Curvesday Thursday: Chiropractic for TMD

Does it hurt when you chew, open wide to yawn or use your jaws? Do you have pain or soreness in front of the ear, in the jaw muscle, cheek, the teeth or the temples? Do you have pain or soreness in your teeth? Do your jaws make noises loud enough to bother you or others? Do you find it difficult to open your mouth wide? Does your jaw ever get stuck/locked as you open it?

If you answered “yes” to some of these questions, you may have a temporomandibular joint disorder, or TMD. TMD is a group of conditions, often painful, that affect the jaw joint.

Signs may include:

  • Radiating pain in the face, neck, or shoulders;
  • Limited movement or locking of the jaw;
  • Painful clicking or grating when opening or closing the mouth;
  • A significant change in the way the upper and lower teeth fit together;
  • Headaches, earaches, dizziness, hearing problems and difficulty swallowing.

For most people, pain or discomfort in the jaw muscles or joints is temporary, often occurs in cycles, and resolves once you stop moving the area. Some people with TMD pain, however, can develop chronic symptoms. Your doctor of chiropractic can help you establish whether your pain is due to TMD and can provide conservative treatment if needed.

What Causes TMD?

Researchers agree that TMD falls into three categories:

  • Myofascial pain—discomfort or pain in the muscles of the jaw, neck, and shoulders;
  • A dislocated jaw or displaced disc;
  • Degenerative joint disease—rheumatoid arthritis or osteoarthritis in the jaw joint.

Severe injury to the jaw is a leading cause of TMD. For example, anything from a hit in the jaw during a sporting activity to overuse syndromes, such as chewing gum excessively or chewing on one side of the mouth too frequently, may cause TMD.

Both physical and emotional stress can lead to TMD, as well. The once-common practice of sitting in a dentist’s chair for several hours with the mouth wide open may have contributed to TMD in the past. Now, most dentists are aware that this is harmful to the jaw. In addition to taking breaks while they do dental work, today’s dentists also screen patients for any weaknesses in the jaw structure that would make physical injury likely if they keep their mouths open very long. In that case, they may use medications during the procedure to minimize the injury potential, or they may send the patient to physical therapy immediately after treatment. In less severe cases, they instruct patients in exercises they can do at home to loosen up the joint after the visit.

While emotional stress itself is not usually a cause of TMD, the way stress shows up in the body can be. When people are under psychological stress, they may clench their teeth, which can be a major factor in their TMD.

Some conditions once accepted as causes of TMD have been dismissed—moderate gum chewing, non-painful jaw clicking, orthodontic treatment (when it does not involve the prolonged opening of the mouth, as mentioned above), and upper and lower jaws that have never fit together well. Popular theory now holds that while these may be triggers, they are not causes.

Women experience TMD four times as often as men. Several factors may contribute to this higher ratio, posture and higher heels.

TMD Diagnosis and Treatment

To help diagnose or rule out TMD, your doctor of chiropractic (DC) may ask you to put three fingers in your mouth and bite down on them. You may also be asked to open and close your mouth and chew repeatedly while the doctor monitors the dimensions of the jaw joint and the balance of the muscles. If you have no problems while doing these things, then the problem is not likely to be TMD. Your DC can then look for signs of inflammation and abnormalities. Sometimes special imaging, an x-ray or an MRI may be needed to help confirm the diagnosis.

If you have TMD, your doctor may recommend chiropractic manipulation, massage, applying heat/ice and special exercises. In most cases, your doctor’s first goal is to relieve symptoms, particularly pain. If your doctor of chiropractic feels that you need special appliances or splints (with the exception of the “waterpack” and other guards against teeth grinding), he or she will refer you to a dentist or orthodontist for co-management.

In addition to treatment, your doctor of chiropractic can teach you how to:

  • Apply heat and ice to lessen the pain. Ice is recommended shortly after the injury or after your pain has started. In the later stages of healing, you need to switch to heat, especially if you are still experiencing discomfort.
  • Avoid harmful joint movements. For example, chomping into a hard apple is just as bad as crunching into hard candy (some hard candies are even called “jawbreakers”—for good reason). And giant sandwiches can cause the mouth to open too wide and have a destabilizing effect on the jaw.
  • Perform TMD-specific exercises. Depending on your condition, your DC may recommend stretching or strengthening exercises. Stretching helps to loosen tight muscles and strengthening helps to tighten muscles that have become loose. Special feedback sensors in the jaw can be retrained, as well, if needed.



Curvesday Thursday: Chiropractic and Immune Function

The nervous system and immune system are hardwired and work together to create optimal responses for the body to adapt and heal appropriately. Neural dysfunctions due to spinal mis-alignments are stressful to the body and cause abnormal changes that lead to a poorly coordinated immune response. Chiropractic adjustments have been shown to boost the coordinated responses of the nervous system and immune system.

