CHIROPRACTIC TREATMENT DURING PREGNANCY

Should you see a chiropractor if you are pregnant?

Easy answer.  YES!  As any woman who has had a child can tell you, your back hurts when you are pregnant.  Pregnancy is a very stressful time for the body, especially the low back, mid back, and pelvis.  First of all, you gain a good deal of anterior weight.  There is another person in there.  That alone is enough to throw things out of whack.

As the abdomen expands and gets heavier, the lumbar spine begins to curve more than normal causing the muscles around the spine to become tighter in an attempt to balance out the stresses.  Visiting a chiropractor can help address these issues and teach you how to cope with your new, temporary body.

Probably the most common spine-related problem with pregnancy is lack of motion of the pelvis.  The joint that connects your pelvis to your tailbone (the sacroiliac or “SI” joint) tends to lose some of its normal motion with pregnancy as the pelvis starts to expand to adapt to the growing fetus.  These joints are crucial for proper pelvic mobility before, during, and after delivery.  Regular chiropractic adjustments during pregnancy can help keep joints mobile and prevent a lot of issues such as pain, intrauterine constraint, and abnormal fetal positioning.

Further, there are muscles that act on the the hip and pelvis that can get extremely tight and cause shooting nerve pain, numbness, and/or tingling down the leg during pregnancy.  By working to stretch these muscles and doing at-home exercises, these symptoms can be managed or even prevented.

Is chiropractic care during pregnancy safe?

Absolutely!  Obviously we aren’t going to just lay you on your stomach and jump on you as hard as we can when you are about to pop.  There are a variety of ways a chiropractor can treat pregnant women that is safe for both the mother and the baby.

With the trending shift towards alternative medicine and more natural treatment choices, many healthcare providers are finding local chiropractors to refer their pregnant patients to.  If you are pregnant or plan on becoming pregnant seek out a chiropractor or consult your other healthcare providers about the benefits of chiropractic.

CHRONIC HEADACHES: CAUSES, PREVENTION, AND INTERVENTIONS

Chronic headaches have become an epidemic, especially with our American culture.  I see countless patients who complain of several headaches per week.  What do most of them have in common?  Desk jobs.  Nashville is a huge healthcare industry hub, and a high percentage of the population spends a lot of time at a desk, in a car, or on the phone.  These activities commonly lead to TENSION HEADACHES.

So what causes these tension headaches?  Our nerves are what carry our pain signals.  The sensory nerves that innervate the top, sides, and back of the head exit the spinal cord between the base of your skull and the top of the neck.  There are several muscles in there called “suboccipital muscles” that, when tight, can irritate these nerves leading to a headache.

Tension headaches are often caused by chronic poor posture.  Common posture problems leading to headaches include:  slouching of the shoulders, forward head carriage, and looking down at computers or phones.  Slouching leads to the shoulders rolling forward.  This leads to over activity of the pec muscles and inactivity of the muscles that hold the shoulder blades together.  When the shoulders are forward the neck moves forward and gravity acts on the head leading to straightening of the normal neck curvature.  This causes the suboccipital muscles to work harder to keep your head upright.  Overactivity of the suboccipital muscles causes tightness, irritation of nerves, and, ultimately, headaches.

How do you treat headaches?  Typically headaches respond well to chiropractic adjustments.  The goal of treatment is to improve spinal mobility in the affected region and the address muscular imbalances and posture abnormalities that may lead to headaches.  The first step is to restore motion.  Next, typically a chiropractor will show you some in-office or at-home exercises that you can do to help stabilize the changes that have been made.  Finally, the doctor will address causative factors and help develop a plan for future headache prevention.

So what about migraines?  Migraines are typically treated with medication and prevention measures.  They are often triggered by external factors and/or food sensitivities.  By addressing common food triggers and external stimuli, many migraines can be prevented; thus, negating the need for the medication.  Proper spinal mobility and muscle tone can especially help with migraine prevention.  Oftentimes tension headaches can lead to migraines in those who are affected by migraines.

