Duncan Blog

Dr. Eric Duncan Blog

Duncan Chiropractic Group P.C.


Wednesday, September 30, 2009

Posttraumatic Fibromyalgia

Fibromyalgia (FM) has a long reputation for being a controversial diagnosis. Some health care providers (HCPs) feel FM is a legitimate condition that warrants treatment and research while others feel it’s a “garbage can diagnosis” that HCPs throw patients into when they’re not sure what diagnostic label to use for a patient’s condition. Regardless of the personal beliefs of individual HCPs, there have been two general classifications of FM - primary and secondary. Primary FM occurs when there is no underlying health condition participating in the patient’s overall health status and onset of FM. Secondary FM results from an underlying condition that contributes significantly to the patient’s health status, such as irritable bowel syndrome and over time, gives rise to the onset of FM.

Posttraumatic FM belongs to the secondary FM classification when the traumatic related injury results in the patient developing FM. A Canadian study reported that 25-50% of FM patients reported a traumatic event just before the FM symptoms began. This study surveyed different specialty physician groups to determine which issues were most important in causing the onset of widespread chronic pain after a motor vehicle trauma. Five factors were studied to determine how important each was to the HCP in arriving at a FM diagnosis in a case study of a 45 year-old female with a whiplash injury who developed chronic generalized pain, fatigue, difficulties in sleeping and diffuse muscle tenderness. These five factors included:

1. The number of FM cases diagnosed weekly by the HCP
2. The patient’s gender
3. The force of the initial impact
4. The patient’s psychiatric history before the trauma
5. The initial injury severity

Also described as important were the patient’s pre-injury health status, fitness level and psychological health. All HCP groups were reluctant to blame the car accident as causing FM, but rather placed more importance on the patient attitude, personality, and level of emotional stress. The least important of the five points were numbers 3 and 5. The orthopedic group also included “ongoing litigation” as a cause but as a group, they were the least likely to agree on the FM diagnosis (29%) in the 45 year old case study. Rheumatologists were highest at 83%, followed by general practitioners at 71%, and physiatrists at 60%. A most interesting observation was that once the data was analyzed, ONLY the patient’s pre-accident psychiatric history remained in the model of predicting agreement or disagreement with the FM diagnosis.

Posttraumatic FM can result from any type of trauma, not just motor vehicle collisions. Other “secondary” FM causes besides trauma, can include systemic conditions such as irritable bowel syndrome, chronic fatigue syndrome, and other internal disorders that in part, alter the person’s ability to obtain restorative sleep. Hence, an important focus of treatment should be placed on helping the FM patient obtain restful sleep. Chiropractic management strategies have included manipulation, mobilization, soft tissue therapies, physiological therapeutic agents such as electrical stimulation, ultrasound, the training for home use of traction, the use of nutritional counseling and supplementation, and the training of exercise. Many studies support success with this multidimensional approach to treating FM as chiropractic attacks the FM condition from multiple directions, often yielding highly satisfying results. We are committed to help you or a loved one that may be suffering with FM, and sharing this information may be one of most significant acts of kindness you can give.

Wednesday, September 23, 2009

Whiplash and Muscle Weakness

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.

Wednesday, September 16, 2009

Help Relieve Back Pain With Exercise..

In addition to chiropractic adjustments, strengthening weak muscles can help relieve pain. Pelvic tilts and lower abdominal exercises can help by relieving pressure on the lumbar facet joints caused by contracting low back muscles

Tuesday, September 15, 2009

Exercise: Pick An Activity You Enjoy

A huge mistake people make when exercising is forcing themselves into an activity they do not care for. If you are a swimmer then swim. If you are not, then it is probably best to stay out of the pool. People are most successful starting an exercise program if they get to participate in an activity they like and choose. Of course, it is okay to try something different but if you do not enjoy it, then it will not be long until you quit your new exercise program.