The autonomic nervous system is hardwired into the lymphoid organs such as the spleen, thymus, lymph nodes, and bone marrow that produce the body’s immune response. Growing evidence is showing that immune function is regulated in part by the sympathetic division of the autonomic nervous system.

Subluxation is the term for mis-alignments of the spine that cause compression and irritation of nerve pathways affecting organ systems of the body. Subluxations are an example of physical nerve stress that affects neuronal control. According to researchers, such stressful conditions lead to altered measures of immune function & increased susceptibility to a variety of diseases.

Inflammatory based disease is influenced by both the nervous, endocrine, and immune systems. Nerve stimulation directly affects the growth and function of inflammatory cells. Researchers found that dysfunction in this pathway results in the development of various inflammatory syndromes such as rheumatoid arthritis and behavioral syndromes such as depression. Additionally, this dysfunctional neuro-endo-immune response plays a significant role in immune-compromised conditions such as chronic infections and cancer.

Wellness based chiropractors analyze the spine for subluxations and give corrective adjustments to reduce the stress on the nervous system. A 1992 research group found that when a thoracic adjustment was applied to a subluxated area the white blood cell (neutrophil) count collected rose significantly.

In 1975, Ronald Pero, Ph.D., chief of cancer prevention research at New York’s Preventive Medicine Institute and professor in Environmental Health at New York University, began researching the most scientifically valid ways to estimate individual susceptibility to various chronic diseases. He has conducted a tremendous amount of research in this area that includes over 160 published reports in peer reviewed journals.

Pero and his colleagues discovered that various DNA-repairing enzymes could be significantly altered following exposure to carcinogenic chemicals. He found strong evidence that an individual’s susceptibility to cancer could be determined by these enzymes. Lack of those enzymes, Pero said, ‘definitely limits not only your lifespan, but also your ability to resist serious disease consequences.’

Pero was fascinated by the relationship cancer-inducing agents had on the endocrine system. Since the nervous system regulates hormone balance, he hypothesized that the nervous system had to also have a strong influence on one’s susceptibility to cancer.

To support this argument he found a substantial amount of literature linking various kinds of spinal cord injuries and cancer. Pero found that these injuries led to a very high rate of lymphomas and lymphatic leukemias. This understanding led Pero to consider Chiropractic care as a means of reducing the risk of immune breakdown and disease.

Pero’s team measured 107 individuals who had received long-term Chiropractic care. The chiropractic patients were shown to have a 200% greater immune competence than people who had not received chiropractic care, and a 400% greater immune competence than people with cancer or serious diseases. Interestingly, Pero found no decline with the various age groups in the study demonstrating that the DNA repairing enzymes were just as present in long-term chiropractic senior groups as they were in the younger groups.

Pero concluded, ‘Chiropractic may optimize whatever genetic abilities you have so that you can fully resist serious disease…I have never seen a group other than this show a 200% increase over normal patients.’


Curvesday Thursday: Alternative Methods to Treat Vertigo

People with vertigo know that the law of gravity prevails, but their brains get confused. They experience an illusion of movement, feeling like they are tilting in space, or that the world is spinning or moving around them. Nausea, sweating, headaches, vomiting and fatigue may add to their discomfort.

Causes of Vertigo

  • Vertigo can be caused by many problems, most of which originate in the peripheral or central nervous system.
  • The causes of vertigo that stem from the peripheral nervous system include benign paroxysmal positional vertigo (BPPV), acute vestibular neuronitis, labyrinthitis and Ménière’s disease.
  • Acoustic neuroma, migraines, cervicogenic vertigo and multiple sclerosis are all related to the central nervous system.
  • Vertigo can also be caused by a wide variety of medications such as antidepressants, anticonvulsants, antihypertensives, diuretics, barbiturates, salicylates (e.g., aspirin), sedatives or hypnotics, some prescription and over-the-counter cold medicines, and some antibiotics and antineoplastics.
  • Diabetes mellitus, hypothyroidism, high blood triglycerides, hypoglycemia, and food allergies or gluten sensitivity can also cause or worsen vertigo.
  • Motor vehicle accidents, falls or other types of traumas or illnesses can also be associated with vertigo.
  • To diagnose the cause of vertigo, your health care provider will perform an examination, including a variety of positioning tests, to check if they will reproduce the sensation of motion. Other tests may also be necessary.

Benign Paroxysmal Positional Vertigo

  • About 65 percent of vertigo is diagnosed as Benign Paroxysmal Positional Vertigo (BPPV)—a result of calcium debris in the inner ear.
  • BPPV is usually treated through the Epley maneuver—a procedure in which the patient is rapidly moved from lying on one side to lying on the other, to move the calcium debris to a less sensitive location in the inner ear.
  • Studies show that up to 80 percent of patients recover after a single treatment with Epley maneuver, and most BPPV cases respond to two to three treatments with Epley.
  • Epley maneuver is contraindicated in patients with severe carotid stenosis, heart diseases and severe neck problems, such as cervical spondylosis with myelopathy or advanced rheumatoid arthritis.
  • Even without treatment, BPPV tends to resolve in weeks or months and also has a tendency to recur.
  • Vestibular rehabilitation exercises (called the Brandt-Daroff exercises) can also be performed at home to help treat BPPV.

