Please often discount how significant of an injury whiplash really can be. I wanted to take a moment to shine a different light on this important subject.
Whiplash, as previously discussed, occurs quicker than the speed at which we can voluntarily contract our muscles in attempt to guard ourselves against injury. Hence, it is nearly impossible to properly brace in anticipation of an impending collision. When muscles, ligament, and joint capsules become injured, there is pain, and as a result, reflex muscle spasm occurs as the body attempts to “splint” the area to protect it. This sometimes sets up a vicious cycle which can make the pain last longer, hurt more intensely and / or hurt more frequently. Because of pain, as well as direct muscle injury that sometimes occurs in whiplash associated disorders (WAD), the natural tendency is to stop doing many activities and guard against motion both because of pain and the fear of it hurting worse. In both cases, the result is the same: muscle atrophy or shrinkage and muscle weakness due to not using the muscle.
There are other reasons that muscles become weak. When an injury occurs, a herniated or “ruptured” disk can injure the spinal nerves exiting the spine. The disk is like a jelly donut where the center is liquid-like surrounded by a thick ring of fibrocartilage and functions as a “shock-absorber” as it sits between 2 vertebral bodies
Think of the spinal nerves like electrical wires that connect a fuse box to a house. The fuse box is the spinal cord and each wire represents the spinal nerves going to different parts of the house (body). In the cervical spine or neck, each wire goes to different parts like the head, shoulder, arm, and hand and innervates specific areas. Patients who have a pinched nerve from a whiplash injury describe their symptoms as numbness, tingling, pain and/or muscle weakness in a specific distribution or area.
There are 8 pairs of nerves in the neck that travel to different parts of the head (C1-3), the shoulders (C4, 5), and the arm (C6-T2). Let’s say a patient has numbness and tingling down the arm to the 4th & 5th fingers and the pinky side of the hand. That immediately tells us as chiropractors that the C8 nerve is injured (pinched) because that’s the pain pattern of the C8 nerve. Certain muscles are controlled by C8 that we can test in our office to determine if they are weak (abnormal) or strong (normal).
We grade the weakness between 0-5 (5=normal). The chiropractic treatment is aimed at un-pinching the nerve which results in a return of normal nerve function or no numbness/tingling and a strong C8 muscle (finger flexion strength). To accomplish this, we may use a combination of treatments such as spinal adjustments, mobilization, traction, exercises, and/or modalities (electric stim, light therapy, ultrasound or others).
That’s it for today.
Troy Don, DC
Low back pain (LBP) has been a challenge to treat for centuries and evidence exists that back pain has been a concern since the origins of man. Chiropractic offers one of the most patient satisfying and fastest treatment approaches available. But, when you go to a chiropractor, there seems to be a lot of different approaches utilized from doctor to doctor. Is there any evidence that suggests one approach is favored over another? How are the patient’s goals addressed?
Let’s look at what chiropractors actually do. Sure, we manipulate the spine and other joints in the upper and lower limbs using a variety of techniques, which seems to be the “brand” of chiropractic. This is good as joint manipulation has consistently been reported to be safe, effective, and with few side effects. Since this is the “staple” of chiropractic, it’s safe to say that regardless of our preferred or chosen technique, obtaining a good result is highly likely.
But, chiropractic includes SO MUCH MORE than just joint manipulation! For example, we focus on the whole person, not just their isolated issue or complaint. Using low back pain as our example, a “typical” evaluation includes a detailed history of the patient’s general health, past history, illness history, family history, personal habits including sleep quality, exercise habits, dietary issues, quality of life measurements and a review of systems. By gathering this information, we can identify areas that may be directly related to low back pain care, indirectly related, or possibly not related at all, but interferes with the person’s quality of life which, in turn, increases LBP. It’s really difficult to separate our low back from the rest of our body.
For example, if a person has plantar fascitis, a heel spur, an ingrown toe nail, diabetic neuropathy in their feet, pes planus or flat feet, an unstable ankle from multiple sprains, knee or hip problems, the gait pattern or, the way a person walks will be affected and the “domino effect” can trickle up to change the low back/pelvic function — resulting in low back pain! Proper management must address all of the issues that are affecting the patient’s gait if long-term success in low back pain management is expected, rather that just putting a “band aid” on the problem.
Let’s talk about what treatment goals we like to address when we treat our low back pain patient population. The most obvious first goal is pain cessation or getting rid of pain! Since this is what usually drives the patient into our office, patient satisfaction with the care received will not be significant unless the pain is managed. This is achieved through advice, reassurance and training. We often recommend ice (vs. heat) aimed at reducing inflammation, activity modification (teaching proper bending, lifting, pulling, and pushing techniques) and gentle stretching exercises when LBP is present in this acute stage.
