CHIROPRACTIC MANIPULATION FOR THE CERVICAL SPINE

This post is taken from our 11 July 14 Spine-Health Powered Newsletter

Manipulation of the cervical spine or neck region is a common technique utilized by doctors of chiropractic for many patients complaining of neck, upper back, and shoulder/arm pain, as well as headaches. Read more about this first line of treatment for cervical spine conditions.

TYPES OF CHIROPRACTIC MANIPULATION

The goals of cervical adjustment include reduction of pain, improved motion, and restored function. There are two general approaches for cervical spine complaints:

- Manipulation - often thought of as the traditional chiropractic adjustment, or a high-velocity, low-amplitude (HVLA) technique

- Mobilization - which is a more gentle/less forceful adjustment, or a low-velocity, low-amplitude (LVLA) technique moving the joint through a tolerable range of motion.

A combination of the various approaches varies among patients depending on the chiropractor's preferred techniques, the patient's comfort and preferences, and the patient's response to the treatment, as well as both past experience and observations made during the course of treatment.

Adjunctive therapies may include massage, therapeutic heat and/or cold application, gentle stretching and strengthening exercises, and more.

THE “CRACKING” SOUND

The HVLA manipulation usually results in a release, called cavitation, which is created in part by gas escaping from the joint capsule when the joint is moved quickly within its passive range of motion, well within the tissue boundaries.

This type of chiropractic adjustment creates the typical cracking sound that is often associated with joint manipulation. It sounds similar to cracking one's knuckles.

While this cracking description of a chiropractic high-velocity, low- amplitude thrust may give an impression of something that is uncomfortable, many patients find the sensation is relieving and may provide immediate relief of painful symptoms.

GENTLE MOBILIZATION OR ADJUSTMENT?

There are several reasons a chiropractor may recommend gentle (LVLA) chiropractic techniques, such as: 

- Patient preference: Some patients do not feel comfortable with the traditional high-velocity thrust manipulation and prefer an approach that does not involve twisting their neck or joint "popping."

- Provider experience: Some chiropractors may favor one technique and most chiropractors utilize several approaches and often modify and adapt several techniques to the patient’s needs and preferences.

- Contraindications: Some patients may not be able to tolerate the traditional chiropractic adjustment based on past experience or a prior injury or condition.

GENTLE TECHNIQUES

If the patient cannot relax, or simply dislikes the cracking feeling or sound, a gentle form of chiropractic adjustment may be utilized. Some of these methods include a slower technique performed within the passive range of joint motion. 

• Cervical mobilization. The chiropractor manually moves the vertebra in the neck left to right, and vice versa, alternating between the side to side motion and a figure 8 movement, applied at varying degrees of moving the head forward, backward, and to the side and in rotation. This is a smooth, non-thrust type of stretch. 

• Cervical manual traction. The chiropractor gently pulls on the neck, stretching the cervical spine often varying the angle between flexion (forward) and extension (backward), based on comfort and searching for the correct angle to most efficiently reduce the tightness. 

• Cervical "drop" techniques. The chiropractor places a hand and/or finger over the spinal segment requiring the adjustment. A medium to high velocity, low amplitude thrust, or a non-thrust gradual increasing downward pressure is applied until the drop section / head piece of the table releases and drops a short distance. The goal is to reduce the fixation or restricted motion of the cervical vertebra assisted by the special table. 

TYPICAL CERVICAL PROBLEMS 

• Mechanical neck pain includes pain generated from muscle, tendons, joint capsules, ligaments and/or the fascia. This type of problem is a common cause of neck pain and stiffness. Most of the time, many of these tissues are simultaneously injured and can cause pain both locally as well as at a distance away from the injury site. 

• Cervical disc problems. Tears can develop in the cervical disc and/or the inside of the disc (the nucleus) can herniate through the outer part (the annulus) and trap or pinch the nerve root as it exits the spine. 

Cervical nerve root irritation can frequently refer pain down the arm and into the hand, usually affecting specific regions such as the 4th and 5th digits, the palm side thumb to 3rd fingers and/or the back of the hand on the thumb, index finger side of the hand, depending on which nerve root is irritated.

