Mid-Back Pain and Its Causes

Posted on February 24, 2023 by Dr. Timothy Durnin

The thoracic portion of the spine the longest part of the spine and is made up of twelve vertebrae (T1-T12), which lies between the cervical spine (C1-C7) and the lumbar spine (L1-L5). The thoracic spine protects the very important spinal cord that begins in the brain and runs down to approximately T12 where the cord turns into what looks like a horse’s tail (the cauda equina). The spinal nerves then travel into the lumbar spine and sacrum (tailbone) and innervate the low back, pelvis, legs, and feet. Nerve roots exit at each vertebral level of the spine innervating the upper (cervical), middle (thoracic) and lower (lumbar) portions of the body.

Looking closer at the T1-T12 nerves, T1-T2 nerves innervate (motor/muscle and sensory/feeling) the top of the chest and the inner arms and hands (providing strength to the deep, intrinsic hand muscles). Nerves T3-T5 innervate the chest wall and help control the rib cage, lungs, and diaphragm (the breathing muscle that separates the chest cavity from the abdominal cavity). The T6-T12 nerves innervates the abdominal and back muscles that work with the lumbar nerves to help stabilize our core, balance, posture, and the coughing process.

The thoracic spine also supports the rib cage, which protects our lungs, heart, and its great vessels that supply our body with fresh, oxygenated (arterial) blood and trades off carbon dioxide (venous blood) for oxygen in the lungs each time we take a breath. All of this is done automatically, without effort or thinking, thanks to our autonomic nervous system (ANS— made up of sympathetic and parasympathetic nerves) of which many of the sympathetic nerves arise in the thoracic region!

Unlike the cervical and lumbar portions of the spine, which allow for a great deal of movement, the thoracic spine is much more rigid and stable, which leads to a lower risk for injury. Potential causes of mid-back pain include poor posture; prolonged sitting; or conditions like scoliosis (curvature) or hyper-kyphosis (increased “humping” of the TS); sprain of the ligaments that hold bones firmly together (usually by a sudden, unexpected movements or trauma); bruising, cracking, or fracturing of the ribs or thoracic vertebrae; compression fracturing due to osteoporosis; and overuse injuries from repetitive lifting, bending, and twisting.

Doctors of chiropractic are trained to evaluate and treat patients with MBP utilizing various forms of manual therapies (including spinal manipulation, mobilization, and massage), exercise training, posture retraining, and more.

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Posted in American Association of Spine Physicians, Back pain, back-pain, Chiropractic, mid back pain, Pain, Pinched nerve | Tagged , , , | Leave a comment

HIIT for Improving Shoulder Function

Posted on February 11, 2022 by Dr. Timothy Durnin

To restore function following a shoulder injury or surgery, it’s important for the patient to perform rehabilitative exercises.  While there are many classic exercises that are considered “standard” in rehab post-injury/surgery shoulder conditions, new research suggests that high-intensity interval training (HIIT) may be more effective.

High-intensity interval training is an exercise concept that is characterized by performing exercise at maximal intensity for short bursts of time followed by periods of low- or moderate-intensity activity. Studies have investigated various HIIT approaches with respect to length of time of maximum effort, rest periods, how many sets to perform during each session, and how often to engage in the exercise. In fact, there is some evidence to suggest individuals may achieve better outcomes in the long-term by mixing up their HIIT approach from time to time.

With respect to addressing the shoulder, in a 2021 study that included 21 patients with subacromial pain syndrome (SAPS), 13 were assigned to an HIIT exercise group and the rest to a usual care rehabilitative exercise group for eight weeks. Examinations conducted at the conclusion of the study period revealed that individuals in the HIIT group exhibited significant improvements in shoulder abduction endurance (by 233 seconds compared with the usual care group), shoulder pain, and shoulder disability. The HIIT group also experienced improved tendinous blood flow, as well as less pain while exercising. The authors concluded that the HIIT exercise approach results in better outcomes than usual care and that HIIT exercise is a feasible treatment approach for SAPS.

Chiropractors usually combine manual therapy with exercise training when treating patients with shoulder pain. This multi-modal treatment approach may also include various forms of physical therapy modalities such as electric stimulation, ultrasound, laser, pulsed electromagnetic field, shockwave therapy, and more.

