Chiropractic and Neck Pain: Conservative Care of Cervical Pain, Injury

Chiropractic and Neck Pain: Conservative Care of Cervical Pain, Injury


Your neck, also called the cervical spine, begins at the base of the skull and contains seven small vertebrae. Incredibly, the cervical spine supports the full weight of your head, which is on average about 12 pounds. While the cervical spine can move your head in nearly every direction, this flexibility makes the neck very susceptible to pain and injury.

The neck’s susceptibility to injury is due in part to biomechanics. Activities and events that affect cervical biomechanics include extended sitting, repetitive movement, accidents, falls and blows to the body or head, normal aging, and everyday wear and tear. Neck pain can be very bothersome, and it can have a variety of causes.

Here are some of the most typical causes of neck pain:

Injury and Accidents: A sudden forced movement of the head or neck in any direction and the resulting “rebound” in the opposite direction is known as whiplash. The sudden “whipping” motion injures the surrounding and supporting tissues of the neck and head. Muscles react by tightening and contracting, creating muscle fatigue, which can result in pain and stiffness. Severe whiplash can also be associated with injury to the intervertebral joints, discs, ligaments, muscles, and nerve roots. Car accidents are the most common cause of whiplash.

Growing Older: Degenerative disorders such as osteoarthritis, spinal stenosis, and degenerative disc disease directly affect the spine.

Osteoarthritis, a common joint disorder, causes progressive deterioration of cartilage. The body reacts by forming bone spurs that affect joint motion.
Spinal stenosis causes the small nerve passageways in the vertebrae to narrow, compressing and trapping nerve roots. Stenosis may cause neck, shoulder, and arm pain, as well as numbness, when these nerves are unable to function normally.
Degenerative disc disease can cause reduction in the elasticity and height of intervertebral discs. Over time, a disc may bulge or herniate, causing tingling, numbness, and pain that runs into the arm.

Daily Life: Poor posture, obesity, and weak abdominal muscles often disrupt spinal balance, causing the neck to bend forward to compensate. Stress and emotional tension can cause muscles to tighten and contract, resulting in pain and stiffness. Postural stress can contribute to chronic neck pain with symptoms extending into the upper back and the arms.

Chiropractic Care of Neck Pain
During your visit, your doctor of chiropractic will perform exams to locate the source of your pain and will ask you questions about your current symptoms and remedies you may have already tried. For example:


When did the pain start?
What have you done for your neck pain?
Does the pain radiate or travel to other parts of your body?
Does anything reduce the pain or make it worse?
Your doctor of chiropractic will also do physical and neurological exams. In the physical exam, your doctor will observe your posture, range of motion, and physical condition, noting movement that causes pain. Your doctor will feel your spine, note its curvature and alignment, and feel for muscle spasm. A check of your shoulder area is also in order. During the neurological exam, your doctor will test your reflexes, muscle strength, other nerve changes, and pain spread.

In some instances, your chiropractor might order tests to help diagnose your condition. An x-ray can show narrowed disc space, fractures, bone spurs, or arthritis. A computerized axial tomography scan (a CT or CAT scan) or a magnetic resonance imaging test (an MRI) can show bulging discs and herniations. If nerve damage is suspected, your doctor may order a special test called electromyography (an EMG) to measure how quickly your nerves respond.

Chiropractors are conservative care doctors; their scope of practice does not include the use of drugs or surgery. If your chiropractor diagnoses a condition outside of this conservative scope, such as a neck fracture or an indication of an organic disease, he or she will refer you to the appropriate medical physician or specialist. He or she may also ask for permission to inform your family physician of the care you are receiving to ensure that your chiropractic care and medical care are properly coordinated.

Neck Adjustments

A neck adjustment (also known as a cervical manipulation) is a precise procedure applied to the joints of the neck, usually by hand. A neck adjustment works to improve the mobility of the spine and to restore range of motion; it can also increase movement of the adjoining muscles. Patients typically notice an improved ability to turn and tilt the head, and a reduction of pain, soreness, and stiffness.

Of course, your chiropractor will develop a program of care that may combine more than one type of treatment, depending on your personal needs. In addition to manipulation, the treatment plan may include mobilization, massage or rehabilitative exercises, or something else.

