East Orlando Chiropractor

Subluxation means a vertebral joint of the spine is out of its normal position. It’s the same as a sprain because the ligaments are stretched when this occurs. But how does a joint get out of its normal position? Usually, the culprit is some sort of trauma but not necessarily at the level of a high fall or a major car accident (although these trauma do cause problems).

Many times, the spine is injured because it is more vulnerable in awkward positions, such as when we bend forward and add a little twist to a lift. Perhaps it’s putting a baby seat into the back seat, or pulling weeds in the garden.

For many patients, it’s life’s trips and tumbles as a child that set the stage for a problem years later. We can all remember how we thought our spines were once invincible. The reality is something much less. Those jumps from the rooftop did have a consequence.

That small sprain of the ligaments did just enough to make the joints function abnormally. Over time the muscles adapt and our movements become less even. Then some twenty years later, a simple sneeze or less throws our back out. Some patients get back pain when they are under work stress or have to sit for long periods of time.

The important thing is to get subluxations reduced or corrected. The adjustments we perform at the clinic are meant to align the spine and make the movements of spine symmetrical from side to side. This tends to reduce the tensions on ligaments and muscles, and most importantly, makes you feel better.

When your spine moves normally, you may have less pain when you exercise or move the spine in a stressful way. We can’t make the ligaments perfect, there will always be scar tissue, but we can optimize your life and improve its quality. For many, just working without constant pain can be a real lifesaver. Many patients find their moods improve and they cannot wait to return to the sports or hobbies they once did. This is true wellness, healing not just the body but also the mind. Being in chronic pain is not much fun. While drugs can help many people and get them out of excruciating pain, they do have their limitations. Chiropractic can be a drug-free and natural alternative for health.

Fibromyalgia (FM) has long been considered a condition involving the soft tissues of the body, that is, the muscles, ligaments, tendons and fascia. It is defined as “a chronic, generalized pain condition associated with symptoms of fatigue, stiffness, and sleep disturbance and is characterized by the physical findings of local tenderness in many specific but widely dispersed sites. Fibromyalgia is the most common cause of widespread pain. The prevalence of this disorder in the general population is between 3% and 5%… Most patients with fibromyalgia remain symptomatic for several years, and no cure has been identified.”  Disturbances in the central nervous system (CNS) has also been linked to this condition.

In one study, 168 FM patients had the CNS evaluated by hearing tests, eye movement tests, and a test that evaluates balance/dizziness.  Abnormal findings were common in the FM patient group compared to non-FM subjects. Another study utilized an electrical current treatment approach through the skull to stimulate part of the brain to see if that would help a group of patients with FM. Two different parts of the brain were stimulated as well as a sham or fake treatment approach.  One of two parts of the brain that was stimulated resulted in reductions of pain that lasted for three weeks and mild improvements in quality of life were reported.

Comparing 287 general practitioners (GPs), 160 orthopedists, 160 physiatrists, and 160 rheumatologists, evaluating a patient injured in a motor vehicle crash, those most likely to diagnose FM were rheumatologists (83%) with physiatrists and GPs in the middle at 60% and 71%, respectively.  Orthopedists were least likely at 29%. There were five factors found to be important in the respondent’s agreement or disagreement with the FM diagnosis:
1.    The number of FM cases diagnosed weekly by the respondent (strong predictor).
2.    The patient’s gender (females > males was a strong predictor).
3.    The force of the initial impact (least important).
4.    The patient’s psychiatric history before the trauma (more important).
5.    The initial injury severity (least important).
This information is important as the shift from considering FM to be strictly a condition of the muscles and other soft tissues to being a condition of the central nervous system will affect our future treatment strategies.  Obtaining multiple opinions from various types of practitioners will most likely result in a variety of opinions.  Previous reports of treatment benefit utilizing chiropractic approaches, exercise, and strategies to facilitate sleep restoration remain strong in the management process of FM.

There are many treatment options for those suffering from neck pain.  There is conventional medical care where the family doctor will usually prescribe a muscle relaxant, anti-inflammatory, and/or pain killer to help patients through episodes of acute neck pain.  However, many patients with neck pain have been through the process of treatments associated with medications and simply cannot tolerate the adverse side effects of stomach pain common with anti-inflammatory drugs such as ibuprofen (Advil, Nuprin, Mediprin, etc.), Aleve (Naproxen), or aspirin.  Others don’t like the groggy, drunk-like feelings associated with pain killers or the sleepiness associated with muscle relaxants.  Therefore, these patients often turn to complementary / alternative care. 