Once the pain becomes more manageable and activities become less limited, the second goal is structural restoration. This usually includes managing the flat foot possibly with foot orthotics, a short leg with a heel lift, sole lift or combination, an unstable ankle, knee or hip with exercise often emphasizing balance challenge exercises, and sometimes an orthotic that can be as simple as an elastic wrap to a more elaborate brace. This goal also includes “functional restoration” or transitioning the patient back into real life activities they may be afraid to try such as work, golf, gardening, walking or running, etc.
The third goal is prevention oriented. This may include nutrition (including vitamin/mineral recommendations), weight management (though this is also part of the 2nd goal), exercises (aerobic, stabilization, balance, stretch), and stress management (yoga, lifestyle coaching, etc.). We treat ALL of you, not just your parts!
That’s if for now.
Reflexology,”means the stimulation of areas beneath the skin to improve the function of the whole body or of specific body areas away from the site of the stimulation” (Mosby’s Fundamentals of Therapeutic Massage, p.466). The theory of reflexology is that there are areas in the hands and feet that correlate with the major organs of the body and other areas of the body. Eunice Ingham is credited with formalizing this method; however its origins can be traced back to China, with foot reflexology being the most popular of the modalities. By stimulating certain areas on the feet the response is communicated to through the neural pathways in the body that activate the body’s electrical and biochemical activities thus promoting healing.
Many people may don’t know this, but the foot is actually a very complex structure. Extensive nerve distributions exist in the hands and feet and in so being the sensory and motor centers of the brain devote a large area to the feet and hands. In so being it would seem logical that by stimulating the hands and feet that a response would be felt in other areas of the body. It is interesting to also see that many of the nerve endings on the feet and hands correlate with well-known acupressure points, which are known to trigger the release of endorphins and other body chemicals.
According to research, these are some of the reported benefits of reflexology: It promotes relaxation, reduces chronic pain, improves blood flow, benefits mental health, reduces stress, helps to control anxiety and much more (www.reflexology-research.com). If you are skeptical of or just interested in how reflexology may be able to help, then my advice is to try it for yourself.
Everyone is different and not every massage therapy modality is for everyone. I can say that I have had clients of mine in the Inland Empire report to me decreases in body pains and headaches due to reflexology. I myself have even experienced headache relief through hand reflexology. Find someone who specializes in reflexology, or call our office and try it for yourself, and then you be the judge.
Today I’d like to start a series in that I speak to and about athletes and the role their Chiropractor plays. Ladies and gentlemen, it is a VITAL role in your performance. If you are not utilizing a chiropractor as a part of your team, I’m going to go as far as to say that you are NOT a serious competitor. If what I said was a slap to your face… if my statement irritated you… if you got pissed off, then YOU must read this article.
Let’s start with the basics – Chiropractic and the body.
Lets face it, as an athlete, you are all focused on improving performance. You base that performance on how happy your muscles are. You know that your muscles move your bones. Your power is directly proportional to you muscles. Weak muscles, low power.
You also know that nutrition is critical to your performance. You need quality fuel for your muscles to fire AND to repair. Deprive your body of the right building blocks and your muscles and tissues will not heal properly! This will lead to greater risk of injury.
Did you know that you could have absolutely no problem with your muscle… perfect nutrition… and yet I could massively weaken your muscle such that they would atrophy (AKA shrivel and die) in weeks!
How would I do that? Simple. Turn off the light switch. Cut the power.
Let me explain.
Your entire body is run and regulated by your Nervous System. It controls everything in your body! Everything! Including your muscles. Including your reaction speed. Including your healing rate. Including your balance. Those are all topics for later, but know this… your brain and spinal cord the spinal nerves are the master control center.
So how do I turn off your muscles… or perhaps turn down the intensity? I affect your nerves.
Your spinal bones (vertebra) can sometimes misalign or not move right (that’s called a Subluxation). That can cause irritation to your nervous system. That will decrease that nerve impulse. That can lower your power.
And the scary thing is, athletes beat the heck out of themselves all the time and so are at greater risk of having something “out of place”. So you may have these already and not even know it!
You want a Chiropractor to evaluate you for these subluxations and the get rid of them.
Ok, that’s it for now… stay tuned for more reasons why SERIOUS, elite, professional athletes make Chiropractic core to their career.
Troy Don, DC QME
Trigger points are persistent, localized muscle spasms that can cause a great deal of pain.1,2,3 Trigger points alone may be responsible for many cases of neck pain, upper back pain, and lower back pain. This relationship is fairly common knowledge among physicians who treat pain, including chiropractors, rheumatologists, and physiatrists (doctors of physical medicine).