Other Types of Vertigo

  • Treatment for vertigo caused by other conditions depends on the individual case.
  • Ménière’s disease patients can benefit from a low-salt diet.
  • Treatment for vertigo associated with migraine headaches should include dietary changes, such as reduction or elimination of aspartame, chocolate, alcohol and caffeine, in addition to exercise, stress reduction, adequate sleep, and vestibular rehabilitation exercises.
  • Vestibular neuronitis and labyrinthitis, which are often attributed to viral infections, can also be treated with vestibular exercises.
  • Working with your doctor of chiropractic to improve postural issues can also bring relief to the patients whose vertigo is exacerbated by sedentary lifestyle or working in certain positions for extended periods.
  • In patients with cervicogenic vertigo, a general ergonomic assessment of work and life activities can help identify the factors contributing to the problem.

Nutrition and Stress Reduction

  • Alcohol, nicotine, fried foods and excessive salt intake are potential sources of trouble for patients of vertigo.
  • Vincopectine, vitamin B6 and ginkgo biloba may be helpful in reducing vertigo.
  • Chromium may be helpful in patients whose vertigo is caused by a blood sugar imbalance.
  • Physical exercise and meditation, adequate sleep and other stress reduction techniques can all help contribute to recovery from vertigo and should be a part of the treatment regimen.
  • Your doctor of chiropractic can help create an appropriate exercise program for you and counsel you regarding healthy lifestyle and stress relief.

Red Flags
Vertigo patients who present with the following signs should immediately go to the emergency room:

  • double vision
  • headache
  • weakness
  • difficulty speaking
  • difficulty waking up or staying awake
  • difficulty walking
  • inappropriate actions
  • difficulty controlling arms or legs
  • abnormal eye movements


Curvesday Thursday: The Importance of Maintenance Care

Every day more and more people are reevaluating their options when it comes to health care. They are realizing that wellness comes from within and that the best way to avoid illness and discomfort is to be “health conscious” in their daily lifestyles. In order to accomplish this we must first understand what it is we need to do to get and stay well.

The simple answer is that we need to adopt lifestyle behaviors that promote health – as opposed to those that lead to sickness. Because the truth is there is no drug that can fix our poor diet or remove the toxins from the processed food we eat. There is no drug that can undo our sedentary living or poor fitness – the answer is in our lifestyle choices. One major lifestyle choice we can adopt is to receive regular chiropractic adjustments, often called maintenance or wellness chiropractic care.

Understanding the reason for maintenance chiropractic care mandates an understanding of two major well documented concepts: 1) immobilization degeneration; and 2) the neurology of pain processing. A primary component of a subluxation (misalignment in the spine) is loss of normal motion in that area; and there is an immense body of research to support the ensuing degenerative process that will occur with this loss of motion and the logical conclusion of restoring movement to the spine.

You see, chiropractic is important for our health in many of the same ways that exercise is so crucial for our overall health and well-being. It’s all about movement. Movement feeds the brain, when we become misaligned we lose the normal motion of that spinal segment – which leads to degenerated joints and  decreases these movement- rich nutrients to the brain (proprioceptive signals).

Immobilization degeneration is supported by over 40 years of research. The literature shows that a joint that has lost a degree of its normal movement will begin degenerating at a rate measurable within one week of onset. Its important to realize that this degenerative process will continue, often painlessly, until significant degeneration has occurred. A big reason why you don’t need to be in pain to be adjusted.

This loss of motion leads to an increase in nociceptors, which are receptors that fire when damage is detected, sending pain signals to the spinal cord and the brain. These impulses account for more systemic autonomic changes which can occur without the perception of pain. This is the same neural mechanism that allows serious disease processes to progress without warning.

What this basically means is that if we allow our body to progress in this direction, we are headed towards a state of alarm and adaptation, and ultimately fatigue, illness and early death. However, if we restore the motion to these spinal segments – through regular chiropractic care – we reduce stress hormone levels in the body and we restore proper brain-body communication, which in turn restores health and function in our body.

What happens when we reduce this stress load on our body? The many well documented improvements of chiropractic patients in areas like immune function, allergies, asthma, anxiety, colic, to name a few – show how far reaching of an effect this has on our body. Regardless of symptoms, the research shows we are much healthier with a properly moving spine than without.


Curvesday Thursday: A Natural way to end GERD

What is GERD?

Most people will experience the symptoms of heartburn at least once in their lives. For most, hopefully, the painful sensation in the chest is limited to a one-time indulgence in jalapeno-flavored donuts, a significant amount of meat-lovers pizza, a pot of coffee, a few beers and a recent break-up after being fired from a job. For many others, heartburn occurs more frequently and it’s causes are harder to pinpoint.