Research Supporting Chiropractic Care
One of the most recent reviews of scientific literature found evidence that patients with chronic neck pain enrolled in clinical trials reported significant improvement following chiropractic spinal manipulation.

As part of the literature review, published in the March/April 2007 issue of the Journal of
Manipulative and Physiological Therapeutics, the researchers reviewed nine previously published trials and found “high-quality evidence” that patients with chronic neck pain showed significant pain-level improvements following spinal manipulation. No trial group was reported as having remained unchanged, and all groups showed positive changes up to 12 weeks post-treatment.

Your NYC Chiropractor www.drshoshany.com
Conservative care for your cervical spine.
We utulize Chiropractic care, Cervical spinal decompression and cold laser therapy

Low-Level Lasers Effective in Chronic Neck Pain

I have used Low-level laser therapy or Cold laser therapy in my NYC practice for close to 7 years, I have found it to be extremely effective in reducing pain and dysfunction.
Cold laser therapy NYC

By John Gever, Senior Editor, MedPage Today
Published: November 13, 2009
Reviewed by Zalman S. Agus, MD; Emeritus Professor
University of Pennsylvania School of Medicine and
Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner
Although no one is sure how it works, low-intensity laser therapy appeared to be effective in relieving chronic neck pain, researchers found in a meta-analysis.

Pooled data from 16 randomized, controlled trials indicated that most patients reported both short- and medium-term pain relief with the noninvasive treatment, according to Roberta T. Chow, MBBS, PhD, of the University of Sydney in Australia, and colleagues.

"The results of low-level laser therapy in this review compare favorably with other widely used therapies, and especially with pharmacological interventions, for which evidence is sparse and side effects are common," the researchers wrote online in The Lancet
The procedure involves shining low-intensity laser beams -- too weak to generate biologically significant heat -- usually at the back or side of the neck, targeting muscles, and vertebral joints. Wavelengths of 780, 810 to 830, or 904 nm are typically used. These beams are able to penetrate several centimeters of tissue.

Several possible mechanisms of action have been proposed. The radiation may have anti-inflammatory effects by inhibiting prostaglandins and/or cytokines. Alternatively, it may reduce oxidative stress and muscle fatigue, with support from some animal studies and clinical experiments.

A third possibility is that the laser light alters nerve signalling at the neuromuscular junction or elicits overt nerve blockade.

Whatever the mechanism, however, the randomized, controlled studies included in the review showed a clear clinical benefit for the treatment.

None of the individual trials were very large -- the biggest (led by Chow herself) had 90 patients. In total, 820 patients participated in the 16 studies.

Five of the studies, with 122 patients, included the presence of global improvement, relative to sham treatment, as an outcome.

The relative likelihood of improvement with the laser treatment was 4.05 (95% CI 2.74 to 5.98), Chow and colleagues found.

In 11 trials with 333 patients, the weighted mean change in pain severity -- as reported by patients on a 100-mm analogue scale -- was 19.86 mm relative to controls (95% CI 10.04 to 29.68).

In four studies that measured pain severity 10 to 22 weeks after treatment ended, with a total of 86 patients, there was a weighted mean improvement from baseline of 23.44 mm at the end of follow-up (95% CI 17.11 to 29.77).

Overall, the researchers said, the trials "show moderate statistical evidence for efficacy of low-level laser therapy" for neck pain.

Limitations to the available evidence include the differences in laser treatments -- schedules and doses as well as wavelengths -- and in the varieties of neck pain with which patients had presented.

Current diagnostic terms "suggest distinct clinical entities; however, there is strong evidence that a definitive diagnosis of the causes of neck pain is not possible in a clinical setting," the researchers wrote.

They said adverse effects from treatment were minimal. Several studies reported increased tiredness.

The primary safety concern with the treatment is the possibility of inadvertently directing the laser into patients' eyes, Chow and colleagues said. Safety glasses would be required in all studies.

In an accompanying commentary, Jaime Guzman, MD, of the University of British Columbia in Vancouver, B.C., said the existing evidence on low-level laser therapy still leaves many questions unanswered, especially on the mechanism of action.

