THE ONE-TREATMENT WONDER: HOW MUCH RELIEF OF LONG-TERM CHRONIC PAIN IS IT POSSIBLE TO GET FROM A SINGLE TREATMENT?Read Now
RELIEF OF CHRONIC PAIN
CHRONIC NECK PAIN
CHRONIC LOW BACK PAIN
NECK PAIN, HEADACHES, VERTIGO
Be honest. How many chiros tell their average non-disc patient that they will know after a single treatment whether or not their approach to healing will be of benefit? That's how I work here. Vic's second treatment (yesterday) was almost three months to the day after his first back in March. No; I don't suggest that everyone is going to be completely "cured" after a single treatment, but if you are looking for fantastic results fast, with no gimmicks, games, or bait-and-switch sales pitches for long-term care, you might want to think about a visit to see us since we are centrally located and easy to find (HERE).
Sure, most people will require some additional help such as rehab type exercises and stretches as well as ADVICE ON WHAT IT TAKES TO REDUCE SYSTEMIC INFLAMMATION in their lives --- most of which can be done in the comfort of your own home. However, if you are hoping to get to the root of your chronic pain issue without addressing scar tissue, you may have a real dilemma on your hands. If you appreciate our site, be sure to like, share or follow on FACEBOOK as it's still a good way to reach the people you love and care about most.
POST-SURGICAL CHRONIC NECK PAIN
SOLVED IN A SINGLE VISIT!
That was the life Tiffany was living until she came to see us for Tissue Remodeling and adjustment (yes, I often manually adjust patients that have had SPINAL FUSION SURGERIES, although I do not adjust the fusion itself). DENSIFIED, THICKENED and ULTRA PAIN-SENSITIVE scar tissue (FASCIAL ADHESIONS of the CERVICAL FASCIA) related to her surgically-fused cervical vertebrae had restricted Tiffany's ability to function to negligible levels, leaving with the kind of pain you cannot understand unless you experience it yourself.
After falling on her butt while pulling a weed in her garden several years ago and hurting her tailbone, she eventually ended up in a specialist's office who did a CERVICAL MRI and told her that without neck surgery she would likely end up paralyzed. Mind you, Tiffany had no signs or symptoms of a neck problem and was there for the pain in her tailbone. As is frequently the case, fear was the tactic used to coerce her into having surgery. It was the typical "if you don't do this immediately you run the risk of (insert threat of choice here_____________)".
The surgery was a nightmare --- a nightmare that turned her life upside down, leading to more than forty (40) different medications (HERE) as well as pain management. One treatment at our clinic, however, made all the difference --- a common theme that I strive for with every patient (HERE). It's why people travel from around the world for treatment (HERE, HERE or HERE ---- in half an hour I will be treating a MUSICIAN from Canada).
Although my site has something like 300 COOL VIDEO TESTIMONIALS, this is undoubtedly one of the coolest. Thanks for the video Tiffany --- we wish you and your family the best! Oh; I almost forgot. If any of you know people struggling with chronic post-surgical pain (like THIS GUY or THIS GAL were) be sure and spread the word by liking, sharing, or following on FACEBOOK as it's still a good way to reach the people you love and value most with information that could positively impact their lives.
WHAT DOES THE LATEST RESEARCH ON NECK PAIN, HEADACHES, AND WHIPLASH REVEAL?
"Opioids appear to be over-prescribed." From last October's issue of Emergency Medicine Australasia (Use of and Attitudes to the Role of Medication for Acute Whiplash Injury: A Preliminary Survey of Emergency Department Doctors)
"The truth is that, among all diseases, headache is one of the hardest to diagnose and treat. It is, in fact a functional central nervous system disorder and no specific markers or organic alterations occur, except when headache is a symptom of another illness. Moreover, after trying several medical, paramedical, or all-but-medical approaches, most patients continue to suffer from their headache and, being often dissatisfied with the responses obtained, they try self-treatments and thus become pain-killer abusers.... This is even more true if we consider that while headaches can, indeed, be described, their description is hardly objective, and they therefore fall within the domain of subjectivity. The subjectivism of this pathology never fails to strike me. Patients describe their symptoms, but physicians can never verify them directly." CHERRY PICKED words from Dr. Gennaro Bussone a 'headache neurologist,' from this month's issue of Neurological Sciences (Clinical Issues of Headaches: A Personal View)
"Medication-overuse headache (MOH) is a common neurologic disorder with enormous disability and suffering and plays a significant role in the transformation from episodic to chronic headache disorders. Multiple terms have been used to describe MOH such as analgesic rebound headache, drug-induced headache or a medication-misuse headache. Patients with established primary headache disorders like migraine or tension-type headaches excessively overuse medication for their acute headache and inadvertently increase the frequency and intensity of their headache. In this manner, a vicious cycle of further drug consumption and increased headache frequency develops transforming the treatment for their headache to the actual cause of their disease (MOH)." From this month's issue of STAT Pearls (Medication-overuse Headache (MOH)
With costs for managing CHRONIC PAIN (including headaches) continuing to soar on a parallel path with the 'we-just-can't-seem-to-get-a-handle-on-it' OPIOID CRISIS, what else can be done? To help answer that, today we are going to take a look at some of the latest research concerning CHRONIC HEADACHES, CHRONIC NECK PAIN, and WHIPLASH --- all of which are intimately related to the cervical spine.
In a study showing the power of PROPRIOCEPTION, this month's issue of Musculoskeletal Science & Practice (Gait Speed and Gait Asymmetry in Individuals with Chronic Idiopathic Neck Pain) revealed that, "Individuals with chronic idiopathic neck pain had slower gait speed in all walking conditions compared to controls. In preferred walking and walking at maximum speed conditions, gait was found to be asymmetric in individuals with chronic idiopathic neck pain." In other words, the neck cannot be separated from the rest of the body musculoskeletally. It's all one organism, connected by the nervous system (HERE) and fascia (HERE).
As you might guess, there are increasing numbers of studies linking headaches to both stress (SYMPATHETIC DOMINANCE) and Gut dysfunction. While a dysfunctional gut can take on many characteristics, they can essentially be broken down into two; THE LEAKY GUT and THE DYSBIOTIC GUT. Listen to next month's issue of Behavioral Pharmacology (Stress and the Gut Microbiota-Brain Axis). "Stress is a nonspecific response of the body to any demand imposed upon it, disrupting the body homoeostasis and manifested with symptoms such as anxiety, depression or even headache." It's why I've said repeatedly that if you want to restore HOMEOSTASIS, it all starts with GUT HEALTH, which usually takes us back to DIETARY FACTORS and ANTIBIOTIC USE / ABUSE (remember, however, that all drugs have gut-destroying antibiotic-like properties --- HERE).
Speaking of dietary factors; when I have patients with chronic headaches, one of the things I usually suggest trying first --- especially for the person who has seemingly tried 'everything' --- is an ELIMINATION DIET. This lets us see whether or not certain foods might be driving the underlying inflammation / immune system responses, which are frequent drivers of headaches. I've spoken in the past about a brain-destroying "PARKINSON'S-LIKE" phenomenon that ravages the lower brain (cerebellum) called CEREBELLAR ATAXIA. A study from this month's issue of the Journal of Oral & Facial Pain and Headache (Headache in Patients with Celiac Disease and Its Response to the Gluten-Free Diet) not only revealed that 6 of 10 CELIACS had abnormal cerebellar MRI's, but that 42% had chronic headaches related to consuming GLUTEN. The only way to avoid the "white matter lesions" of the brain that these authors talked about? The GLUTEN-FREE diet of course. Just be aware that Non-Celiac Gluten Sensitivity (NCGS) is multiple times more common and can be equally as severe as Celiac Disease, although it's not nearly as easy to test for using standard lab / blood tests.
Another study, this one from the same issue of the same journal (Headache in Patients with Celiac Disease and Its Response to the Gluten-Free Diet) looked at over 1,500 Celiacs with chronic headaches, describing them as mostly female (94%) with an average age of nearly 40.....
"Tension-type headache was the most prevalent headache type (52%), followed by migraine (48%). Of the included participants, 24% reported headache as the main symptom that resulted in the diagnosis of CD. Following initiation of a gluten-free diet, headache frequency and intensity improved significantly more in participants with migraine than tension-type headache. Compliance to the diet was higher among subjects with severe manifestations, and compliant individuals showed a 48% improvement in headache frequency. An association between food transgressions and headache was better recognized by migraineurs."
What this tells me is that not only are headaches a common sequalae of Celiac Disease, but that with Celiacs struggling with tension-type headaches there are more likely to be secondary factors at play --- probably mechanical factors like SUBLUXATION or ADHESED FASCIA. While these can and do play a frequent role in MIGRAINE HEADACHES, they are far more common in the tension headache sufferer. Another study --- this one from the current issue of Pain and Therapy (The Relationship Between Musculoskeletal Pain and Picky Eating: The Role of Negative Self-Labeling) showed that of the more than 4,600 adults looked at, "The prevalence of musculoskeletal pain in every region was seen as consistently higher in subjects who self-identified as picky eaters than those who were non-picky eaters." The number one painful association of picky eating was ---- neck pain.
The latest copy of the journal Pain Medicine (Ingrowth of Nociceptive Receptors into Diseased Cervical Intervertebral Disc Is Associated with Discogenic Neck Pain) described a model almost identical to what you see on my CHRONIC PAIN PAGE, although their model was used to describe deteriorating spinal discs in the neck. There is a buildup or ingrowth of inflammation-sensitive fibers into degenerating discs and soft tissues that can make them absurdly pain-sensitive (FAMED NEUROLOGIST, CHAN GUNN, described this phenomenon as causing a neuro-chemical reactivity that could potentially make these tissues over 1,000 times more pain-sensitive than normal). BTW, this testing was done via biopsy instead of MRI. What about MRI findings for these sorts of patients?
I've previously shown you how futile MRI can be in many --- maybe even the majority --- of lumbar disc cases. This is because study after study has shown that somewhere between half to three quarters of the adult population is walking around with MRI-visible disc herniations in their low backs, but have no idea because they do not hurt (HERE --- and the same thing is true of SHOULDERS AS WELL). Now we see that it's also true of necks. A study from January's issue of the Journal of Magnetic Resonance Imaging (Cervical Spine Findings on MRI in People with Neck Pain Compared with Pain-Free Controls: A Systematic Review and Meta-Analysis) looked at the findings of over 4,000 subjects from 32 studies, coming to these conclusions. Other than the fact that the cross-sectional area of a specific muscle --- rectus capitus posterior --- was smaller in people with chronic pain, "The remaining meta-analysis comparisons showed no group differences in MRI findings. Definitive conclusions cannot be drawn on the presence of MRI findings in individuals with whiplash-associated disorders or non-specific neck pain compared with pain-free controls."
When it comes to chronic whiplash-related neck pain, what are the chief factors that indicate that a poor outcome might be on the horizon? Next month's issue of the Clinical Journal of Pain (Precollision Medical Diagnoses Predict Chronic Neck Pain Following Acute Whiplash Trauma) answered that question after comparing 700 WHIPLASH PATIENTS to 3,600 controls. While I expected to see patients with a list of either AUTOIMMUNE or INFLAMMATORY diseases, what we saw instead was...
- People with "pre-collision pain".
- People with "medically unexplained physical symptoms" (MUPS --- many specialists say MUPS is the single biggest medical problem facing modern America).
- People with a "low threshold for contacting health care services" (people who live at the doctor).
As far as treatment of neck pain and headache, whether caused by whiplash or not, numerous studies showed exercise and stretching programs to generally be at least somewhat effective, but not as much so as you would think. The same thing was true of massage, with a study from eight authors found in this month's issue of the Journal of Alternative and Complementary Medicine (Massage for Pain: An Evidence Map). After looking at 49 systemic reviews on the subject, the authors determined that "High quality reviews concluded that there was low strength of evidence of potential benefits of massage for labor, shoulder, neck, low back, cancer, arthritis, postoperative, delayed onset muscle soreness, and musculoskeletal pain." Does this tell us that massage doesn't work? Because the vast majority of those utilizing massage pay out-of-pocket for these services --- something they would not continue if it didn't work --- I would argue that there is something inherently wrong with the study; something I've been hollering about in my EVIDENCE-BASED MEDICINE COLUMN for a decade. BTW, the exact same thing has been said of both chiropractic and physical therapy, which I'll show you momentarily.
Speaking of the combination of adjustments and therapy, a study from last month's Journal of Physical Therapy Science (The Effect of Massage Technique plus Thoracic Manipulation versus Thoracic Manipulation on Pain and Neural Tension in Mechanical Neck Pain: A Randomized Controlled Trial) showed that even though "The exact pathology of mechanical neck pain has not yet been fully elucidated but it has been suggested that it relates to various pain-sensitive structures, including the muscles, ligaments, zygapophyseal joints, uncovertebral joints, intervertebral discs, and neural tissue, a significant reduction in resting neck pain was seen in the thoracic manipulation plus massage group, compared to that achieved using thoracic manipulation alone. The use of thoracic manipulation and massage is recommended to reduce resting neck pain and increase pain-free neural tissue extensibility." While it's certainly not massage, I could say the same thing about the TISSUE REMODELING we do in-house.
A French study from this month's issue of Frontiers in Psychiatry (Bright Light as a Personalized Precision Treatment of Mood Disorders) cemented some non-mainstream facts that I wrote about in my recent articles, OBESITY, LIGHT, LEPTIN RESISTANCE, AND THE BRILLIANT MADNESS OF JACK KRUSE and THE IMPORTANCE OF SUNSHINE BEYOND VITAMIN D. After mentioning headaches as a potential "transient, mild and rare" side effect, the authors revealed of bright light therapy.....
"Bright light therapy (BLT) has physiological effects by resynchronizing the biological clock (circadian system), enhancing alertness, increasing sleep pressure (homeostatasis), and acting on serotonin and other pathways. A growing body of evidence has been generated over the last decade about BLT evolving as an effective depression treatment not only to be used in seasonal affective disorder (SAD), but also in non-seasonal depression, with efficiency comparable to fluoxetine [Prozac], and possibly more robust in patients with bipolar disorders (BD). The antidepressant action of BLT is fast (within 1-week) and safe, with the need in BD to protect against manic switch with mood stabilizers."
I brought this up because the latest issue of Current Treatment Options in Neurology (Antidepressants for Preventive Treatment of Migraine) talked about using, just as the title stated, antidepressants, as a "preventative" for MIGRAINE HEADACHES. The authors prefaced this by revealing that (whisper whisper), "SSRIs including fluoxetine [Prozac] are not effective for most patients..." If not using ultra-common SSRI's, what are they using? SNRI's like amitriptyline / nortriptyline (Elavil / Pamelor and Aventyl) --- drugs with common nasty side effects). The authors prefaced their giddiness by letting readers know that "The side effect burden of antidepressants can be substantial. Patients should be particularly counseled about the possibility of a withdrawal effect from SNRIs." Remember that we've seen just how ineffective these drugs really are for solving depression (HERE) as well as their SEXUAL SIDE-EFFECTS. You need to be aware of this (HERE) because "Antidepressants are commonly used as migraine preventives."
But what happens when the medications, as is often the case, don't work? Worse yet, what if your medications were actually causing the very problem you were using them to solve (a common problem with depression --- HERE)? Although side-effects to all drugs are orders of magnitude greater than typically reported (HERE), when it comes to headaches, this particular phenomenon is so common that it has its own special name ---- medication overuse headaches or simply "rebound". How common are rebound headaches? Just days ago, Neurological Science (Epidemiology and Management of Medication-Overuse Headache in the General Population) answered that question by revealing that "Medication-overuse headache is a worldwide challenge as it affects 1-2% of the general population." What do these numbers tell us? 160 million people worldwide --- a number equivalent to about half the US population --- are dealing with rebound headaches. It also means that in my little town of 3,000 people, there are probably 60 people stuck in this vicious cycle.
A title of a study from this month's issue of Nature Reviews Neurology (Complete Withdrawal More Feasible and Effective than Restriction in Medication-Overuse Headache) said it all via it's title --- describing very same thing I promote for breaking sugar addictions (COLD TURKEY). A study from this month's issue of Frontiers in Neurology (Negative Short-Term Outcome of Detoxification Therapy in Chronic Migraine With Medication Overuse Headache: Role for Early Life Traumatic Experiences and Recent Stressful Events) tried to predict which people would succeed with a headache medicine "DETOX PROGRAM" and which would fail.
"Among the most popular and disabling neurological disorders, migraine is at the top of the list. In most sufferers, attacks recur episodically, even if in a small—but significant—portion of migraineurs the disease evolves into a chronic pattern, that is, chronic migraine (CM). Transition from episodic to CM often occurs in association with a progressive increase in the intake of acute medications, so that the large majority of patients with CM also fulfill criteria for Medication Overuse Headache (MOH). Data suggest that early life traumas and stressful events have a negative impact on the outcome of the detoxification program in subjects overusing acute medication for headache. The history of emotional childhood traumas is associated to the failure to cease overuse, whereas recent very serious life events are associated to the persistence of headache chronicity."
Last month's issue of Frontiers in Neurology (Features of Primary Chronic Headache in Children and Adolescents) stated, "Chronic migraine (CM), chronic tension-type headache (CTTH) and new daily persistent headache (NDPH) are classified as CPH. Chronic primary headaches (CPH) are a disabling disorder for children, adolescents, and adults, with a reported prevalence of 2% in adults and .78% in adolescents, while the prevalence rises up to 1.75% when including medication overuse headaches." Another study, this one from the February copy of Cephalgia (The Prevalence of Headache in German Pupils...) provided more detail of just how common and severe headaches are in the pediatric (under 18) population. So; what about treating children with headaches similar to adults with headaches as far as manual therapy is concerned?
This month's issue of BMC Complementary and Alternative Medicine asked the same question of manual therapy for children that they did pertaining children and massage we looked at earlier. After looking at 50 studies on using manual treatment to affect a wide variety of problems, including back pain, neck pain, and headaches, the authors concluded that "Moderate-positive overall assessment was found for 3 conditions: low back pain, pulled elbow, and premature infants. Unfavorable outcomes were found for 2 conditions: scoliosis and torticollis. All other condition's overall assessments were either inconclusive favorable or unclear. Adverse events were uncommonly reported." In other words, sometimes it works and sometimes it doesn't. The super cool thing, however, is the extremely low side effect profile --- an especially big deal after what we've read about the freaky side effect profiles of some of the most commonly used headache and neck pain medications.
