As your chiropractor in the Woodbridge, Dale City VA area I see lots of low back complaints. When I hear the patient say the pain is on one side or the other with a leg referral my first thought is the SI joint. It is usually that but there are the odd balls (simmer down it is not said in disrespect to the person) that have an IT band injury. This injury tends to be more on the side of the leg.
Symptoms
Symptoms of ITB syndrome consist of pain on the outside of the knee, more specifically at or around the lateral epicondyle of the femur or bony bit on the outside of the knee.
It comes on at a certain time into a run and gradually gets worse until often the runner has to stop. After a period of rest the pain may go only to return when running starts again. The pain is normally aggravated by running, particularly downhill.
Pain may be felt when bending and straightening the knee which may be made worse by pressing in at the side of the knee over the sore part. There might be tightness in the iliotibial band which runs down the outside of the thigh. A therapist or trainer may use Ober’s test to assess this. Weakness in hip abduction or moving the leg out sideways is another common sign. Tender trigger points in the gluteal muscles or buttocks area may also be present.
Causes
TFL muscleCertain factors may make you more susceptible to developing runners knee or iliotibial band syndrome. A naturally tight or wide IT band may make someone more susceptible to this injury. Weak hip muscles, particularly the gluteus medius are also thought to be a significant factor.
Over pronation or poor foot biomechanics may increase the risk of injury. If the foot rolls in or flattens, the lower leg rotates and so does the knee increasing the chance of friction on the band. Other factors include leg length difference, running on hills or on cambered roads.
Treatment
Below are outlined a number of treatment options for ITB friction syndrome. See rehabilitation for more details on how the various forms of treatment might be included in a full rehabilitation program.
Rest
Rest is important to allow the inflamed tendon to heal. Continuing to run with ITB syndrome will most likely make it worse. Initially complete rest is a good idea but later activities other than running which do not make the pain worse such as swimming or cycling should be done to maintain fitness.
Cryotherapy
Apply cold therapy or ice to reduce pain and inflammation. Ice should be applied for 10 to 15 minutes every hour until initial pain has gone then later 2 or 3 times a day and / or after exercise is a good idea to ensure the pain does not return. Once the inflammation has gone then potential causes must be addressed such as a tight ITB or the pain will most likely return.
Medication
A doctor may prescribe anti-inflammatory medication such as NSAID’s e.g. Ibuprofen. This is useful in the early acute stage to reduce pain and inflammation. Long term it is not likely to be of benefit, particularly if it is just being used to mask in injury and not as part of the treatment. Always check with a doctor before taking medication in case you have contraindications which mean they could cause harm, for example asthmatics should not take Ibuprofen.
Stretching exercises for the muscles on the outside of the hip in particular are important. The tensor fascia latae muscle is the muscle at the top of the IT band and if this is tight then it can cause the band to be tight increasing the friction on the side of the knee.
Foam roller exercises
Using a foam roller on the IT band and gluteal muscles can help stretch the iliotibial band and remove any tight knots or lumps in the tendon. therefore friction on the side of the knee.
Strengthening exercises
Improving the strength of the muscles on the outside of the hip which abduct the leg will help prevent the knee turning inwards when running or walking and therefore help reduce the friction on the ITB tendon at the knee. In particular strengthening exercises for the tensor fascia latae muscle and gluteus medius such as heel drops, clam exercise and hip abduction are important.
Sports massage
A professional therapist may perform sports massage to help relax and loosen the tissues and use myofascial release techniques which have been shown to be highly effective. Self massage techniques can also be very helpful in correcting excessive ITB tightness, especially where access to a massage therapist on a regular basis is not possible.
Electrotherapy
Use of electrotherapeutic treatment techniques such as TENS or ultrasound may help reduce pain and inflammation.
Acupunture
Dry-needling techniques or acupuncture may be beneficial also. Acupuncture is performed by inserting needles of various lengths and diameters into specific points over the body and in this case around the knee joint. The needle is usually inserted, rotated and then either removed immediately or left in place for several minutes. It is thought to be beneficial in reduce chronic or long term pain.
Training modification
Errors in training should be identified and corrected. These can include over training or increasing running mileage too quickly. As a general rule a runner should not increase mileage by more than 10% per week. Running across a slope or camber in the road for long periods or poor foot biomechanics should be considered. When training starts again avoid too much downhill running.
A rehabilitation strategy which includes stretches and exercises to strengthen the hip abductors is important. In acute or prolonged cases a corticosteroid injection into the site of irritation may provide pain relief.
