature at 10 weeks, but the scores in pain and dizziness were pretty similar for both groups. Both groups got better, but they had similar improvements.

However, the changes at 1 year were impressive, and highlighted in red. While the control group had some regression into neck pain and dizziness, the cervical curve group maintained their symptomatic improvement much better. The mean improvements for both groups all crushed statistical significance, and the mean difference of the Dizziness Handicap Inventory (DHI) was by almost a whopping 30 points. That’s massive!

Does improvement towards a normal cervical sagittal configuration aid in the management of cervical myofascial pain syndrome: a 1- year randomized controlled trial.

A similar study was published on patients with persistent neck pain where physical manual therapy was compared to manual therapy and curve correction.

Just like the study involving dizziness, this paper on neck pain showed that both groups had similar improvements in scores on the Neck Pain Disability Index (NDI).

Changes in neck pain with manual thearpy and exercise alone vs manual therapy, exercise, and cervical curve restoration. Cervical curve patients were a little btter at 10 weeks, but were much better at 1 year follow up!

Again, like in the previous study, the 1-year follow-up is where things got interesting. The group that had treatment to improve their cervical curve had a much stronger ability to maintain their improvements in neck pain, while the control group started to return to their original pain scores. This was also largely statistically significant.

Long-Term Improvements Matter

So the big thing that changed my mind is that there is a growing body of work that supports the idea that creating structural changes in your cervical curve seem to help improve long term outcomes.

So while I still believe you can get significant improvement with or without a curve in your neck, your chances of maintaining your results over time seem to increase a LOT when you rehabilitate that curve.

Then you have the possible added benefit of improved blood flow to your brain, and that provides a potential bonus of better brain health.

Ringing in the Ears is a Pain in the Neck

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Tinnitus and Neck

Tinnitus is a problem where patients perceive sounds in the absence of sound stimuli. It afflicts between 10-15% of adults, but can be a severe hindrance in about 2% of the population. While tinnitus is classically thought of as a ringing sensation in the ears, there’s a wide variance to what patients perceive. Some describe it as a hissing, sizzinling, whooshing, or clicking.

The cause of tinnitus is known and well established in patients with hearing loss or those whose ears have been subject to noise trauma like loud music or blasts. However many patients experience tinnitus that can come out of the blue without a known cause. There is a growing amount of evidence that points to the neck as a unique source of ringing. Some have identified this type of tinnitus as cervicogenic somatic tinnitus (CST) and is estimated to make up almost 40% of all tinnitus cases.  

How is My Hearing Related to My Neck?

It seems strange that a problem in your neck can interfere with normal hearing, but researchers have been trying to identify why people with tinnitus can get improvement from things like chiropractic or physical therapy interventions. A study in the journal Medical Hypothesis looked at the neurological connections between the neck and the hearing organ of the ear. 

The authors showed that the nerve roots from all of the cervical spine all travel through the spinal cord and travel to the brainstem where your senses can integrate with some of the cells responsible for hearing. Cervical spine dysfunction has also been associated with blood flow problems, and some authors have hypothesized that dysfunction in the top vertebrae in the neck may affect blood flow to the brainstem and inner ear organs. When blood flow to these areas are compromised, then dysfunction from the ear can occur.

Problems like structural shifts in the neck or arthritis can agitate these sensory nerves and affect some of the brainstem regions that modulate your sense of hearing. This may be the reason why some patients can have ringing in the ears that lingers after things like whiplash and head injuries in sports even when there’s been no damage to the ears. 

 

The neurological pathways that tie the neck to the hearing centers in the brain. Graphic from Bressi et al in Medical Hypothesis. 2017

The neurological pathways that tie the neck to the hearing centers in the brain. Graphic from Bressi et al in Medical Hypothesis. 2017

Fortunately for many, research is also showing that addressing the neck can improve tinnitus in patients with some of the most disabling symptoms. A 2016 study in the journal Manual Therapy showed that treating the neck can lead to substantial improvements in up to 53% of patients with severe tinnitus.

Another study in 2018 showed that using both auditory and somatosensory stimulation can induce long lasting changes in the loudness and intrusiveness in tinnitus compared to just using one or the other.

Upper Cervical Chiropractic and Ear Problems

An interesting but little known fact is that chiropractic emerged in 1895 as a treatment for deafness. D.D. Palmer is credited with creating the chiropractic profession, and first performed an adjustment on a janitor with hearing loss named Harvey Lillard. It’s unclear what the circumstances of this first adjustment, but what is known is that Palmer thought he stumbled on the cure for deafness.