"Classical Conditioning" was a phrase coined by Russian physiologist, Ivan Pavlov, back in the late 1800's. In his famous dog experiments he associated feeding time for his dogs with ringing a bell, discovering that even in the absence of food, tinkling his bell would cause the hounds to salivate profusely. Simply Psychology said this of the phenomenon as a form of treatment. "For classical conditioning to be effective, the conditioned stimulus should occur before the unconditioned stimulus, rather than after it, or during the same time. Thus, the conditioned stimulus acts as a type of signal or cue for the unconditioned stimulus." Why is "before" such a big deal when compared to "during or after" --- especially when it comes to headaches? This month's issue of Current Headache Reports (Pavlov’s Pain: The Effect of Classical Conditioning on Pain Perception and its Clinical Implications) explains....
"It has been known for decades that classical conditioning influences pain perception. We first review studies regarding how classical conditioning alters pain perception with an emphasis on two phenomena where conditioning increases pain sensitivity (i.e., conditioned hyperalgesia) or decreases it (i.e., conditioned hypoalgesia). Specifically, we critically examine empirical studies about conditioned hyperalgesia and conditioned hypoalgesia, explore reasons why conditioning leads to these two seemingly opposite phenomena, and discuss the neural mechanisms behind them. We then highlight how conditioning contributes to the development and maintenance of chronic pain, and present neuroscientific evidence for maladaptive aversive conditioning in chronic pain patients. Moreover, we propose a framework for understanding how to exploit conditioning to optimize pain treatment, including minimizing conditioned hyperalgesia, maximizing conditioned hypoalgesia, and eliminating excessive fear and overgeneralization in chronic pain."
I was not going to pay $40 to look at the whole study, but suffice it to say that "conditioning" may be driving your headaches and pain as opposed to being used as a tool against. What are some of the things that we know can adversely condition people's pain levels beyond stress and inflammatory diets? Our national addiction to media (social media, porn, cell phones, computers, TV, etc, etc) has been in the news lately and is proving to be a HUGE PROBLEM in this arena, most particularly for children. It's why I talk on my site so much about getting your mind right. After all, one of King Solomon's proverbs (23:7) tells us that "as a man thinketh in his heart, so is he."
To see our complete (nothing is ever really "complete") ANTI-INFLAMMATION / RESOLUTION PROTOCOL for getting out of pain and starting the process of taking your life back, just click the link. While not everything there will pertain to everyone, there are some great tidbits to be gleaned and digested. And if you appreciate our site, be sure and spread the wealth by liking, sharing, or following on FACEBOOK as it's still a nice way to reach the people you love and value most!
COLORADO CHRONIC NECK PAIN RELIEF
IN MOUNTAIN VIEW, MISSOURI
Due to extraneous circumstances I worked through part of my lunch hour AND AS IS OFTEN THE CASE; the RANGE OF MOTION of her neck literally went from zero (no exaggeration; her neck was like a Kansas HEDGE POST) to virtually normal. Exciting stuff. She left here totally pumped, and this part of the unsolicited email I received yesterday morning.
Hi Dr. Schierling,
First of all, thank you so much for fitting me in March 6th, even though I was late for my appointment after having been on the road for over 24 hours straight.
I just wanted to let you know that for the first time in YEARS...I had a major decease in pain and a major increase in ROM. My neck/upper back pain is usually around a 8/9, and after just one scar tissue treatment and the initial soreness of that....my pain dropped to a 4/5 or less. I have had TOS and neck/back pain for 12 years, and this was the first treatment I've had that has made such an impact on my pain levels, despite years of physical therapy, doctors, specialists, etc, etc. While I did not notice much of a decrease in my TOS symptoms, there was still a very slight relief overall, maybe because my muscles were less tense.
Kim from Colorado
Wow Kim, that's certainly cool! I would tell my average patient to make sure to deal with systemic inflammation since it is such a huge cause of scar tissue (HERE), but Kim has been doing that for years. I wish you well Kimberly, and if you are ever back this way, look me up. If any of you reading this appreciate our site or know someone in a similar situation, be sure to tell others and spread the word to those you love and value most. Liking, sharing or following on FACEBOOK is still an excellent way to accomplish this.
FOUR-PLUS DECADES OF WHIPLASH PAIN SOLVED IN A SINGLE VISIT -- FIVE YEARS AGO
I saw her yesterday and to say she was excited was possibly as big an understatement as her telling me that for much of her life she was "surrounded by testosterone" (she has six sons and no daughters). Just like I have seen hundreds of times before; despite the fact that her hips are quite degenerative and may (emphasis on may) someday need to be replaced, the dietary changes she's made have already REDUCED HER SYSTEMIC INFLAMMATION to a crawl. In other words, she's feeling great (and can immediately tell the difference if she cheats).
Although tissue remodeling was not able to help her with her hips (I had doubts from the beginning), she reminded me of something I had forgotten about ---- the treatment I did on her neck and upper back. Carolyn had been in a WHIPLASH ACCIDENT when she was 18 years old, and had dealt with periods of CHRONIC NECK PAIN ever since, getting much worse once she hit her early thirties. And while chiropractic adjustments were the one thing she could count on to make a positive difference, the pain and HEADACHES always came back in the same place and the same way --- an EXCEEDINGLY COMMON PHENOMENON (or HERE). The video below was shot yesterday regarding the treatment I did about four and a half years ago (Sept of 2014).
For the record, a quick look at our VIDEO TESTIMONIALS (including THIS CRAZY POST ON CHRONIC NECK PAIN) shows that immediate long-term improvements, while certainly not a guarantee, are fairly common in my clinic. Very cool video Carolyn; Thanks and God bless!
ADOLESCENT HAS CHRONIC NECK PAIN & HEADACHES FROM FALLING OUT OF A BARN LOFT ONTO HIS FACE...
SOLVED IN ONE TREATMENT!
If you look at the barn above, you'll see the large opening just under the peak of the roof. Back in the days before electricity, tractors, and gasoline engines, old barns had a system of pulleys and tracks (LIKE THIS) for the express purpose of getting hay into the loft (I actually have several of the huge wooden block & tackle pulleys from two of my Grandpa's huge old barns. Anyway, Tyler was on his knees at the edge and accidentally fell out of the loft. He fell forward and landed on his face with so much force that as his spine went into extreme HYPER-EXTENSION, the back of his knees came over and hit him in the back of his head (there were two witnesses). Although he was knocked cold for a moment, he came to, jumped up and began running, probably due to shock.
After a trip to the ER where he was x-rayed and scanned (and had his mouth stitched up), he was sent home. As many of you reading this have experienced yourselves, he and his parents were told that since there were no broken bones, he'd be fine. He wasn't fine. Tyler began having NECK PAIN & HEADACHES, and by the time I saw him two years later, the range of motion in his cervical spine was less than 50%.
After examining him, I tried an adjustment, getting little or no movement --- something not common for someone his age (he was far too TETHERED to adjust properly). Realizing (as I originally suspected) that due to the trauma, Tyler had developed a significant amount of SCAR TISSUE in the FASCIA of his neck, I did tissue remodeling on his neck and upper back, breaking up the FASCIAL ADHESIONS. Not only did this immediately resolve his neck pain and headaches, it completely restored his neck's ROM back to normal. Considering the time that's elapsed since I've seen him (four years), he's done remarkably well, maintaining all ranges of motion, with no return of the headaches or neck pain. Pretty cool stuff. I say this with all humility, but results like this are not uncommon in our clinic (HERE or HERE).
If you are one of the 100 million Americans struggling with some sort of CHRONIC PAIN ISSUE, I might be part of your solution. Although I see my local patients on Monday, Wednesday and Friday, Tuesday and Thursday mornings are reserved for OUT-OF-STATE & INTERNATIONAL PATIENTS --- just send me a history of your problem using my CONTACT PAGE and I will tell you whether or not I think I can help. For many of you, the solution could be as simple as making some inflammation-reducing lifestyle changes (HERE). Either way, I'm on your side and will do whatever I can do to help get your problem solved as quickly and inexpensively as possible.
WHAT'S NEW IN THE FIELD OF WHIPLASH,
CHRONIC NECK PAIN, AND CHRONIC HEADACHES?
"Approximately 50% of patients with WAD (whiplash-associated disorders) have long-term symptoms after their injury, and a large proportion are reported to have poor quality of life. Additionally, 13–50% are unable to work or participate fully in their daily activities. Changes in self-image were difficult to cope with and likely led to perceived stigmatization. Struggling with feelings of loss of control appeared to lead to low confidence and insecurity. The participants talked about pain and other symptoms interfering with their lives and about the loss of hope, ability, social roles, autonomy, and spontaneity. The participants also noted that it was difficult to continue exercising even though they believed exercise was beneficial. The participants believed that they had lost the physical capacity they had before the injury, and they felt sad and helpless about all physical, psychological, and social losses that were consequences of WAD. The participants struggled with their confidence in their ability to control their pain and daily life. Low perceived control appeared to lead to low confidence and insecurity regarding the ability to manage injury-related problems and the future. The perceived severity, manageability, and realistic expectations of symptom development also influenced the participants’ feelings of control. Severe symptoms were difficult to tolerate and manage and decreased the participants’ beliefs and confidence regarding their ability to control the situation. The participants did not always know what worsened pain and other WAD-related symptoms. The participants tried to determine how to control their situation but did not often succeed. Returning to work was perceived as a challenging outcome. The combination of expectations regarding recovery and daily experiences of fluctuating symptoms decreased the participants’ confidence concerning the future and their return to work."
Thus, it's not too surprising that the same study went on to use these words / terms when describing the effect that chronic whiplash symptoms have on people.
"Loss of ability, loss of confidence, loss of freedom, loss of hope, slavery [to pain] abandoned by those around, loss of social roles, frustration, fear, distress, sadness, worry, negative moods, stigma, chaos, mystery, a riddle needing answers, incongruities, unsure about future, changed self-image, struggling with control....."
Unless you deal with these types of patients on a day-to-day basis, it doesn't make sense. It seems overblown. Over-the-top. Exaggerated. Pretentious hyperbole. Not only is it not an elaboration, the above quotes should help one understand a concept commonly seen in those injured by whiplash --- something known as "catastrophizing".
Catastrophizing is the belief that something, one's pain, the ability to function, or possibly even the future, is or may be much worse or bleaker than it actually is or will be. Also known as "cognitive distortion," Wikipedia describes it as "exaggerated or irrational thought patterns involved in the onset and perpetuation of psychopathological states, especially in those more influenced by psychosocial factors, such as depression and anxiety." All the more important to understand once you realize how often DEPRESSION and ANXIETY plague whiplash sufferers. Allow me to show you just how real this phenomenon of catastrophizing really is in many trying to cope with chronic neck pain.
Lat month's issue of Somatosensory & Motor Research (Observing Neck Movements Evokes an Excitatory Response in the Sympathetic Nervous System Associated with Fear of Movement in Patients with Chronic Neck Pain) showed that for someone with serious neck pain related to movement, just looking at neck movements (pics or video) can invoke a fear-based response of the SYMPATHETIC NERVOUS SYSTEM (fight or flight).
"The objective of this study was to evaluate the response of the sympathetic-excitatory nervous system in patients with chronic neck pain compared with a control group of asymptomatic subjects who underwent an intervention of watching activities involving movements in the neck region. The ANOVA test revealed significant differences in the increase in skin conductance in the chronic neck pain group after observing the activities (both in the photographs and video) at the end of the observation and 5 minutes after the intervention. Ultimately, the correlation analysis revealed a moderate positive correlation between kinesiophobia [fear of movement] and skin conductance at 30 seconds and at 60 seconds of observing the activities in the video for the chronic neck pain group. Based on the results of the present study, we suggest that observing activities involving neck movements causes an activation of the sympathetic-excitatory nervous system in patients with chronic neck pain. These changes could be related to a fear of movement when faced with visual exposure to neck movements that could be interpreted as 'harmful' or 'dangerous'."
Although some may balk at using the term PTSD (post-traumatic stress disorder) to describe whiplash sufferers, whiplash and MVA (motor vehicle accidents) have been widely recognized as a common cause for decades. Less than a month ago, the European Journal of Pain (Trajectories of Post-Traumatic Stress Symptoms After Whiplash) came to some shocking conclusions. The Danish research team looked at PTSD 'predictors' ("pain, fear-avoidance-beliefs, pain-catastrophizing, depression......") and determined that although most people (75%) involved in a whiplash accident showed little or no signs of PTSD, 25% did. Of that 25%, about 40% recovered fully from the PTSD within six months.
However, the rest of the rest (60%) were labeled "chronic," and were described as having, "high initial PTSD symptom levels and a small increase over time. Initial higher pain and depression levels predicted the recovering and chronic trajectories. The chronic trajectory suggested that a significant subset of people does not recover from PTSD symptoms. This class also reported more pain-related disability." In other words, about 15 out of 100 who had at least a degree of PTSD got worse. 15% may not seem like a big number until you start grasping that there are several million such injuries each year.
What's regrettable about this situation is how these individuals are dealt with by the largest portion of the medical community. Even though whiplash research abounds, the chief forms of medical treatment have remained the same as they were since long before I was in practice (I graduated in 1991). In fact, things may have gotten worse. Case in point, a study from last month's issue of Emergency Medicine Australasia (Use of and Attitudes to the Role of Medication for Acute Whiplash Injury: A Preliminary Survey of Emergency Department Doctors) looked at the most commonly prescribed drugs for WAD in an ER setting (NSAIDS --- 78% of the time, PARACETAMOL, what the rest of the world calls acetaminophen --- 75% of the time, OPIOIDS --- 44% of the time, and benzos --- 11% of the time). The authors also concluded that "most [ER docs] were comfortable to prescribe pregabalin" and that "opioids appear to be over-prescribed". For the record, pregabalin (LYRICA) is a terrible drug for most people (HERE). Bottom line, far too many people end up on "THE BIG FIVE" or worse after an MVA.
Although there are an almost unlimited number of ways that people end up being "WHIPLASHED," MVA (motor vehicle accidents) are far and away the most common. Although there are many potential tissue culprits as far as the source(s) of said pain, the CERVICAL FASCIA is arguably one of the most common causes --- particularly when it comes to CHRONIC NECK PAIN. The only reason I use the word 'arguably' is because since the CF does not show up on standard advanced imaging such as MRI (HERE), it's completely off the radar of the average physician. It's a large part of what makes fascia chronic pain's PERFECT STORM. And although the authors were talking about TRIGGER POINTS as opposed to the flip side of the myofascial syndrome (SCAR TISSUE / FIBROSIS), listen to what the National Fibromyalgia & Chronic Pain Association (Cervical Myofascial Pain) said about this phenomenon -- a phenomenon you will see as a common theme in today's post. "The diagnosis of this syndrome is clinical, with no confirmatory imaging or laboratory tests available."
Although the pictures below do not show much fascia (aside from the GALENA APONEUROTICA --- the fascia on top of the skull), don't forget that it's there. The large arrow in the middle of the page is where the external occipital protuberance (EOP) is, which happens to be the center of the occipital ridge (see arrows on all three pictures). As you can see, a number of large muscles anchor to this ridge, and thanks to Wolf's Law (bone grows in response to mechanical stress, whether that stress is normal or abnormal), you can feel these attachment points --- particularly if you have been living with extensive amounts of mechanical stress (excessive pulling) in your neck region (FHP is one of the more common of these). Just how big is this problem of Forward Head Posture (perpetual cervical flexion)?
The August issue of the Journal of Electromyography and Kinesiology described this relationship between PROPRIOCEPTION AND FASCIA and other connective tissues in a study titled Disturbance of Neck Proprioception and Feed-Forward Motor Control Following Static Neck Flexion in Healthy Young Adults. To understand how big a deal this study really is, it's important to grasp the fact that CERVICAL EXTENSION (the opposite of cervical flexion, which describes one's ability to tip one's head backwards, hopefully to the point that the forehead is parallel to the floor) is arguably the most important range of motion in the body.
"The highly complex proprioceptive system provides neuromuscular control of the mobile cervical spine. Static neck flexion can induce the elongation of posterior tissues and altered sensory input from the mechanoreceptors.... Following flexion, the absolute and variable errors in head repositioning significantly increased. The results also showed that there was a significant delay in the onset of myoelectric activity of the cervical erector spinae muscles after flexion. The results of this study suggested that a 10-min static flexion can lead to changes in the neck proprioception and feed-forward control due to mechanical and neuromuscular changes in the viscoelastic cervical spine structures. These changes in sensory-motor control may be a risk factor for neck pain and injury."
And if you already have pain and injury, there is great potential to form a vicious cycle of pain, dysfunction (including abnormal proprioception), and the subsequent degeneration that always follows close on their heels.
RESEARCH CONCERNING NECK,
WHIPLASH, AND HEADACHE SYMPTOMS
As I've shown you in the past, the endproduct of inflammation is always fibrosis (HERE). While a certain amount of this is a good thing (LOCAL INFLAMMATION is critical for healing injured connective tissues), too much inflammation (SYSTEMIC INFLAMMATION) coursing through your body is not only detrimental but highly detrimental. This is why those of you struggling with situations like these or others (UPPER CROSSED SYNDROME, LOWER CROSSED SYNDROME, etc, etc) must get your act together as far as what you are eating, how you are living, as well as the chemicals you are exposing yourself to on a day-by-day basis. Before we delve more into the specific issue of what it might take to get you on the road to recovery, let's take a few moments to look at the latest research on all things neck pain.
When you see the term "Cervicogenic Headache," know that it refers to headaches that are being generated by abnormal structure or function of the cervical spine (chiros refer to this dysfunctional alignment and motion as "SUBLUXATION"). I bring this up because authors of an article from a June issue of the medical educational journal, StatPearls, wrote of the relationship between the nerves in the top of the neck and headaches. "A cervicogenic headache is thought to be referred pain arising from irritation caused by cervical structures innervated by spinal nerves C1, C2, and C3; therefore, any structure innervated by the C1–C3 spinal nerves could be the source for a cervicogenic headache. It is predominant in females. Pain can mimic primary headache syndromes such as tension headache or migraine headache."
