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Neck Pain and Whiplash

September 29, 2010 By Dr. Tuttle Leave a Comment

Neck pain and whiplash-associated disorders (WAD) affect a large number of individuals (approx. 12-70% in a given year). Recently the Bone and Joint Decade 2000-2010 Task Force on Neck Pain (Spine 2008;33[4s]suppl.15:S5-S7) released their findings on treatments for neck pain. Among the highlights were:

  • Most neck pain becomes chronic and symptoms do not completely resolve; between 50 and 85% of patients will experience neck pain one to five years later;
  • For most patients without radicular symptoms, getting back to work and returning to normal activities appears to improve outcomes;
  • Nonsurgical treatments appear to be more beneficial than usual care, sham, or alternative interventions, but none of the active treatments were clearly superior to any other in the short or long term. Manual therapy, mobilization, manual therapy, exercises, low-level laser therapy, educational videos, and perhaps acupuncture appeared to be helpful;
  • When choosing treatments to relieve WAD grades I and II neck pain, patients and their clinicians should consider the potential side effects and personal preferences regarding treatment options;
  • There was a correlation between chiropractic care and subsequent vertebrobasilar artery (VBAI) stroke in persons <45 years, but a similar association was seen in patients receiving general medical practitioner treatment. This may be explained by patients with VBAI dissection-related headache or neck pain seeking care before having their stroke.

We will take great care when adjusting your patient. There are a variety of technical procedures for adjusting the neck.

If any neck pain patients do not respond to the first few treatments, I will let you know. Case series of chronic whiplash patients have shown they can improve their symptoms with chiropractic care (Injury, 1996). A marked increase in symptoms would contraindicate further treatment with that type of manipulation.

Ask how I examine patients, and whether I feel are x-rays are needed to screen for instability or anomalies. If your patient responds positively to treatment, this would justify continued care, provided there is gradually less weekly frequency. Six to eight adjustments in the first two weeks would not be unusual. This frequency would be rare for a patient in the second month of care.

The Healing of
Injured Soft Tissues

In this months issue we’re going to touch on area of patient treatment that has undergone enormous leaps and bounds in our understanding over the last decade.  An area I will refer to as “Post-Traumatic Soft Tissue Injury”.

Even with recent breakthroughs in understanding the physiology of repair (and possibly because of these RECENT breakthroughs) there is a considerable amount of misunderstanding regarding soft tissue injury and its repair.

The most common (almost knee-jerk) misconception is that injured soft tissue will heal in a period of time between four and eight weeks.

Frequently it is claimed that injured soft tissues will heal spontaneously, leaving no long-term residual damage, and that treatment is not required.  This type of information is extremely misleading and confusing to both doctor and patient alike.

Published articles and books concerning the healing of injured soft tissues (Oakes 1982; Roy and Irving 1983; Kellett 1986; Buckwalter/Woo 1988, Majno 2004) indicate that the time frame for such healing is approximately one year.

Needless to say the difference between a recovery time of 4-8 weeks and 12 months dramatically impacts both clinical practice and expected outcomes.

Healing Takes Place In Three Specific Phases.

Soft Tissue Healing Phase #1
Acute Inflammatory Phase.

This phase will last approximately 72 hours. During this phase, after the initial injury, an electrical current is generated at the wound, called the “current of injury.”

This “current of injury” attracts fibroblasts to the wound (Oschman, 2000).

During this phase there is also initial bleeding and continual associated inflammation of the injured tissues. Because of the increasing inflammatory cascade during this period of time, it is not uncommon for the patient to feel worse for each of the first three days following injury.

Because there is disruption of local vascular supplies, there is insufficient availability of substrate (glucose, oxygen, etc.) to produce large enough quantities of ATP energy to initiate collagen protein synthesis to repair the wound.

After 72 hours following injury, the damaged blood vessels have mended. The resulting increased availability of glucose and oxygen elevates local ATP levels and collagen repair begins by the fibroblasts that accumulated during the acute inflammatory phase.

Soft Tissue Healing Phase #2
Phase Of Regeneration

During the regeneration phase the disruption in the injured muscles and ligaments is bridged. Some references call the regeneration phase the phase of repair, which creates confusion about the timing of healing (Jackson, 1977).

“Repair” connotation is that the process has completed, which, as we well see, is not the case. The fibroblasts manufacture and secrete collagen protein glues that bridge the gap in the torn tissues. This phase will last approximately 6-8 weeks (Jackson, 1977).

At the end of 6-8 weeks, the gap in the torn tissues is more than 90% bridged. Many will erroneously claim this to be the end of healing. However, it clearly is not. There is a third and final phase of healing. This phase is called the phase of remodeling

Soft Tissue Healing Phase #3
Phase Of Remodeling

The phase of remodeling starts near the end of the phase of regeneration. During the phase of remodeling the collagen protein glues that have been laid down for repair are remodeled in the direction of stress and strain.

This means that the fibers in the tissue will become stronger, and will change their orientation from an irregular pattern to a more regular pattern, a pattern more like the original undamaged tissues.