The goal of this post is to raise awareness of headaches and encourage people to seek out a qualified physician to address their issues.  No headaches are normal.  Do not assume that your headaches are just a part of you.  Find a good chiropractor to treat your headaches.  You may be surprised!

SACROILIAC JOINT DYSFUNCTION

Sacra-ila-what?  This joint, once thought to be immobile, is a key player in low back pain and sciatica-like symptoms.  Sacroiliac joint dysfunction is a condition that, in many, can go undiagnosed.  If missed, this condition can lead to improper management and unnecessary medical costs, or even unnecessary low back surgery.

The sacroiliac joint (SI joint) is the joint that is made where the pelvis and the sacrum meet.  This joint is crucial for walking as it has to shear back and forth.  If the SI joint becomes fixated the muscles of the back and glutes will be overloaded with the task of extending the low back and trail leg as you walk.  Further, due to most of our jobs as Americans requiring prolonged sitting, glute muscle deterioration is very common.  As a result of SI dysfunction and lack of glute strength, the muscles of the low back have to work much harder and become fatigued leading to chronic low back tightness and increased risk of injury.  

Symptoms of sacroiliac joint dysfunction can include low back pain, glute pain, groin pain, thigh pain, and pain on the outside of the leg.  These symptoms are either a result of improper SI joint mobility itself or secondary symptoms due to improper function.  Further, the piriformis muscle may become tight leading to sciatica-like symptoms.  This muscle runs right next to the sciatic nerve.  If it becomes tight it can irritate the nerve leading to pain, numbness, tingling, and/or weakness of the lower extremity.

So what should you do if you think you might be suffering from this condition?  As a chiropractor, I believe in exhausting conservative treatment options before considering injections or surgery.  In most cases manipulation, passive modalities, and exercise can significantly decrease the symptoms associated with sacroiliac joint dysfunction.  Your chiropractor can assess the joint’s integrity and provide treatments that improve its mobility.  SI joint steroid injections are very common and can provide some benefit to the patient.  However, these do not address the root cause of the pain or why the patient started experiencing the pain in the first place.

The best course of action is to first attempt treatment with a chiropractor to see if your specific condition can be managed conservatively before opting for any irreversible treatments.

EPIDURAL STEROID INJECTIONS

There is a lot of controversy about the use of epidural steroid injections (ESI’s).  Much like a lot of invasive treatment options there is concern for their overuse, necessity, and risk.  A lot of my fellow chiropractors are completely against the use of ESI’s.  With my moderate philosophy, I believe there is a time and place for most treatment options.  Epidural injections can be beneficial in some, but you should know the risks vs. benefits before you jump on board.

Epidural steroid injections are injections of steroids given to the epidural space near the spinal cord and the involved/inflamed nerve root.  The drugs used for these injections are commonly not recommended for “intrathecal” use.  The penetration depth difference between the epidural and intrathecal space is about the width of a tissue.

According to accepted medical treatment guidelines, epidural steroid injections should only be performed on patients with documented objective evidence of radiculopathy with corroborative imaging (MRI) or electrodiagnostic (NCV) findings.  What this means is that not every patient with low back or neck pain is a candidate for these injections.  There must be evidence of radiculopathy, defined as pain, numbness/tingling, or weakness in the distribution of a nerve root.  ESI’s are far more common than these specific symptoms.  Guidelines also recommend a course of conservative treatment prior to ESI use.  There are many other conditions that could cause irritation of a nerve root or nerve.  An ESI might alleviate the pain for a while, but the pain may come back later because nothing was done for the underlying cause of the nerve irritation.

One of the major concerns in the medical field at the moment is some doctors not having enough training when it comes to various pain management techniques.  Quite a few doctors are learning how to give these shots through weekend courses.  ABIPP/FIPP Board Certified Pain Management Doctors go through years of training to master these procedures.  Possible adverse effects involved with these procedures include arachnoiditis, bowel/bladder dysfunction, headache, meningitis, parapareisis/paraplegia, seizures, and sensory disturbances.  This risk is due to the fact that these injections are given so close to the spinal cord.  Other side effects, although rare, are meningitis, paralysis, and even death.