Best way to solve this issue? "Manipulative therapy and therapeutic exercise regimen are effective in treating a cervicogenic headache. .....72% of patients had achieved a reduction of 50% or more in headache frequency at the 12-month follow-up, and 42% of patients reported 80% or higher relief of some sort." Hang on because I will shortly address a common reason that adjustments don't work (or don't hold very long) for a significant portion of the population.
For the record, this study also stated that "the source of the pain must be in the neck and perceived in the head or face." If you have followed my site you are already aware that I have written extensively about both SKULL PAIN and FACE PAIN. What I have found with face pain is that it's more frequently solvable when it can be tied to a specific trauma. A recent study from Neuroimage Clinical helps spell out the reason for this --- the pain can come from BRAIN ABNORMALITIES.
"Chronic orofacial pain (COFP) disorders are prevalent and debilitating pain conditions affecting the head, neck and face areas. Overall, these findings provide evidence of brain abnormalities in pain-related regions, namely the thalamus and insula, across different COFP disorders."
This is of particular interest once you realize how important the role of the thalamus is in chronic pain that originates in the brain itself as opposed to injured tissues, and is otherwise known as CENTRAL SENSITIZATION. Without going into detail, suffice it to say there are numerous studies linking CS to whiplash.
We've briefly discussed cervicogenic headache, but what about cervicogenic dizziness? A study from last month's issue of the European Archives of Otorhinolaryngology (Approach to Cervicogenic Dizziness: A Comprehensive Review of its Etiopathology and Management) stated that, "Though there is abundant literature on cervicogenic dizziness with at least half a dozen of review articles, the condition remains to be enigmatic for clinicians dealing with the dizzy patients." Would it make sense that if the source of the dizziness is the same or at least similar to the source of cervicogenic headaches, you might want to try treating it the same way? Although this and similar situations might call for the expertise of a FUNCTIONAL NEUROLOGIST, this is typically a great starting point, with the potential to help many in this category.
Because MIGRAINE HEADACHES and TEMPOROMANDIBULAR DISORDERS are so frequently seen after whiplash as well, the importance of a study titled Muscle Tenderness Score in Temporomandibular Disorders Patients: A Case-Control Study from this month's issue of the Journal of Oral Rehabilitation cannot be overlooked. Whiplash patients (again, mostly women) showed jaw muscle tenderness and trigger points that were associated with, "female sex, whiplash history, parafunction [poor or abnormal function], co-morbid pains such as headaches and body pain, pain intensity, onset, frequency, and duration." And as for migraines, a study from the September issue of Musculoskeletal Science and Practice (Cervical Musculoskeletal Dysfunction in Headache: How Should it be Defined?) debated whether neck pain is the result of headache, or headache is the result of neck pain. I would argue that the point is moot because the nerve pathways are largely a two way street, with one almost always being able to cause the other (notice below that this study --- by a team of Australian researchers --- gave us an amazing definition of 'subluxation,' actually mentioning the difference between SEGMENTAL AND SECTIONAL NECK MOTION).
"Neck pain commonly accompanies migraine and tension-type headache. Reliance on pain sensitivity or the presence of neck tenderness/trigger points as measures be discarded, as they are not uniquely tied to a musculoskeletal disorder. Instead, place reliance on tests of musculoskeletal (dys)function. A typical presentation includes at a fundamental level, interrelated changes in cervical movement, segmental joint and muscle function."
Another study, this one from Acta Neurologica Belgica (Neck Pain: Is it Part of a Migraine Attack or a Trigger Before a Migraine Attack?) pushed this issue even further when it stated, "Neck pain may actually be the most common migraine symptom despite the fact that it is rarely listed among usual symptoms such as nausea and light sensitivity." The authors, however, could not answer the question posited in the study's title because 90% of the participants said that they started at the same time. Before we head to the next section (treatment), I need to briefly mention a study on neck pain in athletes.
Lat month, the Asian Spine Journal published a systematic review of the scientific literature titled Prevalence of Neck Pain among Athletes that encompassed numerous studies on the subject. "Neck pain was shown to be prevalent in athletes, with a 1-week prevalence ranging from 8% to 45%, a 1-year prevalence ranging from 38% to 73%, and a lifetime prevalence of about 48%. The prevalence of neck pain in athletes is high." Although studies on prevalence of neck pain in the general population are all over the place, the statistics for athletes appear to be at least 10-20 percentage points higher.
RESEARCH CONCERNING NECK,
WHIPLASH, AND HEADACHE TREATMENT
A few months ago the journal Scientific Reports (Neck-Specific Exercise May Reduce Radiating Pain and Signs of Neurological Deficits in Chronic Whiplash) provided some sobering figures before telling us how bad nerve-related whiplash problems can be. "Up to 90% of people with neurological deficits following a whiplash injury do not recover and cervical muscle dysfunction is common." They concluded that neck-specific exercises are helpful in the recovery. Another study, this on from the journal Musculoskeletal Science and Practice (Relationship Between Neck Motion and Self-Reported Pain in Patients with Whiplash Associated Disorders During the Acute Phase), found that the level of neck pain a whiplash sufferer is dealing with can be mapped via "kinematic parameters of neck mobility tests, ranges of motion, motion velocities, repeatability and harmonicity of movements [proprioception]."
This summer the European Journal of Pain published a study titled Seeing the Site of Treatment Improves Habitual Pain but not Cervical Joint Position Sense Immediately after Manual Therapy in Chronic Neck Pain Patients, which concluded that it may actually be helpful for manual therapists to have a way of allowing their patient to visually see what they are doing. "Real-time visual feedback reduces habitual [chronic] pain immediately after the intervention." Just remember that this will tend to throw some people into a sympathetic response that we discussed earlier. In a study titled Comparison of Ozone and Lidocaine Injection Efficacy vs Dry Needling in Myofascial Pain Syndrome Patients, researchers did exactly what the title suggests; observing 72 patients to determine that all injections were about the same efficacy --- a characteristic of DRY NEEDLING that has proven that the action of the needle itself is far more important than the substance being injected through the needle. "No remarkable preference between them."
As far a cupping and acupressure go, there were studies on both. After looking at 18 studies on cupping, a group of nine Korean researchers publishing in this month's issue of BMJ Open (Is Cupping Therapy Effective in Patients with Neck Pain? A Systematic Review and Meta-Analysis) concluded that "Neck pain is a significant condition that is second only to depression as a cause of years lived with disability worldwide. Cupping was found to reduce neck pain in patients compared with no intervention or active control groups, or as an add-on treatment. Depending on the type of control group, cupping was also associated with significant improvement in terms of function and quality of life..." In another Korean study, this one from the September issue of Integrative Medicine Research (Clinical Effects of Acupressure on Neck Pain Syndrome (nakchim): A Systematic Review), the authors looked at the effects of acupressure on a type of non-traumatic neck pain syndrome not associated with trauma they refer to as nakchim. Their conclusions? After looking at 15 studies of over 1,000 subjects, the authors determined that "acupressure may be effective on nakchim."
What about chiropractic care? The West Coast's giant managed care organization (Kaiser Permanente), along with several major universities, published a study in a recent issue of the Journal of General Internal Medicine (Comparative Effectiveness of Usual Care With or Without Chiropractic Care in Patients with Recurrent Musculoskeletal Back and Neck Pain). Not surprisingly, the care for the chiropractic group cost about half that of usual medical care. "As clinical outcomes were similar, and the provision of chiropractic care did not increase costs, making chiropractic services available provided an additional viable option for patients who prefer this type of care, at no additional expense." It costs less, but was it as effective?
After saying that "Neck pain is prevalent, costly and disabling," a team of European researchers from several universities and facilities concluded that, "mobilisation participants reported significantly better global perceived effect and improvements in movement associated pain. Mobilisations produced a significant increase in ROM in side flexion and rotation when compared with placebo.... 29-47% of all movement associated pains were resolved following mobilisations and 11-27% following placebo. Patients in both groups showed a significant increase in movement velocity.... Cervical mobilisations are effective in improving movement-associated pain, increasing ROM and velocity, and patient perceived improvement when applied to patients with neck pain... Their use should be advocated."
In another study --- A collaboration between RAND and the UCLA School of Medicine (Group and Individual-level Change on Health-related Quality of Life in Chiropractic Patients with Chronic Low Back or Neck Pain) that was published in last month's copy of Spine --- the idea of trying to determine responders from non-responders was put forth. After doing interviews and evaluations ("physical function, pain, fatigue, sleep disturbance, social health, emotional distress and physical and mental health summary scores") with over 2,000 patients at 125 chiropractic clinics throughout the United Stated, the authors concluded that....
"Chiropractic care was associated with significant group-level improvement in health-related quality of life over time, especially in pain. But only a minority of the individuals in the sample got significantly better ("responders"). This study suggests some benefits of chiropractic on functioning and well-being of patients with low back pain or neck pain."
Let's talk about these "responders" for a moment and try and flesh out why someone might fall into this category, while the next person, with a seemingly identical situation and symptoms, might wind up labeled a non-responder. First, let me say that 30% of those surveyed showed significant improvement in their "Mental Health Summary Score" --- a big deal for a class of patients, that as I have shown you, struggle with the twin terrors of chronic pain and mental health issues (I have always suggested that chronic pain tends to lead to depression). As far as the "significant," but far from earth-shattering results of chiropractic adjustments on these sorts of patients, I have two thoughts on this, inflammation and scar tissue.
I have heard old timers (chiros) say that getting the average patient better used to be easier (HERE). Much of this has to do with the fact that today's average patient is inflamed beyond belief; here is a simple SELF TEST. Inflammation is not only at the root of virtually all our most common health-related problems (including most we would rather blame on "BAD GENES"), as I showed you earlier, it always leads to the fibrosis (I call it scar tissue) that is arguably the world's number one cause of death (HERE). When this microscopic, fibrotic, adhesed, scarring builds up in compromised connective tissues, the result is a "TETHERING EFFECT" that prevents normal ranges of motion, which thanks to loss of proprioception (see earlier link) perpetuates the cycle of degeneration (calcification, bone spurs, thinning joints and discs).
When it comes to chronic neck pain (as well as most other problems not related to a herniated disc), I run my clinic in much different fashion than the average chiropractor. Because of this different approach, I tell patients that they will know after a treatment whether or not I can help them. There is no trying to up-sell you on drawn out or expensive care plans. It's simple; you come in, I talk with you and examine you. If I think there is a good chance of being able to help you, we go from my office to a treatment room and I do my thing. While one treatment may certainly not be enough to do everything that needs to be done, THIS POST (not to mention my hundreds of TESTIMONIALS) shows what makes us different. And if you are interested in taking that extra step to deal with the chronic inflammation that's wreaking havoc on your life, you can READ THIS FREE POST in your spare time and see what you think.
My goal is to remove as many roadblocks to the healing process as possible, while empowering you to step up and do those things that unfortunately, no one else --- your doctors included --- can do for you. If you appreciate our site and would like to see more people reached with life-changing information, be sure to like, share or follow on FACEBOOK since it's one of the easiest possible ways to reach the people you love and care about most!
CHRONIC NECK PAIN, ARTHRITIS PAIN AND FIBROMYALGIA PAIN IMPROVED BY ADDRESSING CHRONICALLY ADHESED FASCIARead Now
LOOKING TO BREAK FREE FROM CHRONIC FIBROMYALGIA OR ARTHRITIS PAIN?
That goes doubly for those with FIBROMYALGIA and issues such as ARTHRITIS that are intimately related to a LOSS OF PROPRIOCEPTIVE FUNCTION (in this case her dysfunction was causing severe CHRONIC NECK PAIN). If you appreciate our VIDEO TESTIMONIALS, be sure to check out our latest below (Monday was her second visit, with her first being a bit over two years ago). And if you appreciate the totally free information on our site, be sure and like, share, or follow on FACEBOOK, as it's a great way to reach those you love and care about most!
CHRONIC NECK PAIN FROM INJURED FASCIA
TISSUE REMODELING DRAMATICALLY IMPROVES
THE LIFE OF A LOCAL LOGGER CRUSHED BY A TREE
Two years ago TR was logging --- one of the chief industries in our neck of the woods (no pun intended) --- and the skidder driver accidentally pulled a standing cut tree down on top of him. The tree, 24 inches across the stump (a bit bigger than the tree in the picture above), hit TR in the head, neck and back, and then crushed him into the ground in a wadded heap. Two years later he ended up in my office with virtually zero range of motion in his cervical spine and the kind of NECK PAIN and BACK PAIN that had made him start wondering if he might be better off dead. By then he had tried just about everything the medical community had to offer and was looking for anything that might provide a solution.
I saw TR back in March, two visits, consecutive Friday's, and then saw him on Friday when he did these videos for us. I say videos, plural, because the camera was accidentally stopped during filming. If you are interested in looking at other similar videos, I have hundreds, along with dozens of case histories (HERE). Be sure and like, share, or follow on FACEBOOK if you have friends or loved ones whom you feel might benefit from this type of information.
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MORE RESEARCH ON FASCIA
THE TEMPOROPARIETAL FASCIA
The authors, Dr. Carl Shermetaro, an EENT, and Dr. Colin Bohr, a plastic surgeon (both practice at McLaren Oakland Hospital in the Detroit area) kicked things off by talking about the temporoparietal fascia (the FASCIA that is associated with the temporalis muscle, which is housed in the cupped, bony region of the temple --- the area of the head just in front of the ears --- see pictures below). They say of this fascia.......
"It is continuous with thesuperficial musculoaponeurotic system that is inferior to the zygomatic arch. These 2 structures are continuous with the platysma muscle in the neck creating a unified fascia layer from the scalp to clavicle. The temporoparietal fascia joins the orbicularis oculi and frontalis muscles anteriorly and the occipitalis muscle posteriorly."
The fascia on your skull (from the frontalis muscle in your forehead to the occipitalis at the base of the rear of the skull) attaches to the round muscles surrounding your eyes, which attaches to the fascia on and around your cheek bones (as you'll notice in a moment, the temporalis tendon runs underneath the zygomatic arch / cheekbone), which attaches to the 'shaver's muscle" (THE PLATYSMA), which is anchored to your collar bones. Think for a moment about the implications not only for the people struggling with the problems mentioned in the first paragraph, but especially for those whose lives have been turned upside down by WHIPLASH INJURIES.
The authors go on to describe two layers of fascia (the temporoparietal fascia and the deep temporal fascia) that are separated by "a loose areolar and avascular layer... referred to as the innominate fascia." This layer allows people to put their hands on their head and move them around, feeling the more superficial tissue move over the skull and deep fascia (sort of like THIS). When these tissue layers become adhesed or "TETHERED" together, it not only becomes restricted (HERE), but has the potential to make the sounds --- sounds that many of my patients have described as CRINKLING OR RUSTLING LEAVES --- an almost crunchy sort of thing that reminds them of wadding up a piece of paper. These adhesions not only cause pain in and of themselves, but can ENTRAP CUTANEOUS NERVES.
CHRONIC NECK PAIN?
A SIMPLE SELF-TEST FOR HELPING DETERMINE
WHETHER CERVICAL FASCIA MIGHT BE THE CULPRIT
A perennial question facing the chiropractic profession is how far its members are willing to deviate from the joint component as emphasized in the majority of chiropractic colleges. Research has proven the value of the chiropractic adjustment, but research has also described most of the conditions chiropractors treat as having multifactorial causes. After the joint, most of the etiologies remaining for the majority of musculoskeletal problems relate to tissues such as muscles, ligaments, tendons, and fascia.
FASCIA. While an extremely common source of CHRONIC NECK PAIN, the fact that it is virtually impossible to image using standard tests can make visualizing the most common reasons for said pain likewise impossible (HERE). While I am certainly not against imaging, it's important to realize that in most cases it's unlikely to provide a diagnostic "ah ha" moment, and explains why so many of you have been through CT SCANS, MRI, and PLAIN FILM X-RAYS with nothing to show other than being told you aren't as young as you used to be. What do I do in my clinic? Beyond simple ranges of motion (HERE) and motion palpation, which checks both SEGMENTAL & SECTIONAL spinal motion, there is another simple test that I often use; particularly for people whose problems are at least somewhat localized. It's a "MYOFASCIAL SLING" test that people can do themselves.
First, while looking in a mirror to get a rough estimate of your ranges of motion, move your head and see where the pain localizes to. Next, grab the painful area and squeeze (you may need to use both hands and you may need to squeeze or "pinch" with a fair bit of force), while attempting the same ranges of motion. Did the pressure make the movement any easier, freer, or less painful? If so, it's likely there is a significant soft tissue component to your problem, probably the CERVICAL FASCIA. Considering what Dr. Warren Hammer said in the quote above, FASCIAL ADHESIONS in the cervical spine are not only common, they are dog common, with far too may practitioners trying to treat their patients without addressing the underlying FIBROSIS / SCAR TISSUE (HERE or HERE).
The really cool thing is that in most cases your DIY test is easy to confirm because a visit to my office is so simple. If you decide to come see me, you'll know AFTER YOUR FIRST VISIT whether this approach was helpful for your particular situation. How much better is this than a lifetime of "CHIROPRACTIC MAINTENANCE" that by definition, is in most cases anything but? Need more evidence? Be sure to take a look at some of our TESTIMONIALS as well as our FACEBOOK PAGE.
CHRONIC NECK PAIN SOLUTIONS
ADDRESSING THE CHEMICAL, MECHANICAL, AND STRUCTURAL CAUSES OF PAIN
- CHEMICAL: Inflammation is the name given to a group of chemical mediators that help cells and tissues communicate with each other (HERE). While needed for the HEALING PROCESS, too much inflammation can be a big problem. The biggest problem here is that inflammation always leads to the scar tissue that the medical community refers to as fibrosis (HERE, HERE, HERE, HERE, HERE, HERE, HERE, HERE, and HERE). In other words, if you are SYSTEMICALLY INFLAMED, you are essentially TETHERING YOURSELF. You'll see why that's such a big deal in just a moment.
