01.08.2019
Dr. John Conflitti
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“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. Positioning Matters 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 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. Back Sleeping 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.
01.07.2019
Dr. John Conflitti
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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. What Happens? 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.
01.06.2019
Dr. John Conflitti
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One 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. TMD 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: Sharp/stabbing jaw pain Inability to open the jaw properly Headaches Neck pain Painful clicking Teeth grinding Clenching and much more... It 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. What does this have to do with the neck? A 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 addressed properly. TMD usually comes in 2 varieties: 1. Muscular dysfunction – the muscles of the jaw (pterygoids, masseter, temporalis) become hypertonic and dysfunctional creating painful musculature and sloppy movement. 2. 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. Not 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. So 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 stomach. For 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) The 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 brain stem. Cervical Displacement, Whiplash, and the Brain Stem One 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 of anatomy. When 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. This 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. To get to the root of someone’s problems, we have to evaluate this critical, but under studied part of the nervous system.  How does 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 necessary. 
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