The issue I have with ESI’s are their efficacy and the risk vs. benefit.  In a March 2013 paper published in Surgical Neurology International, Dr. Nancy Epstein of Winthrop University Hospital in New York, put it more bluntly than any doctor to date: “The multitide of risks attributed to these injections outweighs the benefits,” she wrote.  Epstein went on to say, “These procedures are not FDA approved, and, according to the majority of the literature, are both ineffective and unsafe.”  Further, if the injection does help, then more injections are usually recommended.

As a workers compensation case reviewer I get many cases with requests for ESI’s.  The majority of them are denied due to a lack of evidence of radiculopathy.  These are expensive invasive procedures that are utilized far too often.  Conversely, they may be necessary when the presentation fits the intervention criteria.  If you do decide to go ahead and get an injection then follow these steps I’ve modified from an article on Dr. Oz’s website.

• Confirm your diagnosis. Make sure that you have the one diagnosis that may respond to ESIs: a pinched or inflammed nerve with radiating pain. This is sometimes called a “herniated” or “bulging” disc with “radiculopathy” or “sciatica.”
• Give it time. Most back pain resolves on its own with rest and with chiropractic care or physical therapy. Try these for at least 6 weeks, the typical time frame after which patients see improvement. Only get an injection if you are seeing zero progress after this conservative wait-and-see period.
• Look for an experienced doctor. If you are going to try an epidural steroid injection, choose a doctor who is board certified in a relevant specialty and had extensive ESI training, rather than a weekend course.  Avoid doctors who automatically recommend an entire course of steroid shots rather than trying just one to see if it will help you.
• X-ray guidance. Most ESIs today are performed under “fluoroscopic guidance,” kind of like a live X-ray, so that the doctor can position the needle correctly in the epidural space before releasing the medication. Insist on this as part of your treatment.
• Procedure or operating room. Go to a surgery center or hospital with a sterile environment. Your back should be swabbed with sterile solution and draped to lessen the chances of germs from your own skin entering the injection site.  One advantage to getting an ESI at a hospital is that the doctors there do not work on their own. They are overseen by the hospital’s credentialing committee.

My recommendation… why not try conservative therapy options such as chiropractic treatment before choosing any invasive interventions such as injections or surgery?

For more information see the article from Dr. Oz’s website.

CHIROPRACTIC FOR FOOTBALL NECK INJURY PREVENTION

As you probably know, football players get hurt…a lot.  Neck injuries are fairly common, especially those involving the disc.  Probably the most famous player to have recent neck issues is Peyton Manning.  He received three, maybe four depending on your source, neck surgeries for his injured disc.  In some cases, chiropractic care can prevent the structural and mobility faults that may contribute to injuries like this one.

The neck has a gentle backwards curve, called a lordosis, that aids in shock absorption.  The discs are also made to absorb compressive forces.  Straightening of the cervical curve leads to increased pressure on the joints and discs of the neck.  Over time this leads to decreased strength and height of the discs and degeneration of the joints.  As the integrity of the discs decreases the risk of sports related injury increases.

The outer part of the disc acts like a ligament that helps hold the watery inner nucleus of the disc in place.  This nucleus is what absorbs compressive forces.  When the outer disc gets weak the inner disc is able to exert pressure outwards leading to a disc bulge or even herniation.  If bad enough, this can press on the nerve roots exiting the spinal cord and cause all sorts of symptoms including pain, numbness, tingling, and weakness of the arms.

Routine chiropractic check-ups can help screen athletes for spinal abnormalities that could increase the risk and severity of sports related injuries.  Proper spinal mechanics can help the body resist injury and function at its maximum level.  A body in motion stays in motion.  A chiropractor’s goal is to keep it that way.