What is not generally known is that trigger points may also be implicated in radiating pain into the arm and hand or radiating pain into the leg and foot. In fact, radiating pain due to trigger points may be mistaken for pain caused by a herniated disc, in either the neck or lower back. Trigger point pain affecting the wrist and hand may even be misdiagnosed as carpal tunnel syndrome. A patient in whom a correct diagnosis of trigger point pain is missed may lose much precious time and other resources, as she fruitlessly “tries” one doctor after another and needlessly undergoes all sorts of complex and costly testing.
The key to correctly identifying the source and cause of upper or lower extremity radiating pain is to be able to accurately characterize its nature. Radiating pain caused by trigger points is diffuse – the pain broadly covers a region. This diffuse pain is described as “scleratogenous”, meaning that it is pain referred from connective tissue such as muscle and tendon. Radiating pain caused by a compressed spinal nerve (ultimately caused by a herniated disc, for example) is described as “radicular” or “dermatomal”. This pain is confined to a specific area – the area that is supplied by a specific spinal nerve. For example, pain involving the thumb and index finger could be caused by compression of the C6 spinal nerve. Pain involving the outside of the foot and the little toe could be caused by compression of the S1 spinal nerve.
Scleratogenous pain is not specific. A person might complain of pain across the “shawl” portion of the upper back and traveling into the upper arm, experienced “all over” the upper arm. Another person might be experiencing pain across the gluteal region, hip, and upper thigh. Both of these patterns of radiating pain are likely due to several trigger points, localized to the respective areas.
Of course, an accurate diagnosis is necessary to be able to develop an effective treatment strategy. The good news is that although trigger points necessarily represent a chronic muscular process, they may be treated with very good to excellent outcomes using conservative protocols. Chiropractic care is the optimal method for managing trigger point pain. Chiropractic care is a drug-free approach which directly addresses the biomechanical causes of these persistent trigger points and their associated patterns of radiating pain. Chiropractic care improves mobility and restores function, helping to reduce and resolve chronic pain.
That’s it for now…
Dr. Troy Don, DC QME
1Alonso-Blanco C, et al: Multiple active myofascial trigger points reproduce the overall spontaneous pain pattern in women with fibromyalgia and are related to widespread mechanical hypersensitivity. Clin J Pain Feb 28 2011 (Epub ahead of print)
2Bron C, et al: Treatment of myofascial trigger points in patients with chronic shoulder pain: a randomized, controlled trial. BMC Med 9:8, 2011 (January 24th)
3Renan-Ordine R, et al: Effectiveness of myofascial trigger point manual therapy combined with a self-stretching protocol for the management of plantar heel pain: a randomized controlled trial. J Orthop Sports Phys Ther 41(2):43-50, 2011
In continuing to explore the many different types of massage therapy that is available to the massage, the next modality we will talk about is an Asian method of body work called Shiatsu. The Japanese word Shiatsu is translated to finger pressure and is probably one of the more common Asian types of massage that one would encounter in a spa or therapeutic massage atmosphere. Shiatsu massage “…is a form of massage in which the fingers are pressed onto particular points of the body to ease aches, pain, tension, fatigue, and symptoms of disease.” (Mosby’s Fundamentals of Therapeutic Massage, p. 477). Shiatsu works using finger pressure along certain point around the meridians of the body. This helps to restore balance to the body by strengthening and stimulating these energy circuits of the body.
Meridians are the foundation of shiatsu and so it is important to understand, at least in part, the role that they play in this modality. The Meridian System “is a distribution network for the fundamental substances of Qi (pronounced chee), blood and body fluids throughout the body”…pathways created my the meridian system “make up a comprehensive yet complex body map that supplies vital energy to every part of the body.” (http://www.shen-nong.com/eng/principles/whatmeridian.html). There are twelve different meridians in the body and each governs the function of our major organs. The list of meridians includes the lung, large intestine, spleen, stomach, heart, small intestine, kidney, bladder, heart constrictor (helps function of the heart related to circulation), triple heater (support function of the small intestine, controls visceral organs circulation energy to the entire body, support functions of the lymphatic system), liver, and gallbladder meridians (Mosby’s Fundamentals of Therapeutic Massage, p.479).
If you suffer from headaches or migraines, constipation, menstrual cramping, back pain during pregnancy, rheumatoid arthritis, get sick often or just have trouble relaxing, then this is the massage for you!
When it comes to massage therapy there is such a variety of different types of massage techniques that it can be difficult to choose the right style for the goal or goals you have for your health and wellness. I hope that my next few articles will help you find the right type of massage for you and inform you on the benefits of the multitude of massage techniques available.