- STRUCTURAL: When most people think of chiropractic, they think of alignment. Are my bones in place or out of place? Furthermore, they tend to think of alignment in an A-P view. In other words, is the spine straight when looking at it from the front or back? While I don't want to minimize the importance of this sort of alignment (scoliosis, various sorts of distortions, and pelvic torque), what's far more common is loss of the normal lordotic curve of the neck (loss of the curve seen via a lateral view --- HERE & HERE are a bunch of pics).
- MECHANICAL: When I talk about mechanical dysfunction, I am talking about loss of motion. What's critical for people to understand is that spinal motion comes in two distinct flavors --- sectional and segmental (HERE). It is critical to address both of them. Loss of structural and mechanical integrity (especially loss of motion) of the spine causes a loss of proprioception (HERE). While that might not seem like a big deal to the uninitiated, loss of proprioceptive ability of joints (particularly the spine, and most particularly the cervical spine) is being touted as the primary cause of all sickness and disease (HERE).
Understanding these points will help you grasp the differences between PHASE I and PHASE II of solving chronic neck pain (not just living the rest of your life on a CHIROPRACTIC "MAINTENANCE" PROGRAM). If you want to see how it all works together, take a look at a few of our VIDEO TESTIMONIALS. My goal is always to make as much change as possible as quickly as possible, while giving you the tools to do as much as you can on your own (HERE and HERE). If this concept resonates with you, be sure to spread the wealth by giving us some props on FACEBOOK.
IS IT "MAINTENANCE" OR SOMETHING ELSE?
The hope with any kind of maintenance is that it makes the useful life of whatever you are maintaining both longer and better (more functional). As a CHIROPRACTOR, I am a big fan of maintaining proper function in the spine and other joints. Joints wear out when they don't work properly, and with your neurological function being intimately tied to spinal function via something called PROPRIOCEPTION, it's easy to understand why mainstream scientists and physicians are increasingly touting joint function as the single most important factor in overall health (HERE). In terms of chiropractic, I've seen this phenomenon in action over and over again, at times with almost unbelievable results. Restore proper ALIGNMENT and movement to the spine, and watch what can happen (HERE). Thus, chiropractic adjustments should be a valid part of "maintaining" your body to prevent pain, preserve joint function, and maintain overall health.
I've recently been treating a person, whom for the last 45 years has struggled with CHRONIC NECK PAIN thanks to a severe (emphasis on severe) physical trauma that took place in childhood. This person has not only had years and years of chiropractic adjustments (along with various forms of massage and other bodywork), but for a significant number of years has been getting adjusted 3-4 times a week in the name of "maintenance". In other words, by the time this individual saw me, they had been adjusted hundreds upon hundreds upon hundreds of times, with no appreciable long-term (more than a day or so) reduction in their CHRONIC PAIN. To put it differently, it was a steady stream of neck adjustment, after neck adjustment, after neck adjustment, because neck adjustments were the only thing that brought any relief, it just wouldn't last or hold very long (and this person was not interested in TAKING THESE DRUGS).
Since the end of last year, I've seen this person 3 or 4 times, doing TISSUE REMODELING with an adjustment on each occasion (along with a DAKOTA TRACTION DEVICE for use at home). What's cool is that not only has this individual's pain diminished by 80% or better, but their RANGE OF MOTION IN THEIR NECK has doubled (maybe tripled) to the point of approaching normal (nope; hundreds of adjustments did not solve the crappy ROM). What's doubly cool is that this happens with surprising regularity (HERE). In fact, if you take a look at some of our VIDEO TESTIMONIALS you'll see that it's actually a rather common theme in our clinic.
My goal is to get you off the MEDICAL MERRY-GO-ROUND, and away from reliance on health care providers (self included). It's not that I'm against a certain degree of "maintenance," but let's be honest with each other for a moment; since when is a reliance on REPEATED ADJUSTMENTS just to get through the day considered maintenance? If your vehicle was up on the mechanic's rack three times a week, always for the same problem, you certainly wouldn't call that maintenance would you? Why would you call it maintenance just because it's your neck or back (HERE)?
To address the underlying inflammation that always leads to the scar tissue that the medical community refers to as fibrosis, THIS PROTOCOL might be right up your alley. And if you know people who could benefit from this information, be sure to like, share, or follow on FACEBOOK as it's an easy way to reach those you love and care about most.
25 YEARS OF CHRONIC NECK PAIN...
CHRONIC NECK PAIN
WHAT DOES THE JANUARY 2018
SCIENTIFIC LITERATURE SAY?
- WHAT'S IT LIKE TO LIVE WITH CHRONIC WHIPLASH (WAD)? A month ago, researchers for BMC Musculoskeletal Disorders (Living with Ongoing Whiplash Associated Disorders: A Qualitative Study of Individual Perceptions and Experiences) talked about what it's like to live with chronic whiplash. "Whiplash associated disorders (WAD) are the most common non-hospitalized injury resulting from a motor vehicle crash. Over the past few decades, recovery rates have remained unchanged with approximately 50% of individuals experiencing on-going pain and disability. Results from intervention trials for individuals with chronic WAD are equivocal and optimal treatment continues to be a challenge. ll participants described navigating the healthcare system after their whiplash injury to help understand their injury and interpret therapeutic recommendations. Participants highlighted the need to find the right healthcare practitioner to help with this process. Many participants also described additional complexities in navigating and understanding healthcare incurred by interactions with compensation and funding systems. Participants in this study had been living with WAD for an average of 6.5 years and continued to find it challenging and exhausting." It's called the MEDICAL MERRY-GO-ROUND folks, and unfortunately, it's dog common to watch people going round and round until it literally destroys them. One of the situations that these authors spoke of was the reluctance of doctors to believe these patients, instead, seeing it as a ploy for a legal / financial settlement, or getting their disability.
- WAD SCREWS UP THE BRAIN: In the brain and spinal cord, the gray matter is the inner portion, where most of the nervous system's chief functions take place. The white matter (it's white because it's cells are covered by a fatty substance called myelin) is made up of cells that connect the gray areas to each other. Although there are numerous studies showing that whiplash affects the brain, this month's issue of Human Brain Mapping (Differences in White Matter Structure and Cortical Thickness Between Patients with Traumatic and Idiopathic Chronic Neck Pain: Associations with Cognition and Pain Modulation?), concluded that, "Cortical thinning in the left precuneus was revealed in WAD compared with CNP (chronic neck pain) patients. The extent of white matter structural deficits in the left tapetum coincided with decreased conditioned pain modulation efficacy in the WAD group. This yields evidence for associations between decreased endogenous pain inhibition, and the degree of regional white matter deficits in WAD." Thin the precuneus and you'll end up with memory, visuo-spatial processing, and self consciousness issues. The tapetum is important because it's associated with the Corpus Collosum --- the connection between the brain's two hemispheres. Mess with the tapetum and the two sides cannot communicate properly.
- WAD & NECK PAIN BOTH CAUSE IMPAIRMENT OF MOTOR FUNCTIONS: When there is enough damage to the brain, not only does this affect the sensory side of the brain (PAIN, paresthesias, LOSS OF PROPRIOCEPTION, etc), but it's becoming increasingly clear that it affects the motor side of the brain as well. The journal Spine (Motor Impairment in Patients with Chronic Neck Pain: Does the Traumatic Event Play a Significant Role?) recently concluded that, "Motor impairment was observed in both patient groups (CNP & WAD) with a higher degree in patients with chronic WAD. These impairments were linked to self-reported disability and were in most cases associated with pain, fear-avoidance, and symptoms of central sensitization." Click the link if you are not sure what CENTRAL SENSITIZATION is. This was confirmed visually (DIAGNOSTIC ULTRASOUND) in a study published in the American Journal of Physical Medicine & Rehabilitation (Alterations in the Mechanical Response of Deep Dorsal Neck Muscles in Individuals Experiencing Whiplash-Associated Disorders Compared to Healthy Controls: An Ultrasound Study), which concluded that "the mechanical responses of the deep dorsal neck muscles differ between individuals with WAD and healthy controls, possibly reflecting that these muscles use altered strategies while performing a neck extension task." Just realize that when you start down the road of ALTERED SPINAL / FASCIAL BIOMECHANICS, degenerative arthritis isn't far behind.
- WAD TURNS NECK MUSCLES TO FAT: Although we've known about this phenomenon in the low back for decades (THORACOLUMBAR AREA), not surprisingly, the same thing occurs in necks. After comparing "Thirty-one subjects with WAD and 31 age and sex matched controls, twenty-one (68%) patients had mild/moderate disability and 10 (32%) were considered severe. Statistically significant differences in regional MFI (Muscle Fatty Inflitration) were particularly notable between the severe WAD group and healthy controls." This study was found in the journal Spine (The Qualitative Grading of Muscle Fat Infiltration in Whiplash Using Fat/Water Magnetic Resonance Imaging) and is why strength training is so critical, not just for chronic neck pain, but in general.
- PREDICTING WHO'S GOING TO GET OVER THEIR WAD: As I have shown you in the past, predicting who is going to improve after having a whiplash injury is difficult to determine, although there are a few things we know --- women and the elderly almost universally have a much tougher row to hoe than young, healthy, males. Just days ago, the journal Spine (The Potential and Perils of Prognosticating Persistent Post-Traumatic Problems from a Post-Positivist Perspective) stated that, "Predicting recovery following traumatic neck pain has become an active area of research but is moving in several different directions with currently little consensus on the important outcomes to predict or relevant variables to predict them." The Journal of Physiotherapy confirmed this with a paper that reviewed 46 studies of 99 models used to predict whiplash severity and subsequent improvement. The study's title tells the story, Few Promising Multivariable Prognostic Models Exist for Recovery of People with Non-Specific Neck Pain in Musculoskeletal Primary Care: A Systematic Review.
- WHAT IS THE MEDICAL COMMUNITY DOING ABOUT WAD? Not to sound harsh, but who do you think brought us the opioid epidemic? (Doctors were not the sole culprits; THE GOVERNMENT was in on this as well.) In this vein, we can't be shocked that THE BIG FIVE still rules the day (along with a round-robin of ever-changing novelties). A few weeks ago the journal BMC Musculoskeletal Disorders published a study called Management of Whiplash Associated Disorders in Australian General Practice that stated, "Whiplash Associated Disorders (WAD) are common and costly, and are usually managed initially by general practitioners (GPs). Motor Vehicle Crashes (MVCs) are the cause of 50 million injuries worldwide and nearly four million emergency department (ED) consultations annually in the US. After being medically evaluated, approximately 90% of those who present to ED after MVC return home. Only around 50% of those with WAD will fully recover, with 30% remaining moderately to severely disabled, creating significant personal, economic, and social distress. Worldwide, chronic pain following MVC is a significant burden and a frequent and expensive public health problem. Current clinical guidelines recommend that the most important aspect of management of acute WAD is providing assurance and encouragement to return to normal activities and exercise, but GP provided advice/education was only documented in 5.8 per 100 WAD problems in our study. Local injections, muscle relaxants, anti-convulsants, benzodiazepines and anti-depressants, for which there is no evidence for efficacy and which are not recommended, were overused. Non-recommended treatments were used in a total of 34.4 per 100 WAD cases."
- WHAT IS THE MEDICAL COMMUNITY DOING ABOUT CHRONIC WHIPLASH PART II? LYRICA is a terrible drug (not my opinion, but verified by studies and the majority of those who have tried it). It is essentially second generation Neurontin (gabapentin) --- one of the FOUR DRUGS that Pfizer was fined 2.3 billion dollars for promoting "OFF LABEL" (they were fined 430 million dollars for the same thing with Neurontin itself). Just last week, Australian officials announced plans for a study to see if Lyrica could prevent chronic WAD if given in a prophylactic manner in the ER, post-accident (Pregabalin Versus Placebo in Targeting Pro-Nociceptive Mechanisms to Prevent Chronic Pain After Whiplash Injury in At-Risk Individuals - A Feasibility Study...).
WHAT'S BEING DONE TO SOLVE
CHRONIC WHIPLASH PAIN (WAD)?
- THE RIGHT KIND OF PATIENT EDUCATION: One thing we are seeing again and again in peer-review is the need for quality patient education (by "patient education" I do not mean trying to convince patients they will require MASS QUANTITIES OF ADJUSTMENTS). In a Disability and Rehabilitation study from a year ago (What Information do Patients Need Following a Whiplash Injury? The Perspectives of Patients and Physiotherapists), the consensus seemed to be that those with WAD need to be reassured as well as educated. "Reassurance can be an effective communication tool to decrease patients concerns about their injury and help strengthen the patient-health practitioner relationship. Although clinical guidelines for the management of whiplash injuries recommend that individuals must remain physically active post-injury, statements from the patient group indicate that this information is not always provided and clearly explained to patients." A brand new study from Physiotherapy Theory and Practice (The Effects of Pain Neuroscience Education and Exercise on Pain, Muscle Endurance, Catastrophizing and Anxiety in Adolescents with Chronic Idiopathic Neck Pain) talked about the need for both pain neuroscience education (PNE) and exercises for those with chronic neck pain. What is PNE? It's essentially explaining to patients that their pain may no longer be arising from damaged tissue, but might be coming from the brain itself. In other words, the pain may have become "centralized" (CENTRAL SENSITIZATION), which is never a good thing.
- EXERCISES PLUS MOBILIZATION / MANIPULATION IS BETTER THAN EITHER ONE ALONE: Yet another study (The Effects of Neck Mobilization in Patients with Chronic Neck Pain), this one from Monday's issue of the Journal of Bodywork and Movement Therapies, provided evidence to this thought process. Stick around and in just a moment I will show you why ADJUSTMENTS work like magic for many sufferers of WAD --- but only under certain specific circumstances.
- DIRECTION-MOVEMENT CONTROL TRAINING MAY PROVE EFFECTIVE FOR CHRONIC NECK PAIN: It's unsettling when a journal (in this case, this month's issue of the Journal of Bodywork and Movement Therapies) makes this sort of statement. "There is low level evidence that cervical interventions are effective on pain and range of motion at the immediate follow up, but no evidence on the effectiveness of the direction movement control intervention especially on the effectiveness of long term follow up." The study (Long-Term Effect of Direction-Movement Control Training on Female Patients with Chronic Neck Pain) concluded, however, that "Direction-movement control training is likely to be an effective training program to enhance body functionality through improvement of pain, function, endurance, head repositioning accuracy, range of motion, and cervical flexor endurance." If you want to see what Direction-Movement Control Training looks like, the study is free online.
- PILATES FOR CHRONIC NECK PAIN: Earlier this week, the same journal published yet another study on chronic neck pain (Is Pilates an Effective Rehabilitation Tool? A Systematic Review) showing that after reviewing 23 studies on the subject, "The majority of the clinical trials in the last five years into the use of Pilates as a rehabilitation tool have found it to be effective in achieving desired outcomes, particularly in the area of reducing pain and disability." I've shown you in the past that the same thing is true of yoga.
What kind of conclusions can we make from this mish mash of research? I'm honestly not quite sure. As the very first study discussed stated, part of the process is about each individual figuring out their own unique situation and what works for them. "A process of trial and error by participants was used to identify suitable strategies. Specific but different strategies were employed to prevent pain or to alleviate pain. Establishing these strategies took time, and several participants felt that an early lack of awareness of the potential for on-going pain led them to underestimate the importance of early management and ultimately contributed to their chronic condition. Individuals with acute WAD have also expressed a desire for more realistic expectations of recovery." What makes it so darn difficult is that when it comes to the tests, you're not likeely to have anything to show for them (all tests and imaging are usually normal / negative after whiplash-like injuries; even the more serious ones).
My opinion, especially when it comes to those dealing with chronic or long-term WAD, is that there are frequently some missing links. One of these is dealing with SYSTEMIC INFLAMMATION. And related to it, dealing with SCAR TISSUE as well (inflammation always leads to formation of scar tissue that the medical community refers to as "fibrosis" --- HERE). As I wrote about a couple of years ago, the first step in solving chronic neck pain is to restore normal cervical range of motion (HERE), which must involve both sectional and segmental motion of the neck (HERE). These points provide the basis for PHASE I and PHASE II of effectively addressing chronic neck pain and/or issues related to WAD.
Bear in mind that when I talk about dealing with inflammation, I am not simply talking about (as is usually the case with the medical community) making sure you have plenty of the "BIG FIVE" class of drugs on hand. I am talking about the need to effectively deal with whole body inflammation that can arise from numerous sources and be magnified by the effects of the WAD. To get a better idea of what I mean, take a look at THIS POST.
CHRONIC NECK PAIN
COULD THERE BE A SOLUTION FOR YOU?
If you are wanting to solve your chronic neck pain, there is a STEP-WISE PROTOCOL that must be followed (HERE is the second part of the protocol). Firstly, you will have to deal with any underlying SCAR TISSUE (FIBROSIS). It's no wonder this young man (early twenties) was told his neck was like that of a dead person. Trying to get good adjustments without first dealing with the FASCIAL ADHESIONS is an exercise in futility that will never bear any fruit other than possibly some temporary relief. However, once the Scar Tissue has been dealt with properly, adjustments will work, and you can start to address FORWARD HEAD POSTURE (FHP) and any SYSTEMIC INFLAMMATION that might be present (the latter of which should be done anyway).
I kick myself because I actually thought about doing a before / after video on both of these individuals, but we were swamped and I didn't feel I had the time. Both of these men came in with terrible ROM and left with ROM that was nearly normal. That's what it's about in my clinic --- LESS VISITS INSTEAD OF MORE. And the only way to get results like this is to deal with the TETHERING effects of the Scar Tissue, which unfortunately, are neglected by way too many practitioners, most of which try and convince you that if you just get more treatment (adjustments, THERAPY, massage, DRUGS), everything is going to eventually resolve itself and be OK. If you simply play the odds (HERE), you realize that this at best a crapshoot.
Interestingly, on the same day that these two gentlemen came in, I saw another person who had been in the same boat. Near-zero range of motion in his cervical spine (neck) despite lots and lots of adjustments. Since last week was his second visit and he had done so well after his first (his first was the day after Halloween, and remember that I'm the guy who rarely makes patients a follow-up appointment after their first visit -- HERE), I asked if he would do a video for us. Although Gaylon is not the sort of person who gets very worked up, his was a very cool case, with thus far an excellent outcome. And for those of you who enjoy similar testimonials, I have a boatload of them HERE.