Proper treatment during this remodeling phase is very necessary if the tissues are to get the best end product of healing. It is during this remodeling phase that the tissues regain strength and alignment. Remodeling takes approximately one year after the date of injury.

It is established that remodeling takes place as a direct byproduct of motion.  Chiropractic healthcare puts motion into the tissues in an effort at getting them to line up along the directions of stress and strain, thereby giving a stronger, more elastic end product of healing.

Traditional chiropractic joint manipulation healthcare is directed towards putting motion into the periarticular paraphysiological space.

The concept of paraphysiological joint motion was first described by Sandoz in 1976, and is explained well by Kirkalady-Willis 1983 and 1988, by Kirkalady-Willis/Cassidy 1985, and in the 2004 monograph on Neck Pain (edited by Fischgrund) published by the American Academy of Orthopedic Surgeons (see picture).

These discussions clearly show that there is a component of motion that cannot be properly addressed by exercise, massage, etc, and that this component of motion can be properly addressed by osseous joint manipulation.

Therefore, traditional chiropractic osseous joint manipulation adds a unique aspect to the treatment and the remodeling of periarticular soft tissues that have sustained an injury.

There are some problems associated with the healing of injured soft tissues.  Microscopic histological studies show that the repaired tissue is different than the original, adjacent, undamaged tissues.

During the initial acute inflammatory phase there is bleeding from the damaged tissues and consequent local inflammation. This progressive bleeding releases increased numbers of fibroblasts into the surrounding tissues.

Chemicals that are released trigger the inflammation response that is noted in cases of trauma. Subsequent to the inflammatory response and to the number of fibrocytes that are released into the tissues, the healing process is really a process of fibrosis.

Fibrosis

In 1975, Stonebrink addresses that the last phase of the pathophysiological response to trauma is tissue fibrosis. Boyd in 1953, Cyriax in 1983, and Majno/Joris in 2004 note that there is tissue fibrosis subsequent to trauma.

This fibrosis of repair subsequent to soft tissue trauma creates problems that can adversely affect the tissues and the patient for years, decades, or even forever.

Fibrosed tissues are functionally different from the adjacent normal tissues. The differences fall into two main categories:

Fibrosis Category 1

The repaired tissue is weaker and less strong than the undamaged tissues. This is because the diameter of the healing collagen fibers is smaller, and the end product of healing is deficient in the number of crossed linkages within the collagen repair.

Fibrosis Category 2:

The repaired tissue is stiffer or less elastic than the original, undamaged tissues. This is because the healing fibers are not aligned identically to that of the original. Examination range of motion studies will indicate that there are areas of decrease of the normal joint ranges of motion.

In addition, Cyriax notes “fibrous tissue is capable of maintaining an inflammatory response long after the initial cause has ceased to operate.”

Since inflammation alters the thresholds of the nociceptive afferent system, physical examinations in these cases will show these fibrotic areas display increased sensitivity, and digital pressure may show hypertonicity and spasm.

This increased sensitivity can be documented with the use of an algometer, which is a device that uses pressure to determine the initiating threshold of pain.

Because the fibrotic residuals have rendered the tissues weaker, less elastic, and more sensitive, the patient will have a history of flare-ups of pain and/or spasm at times of increased use or stress.

These episodes of pain and/or spasm at times of increased use or stress of the once damaged soft tissues is the rule rather than the exception, and a problem that the patient will have to learn to live with.

It is likely that the patient will continue to have episodes of pain and/or spasm for an indefinite period of time in the future. It is probable that the patient will have a need for continuing care subsequent to these episodes of pain and/or spasm.

Consistent with these concepts, a study by Hodgson in 1989 indicated that…

62% of those injured in automobile accidents still have significant symptoms caused by the accident 12 1/2 years after being injured; and that of the symptomatic 62%, 62.5% had to permanently alter their work activities and 44% had to permanently alter their leisure activities in order to avoid exacerbation of symptoms.

One of the conclusions of the article is that these long-term residuals were most likely the result of post-traumatic alterations in the once damaged tissues.

A study by Gargan in 1990 indicated that…

Only 12% of those sustaining a soft tissue neck injury had achieved a complete recovery more than ten years after the date of the accident.

One of the conclusions of this study is that the patient’s symptoms would not improve after a period of two years following the injury.

It is established neurologically (Wyke 1985, Kirkalady-Willis and Cassidy 1985) that when a chiropractor adjusts (specific directional spinal manipulation) the joints of the region of pain and/or spasm, that there is a depolarization of the mechanoreceptors that are located in the facet joint capsular ligaments, and that the cycle of pain and/or spasm can be neurologically aborted.  This is why many patients feel better after they receive specific joint manipulation from a chiropractor following an episode of increased pain and/or spasm.

What Is The Basis For The
Chronic Post-Trauma Pain Syndromes
So Many Patients Suffer From?

A good explanation is found from Gunn (1978, 1980, 1989).   He refers to this type of pain as supersensitivity.