Summer is here and based on vanity alone it is time to lose some weight. That being said there is another reason to drop those extra pounds. Low back pain is one of the most common reasons people go to the doctors. As a chiropractor in the Woodbridge, Dale City VA area I obviously see lots of low back pain. Not all of it is weight related but it is a major factor in the cause of low back pain.
According to the American Obesity Association, episodes of musculoskeletal pain, and specifically back pain, are prevalent among the nearly one-third of Americans who are classified as obese.2 The American Obesity Association also reports that more obese persons say they are disabled and less able to complete everyday activities than persons with other chronic conditions.1
Some of the most common obesity-related problems include musculoskeletal and joint related pain.1 For people who are overweight, attention to overall weight loss is important as every pound adds strain to the muscles and ligaments in the back. In order to compensate for extra weight, the spine can become tilted and stressed unevenly. As a result, over time, the back may lose its proper support and an unnatural curvature of the spine may develop.
In particular, pain and problems in the low back may be aggravated by obesity. This occurs for people with extra weight in their stomachs because the excess weight pulls the pelvis forward and strains the lower back, creating lower back pain. According to the American Obesity Association, women who are obese or who have a large waist size are particularly at risk for lower back pain.1
Obese or overweight patients may experience sciatica and low back pain from a herniated disc. This occurs when discs and other spinal structures are damaged from having to compensate for the pressure of extra weight on the back.
In addition, pinched nerves and piriformis syndrome may result when extra weight is pushed into spaces between bones in the low back area.3
Arthritis of the spine that causes back pain may be aggravated when extra body weight strains joints. Those patients with a Body Mass Index (BMI) of greater than 25 are more likely to develop osteoarthritis than those with a lower BMI. The American Obesity Association recommends modest weight loss as a treatment for some types of osteoarthritis.2
The effectiveness of back surgery may also be affected by a patient’s weight. Obese patients are at higher risk for complications and infections after surgery compared to patients who are not obese.2 For seriously overweight patients, paying attention to weight loss before undergoing back surgery may improve the healing process after surgery.
Identifying the Need for Weight Loss
Body Mass Index (BMI) is a measure commonly used by medical practitioners. BMI is a mathematical formula (BMI=kg/m2) that takes into account a person’s weight in kilograms and height in meters and calculates a number. The higher a person’s BMI falls on a pre-determined range of values, the higher the likelihood for obesity. Although there is some debate over the specific meaning of BMI measurements, a BMI of 30 or higher is typically considered to be obese, while a measure of 25 to 29.9 is typically considered to be overweight.4
It is also important to evaluate where excess fat is carried on the patient’s body. Patients who carry more weight around their midsection are at greater risk for obesity-related health problems, such as low back pain. Weight loss for health considerations is often advisable for women with a waist measurement of more than 35 inches or men with a waist measurement of more than 40 inches.4
References
1 American Obesity Association. “Health effects of obesity.” AOA Fact Sheets. 2002.
2 American Obesity Association. “What is obesity?” AOA Fact Sheets. 2002.
3 Fishman L., Ardman C. Back Pain: How to Relieve Low Back Pain and Sciatica. New York: W.W. Norton & Company, 1997: 248.
4 National Institutes of Health. National Institute of Diabetes & Digestive & Kidney Diseases. “Understanding adult obesity.” 2001. http://win.niddk.nih.gov.
I treat all sorts of headaches in my Woodbridge, Dale City VA Chiropractic office and I have noticed that many headaches that people classify as migraines are actually not migraines at all. Two of the most common headaches confused with migraines are sinus headaches and occipital neuralgia.
Occipital neuralgia can be debilitating but there are treatments, including chiropractic, that are very effective. Understanding occipital neuralgia can help patients better manage it so they can minimize the pain and symptoms of the condition.
What is occipital neuralgia?
Occipital neuralgia is a neurological condition that affects the occipital nerves which run from the top portion of the spinal cord, through the scalp, transmitting messages to and from the brain. There are two greater occipital nerves, one on each side of the head, from between the vertebrae located in the upper neck through the muscles that are located at the base of the skull and back of the head.
While they do not cover the areas on or near the ears or over the face, they can extend over the scalp as far as the forehead. When those nerves are injured or become inflamed, occipital neuralgia is the result. A person with this condition may experience pain at the base of their skull or the back of their head.
What are the symptoms of occipital neuralgia?
Pain is the prevalent symptom of occipital neuralgia. It often mimics the pain of migraine headaches or cluster headaches and is described as throbbing, burning, and aching.
There may also be intermittent shooting or shocking pain. Typically, the pain begins at the base of the skull but may radiate along the side of the scalp or in the back of the head. Other symptoms include:
Pain is experienced on one side (but sometimes both sides)
Pain behind the eye of the side that is affected
Tenderness in the scalp
Sensitivity to light
Pain triggered by neck movement
What causes occipital neuralgia?