The above are two broad examples of types of cervical spine problems that may be treated with cervical spinal manipulation. The patient needs to receive a complete exam prior to cervical manipulation.




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“Conservative Care First” is more important today than ever in facing our nation’s healthcare challenges

Chiropractic physicians are the highest-rated healthcare practitioners for low-back pain treatments with their patient-centered, whole-person approach that provides greater interaction and communication for appropriate diagnosis and developing more cost-effective treatment planning.

 

October is National Chiropractic Health Month

What Everyone Should Know About Chiropractic

Post by Life in Motion Chiropractic and Wellness, PLLC.

Integrative Care for Headache Pain

Headache has been a bane of humankind for centuries and one of the most common conditions that affects the nervous system. The universally accepted premise is that pain sensitive components of the head and neck are what elicit headache.[1] It is estimated that 47% of adults will experience a headache at least once within the next year.[2]

In 1988, the International Headache Society (IHS) devised a uniform system for classifying headaches which has unequivocally aided headache research. However, the clinical application of this system is limited due to its length, intricate detail, contradictory elements, and lack of real-world observation and data.[3] In fact the World Health Organization admits that many people have their headaches inaccurately diagnosed by their health-care provider.[1] An understandable fact when primary care physicians (PCP) only receive an average of four hours of instruction on headache disorders while in medical school.[1]
This statistic in no way indicates incompetence, just inadequate training with regard to headache. A comprehensible fact given the other more fatal pathologies a PCP must learn about on an intricate level.

This does, however, lead one to theorize that the prescribed drug treatments utilized to combat headache pain may be improperly applied due to the many coinciding aspects of migraine and tension-type [4] headaches. Therefore these analgesics provide no lasting relief to the patient and out of their frustration to feel better easily leads to the development of a medication-overuse headache (MOH).[5]

An integrative approach to headache pain is the most logical way to manage this epidemic given the reasons and biologic elements that contribute to it. According to the research, especially in the case of migraine and tension-type headaches, this may be the most successful strategy to help patients overcome their headache pain.

Since the principal causative factor of headache is spine related, wouldn’t it make sense to have a physician who is specifically trained in spine related disorders be the hub of the diagnostic, management and treatment of headache pain. The doctors at Life in Motion Chiropractic and Wellness are trained Primary Spine Practitioners who can deferentially diagnosis, rule out serious pathology, and provide evidence-based management for the majority of headache patients while also integrating that care with their already established healthcare providers.

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[1] Swenson, Rand and Grunnet-Nilsson, N. 2005. The Management of Headache. In: Haldeman, Scott, et        al, eds. Principles and Practice of Chiropractic. New York: McGraw-Hill, pp. 999-1011

[2] "Headache Disorders." WHO. Ed. WHO Media Center. World Health Organization,
         Oct. 2012. Web. 12 Mar. 2014.

[3] McKenzie, Robin, Stephen May. The Cervical & Thoracic Spine – Mechanical Diagnosis & Therapy.
            Raumati Beach: Spinal Publications New Zealand Ltd, 2006. Print.

[4] Most common type of primary headache. Its mechanism may be stress-related or associated with musculoskeletal problems in the neck. [World Health Organization]

[5] Most common type of secondary headache. [World Health Organization]

Primary Spine Practitioner

The Primary Spine Practitioner (PSP) is, in my humble opinion, the evolution of the chiropractic profession. Over the last 100+ years every field of medicine has striven to make itself better in order to provide individuals seeking treatment the most evidence based care possible within their specialty. The days of the vertebral subluxation complex are over, the chiropractic profession needs to move beyond its 1895 mindset and embrace the concepts developed by the pioneers at Spine Care Partners.

My sincere thanks to Dr. Donald Murphy for his tireless effort in the advancement of our profession via his research and presentation of the facts to those who find chiropractic medicine harmful to the public. Also to doctors, Brian Justice and John Ventura for their community based diligence promoting our profession’s evolutionary change.

I would encourage every chiropractor to embrace this change and move beyond his or her own professional idiosyncrasies because you are in business for only one reason, your patients, and that is what being a PSP is all about!