CHRONIC NECK PAIN
ACCORDING TO THE LATEST RESEARCH
In plain English it means that you ignore neck pain at your own peril. A failure to deal with your neck issues today means that you'll likely be dealing with them tomorrow, only it will be worse, with incidents coming closer together and lasting longer, until it all runs together, becoming constant and chronic. This is why the term "self limiting," while true for colds, FLU, WHOOPING COUGH, CHICKEN POX, and most other infectious diseases, may not be a good descriptor of musculoskeletal problems, including neck pain.
Although statistics have shown that just under a third of all Americans deal with some sort of CHRONIC PAIN ISSUE, a recent article from the American Pain Society (NIH Study Shows Prevalence of Chronic or Severe Pain in U.S. Adults) revealed that according to peer-review, "Nearly 50 million American adults have significant chronic pain or severe pain, according to a new study prepared by National Institutes of Health’s National Center for Complementary and Integrative Health (NCCIH)." A study from the July/August issue of the Brazilian Journal of Physical Therapy (Prevalence and Factors Associated with Neck Pain: A Population-Based Study) painted a similar picture.
Neck pain is one of the major musculoskeletal disorders in the adult population; its prevalence in the world ranges from 16.7% to 75.1%. This condition has a complex etiology, including a number of factors: ergonomic (strenuous physical activity, use of force and vibration, inadequate posture, repetitive movement), individual (age, body mass index, genome, musculoskeletal pain history), behavioral (smoking and level of physical activity), and psychosocial (job satisfaction, stress level, anxiety, and depression). In the United States, neck pain was associated with women and people who suffered from some morbidity (respiratory, cardiovascular, and gastrointestinal diseases, among others) and psychological alterations (depression, difficulty falling asleep, and insomnia).
What does this paragraph tell us? For starters it shows us how intimately neck pain is related to inflammation (most of the physical problems listed above can be found filed under "INFLAMMATORY DISEASES"). This means that a failure to address inflammation means a greater likelihood of failure in addressing your pain --- the reason that we'll see momentarily that "best evidence" says most interventions for chronic neck pain are of little help (the drugs used to treat inflammation cause major problems with the healing of connective tissues such as LIGAMENTS, FASCIA, and TENDONS ---- HERE). With both incidence and prevalence exploding; how badly are our collective wallets being affected?
According to last December's issue of the Journal of the American Medical Association (US Spending on Personal Health Care and Public Health, 1996-2013), DIABETES and HEART DISEASE were the number one and two costliest diseases facing Americans. Guess what number three was? "US health care spending has continued to increase, and now accounts for more than 17% of the US economy. with estimated spending of $88.1 billion, low back and neck pain accounted for the third-highest amount. Spending on low back and neck pain and on diabetes increased the most over the 18 years, by an estimated $57.2 billion and $64.4 billion respectively." By the way, this was "across all age and sex groups and types of care." It's another proof that our healthcare system is "UNSUSTAINABLE".
Earlier this year, Sarah Boseley of The Gaurdian wrote about this study in an article titled Epidemic of Untreatable Back and Neck Pain Costs Billions, Study Finds. Listen as she echos the futility of most treatments as shown by decades of scientific studies. "Injections, electrical nerve stimulation, opioid drugs and a whole host of other interventions are not recommended for lower back and neck pain. The Cochrane group have found no evidence in favour of using these or many other interventions; in the UK, guidance from the National Institute for Health and Care Excellence advises healthcare staff not to offer them. Low back and neck pain is an increasingly widespread and expensive condition worldwide, costing the US alone $88 billion a year – the third highest bill for any health condition – despite evidence most treatments do not work." She is talking mostly here about THE BIG FIVE, which you already know don't work well. Let's look, however, at some things that might be of benefit.
- GENERAL RISK FACTORS FOR NECK PAIN: Less than three weeks ago, a team of five researchers from Duke looked at almost 900 articles and concluded in the journal Musculoskeletal Science and Practice (Identifying Risk Factors for First-Episode Neck Pain: A Systematic Review) that, "Because of the tendency for neck pain to become a chronic issue, it is important to identify risk factors that could encourage prevention and early diagnosis. The strongest psychosocial risk factors were depressed mood, high role conflict, and perceived muscular tension. The most commonly reported physical risk factor was work in awkward/sustained postures. Protective measures found included high perceived empowering leadership, high perceived social climate, leisure physical activity, and cervical extensor endurance. Most risk factors found for neck pain were related to psychosocial characteristics, rather than physical characteristics." If you are struggling with Depression, make sure to read these amazing posts (HERE).
- NECK PAIN FREQUENTLY STARTS IN THE WORKPLACE: In October, the International Journal of Occupational Medicine and Environmental Health (Determination of Pain in Musculoskeletal System Reported by Office Workers and the Pain Risk Factors) said that risk factors for spinal pain in office workers (52% of the 528 workers quizzed had neck pain) include, "sitting at the desk for a long time without a break, working sitting on a chair that supported only the lumbar area and the arms, having the computer mouse at a distance from the keyboard, having the head inclined at 45° when working, working holding both forearms above the level of the desk, not taking exercise in daily life, and having a moderate or extremely stressful workplace." The next month the same journal looked at risk of neck pain for all workers in a study titled Risk Factors for Episodic Neck Pain in Workers: A 5-Year Prospective Study of a General Working Population. The biggest factor here were things like work pace, sustained/repeated arm abduction (raising your arms to the side), and high physical exertion.
- CHRONIC NECK PAIN TIED TO OCCIPITAL BONE SPURS: If you reach back to the back of your head, halfway between your ears, you can feel a knob of bone called the EOP (External Occipital Protuberance), which is the point where lots and lots of muscles attach. WOLF'S LAW says that bone grows in response to stresses put on it, whether that stress is normal or abnormal. So, if there is abnormal tension in the neck, it only makes sense that the EOP turns into what amounts to an oversized bone spur, which is by the way, a commonly seen occurrence in any chiropractic clinic. A study published in last week's edition of the Journal of Craniofacial Surgery (An Anatomic Morphological Study of Occipital Spurs in Human Skulls) concluded that, "Occipital spurs are quite common; however, they are also the source of frequent discomfort to the patients. Their role has been implicated in causation of pain at the base of skull, which may extend to shoulder limiting the movement of the shoulder and neck." The paper said that about 10% of the population has tight enough muscles to cause an occiptial bone spur. The x-rays at the top of the page all have an occipital bone spur (click pics to enlarge). In the middle pic, you can see not only the EOP, but the entire ridge of bone where muscles attach along the back of the skull. This should help you understand why I frequently work on the back of the skull when treating people with chronic neck pain, HEADACHES, or SKULL PAIN.
- NECK PAIN AND TRAUMATIC BRAIN INJURIES IN CHILDREN: After looking at some of my posts on TBI (Traumatic Brain Injuries --- HERE is one from just the other day showing how they cause any number of diseases via genetic mutations), make sure to glance at this study from last week's issue of the Journal of Neurotrauma (A Review of Pain in Children Following Traumatic Brain Injury: Is There More than Headache?), which helped shed some light on this all too common problem by concluding "Headache is a common source of pain in children following traumatic brain injury (TBI). Pain assessment in children after TBI needs improvement, given that pain is linked to worse recovery, poorer quality of life, and can be long-lasting. More rigorous examination of non-headache pain and its role in impeding recovery in children following TBI is imperative, and has the potential to improve the care and management of children with TBI." This means that if the only treatment your child gets for a CONCUSSION, WHIPLASH or TBI/MTBI is THESE DRUGS, noting is being done to address the problem.
- NECK PAIN AND CHOLESTEROL LEVELS: Three weeks ago the Journal of Orthopedic Science (Associations Between Neck Symptoms and LDL Cholesterol) found a relationship between CHOLESTEROL LEVELS (LDL -- the so-called "bad" cholesterol) and chronic neck pain. "Studies have reported associations between neck pain and degenerative changes in the cervical spine in women, and between neck pain and obesity or metabolic syndrome. The 1122 volunteers who participated in this study included 426 men and 696 women. Each subject filled out a questionnaire about any neck pain or neck-shoulder stiffness experienced in the previous 3 months. We recorded the following laboratory results related to metabolic factors, including lipid profiles: total cholesterol, LDL and HDL cholesterol, triglycerides, free fatty acids, glucose, and hemoglobin A1c. The prevalence of neck and shoulder stiffness was significantly higher in women (60.3%) than in men (38.0%). Analyses showed a significant negative correlation between the prevalence of neck pain and LDL cholesterol. LDL cholesterol was correlated with neck pain in this cross-sectional population-based study." I talked extensively HERE about the intimate relationship between cholesterol and inflammation.
- NECK PAIN AND THE RELATIONSHIP TO TACTILE SENSATION: Researchers from the University of Queensland's Centre of Research Excellence in Recovery Following Road Traffic Injuries, published a study a few weeks ago in Musculoskeletal Science and Practice (Tactile Acuity is Reduced in People with Chronic Neck Pain). This isn't surprising considering what we know about the neck as related to RADICULAR PROBLEMS, the authors stated that, "Tactile acuity deficits have been demonstrated in a range of persistent pain conditions and may reflect underlying cortical re-organisation. People with chronic neck pain demonstrated tactile acuity deficits in painful and non-painful regions when measured using the Two-Point Discrimination test, with the magnitude of deficits appearing greatest at the neck. The study also revealed a positive relationship between Two Point Discrimination and pain intensity/duration, further supporting the main study finding." These findings are intimately related to PROPRIOCEPTION, which when lost, is a huge factor in developing DEGENERATIVE ARTHRITIS.
- CHRONIC NECK PAIN AND CENTRAL SENSITIZATION: CHRONIC PAIN is bad enough on its own but when it becomes "learned," locked into the brain and playing on a loop, it's really bad news. This is because in the same way it is almost impossible to unlearn how to ride a bike, it's likewise difficult to unlearn pain that has been creating neural pathways that can end up more aptly described as highways. A Belgian study published in last week's issue of Pain Practice (Convergent Validity of the Dutch Central Sensitization Inventory: Associations with Psychophysical Pain Measures, Quality of Life, Disability, and Pain Cognitions in Patients with Chronic Spinal Pain) dealt with CENTRAL SENSITIZATION as related to chronic neck pain. "Symptoms of Central Sensitization have been described in patients with chronic spinal pain. Although a gold standard to diagnose Central Sensitization is lacking, psychophysical pain measures are often used. Moderate to strong associations were found with current pain intensity, quality of life, disability, and catastrophizing." CATASTROPHIZING is freaking out over your situation. Because there is, as these authors said, no gold standard for diagnosing it, my opinion oon using TISSUE REMODELING on those with potential CS is let her rip --- there's nothing to lose (HERE).
- WHAT'S THE BEST WAY TO TEST FOR CHRONIC NECK PAIN: What would be really cool is if doctors had a way to test people in the same way mechanics hook up your car to their diagnostic computer to see what's wrong. Unfortunately, the fact that pain is subjective is at least part of what's led to the OPIOID EPIDEMIC. If you look at the final link in the "Tactile Sensation" bullet above, or better yet, THIS LINK on MRI's, you quickly realize that imaging --- at least in the sense that we currently use it today --- isn't necessarily much help. Thus, my opinion based on a number of studies is that RANGE OF MOTION is the best and easiest way to get a picture of how bad neck pain might be. Although there are a number of companies selling ROM-measuring devices for thousands, or even tens of thousands of dollars, a study from the October issue of JMPT (Intrarater and Inter-rater Reliability of Active Cervical Range of Motion in Patients With Nonspecific Neck Pain Measured With Technological and Common Use Devices: A Systematic Review With Meta-Regression) revealed that simple, low tech, inexpensive devices work just as well. "The use of expensive devices to measure active cervical range of motion in adults with nonspecific neck pain does not seem to improve the reliability of the assessment."
- HOW BEST TO TREAT THOSE STRUGGLING WITH CHRONIC NECK PAIN: Back in July, eight PT's wrote an 83 page position paper for their profession called Neck Pain: Revision 2017 Clinical Practice Guidelines Linked to the International Classification of Functioning, Disability and Health From the Orthopaedic Section of the American Physical Therapy Association that was published in the Journal of Orthopedic and Sports Physical Therapy. Their conclusions could be boiled down to a few sentences. "For patients with chronic neck pain with mobility deficits, clinicians should provide a multimodal approach of thoracic manipulation and cervical manipulation or mobilization, mixed exercise for cervical/scapulothoracic regions (neuromuscular exercise, coordination, proprioception, postural training, stretching, strengthening, endurance training, aerobic conditioning, and cognitive affective elements), dry needling, laser, or intermittent traction"
In the words of YODA, correct they are. When treating people with chronic neck pain, the very first thing that must be accomplished is breaking the ADHESED FASCIA and SCAR TISSUE / FIBROSIS. This needs to be followed by "MANIPULATION" (not to be confused with mobilization --- HERE). There are so many cool ways to improve PROPRIOCEPTION that can be combined with various forms of EXERCISE (both specific and non). DRY NEEDLING, LASER THERAPY, and intermittent traction (otherwise known as SPINAL DECOMPRESSION THERAPY) all follow if needed. I have written about these in my PHASE I and PHASE II for dealing with people who have chronic neck pain. Don't forget how important it is to deal with SYSTEMIC INFLAMMATION (or overabundance of local inflammation) that might be present.
- YOGA IS HELPFUL FOR THOSE WITH CHRONIC NECK PAIN: I have spoken of YOGA on my site previously. The October issue of Complementary Therapies in Clinical Practice (Effects of Yogic Exercise on Nonspecific Neck Pain in University Students) concluded that at least in college students, "The yoga group showed significantly decreased neck pain scores compared with those of the control group." Last month's issue of the Journal of Rehabilitative Medicine (Effects of Pilates and Yoga in Patients with Chronic Neck Pain: A Sonographic Study) looked at the effects of neck pain on one of those new imagining technologies mentioned earlier (DIAGNOSTIC ULTRASOUND) determining that although yoga did not change the ultrasound itself, "All 3 types of exercise (yoga, Pilates, and isometrics) had favorable effects on pain and functional scores." Two weeks ago today, Clinical Rehabilitation (Effects of Yoga on Chronic Neck Pain: A Systematic Review and Meta-Analysis) concluded that, "Yoga has short-term effects on chronic neck pain, its related disability, quality of life, and mood suggesting that yoga might be a good treatment option."
- WHAT ABOUT THOSE ADJUSTMENTS? I've shown you repeatedly that repeated adjustments in and of themselves are a waste (HERE). A study from last month's issue of Chiropractic and Manual Therapies (The Chiropractic Profession: A Scoping Review of Utilization Rates, Reasons for Seeking Care, Patient Profiles, and Care Provided) looked at hundreds of studies and determined that neck pain is the second most common reason people visit the chiro (LBP is first). Fortunately, the second most common treatment used on these folks (behind manipulation) was soft tissue therapy. But what about the question of when you should be adjusted if you are injured? It was answered by a group of European osteopaths in last month's issue of Alternative Therapies in Health and Medicine (Immediate Effects of Osteopathic Treatment Versus Therapeutic Exercise on Patients With Chronic Cervical Pain) who concluded that, "Although both interventions were associated with immediately improved ROM and pain after treatment, high velocity, low amplitude manipulation was more effective than craniocervical flexion exercise in improving ROM and visual analog scales (1-10 pain diagrams) during ROM." Please note the word "immediately". Very cool, but what I am looking for in my clinic are LONG TERM RESULTS. It's ironic that as groups of American chiros pine for prescription rights, European physicians are taking courses to learn how to manipulate the spine. In a study published in last week's issue of BMC Musculoskeletal Disorders (Physicians Using Spinal Manipulative Treatment in The Netherlands: A Description of Their Characteristics and their Patients) a team of four Dutch physicians, chiros, and other similar, were starting to use manual techniques to treat patients.
- WHAT THE HECK IS ACOPOTOMY? According to Qiao Jinlin, the director of China's Naval General Hospital's Department of Rehabilitation, "Soft tissue trauma includes muscular pain, fascia and tendon injury, as well as articular cartilage, joint capsule [ligaments] and bursa." What's one of the hottest methods of dealing with these problems? I mentioned it earlier ---- NEEDLING. I have said for a very long time that while super cool, acupuncture needles are often too small to affect the needed change (which is why I usually use hypodermics). A relatively recent treatment known as Acopotomy ("a non-invasive acupuncture/ micro surgery using a small needle-scalpel invented by Professor Zhu Hanzhang around 30 years ago in China") is being used to break deeper tissue adhesions. HERE is a super cool video of Dr. Steven Woo of the OG Pain Clinic fixing a shoulder problem. And while there are actually a fair number of studies on acopotomy, a group of six Chinese physicians published a study back in August called Acupotomy Therapy for Chronic Nonspecific Neck Pain: A Systematic Review and Meta-Analysis. After looking at results of ten trials involving 433 patients, the authors concluded that, "Acupotomy therapy may be beneficial to chronic nonspecific neck pain patients." What's doubly cool is that these authors also reported that the procedure, used by 360,000 people a day in China, saves over ten billion dollars annually in surgery and other medical services. Take a look at the previous link to see why.
As I have been telling people for nearly three decades, if you want to solve your chronic issues, you're going to have to step out of the box. In a nation where we account for less than 5% of the world's population, but are, according to our own government (HERE), using 75% of the world's medication, it's clear that we are not as adept at this as we should be. After all, big pharma, corporate medicine, our government, and the insurance industry, all want to keep you in the box. That way you can be a MONEY-MAKING COMMODITY for decades to come. That way no one upsets the status quo. That way the people at the top of the pyramid make obscene amounts of cash.
If you are looking to step outside the box, I've given you some information to help you get started. Nope, it's not meant to diagnose, treat, or cure diseases --- that's what the FDA says can only happen if you stay in the box. THIS POST is meant to give you a starting point as far as doing your own research. Because after everything shakes out in the wash, your health is up to you.