Trigger Point Therapy is a popular massage technique that is used fairly often by many massage therapists. A trigger point is a small area in the muscle that has a level of hyperirritability. Once a trigger point is found, your massage therapist will use either or a combination of pressure technique, which is a form of direct pressure on the trigger point against an underlying hard structure or bone. Direct manipulation, which consist of a kneading motion that pushing the muscle together at it’s belly or most center point. Or muscle energy work, which causes the muscle to contract before lengthening with a series of stretching motions in order to release the trigger point.
So how will you know if trigger point therapy is right for you? Well this form of massage is a very useful technique in the treatment of myofascial problems. So if you or someone you know suffers from a chronic pain condition like fibromyalgia, arthritis and or are recovering from an injury or accident this therapy may be helpful. It can also be use in the treatment of tendonitis, bursitis, carpal tunnel syndrome and migraines (www.mamashealth.com/massage/trigger.asp).
As is common with most massage therapy methods additional training is required in order for a massage therapist to perform this technique efficiently. However it is not uncommon to encounter mild trigger point activity in general massage application.
I’ve been a Chiropractor for over 10 years now (time really flies when you’re having fun), and I’ve heard many things during consolations. Today, I’m going to share with you 2 of the fears that I hear. Perhaps you can identify with them.
Fear #1 – “I might be made worse.”
I completely understand this fear! Here you are feeling severe pain in your back. The pain makes life living hell – cant walk, sleep, even going to the bathroom is difficult! Each movement and each step are taken with guarded arms and muscles. I’ve been there, and it sucks.
Then a friend tells you that you need to go to their Chiropractor, because “he’s the best.” (it reminds me of a Jerry Sinfeild episode). Everyone’s Chiropractor is “the Best”. And you know what most are going to be just time to help you with your condition. But it only takes one off day for that Chiropractor and a few other variables that cause someone to feel worst after a treatment; especially if the typical treatment response for your condition is to feel worse after the first session.
Heck, I’ve had an experience where I’ve felt worse after the treatment, BUT I knew what to expect. Sometimes, the doctor fails to inform you as to what to expect to feel.
The biggest issue is when a patient see a chiropractor, and the chiropractor fails to properly evaluate the patient and misses the real problem. The chiropractor performs a treatment that should not have been done, and the patient gets worse. Herniated disc are a condition that needs to be treated with real care. Discs don’t like to be twisted.
This is why we go to such great lengths to get an accurate diagnosis through thorough history, examination, and often special studies. Then we sit down with a patient so they can know exactly what’s going on in our mind and what to expect. This is also why our technique for treating the spine is so specific and so safe (no twisting). Go here for more info on our technologies http://www.ranchochiropractor.com/technologies.
Lets face it, there are some bad chiropractors out there, like in any profession.
Fear # 2 – “I can’t stand the sound/idea of my bone being popped/cracked.”
The popping sound is something that people love or hate. The popping, or cavitation, is actually the formation of gas in joint capsules. It is NOT cracking bones. When a joint moves quickly the change in pressure can cause the cavitation to occur.
Here’s what you need to know!
Cracking does not mean correction!
That’s right, just because something popped, does not mean that the problem has been fixed. It just means that a joint moved enough to cause the popping. In fact, the correction of the joint does not even require caviation. Joints/bones can be gently corrected.
So if you have a significant fear of the popping sound…. Or if it just plan grosses you out… no problem! We just have to get you to a doctor that provides a technique the doesn’t pop you joints and that gets the job done.
In our office, we offer both – popping or no popping. Either way, we do it in a safe and comfortable way.
What to do?
These are 2 fears that I hear when patients are sitting with me during a consultation… in other words, they are hurting so bad they are willing to face their fear. Needless to say, they are quite relived when I tell them that their fear is greatly minimized by what and how we provide as care and the fact that we are pretty darn good Chiropractors too. Heck, take a moment and look at our testimonials.
If you are not in our area… be sure to do your homework and talk to your friends and family and as who they use. Go to those Chiropractors’ offices and ask them questions about the type of care they provide. Heck, after a tour of the office you may know in your gut – your instinct – whether your in the right place or not.
If so, great!
If not, get out of there fast and KEEP LOOKING!
That’s if for now,
Dr. Troy Don, DC QME
The word, “Ergonomics” is thrown around a lot when it comes to Carpal Tunnel Syndrome (CTS). The term ergonomics comes from the Greek ergon, meaning “work”, and nomos, meaning “natural laws.” By definition, ergonomics means, “…the study of efficiency in working environments.” Wikipedia describes it as, “…the study of designing equipment and devices that fit the human body, and its cognitive abilities.” The International Ergonomics Association offers this definition: “Ergonomics (or human factors) is the scientific discipline concerned with the understanding of interactions among humans and other elements of a system, and the profession that applies theory, principles, data and methods to design in order to optimize human well-being and overall system performance.”