Heartburn that occurs frequently is called GERD, or gastroesophageal reflux disease. It is a disorder in which the contents of the stomach, (gastro) including digestive juices and partially digested food, get by the barrier between the stomach and the esophagus (the lower esophageal sphincter) and come up (reflux) into the esophagus. This is problematic since the esophagus is not designed for digestion, but is rather a conduit from the mouth to the stomach, where digestion begins.

Acids that break down proteins and enzymes that break down protein, fats, and carbohydrates, are present in the stomach juices. This combination of acid and enzymes irritates the lining of the esophagus producing what most people describe as a burning sensation in the chest. Occasionally people have GERD that is pain free—these people may experience a hoarse voice that is more pronounced upon waking.

The symptoms of GERD can be extremely irritating. GERD that exists for a period of time causes changes in the esophagus. The constant aggravation to the esophageal lining can lead to pre-cancerous changes (called Barrett’s esophagus) that greatly increase one’s risk for cancer. For this reason, it is necessary to take very good care of your esophagus—and by extension, your digestive tract in general, and while we’re at it, the rest of your physical, mental, and spiritual being.  Rates of esophageal cancer are increasing in industrialized nations at a rate faster than any other cancer.

Pharmaceutical drugs used for GERD fall into several categories; H2 receptor antagonists (Tagament, Zantac), proton pump inhibitors (Prilosec, Prevacid), and antacids (Tums and baking soda). All of these drugs decrease the acidity of your stomach. The problem, of course, is that the stomach is supposed to be acidic. Acid in the stomach is needed to break down protein into its constituent parts, called amino acids. If the protein is not completely broken down and gets into the blood stream, your body can develop an allergy against that protein. This can cause both food allergies and autoimmune disease.

The problem with pharmaceuticals is that while these relieve symptoms, they do nothing to stop the reflux or the increased risk of developing digestive tract cancers. Also, your stomach detects the low-acid environment that the drug has created and secretes large amounts of the hormone gastrin (a hormone that stimulates the proton pumps to create acid). Elevated levels of gastrin are associated with many digestive tract cancers including esophageal, pancreatic, and stomach cancer.

The risks associated with pharmaceutical drugs for GERD are greatest with long-term use. A recent study by University of Michigan scientists found that mice given proton pump inhibitors for gastritis (inflammation of the stomach lining), acquired more “bad” bacteria and developed more inflammatory changes in their stomach linings than untreated mice. All this being said, there are times when the aforementioned pharmaceuticals may be appropriate to treat GERD. If you are on a prescription pharmaceutical, you should discuss this with your doctor. Do not stop taking any prescription mediation without your doctor’s knowledge and consent.

short term relief:

Rule number one is do not lie down within three hours of eating. Simply being vertical helps your stomach contents to stay where they belong. Lying down with an incompetent lower esophageal sphincter encourages stomach contents to reflux, causing the uncomfortable burning sensation (and damage) .

Rule number two is to avoid those things that cause the LES to relax, especially in the evening:

  • Peppermint
  • Chocolate
  • Soda
  • Coffee
  • Tea (herbal teas are OK)
  • Smoking
  • Alcohol
  • Bad fats—especially fried foods

There is also a range of herbal supplements that can be taken to calm the inflammation in the esophagus and help rebuild the damaged lining. Consult a functional medicine physician to determine which herbal supplements would be best to add to your individualized treatment plan.

Long Term Cure:

Chiropractic can work in two ways to help you to heal your GERD. First, chiropractic is the most effective means of treating a hiatal hernia, a common but often overlooked cause of GERD. A hiatal hernia is when the top part of your stomach “pops through” (herniates through) your diaphragm. The diaphragm muscle pinches the top part of your stomach and can cause reflux. A chiropractor trained in reducing hiatal hernias can fix this rapidly and your troubles are over.

The second way chiropractic can help is through manipulation of the spine. Research has shown that people with stomach ulcers who receive chiropractic adjustments heal much faster than people who do not. Often people who suffer from GERD and/or stomach ulcers develop pain in the upper back-between the shoulder blades. This is because the nerve supply is the same to both areas. Chiropractic adjustments to the upper back can “reconnect” the nerve supply to the esophagus and stomach and hasten healing.

Lifestyle Changes:

Lifestyle changes that could reduce or eliminate the occurance of GERD include the following:

Lose weight if you are overweight.

Eat a good organic whole yogurt on a regular basis, preferably raw.

Eat foods high in good bacteria include kim chee, sauerkraut, kombucha tea, and Miso.

Quit eating refined sugars and carbohydrates. This excess sugar and lack of fiber and nutrients disturbs the balance of bugs in your gut.

Cut down on coffee and alcohol. Do not have either on a daily basis, and when you do have them limit yourself to one cup of coffee or one alcoholic drink.

