Neck-Headache Connection

Health Update: Neck Pain

The Neck and Headache Connection

            Patients with headaches also commonly complain of neck pain.  This relationship is the rule, not the exception and therefore, treatment for headaches must include treatment of the neck to achieve optimum results.  The term, “cervicogenic headaches” has been an accepted term because of the intimate connection between the neck and head for many years.  There are many anatomical reasons why neck problems result in headaches.  Some of these include:

·         The first 3 nerves exiting the spine in the upper neck go directly into the head.  They penetrate the muscles at the top of the neck near the attachments to the skull and therefore, any excess pressure on these nerves by the muscles or spinal joints will result in irritation and subsequent pain.

·         The origin or nucleus of the 5^th cranial nerve called the Trigeminal, innervates the sensation to the face and is located in the upper cervical region near the origin of the 2^nd cervical spinal nerve, which innervates sensation to the back of the head up to the top.  Therefore, problems located in the upper neck will often result in pain radiating up from the base of the skull/upper neck over the top of the skull to the eyes and /or face.

·         The 11^th cranial nerve that innervates the upper shoulders and muscles in the front of the neck arises from the top 5 to 7 spinal cord levels in the neck.  Injury anywhere in the neck can result in spasm and pain in these large muscle groups.

·         Other interconnections between the 2^nd cervical nerve and trigeminal/5^th cranial nerve include communication with the 7^th cranial / facial nerve, the 9^th cranial / glossopharyngeal nerve, and the 10^th cranial / vagus nerve.  These connections can affect facial muscle strength/movements, taste, tongue and throat movements, and stomach complaints such as nausea from these three cranial nerve interconnections, respectively.

            When patients seek treatment for their headaches, a thorough examination of the neck, upper back, and cranial nerves is routinely performed for the above reasons.  It is common to find upper cervical movement and vertebral alignment problems present in patients complaining of headaches. Tender points located between the shoulder blades, along the upper shoulders, on the sides of the neck and particularly, at the base of the skull are commonly found.  Pain often radiates from the tender point over the top of the skull when pressure is applied in the upper neck/base of the skull area. Tenderness on the sides of the head, in the temples, over the eyes, and near the jaw joint are also common. Traction or pulling the head to stretch the neck is often quite pain relieving and this is often performed as part of the chiropractic visit and can also be applied at home with the use of a home cervical traction unit. Chiropractic adjustments applied to the fixated or misaligned vertebra in the upper neck often brings very satisfying relief to the headache sufferer.  Exercises that promote movement in the neck, as well as strengthening exercises are also helpful in both reducing headache pain and in preventing occurrences, especially with stress or tension headaches.  

Contact Dr. DeSalvo by scheduling a complimentary consulation by calling 415-898-6888

www.DeSalvoChiropractic.com

Health Update: Neck Pain

Neck Pain – Can Chiropractic Really Help?

            The following blog posts will be a series of articles on neck pain.  Neck pain is a very common problem affecting up to 70% of the adult population at some point in life.  Though there are specific causes of neck pain such as arising from a sports injury, a car accident or “sleeping crooked,” the vast majority of the time, no direct cause can be identified and thus the term nonspecific is applied. There are many symptoms associated with patients complaining of neck pain and many of these symptoms can be confused with other conditions.  Wouldn’t it be nice to know what neck related symptoms are most likely to respond to chiropractic manipulation before the treatment has started?  This issue has been investigated with very favorable results!

            The ability to predict a favorable response to treatment has been termed, “clinical prediction rules” which in general, are usually made up of combinations of things the patient says and findings from exams. In a large study, data from about 20,000 patients receiving about 29,000 treatments, was collected and analyzed to find out what complaints responded well to chiropractic treatment.  The results showed that the presence of any 4 of these 7 presenting complaints predicted an immediate improvement in 70-95% of the patients: 1. Neck pain; 2. Shoulder, arm pain; 3. Reduced neck, shoulder, arm movement; 4. Stiffness; 5. Headache; 6. Upper, mid back pain, and 7. None or one presenting symptom.  Items not associated with a favorable immediate response included “numbness, tingling upper limbs,” and “fainting, dizziness and light-headedness in 4-12% of the patients.  The “take-home” message here is that was far more common to see a favorable response (70-95%) of the patients compared to an unfavorable response (4-12%), supporting the observation that most patients with neck complaints will respond favorably to chiropractic treatment.