The supersensitivity type pain is a residual of the scarring or the fibrosis that was created by the injuries sustained in this accident.

The treatment that we give to the patient for the injuries sustained in an accident is really not designed to heal the sprain or strain but rather, to change the fibrotic nature of the reparative process that has left the patient with residuals that are weaker, stiffer, and more sore.

The actual diagnosis for this type of problem is initial sprain/strain injuries of the paraspinal soft tissues with fibrotic residuals subsequent to the fibrosis of repair of once damaged soft tissues that have left these tissues weaker, stiffer, and more sensitive as compared to the original tissues.

The majority of our efforts in the treatment of post-traumatic chronic pain syndrome patients is in dealing with the residual fibrosis of repair and its associated mechanical and neurological consequences.

These residuals to some degree are most probably permanent.  The patient will have to learn to deal with the long-term residuals and the occasional episodes of pain and/or spasm.

However, as noted above, occasional specific joint manipulation in the involved areas can neurologically inhibit muscle tone, improve ranges of motion, disperse accumulated inflammatory exudates, and the patient will have less pain and improved function.

The concepts briefly discussed above are frequently not understood or appreciated. There is a tendency for healthcare providers to not properly examine the patient in order to document these regions of tissue fibrosis and its consequent mechanical and neurological consequences and, therefore, to quote Stonebrink, the real problem is missed.

References

Boyd, William, M.D., Pathology, Lea & Febiger, (1952).

Cyriax, James, M.D., Orthopaedic Medicine, Diagnosis of Soft Tissue Lesions, Bailliere Tindall, Vol. 1, (1982).

Fischgrund, Jeffrey S, Neck Pain, monograph 27, American Academy of Orthopaedic Surgeons, 2004.

Gargan, MF, Bannister, GC, Long-Term Prognosis of Soft-Tissue Injuries of the Neck, Journal of Bone and Joint Surgery, September, 1990.

Gunn, C. Chan, Pain, Acupuncture & Related Subjects, C. Chan Gunn, (1985).

Gunn, C. Chan, Treating Myofascial Pain: Intramuscular Stimulation (IMS) for Myofascial Pain Syndromes of Neuropathic Origin, University of Washington, 1989.

Hodgson, S.P. and Grundy, M., Whiplash Injuries: Their Long-term Prognosis and Its Relationship to Compensation, Neuro-Orthopedics, (1989), 7.88-91.

Kellett, John, “Acute soft tissue injuries-a review of the literature,” Medicine and Science of Sports and Exercise, American College of Sports Medicine, Vol. 18 No.5, (1986), pp 489-500.

Kirkaldy-Willis, W.H., M.D., Managing Low Back Pain, Churchill Livingston, (1983 & 1988).

Kirkaldy-Willis, W.H., M.D., & Cassidy, J.D.,”Spinal Manipulation in the Treatment of Low-Back Pain,” Can Fam Physician, (1985), 31:535-40.

Majno, Guido and Joris, Isabelle, Cells, Tissues, and Disease: Principles of General Pathology, Oxford University Press, 2004.

Oakes BW. Acute soft tissue injuries.  Australian Family Physician. 1982; 10 (7): 3-16.

Oschman, James L, Energy Medicine: The Scientific Basis, Churchill Livingstone, 2000.

Roy, Steven, M.D., and Irvin, Richard, Sports Medicine: Prevention, Evaluation, Management, and Rehabilitation, Prentice-Hall, Inc. (1983).

Stonebrink, R.D., D.C., “Physiotherapy Guidelines for the Chiropractic Profession,” ACA Journal of Chiropractic, (June1975), Vol. IX, p.65-75.

Wyke, B.D., Articular neurology and manipulative therapy, Aspects of Manipulative Therapy, Churchill Livingstone, 1980, pp.72-77.

Woo, Savio L.-Y.,(ed.), Injury and Repair of the Musculoskeletal Soft Tissues, American Academy of Orthopaedic Surgeons,(1988), p.18-21; 106-117; 151-7; 199-200; 245-6; 300-19; 436-7; 451-2; 474-6.

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Neck and Arm Pain – The Herniated Disk?

September 20, 2010 By Dr. Tuttle Leave a Comment

 

Patients that present with neck pain along with arm numbness, pain, and/or weakness, often ask, “…what’s causing this pain down my arm?”  The condition is often caused from a bulging or herniated disk pinching a nerve in the neck.  The cause of this complaint can include both trauma as well as non-traumatic events.  In fact, sometimes, the patient has no idea what started their condition, as they cannot tie any specific event to the onset.

The classic presentation includes neck pain that radiates into the arm in a specific area as each nerve affects different parts of the arm and hand.  Describing the exact location of the arm complaint such as, “I have numbness in the arm and hand that makes my 4th and pinky fingers feel half asleep,” tells us that you have a pinched C8 nerve.  This nerve can also be pinched at the elbow and make the same two fingers numb.  The difference between the two different conditions is when the nerve is pinched in the neck, the pain is located from the neck down the entire arm and into digits 4 & 5 of the hand.  When the nerve is pinched at the elbow, the pain/numbness is located from the elbow down to the 4th & 5th digits, but no neck or upper arm pain exists.