Cut out bad fats. These include hydrogenated oils, saturated fats from meat products, and many vegetable oils. Instead eat cold pressed organic olive, flaxseed, coconut, and sesame oils, organic butter, avocados, fresh nuts, lean meats and fatty fish.

Eat lots of fresh fruits and veggies. These foods contain the vitamins and minerals that your digestive track needs to function properly. The fiber and minerals also act as an acid buffer.

Check in with yourself regarding your stress levels. Your stress levels can play a large role in the state of your digestive track. If you are high strung, learn some technique of stress reduction. Learn to control your stress by practicing stress reduction daily.

Lastly, avoid taking pain medication unless absolutely necessary. NSAIDs and other pain medications eat the lining of your stomach and esophagus. Even Tylenol, which doesn’t have the systemic effect on your gastrointestinal tract, will eat your esophagus if it spends any length of time there. Tylenol is also the leading cause of liver failure in this country.

GERD can pose serious risks to your health over time. Do not let this disease go untreated. If you follow the outline above, you will be healing yourself at a much more meaningful level. GERD is often a symptom of a much greater problem involving diet, lifestyle, stress, the digestive tract as a whole. As always, it is better to treat the disease, not the symptoms.


Curvesday Thursday: Exercise and Chiropractic Therapy

If a patient has a history of heart problems, it is important for the patient to consult with not only the doctor of chiropractic but their primary care physician to be certain that they can tolerate cardiovascular fitness-promoting activities.

Cardiovascular and strengthening exercises combined with chiropractic care are important in the management of low back pain.  Specific instructions are given by the chiropractor with respect to proper exercise for the patient’s condition before beginning any exercise program. In general, a reasonable amount of exercise that is performed daily and utilizes activities that are enjoyed is recommended for patients undergoing chiropractic treatment.

Many studies have reported the importance of exercises in managing acute and chronic low back pain, strengthening the low back, preventing and keeping back patients working, and to improve quality of life. The strength of the abdominal muscles was also found to be able to differentiate between those with vs. without chronic LBP. Overall and when combined with chiropractic care, aerobic exercise helps promote proper digestion, keeps the muscles in proper tone and promotes better circulation. Walking briskly around the block at least once or twice is a convenient and popular activity. Also, many forms of work and/or household tasks can function as an exercise program. The important point is to exercise!

There are many applicable back exercises that are available for patients also undergoing chiropractic care for lower back pain. The physician or physical therapist can classify the chiropractic patient into a flexion or extension biased category to determine the variety that is best for that patient and recommend specific exercises to be completed at home.

For example:

  • If a patient feels best when bending over (flexion biased), exercises that promote low back flexion such as pulling the knees to the chest, posterior pelvic tilts, bending forward from a sitting position and others are usually helpful.
  • If a patient is least symptomatic in extension, especially if leg pain centralizes or diminishes (extension biased), prone press-up type exercises usually yield the best results.

Other exercises that can help reduce lower back pain include:

  • Strengthening of the pelvic stabilizing muscles (trunk muscles)
  • Stretching of the hamstrings, adductors, and other overly short or tight postural muscles
  • Proprioceptive or balance promoting.According to the Scientific Commission of the Council on Chiropractic Guidelines and Practice Parameters (CCGPP):
    • Strong evidence supports exercise as being at least as effective as other non-surgical treatments for chronic low back pain
    • Moderate evidence supports use of a graded-activity exercise program in occupational settings for subacute lower back pain
    • Some evidence shows that exercises are no more effective than other nonsurgical treatments for acute lower back pain.

As with any chiropractic treatment, it is important for chiropractors to perform a focused reevaluation of an exercise program following its initial therapeutic trial to determine its effectiveness. Using spinal range of motion as a measurement of the effectiveness of exercise is just one way in which chiropractors can make such determinations.



Curvesday Thursday: Degenerative Disc Disease

Degenerative disc disease is one of the most common causes of low back pain and neck pain, and also one of the most misunderstood. Simply put, degenerative disc disease describes the symptoms of pain and possibly radiating weakness or numbness stemming from a degenerated disc in the spine. While the definition sounds simple, many patients diagnosed with degenerative disc disease are left wondering exactly what this diagnosis means for them.

Common questions often include:

  • If I have this much pain in my thirties, how much worse will it become with age?
  • Will the disease become a crippling condition? Will I end up in a wheelchair?
  • Should I restrict my activities? Can I still play sports?
  • Will the disease spread to other parts of the spine?
  • Will the degenerated disc(s) cause any permanent damage?
  • Is surgery inevitable?

A diagnosis of “degenerative disc disease” is alarming to many patients because it sounds like a progressive, threatening disease. However, it is not really a disease, and it is not strictly degenerative.

For most people the term degenerative understandably implies that the symptoms will get worse with age. However, the term does not apply to the symptoms, but rather describes the process of the disc degenerating over time.

