1. Significant injuries occur at low-speeds.
2. Women suffer greater injuries than men because they have less strength in their neck muscles.
3. Early mobilization is critical. Use of a cervical collar actually gives worse results than no treatment at all. Immobilization following injury causes muscle wasting and loss of strength that significantly delays recovery. Corticosteroids damage articular cartilage & decrease collagen strength & repair. Early mobilization improves healing & repair of bone, cartilage, ligaments, & tendons. It also improves joint proprioception, which helps to prevent early joint degeneration.
4. Most whiplash injuries are occult and cannot be identified on conventional imaging such as x-ray, MRI, or CT scans.
5. The peak inflammation associated with whiplash is located around the C2 vertebra and is the most common origination of headache symptoms. The C2/C3 facet joint in particular is the cause of cervicogenic headache 53% of the time.
6. The severity of vehicle damage is not predictive of injury or outcome. Stiffer vehicles actually increase the probability of long-term consequences because the forces get focused on the head & neck. A more accurate predictor of outcome is if the injured person experiences acute neck pain within the same day of injury. These people are 3x more likely to report chronic neck pain 7 years later. Also of note, younger people generally have a better prognosis & require less treatment.
7. Upper Cervical spine is most injured when head & neck are in flexed & rotated position at time of impact (e.g. looking at cell phone or child in back seat).
8. Whiplash patients are 5x more likely to suffer from chronic neck pain compared to control population.
9. Whiplash patients are at a significantly increased risk for premature disc degeneration. Most common site of disc injury is C5/C6.
10. Cervical range of motion is the most important indicator of physical impairment. It has proven to be 90% accurate in diagnosing people with whiplash symptoms. Flexion and extension are usually the most impaired movements.
11. Over 90% of whiplash patients under chiropractic care showed notable improvement over a 6 month period of care. Chiropractic treatment has been shown to be 5x more effective than Celebrex or Vioxx within 9 weeks of treatment. Chiropractic care has also been shown to have a 2x greater success rate than standard medical care, and a significantly higher success rate than Physical Therapy. Some measured markers include less work absences and less reliance on pain medications. Passive joint motion is superior to active exercise therapy.
12. In order to get the best therapeutic outcome, treatment must be initiated within the first 3 months following whiplash injury. Recommended guidelines for acute or sub-acute recovery with treatment ranges from 2 months to 2 years, with a mean of 7 months. An appropriate initial treatment frequency is 2-3 x per week for the initial 10 weeks of care.
Migraine headaches are among the most debilitating and dreadful neurological problems that exist. They may not be fatal, but the effect on someone’s quality of life can be dramatic. Imagine having days where the sight of light cripples you. Imagine having terrible nausea, and a constant pounding in your head so bad that you wish that someone would just cut the darn thing off your neck. Imagine that pain lasting for hours or even days at a time.
You probably already know that feeling, and you’ve almost certainly been in the same room as someone going through a migraine attack. Fortunately, most people experience a migraine on rare occasion. However, there are those among us that experience these terrible headaches several times a month, and others even experience them on a DAILY basis.
This is the typical life of a chronic migraine patient in my office. Many times these patients have seen several headache specialists. They’ve seen the best neurologists that the Mayo Clinic and Cleveland Clinic have to offer, and have been through every MRI and brain scan available. They’ve tried several different medication regiments, altered their diets, and spend their lives in fear of triggers like meat, wine, and sometimes caffeine.
Many have even tried alternative therapies like acupuncture and conventional chiropractic with no change.
When they finally sit down and speak with me, they’ve been suffering for years, and almost numb to the fact that they have constant pain in the head. Some look a little pale, others need the lights off in the office, and some even come in wearing sun glasses. All of them are a little doubtful and skeptical that their condition can be cured.
Less Focus on Cure, More Focus on Cause
When most people walk into a doctor’s office with an ailment, what they are most often searching for is a cure. Though migraines are terribly common, and have been around for centuries, a cure has been elusive for the millions of patients suffering on a daily basis. Over the counter migraine medications are usually a first line of treatment, followed by prescription medications. There is also a focus on removing triggers from a person’s life like chocolate, caffeine, and certain scents/perfumes.
The truth is that headaches (especially migraines) cannot be treated as a simplistic disease that is the same in all people. Headaches are a dynamic entity with causes that are multi-factorial. Instead of looking at a migraine as a disease entity, it should be seen as a symptom of a neurophysiological process gone haywire.
The Trigeminocervical Complex: The Pain Gate Keeper of the Head/Neck
Don’t get hung up on the terminology, the name is not important for the casual reader. It is important to understand that near the top part of your spinal cord. In the area surrounded by your top 3 neck vertebra is a very important bundle of nerve cells. These specific nerve cells filter incoming signals from the outer covering of the brain known as meninges. They also filter incoming signals from the blood vessels of the brain, as well as signals that come from the neck.