Nevertheless, he said, "this evidence is more solid than that for many current interventions."

"Although mechanisms of action and effects on function and occupational outcomes are not clearly understood and warrant further impartial study, low-level laser therapy is an option worthy of consideration for management of nonspecific neck pain," Guzman wrote.

External funding for the study was not reported.

Chow and some co-authors reported relationships with the World Association for Laser Therapy and healthcare professional societies. No authors reported relationships with manufacturers of laser therapy devices.

Guzman declared he had no conflicts of interest.


Primary source: The Lancet
Source reference:
Chow R, et al "Efficacy of low-level laser therapy in the management of neck pain: a systematic review and meta-analysis of randomised placebo or active-treatment controlled trials" Lancet 2009; DOI: 10.1016/S0140-6736(09)61522-1.

Additional source: The Lancet
Source reference:
Guzman J "Neck pain and low-level laser: Does it work and how?" Lancet 2009; DOI: 10.1016/S0140-6736(09)61837-7.
Cold Laser therapy, Low-level laser therapy NYC
www.livingwellnewyork.com

Carpal tunnel syndrome NYC- Cold laser treatment-non surgical treatment for carpal tunnel syndrome in Manhattan, NYC

Carpal Tunnel Syndrome in NYC? visit our website www.livingwellnewyork.com

Important News If You've Got Tingling, Numbness or Pain in the Hands, Wrist... and You're Desperately Seeking Answers...

You May NOT Have a Wrist Problem at All!

Discover the Blazingly Obvious Area of Your Body That Doctors May Miss When Diagnosing Carpal Tunnel Syndrome.

In our NYC Physical therapy practice we see patients getting better everyday.

The U.S. Department of Labor called Carpal Tunnel Syndrome (CTS) the “chief occupational hazard of the 90’s”… disabling workers in epidemic proportions. “Carpal Tunnel Syndrome” affects over 8 million Americans.
It’s also the #1 reported medical problem, accounting for about 50% of all work related injuries. And while over 200,000 surgeries are performed annually, reports have revealed only about 25% of all patients are able to return to their previous professions following surgery…and up to 36% of carpal tunnel syndrome patients require unlimited medical treatment. Hmm…

Could it be that carpal tunnel surgery is something to be questioned more carefully?
Carpal tunnel syndrome isn't like a broken bone or a cut. It develops slowly; it's barely noticeable. One might not even take it seriously at first. But the symptoms slowly build and build. It could start with some numbness and tingling... then it might become more difficult to type at the computer.
So you give your family doctor a visit. If you're like many people, here's what you've been told: "You’ve got carpal tunnel syndrome. Take this medicine and wear these wrist braces... come back if it doesn't work."

The problem here is that the exact same symptoms of "Carpal Tunnel Syndrome” can have several different causes... many of which are NOT even near your wrist!
FACT: If your doctor doesn't examine or consider those other areas...you have NOT been given a thorough examination for your condition. Any doctor that assumes you have true carpal tunnel syndrome, simply because you have wrist or hand pain, tingling, numbness or weakness is...
Missing the Boat!
If your doctor assumes that your wrist is the ONLY cause of the symptoms, and focuses treatment only on that, the same criticism applies.

Myth: Carpal Tunnel Syndrome is Caused by Computer Usage.
Reality: A 2005 Harvard medical study reports that Carpal Tunnel Syndrome is simply NOT caused by computer usage! A 2001 Mayo Clinic neurology study reported the same. You’ll soon understand why!
Why treatment for Carpal Tunnel Syndrome may fail
Fortunately for you, if your doctor's treatments fail it doesn’t mean you're incurable. It may simply be that nobody was looking in the RIGHT place, or places.