PHARMACIST TURNED PROFESSIONAL PHOTOGRAPHER DRIVES FROM DENVER TO FIND RELIEF FOR HER CHRONIC NECK PAINRead Now
KARINA'S PAIN RELIEF STORY
Karina and her lovely mother drove from Denver to see me about six weeks ago. Not only was I able to help her with her CHRONIC NECK PAIN and associated symptoms (cervical vertigo for one), I was able to spend about 10 minutes with her mom fixing a three year old case of DEQUERVAIN'S THUMB. It was so much fun meeting them and getting to share a couple hours together. God bless you both and thanks for the kind words! If you ever decide to come back, bring your camera and our family will take yours' to THE RIVER. Oh, and for those who are interested, I have a couple hundred SIMILAR TESTIMONIALS showing that this isn't a fluke.
Dr. Schierling is amazingly knowledgeable, professional, and kind. After living with chronic neck pain for a year and trying all kinds of treatments, from chiropractic, to massage, dry needling, and spending a fortune on these treatments as they are not covered by any insurance, I started to research more about the effect of the fascia on our overall health. When I found Dr. Schierling's website I was fascinated by all the vital information he had in it and I was immediately interested in his treatment. Unfortunately I could not find a doctor here in Denver that did Tissue Remodeling, so I decided to drive all the way to Missouri to see him.
My mom and I were both treated by Dr. Schierling for different conditions and we could not be happier with the results. I have gotten at least 50% better after seeing him only once and I keep improving. My mom, got treatment for her carpal tunnel problem, and now she can use her hand without any pain. We highly recommend Dr. Schierling and his treatments!!
If you are one of those people who finds themselves spending more time on our site than you intended, make sure to share the wealth. The easiest way to reach those you love and care about most with incredible (and free) information is to show us some love on FACEBOOK.
A COOL TESTIMONIAL FROM GERMANY
I am happy to write about being treated by Dr. Russell. I have been living in Germany for over 9 years and my problems started when I had an incident of lumbago on my low back 3 years ago. After a month my upper back started feeling really weak and tight. I first thought it was an after-effect of the high dosage of NSAID's but I was wrong as the pain & stiffness became a companion / guest who just would not leave. I tried all treatment after that to help the problem. I visited numerous orthopedics and neurology experts in the field (Germany has one of the best medical aid in the world) and after numerous MRI / CT Scans and Xrays I was always dismissed as a normal patient with no problems. In other words, my pain was left to be treated as muscular in nature which could he treated by physical therapy / manual therapy.
For last 3 years I have tried everything possible to get rid of the pain; exercising, power training, swimming, yoga, stretches, therapies, chiropractic, etc, and the pain would always come right back. When I found Dr. Russell's webpage I had almost given up hope and thought OK here is a person who has a rich history of treating patients with chronic pain and his method sounds quite unique. I wrote to Dr. Russell about my problem and I must say that I was very happy that he said my problem sounded treatable.
The journey from Germany to Mountain View Ozarks was a long one but full of hope. When I started, my up and down movement in my neck [flexion / extension] were restricted to around 30° [CERVICAL EXTENSION is the most important ROM in the body and should be 90 degrees or more]. After the first treatment I was much better, and one session later I could completely go back to 90° [GK could tip his head backwards so that his forehead was parallel to the floor]. I must say my upper back was a piece of work. We had 4 sessions in a period of 3 days [I did not treat the same areas on consecutive days] uncovering so many scar tissues to my surprise. No wonder my upper back was a mess.
Today, 3 weeks after treatment, my pain has significantly reduced. I can see light at the end of the tunnel. "Scar Tissue Remodeling" works! I am happy that I made the trip to Dr. Russell. It’s strange that I had to embark on a journey from Germany to Missouri Ozarks to find a cure, but the reason to share my story is that I want other people suffering from pain similar to my condition to be helped by Dr. Russell. His treatment in working for me and I hope that it works for you too. Please make sure to follow the plan Dr. Russell gives you to the spirit and word.
It's not that any of these other treatments that GK did are a bad thing. Not by a long shot. In fact, I not only think they can be super beneficial, but are all things that I recommend. However, if there are significant amounts of Scar Tissue that are "TETHERING" a specific anatomical area, trying to break through said tissue with things like adjustments, stretches, exercises, therapy, etc, etc, might not simply prove to be an exercise in futility, it can sometimes EXACERBATE THE SITUATION --- something that GK was experiencing at times.
For the record, I have GK using a DAKOTA TRACTION DEVICE to stretch out his extremely shortened SCM MUSCLES as well as his "tethered" CERVICAL FASCIA. And while he was actually doing a pretty good job in the SYSTEMIC INFLAMMATION department, many of you reading this will need to ADDRESS YOUR UNDERLYING INFLAMMATION before making a visit to see me. this way we can help rule out things like AUTOIMMUNE FASCIA ISSUES or a similar situation (HERE).
CHRONIC NECK PAIN: SYSTEMIC INFLAMMATION -VS- LOCAL INFLAMMATION --- HEALING CHRONIC NECK PAIN BY INDUCING INFLAMMATIONRead Now
CHRONIC NECK PAIN
SYSTEMIC INFLAMMATION -VS- LOCAL INFLAMMATION
HEALING CHRONIC NECK PAIN BY
INDUCING LOCAL INFLAMMATION
First off, inflammation is a name, just like Jeff, Roger, or Sally is a name. It happens to be the name given to the chemical mediators that are responsible for intercellular communication. In other words, inflammation allows cells to talk to each other, which is a good and necessary thing. If you were to have a local injury ( a cut or SPRAIN / STRAIN), inflammation is released into the local tissue to start a process to protect you from invaders (bacteria, virus, etc, etc). The other chief purposes of inflammation are to get rid of said invader (if in fact there is one), get rid of dead or damaged tissue that could be the result of the initial injury or the inflammatory process itself, and finally to kick-start the process of tissue repair and regeneration.
Something that is important to remember is that inflammation is not synonymous with either swelling or infection. While infection can and certainly does (at least most of the time) cause inflammation, they are a totally different physiological process. And as for swelling; even though you hear the two words ("swelling & inflammation") used interchangeably, this is also incorrect. Acute inflammation often causes swelling because it not only attracts fluid to it, but increases blood flow, vasodilation (the blood vessels dilate), and permeability of the capillary bed, which allows more fluid and certain chemicals to leak out more easily.
If you are still confused, or simply interested in more information concerning the various mediators known as "inflammation," make sure to check out my post on this topic (HERE). I also have information on the phases of healing that occurs after the inflammatory phase --- a phase that is essentially over in a few days (HERE). Bottom line, when it comes to hardcore CHRONIC NECK PAIN, to have any hope of defeating it, you'll have to figure out a way to manage inflammation
CHRONIC NECK PAIN: HOW TO MANAGE INFLAMMATION
A second key is that you may actually have to induce some inflammation to get the healing process re-started. I've written a slew of articles (HERE is one of the more recent) showing that inflammation always leads to Scar Tissue / Fibrosis. This is problematic because Scar Tissue always leads to degeneration, which in turn leads to more inflammation (HERE). Even though Scar Tissue is not a grand thing as far as normal neck function is concerned, it's living tissue with a blood supply. BREAKING SCAR TISSUE not only mechanically "UNTETHERS" people, it induces a potent local inflammatory response, which, as I've explained to you, restarts the healing process.
The coolest thing about harnessing the power of inflammation (local inflammation) to treat patients with chronic neck pain is just how powerful it can be. Rather than seeing patients over and over and over again on long, drawn-out treatment schedules, most patients respond rapidly --- many of them instantly or almost so --- to this method of treatment. The best example I can give you is to look at just a few of our mind-blowing VIDEO TESTIMONIALS.
AMERICA'S NUMBER ONE SOURCE
FOR CHRONIC NECK PAIN?
For instance, Medline Plus (Neck Injuries and Disorders) says of neck pain, "Any part of your neck - muscles, bones, joints, tendons, ligaments, or nerves - can cause neck problems. Falls or accidents, including car accidents, are a common cause of neck pain." A 2009 position paper by the IASP (International Association for the Study of Pain) said, "Neck pain is a common global problem, at least in the industrialized world, and it constitutes an important source of disability. Neck pain affects 30–50% of the general population annually."
According to the American Academy of Pain Medicine, "severe headache or migraine pain (15%), neck pain (15%) and facial ache or pain (4%)" are some of the leading causes of pain in America (HERE). Furthermore, "Almost 59% reported an impact on their overall enjoyment of life, 77% reported feeling depressed, 70% said they have trouble concentrating, 74% said their energy level is impacted by their pain, and 86% reported an inability to sleep well." And as for how many MVA's there are here in America, USA Coverage (How Many Driving Accidents Occur Each Year?) says, "The most common question in issues involving vehicular fatalities is how many driving accident occur each year? If it’s all summed up in a yearly basis,there are 5.25 million driving accidents that take place per year. Statistics show that each year, 43,000 or more of the United States’ population die due to vehicular accidents and around 2.9 million people end up suffering injuries." But these statistics don't really tell the whole story.
Fetterman and Associates (How Many Car Accidents Occur Per Year?) reveal on their website that, "The most up-to-date information currently available only extends to 2012, and is provided by the Bureau of Transportation Statistics. In 2012, there were an estimated 5,615,000 highway accidents. But that number does not include accidents that occur in neighborhoods or parking lots. Highway accidents are easier to track. Some estimates of total accidents including the more minor ones are as high as 10 million per year." But even this is not presenting the entire picture. Less than two years ago, Consumer Reports (14 Million Americans Were Involved in Accidents with Senior Drivers this Past Year) said that, "Over the past year, 14 million Americans aged 18 to 64 were estimated to be involved in accidents caused by drivers aged 65 and over." It's almost like every study and statistic that comes out is worse than the one that came out before it.
WHAT CAN YOU DO TO MAKE SURE YOU DO NOT BECOME A WHIPLASH STATISTIC?
- HEAD RESTRAINT ADJUSTED PROPERLY: This is the inarguable #1, with tons of information found on this topic online, much of it in the form of peer-review. Without going in to great detail, make sure that the middle of your head restraint is even with your ear. Part of the problem is that many people keep their head restraints all the way down, allowing it to act as a fulcrum as the head is forced over it in the the event of a rear end collision. Be aware that studies have shown that most (over 85%) head restraints are positioned improperly.
- SEAT POSITIONED PROPERLY: Keep the seat in a relatively upright position. This has become a bigger deal in recent years, with younger people wanting to recline their seats.
- DRIVE A SAFER CAR: It seems like year in and year out, the safest cars are made by Volvo and Saab (not that I own or promote either brand). It is also important to remember that the smaller the vehicle you drive, the greater the chance of all injuries, including whiplash. Make sure to check out the various safety features and safety ratings before buying.
- PREPARE FOR THE REARENDER IN ADVANCE: I get it; you can never completely prepare to get rearended. However, if you hear brakes squalling, rather than first looking in the mirror or turning your head to look (whiplash is much worse in side impacts or if the head is turned at impact), plaster your back and head to your seat back and head restraint. If the head and neck don't move (whip) on impact, there is no tearing of soft tissues in the neck
- SEAT BELTS: While seat belts unarguably save lives, they do not prevent or even reduce whiplash. A similar thing can be said of airbags. While I am a fan of airbags (I will forever have the scars from the "rug" burns on the insides of my arms from THIS CRASH), airbags will not help you out in a rear-ender type accident. They will, however, help in front end collisions.
WHAT TO DO IF YOU ARE INJURED IN A WHIPLASH TYPE OF ACCIDENT
- HOW LONG DOES IT TAKE INJURED SOFT TISSUES TO HEAL? I answer this question in my COLLAGEN SUPER PAGE. The bottom line here is that current peer-review shows that although the first phases of healing only take about three weeks, the final phase --- the part where the Scar Tissue is strengthened and remodeled --- can take two years or more. If you don't know this, I promise that insurance companies will use it against you.
- WHAT IS PHASE I OF TREATING PEOPLE WITH WHIPLASH INJURIES? HERE is Phase I of treating Whiplash Injuries. Way too often people are bypassing Phase I and going straight to Phase II.
- WHAT IS PHASE II OF TREATING PEOPLE WITH WHIPLASH INJURIES? PHASE II of dealing with whiplash-induced soft tissue injuries is the focus of the majority of treatment plans. Unfortunately, the final aspect of Phase II --- dealing with FHP --- is rarely addressed (HERE).
The end result of either of the latter two bullets is people who frequently do great with adjustments. For a very short time. Often times just a day or two. Or maybe only an hour or two. If you want to see what makes a visit to my clinic different, take a look at THIS SHORT POST. As I have talked about at length in the past (HERE is one example), my goal is always to help you ASAP, as opposed to long and drawn out treatment schedules.
CHRONIC NECK PAIN
HOW MUCH STRETCHING IS TOO MUCH STRETCHING?
"Now, two new studies are giving us additional reasons not to stretch. One, a study being published this month in The Journal of Strength and Conditioning Research, concluded that if you stretch before you lift weights, you may find yourself feeling weaker and wobblier than you expect during your workout. Those findings join those of another new study from Croatia, a bogglingly comprehensive re-analysis of data from earlier experiments that was published in The Scandinavian Journal of Medicine and Science in Sports. Together, the studies augment a growing scientific consensus that pre-exercise stretching is generally unnecessary and likely counterproductive." From Gretchen Reynold's Reasons Not to Stretch from the April 3, 2013 issue of the New York Times
"In recent years, however, these commonly held beliefs have come under fire. In 2004, a report published by the American College of Sports Medicine (ACSM) questioned the efficacy of stretching, noting that more than 350 studies conducted over four decades had failed to establish that stretching prior to activity prevents injury. To date, studies have also failed to prove that stretching after exercise prevents muscle soreness." From Kelle Walsh's June 2008 article (Stretch and Reach: The Unexaggerated Truth About Stretching) in Experiencing Life
What I want to answer today is how much stretching a neck requires after the restricted fascia has been broken. The first thing we have to take into account is that everyone will be somewhat unique. In other words, there are any number of factors that must be taken into account such as age, lifestyle factors, inherent flexibility, etc, etc. For instance, I am not going to use the Dakota Traction Device or similar on a 90 year old that has almost no cervical extension.
However, the generic stretches I gave my grandmother to teach her group of exercisers at the retirement community she lived in before she passed away a number of years ago will work for anyone. I will never forget what happened at her memorial service. Two brothers, bent, crooked, and holding each other up arm-in-arm, came over to talk to me. They were both over 100, and both spoke at length about how much the exercises and stretches that my Grandma Alma regularly led them in had helped (I heard that from many of the people she led). What's the point?
The point is that stretching can be really good. But it can also be unhelpful. If you start looking at studies and articles about stretching, they are literally all over the place, with many actually saying that stretching is worse than not stretching (see quotes from the top of the page). As long as you don't have hardcore RADICULOPATHY, INFLAMMATORY ARTHRITIC CONDITIONS, SURGICAL FUSIONS, END-STAGE DEGENERATIVE CHANGES (i.e. non-surgical fusions), etc, etc, etc, stretching is quite necessary after Tissue Remodeling. In fact, the stretching is what "UNTETHERS" the scar or untangles the proverbial HAIRBALL. A failure to stretch post-treatment means that the scar is more likely to heal back like it was before --- in a fibrotic clump of SCAR TISSUE.
What should this stretching look like? For some people, all they need are a few simple neck ROM stretches as seen in the first link at the top of the page. However, some of you are going to have to go further. When I say further, I mean that you are going to have to deal with the underlying UPPER CROSSED SYNDROME and FHP that usually accompanies it. EXTENSION THERAPY is great for this, but in many cases the stretching needs to go farther still. To see why some of you will need to spend a significant amount of time in extension traction of the cervical spine, simply click THIS LINK. As for ridding your life of runaway inflammation, HERE is a starting point.
CHRONIC NECK PAIN?
CERVICAL (NECK) FASCIA MAY BE A CULPRIT
The area of cervicothoracic transition is a complex of prevertebral and postvertebral fascia and ligaments subject to shortening. It offers a multitude of attaching and crossing muscles such as the longus colli, trapezius, scaleni, sternocleidomastoid, erector spinae, interspinous and intertransverse, multifidi and rotatores, splenius capitis, splenius cervicis, semispinalis capitis, semispinalis cervicis, longissimus capitis, longissimus cervicis, and the levator costarum and scapula —all subject to spastic shortening and fibrotic changes that tether normal dynamics. There is a rough correlation between the degree of structural damage present and the extent of neurologic deficit. This is more true in the lower cervical area than in the upper region where severe damage may appear without overt neurologic signs. In either case, it’s doubtful that a deficit would exhibit without an unstable situation existing. It is not unusual for a patient to exhibit a neurologic deficit without static displacement; ie, the vertebral segment has rebounded back into a normal position of rest. Markovich, the renowned neurologist, found that the most common headache is the type caused by neuromuscular skeletal imbalance.
Look at how many muscles are prone to, "spastic shortening and fibrotic changes". Schaffer then uses a word descriptor that I use a lot when I talk about this problem --- "tether". He is exactly correct; the Scar Tissue that is more appropriately called FIBROSIS, has the ability to TETHER those it gets its claws in. The real problem is that 'tethering' always leads to a host of downstream problems that culminate in various sorts of neurological deficits and physical degeneration (HERE). And lest we forget; CHRONIC PAIN.
Despite the fact that Fascia is so often ignored by practitioners of all sorts, it's not like you could really call it a "fad". Back in 1950, Dr. ES Meyers published The Deep Cervical Fascia: A Study in Structural, Functional and Applied Anatomy. Not quite a century before that, Henry Gray and Henry VanDyke Carter were publishing their amazing anatomy atlas, Gray's Anatomy. But even that is nothing new. Back in April of 1489, Leonardo Da Vinci, began writing his book, "On the Human Figure". Now, over 500 years later, let's use our computers to take a brief look at some of this anatomy ourselves.
If we were to peel away the skin in the neck region, we would find the Superficial Cervical Fascia, which is continuous with the Fascia from both the deltoid (shoulder) and pectoral (chest) muscles, which travels over the top of the clavicle, and becomes continuous with the PLATYSMA MUSCLE as well. Everything underneath the Superficial Cervical Fascia is considered to be Deep Cervical Fascia. What's interesting is the quantum variation in description and layers of the Deep Cervical Fascia (HERE or HERE), which itself is divided into three different layers --- superficial (investing), middle (pretracheal), and deep (prevertebral). When studying the attachment points of the investing layer, the most interesting feature I personally found was that it actually attached to the zygomatic arch (cheek bone), which helps to explain certain cases of FACE OR SKULL PAIN --- particularly in people who were not actually hit in the face.
