Can a Chiropractor Really help Neck pain?

Neck pain is a very common problem affecting up to 70% of the adult population at some point in life. Though there are specific causes of neck pain such as arising from a sports injury, a car accident or “sleeping crooked,” the vast majority of the time, no direct cause can be identified and thus the term nonspecific is applied. There are many symptoms associated with patients complaining of neck pain and many of these symptoms can be confused with other conditions. Wouldn’t it be nice to know what neck related symptoms are most likely to respond to chiropractic manipulation before the treatment has started? This issue has been investigated with very favorable results!

The ability to predict a favorable response to treatment has been termed, “clinical prediction rules” which in general, are usually made up of combinations of things the patient says and findings from exams. In a large study, data from about 20,000 patients receiving about 29,000 treatments, was collected and analyzed to find out what complaints responded well to chiropractic treatment. The results showed that the presence of any 4 of these 7 presenting complaints predicted an immediate improvement in 70-95% of the patients: 1. Neck pain; 2. Shoulder, arm pain; 3. Reduced neck, shoulder, arm movement; 4. Stiffness; 5. Headache; 6. Upper, mid back pain, and 7. None or one presenting symptom. Items not associated with a favorable immediate response included “numbness, tingling upper limbs,” and “fainting, dizziness and light-headedness in 4-12% of the patients. The “take-home” message here is that was far more common to see a favorable response (70-95%) of the patients compared to an unfavorable response (4-12%), supporting the observation that most patients with neck complaints will respond favorably to chiropractic treatment.

So, what do we do as chiropractors when a patient presents with neck pain? First, after gathering preliminary information such as name, address and insurance information, a history of the presenting complaint is taken. This consists of information including what started the neck complaint (if you know), when it started, what makes it worse, what makes it better, the quality of pain (aches, stiff, numb, etc.), the location and if there is radiating complaints, the severity (0-10 pain scale), timing (such as worse in the morning, evening, etc.), and if there have been prior episodes. Various questionnaires are included that are scored so improvement down the road can be tracked and a past history that includes a medication list, past injuries or illnesses, family history and a systems review are standard. The exam includes vital signs (BP, pulse, height, weight, temperature and respiration), palpation, range of motion, orthopedic and neurological examination. X-ray and/or other “special tests” may also be included, when needed. A review of all the findings are discussed and after permission to treat is granted, a chiropractic adjustment may then be rendered. A list treatment options may include: 1. Adjustments; 2. Soft tissue therapy (trigger point stimulation, myofascial release); 3. Physical therapy modalities; 3. Posture correction exercises and other exercises/home self-administered therapies; 4. Education about job modifications; 5. Co-management with other health care providers if/when needed.

Herniated Disc: Do You Have a Pinched Nerve or Disc Pain? What Next?

Two Causes of Pain: Pinched Nerve vs. Disc Pain

In identifying the cause of the patient’s pain, there are two general types of spinal disc problems physicians classify as the cause of the pain:

• Pinched nerve – When a patient has a symptomatic herniated disc, it is not the disc space itself that hurts, but rather the disc herniation is pinching a nerve in the spine. This produces pain that is called radicular pain or radiculopathy (e.g., nerve root pain) leading to pain that may be referred to other parts of the body, such as from the low back down the leg or from the neck down the arm. Leg pain stemming from a pinched nerve in the lower spine is usually described as sciatica. On Spine-health, this type of condition where there is nerve root pain is referred to as a herniated disc. Other causes of a pinched nerve may include spinal stenosis and bone spurs from spinal arthritis.
• Disc pain – When a patient has a symptomatic degenerated disc (one that causes low back pain and/or leg pain), it is the disc space itself that is painful and the source of pain. This type of pain is typically called axial pain. On Spine-health, this type of condition where there is actual disc space pain is referred to as degenerative disc disease.

Either of the above two conditions can occur in the neck, upper back or lower back. They tend to be most common in the lower back because the lower back bears the most torque and force on a day to day basis.

It should be kept in mind that all the terms – herniated disc, pinched nerve, bulging disc, slipped disc, ruptured disc, etc.– refer to radiographic findings seen on a CT scan or MRI scan. While these test results are important, they are not as meaningful as the patient's specific symptoms and the doctor's physical exam results are in determining the source of the back pain and then evaluating potential back care and pain treatments.

My Take: It's a known fact that most of us have bulging or herniated discs and don't even know it. Most of the people that have herniated disc will live and die with them and never have problems.

Then, there is the group of patients that we know have herniated discs...and it's a big big number. But just because they have a lumbar disc herniation or a herniated disc in the neck, it does not mean they need surgery. Chiropractic, physical therapy, exercise, and sometimes just time will help most.

The problem lies with the sub-set of herniated disc patients that become chronic (back pain that lasts over 3 months) and do not respond to conventional conservative therapies. I estimate this to be 10-15% based on my 18 years clinical experience working with herniated disc patients in San Francisco.

Chronic back pain secondary to disc herniations, whether it be a pinched nerve (radicular pain) or axial pain (degenerated disc) is a major problem in the US, and conventional medical treatment options are limited primarily to epidural injections or surgery.

HAPPY NEW YEAR!

Here are a few thoughts to take into the New Year. 

1. It only makes sense focusing on things I can control.
2. Most people focus on the negative. Beware; it's contagious.
3. Taking time off and taking good care of myself isn't a cost, it's an investment with high dividends.
4. Fight for what's right.
5. Nurture the relationships that matter.
6. Manage people's expectations makes them happier than attempting to solve all their problems.
7. Competition and controversy is a form of flattery.
8. Even though people can fix/improve their situation, many choose to justify it; it requires less integrity and work.
9. Simple and conservative is best.
10. There are bad people in this world. The faster you identify them and stay away from them the better. Go with your gut.

6 Cancer-fighting Super Foods

Take a look at this blog post: 

http://shine.yahoo.com/event/vitality/6-cancer-fighting-superfoods-2428408/