While it is true that the disc degeneration is likely to progress over time, the pain from degenerative disc disease usually does not get worse and in fact usually gets better given enough time.

Another source of confusion is probably created by the term disease, which is actually a misnomer. Degenerative disc disease is not really a disease at all, but rather a degenerative condition that at times can produce pain from a damaged disc.

Disc degeneration is actually a natural part of aging, and over time all people will exhibit changes in their discs consistent with a greater or lesser degree of degeneration. However, not all people will develop symptoms. In fact, degenerative disc disease is quite variable in its nature and severity.

Generally, the pain associated with degenerative disc disease is thought to stem from two main factors:

  1. Inflammation
    The proteins contained within the disc space can cause a lot of inflammation, and as a general rule inflammation will cause pain.
  2. Abnormal micromotion instability
    If the annulus – the outer rings of the intervertebral disc – degenerates and wears down, it is not as effective in resisting motion in the spine. This condition has been termed “micromotion” instability because it is usually not associated with gross instability (such as a slipped vertebral body or spondylolisthesis).

Both the inflammation and micromotion instability can cause lower back or neck muscle spasms. The muscle spasm is the body’s attempt to stabilize the spine. It is a reflex, and although the body’s response of muscle spasm is not necessary for the safety of the nerve roots, it can be quite painful. The muscle spasms associated with the instability are thought to cause the flare-ups of intense pain often associated with degenerative disc disease

The two findings most correlated with a pathological disc (a degenerating disc that is painful) are:

  • Cartilaginous end plate erosion
  • Disc space collapse

Like other joints in the body, each vertebral segment is a joint that has cartilage in it. In between the vertebral body and the disc space is a layer of cartilage, which is known as the cartilaginous end plate.

The cartilaginous end plate is the source of disc nutrition. If it becomes eroded, it is thought that the disc is likely to go through a degenerative cascade leading to the inflammation and micromotion instability, which in turn causes pain. As it goes through the process, the disc space will collapse.

MRI findings of spinal degeneration are not specific causes of back pain. Typical MRI findings may include:

  • Disc dehydration, also called disc desiccation, and often referred to as a dark disc or black disc, because a disc with less water in it looks dark on an MRI scan
  • Annular tears
  • Disc bulges

These findings may or may not be the cause of the patient’s low back pain. It is well known that the results of surgically fusing a spine with these findings will be less reliable than fusing a disc space that has disc space collapse and cartilaginous end plate erosion.

There are several symptoms that are fairly consistent for people with lower back pain or neck pain from degenerative disc disease, including:

  • Pain that is usually related to activity and will flare up at times but then return to a low-grade pain level, or the pain will go away entirely
  • The amount of chronic pain—referred to as the patient’s baseline level of pain—is quite variable between individuals and can range from almost no pain/just a nagging level of irritation, to severe and disabling pain
  • Severe episodes of back or neck pain that will generally last from a few days to a few months before returning to the individual’s baseline level of chronic pain
  • Chronic pain that is completely disabling from degenerative disc disease does happen in some cases, but is relatively rare.
  • Activities that involve bending, lifting, and twisting will usually make the patient’s pain worse
  • Certain positions will usually make the pain worse. For example, for lumbar degenerative disc pain, the pain is generally made worse with sitting, since in the seated position the lumbosacral discs are loaded three times more than standing
  • Walking, and even running, may actually feel better than prolonged sitting or standing
  • Patients will generally feel better if they can change positions frequently
  • Patients with lumbar DDD will generally feel better lying in a reclining position (such as with legs propped up in a recliner), or lying down with a pillow under the knees, since these positions relieve stress on the lumbar disc space

The goals for treatment of degenerative disc disease usually include a combination of three areas: pain control; exercise and rehabilitation; lifestyle modifications.

  1. Pain Control
    The focus of this part of treatment is on achieving enough pain reduction to enable the patient to pursue a specific exercise and rehabilitation program. Pain from a degenerated or collapsed disc is usually caused by both instability and inflammation, so both of these causes of pain should be addressed. For most people treatment is nonsurgical and may include one or a combination of many medical, alternative, and/or self care approaches. Often a patient needs to take a trial and error approach to find which types of treatment work best.
  2. Exercise and Rehabilitation
    The goals of exercise are both to help the back heal and to prevent or reduce further recurrences of pain. For people with symptomatic degenerative disc disease, exercises are usually best done under the guidance of a physical therapist or other appropriately trained healthcare professional. A side benefit of exercise is that it can also help reduce pain naturally, as it releases endorphins that serve as the body’s natural pain reliever. Exercise is best done in a controlled progressive manner and with the help of a trained health professional, such as a physiatrist, physical therapist, or chiropractor.
  3. Lifestyle Modifications
    The focus of this part of treatment is education and resources to help the patient develop a healthier lifestyle. Often, people can make lifestyle changes that aim at both avoiding stress on the spine and supporting the spine through the right ergonomics and posture.