While looking at a sharing site, where medical students post their class notes for everyone to see, I found this interesting comment in a long group of notes (Useful Notes on the Deep Cervical Fascia of Human Neck), which other than this sentence, completely stuck to anatomy. "Collection of inflammatory exudate beneath this fascia produces severe radiating pain." As is always the case, INFLAMMATION, whether systemic or local can be a huge problem, hypersensitizing nerves and potentially leading to TYPE III PAIN and even CENTRAL SENSITIZATION. But this isn't the only problem related to the Cervical Fascia; not by a long shot!
Because of TISSUE REMODELING, I've had several people get their sense of smell back after decades of having lost it (two of them thirty years or more) as well as seeing interesting changes in other special senses (HERE for instance). One of the many problems associated with the Deep Cervical Fascia in peer-review is something called Cervical Vertigo. I guess because I've seen this a bunch of times in practice, I always suggest that people struggling with VERTIGO try conservative treatment before going the medical route (in many cases I see these folks after they've already been the medical route). Engineer and sufferer Pavel Kotlykov put a well-bibbed website together over at Vertigo Treatment dot org, and in his article Cervical Vertigo Caused by Neck Postures, stated.....
"The etiology of cervicogenic vertigo can be traced to pathophysiological changes in the inner ear, head or neck region. Despite the somewhat ominous-sounding name, “cervicogenic dizziness” is simply a variety of vertigo brought on by conditions related to the neck (or cervico-), and one of several “vestibular” apparatus disorders associated with the inner ear. Among the symptoms commonly associated with this form of vertigo are neck pain and/or stiffness, headache, distorted vision, nausea, ear congestion, sweating, and tinnitus—to varying degrees." One of the specific causes mentioned by the authors included, "Vascular compression of the vertebral arteries in the neck by the vertebrae and other structures (Sakaguchi and Kitagawa et al. 2003), especially, compression due to incongruity of the origin of the vertebral artery, an inconsistent course between the fascicles of either longus coli and bands of deep cervical fascia (Bogduk, 1986) have been shown to be associated with obstruction of blood flow while turning the neck. Spasm of the vertebral arteries can occur due to their close association with the sympathetic trunk (Bogduk, 1986)."
We see here that over three decades ago one of the most renowned WHIPLASH RESEARCHERS of the twentieth century (Nikolai Bogduk) was talking about the relationship between Fascia and THE SYMPATHETIC NERVOUS SYSTEM. The biggest problem with the whole I-think-fascia-may-be-causing-my-problem scenario is that fascia doesn't show up on tests (HERE) --- at least it doesn't show up on the standard advanced imaging tests commonly used by the medical community after trauma (CT), or after the situation becomes chronic (MRI). The interesting thing is, there are actually tests available that allow you to image Fascia, but for whatever reasons, they aren't commonly used. However, as the technology behind Diagnostic Ultrasound continues to improve, practitioners are increasingly able to image Fascial Adhesions (HERE is a really cool example using two 10 second videos for side-by-side comparison).
Last July, the OSTEOPATHIC journal Research Bank (Reliability of Deep Cervical Fascia and Sternocleidomastoid Thickness Measurements Using Ultrasound Imaging) concluded that, "Recent literature has provided a hypothetical framework for the possible role of fascia within myofascial pain. This hypothesis involves structural alteration of deep cervical fascia within the loose connective tissue layer, as observed through ultrasound imaging (USI). This structural alteration has been termed ‘densification’, and has been associated with increased fascia thickness and reduced tissue compliance." The authors came to the conclusion that while it was fairly easy to measure the thickness of the SCM using a novice operator, in order to measure the thickness of the fascia surrounding the SCM required an advanced operator. Oh, and because the authors mentioned the term "DENSIFICATION," it might behoove you to read the short post I wrote on the topic.
This next study (Ultrasound Assessment of Fascial Connectivity in the Lower Limb During Maximal Cervical Flexion), published in last July's issue of BMC Sports Science, Medicine & Rehabilitation looked at just how interconnected the body really is because of Fascia. The authors stated, "The fascia provides and transmits forces for connective tissues, thereby regulating human posture and movement. One way to assess the myofascial interaction is a fascia ultrasound recording. The present analyses suggest statistically significant displacement of deep fascia."
In other words, when subjects sitting in a "kyphotic" or "flexed" posture (bent forward --- THE POSTURE OF AGE) moved their chins towards their chests as far as they could go (MAXIMAL CERVICAL FLEXION), it moved the Fascia in their calves enough to be able to measure it. Not only is this very cool for a wide variety of reasons they mentioned in their paper, it proves just how interconnected the body is by fascia (HERE). It also shows that Tom Meyers (ANATOMY TRAINS) and Dr. Janda (UPPER CROSSED SYNDROME / LOWER CROSSED SYNDROME) were right all along, how Fascia is able to act as a second nervous system (HERE), and even how it provides a potential basis for a great deal of sickness and disease (HERE) --- not merely pain --- when not working properly. If you enjoy posts on fascia, be sure and take a look at my FASCIA SUPER-POST, with all 160+ of our posts on fascia categorized for easy reference. And be sure to like us on FACEBOOK while you're at it!
CHRONIC NECK PAIN
SUBLUXATION, SCAR TISSUE (FASCIA), OR TRIGGER POINTS?
As I start my 26th year of practice, I have to admit that I've figured a few things out. The first is that I rarely have anything completely figured out. So, while the following is certainly not true all the time and with every individual person --- anytime you deal with real people there are always plenty of outliers ---- it's true more often than not. Here are some simple evaluations that I automatically look for when seeing patients (you can do some of these at home).
- POSTURE: The very first thing I look at is posture. No; I'm don't make a list of every single thing that's not perfect like some people do. But when there is Forward Head Posture (FHP) present, you need to know that it is usually a very big deal. How do I recommend addressing it? Various sorts of EXTENSION THERAPY (ET) Just be sure to realize that you may have to be very intentional about the way you go about doing this (HERE). Also remember that ET is not usually the best place to jump in with treatment; particularly true in people with greater problems. For the record, FHP is rarely just a Subluxation issue.
- RANGE OF MOTION: NORMAL ROM'S ("sectional" ranges of motion) are utterly simple to check. They'll also frequently fool you. Why? Because there are lots of people out there (especially younger or petite women) who have restricted neck motion even though according to the charts, it looks "normal" (HERE). And while sectional motion is fairly easy, you'll have to be proficient in MOTION PALPATION to effectively check SEGMENTAL MOTION (for instance, is C4 moving properly on C3?). Thus, problems with ROM can be either Subluxation or Scar Tissue --- sectional or segmental. I've gotten to the point that with MOST NEW PATIENTS, I simply check both.
- SUBLUXATION: These are the vertebra that have lost their normal alignment and / or motion in relationship to each other. It also happens to be the area where most chiros live. Don't get me wrong, addressing SUBLUXATION is a big deal --- a really big deal. The truth is, I spend the biggest part of my normal office hours dealing with Subluxations. But all too often (HERE and HERE are examples), people are getting lots of adjustments with only short-term relief. Why is this? Click the bracketed links and the picture will become clearer.
- SCAR TISSUE: When you adjust people who have lots of SCAR TISSUE and ADHESED FASCIA without addressing it first, a couple of things happen. Firstly, because these individuals are perpetually "TETHERED," they'll only hold adjustment for a short time (HERE). Secondly, FIBROTIC TISSUES in the area not only make it difficult for patients to hold their adjustment, they can make it very difficult to even perform the adjustment. If a person has only half the normal range of neck motion because of copious amounts of Scar Tissue (extremely common), getting them to the point to actually get a good adjustment without addressing said tissue can present a significant challenge (it's either uncomfortable for the patient, or it simply doesn't work). And none of this deals with THE MANY OTHER REASONS that Scar Tissue is so often the "Perfect Storm" of Chronic Neck Pain.
- TRIGGER POINTS: In some ways, TRIGGER POINTS are the wild card in this equation. If they are active (or crazy overactive), they have the ability to affect tissue and subluxation alike (HERE). TP's are hard marble-sized or pea-sized nodules of chronically contracted muscle --- not to be confused with a muscle spasm, although they can be very related (see last link). Start digging around with a thumb or fingers, and when you get to a hard knot, start rubbing over it back and forth. Most of the time you can feel the knots kind of "squishing" and "popping" as you run your thumb over them. Difficult to describe, but once you feel it you'll never forget it. Just remember that TP's are common in the neck (Traps, LEVATOR, Scalenes, SCM, etc, etc, as well as the Pec Minor, which, while not in the neck, are involved in many of these cases).
- INFLAMMATORY LOAD: Although there are many people who couldn't care less about addressing this last point (unless they can DO IT WITH DRUGS), skipping it has the potential to be a deal-breaker due to CHRONIC SYSTEMIC INFLAMMATION. Why? Namely because inflammation always leads to fibrosis (the medical word for Scar Tissue) and fibrosis always leads to degeneration --- NO EXCEPTIONS. This is why if you are trying to solve your Chronic Neck Pain and the things that so frequently go along with it (HEADACHES are definitely the big dog in this category), you are working against yourself if you have INFLAMMATION coursing through your body. HERE is a little self-test for determining whether or not you are inflamed.
Each one of these problems has to be dealt with a bit differently. This is why trying to deal with every patient the same way is doomed to fail with lots of them. Honestly, this post is just a little bit different way of looking at PHASE I NECK REHAB -vs- PHASE II NECK REHAB. Oh; and for those of you who may have be dealing with a concussion or head injury on top of everything else --- particularly one that involved LOSS OF CONSCIOUSNESS --- you need to read THIS, THIS, and THIS.
IS YOUR CHRONIC NECK PAIN AFFECTING YOUR BRAIN AND NERVOUS SYSTEM?
"Chronic musculoskeletal pain is one of the most intractable clinical problems faced by clinicians and can be devastating for patients. Perhaps no other symptom induces such fear and loathing as chronic pain. Most images of pain are focused on portraying negative emotions and the intrusive nature of the pain experience. Clinicians as people fear chronic pain, a symptom that demands attention and intrudes into every aspect of a person's life. Clinicians also loathe chronic pain, perhaps the symptom that brings more patients into our practices than any other but also the symptom most likely to make us feel helpless as healers" Dr. Leslie Crofford from a 2015 issue of the Transactions of the American Clinical And Climatological Association (Chronic Pain: Where the Body Meets the Brain)
"Some recent studies have also shown that chronic pain can actually affect a person’s brain chemistry and even change the wiring of the nervous system. Cells in the spinal cord and brain of a person with chronic pain, especially in the section of the brain that processes emotion, deteriorate more quickly than normal, exacerbating many of the depression-like symptoms. It becomes physically more difficult for people with chronic pain to process multiple things at once and react to ongoing changes in their environment, limiting their ability to focus even more. Sleep also becomes difficult, because the section of the brain that regulates sense-data also regulates the sleep cycle. Untreated pain creates a downward spiral of chronic pain symptoms, so it is always best to treat pain early and avoid chronic pain." Integrative Pain Center of Arizona (The Long-Term Effects of Untreated Chronic Pain)
"Chronic pain is certainly a difficult condition to live with, affecting everything from your activity levels and your ability to work to your personal relationships and emotional states. But did you know that it could also be affecting your brain and the way that it functions? Chronic pain doesn’t just affect a singular region of the brain, but in fact results in changes to multiple important regions, which are involved in many critical functions and processes. Various studies over the years have found changes to the hippocampus, in addition to reduction of gray matter in the dorsolateral prefrontal cortex, amygdala, brainstem and right insular cortex, to name a few. Pain’s effects on the brain may seem overwhelming, but there’s good research to suggest that the changes are not permanent; they can be reversed when patients receive treatment for their painful conditions. “Gray matter abnormalities found in chronic pain,” a 2009 study concluded, “do not reflect brain damage, but rather are a reversible consequence … which normalizes when the pain is adequately treated.” The 2011 study concurred, suggesting that “treating chronic pain can restore normal brain function in humans.”" From Brenda Poppy's post (How Pain Can Seriously Affect Your Brain) on the Pain Management Resource Blog
I showed you via the first link of the previous paragraph that those of you living with Chronic Pain are degenerating your brains at a rate 10 times higher than the general population. Unfortunately, that's just the tip of the iceberg. Thanks to Chronic Neck Pain, some people wind up living with things like FIBROMYALGIA and CENTRAL SENSITIZATION. Allow me to show you how crazy the newest studies on this topic really are specifically for those of you struggling with Chronic Neck Pain.
- ABNORMAL BRAIN ACTIVITY AND CHRONIC NECK PAIN: Sure, we've seen that generalized Chronic Pain leads to abnormalities in the brain, but what about Chronic Neck Pain specifically? A study from February's issue of the Journal of International Medical Research (Abnormality of Spontaneous Brain Activities in Patients with Chronic Neck and Shoulder Pain) answers this question by saying, "Most chronic pain diseases are accompanied by structural and functional changes in the brain. This initial structural and functional MRI study of CNSP (chronic neck and shoulder pain) revealed characteristic features of spontaneous brain activity of CNSP patients." Believe me when I tell you that spontaneous brain activity (activity that happens out of the blue for no good reason) is never a good thing.
- CONCUSSIONS, BRAIN ISSUES, AND CHRONIC NECK PAIN: Last month's issue of Medicine (Concussion / Mild Traumatic Brain Injury-Related Chronic Pain in Males and Females) concluded that, "Of the 94 participants diagnosed with mTBI, head/neck and bodily pain were reported by 93% and 64%, respectively...... a primary complaint of head and/or neck, or bodily pain that persists long after concussion – one of the most common types of mild traumatic brain injury (mTBI) – represents an activation of brainstem structures." Not only have I shown you that HEAD INJURIES are bad news in ways the general public CANNOT BEGIN TO COMPREHEND, but loss of consciousness (LOC) is a huge deal when it comes to Chronic Neck Pain. "Participants who experienced LOC during the concussive event and those who reported head and neck pain had significantly higher pain scores than those who did not experience LOC and those without head and neck pain."
- CHRONIC NECK PAIN, NECK DYSFUNCTION, AND MIGRAINE HEADACHES: In a study from January's issue of the European Journal of Physical and Rehabilitative Medicine (Musculoskeletal Disorders of the Upper Cervical Spine in Women with Episodic or Chronic Migraine), we see just how devastating this link between Chronic Neck Pain and MIGRAINE HEADACHES really is. The authors, a group of doctors and researchers from Spain and Brazil, concluded that, "Women with migraine showed reduced cervical rotation compared to healthy women. Significant differences for flexion- rotation test were also reported, suggesting that upper cervical spine mobility was restricted in both migraine groups. Referred pain elicited on manual examination of the upper cervical spine mimicking pain symptoms was present in 50% of migraineurs." For more on the Upper Cervical Subluxation and its ability to adversely affect the brain, I talked a bit about it the other day (HERE).
- CHRONIC NECK PAIN, CATASTROPHISING, AND DEPRESSION: When it comes pain, there are catastrophizers (it's the worst ever --- SOCCER FLOPPERS) and minimizers (it's no big deal, I'm fine --- MONTY PYTHON'S BLACK KNIGHT). Two studies from 2016, one from Medicine (Factors Associated with Increased Risk for Pain Catastrophizing in Patients with Chronic Neck Pain) and the other from the Pan African Medical Journal (Chronic Neck Pain and Anxiety-Depression: Prevalence and Associated Risk Factors) had some things to say about ANXIETY / DEPRESSION and their link to Chronic Neck Pain. Even though doctors want to way over-emphasize Depression's causal role in Chronic Pain, I've always argued that the opposite is a far more accurate description of what's really going on --- pain is causing the Depression. "Chronic neck pain is a frequent reason for consultation. It's a highly prevalent condition with about two thirds of the adult population affected at some time in their lives. 10% neck pain recurs or persists with consequences which are responsible for physical disability and high health care cost. In our study which concerned eighty patients with chronic neck pain, a state of anxiety was found in 68.4% cases, and 55.7% patients had depression. High pain intensity, clinical insomnia, and a high level of depression/anxiety were strongly associated with high pain catastrophizing in patients with chronic neck pain. Depression was the strongest predictor of high pain catastrophizing. In conclusion, poor psychological states should be addressed as an important part of pain management in chronic neck pain patients..." You'll see how this is done shortly.
- CHRONIC NECK PAIN, CHRONIC TRIGGER POINTS, AND ABNORMAL NERVOUS SYSTEM FUNCTION: There are two sides of the "Myofascial" coin; TRIGGER POINTS and FASCIAL ADHESIONS. Both can be brutal, and while in most cases intimately linked to each other, are not the same thing. A year ago in June, the journal Pain Medicine published a study called Prevalence of Myofascial Pain Syndrome in Chronic Non-Specific Neck Pain. "Chronic non-specific neck pain is a frequent complaint. In recent years, case reports about myofascial pain syndrome (MPS) are emerging among patients suffering from pain. MPS is a regional pain syndrome characterized by myofascial trigger points (MTrP) in palpable taut bands of skeletal muscle that refer pain to a distance, and that can cause distant motor and autonomic effects. All participants presented with MPS. MTrPs of the trapezius muscles were the most prevalent, in 93.75% of the participants. Furthermore, active MTrPs in the levator scapulae, multifidi, and splenius cervicis muscles reached a prevalence of 82.14%, 77.68%, and 62.5%, respectively. MPS is a common source of pain in subjects presenting chronic non-specific neck pain." Now check this out. A study from a 2011 issue of Chinese Medicine (Myofascial Trigger Points: Spontaneous Electrical Activity and its Consequences for Pain Induction and Propagation) stated, "Active MTPs contribute significantly to the regional acute and chronic myofascial pain syndrome apart from localized pain conditions, such as chronic tension type headache and migraine, myofascial low back pain, chronic prostatitis/chronic pelvic pain syndrome in men, lateral epicondylalgia [HERE], headache, mechanical neck pain, whiplash syndrome and fibromyalgia. Current evidence shows that spontaneous electrical activity at myofascial trigger point originates from the extrafusal motor endplate. The spontaneous electrical activity represents focal muscle fiber contraction and/or muscle cramp potentials depending on trigger point sensitivity. Active myofascial trigger points may play an important role in the transition from localized pain to generalized pain conditions via the enhanced central sensitization, decreased descending inhibition and dysfunctional motor control strategy." Although there is a lot here, suffice it to say that TP's usually indicate that something is fouled up in the nervous system. Read my link on Trigger Points above to see how to successfully address them.