Monday, September 14, 2009

Preventing Back Pain

While 80% of us will suffer a severe back pain episode at some point in our lives, most of us at any given time should be more concerned about preventing or aggravating back pain, rather than resolving a set-back. As they say, an ounce of prevention is worth a pound of cure. There are two aspects to prevention of back pain: keeping strong and flexible, and avoiding mistakes during movements.

As far as exercise is concerned, nothing is more beneficial to the spine than walking. Remember that your spine is your “core,” and the core is activated with fast-paced walking. Most of us don’t think of how the spine is affected with walking, instead focusing on the legs. Make walking part of your daily routine. Walk a few blocks or across town to run an errand, rather than getting into a car for these short trips. Park a few blocks away when you have to use the car, so that you can get in a few minutes of walking. Some of us spend five minutes circling in a parking lot just to get a space close to the front door or we get frustrated when we can’t find a space close to the gym! In contrast to sitting, which increases pressure on our disks, walking strengthens muscles and dissipates the pressure on our lower disks.

Keep the back flexible through slow stretching in all of the different ranges. Tight muscles at the back of the thighs-the hamstrings are an often neglected area that affects the lower spine tremendously. To stretch these muscles, stand upright and put on foot on the back of a chair or sofa. Slowly bend forward and hold this position for 30-40 seconds. It should cause a tight burning pain at the back of the leg. It should not cause a shooting pain down your leg, or increase pain in the lower spine. If it does, then see a health care provider immediately. When the hamstrings are flexible, this allows the pelvis to rotate forward when you bend over. If the hamstrings are not flexible, then the lower spine will bend too much to accomplish any lifting task.

The second aspect to preventing back pain is avoiding mistakes, such as lifting with your back, instead of your legs. This is especially true if an object is very heavy. Sometimes the object is light, but we lift in an awkward position, standing with most of our weight on one leg, then bending and twisting, such as getting grocery bags from a back seat, or moving and positioning a child safety seat. Especially avoid twisting motions of the lower spine while bending over. Also, use one of your hands to help brace your spine, which will decrease the pressure on your disks.

Tuesday, September 8, 2009

Headaches From The Neck?

Cervicogenic headache is the term used to describe a headache that has its cause in the neck region. It used to be thought headaches were caused by something in the head itself, but researchers have now learned that neck injuries can produce head pain.
A study from Norway (Acta Neurol Scand 2007;Nov.20; Sjaastad O, Bakketeig LS) showed that about 4% of the population will have this type of headache. Taking medications to cover the pain will not ultimately correct a mechanical neck problem.
The symptoms of a cervicogenic headache are as follows: one-sided head pain and same side shoulder and arm pain. Patients also have limited mobility of the neck region. Rarely a patient may also have a migraine trait such as nausea, vomiting, or throbbing sensations. Because of these different signs from a typical migraine headache a physician may have overlooked the neck as a potential source for the cause of your head pain. Self-diagnosing your headache can be even worse since potentially serious causes of your head pain, such as high blood pressure may go undiscovered and left untreated. In any case it’s unlikely that your headache has been caused by a deficiency of pain pills in your diet. There are also unintended side effects that have to be considered when weighing any health care option.
Another study from Norway (Funct Neurol 2007;22:145; Drottning M, Staff PH, Sjaastad O) looked at causes of cervicogenic headaches, specifically whiplash injuries of the neck. In this study, 587 whiplash patients were followed over a six-year period. About 8% of the whiplash sufferers developed a cervicogenic headache six weeks after the initial trauma. Thirty-five percent of these patients were still suffering six years later.
Our clinic specializes in the treatment spine-caused head pain especially cervicogenic headache. To determine this we have to perform a comprehensive examination of your spine to see if sprains of your cervical or thoracic joints are present and review whether you’ve suffered a trauma in years past that could have affected the posture and mobility of these delicate spinal structures.
For patients who do not go down the road of medications for treating their head pain chiropractic care can be a more healthful option.

Saturday, September 5, 2009

After my car accident, why do i hurt so much???

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.