Examination findings usually include limitations in certain cervical (neck) ranges of motion (ROMs) – usually in the direction that increases the pinch on the nerve. Another common finding is the arm is often held over the head because there is more stretching on the nerve when the arm is hanging down and pain in the neck and arm increases.  Hence, raising the arm over the head reduces the neck/arm pain.  To determine where the nerve is pinched, there are a number of different compression tests that can recreate or increase the symptoms.  Some compression tests include placing downward pressure on the head with the head pointing straight ahead, bent or rotated to each side.  Other compression tests are performed by pressing in areas where the nerve travels such as in the lower front aspect of the neck, in the front of the shoulder where the arm connects to the chest/trunk, at the elbow and at the wrist.  If there is a pinched nerve, numbness, tingling and/or pain will be reproduced when pressure is applied to these regions.  Other tests include testing reflexes and muscle strength in the arm.  When a nerve is pinched, the reflexes will be sluggish or absent and certain movements in the arm are weak when compared to the opposite side.  Another very practical test is called the cervical (neck) distraction test where a traction force is applied to the neck.  When neck and/or arm pain is reduced, this means there is a pinched nerve.  This test is particularly useful because when pain is reduced, the test supports the need for a treatment approach called cervical traction.  It has been reported that the use of cervical traction when applied 3x/day for 15 minutes each, at 8-12 pounds, 78% of 81 patients reported a significant improvement in symptoms, which is very effective.  Other forms of care that can be highly effective include spinal manipulation, spinal mobilization, certain exercises, physical therapy modalities, and certain medications.

If you, a friend, or a loved one are struggling with a herniated disk in the neck with associated arm complaints, we will properly assess your condition, run the appropriate tests, and administer the appropriate care that is needed.  We also coordinate services with other health care providers when necessary.  This recommendation may represent one of most significant acts of kindness you can give to those that you care about.

Want More? Call Tuttle Chiropractic today at 693-9200, or click here for more info.

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“The Only Proven Effective Treatment” for Chronic Whiplash?

September 15, 2010 By Dr. Tuttle Leave a Comment

You may have wondered, “If I get hurt in a car accident, who should I go to for treatment of my whiplash problem?”  This can be quite a challenge as you have many choices available in the healthcare system ranging from drug-related approaches from anti-inflammatory over-the-counter types all the way to potentially addicting narcotic medications.  On the other side of the fence, there are nutritional based products such as vitamins and herbs as well as “alternative” or “complementary” forms of treatment such as chiropractic, exercise, and meditation, with many others in between.  Trying to figure out which approach or perhaps combined approaches would best serve your needs is truly challenging.  To help answer this question, one study reported the superiority of chiropractic management for patients with chronic whiplash, as well as which type of chronic whiplash patients responded best to the care.  The research paper begins with the comment from a leading orthopedic medical journal stating, “Conventional [meaning medical] treatment of patients with whiplash symptoms is disappointing.”  In the study, 93 patients were divided into three groups consisting of:

Group 1: Patients with a “coat-hanger” pain distribution (neck and upper shoulders) and loss of neck range of motion (ROM), but no neurological deficits;

Group 2: Patients with neurological problems (arm/hand numbness and/or weakness) plus neck pain and ROM loss); and,

Group 3: Patients who reported severe neck pain but had normal neck ROM and no neurological losses.

The average time from injury to first treatment was 12 months and an average of 19 treatments over a 4 month time frame was utilized.  The patients were graded on a 4-point scale that described their symptoms before and after treatment.

Grade A patients were pain free;

Grade B patients reported their pain as a “nuisance;”

Grade C patients had partial activity limitations due to pain; and

Grade D patients were disabled.

Here are the results:

Group 1: 72% reported improvement as follows: 24% were asymptomatic, 24% improved by 2 grades, 24% by 1 grade, and 28% reported no improvement.

Group 2: 94% reported improvement as follows: 38% were asymptomatic, 43% improved by 2 grades, 13% by 1 grade, and 6% had no improvement.

Group 3: 27% reported improvement as follows: 0% were asymptomatic, 9% improved by 2 grades, 18% by 1 grade, 64% showed no improvement, and 9% got worse.

This study is very important as it illustrates how effective chiropractic care is for patients who have sustained a motor vehicle crash with a resulting whiplash injury.  It’s important to note the type of patient presentation that responded best to care had neurological complaints and associated abnormal neck range of motion.  This differs from other non-chiropractic studies where it is reported that patients with neurological dysfunction responded poorly when compared to a group similar to the Group A patient here (neck/shoulder pain, reduced neck ROM, and with normal neurological function).  We realize you have a choice in where you go for your health care needs and we truly appreciate your consideration in allowing us to help you through this potentially difficult process

Want More?  Call me today at Tuttle Chiropractic in Peoria 693-9200 or click here for more info.