The study of ergonomics is not new as it dates back to Ancient Greece with substantial evidence that, in the 5th century BC, ergonomic principles were applied to tool design, jobs and workplaces. Examples include Hippocrates giving surgeons recommendations on how to arrange their table and tools during surgery.
Some ergonomic concepts we can employ on a daily basis include:
- Take frequent breaks, every half-hour if possible, but at least every 60 to 90 minutes. Get up, stretch and walk around. If nothing else, perform stretches while sitting in your work chair.
- Maintain “good posture” (tuck in the chin and hold the retracted position).
- Evaluate your workstation: proper sitting position, how you hold the phone, keyboard/monitor positions, type & position of the mouse, reaching requirements, avoid twist/bending the wrists.
- When grasping/gripping, use the whole hand – not just the fingers or thumb tips alone.
- Keep cutting instruments sharp (scissors, knives, etc.) and maintain locks on hinged knives.
- Consider modifications if tools are too heavy, buttons too high, too much required force, etc.
- Stay in shape as obesity is a risk factor for carpal tunnel syndrome.
- Rotate job tasks rather than continuing with one task until finished (less repetition)!
- Communicate with your supervisor and HRO person about improving the workplace.
We realize you have a choice in who you consider for your health care provision and we sincerely appreciate your trust in choosing our service for those needs. If you, a friend or family member require care for CTS, we would be honored to render our services.
Troy Don, DC QME
Many of us have had sinus related headaches, right? You know, these are the headaches that hurt over the sinuses (above the eyes or in the cheek bones next to your nose) and, when you blow your nose, it’s not pretty! Sinus infections often lead to sinus headaches – wouldn’t you say that’s a true statement?
A recent November 2011 study begs to differ. Researchers took 58 patients with a diagnosis of “sinus headache” made by their primary care physician and asked them the following questions:
- Have you had a previous diagnosis of migraine or tension-type headache?
- Is their clinical evidence of a sinus infection during the past 6 months?
- Is there the presence of “mucopurulent secretions” (that’s the “not so pretty stuff” when we blow our nose)?
All 58 patients clearly seemed to have chronic sinusitis with an acute flair up and were given complete thorough examinations by a neurologist and an ears, nose, throat specialist (otolaryngologist) on a monthly basis for 6 months during treatment. The surprising results showed that final diagnosis in these 58 cases were 68%, 27% and 5% of the patients really had migraine, tension-type headache and chronic sinusitis with recurrent acute episodes, respectively. Treatment during the 6 months included antibiotic therapy in 73% of the patients with tension-type headache and 66% with migraine. Sinus endoscopy (taking a look up the sinuses with a scope – ouch!) was performed in 26% of the patients, and therapeutic nasal septoplasty (surgery!) was performed in 16% of the migraine patients and 13% of patients with tension-type headache (a pretty BIG mistake, wouldn’t you say?). The conclusion was that many patients with self-described or primary care physician diagnosed “sinus headaches” have no sinonasal abnormalities but instead, met the criteria for migraine or tension-type headache.
So, what does this mean? Well, for one thing, too many antibiotics are prescribed for tension-type or migraine headaches and have no place in the treatment process of these two common headache categories. Side effects of antibiotics include (but are not limited to): stomach and intestinal irritation, nausea, and if one is allergic to the antibiotic, a potentially life-threatening condition call anaphylactic shock. Let’s not forget to mention that sinus surgery was performed in 29% of the cases where the sinuses were NOT causing the headaches and we all know the risks of undergoing anesthesia and surgery can include death and infections, among other problems.
Chiropractic was reported to be a wise choice in the treatment of headaches by several publications, one of which provided a large review of the literature on the “Effectiveness of manual therapies: theUKevidence report,” released in 2010 (http://chiromt.com/content/18/1/3). In this report, both migraine and cervicogenic-type (headaches that start in the neck) headaches were found to have strong research support for manipulation or, chiropractic adjustments. In this day and age, you can be very confident that choosing chiropractic services for headache treatment is a wise, safe, and very cost-effective approach for a very disabling condition.
We realize that you have a choice in where you choose your healthcare services. If you, a friend or family member requires care for headaches, we sincerely appreciate the trust and confidence shown by choosing our services and look forward in serving you and your family presently and, in the future.
Dr. Troy Don, DC QME