As noted in the May, 2009 issue of Consumer’s Report for low back pain, chiropractic was the most sought after form of treatment, but there has been no extensive review of neck pain regarding evidence-based treatment approaches - at least not until February, 2008.  An international “team” representing 9 countries screened over 31,000 titles of articles published between 1980 and 2006, reviewed more than 1200 articles and eventually reported on 552 studies in their final report.  Their findings included the following:

• In the US, 54% utilized complementary (alternative) treatment approaches compared to 37% that obtained conventional medical care.
• Neck pain was the 2^nd most common reason Americans obtained chiropractic care.
• Chiropractic was found to be the most frequently reported form of treatment for upper back or neck pain (ahead of massage therapy, relaxation therapy, acupuncture).
• Those who obtained complementary AND conventional medical care were much more likely to perceive the complementary/alternative therapy as being helpful (61% vs. 6.4% for neck conditions and 39.1% vs. 19% for headaches).
• Women more commonly obtained care than men for neck/shoulder pain (29% vs. 18% men) over a 4-6 year time frame.
• Manual therapy (mobilization, manipulation, stretching) was associated with greater pain reduction in the short-term among patients with acute whiplash when compared with usual medical care, soft collars, passive modalities, or general advice.
• For non-whiplash neck pain (without arm radiating pain), manipulation or mobilization, exercise, low level laser therapy (LLLT), and “…perhaps acupuncture…” were reported as more effective than no treatment, sham, or other alternative interventions.
• For both whiplash and non-traumatic neck pain, supervised exercise with or without manual therapy was favored over usual medical care or no care.

What does all this mean?  Simple!  Everyone who is suffering from neck or upper back pain should seek chiropractic care which includes manipulation, mobilization, exercise training, and activity modifying advice, as these approaches have been found to be more effective than usual medical care!  Why waste time with a “wait and watch” with or without drug intervention approach when the evidence favors chiropractic related interventions.  If you, a friend, or a loved one is struggling with neck or upper back pain, we will properly assess your condition and administer the appropriate care that is required.  We will coordinate care with other health care services when necessary.  This recommendation may represent one of most significant acts of kindness you can offer those that you truly care about.

Last week while driving to work, you’re stopped at a red light and glance in the rearview mirror and notice that a car is approaching from behind way too fast.  The next thing you remember is the squeal of the tires and a loud crash with an accompanied sudden jolt as your car is propelled forward by the impact. Your initial reaction is one of shock, wondering is anyone hurt? How bad is my car damaged? Will there be another hit? Should I get out of the car? I’m going to be late for work! Within a few minutes, the police arrive and after about an hour of taking statements from the two drivers and a few witnesses, you decline an ambulance offer to take you to a nearby hospital for an examination as, “…this little stiffness and ache in my neck is no big deal.”  Happy you can still drive your car, you arrive at work an hour and a half late.  After reviewing the details of the crash with co-workers several times, you begin to notice a headache, your neck stiffening up and movements becoming limited and painful.  After another couple of hours and a few Ibuprofen, the pain has increased and you now have a whopping headache. You decide, “I better go see my chiropractor to see if something is wrong.”

After the exam and x-rays, the chiropractor shows you a chart and explains the mechanism of injury that usually occurs in a low speed rear-end collision.  A couple of things that were said really hit home in helping you to understand how such a seemingly minor crash can create so much pain.  The first is that it is not possible to voluntarily contract a muscle quick enough and “brace” to prevent the acceleration of the head. Upon impact, as the car is propelled forwards, the head initially goes backwards and then when the muscles in front of the neck are stretched to their limits, the head is then “whipped” forwards in a “crack the whip” type of response and all of this takes less than 600-700 milliseconds!  Because of the far limits of neck motion being reached during this process, the ligaments that hold the vertebra together are often stretched and/or torn.  This can be appreciated on the bending neck x-rays which shows one vertebra sliding forwards on the one below and the angle created being greater when compared to the surrounding vertebra.  The second point of discussion that stands out was the fact that your head was rotated at the time of impact from looking in the rearview mirror places the neck at a greater risk of injury because of the twisting motion that occurs during the “crack the whip” process.  Another interesting point: because there wasn’t a lot of car damage, the shock and force of the impact was not absorbed by crushing metal and that energy is therefore transferred to the contents in the vehicle, including the occupants.  That is why your briefcase ended up on the floor and your glasses flew off during the crash. Another point of discussion was made concerning the difference between genders and the degree of injury, as women are more likely to be injured more severely because of the less muscular and sometimes longer female neck.  The degree of injury is also at greater risk when there is osteoarthritis in the neck that pre-exists the crash.  An analogy of how a young sapling branch can bend without breaking verses the “old oak branch” which snaps and breaks when its only bent slightly. So, if you are a middle aged, female with a long slender neck with pre-existing arthritis looking in the rearview mirror prior to impact in a rear-end collision, ligament over stretching / tearing is highly probable.