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Headaches From The Neck?

September 13, 2010 By Dr. Tuttle Leave a Comment

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.

Call Tuttle Chiropractic for more information

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Stress and Chiropractic

September 9, 2010 By Dr. Tuttle Leave a Comment

Not all stress is bad. A 20-minute workout at the gym for a fit 25-year old is good stress. The same workout for your 75-year old grandmother would likely be bad stress!

Physical Stress

Repetitive motions (painting the ceiling), postural distortions (falling asleep with your neck twisted) and whiplash  injuries from a car accident are physical stresses. So are slips and falls. Even being born!

Mental Stress

Ever faced an impossible deadline at work? Or grieved the loss of a loved one? Notice the posture of someone who is depressed. Frustration, or a sense of powerlessness at work are common forms of emotional stress.

Chemical Stress

Today’s environment constantly assaults us with chemicals. Drugs, preservatives, tobacco, alcohol, pollen and a host of other substances can affect our nervous system and muscle tone.

When your body reacts by “tripping a circuit breaker” and causing vertebral subluxation, or misalignment causing pressure on nerve tissue chiropractic care may help.

Stress can’t be eliminated, but regular chiropractic care may help you better accommodate and adapt to it. Give us a call. 

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Consumer Reports Survey Shows Hands-on Therapies Were The Top-rated Treatments

September 7, 2010 By Dr. Tuttle Leave a Comment
April 10, 2009 — A study in the May issue of Consumer Reports shows that hands-on therapies were tops among treatments for relief of back pain. The study, which surveyed more than 14,000 consumers, was conducted by the Consumer Reports Health Ratings Center.

According to the report, the survey respondents tried a variety of different treatments and rated the treatments on how helpful and satisfied they were with the results. The report concluded that hands-on therapies were the top-rated.

The report states that, “eighty-eight percent of those who tried chiropractic manipulation said it helped a lot, and 59 percent were ‘completely’ or ‘very’ satisfied with their chiropractor.”

The Results at a glance:

Professional Highly satisfied
Chiropractor 59%
Physical therapist 55%
Acupuncturist 53%
Physician, specialist 44%
Physician, primary-care doctor 34%
 
From their article:

About 80 percent of U.S. adults have at some point been bothered by back pain. The Consumer Reports Health Ratings Center recently surveyed more than 14,000 subscribers who had lower-back pain in the past year but had never had back surgery. More than half said pain severely limited their daily routine for a week or longer, and 88 percent said it recurred through the year. Many said the pain interfered with sleep, sex, and efforts to maintain a healthy weight. Back pain can be tough to treat. Most of our respondents tried five or six different treatments. They rated the helpfulness of the treatments tried and their satisfaction with the health-care professionals visited.

Hands-on therapies were among the top-rated. Fifty-eight percent of those who tried chiropractic manipulation said it helped a lot, and 59 percent were “completely” or “very” satisfied with their chiropractor. Massage and physical therapy were close runners-up.

Many of those who tried spinal injections found them to be very helpful, although the techniques their doctors used varied. Most respondents had used some type of medication. Forty-five percent of those who took prescription drugs said they helped a lot, double the percentage of those who said they were helped by over-the-counter medications.

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Back Pain Worsens When One Avoids Using the Back

August 30, 2010 By Dr. Tuttle Leave a Comment

A team of researchers has identified a catch-22 of lower back pain.

Those with lower back injuries can worsen their pain by avoiding using hurt muscles.

Other muscles, including those in the abdomen or on the sides of the torso, contort to compensate, leading to greater pressure on the spine and damaging discs.

Researchers have long suspected that patients guard their trunk muscles but this study has shown for the first time how this results in increases in spine loading that can lead to secondary back injuries.

The investigators then measured the electrical activity of participants’ muscles and compared pressure on the spine, known as spine loading, and the side-to-side force on the spine, know as lateral shear.

Adults with lower back injuries used more muscles in the back when lifting, creating greater pressure on the spine. Injured patients experienced about 26% greater spine compression, a 75% increase in lateral shear, and used significantly more muscle activity for 10 muscles than noninjured adults.

Additionally, people with lower back pain weighed more than their uninjured peers, a factor that significantly increased pressure on the spine.

Excessive body weight, or a protruding stomach, is like always holding a box in front of you. One must counterbalance the weight with more activity in the back muscles that aren’t as far from the spine. It is like a seesaw where the back muscles are not as far from the fulcrum as the weight of the belly.

The results of the study underscore the need for people with lower back pain to trim down, and suggest that physical therapy for certain types of back injuries aim to teach patients how to use their back muscles appropriately, the authors note. Typically, physical therapy focuses on strengthening the trunk muscles.

Spine December 1, 2001;26:2566-2574

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Chiropractic and Children

August 24, 2010 By Dr. Tuttle Leave a Comment

I came across this peer reviewed journal today.  The thing to be noted is where this article is from.  It is not from a chiropractic based publication, but a SCIENTIFIC publication.  Children need Chiropractic care also.  Even babies.