If the diagnosis is WRONG; the treatment is likely to be WRONG too

Again, focusing exclusively on the WRIST is a huge mistake when considering the symptoms of pain, tingling, numbness and weakness in the wrist and hand.
Here's why:

Wrist pain, tingling, numbness, and weakness are symptoms of NERVE entrapment. In other words, the nerves that travel from your brain to your fingers must be "pinched" or compressed somewhere along that pathway. The amazing thing about your nervous system is that interference in one place can give you symptoms in other places…far away from the interference.
Because of the complexity of the nerve pathways from your BRAIN, down and out through your NECK... through your SHOULDER area... down your ARM... and finally... through your wrist... It is possible that...
You May NOT Even Have Carpal Tunnel Syndrome!
If you think that all cases of wrist or hand pain, tingling, numbness or weakness are caused by Carpal Tunnel Syndrome... Think again!
The TRUTH: solid scientific evidence reveals that many cases of so-called “carpal tunnel syndrome” have little or nothing to do with the wrist at all! Let's explore this by first answering the "burning question"...

What Exactly IS Carpal Tunnel Syndrome?
The term "carpal" simply means WRIST.
The Carpal Tunnel is: a small tunnel or canal inside the wrist. It's formed by the bones of the wrist, which are of course called: CARPALS. The other part that makes up the Carpal Tunnel is a ligament - a tough band between some of the bones.
There Are 3 Structures
Inside The Carpal Tunnel:

1. The Median Nerve – controls some hand movement and sensation
2. Nine Flexor Tendons that enable you to curl your wrist and fingers
3. Blood vessels

"True Blue" Carpal Tunnel Syndrome is when the MEDIAN NERVE is compressed or entrapped within the CARPAL TUNNEL.
What few people seem to understand is that the MEDIAN NERVE originates in the NECK. Then it travels under your collarbone, down the center of your forearm and finally through the carpal tunnel to the hand muscles.
Why is this SO important?
There Are 8 Possible Areas Where the Nerve Can Be Compressed!

Consider some of the symptoms of MEDIAN NERVE Compression (not necessarily Carpal Tunnel Syndrome): Pain in the Wrist… Numbness in the fingers… Tingling or other abnormal hand sensations…Weakness of hands… Neck Pain… Swelling
These are ALL symptoms commonly misdiagnosed as Carpal Tunnel Syndrome…when in fact…they are caused by Median Nerve compression in ANY or ALL of the 8 areas!!

How Does The Median Nerve Become Compressed?
The Median Nerve comes straight out between the bones of your NECK


If your doctor does not properly examine your neck, as well as all possible “crush sites” he/she is missing the boat and should not (in my opinion) be treating you for "carpal tunnel syndrome! See in the Gray's Anatomy diagram to the left how the nerves depicted in yellow,
travel down the arm to the hand?
This means that a problem anywhere from the NECK to the actual carpal tunnel can cause nerve
compression.
Misaligned bones in the neck, bulging discs, tight neck muscles, an extra rib (some people are born with them), shoulder or elbow injuries, inflamed tendons, and misaligned wrist bones can ALL compress the Median Nerve, causing in the SAME SYMPTOMS!
Since you're aware that most doctors are trained to treat symptoms, you can understand how they might miss the neck and the other zones when treating “carpal tunnel syndrome?”

Treatment for "Carpal Tunnel Syndrome" and other sources of Median Nerve Compression:
The proper treatment is determined through proper diagnosis. For example, if the cause of symptoms of hand tingling, numbness, weakness and/or pain is coming from the neck, the primary treatment could be Atlas Orthogonal, manual therapies, Cold Laser therapy , and/or home traction devices.

If the wrist is indeed the culprit, Cold Laser therapy would be my first choice, and/or Kinesio-taping. These have all been outstanding treatments for median nerve compression syndromes.
If you have TRUE Carpal Tunnel Syndrome (Median Nerve compression at the wrist, or carpal tunnel), Cold Laser therapy is an outstanding treatment method which is painless and non-surgical. It has been effective even for patients who have had failed wrist or neck surgery.
To learn more about cold laser therapy in Manhattan, New York City(NYC) visit my website at www.drshoshany.com or our physical therapy/pain management site which offers the most comprehensive treatment for cervical and lumbar herniated discs in NYC www.livingwellnewyork.com we offer a comprehensive approach which includes Chiropractic, Physical therapy pain management, Cold laser therapy, Kinesio-taping,Graston technique, Spinal decompression using the DRX9000, Core stabilization using the SpineForce and Powerplate.