    In addition, many people can benefit from the following changes:

    • Avoid nicotine
    • Avoid excess alcohol
    • Incorporate movement into one’s daily routine and avoid staying in one position for too long. For example, stand up and stretch and walk around every 20 to 30 minutes instead of sitting for a prolonged period.
    • Drink plenty of water
    • For lower back pain from DDD, most patients can benefit from a gentle hamstring stretching routine


Curvesday Thursday: Sitting is the New Smoking!

More and more studies are showing the health risks of sitting at your desk for too long. Heart disease, diabetes and certain types of cancers have all been shown to increase in those individuals that lead a sedentary lifestyle. Studies are beginning to equate sitting to smoking in terms of harm to overall health. Compound that with sitting at home and watching television when you get home and people fail to realize how long they are truly sitting in a day. Sitting for an hour can already start to have harmful effects. We have become a culture of sedentary individuals.

There are small things that you can do every day that will make you a less sedentary person. The difficulty for most people is getting started. However, once you used to doing these things then they will become habits as opposed to things that you constantly have to think about on a daily basis. Start small and work up to some of the ones that take more time and thought. Getting up for five minutes can change how your body is reacting.

Chiropractors treat people every day that do not understand how harmful sitting is for your body. For example, back and neck pain. These are two diagnoses chiropractors treat on a regular basis—patients with back and neck pain compose more than fifty percent of any practice. Education is a big part of the treatment plan and getting you to understand your body and ways to make changes to your environment that will help the pain that you are dealing with not become chronic pain.

The one consistent thing that is that if people got up more from their desks, from watching television, there would be far less back and neck pain diagnoses. And many of the things that people can do to save themselves from a life time of pain are so simple, yet many people ignore it until it is too late which leads to a long and costly fix where the person spends many days in therapy or getting injections. But just a few adjustments to your every day routine could help. Here are a few suggestions to begin being healthier even though you may have a desk job:

  1. Get up. You should not be sitting for more than a half hour at a time. Posture can become poor meaning your shoulders can slump forward and your back can become curved in the wrong position—putting an extremely high amount of pressure on the discs in your spine. Over time this can lead to herniated discs which can cause numbness and tingling.
    By getting up every half hour it prevents a lot of bad habits from developing. And when I say get up it does not need to be a lengthy trip out of the office, stand up at your desk, walk around your chair, walk to a file cabinet, and stand up during a conference call are all quick and simple ways to get moving during the day.
  2. Do exercises throughout the day. Exercises do not have to be squats at your desk chair, but standing up and doing some heel raises, taking the stairs instead of the elevator, stretching and shoulder rolls will help minimize the ill effects of sitting. If you find yourself at night sitting in front of the TV for long periods get up during commercial breaks, try not to get sucked in for hours with just sitting or laying.
  3. Walking meetings.  Scheduling meetings where you can be walking from one place to the next or just scheduling a meeting to walk for an hour will make it a much more productive meeting. Exercise has been shown to increase brain activity. Walking or doing some type of exercise will allow for not only increased brain activity but also minimize the amount of sitting and often eating that is done because as we all know many meetings have been scheduled around consuming a meal or coffee.
    Save yourself some sitting time and some calories by having these meetings while walking around.
  4. Look for ways to get up and moving, do not look for excuses. After reading these points, many of you have already formed 20 excuses as to why you cannot be doing any of these things and you are thoroughly convinced in your head that there is just no possible way. But if you truly take a step back, there are ways to have a more active lifestyle. Start with changing just one thing and then when that one thing becomes a habit, then change the next thing. This is an ongoing evolving process.

These are just a few points to give you ideas to get up and moving during the day. If you look hard enough you can find ways that can make your day more active. It is important when making changes to make changes that you incorporate into your lifestyle not just ones that you are going to do for a week and then quit. Finding a long term solution to sitting less will make you a healthier person.


Curvesday Thursday: Can Chiropractic Help Me?

Before we talk about Chiropractic Conditions, let us first review a little bit about chiropractors. A Doctor of Chiropractic (DC or D.C.) is an academic degree that chiropractic providers receive. Chiropractors are primary contact health care professionals that can help treat and remedy many of your health related conditions, without the necessity of a referral. As a result of this, chiropractors are considered to be a portal of entry to the health care system.

The role of a chiropractor is distinctly different from that of medical doctors and yet similar in other ways. Chiropractors are considered to be specialists in spinal pain, and yet their patients have a wide variety of complaints and conditions being successfully treated. Chiropractic focuses on prevention through a healthy lifestyle as opposed to taking medications, placing them in a unique position as wellness advocates.