- WHIPLASH WILL SCREW YOU UP IN WAYS YOU COULD NOT HAVE IMAGINED UNTIL YOU WERE REARENDED: After talking extensively about how medicine was on the cusp of solving the WHIPLASH PROBLEM, the authors of last October's issue of the Journal of Orthopedic and Sports Physical Therapy (Whiplash Continues it's Challenge) had to admit that, "management of whiplash, especially the challenge of lessening the rate of transition to chronicity, has yet to be achieved." A 2015 issue of BMC Public Health echoed that thought with a study (Five Years After the Accident, Whiplash Casualties Still Have Poorer Quality of Life in the Physical Domain than Other Mildly Injured Casualties) that let us know that, "Defined as an acceleration-deceleration mechanism in the neck, whiplash is the most common injury in road accidents, particularly for motorist. Considered a minor injury, whiplash is reported to generate both short and long-term consequences, such as neck pain, headache, dizziness, sensory disorder and reduced neck mobility. In most studies described in the international literature, more than half of whiplash casualties reported non-recovery one year after the accident. Five years after the accident, whiplash casualties were twice as likely to report pain as non-whiplash casualties (40.7 % vs. 22.2 %). Whiplash casualties suffered from neck pain." Furthermore, after looking at just under 400 studies on the topic, Belgian researchers writing in last April's Manual Therapy (Does Muscle Morphology Change in Chronic Neck Pain Patients?) revealed that muscles can be so screwed up by whiplash injury that they sometimes turn to fat. "Increasing evidence suggests that morphological muscle changes, including changes in cross-sectional area (CSA) or fatty infiltration, play a role in chronic neck pain. Fatty infiltration, which could be accountable for an increased CSA, of both cervical extensors and flexors seems to occur only in patients with WAD." By the way, WAD stands for Whiplash Associated Disorders (HERE).
- WHIPLASH, NECK PAIN, AND BLOOD FLOW TO THE BRAIN: Last August's issue of EBioMedicine (Altered Regional Cerebral Blood Flow in Chronic Whiplash Associated Disorders) said that, "There is increasing evidence of central hyperexcitability in chronic whiplash-associated disorders (cWAD). WAD includes neck pain and headache as the most frequent symptoms. Although WAD includes regional neck symptoms, the common presence of psychological manifestations suggests the involvement of central nervous system processes in WAD symptom presentation." What could possibly be causing some of this mess? Among other things, researchers have discovered that, "The present study shows that, compared with healthy volunteers, chronic WAD patients have increased perfusion of the right posterior cingulate gyrus and right precuneus, and decreased perfusion of the right superior temporal gyrus, right parahippocampal gyrus, left inferior frontal gyrus, right dorsomedial thalamus, and in the bilateral insular cortex." In other words, with WAD, the blood flow to the brain is all kinds of screwed up. The real problem is that this is known to lead to "LEAKY BRAIN / NERVE / CORD SYNDROME".
- YOU CAN'T FIX WHIPLASH ASSOCIATED DISORDERS (INCLUDING CHRONIC NECK PAIN) WITH DRUGS: Get in a whiplash accident and I promise you will be prescribed drugs --- probably lots of drugs (PAIN MEDS, NSAIDS, MUSCLE RELAXERS, and if chronic, CORTICOSTEROIDS and ANTI-DEPRESSANTS. The thing is, I've shown you over and over again via peer-review that this approach does not only not work, it's DOWNRIGHT DANGEROUS. "Whiplash-associated disorder (WAD) is a group of symptoms and clinical manifestations resulting from rear-end or side impact. Despite the wide use of medications in WAD, the published research does not allow recommendations based on high evidence level. In chronic WAD, the use of nonsteroidal anti-inflammatory drugs is more concerning due to potential gastrointestinal and renal complications with prolonged use and lack of evidence for long-term benefits. Antidepressants can be used in patients with clinically relevant hyperalgesia, sleep disorder associated with pain, or depression. Anticonvulsants are unlikely first-choice medications, but can be considered if other treatments fail. The use of opioids in patients with chronic pain has become the object of severe concern, due to the lack of evidence for long-term benefits and the associated risks. Extreme caution in prescribing and monitoring opioid treatment is mandatory. As for any chronic pain condition, concomitant consideration of rehabilitation and psychosocial interventions is mandatory." In other words, since all the medical community has to offer you is THE BIG FIVE, you might want to take a rain check and look into something that actually addresses the underlying problem instead of merely covering the symptoms.
- CHRONIC NECK PAIN AND ABILITY TO BREATHE: Remember that the level of C1 (Atlas) has the potential to affect breathing via the part of the brainstem known as the Medulla Oblongota. A brand new review of almost 80 studies from this month's American Journal of Physical Medicine and Rehabilitation (The Association Between Neck Pain and Pulmonary Function) concluded that, "Significant difference in maximum inspiratory and expiratory pressures were reported in patients with chronic neck pain compared to asymptomatic subjects. Some of the respiratory volumes were found to be lower in patients with chronic neck pain. Muscle strength and endurance, cervical range of motion, and psychological states were found to be significantly correlated with respiratory parameters. Lower Pco2 in patients and significant relationship between chest expansion and neck pain were also shown. Respiratory retraining was found to be effective in improving some cervical musculoskeletal and respiratory impairment. Functional pulmonary impairments accompany chronic neck pain." The truth is, breathing is one of the most-affected (in a good way) arenas when it comes to chiropractic adjustments (HERE).
- VISUAL EFFECTS AND VERTIGO: A study from January's issue of Frontiers in Neurology (Inaccurate Saccades and Enhanced Vestibulo-Ocular Reflex Suppression during Combined Eye–Head Movements in Patients with Chronic Neck Pain: Possible Implications for Cervical Vertigo) determined about Chronic Neck Pain and VERTIGO that, "In patients with chronic neck pain, the internal commands issued for combined eye–head movements have large enough amplitudes to create accurate gaze saccades; however, because of increased neck stiffness and viscosity, the head movements produced are smaller, slower, longer, and more delayed than they should be. VOR suppression is disproportionate to the size of the actual gaze saccades because sensory feedback signals from neck proprioceptors are non-veridical, likely due to prolonged coactivation of cervical muscles. The outcome of these changes in eye–head kinematics is head-on-trunk stability at the expense of gaze accuracy. In the absence of vestibular loss, the practical consequences may be dizziness (cervical vertigo) in the short term and imbalance and falls in the long term." By the way, saccades (a normal eye movement) are defined as quick (ballistic) movement of both eyes simultaneously between two or more points in the same direction.
- CHRONIC NECK PAIN AND DHEA: You may have heard of DHEA before as a nutritional supplement. The reason is that (according to a well known online encyclopedia), DEHA is "also known as androstenolone and is an endogenous steroid hormone. It is the most abundant circulating steroid hormone in humans, in whom it is produced in the adrenal glands, the gonads, and the brain, where it functions predominantly as a metabolic intermediate in the biosynthesis of the androgen and estrogen sex steroids." In other words, no DHEA, and you can count on FEMALE PROBLEMS, INFERTILITY, LOW T, and SEXUAL DYSFUNCTION. Another study ---- this one from the August issue of Pain Medicine (Different DHEA-S Levels and Response Patterns in Individuals with Chronic Neck Pain, Compared with a Pain Free Group) compared groups of "persons with chronic neck pain and controls without present pain." The authors, all Swedish doctors and researchers, concluded that, "the plasma DHEA-S levels appeared to be lower among the persons with chronic neck pain, compared with the control group."
- CHRONIC NECK PAIN AND INSOMNIA: INSOMNIA sucks (as does SLEEP APNEA) and is frequently a function of something called SYMPATHETIC DOMINANCE. The November 2015 issue of Pain Physician (Factors Associated with Increased Risk for Clinical Insomnia in Patients with Chronic Neck Pain) concluded that, "Insomnia is highly prevalent among people with chronic pain conditions. Because insomnia has been shown to worsen pain, mood, and physical functioning, it could negatively impact the clinical outcomes of patients with chronic pain. Neck pain development; 22.9% of patients met the criteria for clinically significant insomnia. In analysis, high pain intensity, the presence of musculoskeletal pain, and a high level of depression were strongly associated with clinical insomnia in patients with CNP. Among these factors, a greater level of depression was the strongest predictor of clinical insomnia. This study was conducted in a single clinical setting including a selected study population with a homogeneous racial background. Insomnia should be addressed as an indispensable part of pain management in CNP patients with these risk factors, especially depression." The problem is, the medical community is going to address it with one of the most dangerous drugs on the market --- SLEEPING PILLS.
- BRAIN, MEMORY, AND CHRONIC NECK PAIN: I've shown you how in people with TYPE III PAIN, their pain plays on a loop --- sort of like the cassette tape of a bad memory going around and around and around on auto-reverse (anyone older than 35 will understand). A study from January's edition of Pain Physician (Neural Correlates of Maladaptive Pain Behavior in Chronic Neck Pain - A Single Case Control MRI Study). "Functional magnetic resonance imaging (fMRI) showed distinct brain activation patterns that depended on the side of rotation (pain-free versus painful side) and the kind of movement (distracted versus non-distracted head rotation). Interestingly, brain areas related to the processing of pain such as primary somatosensory cortex, thalamus, insula, anterior cingulate cortex, primary motor cortex, supplementary motor area, prefrontal cortex, and posterior cingulate cortex were always more strongly activated in the non-distracted condition and when turning to the left. In the patient, maladaptive pain behavior and the activity of pain-related brain areas during imagined head rotations were task-specific, indicating that the activation and/or recall of pain memories were context-dependent."
- CORRECTING FORWARD HEAD POSTURE AFFECTS BRAIN: I've shown you a bunch of studies revealing how bad FHP (Forward Head Posture) really is --- not to mention the fact that it's intimately associated with Chronic Neck Pain (HERE). Not surprisingly, a study from last October's issue of Physical Therapy Science (Effects of Neurofeedback Training on the Brain Wave of Adults with Forward Head Posture) showed that it affects the brain as well. "Owing to the prevalence and popularity of computers, students and workers are increasingly experiencing musculoskeletal abnormalities in their neck and shoulders. Using computers and smart phones for many hours, coupled with lack of exercise, may cause stiffness of the muscles in the neck and shoulders, inducing weakness in the soft tissues. Such postural and lifestyle habits lead to forward head posture (FHP), which can cause relative compensation such as increased lordosis in the junction of the skull and neck [a hump] consistent muscular contraction inducing changes in the craniocervical junction. Posture affects people in terms of psychological, physical, structural, and functional changes. Specifically, bad posture is thought to increase the possibility of a decline in learning efficiency, attention, and memory. The column and the brain, in particular, are closely situated in terms of anatomical structures. According to previous research, FHP may induce a reduction in proprioceptive sensibility, in addition to interference between the nerves and the muscles. These problems may, in turn, affect an individual’s mind and emotions. It is thought that neurofeedback training, a training approach to self-regulate brain waves, enhances concentration and relaxation without stress, as well as an increase in attention, memory, and verbal cognitive performance. Therefore an effective intervention method to improve neck pain and daily activities." While this is well and good, there are ways to deal with FHP that actually help correct it --- not just manage it. But.........
- FHP CANNOT BE CORRECTED WITH ADJUSTMENTS ALONE: The December 2015 issue of the journal, Chiropractic and Manual Therapies published a study called Does Cervical Lordosis Change After Spinal Manipulation for Non-Specific Neck Pain? In this study, the authors (a group of European chiros and research scientists) looked at sixty volunteers who underwent several weeks of chiropractic adjustments. Not surprisingly, and as I have told you time and time again, adjustments alone never solve the reverse cervical curve (FHP). "This study found no difference in cervical lordosis (sagittal alignment) between patients with mild non-specific neck pain and matched healthy volunteers. Furthermore, there was no significant change in cervical lordosis in patients after 4 weeks of cervical spinal manipulation." The good news is, there are things you can do to help reverse the reversed cervical curve, and most of them can be done at home under the supervision of a competent chiropractor (HERE).
- NECK ADJUSTMENTS AFFECT BRAIN AND METABOLIC PATHWAYS: Knowing the numerous ways that CHIROPRACTIC ADJUSTMENTS AFFECT THE NERVOUS SYSTEM, we should not be surprised to find a study showing us that adjustments affect metabolic pathways as well. The January 2017 issue of Evidence-Based Complementary and Alternative Medicine (Glucose Metabolic Changes in the Brain and Muscles of Patients with Nonspecific Neck Pain Treated by Spinal Manipulation Therapy) looked at PET Scans --- remember that PET Scans are used to find cancer by finding areas of increased sugar uptake (HERE) --- of people with Chronic Neck Pain, determining that, "Glucose uptake in skeletal muscles showed a trend toward decreased metabolism after SMT (spinal manipulative therapy)... Other measurements indicated relaxation of cervical muscle tension, suppression of sympathetic nerve activity, and pain relief after SMT. Brain processing after SMT may lead to physiological relaxation via a decrease in sympathetic nerve activity." Again, why is this a big deal? Can anyone say "SYMPATHETIC DOMINANCE"? Chiropractic adjustments have been shown time and time again to help down-regulate the Sympathetic Nervous System (the "fight or flight" response) that so frequently ruins people's lives when it is flipped to the "on" position.
- STRESS MANAGEMENT AND COGNITIVE BEHAVIORAL THERAPY FOR THOSE WITH CHRONIC NECK PAIN DRAMATICALLY IMPROVES OUTCOMES: Last May's respective issues of the Journal of Back and Musculoskeletal Rehabilitation (Effect of a Stress Management Program on Subjects with Neck Pain) and Clinical Rehabilitation (Group-Based Multimodal Exercises Integrated with Cognitive-Behavioral Therapy Improve Disability, Pain and Quality of Life of Subjects with Chronic Neck Pain) concluded that, "A group-based multidisciplinary rehabilitation program including cognitive-behavioral therapy was superior to group-based general physiotherapy in improving disability, pain and quality of life of subjects with chronic neck pain. The effects lasted for at least one year. Stress management has positive effects on neck pain patients." This is not really anything new as the venerable Hans Seleye (AN ENDOCRINOLOGIST) was discovering the General Adaptation Syndrome and HPA-Axis back in the 1930's and 40's.
Knowing this information is great. After all, knowledge really is power (HERE). However, the real rubber-meets-the-road question is what are you who are struggling going to do with it? In other words, how can you, the Chronic Neck Pain sufferer, use this information to help your cause, decrease your pain, and increase your ability to function on a day to day basis? Glad you asked.
- FIRSTLY: You must understand the difference between acute inflammation and chronic inflammation, and control the latter (HERE). Diet plays a huge roll in this, and the diet I recommend to my patients helps control CHRONIC INFLAMMATION like nothing you've ever seen before (HERE).
- SECONDLY: You will need to read a bit about PHASE I and PHASE II of solving the underlying physical / mechanical basis of your neck pain. If you fail to address these, or address them out of order, I promise that your results will be compromised --- especially in people with the more severe problems. For those of you who are really struggling, this can be difficult (HERE).
- THIRDLY: You are going to have to learn how to control your thoughts and fears, get active, and develop strategies to cope with the situation. While formal group CBT (Cognitive Behavioral Therapy) mentioned earlier can be fantastic, many of you will find the same level of therapeutic benefit by becoming part of a community on an internet message board. I don't really care how you go about it, but you are going to need some sort of sounding board and support group, possibly someone with letters behind their name.
- FOURTHLY: Purchase your own pain aids and modalities. There are any number of great "gizmos" that have amazing potential modulate / down-regulate Chronic Neck Pain. COLD LASER is amazing as is WHOLE BODY VIBRATION. Electric massagers, Theracanes or similar, FOAM ROLLERS, EXTENSION AIDS and EXERCISE BALLS, cervical pillows, home traction devices (over-the-door, DAKOTA, or any number of others), heat lamps, and even ULTRASOUND as long as you use it correctly / safely...... And that's just for starters. There are almost an infinite number of things out there that can help you help yourself. The tough part is trying to wade through the sales pitches by those individuals and companies PREYING ON PEOPLE WITH CHRONIC PAIN.
- FIFTHLY: Educate yourself. As I said earlier, knowledge is power. Find people or sites and study. What makes my site different than most others is that I'm not trying to sell you anything. My goal is to weed through the sales pitches and BS so that you can have the facts, the whole facts and nothing but the facts. Just realize that when it comes to science, the facts are (FOR ANY NUMBER OF REASONS) constantly changing.
Don't kid yourself. This list could be infinite if I had the time to sit down and write a book. HERE is a bit more in-depth information on how you might accomplish some of these things. And as I always suggest to people, after studying the situation, sit down and create a personalized EXIT STRATEGY for yourself --- a way to take your life back and start living again. If you want to see some examples of this in action, take a look at some of our CASE HISTORIES.
Dr. Schierling completed four years of Kansas State University's five-year Nutrition / Exercise Physiology Program before deciding on a career in Chiropractic. He graduated from Logan Chiropractic College in 1991, and has run a busy clinic in Mountain View, Missouri ever since. He and his wife Amy have four children (three daughters and a son).
Brain Based Therapy
Can You Help
Cardio Or Strength
Cold Laser Therapy
Death By Medicine
Degenerative Joint Disease
D's Of Chronic Pain
Evidence Based Medicine
Gluten Cross Reactivity
Ice Or Heat
Jacks Fork River
Leaky Gut Syndrome
Number One Health Problem
Platelet Rich Therapy
Post Surgical Scarring
Re Invent Yourself
Rib And Chest Pain
Scar Tissue Removal
Sleeping Pills Kill
Stay Or Go
Stretching Post Treatment
Tensegrity And Fascia
The Big Four
Thoracic Outlet Syndrome
Whole Body Vibration