It’s obvious that chiropractic is not a cure or treatment for hearing loss otherwise our offices would be filled with the deaf and hard of hearing. However, current neuroscience research has helped us understand how several patients with hearing disorders like tinnitus can get relief from a neck procedure like the Atlas correction.

While it may not help every person with tinnitus, a thorough history and examination may be able to help us figure out if we can get that bothersome ringing out of your ears.

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A Gentle Approach to Chronic Pain

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A Gen

Breaking the Chronic Pain Cycle of Fibromyalgia

                  Chronic pain takes many shapes and forms, but we know that it has a huge social and economic burden. The Institute of Medicine reports that roughly 116 million, or 30% of the population suffer from pain lasting a year or longer. Although chronic pain isn’t a life threatening issue, it’s certainly a problem that has a dramatic effect on the quality of someone’s life. After taking care of hundreds of people with conditions like fibromyalgia, I know that these people experience quite a toll both physically and emotionally.

NUCCA requires a specific angle to achieve a desired correction angle.

NUCCA requires a specific angle to achieve a desired correction angle.

                  Perhaps the worst part about fibromyalgia is that there is no known cause or cure. It’s basically invisible to any blood tests or MRI studies, and most of the drugs available are for pain control. People with fibromyalgia may often be depressed, have anxiety, and have a sense of isolation because they don’t feel that their friends and family understand their struggle. This often compounded by the fact that their doctors have told them that the pain is psychosomatic, or just in their minds because no tests can reveal an underlying disease process.

                  In recent years, fibromyalgia has become one of the most published topics in medical journals. As a result, we are starting to develop an understanding of the disease on a deeper level to know that it’s certainly NOT just in the patient’s mind. Research is pointing to problems within the central nervous system and tiny blood vessels in the skin as likely causes of the deep body-wide pain. But what does this mean in terms of treatment?

                  For most people, drugs that target the nervous system like Lyrica or Gabapentin are the first line of treatment and many have had success. However, some patients can be sensitive to drug reactions, or their bodies may develop a high tolerance for the dosages. In cases like these, many patients start to seek out alternative therapies like acupuncture, reiki, and homeopathy.

                  Traditional chiropractic has also been a source of relief for many people seeking help with chronic pain. However, many people with the chronic pain of fibromyalgia can feel apprehensive about seeing a Doctor of Chiropractic because manipulations can seem too rough for someone who can barely stand to be touched.

Not All Adjustments are Built the Same

                  In chiropractic, there are dozens of techniques and approaches to correcting the spine. Some are heavy handed and require a lot of force, but others are very gentle and rely more on precision. It’s not to say that one is better than the other, but some are just designed for specific patient populations in mind.

                  In my office, I attract many patients with fibromyalgia, trigeminal neuralgia, and TMJ problems that are Secondary to a Structrual problem in the neck called Atlas Displacement Complex. Most of these people are afraid to be touched, and gravitate to a lighter approach. This type of condition requires a precision type of adjustment called an Atlas Correction. This type of adjustment is so light, that most people often wonder if I even touched them, and then they start to feel their body change. Currently, only about 1000 doctors in the country are trained in this type of care.

                  This approach is effective because of the spine’s influence on the central nervous system. When the top of the neck shifts abnormally and moves improperly, the nerves firing into the brainstem become distorted. In this way, the brain is like a computer that relies on spinal positioning to operate normally. When there are garbage signals going into the brain, then garbage signals come out in the form of pain. This phenomenon in fibromyalgia patients creates a condition called central sensitization. This is the reason why people with fibromyalgia can feel excruciating pain from a light touch. It’s not that there’s a physical injury, but the nervous system is getting scrambled signals and is primed to experience pain.

Your nervous system can act like a computer. If poor information comes in, then poor information will come out.

Your nervous system can act like a computer. If poor information comes in, then poor information will come out.

                  This is NOT designed to cure you. The cure lies in the fact that the body is capable of healing itself. When you remove interference to the body’s self-healing ability, I find that people can return to a level where life is livable again. By breaking the pain cycle through the nervous system, you can impact the way stress affects the body and the immune system. By no means is this a cure all, but it can be a great catalyst to being steered back on the path towards a normal life. I’ve seen numerous patients who’ve been able to go from disability to working or resuming exercise again in a matter of months.