Heart rate changes in response to mild mechanical irritation of the high
cervical spinal cord region in infants
Forensic Science International
Volume 128, Issue 3, August 28, 2002, Pages 168-176
L. E. Koch, H. Koch, S. Graumann-Brunt, D. Stolle, J. M. Ramirez and K. S. Saternus

“In first world countries, sudden infant death (SID) is the most common cause of death
during the first 12 months of postnatal life.”
In this study, infants between 1 and 12 months of age were given upper neck
chiropractic adjustments if they were thought to be at risk of sudden infant syndrome,
by noting “asymmetries in the horizontal and sagittal plane of body posture and
motion.” [Postural and segmental chiropractic subluxation complexes]
Asymmetry in the atlanto-occipital-C2 region was determined by x-rays.
“For the chiropractic therapy the infants were positioned on their back while the
chiropractor was sitting perpendicular to the child’s head. Great care was taken that
the infant was comfortable before the impulse [adjustment] was administered. The
impulse [adjustment] was applied to the side of the asymmetry.”
“How safe is chiropractic treatment for young infants?”
“The chiropractic therapy has proven to be a successful technique which can be used to
treat disorders, especially cerebral disturbances of motor patterns of various etiology
(wryneck, c-scoliosis, irritation of the plexus brachialis), sensomotoric disturbances of
integration ability (retardation of sensation and coordination), as well as pain related
entities such as cry-babies with ‘3-month colic’ or hyperactivity with sleeplessness.”
“In older children disturbances of this kind are known as retardation of development in
motor patterns as well as in sensory abilities.”
The epidemiological prevalence of such disturbances is as high as 17.8% of children.
“Chiropractic treatment seems to be the most successful therapy which helps to treat
such disorders.”
“Therefore, chiropractic treatment and manual therapy have become increasingly
popular over the past decade.”
“We can report more that 20,000 children treated without serious complications.”
“Thus, our findings are consistent with the possibility that a minor mechanical irritation
of the cervical region may trigger the first step in the events that lead to SID.”
“Children with a disturbed symmetry of the atlanto-occipital region could be of higher
risk for SID.”

for more information go to www.tuttlechiropractic.net

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Chiropractors and Low Back Pain

August 23, 2010 By Dr. Tuttle Leave a Comment

Occasionally I stumble across an article or a peer reviewed journal that is very interesting so I like to share them.  Keep in mind most of what I’ll post is from the the top peer reviewed journals and written by the top scientific minds that we have.  This is an “oldie, but  goody” as they say.

Chiropractors and Low Back Pain
The Lancet
July 28, 1990, p. 220

The editors of THE LANCET review the June 2nd 1990 British
Medical Journal article by Meade: Low back pain of mechanical origin:
randomized comparison of chiropractic and hospital outpatient
treatment. The study used 741 patients. They note:
The article “showed a strong and clear advantage for patients with
chiropractic.”

The advantage for chiropractic over conventional hospital
treatment was “not a trivial amount” and “reflects the difference
between having mild pain, the ability to lift heavy weights without extra
pain, and the ability to sit for more than one hour, compared with
moderate pain, the ability to lift heavy weights only if they are
conveniently positioned, and being unable to sit for more than 30
minutes.”

“This highly significant difference occurred not only at 6 weeks,
but also for 1, 2, and even (in 113 patients followed so far) 3 years
after treatment.”
“Surprisingly, the difference was seen most strongly in patients
with chronic symptoms.”
“The trial was not simply a trial of manipulation but of
management” as 84% of the hospital-managed patients had
manipulations.

“Chiropractic treatment should be taken seriously by conventional
medicine, which means both doctors and physiotherapists.”
“Physiotherapists need to shake off years of prejudice and take on
board the skills that the chiropractors have developed so successfully”

For more information on how chiropractic can help YOU check out tuttlechiropractic.net

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Chiropractic the Natural Pain Reliever

August 19, 2010 By Dr. Tuttle Leave a Comment

American Prescription Drug Use

“The average number of prescriptions [drugs] per
person, annually, in 1993 was seven.

The average number of prescriptions [drugs] per
person, annually, in 2000 was eleven.

[The average number of prescriptions drugs per
person], annually, in 2004 was twelve.

The total number of annual prescriptions [drugs] in
the United States now stands at about 3 billion.
The cost per year is about $180 billion, headed to an
estimated $414 billion by 2011.
Pretty soon, you are talking real money.”

Generation Rx
How Prescription Drugs Are Altering American Lives,
Minds, and Bodies
Greg Critser
Houghton Mifflin Company
2005
Page 2

Chiropractic helps treat aches and pains naturally by restoring proper motion and function to misaligned joint.  It is a safe and effective alternative.

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Chiropractic Treatment for Headaches

June 7, 2010 By Dr. Tuttle Leave a Comment

I don’t know about you, but I am a headache wimp. I hardly ever get headaches, when I do I don’t handle them very well. I get moody and I tend to “snap” at people that really mean me no harm.