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Manual Therapy for Cervicogenic Headaches

Posted on February 4, 2022 by Dr. Timothy Durnin

By some estimates, up to 20% of headaches are caused by a disorder of the cervical spine and its components (bone, disk, and soft tissue) usually accompanied by neck pain. It’s very common for patients with a cervicogenic headache to seek and receive manual therapies—like spinal manipulation and mobilization—from chiropractic care. Spinal manipulation is characterized by a high-velocity, low amplitude (HVLA) thrust accompanied by joint cavitation (release of gas causing a cracking sound) and spinal mobilization consists of slow, rhythmic, oscillating movements. Which approach is the most effective for this cervicogenic headaches?

In a 2016 randomized controlled study, researchers compared the effect of upper cervical and upper thoracic manipulation against mobilization plus exercises in a group of 110 patients with cervicogenic headache. Participants received six to eight treatments spread over four weeks, and researchers assessed headache intensity (0-100 scale), headache duration, disability, medication intake, and overall improvement at baseline, after one week of treatment, after four weeks of treatment, and after two months following the conclusion of care.

The data show that patients in the manipulation group experienced less frequent headaches and shorter headache duration at all follow-up points, greater overall improvement at the one-week and four-week time points, and greater reductions in headache intensity and disability at the final follow-up.  Patients in each group reported improvements compared with their baseline readings, which suggests that both manual therapies can benefit the cervicogenic headache patient. It’s very common for chiropractors to incorporate both approaches into a treatment plan, depending on the patient’s unique case, as well as their own training and clinical preferences. This multimodal approach may also include other manual therapies, traction, physical therapy modalities, nutrition recommendations, and specific exercises targeting the neck and upper back.

It’s also important to note that while this study focused on cervicogenic headache patients, dysfunction in the cervical spine and associated tissues may also play some role in other forms of headache, such as migraines. In fact, studies have demonstrated that migraineurs often have an increased number of trigger points in their cervical muscles and that treatment aimed at reducing these trigger points is associated with reduced headache frequency and intensity.

For patients suffering from headaches of any type, it may be prudent to consult with a doctor of chiropractic to assess the cervical spine for any issues that may contribute to their headaches.

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Lowering the Risk for Knee Osteoarthritis

Posted on October 15, 2021 by Dr. Timothy Durnin

Osteoarthritis is the most common chronic joint condition. It causes local inflammation and breakdown of cartilage with joint structural changes that provoke pain and loss of function that results in a considerable reduction in quality of life. Knee osteoarthritis (KOA) is one of the most disabling osteoarthritic conditions and it’s becoming more prevalent. So, what can be done to reduce the risk for osteoarthritis of the knee?

1) Weight loss. Obese men and women are four times more likely develop KOA than their non-obese peers! Past research suggests that a loss of 11 pounds (4.99 kg) can reduce KOA risk in some individuals by as much as 50%.

2) Exercise. Studies have shown that weakness of the quadriceps femoris (the front thigh muscle group) increases the risk of developing KOA. The good news is that strengthening exercises are very effective in reducing or eliminating that risk, as even a minor increase in strength is beneficial. Squat wall slides work well if the KOA is not too advanced. In which case, knee extension water exercises and/or light weights from sitting may be a better starting option. Your chiropractor will instruct you in this process. Additionally, cartilage does not have a blood supply and requires compression forces to draw nutrients into the tissue. Too much sedentary behavior can dehydrate the joints, elevating the risk for poor joint health.

3) Avoid knee injury.  A long-term study that included 1,321 graduates of Johns Hopkins Medical School reported that a knee injury can increase the risk of future KOA by three to five times! Such injuries can largely be avoided by the following: avoid knee bending greater than 90 degrees when squatting; avoid twisting the lower leg during activities; land with the bent knees when jumping; warm up before physical activity and cool down afterward; wear shoes that fit properly, provide shock absorption, and give stability; and exercise on soft surfaces if possible (avoid asphalt or concrete). If you have an injury, prompt care is very important, and modifying activities and/or utilizing a brace to help stabilize the joint is wise. Your chiropractic can guide you in this process!

4) Proper nutrition. Although there is no specific diet that can prevent KOA, an anti-inflammatory diet pattern, such as the Mediterranean diet, can help reduce inflammation in the joints.

Additionally, improper biomechanics that can result from dysfunction in the ankle, hip, and lower back can place excess stress on the knee. If you experience pain or disability in these areas, consult with your doctor of chiropractic as managing an ankle condition today could stave off a future problem in one or both knees. And if you’re experiencing pain in your knee, your doctor of chiropractic can help manage the condition with a multimodal approach that may include manual therapies, modalities, specific exercises, and nutritional advice.