In summary, it is important to obtain prompt evaluation and treatment by your chiropractor as soon as possible as when time passes without treatment, it is more difficult to bring about a reduction of pain and increased motion and, it will generally take longer.  Taking medication for pain only postpones the needed process of restoring movement and function of the neck so that should not be the only treatment.  In general, a “wait and watch” approach is not wise in these types of injuries. If you or a loved one is suffering with whiplash, sharing this information may be one of most significant acts of kindness that you can give to those that you care about.

There are many different reasons why injuries sustained in car crashes result in chronic or long term pain.  First, there are several types of tissues in the neck that can give rise to pain.  The most intense pain comes from the tissues with the greatest density of nerve fibers, such as the joint capsules and the ligaments holding the bones of the neck together.  There are many ligaments in the neck that are vulnerable to being over-stretched and injured in a motor vehicle collision.  The mechanism of a “whiplash” injury in a rear-end collision is unique.  Upon impact, the vehicle rapidly accelerates forward while the head momentarily remains in its original position, resulting in an initial straightening of the neck followed by extension. At the extreme end-range of backward extension motion, the ligaments in the front of the neck are over stretched and can tear.  Within milliseconds, the head is then propelled forwards into flexion which can then injure the ligaments in the back of the neck placing a significant amount of force on the joint capsules and ligaments holding the bones in close proximity.  Another reason the neck is injured is the speed at which the head and neck “whip” in the backwards and forwards directions after the impact. This occurs faster than what we can voluntarily contract our neck muscles to resist–within 600 milliseconds!  Therefore, even if we brace ourselves in preparation for an impact, we can’t avoid injury to the ligaments and joint capsules. Damage to the ligaments is difficult to “prove” by conventional x-ray, which is why bending views or, flexion/extension x-ray methods are needed.  When there is damage to the ligaments, the vertebra will shift forwards or backwards excessively compared to neighboring vertebra.  This can be measured to determine the extent of ligament laxity or damage and can help explain why neck pain can be so intense and/or chronic.  Not all car accidents occur from behind. In fact, only about 1/3 occur from this direction.  One study investigating which direction created greater degrees of injury reported 57% of chronic pain patient group occurred from rear-end collisions.  It also found that woman sustained more ligamentous injury compared to men and that frontal and rear end collisions resulting in significantly higher levels of ligament injury compared to side impacts

Another well published reason why neck pain can “hurt so much” after a car crash is that the sensory input from the injured area to the brain can be so extreme that it leaves an “imprint” in the sensory portion of the nervous system and it becomes hypersensitive or sensitized, resulting in a lower pain threshold or being more sensitive to pain. This is similar to the “phantom limb” phenomenon that often occurs after a leg is amputated where the brain still “feels” leg pain after the limb has been removed.  This has also been reported to be a reason for the significant constellation of symptoms often accompanying “whiplash” injuries.  A partial list of associated symptoms with whiplash injuries includes neck pain, headache, TMJ / jaw pain, dizziness, coordination loss, memory loss, cognitive difficulty in formulating thought, communicating, losing your place during conversation, and more.

Understanding whiplash and all of its nuances regarding signs and symptoms, x-ray requirements and measurement techniques, and treatment / management strategies are well understood at this office.  Chiropractors have a unique advantage over other health care providers as manual therapies, including spinal manipulation, have been shown to yield higher levels of satisfaction and faster recovery rates compared to other forms of health care.  We pride ourselves in performing thorough history and physical examinations, offering high quality evidence-based therapeutic approaches and teaching necessary home-based, self-management procedures.  If you, a loved one, or a friend are struggling with whiplash residuals from a motor vehicle collision, you can depend on receiving a multi-dimensional assessment and therapeutic approach at this office.

While most of us have a look in the mirror at least once a day, few of us look at our appearance from a different angle, such as from the side. But, the view from the side can be quite revealing if you suffer from chronic neck pain.

First, note the position of your head in relation to you shoulders. Is it right above the shoulders or does it lean forward from your chest? If it does, this would be called forward head posture, and can come from a problem in your neck. Lower areas of your spine can also cause this problem. Some of us have increased our weight over the years with much of it added to our abdominal region. Because of this increased core weight, the body must counter-balance the weight gain by causing the lumbar spine to “sway- back.”