In addition to my San Diego chiropractic office treating patients with neck pain and low back pain, we see many people with headaches. Headaches have many causes and there are many different types of headaches as well.

The most common types of headache that we provide treatment for are migraine and muscle tension headaches.

Muscle tension headaches typically begin in the muscles of the neck and upper back. When these muscle become tense, they pull on the muscles that cover your head. This tension results in a headache.

Muscle tension headaches can result from postural stresses such as long hours of computer work, they can develop as a result of whiplash type car accident injuries, pinched nerves or just plain old work and home stresses.

One common reason for chronic, on going tension in the muscle is miss-aligned vertebra. When the vertebra become miss-aligned due to postural stress, awkward sleeping positions, accidents, etc., the muscles around that vertebra tighten up as a protective mechanism. The tight muscles are commonly the root cause of the muscle tension headache.

Chiropractic care re-aligns the joints of the spine causing a relaxation of the surrounding muscles. When the joints in the neck are re-aligned, the muscles that move and support that particular vertebra relax and return to their normal functions.

When the muscles are relaxed, the muscle tension subsides and the headache goes away. Treatment for muscle tension headaches usually requires a series of treatments but you should notice a decrease in the frequency and the severity of your headache with subsequent treatment.

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Weight and Back Pain

June 7, 2010 By Dr. Tuttle Leave a Comment

The kids were obnoxious as they often are, but they were right.

I was at Costco the other day looking at pants when I found myself standing near a few guys in their late teens / early twenties who were also looking at pants.  I remember when I was in my twenties thinking that guys my age (45) were old as dirt and I occasionally enjoyed saying things for shock value in order to stir up the “older” folks.  That is exactly what the one younger guy did when he said “none of these sizes will fit me – it is a short fat world isn’t it?” with enough volume for me to easily hear this comment.  Quietly, I agreed with him.

As I stood there looking at pant sizes, I realized that they did not have any in my size either.  Had my waist measurement exceeded my length, Costco would have had plenty of pants to choose from.  I find it difficult to find pants at most stores that I shop at because waist sizes run so large compared to lengths  –  it is really sad that as a society we have reached this point.

Being a Peoria chiropractor, I am always concerned with the health of my patients.  In addition to neck pain, back pain, headaches and other pain related issues, my patient’s weight and fitness are equally important.  Every extra pound that we carry increases the stress on our joints.  As joint stress increases, the chances of irritation, inflammation, joint pain and eventually arthritis increase as well.

Not to imply that weight control is only important for our joints but it is one more reason to either lose the extra weight or at least keep it in check.

I attended a seminar recently and learned that large deposits of fat can actually work like an endocrine organ that predominantly produces estrogen.  This is true in men as well.  Excess estrogen in men is associated with increased risks of heart attack, stroke, and prostate disease.

I always bring up the topic of weight loss with my patients that would benefit from losing a few pounds – but I never ride them.  Losing excess weight is necessary in order to live a healthy lifestyle, but you have to want that in order to obtain it.

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Neck Pain and Whiplash

June 7, 2010 By Dr. Tuttle Leave a Comment

Neck pain is common after a car accident. The treatment that you receive following that accident can have an impact on your spinal health for the rest of your life.

Whiplash does nasty things to your joints and the muscles and ligaments that support them.  Sometimes these processes are painful immediately and other times they don’t become symptomatic until years later.  The key to relieving pain now and / or avoiding future episodes of pain or disability is to get treatment for your whiplash as soon as possible.

Tremendous amounts of force are placed on the muscles and ligaments when we are involved in whiplash accidents – these forces far exceed normal movements that we purposefully engage in.  The force of a whiplash accident tears muscles and ligaments resulting in swelling, pain, spasms and scar tissue formation.  Scar tissue can not only become a source of pain but it can severely restrict your range of motion as you age.

We all know those older (and sometimes younger) people who have to turn their entire bodies in order to look behind them.  Those people have limited range of motion of the joints in their necks.  With rare exception, this limited range of motion is caused by scar tissue formation and arthritis that has accumulated from old injuries.

Chiropractic treatment helps with many different conditions and is even beneficial as a health maintenance type of treatment.  That being said, chiropractic care is the perfect therapy for most injuries that are related to whiplash.  Chiropractic care helps control the pain associated with torn muscles and ligaments and it is also very effective with breaking down excessive scar tissue that restricts normal range of motion.

We have successfully treated hundreds if not thousands of patients who suffer from either current whiplash injuries or the later effects of those injuries in my Chiropractic Office in Perioa.  Chiropractic treatment combined with a structured stretching / exercise program and proper nutritional support can be the difference between chronic long lasting pain and a healthy pain free spine.