Irritation or pressure to the occipital nerves are what actually cause the pain. This may be due to tight muscles in the neck that squeeze or trap the nerves, injury, or inflammation.
However, much of the time doctors are unable to determine the cause. There are several medical conditions linked to occipital neuralgia:
Tight neck muscles
Diabetes
Trauma or injury to the back of the head
Gout
Tension in the neck muscles
Whiplash
Inflammation of the blood vessels in and around the neck
Infection
Neck tumors
Cervical disc disease
Osteoarthritis
What are the treatments for occipital neuralgia?
Occipital neuralgia treatment focuses on pain relief. It often begins with conservative treatments that include:
Chiropractic
Rest
Heat
Physical therapy
Anti-inflammatory over the counter medication
Massage
In more severe cases the patient may be prescribed a stronger anti-inflammatory medication, muscle relaxants or in some cases an anticonvulsant medication.
If these therapies are not effective or do not bring about the desired level of pain relief, then doctors may recommend percutaneous nerve blocks and steroids. Sometimes surgery is recommended in cases where the pain is severe, chronic, and is unresponsive to more conservative treatments.
Chiropractic for occipital neuralgia
Chiropractic was once considered an “alternative” treatment for occipital neuralgia, but now it is often a regular part of recommended patient care. The advantage of chiropractic over medication or surgery is that chiropractic does not come with the side effects of drugs or the risks of surgery.
Another advantage is that chiropractic seeks to correct the root of the problem, not just manage the pain like other treatments.
Chiropractic treatment for occipital neuralgia may include lift adjustments, heat, massage, and traction. This will bring the body back into proper alignment and take the pressure off of the nerves as it loosens the neck muscles.
I can remember doing manual labor during college and envying the guy who sat at his desk. Now if I sit at mine for more than ten minutes my back hurts, my right shoulder blade area gets a sharp pain, my hand tingles… Than starts the butt pain! As your chiropractor in the Woodbridge, Dale City VA area I also hear the same thing from my patients. Sitting doesn’t have to be painful you just have to makes sure your workstation is correct!
The first step in setting up an office chair is to establish the desired height of the individual’s desk or workstation. This decision is determined primarily by the type of work to be done and by the height of the person using the office chair. The height of the desk or workstation itself can vary greatly and will require different positioning of the office chair, or a different type of ergonomic chair altogether.
Once the workstation has been situated, then the user can adjust the office chair according to his or her physical proportions. Here are the most important guidelines – distilled into a quick checklist – to help make sure that the office chair and work area are as comfortable as possible and will cause the least amount of stress to the spine:
Elbow measure
First, begin by sitting comfortably as close as possible to your desk so that your upper arms are parallel to your spine. Rest your hands on your work surface (e.g. desktop, computer keyboard). If your elbows are not at a 90-degree angle, adjust your office chair height either up or down.
Thigh measure
Check that you can easily slide your fingers under your thigh at the leading edge of the office chair. If it is too tight, you need to prop your feet up with an adjustable footrest. If you are unusually tall and there is more than a finger width between your thigh and the chair, you need to raise the desk or work surface so that you can raise the height of your office chair.
Calf measure
With your bottom pushed against the chair back, try to pass your clenched fist between the back of your calf and the front of your office chair. If you can’t do that easily, then the office chair is too deep. You will need to adjust the backrest forward, insert a low back support (such as a lumbar support cushion, a pillow or rolled up towel), or get a new office chair.
Low back support
Your bottom should be pressed against the back of your chair, and there should be a cushion that causes your lower back to arch slightly so that you don’t slump forward or slouch down in the chair as you tire over time. This low back support in the office chair is essential to minimize the load (strain) on your back. Never slump or slouch forward in the office chair, as that places extra stress on the structures in the low back, and in particular, on the lumbar discs.
Resting eye level
Close your eyes while sitting comfortably with your head facing forward. Slowly open your eyes. Your gaze should be aimed at the center of your computer screen. If your computer screen is higher or lower than your gaze, you need to either raise or lower it to reduce strain on the upper spine.
Armrest
Adjust the armrest of the office chair so that it just slightly lifts your arms at the shoulders. Use of an armrest on your office chair is important to take some of the strain off your upper spine and shoulders, and it should make you less likely to slouch forward in your chair.