You see, the brain does not have any receptors that trigger pain. It’s kind of crazy to think about, but it’s true. However, the outer protective covering of the brain, and the blood vessels are very pain sensitive. When the receptors from these structures get set off, then a cascade of events can take place leading to the blood vessels in the brain opening up and becoming inflamed.
It’s important that we have ‘filters’ like the trigeminocervical complex around to make sure that not every pain signal gets to the brain. In that way, it acts like a gatekeeper. If it let every pain signal through, you would be in a state of pain without end.
So what went wrong with the built-in gate keeper of pain to the brain?
The normal alignment and movement of the head and neck serve as a buffer to pain signals that go into the gate keeper. When you lose the normal alignment, several things can happen.
Blood flow in and out of the brain is compromised
Inflammatory molecules stay in the brain’s blood supply longer
Muscles and ligaments of the neck misfire
Low grade inflammation persists in the joints of the neck
Small muscles in the neck may pull against the brain’s outer covering
When this happens, you have an environment where the trigeminocervical nucleus can get overloaded with pain signals without the buffer of signals from normal head and neck movement. All of a sudden, a seemingly harmless trigger can send someone with a tendency towards migraines can be sent in a downward spiral of a pounding headache.
Correction not Cure
Our focus is on correcting the Structural positioning rather than curing migraine headaches. The truth is that Structural Correction has benefits that go beyond treating or curing a specific illness or disease. Correction of Spinal Displacement does one thing, and only one thing:
It mobilizes the self-healing, self-restoring potential within your own body.
If we believe that our bodies were meant to be healthy, pain-free, and vibrant, then we must only find what is inhibiting the body’s self-healing potential.
“Doc, I know that you can help me get better, but what can I do on my own to keep this problem from coming back again?”
Almost everyone who comes to my office want to know what they can do to protect their neck from shifting into a bad position again, and one of the most important things someone can do to protect their neck is to create an optimal position for sleep.
Why is sleep important? Aside from the obvious benefits it has on mood, energy, healing, and overall longevity, the way we sleep also impacts the structural integrity of the spine. Just think about it, most of us spend almost 1/3 of our lives sleeping, and that time is often spent in one of a few postures.
In fact, I’ve seen numerous patients tell me that their problem began upon waking, or that they think that their problem began because they slept funny. The fact is that a prolonged period in a structurally poor position can affect the neck and affect the neurovascular tissues that travel through the neck. This can lead to Secondary Conditions like torticollis, neck pain, headaches, and back problems.
So how do we protect our neck and the nerves that pass through it? These tips should get you off on the right foot.
There are 3 primary positions, and sub variations around that.
Stomach Sleeping – Avoid it:
If you haven’t been told already, stomach sleeping without a specialized pillow can put your neck in too much twist in your neck.
Just try this. Turn your head to your right. Now keep it there for an hour.
I bet that sounds pretty terrible. Now think about how that must feel to have your neck sitting like that for 6-8 hours by the time you wake up.
Stomach sleeping also puts the spine in a hyper-extended position which can also lead to back pain on rising.
Side sleeping is a position where almost anyone can get their spine into a neutral position. It allows thelumbar, thoracic, and cervical spine to line up in one plane when the correct pillows are used.
A pillow between bent knees helps keep the pelvis neutral, while a head pillow should be high enough to support the neck, but not be so high that it pushes the neck upwards like you see on the right.
Side sleeping can cause shoulder pain on the side of the low shoulder. This can be corrected by laying on the shoulder blade rather than the arm itself.
Sleeping on your back is probably the easiest way to protect your neck. However, it is associated with higher incidences of snoring and sleep apnea. Back sleeping can also be excruciating for someone suffering from acute low back pain. If this is the case for you, then a side sleeper may be your best resort.
What Pillow Do I use?
EVERYONE wants to know about pillows. It’s almost like they’re looking to justify buying $100 pillow as long as it’s approved by their doctor.
What’s the best brand? Does it need to have contours? What should it be made of? Water? Foam? Feathers?
While I do make specific recommendations for my patients in the office, the truth is that the brand and material matter far less than what the pillow is looking to accomplish.
Pillows should comfortably support the structure of your spine. If your head feels jammed or you feel too extended, then you are not getting the necessary support.
Any conversation about investing in a pillow should involve measurements of your head and neck so that your pillow fits your specific anatomy (it keeps your spine inline when lying down). The material should be hypoallergenic and supportive for long term use. That will usually leave feather based pillows out of the conversation, which they are shown to increase discomfort in pain patients.