One of the greatest joys of doing this type of work is giving people a glimmer of hope. So many people are convinced that they have to live in pain, or have been told that the problem they’re having is all in their head. In my office, I’ve helped hundreds of people recover from chronic pain with this gentle procedure. However, it’s not for everyone. Only people with a problem in their Atlas can receive this type of care, and that requires a detailed Upper Cervical Chiropractic Examination to identify the problem. Sometimes a little bit of hope is all a person needs to start healing again.

Getting a Safe Correction after Spine Surgery

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Spine Surgery

Read Time: [3 minutes]

Over the past few weeks, I’ve been seeing a lot of posts about this article filling up my Facebook newsfeed. The article talks about how a specific type of spine surgery called spinal fusion has been found to be mostly ineffective. The author goes so far to say that the surgery should be put to rest.

rip-fusion

Article by Dr. Chris Centeno http://www.regenexx.com/nejm-back-neck-fusion-surgeries-not-needed/

I’ve seen a lot of patients with a previous history of spinal fusion. Some people feel like their life was made dramatically better by spine surgery, others feel like it didn’t have any effect at all, and some people will actually feel a lot worse. Overall, the verdict on fusion surgery seems to be pretty dim.

People Don’t Volunteer for Spine Surgery. It’s a choice made out of desperation

Here’s the thing. I don’t blame people who choose to elect spinal fusion even in the face of the world’s best evidence. Why?

I’ve never experienced the level of pain that makes someone consider spine surgery an option.

It’s the easiest thing in the world to be a chiropractor, physical therapist, or pain management doctor to tell someone that they don’t need spine surgery. Our professions are invested in the idea that you should choose us over surgery because you should exhaust your conservative options before being cut open.

However, someone who is choosing spine surgery is often someone who is desperate. Their pain is debilitating and costing them the ability to work and move like a normal human being. Many patients have tried numerous conservative options and feel like they have spent years feeling debilitated. They are tired, frustrated, and just want something, anything to make their pain go away.

I hear it in my office all the time. “Doc, can you just cut this thing out of me?”

Sure it’s said in jest, but it opens a window to what someone’s last option looks like. Just cut me open, and take whatever is causing this pain, and remove it.

You’ve had surgery, now what?

People that choose surgery often feel like they’ve exhausted all possible treatment options.

If your pain didn’t improve or if you develop or new and worse pain after surgery, it can be devastating to the psyche. You tried everything and it still didn’t work. Will you have to suffer like this for the rest of your life? Do I just have to rely on pain management and more surgery?

From time to time, I’ll meet people who tell me about how bad their back or neck problems are, but they’ll usually say something like:

But I’ve already had surgery, and my doctor says I shouldn’t have my back cracked.

I understand this fear. If I had hardware in my spine, the last thing I would want is someone just jerking my back or neck around and possibly hitting one of those fused parts.

Here’s the thing though. Not all chiropractic techniques require heavy force.

There are a lot of chiropractors trained to be extremely precise with their adjustments. With a high level of precision, you can avoid doing anything to the spine that may jar or disturb these fused vertebrae.

This is important to remember because precise Structural Correction of the spine is something that can really help these patients! It’s one of the reasons that there are doctors in Palm Beach County that refer cases to our office when patients still have pain after surgery.

The Problem Isn’t Just the Spine, it Might Be in the Brain

Pain is a complex physiological phenomenon. As doctors, we can sometimes oversimplify back and neck pain as a bad bone or a bad disc. The fact that people don’t get better after surgery isn’t the fault of the surgeon. The problem is that the bones and discs in the back may not have been the actual cause of the pain to begin with.

Pain can exist in the absence of physical tissue damage as is often seen in things like fibromyalgia or complex regional pain syndrome. In these cases, there is a problem with the way the brain perceives the environment. It is overreacting to normal stimuli.

When people have successful cases with surgery, then we can probably assume that a bad disc or some bad vertebrae were big contributors to the patient’s pain process. However, if we are operating on patients whose symptoms are coming from a brain that is overly sensitive to pain, we are giving that sensitive brain more ammunition to be in pain because of the surgery itself.

Sometimes the answer is not simply to change the bones, but we have to desensitize the brain to normal living.

That’s one of the biggest unknown benefits to Structural Correction with the NUCCA procedure. Normal Structure plays a vital role in normal input into the brain. Our gentle approach to correcting the spine is capable of changing the signals the brain should be focusing on and reducing some of the chronic inflammation impacting your sensitive brain tissues.