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Good Health – smart ways to stay well, eat right, get fit

June 7, 2010 By Dr. Tuttle Leave a Comment

Common Exercise Mistakes: How to Correct Them Before You Get Hurt
Taken from “To Your Health” magazine

Did you know that more than 60% of people who begin working out for the first time, or pick it up again after taking some time off, hurt themselves in the first month?? That’s significant for several reasons. If you are hurt, how are you going to keep working out and reaching your fitness goals? The most important goal when undertaking any exercise program is to keep yourself from being injured. That is the only way you’ll have a real chance of reaching your fitness goals like building muscle, burning fat, and increasing your cardiovascular capacity!

Here are 4 movements to avoid when exercising:

1. Using jerking motions, especially when lifting: speed is fine when done appropriately, but you should always have fluid motion and proper form when performing any and all exercises; otherwise you could strain or even tear something.

2. Using body parts not required for the exercise: have you ever seen people doing biceps curls and rounding their shoulders or arching their backs? Those are just 2 of the “no-no’s” that can lead to an injury.

3. Locking out your knees or elbows: never lock any of your joints when working out; keep them slightly bent so that the weight will not be transferred to the joints.

4. Arching your back: picture someone on the barbell bench press, lifting a weight that is actually too heavy for them. Chances are that eventually, they will start arching their back. Sooner than later, that back is going to give out and they won’t be able to exercise for days, weeks, or even longer.

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You Could Still Have Whiplash

June 7, 2010 By Dr. Tuttle Leave a Comment

Your Peoria Chiropractor knows, all too well, that you could have whiplash injuries from what appears to be a minor auto accident.  If you’ve been driving around in a big tank-of-a-car and you’ve been in an auto accident, if your car looks “uninjured,” it’s easy to believe that you are uninjured, too. After all, isn’t that the purpose of driving a big vehicle? It’s for protection, right? Well, research has revealed that occupants of vehicles, both large and compact, can be hurt a lot more than might be expected from a minor auto accident. Actually, as far as your body goes, there’s really no such thing as a “minor fender-bender.”

Let’s face it. There are going to be reverberations when your body is forced to stop suddenly and unexpectedly. An emergency room attendant may hand you a clean bill of health because you haven’t broken any bones, and you may be given a prescription for medication to reduce the muscle spasms that you are surely experiencing due to the structural changes in your neck or lower back that you encountered from the impact. But, your situation could go from bad to far worse unless you’re treated for the injuries you’ve received. In fact, many people encounter problems years after a car accident due to the fact that they didn’t get the help they required in the first place.

Your Peoria Chiropractor absolutely understands what your body experiences during a car accident. Chiropractic therapies include treatment for soft tissue injuries and spinal bio-mechanics abnormalities. And your chiropractor is an expert in rehabilitation strategies.

If you’ve been in a minor auto accident, even if your car may not require much repair, more than like you do. Neck and back injuries are not only painful in the places in which they happen, but they can also generate pain, tingling, and numbness in your arms and hands and result in headaches days, weeks, even months after an accident occurs.

Chiropractic care offers a drug-free, natural road back to feeling good again.  It will go a long way in putting the trauma of your accident where it belongs – behind you. In addition, because your chiropractor has experience communicating effectively with insurance companies and lawyers, not only will you feel less physical stress , but less emotional stress, too!

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Chiro Care VS Medical Care: What is the Difference?

June 7, 2010 By Dr. Tuttle Leave a Comment

At my Peoria Chiropractic office I often find that patients that are both new and returning to chiropractic care have misconceptions regarding the differences between medical care and chiropractic treatment.

Most of my patients initially come to my office with neck pain, back pain or headaches.  Regardless of the complaint, I often check many chiropractic subluxation indicators in order to find the cause of the complaint.  This is method is typical for the kind of care you would get from a holistic practioner.

One of the most substantial differences between chiropractic treatment and medical treatment is the way in which we look at you, the patient.  Chiropractic care is holistic in its approach to you.  A holistic approach sees you as a whole person whose parts are interdependent on each other.  Medical care takes an allopathic approach meaning that your care tends to be focused on the specific area that has become problematic.

If we use tension headaches as an example to expose the differences between the two types of care the differences between allopathic and holistic treatment become clear.

As a chiropractor the first thing that I do when a patient comes to me complaining of muscle tension headaches is look for the source of the muscle tension.  Sometimes the muscle tension lies in the thin band of muscle that crosses the bottom of the skull while other times the muscle tension comes from the neck or shoulders / upper back.  The point here is that different sources of pain drive a need for different types of care.  After the source of the muscle tension is found, treatment is delivered to the source of the problem.

If you present to your MD with the same muscle tension headache, you will probably be prescribed some kind of medication to dull the pain but not to address the cause of your headache.   This kind of care is allopathic – focusing only on the pain of the headache – not the cause of the headache.

But that’s where the similarity ends because each discipline looks at health and healing in very different ways.

Chiropractors and medical doctors have two very different philosophies, yet each has its place. If you have broken bones or you’re bleeding by the side of the road, you need the lifesaving measures of emergency medical treatment.

On the other hand, if you have chronic aches and pains or if your interest lies in wellness and health maintenance, you definitely want the “focus on health” approach that is the objective of chiropractic care.

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