Side sleepers – Side sleeping puts your shoulder distance between the head and the bed. Alarger pillow with firmer material is best to support the head and reduce cervical strain.
Back sleepers – Sleeping on your back puts a small distance between the head and the bed. A thinner pillow is usually helpful here. However, if you have severe Anterior Head Syndrome, than a flat pillow may be very uncomfortable and force too much hyperextension. Measurement is key to address your pillow concerns here, but correcting the anterior head syndrome will require a chiropractic approach.
While this may not solve all of your sleep dilemmas. It’s a fast and easy way to start getting better sleep today.
I’m sure you see it almost everyday. Whether it’s the fidgety co-worker who likes to hear all of his joints pop, or the guy on the plane that’s been rubbing his neck all day.
It’s the serial neck popper. They look straight out of the warm up scene of a martial arts movie, sound effects and all. While most will cringe and bite their tongue when they see it, the serial neck popper looks more focused and at ease. In fact, if their joints were capable of it, these people might pop it more often. It might even be you.
“It feels so good, how bad can it be?”
Some of the people who come into my office for care used to be serial neck poppers. Emphasis on the words “used to be”. One recommendation for people when they get their first adjustment is to avoid popping or cracking their neck. There’s usually a look of defeat on their face when the recommendation is given. The truth is that one of their greatest sources of relief from neck discomfort was actually the very thing that was making their problem a chronic issue.
The loose ligaments, and uncontrolled forces from self-manipulation prevent this neck from staying in place.
The x-ray on the right is an example of someone who spends a lot of time popping their own neck. He had no history of a car accident, sports injury, fall, or trauma. However, he has been popping his neck aka, self-manipulating multiple times per day for years.
The green line represents the center point where a person’s head and neck should line up. The red line represents how the patient’s head and neck currently line up in their “normal” seated position.
The level of displacement is not hard to see. In fact, most of you would probably notice someone like this who always holds their neck off to the side.
Though he always feels his neck is very tight, the neck tends to be very floppy without a strong degree of stability. Even after several corrections, his neck will continue to have a tendency to slip towards the side until the ligaments tighten up and heal.
So what exactly happens when you self-manipulate?
Despite popular belief, there is nothing insidious about the popping sound made by joints. The classic crunching sound that you hear, and is stereotyped with chiropractic has nothing to do with broken bones, or rubbing bones against each other. The sound comes from tiny gas bubbles within the fluid that lubricates your joints. When the joint opens up rapidly, these bubbles get released and pop causing those sounds.
It’s more like opening a can of soda than the crunching of a bone. If your neck or back cracks here and there with normal movement, it’s not a cause for concern most of the time.
The sound is ultimately not the problem. What truly is a problem is the way the thrust affects the spine.
In recent years, there have been videos, articles, and books that teach people how to adjust themselves. Now bear in mind, the neck is one of the most sensitive and important pieces of anatomy in the human body. So people are being taught to manipulate their neck without regard for the following factors:
1. Risk factors – Does your neck have disc bulges or protrusions? Are there plaques or anatomical malformations? Some of these risk factors are susceptible to rotation/twisting forces in the neck. Many of these problems can be identified and planned for with a proper examination, but without one, how do you know?
2. What is the current structure of the spine? – How is the spine currently aligned? Do you know which direction puts you into a better position? Are you moving the right vertebra? Are you pushing the vertebra into a worse position than it already is?
Our office uses x-rays to identify these malpositions. Can your own hands measure precise alignment in your neck?
3. Constant Manipulation = Loose ligaments = Poor Stability – Every time you manipulate your spine, you are causing ligaments in the spine to stretch like a rubber band. When you stretch a rubber band enough times, it eventually loses it’s shape and becomes less stable. Your ligaments work the same way. If you keep pounding on your neck with self-manipulation, your neck eventually becomes a sloppy mess like the x-ray above.
When people have ligament instability, it leads them down the road where they depend on manipulation to keep feeling good. Not a good situation, and a big reason chiropractors get a bad rap for getting people “addicted to adjustments”.
So what now?
When choosing a chiropractor, it’s important that they are actually measuring what they are doing to the spine. Almost any chiropractor is able to make someone feel better with manipulation. Manipulation sends a rush of feel good signals into the brain. However, a Structural Chiropractic approach is more than about feeling better in the moment.
It’s about restoring your spine and your nervous system to a state of Normal. A normally functioning spine has the ability to heal and maintain itself without relying on constant manipulation.
That’s why the procedures we perform in our office is truly about fixing the problem and getting it to stay fixed. Many times, these corrections can be performed without any rotation or twisting of the spine. It’s very gentle, and very effective.