Changing the Conversation

Millions of people every year are going to have spine surgery. It’s up to the doctors and surgeons to decide if surgery is appropriate for a patient’s situation. There’s no use in beating a patient up for making a decision that they think is going to help them live a better life.

It’s our job to let people know that whether you had surgery or not, there are still options available to help people live a normal life without feeling debilitated.

Ask Dr. Chung a Question

Case Study: 6 months of Post-Concussion Syndrome

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Post-Concussion Syndrome

 

Read Time: [3 minutes]

Post-concussion syndrome has become a big deal with more athletes showing concern about the risks of chronic brain injury. Recovery from a concussion usually takes about 7-10 days for most people but many will have symptoms that last 30 days or more.

Our most recent case had post-concussion syndrome that lasted 6 months prior to visiting our office.

Background

A young woman was a passenger in a car that was struck from the side. The shock of the accident caused her head to whip from side to side and she lost consciousness immediately.

Although many concussions are a result of a direct blow to the head, a concussion can occur through rapid acceleration and deceleration of the head causing the brain to move and collide with the inside of the skull.

Following the concussion, the patient began having daily episodes of migraine headaches. During the migraine attacks, she would also have vertigo that led to a persistent feeling of nausea.

After being discharged from the hospital the patient was seen by an orthopedist and chiropractor. While chiropractic adjustments were helpful, she felt her symptoms come back repeatedly within hours of her treatment. The patient had an appointment with her orthopedist to receive neck injections, but was referred to our office before that to see if correcting her atlas would help.

Assessing the Neck in Concussion

The patient was put through a full examination to evaluate the  neck. In many cases of post-concussion syndrome, the neck has numerous pain-generating tissue that can be responsible for these neurological symptoms. This includes precise x-rays of the top of the neck, evaluation of neck muscle tone, structural positioning, and evaluation of head and neck control.

You can see some images of our head control laser testing below.

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Laser head positioning system

Testing head control using a maze

Testing head control using a maze

When people suffer a concussion or whiplash injury, it can cause damage to the muscles and allow us to control our head and neck movement. These injuries can lead to headaches, but they also cause problems with our sense of balance.

Once we have some baseline information on their current abilities, we can monitor how they respond and heal from the damage to their neck.

Results:

After her 2nd visit, the patient said that her headaches and nausea were almost completely non-existent.

Imagine that. Going from daily migraines, to no headaches for an entire week. All from a getting the head and neck into a better structural position.

Now that isn’t to say that life is perfect after that. There were certainly some ups and downs along the way. Overall, the patient’s headaches have improved about 80% in frequency and intensity. She has elected to skip getting injections, and is working hard everyday to get stronger.

Here’s the most important element and really the part that matters:

After the head injury, the patient was unable to do the things that made her life fun. She had trouble working out and getting motivated to exercise. Staying focused at work meant having to rely on pain killers. Taking care of a young daughter meant gritting her teeth through pain and nausea instead of being present in the moment.

That’s what all of this is about. It’s not about the pain reduction, it’s about the restoration of normal life!

For more information, you can read this patient’s testimonial below:

I’m a very active mommy that carries around the weight of a 6 year old and owning a salon full time. Work and mommy duties call for my body to be at all times ready and with it. There isn’t time for rest, much less any fatigue or achy-ness. Between playing sports when I was young, actively working out and having the burden of standing on my feet the majority of my work days, my simple adjustments just got me through. I didn’t realize that there could be a cure for my migraines, constant neck stiffness and what seemed to be a much older body that I was trapped in.

I was a back seat passenger in a car crash on New Years, where the car was deemed totaled. There were no major signs of trauma, besides the concussion and black eye I received, however, I knew something was wrong when my pain was continuing to get worse months after the accident. My routine visits to the chiropractor, became tedious weekly visits that just got me through; my pain kept coming back if I didn’t get adjusted that day. I refused to succumb to cortisone shots previously, but felt desperate. Instead of my Chiropractor sending me off the receive the possible relief from an invasive procedure, he referred me to his dear friend Dr. Chung that specializes in post concussion, migraines, fatigue and achy-ness.