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Traction for Low Back Pain

Posted on October 7, 2021 by Dr. Timothy Durnin

When it comes to a condition like low back pain, the care a patient receives can depend on case history and examination findings, as well as the doctor’s training and treatment preferences. For the patient with a lumbar disk pathology, a doctor of chiropractic may employ lumbar traction in combination with manipulation and joint mobilization techniques.

Lumbar traction (LT) is often performed on patients with radicular pain, or pain that radiates into the leg due to intervertebral disk conditions such as a herniated disk, degenerative conditions such as osteoarthritis, and/or spinal stenosis (a combination of aging factors that result in narrowing of the foramen, or holes that nerves travel through). The specific benefits of LT include increasing the disk space, which produces a negative pressure within the disk to draw in a disk protrusion, stretching ligaments, widening the foramen, and encouraging movement of the facet joints. Unfortunately, there is no hard and fast rule that exists for when and/or how to apply traction, leaving this decision up to each clinician to judge what, when, and how—that is until recently!

A group of researchers tackled the job of developing a clinical guideline to identify patients with lumbar disk herniation (LDH) that would most likely benefit from mechanical lumbar traction (MLT). Doctors applied MLT on over 100 LDH patients over the course of two weeks and measured the benefits using history and physical examination as well as various questionnaires that measure pain intensity, function, and psychological parameters. The research team defined “responders” as those who improved at least 50% over the initial, baseline evaluation.

Of the 103 participants, 24 were responders (23.3%), and from this group, the researchers used the following five features to establish clinical prediction rules: 1) limited lumbar extension (backward bending) movement; 2) low-level fear-avoidance beliefs regarding work; 3) no segmental hypomobility in the lumbar spine; 4) short duration of symptoms; and 5) sudden onset of symptoms. For those who had at least three of five of these predictors, the probability of pain and function improvement rose from 23.3% to 48.7% compared to those with fewer predictors. The authors concluded that healthcare providers can use these five predictors to help select patients with LDH who might benefit from applying lumbar traction.

A 2020 study reported that combining spinal manipulation and mobilization with traction produced better outcomes than traction alone. Doctors of chiropractic offer a multi-modal treatment approach to patient with LDH, of which traction may be included in the management plan. These non-surgical options frequently work very well, and guidelines recommend utilizing non-surgical care options before considering surgery.

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Posted in AxialTrac, Back pain, Chiropractic, flexion-distraction, herniated disc | Tagged , , | Leave a comment

Five Things Many People Don’t Know About Whiplash

Posted on July 30, 2021 by Dr. Timothy Durnin

It’s estimated that more than two million Americans sustain a whiplash injury each year. Despite the prevalence of the condition, the general population doesn’t know much about it. Here are five important things everyone should know about whiplash.

1) Whiplash isn’t only caused by car accidents. Although motor vehicle collisions are the most common and well-studied mechanism for whiplash, this type of injury can occur any time there is a sudden acceleration and deceleration of the neck. Other whiplash causes include falls, sport collisions, and physical altercations.

2) The force of the impact is less important than the forces applied to the cervical spine and tissues. Studies have shown that the forces that can cause whiplash can occur at speeds as low as 5-10 mph (8.04-16.09 km/h). This is due to plastic vs. elastic deformity. That is, the LESS vehicular damage (think “plastic” breaking absorbs energy), the GREATER the forces are transferred to the contents within the vehicle (think “elastic” or bounce).

3) Whiplash injury risk increases with age. Older individuals tend to have less movement in the neck largely because of wear and tear on the disks in the cervical spine (osteoarthritis).  A less flexible neck appears to be more prone to injury during the back-and-forth whiplash process.

4) You may not feel pain immediately after a crash as symptoms often will not manifest for hours, days, and sometimes even weeks. Don’t ignore injury warning signs. Experts in the field recommend an early evaluation to detect potential trauma BEFORE symptoms are apparent. Simple tests can often reveal abnormal findings. Studies show that the treatments that promote movement and enhance mobility—such as chiropractic spinal manipulation and mobilization—performed EARLY ON help to speed recovery.

5) Rest is NOT best! The MOST important “take-home” message that can be gleaned from this article is RESUME NORMAL ACTIVITIES ASAP! Although it may seem intuitively wise to rest after a whiplash injury, this approach can quickly cause the muscles to atrophy or shrink and weaken as fast as only 24 hours of bed rest. This can lead to fear of movement and reinjury, which can prolong recovery.