While this “sway-back” problem can create pain this the lumbar spine, it can also have far reaching effects in the posture of the neck. Usually someone with a protruding stomach and sway back will have somewhat rounded shoulders and a forward head posture. If treatment is only directed at the neck without considering how other areas may affect the stability of the neck, then the results may be less than optimum.

In an accident, many areas of the body can potentially be injured.

As a chiropractor, I not only look at your primary injuries but also how mechanically one area of the spine can affect a distant area. These more distant areas can cause neck pain by referral or they can impede complete recovery because the body is compensating for abnormal posture or movement elsewhere.

X-rays of the full spine can show this abnormal posture as can a detailed postural analysis from our office.

So do you like what you see when you view your posture from the side? If your posture leaves something to be desired, or you’re wondering whether your neck problem could be improved by changing another part of your spine, then it is important to be thoroughly checked. Just examining the neck after a whiplash may leave some injuries undiscovered. Are there tender spots in other areas of the spine? Does your overall upright posture seem lacking?

The neck is the most flexible part of your spine and just like any other area of the body, movement exercises and good posture are important to maintain its health. Neck pains can be brought on or aggravated by how you treat this vital structure. We often neglect our neck when it comes to exercises, focusing instead on our legs or heart. So try these helpful hints and incorporate them into your daily routine.

Moving your neck slowly through all its ranges is key. It is important to do pure movements rather than combinations, rolling the neck around like a ball and socket joint (such as the hip or shoulder) is to be avoided. Instead, flex the neck forward until your chin touches the top of your chest. Then, slowly bend your neck backwards, chin to the sky These movements should not cause pain if they are done slowly and you have no pre-existing injury.

The next movement is side bending and is accomplished by trying to bend either ear towards the shoulder. Do this in front of a mirror so that you keep your head straight looking forward. Note whether you can do this the same amount to each side.

The last movement is rotation. Simply rotate your chin slowly so that you are looking over one shoulder. None of these movements should cause pain or make you dizzy. If they do, then it’s a sign you have a neck injury.

An important aspect of neck function is how the shoulder girdle influences neck posture and motion. Try rolling your shoulders forwards and backwards, stretching slowly, to help ease tension at the neck. General exercises such as fast paced walking or hiking are important for your neck too. Remember, your spine is the core of your body and walking is one of the least “injury-producers,” something you can keep up well into your later years.

Lastly, make sure your neck posture is kept upright when you are talking on the phone, driving, reading, doing other tasks, or sleeping.  A very small pillow is usually best for sleeping and neck support pillows are available to help maintain the normal forward arch of the neck. A small pillow will allow your head to ease back, relaxing the muscles at the back of the neck.

Whiplash involves the stretching of nerves, muscles, and ligaments. The forces are so great during even low speed collisions, that the muscles cannot resist the forces. The injury of whiplash produces inflammation to repair the damaged tissues. During this time, fast movements of your head and neck will result in pain, so most patients become overly cautious and move their neck very little. Unfortunately over time, because of the lack of muscle use, you become weak. This sets up the difficult combination of both damaged ligaments and weak muscles. Now there is little strength and support for the neck. This may make you very vulnerable to a future injury. Even slight movements can produces flare-ups when the muscles are too weak. The patient may feel their head to be heavy. Sometimes patients’ injuries can be so severe that dizziness develops due to the asymmetrical muscle and nerve activity. This is called cervicogenic vertigo. If you get dizzy when you move your head, then you may have this condition.

While it may seem intuitively obvious that addressing weak neck muscles are important to a full recovery, few patients will do them unless prompted and explained by their doctor. Specific muscles need to be strengthened in a way that does not cause further damage to the ligaments. If the muscles are tight in certain areas, then stretching or deep tissue massage, or trigger point therapy, can help to loosen areas and decrease pain.

But the most important thing you can do on a daily basis is to keep exercising. Studies have shown this to be effective in whiplash treatment when there is a mechanical neck disorder. A specific exercise program can be prescribed by a doctor of chiropractic Special attention should be made to your posture and x-rays, and how specifically you were injured. Only in this way, will the treatment be effective and not risk further trauma.

Exercises such as rolling the head around the shoulders should be avoided since the neck is not a ball and socket joint like the shoulder. In some directions, the joints will have excessive laxity and the muscle exercises should be done in the neutral position versus at the end range or limit.

Because the ligaments are so badly damaged in whiplash, it’s important to maintain the supporting muscles (both strong and flexible), to keep the spine stable and pain free