Dr Chung was very thorough and did a series of X-rays and tests to see how my whole body was aligned and reviewed my MRI. He explained the symptoms and showed me what was happening to my brain and surrounding inflamed tissues. After one precise adjustment and many months of not being able to be active or myself, I felt 150%. I was scared and apprehensive as to when my pain would return. To my surprise, months later and just a few maintenance NUCCA adjustments, my pain has not returned and I was immediately able to carry on with my workouts, mommy life and my physically involved career. I was even able to hike, travel and do Cross-fit within weeks of being adjusted. My energy and range of motion has returned. I couldn’t be happier for the referral to such a dedicated, intelligent, passionate Doctor of Chiropractic. Thank you so much for your passion to treat your patients and wish you much success.
Jessica S.

Anatomy of a Pinched Nerve

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Pinched Nerve

Read Time: [6-7 minutes]

After the wide success of my article Anatomy of a Headache I decided to tackle another common problem we see every single day in the office.

Pinched Nerves

When someone gets an acute pinched nerve, it can be amongst the most painful problems that afflict human beings. Pinched nerves can leave people in lying in bed with an inability to work, exercise, sleep or play. When it happens people take on really strange and awkward postures to try to avoid the pain.

If you are like Mr. Stock Image here where you lean away to one side and lift your arm, you might have a pinched nerve in your neck. Image Credit: Can Stock Photos

If you are like Mr. Stock Image here where you lean away to one side and lift your arm, you might have a pinched nerve in your neck.
Image Credit: Can Stock Photos

 

But there’s a lot of misconceptions about what a pinched nerve actually is. A lot of people feel like if their neck or back has a pinching or stabbing type pain, then it’s likely a pinched nerve. However, multiple types of neck pain can lead to a pinching type of pain.  A true pinched nerve involves multiple factors.

1. A Tissue Offender

There are several different types of tissues that can pinch a nerve. Bone, muscle, tendons, and calcified ligaments are all compress nerve tissue throughout the body. Even tumors can cause pinched nerves, but those are in much more rare circumstances.

The overwhelming majority of pinched nerve pain stems from a problem you’re probably familiar with. The slipped/herniated disc. Tearing of the outer part of the disc allows for a gel like material to spew out into a small space where a nerve travels.

Most herniated discs don’t cause problems. I can take an MRI of 100 random people with no pain and chances are high that many of them will have a disc herniation.

The herniation only becomes problematic when it is large enough, or you move in a way to force this gel into the nerve against some of the other hard structure in the spine.

When a disc breaks down and leaks a hard fluid on top of the nerve, the nerve can become pinched between a rock (bone) and a hard place (disc) Image Credit: Can Stock Photos

When a disc breaks down and leaks a hard fluid on top of the nerve, the nerve can become pinched between a rock (bone) and a hard place (disc)
Image Credit: Can Stock Photos

2. Soft and Sensitive Nerves

Nerve tissue is soft and sensitive. Even small amounts of pressure against a nerve can make it go haywire. They are like the iPhone charging cables of the tissue world. Just a little bit of stress and the whole thing comes unraveled.

That’s why your body protects the most sensitive nerve tissue (brain, spinal cord, spinal nerves) in a case of bone called your skull and your spine.

But it’s not just sensitive to pressure. It’s also sensitive to chemical signals like inflammation. Which brings us to the third important piece of anatomy.

3. Inflammatory Chemicals

Inflammation from a torn or damaged disc can build up around the nerve and stimulate the nerve to create a pain response. This is especially true when you injure a disc very suddenly….like in a car accident or picking up a heavy box. Cells from your immune system rush to the site of damage and try to clean up the mess. The result is a large number of inflammatory molecules called cytokines and substance P fills that area and can trigger a pain response from the nearby nerve.

I always compare the body’s use of inflammation to a fire/burning process. When your body uses inflammation it is like using a fire to burn away germs or damaged tissue in the body. The main problem with fire is that it can sometimes cause damage your own body too. This is especially problematic when inflammation affects a nerve.

Image from published article: Inflammation ain intervertebral disc degeneration and regeneration. Journal of the Royal Society Interface. 2015. http://rsif.royalsocietypublishing.org/content/12/104/20141191

Image from published article:
Inflammation ain intervertebral disc degeneration and regeneration. Journal of the Royal Society Interface. 2015.
http://rsif.royalsocietypublishing.org/content/12/104/20141191

 

When a Pinched Nerve is a Serious Problem

The pain from a pinched nerve can be excruciating. It’s not uncommon for someone with pain from a fresh pinched nerve to go to a hospital to get checked for something serious.

With that said, the pain from a pinched nerve is not the worst thing that can happen. The worst case scenario for pinched nerves are a loss of function.