Doctors of chiropractic utilize physical techniques that help to restore motion, which minimizes pain and promotes recovery, an approach that falls in line with treatment guidelines for whiplash care.

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Posted in ChicagoSouthSuburbs, Chiropractic, mid back pain, Neck pain, neck stiffness, Spinal Cord, whiplash | Tagged , , | Leave a comment

Can Carpal Tunnel Syndrome Be Hereditary?

Posted on April 9, 2021 by Dr. Timothy Durnin

Carpal tunnel syndrome (CTS) is a disorder caused by compression of the median nerve that alters the nerve’s function (neuropathy), leading to pain and numbness/tingling (paresthesia) primarily on the palm-side of the wrist and hand.  While factors like hormonal changes and repetitive motions are known to increase the risk for CTS, there might be a genetic component to the condition.

It’s known that conditions that can elevate the risk for CTS—like diabetes, thyroid disease, rheumatoid or osteoarthritis, and obesity—can run in families.  Additionally, the data show that having a family member with CTS raises the risk that you too can develop the condition, but it’s not entirely clear to what extent genetic traits are responsible versus shared environmental factors among family members. 

In 2007, at the 74th Annual meeting of the American Academy of Orthopaedic Surgeons in San Diego, Harvard professor Dr. David Ring and colleagues presented their evaluation of 117 previously published studies to determine the strength of a “cause-and-effect” relationship for CTS using a scoring system that included both biological and occupational factors.  Their analysis revealed that genetic risk factors were two times stronger than the evidence supporting occupational risk factors, such as overuse.

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Dr. Barry Simmons, chief of the Hand and Upper Extremity Service at Brigham & Women’s Hospital reported that 75-80% of CTS found in women age 50-55 is idiopathic, or of unknown cause, further supporting genetics as the primary factor.  Dr. Ring states, though the evidence suggests genetics are a risk factor for CTS, there may be epigenetic factors or environmental changes to genes based on certain foods eaten or certain activities might increase a person’s risk beyond their genetic makeup.  As of 2015, no epigenetic factors have been identified in idiopathic CTS.

The good news is that even if you have a family history of carpal tunnel syndrome, you can reduce your risk for developing CTS by managing any conditions or activities that can contribute to inflammation along the course of the median nerve.  This includes maintaining a healthy weight, eating a low-inflammation diet, getting regular exercise, taking frequent breaks from repetitive tasks involving the hand, reducing exposure to awkward hand postures and vibratory forces, etc.  If you are experiencing CTS-related symptoms in the hand and wrist, a thorough examination by a doctor of chiropractic can help identify potential causes and help you manage the condition so you can return to your normal activities as soon as possible.

 

November 1, 2019 by Chirotrust

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COULD IT ALL BE IN MY JAW?

Posted on April 2, 2021 by Dr. Timothy Durnin

At the best of times, our bodies work like well-oiled machines. We don’t even have to think about the movements our joints make to get us through daily life, from knees bending as we walk to our jaws opening and shutting when we chew and talk. But for people who suffer from TMJ, the simple act of chewing or even talking can cause pain in the jaw, ear aches or headaches, or neck pain.

TMJ is the common acronym people use when referring to temporomandibular joint disorders. You might also see it referred to as TMD. This is when the temporomandibular joint, the connecting point between the jaw and the skull, becomes painful or swollen. The exact cause of TMJ can often be hard to determine, as there are many factors that can contribute to this pain. Some causes include:

·      Grinding or clenching teeth, which puts pressure on the joint

·      An injury to the jaw

·      Arthritis in the joint

·      Stress, causing teeth to clench

When it comes to treating TMJ, there are many options. Over-the-counter pain medications or the use of moist hot or cold packs can help relieve symptoms. Chiropractic treatment is also an option for people suffering from TMJ. At Lansing Chiropractic Clinic, we take a holistic approach to healing, a method that is helpful with TMJ.

The first step in chiropractic treatment of TMJ is to help get the jaw working properly. If the cartilage in the joint is worn down from excessive grinding, the joint can become misaligned. Chiropractic care can relieve the tension on this area. It might even be that poor posture or spinal misalignment is contributing to TMJ, and getting everything back in line will help relieve the pain.

In addition to the work at the office, we will suggest patients do jaw exercises at home to help strengthen the joint and reduce stress. We’ll also work with you to modify certain habits that might be leading to TMJ pain. Things like clenching teeth, biting nails and excessive chewing can all contribute to TMJ. Understanding what causes the pain, being aware of your habits and alleviating the stress that might lead to those habits can all help reduce the occurrence of TMJ.