People tend to think of chiropractic only treating neck and back pain, but that isn’t true. Chiropractic focuses on realigning the body, allowing it to successfully heal itself and return to homeostasis. Below is a list of conditions that respond well to chiropractic adjustments:

Curvesday Thursday: Chiropractic Adjustments for Carpal Tunnel Syndrome

When people think “chiropractic,” they often think of back and neck problems. But chiropractic has many applications beyond these typical uses, and it can improve quality of life for a broad range of health conditions. One such condition is carpal tunnel syndrome, a repetitive stress injury (RSI). Chiropractic can be a beneficial treatment for patients seeking noninvasive relief from this ailment that has become all too common in the modern world.

What Is Chiropractic?

Chiropractic subscribes to the belief that the body’s structure is related to its function. More specifically, the profession focuses on the structure of the spine and how that affects the state of health and the functioning of not only the neck and back but other areas of the body as well.

It holds to the philosophy that misalignments of the spine affect the body’s ability to function and can contribute to health problems. These misalignments need to be, and can be, corrected through chiropractic therapy. The nervous system, including the spine’s nerves, affects the flow of energy throughout the entire body. Another foundational belief of chiropractic is that the body has a powerful ability to heal itself. Chiropractic aims to stimulate that ability.

What Is Carpal Tunnel Syndrome (RSI)?

Carpal tunnel syndrome, a repetitive stress injury (RSI), was named as such because the anatomical structure of this form of injury. The bones in the wrist (called carpals) form a tunnel, and the median nerve travels from the forearm to the hand through this carpal tunnel. Carpal tunnel syndrome is, therefore, an injury to this area of the body. Often, the dominant wrist is the injured one, but in some patients, both left and right wrists are involved. Symptoms include pain and numbness in the index, middle fingers, and thumb, tingling in the hand(s), weakness, and pain shooting up the arm.

Carpal tunnel syndrome can be caused and worsened by repetitive motion and tasks, whereby the tendons in the carpal tunnel become swollen, which contributes to a pinched nerve in the carpal tunnel. Examples of repetitive motion include using a computer for long periods of time, performing a job on an assembly line, and using hand tools. Patients suffering with this condition are more often female than male. Middle age is the most common time in life for carpal tunnel syndrome to occur.

How Does a Chiropractor Treat Carpal Tunnel Syndrome (CTS)?

Carpal tunnel syndrome is a repetitive stress injury (RSI). This category of injuries is caused by repetitive motion, such as typing or assembly line work, which causes pain and injury over time. The earlier that an RSI is diagnosed and treated, the better the outcome can be. Diagnosis includes physical examination and possibly x-rays. Typically, the chiropractic treatment for RSI includes manipulation of the affected wrist and elbow, as well as manipulation of the upper spine. A spinal manipulation involves applying controlled pressure to a joint. The chiropractor may also advise the patient to rest the affected arm, apply cold to reduce inflammation, perform appropriate exercises, or wear a splint or brace to immobilize the area.

Some common treatments chiropractors use for carpal tunnel syndrome include:

  • Manipulation of the wrist, arm, and upper spine: Misalignment in the spine could contribute to symptoms of carpal tunnel syndrome. Doctors of Chiropractic (DCs) perform adjustments (also called spinal manipulations) that aim to correct improper alignment in the spine. The chiropractor typically performs an adjustment using his or her hands, but sometimes devices are employed. Chiropractors may also adjust and treat other areas of the body as needed, including the wrist and arm.
  • Ultrasound therapy: This therapy uses either very high-energy or low-energy sound, both of which are outside the range of normal human hearing. The chiropractor uses a device that emits focused sound waves that penetrate deep into body tissue. Sound waves can relax muscles, alleviate pain, and reduce inflammation.
  • Wrist supports: Wrist supports seek to keep the wrist in the proper alignment and can be used to treat or prevent carpal tunnel syndrome.

What Can Be Expected During the Healing Process?

Chiropractic is generally a relatively safe practice and is a noninvasive treatment for carpal tunnel syndrome, especially compared to treatment involving medications and surgery. Studies have shown improvement in symptoms of repetitive stress injuries (RSIs), including carpal tunnel syndrome, as a result of chiropractic treatment. Some research has concluded that chiropractic can be just as effective as allopathic care for RSIs.

As with any medical treatment, prognosis for resolution of an Repetitive Stress Injury (RSI) can vary from patient to patient, based on such factors as the nature and severity of the RSI, the age and overall health of the patient, and simultaneous use of other therapies. But in many cases, chiropractic treatment has helped patients struggling with carpal tunnel syndrome. So although carpal tunnel and other RSI patients must face the realities of modern-day society with its risks of conditions like RSI, chiropractic can provide hope for managing this condition.

Many of the patients who seek chiropractic treatment for repetitive stress injuries (RSIs) do so because it is not nearly as invasive as other, more allopathic, treatments, which often rely on treatments such as medications and/or surgery.

If you or someone you know is suffering from an RSI, please call (304) 263-4927 to schedule an appointment to discuss how chiropractic can help you.