If you have a pinched nerve and you start to have things like weakness and complete loss of feeling in your arm, legs, or hands, then it can be a serious issue that needs to be addressed by a surgeon. In cases of pinched nerves in the lower back, sometimes the nerves can affect bowel and bladder function leading to a condition called Cauda Equina syndrome which is a medical emergency.

If left for too long, your muscles can begin to atrophy and you may never get full function back. These are scenarios that shouldn’t be trifled with.

90% of Pinched Nerves Can Be Addressed Conservatively

That previous section wasn’t meant to scare you, but it’s a reality that we sometimes we have to face. The good news is that the vast majority of pinched nerves respond great to conservative care. That means things like physical therapy, anti-inflammatories, and decompression can all be helpful modalities in dealing with pinched nerves.

All of the above therapies can provide some relief from the pain of a pinched nerve, but one thing that is important is addressing some of the biomechanical issues that lead to a herniated disc becoming a pinched nerve.

 A Delicate Balancing Act

The spine has many functions. It protects the delicate spinal nerves, it’s the central attachment point for numerous muscles, and allows for a wide range of movement. Another key function is the way that it distributes force throughout the body.

One of the key facets of Normal Structure is that it provides an ideal way for the human frame to distribute force evenly through the body’s muscles and joints. When we lose normal structure, we start to put more stress on some parts of the body over others leading to increased joint stresses in select areas.

body imbalance

Loss of Normal Structure leads to abnormal joint stresses

Want proof that your structure exacerbates pain from a herniated disc. Look at the way that people hold their posture. People with pinched nerves usually can’t stand bending their neck or back in a specific direction, so they lean towards one side over the other. You’ll also see that they avoid forward bending too.

But why? Because bending forward and into the side of the pinched nerve will increase force into the disc and force it further into the nerve.

When your spine bends forward and to the right, it's going to push that purple-ish goo further into the nerve

When your spine bends forward and to the right, it’s going to push that purple-ish goo further into the nerve

That’s why correcting the underlying foundation of the spine helps with pinched nerves because we can help the body naturally equalize the forces going into your discs. Sometimes the body will actually find a way to make the herniated disc go away! Although it’s not expected, the body is always going to move in a direction of healing itself, and sometimes that means getting rid of an offending disc problem.

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Whiplash Disorders: Why You Should Get Your Fat Neck in Shape

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Whiplash Disorders: Why You Should Get Your Fat Neck in Shape

 

Read Time: [7-8 min]

I know it’s a little bit of a crazy headline, but today we’re going to talk about how a fat neck can contribute to chronic whiplash pain.

But I’m not talking about the width of someone’s neck. The neck I’m talking about can be thin on the surface, but have fat tissue build up in places where it shouldn’t. Namely, inside of your muscles.

It’s helped us to reveal a problem that many doctors miss when looking at conventional MRI findings.

Don’t Put So Much Stock in Disc Problems

For better or for worse, injuries from auto accidents are usually made or broken by MRI findings. That’s why your attorney has likely pushed you to get an MRI even though your doctor may have chosen against it.

If your doctor is like me, they avoid too jumping to MRI’s too quickly because sometimes it can really cause more harm than good. MRI’s give you the most highly detailed images available to the average consumer, but those extra details can be counterproductive.

In a patient’s eyes, an MRI report can be intimidating and scary. It’s common for most MRI reports to say things like:

  • Disc herniation
  • Degenerative changes
  • Stenosis
  • Loss of disc space
  • etc

Which is fine if you’re a health care professional and you need to know what’s going on. However, a lot of patients will look at these words, do a quick google search, and end up looking like this:

 

There’s a couple things to remember when seeing some of your MRI findings:

  1. Many of these findings are seen in normal aging
  2. Just because it’s on an MRI doesn’t mean it’s causing your pain or condition

To add more insult to injury (pun intended), things like herniated and degenerated discs are very disempowering as a diagnosis. In most cases, those findings are going to stay with you throughout your life, and that’s okay because even healthy pain-free people will have it throughout their lives too!

….even healthy pain-free people will have have herniated and degenerated discs throughout their lives too!

Whiplash and Fatty Neck Muscles

Generally we all wish we had a little less fat around our waist lines. In recent years, researchers have been seeing that fat can build up in muscular tissue and is associated with problems of aging. You can read some more about the science behind this problem in a great article on the Strength Theory Blog here.  This includes chronic pain which is the major concern for patients with whiplash.