Working together with your dentist or physician, we can create a treatment plan that works for you.

If you are suffering from pain or swelling from TMJ, call Lansing Chiropractic Clinic at (708) 895-3228 for a consultation. 

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Carpal Tunnel Syndrome Linked to Migraine Headaches

Posted on June 29, 2020 by Dr. Timothy Durnin

Carpal tunnel syndrome (CTS) is a condition caused by compression of the median nerve as it passes through the wrist that’s characterized by pain, numbness, tingling, and weakness in select parts of the hand.  The result of a 2019 study suggests that CTS may be associated with migraine headaches.  How can these two seemingly disparate conditions be related?

The study itself analyzed data gathered from a survey of nearly 26,000 adults in the United States.  In particular, the researchers looked at responses to questions about CTS-related symptoms within the previous year and whether or not respondents had a migraine in the past three months.  The results showed that 3.7% of participants had CTS symptoms in the last twelve months and 16.3% had a migraine in the last 90 days.

 

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When the research team compared those with CTS symptoms and those with migraines, they found that roughly a third (34%) of CTS-positive respondents also reported migraines, which is about 2.6 times more than study participants who did not experience CTS-related symptoms.  On the other hand, 8% of individuals in the migraine group had CTS-associated symptoms in the last year compared with just 3% in the non-migraine groups.

The relationship between the two conditions indicates they may share one or more underlying cause.  One such cause may be cervical dysfunction.  While CTS is generally described as a condition caused by compression of the median nerve at the wrist, pinching of the median nerve anywhere along its course from the neck to the wrist can generate hand/wrist symptoms.  In many cases, a patient complaining of such symptoms may have median nerve entrapment in several areas that all need to be treated to achieve a successful outcome.  While there are many potential triggers for a migraine episode, the root cause/s of the condition are not well understood.  However, several studies have found that patient with migraines are more likely to have trigger points in the neck muscles and other cervical issues, and treatment to improve function in this area can reduce the intensity and frequency of migraines.

With both conditions, it’s important to undergo a thorough examination to identify any and all contributing factors—including cervical dysfunction.  Doctors of chiropractic are trained to address such issues with manual therapies including spinal manipulation, mobilization, and trigger point therapy, in addition to modalities, nutritional recommendations, and specific exercises.

 

March 2, 2020 by Chirotrust

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Spinal Manipulation and Headaches

Posted on March 3, 2020 by Dr. Timothy Durnin

 

Cervicogenic headache (CGH) refers to headaches caused by dysfunction in the neck, and expects estimate that 18% of chronic headache patients have cervicogenic headaches.  Spinal manipulative therapy (SMT) is a form of treatment most commonly provided by doctors of chiropractic, and several studies have demonstrated that SMT is highly effective for patients suffering musculoskeletal disorders of the neck, including those with cervicogenic headaches.  However, there remains little consensus on the appropriate number of SMT treatments to achieve maximum benefits for CGH.

In a 2018 study, a team of researchers conducted a large-scale study involving 256 chronic CGH patients to determine how many treatments are needed to achieve optimum results using SMT for CGH.  The investigators randomly assigned participants to one of four dose levels (0,6, 12, or 18 visits) of SMT for six weeks.  The type of SMT consisted of a manual high-velocity, low-amplitude (HVLA) thrust manipulation in the cervical and upper thoracic regions.  The location of the spinal adjustment was determined by a brief, standard spinal palpatory examination from the occiput to T3 to assess for pain and restricted motion.  For older patients and/or those in acute pain, the manual therapy was modified to a low-velocity, low-amplitude mobilization.  To control for visit consistency and provider attention, patients continued to receive a light massage treatment once a patient’s assigned number of visits was satisfied, until the six-week treatment period ended.

 

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After the conclusion of the treatment phase of the study, the participants used a headache diary to keep track of their headaches for the next year.  The results showed that the patients who received the most SMT treatments had fewer headaches over the following twelve months.  More specifically, the researchers calculated that six additional SMT visits resulted in about twelve fewer days with headaches over the next year.

If you suffer from headaches, consider consulting with a doctor of chiropractic to determine if cervical dysfunction is a potential cause or contributing factor and whether you are a candidate for spinal manipulative therapy.

 

November 1, 2019 by CHIROTRUST

Posted in Back pain, Chiropractic, Chiropractic Video, Headaches | Tagged , , , , , | Leave a comment