Self-manipulation, while a temporary rush and feel good sensation can create hyper-mobility and long term structural problems in the neck. Additionally, it’s easy to become addicted to that feeling, and make your body dependent on constant manipulation to feel normal. In our world, we call that getting “hooked on the crack”. There are just too many questions about what can happen when you self-manipulate. It just doesn’t make sense to do something likely harmful for a few minutes of temporary relief.
of the most common and troublesome problems is a condition known as
Temporomandibular joint dysfuction, or TMD for short. In fact, many
of you may have heard someone talk about their TMJ or having TMD, but
didn’t quite know what it was.
involves the joint that connects your jaw to your head. Proper
movement of this joint is critical to proper function. It has a
profound affect on people because dysfunction of that joint can cause
a variety of problems including:
to open the jaw properly
has rapidly become one of the more common reasons for visits to a
neurologist and pain clinics, because of the dramatic impact that
this sensitive piece of anatomy has on a person’s quality of life.
Many times, this condition is treated with medications. In some
cases, muscle relaxers or injections to the joint.
does this have to do with the neck?
search of PubMed will show numerous references for increased
incidence of TMD in conjunction with a whiplash injury, or head/neck
trauma. A systematic review of
these papers show that people with whiplash/head injury actually have
more severe pain and more pronounced dysfunction of the joint.
Another review showed
that just treating the TMJ in these whiplash related cases poor
outcomes suggesting that the cause of the problem may be outside the
joint itself. The whiplash associated cases showed just a 48%
improvement compared to the non-whiplash cases which improved 75% of
the time. That leaves a huge amount of people who are still in pain
and suffering because the primary insult to the body was not
usually comes in 2 varieties:
Muscular dysfunction – the muscles of the jaw (pterygoids,
masseter, temporalis) become hypertonic and dysfunctional creating
painful musculature and sloppy movement.
Articular dysfunction – the joint itself can have problems.
Dislodging of the disc, arthritic degeneration, and inflammation can
irritate the very sensitive nerve endings that cover the joint.
much can be done about arthritic breakdown of a joint. However, this
is a less common cause of TMD. The most common causes of TMJ problems
stem from muscular imbalance and dislodging of the articular disc. In
a way, these two problems are intimately related. When you have bad
jaw muscles moving the jaw abnormally, then it leaves more room for
the articular disc to shift out of place.
what can make these jaw muscles dysfunctional? To know that, we have
to know what controls the muscle. Every muscle in your body is
controlled by a nerve. Whether it be a big bulky bicep, an achy sore
back muscle, the blood pumping heart muscle, and the food digesting
the jaw muscles, a special nerve called the Trigeminal Nerve emanates
from the skull and provides innervation for the face, jaw muscles,
teeth, brain, and other important structures. (as seen in the above image)
trigeminal nerve is one of twelve specialized nerves called Cranial
Nerves. The unique thing about Cranial Nerves is that they do not
exit out of the spine. They actually begin come out of the brain and
the brainstem, and exit out of the skull. Therefore, a problem with
one of the cranial nerves is usually indicative of a problem at the
Cervical Displacement, Whiplash, and the Brain Stem
of the reasons that our office gets referrals is because of how Cervical Displacement impacts
the health and function of the brain stem. While the top of the neck
doesn’t apply direct pressure to the brain stem, the movement and
function of the neck has large implications for this important piece
someone has an episode of whiplash, there can be substantial damage
and injury to the neck, but the more concerning portion is what
happens to the nervous system. A phenomenon known as Central
Sensitization occurs. This problem happens when the brain stem fires
inappropriately to the limbic system (controls the basic emotions (fear, pleasure, anger) and drives (hunger, sex, dominance, care of offspring)) and reticular activating system
(the places where pain is interpreted in the brain). When this
happens, even the slightest touch or movement can trigger a pain
sensation in the brain.
is why many doctors can find no physical damage to the body, but
people will suffer with chronic pain issues like fibromyalgia. People recognize this quickly when the pain is stemming from the
neck, shoulders or back, but the reality is that this same thing is
happening in the jaw muscles.
get to the root of someone’s problems, we have to evaluate this
critical, but under studied part of the nervous system.
Structural Chiropractic address this?
1. Restore healthy biomechanics to the spine –
create a state of Normal Structure in the neck so that the proper
signals get to the brain.
2. Increase circulation through the brain –
proper alignment ensures that blood to and from the brain stem
properly. Proper blood flow means better nerve firing.
3. Restore health biomechanics to the jaw –
Once the neck alignment is restored, most of the time the jaw will
reset on it’s own. However, sometimes gentle jaw adjustments may be