Some recent studies are starting to show that identifying fat build up in your neck muscles can predict how well someone with whiplash will recover. [1, 2, 3, 4]

If you don’t want to read the abstracts, here’s the summary:

Patients with greater fat build up in neck muscles after an accident are more likely to have more persistent whiplash symptoms.

This runs counter to people with herniated discs because the presence of herniations is generally a poor predictor of pain.

Normal vs. Fatty Muscle Tissue

 

The problem with fatty muscles is that they don’t work the same way as lean muscle. Fatty muscle tissue is weaker in strength and endurance than lean muscle tissue.

But if you’re in pain, you don’t really care that much about your strength and endurance. You just want to feel better. As my friend Morpheus from the Matrix says:

What if I Told You

When muscle tissue becomes dysfunctional, your body loses a valuable neurological input to the brain that helps to modulate pain. That’s why exercise is such an effective form of medicine for people with various types of pain.

On top of that, when fat builds up in muscle tissue, it has neuroendocrine effects on the muscle tissue itself. These effects include:

  • Reducing sensitivity of muscle to insulin (Translation: muscle won’t eat as much sugar as it normally does)
  • Reducing Kreb’s cycle activity of muscle (Translation: muscle won’t use energy as efficiently)
  • Increasing the release of pro-inflammatory cytokines (Translation: more inflammation around muscle –> More pain)

Ultimately, fatty muscle tissue effects how the muscle contracts, how the muscle eats, how the muscle digests, and it predisposes your muscles to pain and inflammation.

While the evidence is still pretty new , it does seem to reflect why people who are stronger and have more muscle seem to be more resilient to pain problems.

Unlike Bad Discs, This Problem is Fixable

Fatty muscles can result from prolonged periods of inactivity. So it seems like a pretty simple fix. Move more, exercise, and get stronger. A small study on exercise for women with whiplash disorders show that neck exercise can reduce fat content in neck muscles and improve someone’s prognosis, so it does look like this problem is fixable. [Source]

However, one of the things that triggers inactivity after a whiplash accident is the immediate pain itself. When you have a whiplash, even small amounts of movement tend to be painful or instigate symptoms. The thought of exercising just sounds….painful.

So what can you do after an accident? Fortunately, these same rules apply with or without an MRI.

  1. Get the initial pain under control – There’s no shortage of therapies that can help control pain. Some use ice, heat, TENS, acupuncture, spinal manipulation, massage,  meds, etc. In order for you to get your body moving, you have to overcome the fear of movement that pain can cause.
  2. Position Matters – the ability to control the position of the neck is a key piece in normal movement. Developing this control depends heavily on establishing normal structure and normal positioning of the neck. This is where a structural approach to chiropractic plays a major role in recovery.Abnormal loading of the joints in your neck from Atlas Displacement Complex can contribute to pain, but it also can lead to Secondary problems like vertigo, headache, and brain fog after a whiplash.
  3. Gradual Progressive Loading – As the neck feels better and your positioning improves, you will want to gradually increase the strength of the muscles in the neck. Basic neck exercises like the chin tuck and chin nod can help train the small deep muscles of the neck. As the muscles get stronger and more functional, you will protect your muscles from fatty degeneration.Starting slow and gradually building up the resistance and endurance of your neck muscles is a key step in getting a good long term result after a car accident.

With a great understanding of the problems associated from chronic whiplash, we can utilize better tools to make sure that you don’t become a victim to chronic pain.

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What a 10 mph car accident does to the neck

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What a 10 mph car accident does to the neck

Pain after a car accident can be very strange and confusing. Take a look at these examples from my office and tell me if this reminds you of a situation that you or someone you know have been in.

Person A: Healthy and fit 37-year-old man in a car and gets hit at 45 mph+. The impact drives his car into the car in front causing extensive damage.

Person B: Healthy and fit 29-year old woman. Sitting in line in a parking lot when another car runs into the back of her at 10 mph or less. Minimal damage to the car and wore a seat belt.

Which one do you think had a worse whiplash injury and had pain immediately and which do you think just had soreness that they wanted to to get checked out?

Both had substantial biomechanical changes on their x-ray and MRI, but only one had a significant amount of pain immediately after the incident.

If you guessed that Person B with the parking lot bumper tap had the most pain, then you win! Congratulations on using the article title to your advantage.

The Deceptive Nature of Pain

Pain is one of medicine’s greatest tricksters. To this day, researchers and scientists don’t have a strong grasp on the nature pain disorders.