            So, what do we do as chiropractors when a patient presents with neck pain?  First, after gathering preliminary information such as name, address and insurance information, a history of the presenting complaint is taken. This consists of information including what started the neck complaint (if you know), when it started, what makes it worse, what makes it better, the quality of pain (aches, stiff, numb, etc.), the location and if there is radiating complaints, the severity (0-10 pain scale), timing (such as worse in the morning, evening, etc.), and if there have been prior episodes. Various questionnaires are included that are scored so improvement down the road can be tracked and a past history that includes a medication list, past injuries or illnesses, family history and a systems review are standard.  The exam includes vital signs (BP, pulse, height, weight, temperature and respiration), palpation, range of motion, orthopedic and neurological examination.  X-ray and/or other “special tests” may also be included, when needed. The most common condition found is a "subluxation", which is a misalignment of the spine.  This can be associated with degenertive changes in the spine and/or more severe nerve pinch (neuropathy). A review of all the findings are discussed and after permission to treat is granted, a chiropractic adjustment may then be rendered.  A list treatment options may include:

1.      Adjustments;

2.      Soft tissue therapy (trigger point stimulation, myofascial release);

3.      Physical therapy modalities;

4.      Posture correction exercises and other exercises/home self-administered therapies;

5.      Education about job modifications;

6.      Co-management with other health care providers if/when needed.  

Schedule a complimentary consultation with Dr. DeSalvo by calling 415-898-6888.

DeSalvoChiropractic.com

Douglas DeSalvo DC

Are you sitting on your wallet?

www.DeSalvoChiropractic.comWallets cause pelvic imbalance and misalignments (subluxations) that can cause problems in the lower back as well compensation throughout the rest of the spine. Just think of the extra tension on the nervous system that you don't need.

Will medications help me get better?

Will medications help me recover from auto injury and scar tissue formation?

Medications may mask the pain for a few hours, but they do not aid your body's ability to heal itself, and may hinder the healing process. Medications cannot correct the soft tissue damage that is caused by auto accidents. If you are only taking pills, irritated nerves will continue to cause pain, suffering, and the problems listed earlier. Therefore, the adverse effects of your injuries will continue to plague you until you seek treatment. In certain situations we will recommend you seek medical attention; however, pain medications alone will only mask the symptoms and not treat the problem.  The most common problem that occurs from an injury is subluxation and ligament injuries.  Subluxation is spinal misalignment.  This will irritate or pinch nerves.  Chiropractic care will help to get to the cause of the problem by directly relieving the pressure off the nerve and restoring function to the injured area.

DeSalvo Chiropractic and Injury Center, Novato, CA

Douglas DeSalvo DC, DAAMLP
American Academy of Medical Legal Professionals, California, President, 2012 - present

What if my car only had minor damage and I have pain?

Injuries have no relation to the amount of damage to the car!

There has been a great deal of research done over the last several years, which proves that injury, can and does occur in low impact collisions. The most common of these injuries is "whiplash". When low-speed crash tests were performed with sudden changes in vehicle speed of only 2.5 mph, 29% of occupants experienced symptoms of neck or back injury, while a sudden change in speed of 5 mph resulted in 38% of occupants being injured. Automobile bumpers are built to the government standard of being able to withstand a 5 mph crash without damage. These standards are not related to the safety of the occupant, but are to protect and limit the damage to the bumpers, keeping the cost of repair to a minimum. Many times, vehicles can sustain an impact at 8-9 mph before there is recognizable damage. This varies by car model as each manufacturer has a different method for building bumpers. Some cars are made more sturdy than the more newer vehicles. The point is that when the bumper (and other metal) doesn't crumple and absorb the force of the impact, more of that force is transferred directly to the occupant of the vehicle. Whiplash injuries are often caused by rear-end collisions, and frequently by collisions from other angles. A tremendous volume of research has been conducted to determine the amount and extent of these injuries. Because these injuries are not usually life threatening, the insurance industry, your spouse/family/friends, and even many doctors really do not understand the ordeal that you are suffering through. After your accident, you may have experienced severe or moderate pain, or no pain at all. Surprisingly, most auto injuries are hidden and seldom detected for months, or even years. Often, the initial pain subsides, only to return full-blown later. Soft tissue injuries (injuries to muscles, ligaments, and discs) caused by auto accidents can be very deceiving. Soft tissue injuries heal with scar tissue and don't always cause pain immediately, but the damage done to your spine can lead to the following problems:

Recurring headaches, Neck pain and stiffness, Numbness, tingling, or pain in the arms or hands, Chronic muscle tension, and spasm.  Low back pain, Spinal disc degeneration, Painful inflamed arthritis, Sore tight inflexible muscles, Decreased athletic ability, Greater chance of re-injury, and Poor posture.

Documented studies done by Charles Carroll, M.D., Paul McAtee, M.D., and Lee Riley, M.D., revealed that: "The amount of damage to the automobile bears little relation to the force applied to the cervical spine (neck) of the occupants." In other words, the damage to the passengers is not necessarily directly related to the damage of the vehicle. Studies have shown that damage can occur to a driver/passenger at vehicle collision speeds of less than 5 miles per hour (4.87 miles per hour to be exact) and the subjects tested in this study were healthy young males!

Contact: Douglas DeSalvo DC, DAAMLP

American Academy of Medical Legal Professional, California, President, 2012 - present.