Why is it tricky? Because the pain someone feels isn’t necessarily related to the amount of damage in the body. Patients with fibromyalgia have crippling pain despite not having any visible damage to their bodies.

On the flip side, you can have someone like the image below with a broken neck and walk into an office with 3 days of shoulder pain after hitting his head. Thank you to my favorite radiologist, Cliff Tao, DC DACBR for letting me share this case.

Image credit to Cliff Tao DACBR http://www.clifftaodacbr.com

Show this to a doctor or health care provider if you want to watch them squirm. Image credit to Cliff Tao, DC DACBR http://www.clifftaodcdacbr.com

 

Pain is the most important factor to a patient, but it can be the most deceptive factor to a clinician. When it comes to taking care of people after an accident, we have to measure a patient’s function regardless of their pain status.

What Happens to the Neck After an Accident?

Insurance companies will only consider it a accident-related whiplash injury if you see a doctor within 14 days of the accident. So if you have no pain after the accident or the pain wasn’t bad enough to drive you to a physician until day 15, then you didn’t have a whiplash (I know how silly it sounds).

But going back to the previous example, we know that both Patients A and B had biomechanical flaws as a result from trauma to the spine. Despite the fact that there were 2 very different accidents and 2 different pain statuses, there are similarities in what can happen to the neck even after the smallest collisions. Take a look at the video below which simulates an accident less than 10 mph.

What Happens to the Neck in an Accident?

After watching the video, you can get the impression that a collision at just 5-7 mph causes rapid movement of the head and neck.

Despite the fact that your body is encased by a 2 ton metal box, it’s easy to see that even though the vehicle stops moving, there is still a transfer of energy into the body. When you’re wearing your seat belt, it causes a rapid deceleration of your body, but your head will continue to move forward and backward very rapidly.

In fact, a large enough force to the neck can actually produce a concussion even if there’s not direct contact to the head! These accidents would need somewhere around 90 G’s of force to the head.

While that would cease to be a small accident, the smaller 10 mph accidents can produce 3-5 G’s of force which is enough to damage the tissues of the neck. The way your head accelerates and decelerates can put 3-6 G’s of force into the cervical spine. This force gets transferred into the ligaments, muscles, discs, and joints of the neck more than any other piece of anatomy.

While the body can tolerate large amounts of force in brief periods, a large amount of force applied to a small region of anatomy as seen in a car accident can damage the tissues of the neck.

Whiplash
Ligament Injury

Ligaments are like the rubber bands of the spine. They can be stretched, but once they stretch too far, they can’t go back to normal again. As ligaments are damaged, scar tissue is used as a patch, but it’s not as functional as the stuff you were built with.

Just like when you sprained your ankle as a kid and that ankle never worked the same, damage to ligaments of your neck can happen the same way. Fortunately, true sprains of the neck take a lot of force and don’t happen with most accidents.

Muscle Strains

When muscle works beyond it’s capacity, or gets stretched beyond it’s end range, it forms small tears within the muscle belly. That’s why there’s no consensus as to whether you’re better off knowing about a coming accident and bracing, or if you’re better off being surprised.

Either way, damage to the muscle tissue can happen depending on the nature of the collision.

Muscle strains can be painful, but they can and do heal with time. Strain to muscle tissue is one of the most common sources of pain from whiplash injuries and resolve well with chiropractic and exercise.

Disc Damage

Accidents are one of the most common ways that people under 30 can suffer herniated discs in the spine. When the force of an accident overcomes the resistance of the disc materail, small tears in the disc can result in the inner fluid spilling into the spinal canal.

Sometimes this results in a pinched nerve, but most of the time it does not. A disc problem doesn’t have to be a big problem. Many people have disc damage and have no idea because it’s not symptomatic.

Structural Shifting

The muscles, ligaments, discs, and nerves of the neck help dictate the Structural Positioning of the spine. The force of an accident can deform one or all of these tissues leading to abnormal positioning of the head and neck.

This leads to abnormal neurological input to the brain and what manifests as poor posture (slouching, head tilt, antalgic lean). While poor posture is not the problem that needs to be treated, it’s an objective sign of a nervous system is operating at less than it’s full capacity.

Remember That It’s Not About Pain

Remember at the beginning of the article we talked about how pain can be deceptive. The reason I wanted to point that out is because you can experience damage to all of the above structures and not feel an immediate onset of pain. Pain is just tricky like that.

Whether you feel immediate pain or not, your neck should always be evaluated even after minor accidents because it gives the earliest and best opportunity to correct a silent problem.

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