Benefits of Chiropractic Care

www.DeSalvoChiropractic.com 

Benefits Of Chiropractic

Source: The Chiropractic Impact Report

• It has been known for 70 decades that the best healing of injured soft tissues requires early and persistent motion.
  (American Journal of Anatomy, 1940)
• It has been established more than a half century ago that the best treatment for whiplash injuries does not involve drugs, but rather requires mobilization, manipulation and traction. The best outcomes from whiplash injury require early and persistent mobilization of the injured joints, always by someone expertly trained in rehabilitative techniques.
  (Journal of the American Medical Association, 1958)
• The healing of injured soft tissues requires that the healing takes place in the presence of movement, and immobilization should be avoided.
  (Textbook of Orthopedic Medicine, 1982)
  (Continuous Passive Motion, 1993)
• Chiropractic spinal adjusting can essentially fix 81% of disabled patients suffering from chronic low back and leg pain, even when other treatment approaches had failed.
  (Canadian Family Physician, 1985)
• Chiropractic spinal adjusting has been shown to be significantly superior in the treatment of low back pain compared to hospital outpatient treatment. These benefits of chiropractic adjusting were still present 3 years after treatment.
  (British Medical Journal, 1991)
  Chiropractic spinal adjusting has been shown to be significantly superior to physical therapy mobilizations and manipulations.
  (Lancet, 1991)
• 93% of patients with chronic whiplash pain who have failed medical and physical therapy care improve significantly with chiropractic adjustments.
  (Injury, 1996)
• Manual manipulative therapy for the treatment of neck pain has been shown to be significantly superior to pain medicines and to exercise.
  (Annals of Internal Medicine, 2002)
• Chiropractic spinal adjusting has been shown to be better than 5 times more effective than the prescription nonsteroidal anti-inflammatory pain medicines (NSAIDs) Celebrex and Vioxx in the treatment of chronic neck and low back pain. In addition, the chiropractic treated group suffered from no adverse reactions, while in the drug-treated group, more patients reported an adverse reaction than were benefited.
  (Spine, 2003)
• In the treatment of chronic neck and back pain, chiropractic spinal adjusting is not only superior to acupuncture and to pain medicines, it is the only treatment that gave the patient long-term therapeutic benefit one year later.
  (Journal of Manipulative and Physiological Therapeutics, 2005)
• In patients suffering from chronic pain subsequent to degenerative spinal disease, 59% can eliminate the need for pain drugs by consuming adequate levels of omega-3 essential fatty acids.
  (Surgical Neurology, 2006)
• In the recent publication “A Review of the Evidence for the American Pain Society and the American College of Physicians Clinical Practice Guideline” for the treatment of low back pain, only spinal manipulation was advocated in the treatment of acute, sub-acute and chronic low back pain.
  (Annals of Internal Medicine, 2007)
• Top researchers from the University of California, San Francisco, and from Harvard Medical School, have determined that “Chiropractic care is more effective than other modalities for treating low back and neck pain.”
  (Do Chiropractic Services for the Treatment of Low Back and Neck Pain Improve the Value of Health Benefits Plans? An Evidence-Based Assessment of Incremental Impact on Population Health and Total Health Care Spending, 2009)

Computer Neck Strain or Strain from Texting

Definition: Computer neck is defined as an overuse syndrome involving the head, neck and shoulders, usually resulting from excessive strain on the spine from looking in a forward and downward position at any hand held mobile device, i.e., mobile phone, video game unit, computer, mp3 player, e-reader. This can cause headaches, neck pain, shoulder and arm pain, breathing compromise, contribute to lower back pain and much more.

Dr. Doug DeSalvo at DeSalvo Chiropractic in Novato, CA is seeing an increase in neck pain cases over the last 5 years.  He and other colleagues predict that neck strain from over use of texting and computers is going to reach epidemic proportions as everyone young and old is using some kind of hand-held device.

Dr. DeSalvo offers the following tips for minimize the effects of ‘computer neck’:

1. Keep the phone up and text at eye level rather than leaning over the phone and look down with your eyes and gently tuck your chin in, not forward.
2. Good posture – sit upright, keeping your ears over your shoulders and hold the device below your heart.  Check out this link on posture: http://desalvochiropractic.com/index.php?p=76676
3. Keep the device 90 degrees perpendicular to your fingers as you press the buttons and use two hands to type.
4. Support your forearms on a desk or a pillow during extended texting to reduce the strain on your neck and shoulder muscles.
5. Remember to take a break to stretch and shake out the hands and stop when it hurts.
6. Return only urgent e-mails on the PDA. Respond to other e-mails from your computer.
7. Stretches: Loosen the hands by stretching the wrist backward for 2-3 seconds, then forward for 2-3 seconds. Spread your fingers as wide apart as you can and hold them for 2-3 seconds.  Stretch your neck to the side and backward.  Push your head back against your hands while your hands offer resistance to strengthen the neck muscles. Tuck your chin in and make a double chin, hold for 2-3 seconds. Fold your hands together and turn your palms away as you extend your arms forward.
8. Monitor the time you (or your child) spend on the phone or PDA and be conscious of the risks involved with excessive use of PDAs or cell phones.

More exercises can be found at:

http://desalvochiropractic.com/index.php?p=76675

www.DeSalvoChiropractic.com