Well here we go again! The DC/Nova area has the most unpredictable weather I have ever seen. You never know when winter starts. I have golfed in shorts around New Years and also frozen my butt off around New Years. One thing we all know is there is at least one snow storm. We also know that no matter how much it is predicted it catches VDOT by complete surprise. That doesn’t change the fact we still have to shovel!! As your Woodbridge, Dale City VA Chiropractor I have some tips to help prevent injury while shoveling.
Typically, the arms, shoulders and back get sore and may occasionally feel pain. The cold air invigorates most people into action; however, the same cold air can numb the sensations of pain and fatigue. Unfortunately, pain is a sign that an injury has already occurred or that mechanically you are doing something incorrect in shoveling the snow. In short, there is a right way and a wrong way to shovel snow, and paying attention to your technique can make a big difference in how you feel the next day. As with any project, the prep work is the most important. The following are some quick tips on how to shovel snow smarter:
Spray your shovel with Teflon so the snow won’t stick to it. The more snow that stays on the shovel, the heavier it gets and the more chance for injury – and frustration.
Do a warm-up first. A tight, stiff body is asking for injury. A few minutes of stretching can save you a lot of pain later. When you are shoveling, don’t forget to breathe. Holding your breath makes you tight and stiff.
Layer your clothing. Layered clothing will keep your muscles warm and flexible. You can shed a layer if you get too hot. Make sure you wear gloves that cover your wrists; if your wrists get cold, your fingers, hands and arms will be cold, too.
Wear the right shoes. Choose shoes with plenty of cushioning in the soles to absorb the impact of walking on hard, frozen ground.
Use the right size shovel. Your shovel should be about chest high on you, allowing you to keep your back straight when lifting. A shovel with a short staff forces you to bend more to lift the load; a too-tall shovel makes the weight heavier at the end. (Note: Save your money – don’t buy a fancy ergonomic shovel; studies have shown that in some models, the hook end is too deep. Twisting to unload a shovelful of snow with this tool may hurt your wrists.) Also keep one hand close to the base of the shovel to balance weight and lessen the strain on your back.
Timing is everything. Listen to weather forecasts so you can shovel in ideal conditions. If possible, wait until the afternoon to shovel. Many spinal disc injuries occur in the morning when there is increased fluid pressure in the disc because your body has been at rest all night.
Drink lots of water. Drinking water frequently throughout the day helps to keep muscles and body hydrated. Be careful with hot drinks like coffee or hot chocolate. Coffee contains caffeine, which has a dehydrating effect and adds even more stress to the body.
Use proper posture. When you do shovel, bend your knees and keep your back straight while lifting with your legs. Push the snow straight ahead; don’t try to throw it. Walk it to the snow bank. Try to shovel forward to avoid sudden twists of the torso and reduce strain on the back. The American Chiropractic Association recommends using the “scissors stance,” in which you work with your right foot forward for a few minutes and then shift to the front foot.
Take your time. Working too hard, too fast is an easy way to strain muscles. Take frequent breaks. Shovel for about five minutes at a time and then rest for two minutes.
See your chiropractor. Gentle spinal manipulation will help keep your back flexible and minimize the chance for injury. If you do overdo it, your chiropractor can help you feel better and prevent more injury.
One of the most common low back complaints I see doesn’t really end up being the lumbar spine. It is usually the SI joint. The term is very common with regards to low back pain but when I say it to patients most have never heard of it. And rightfully so! As your chiropractor in the Woodbridge, Dale City VA area I want to change that with some basic information on the SI joint.
Chiropractic is all about expression of optimal health and living the best possible life for you. The focus, especially with doctors of chiropractic at The Joint, is about improving the overall quality of your daily life through regular spinal adjustments. An adjustment helps restore spinal movement, which allows the nervous system to function at its highest possible level. Because the nervous system controls everything we do (including breathing, blinking and swallowing), a system operating optimally is extremely valuable. One of the additional perks — the one that often brings people in — is that pain and joint dysfunction often go away. That’s like magic! Many times people are freed to return to activities they love but have struggled participating in, whether it’s skateboarding, surfing, or lifting a little one up over their head. One of the most common issues that chiropractors see is SI joint dysfunction. It’s common enough that many people know what the SI joint is, but if you don’t, don’t worry — just keep reading. I’ll go over a bit of the science and how chiropractic can play a role in resolving SI joint issues.
The Science
SI stands for sacroiliac. You have two SI joints. The joints are on either side of the sacrum and each ilium (you know this as your hip bone). They are at the bottom of the spine and connect the sacrum and ilium on each side. The main motion of the joint is a shearing motion (a sliding motion back and forth between two parallel surfaces, joint facets in this case).
Dysfunction
SI joint dysfunction means the SI joint is not moving the way it’s intended. Perhaps this means its range of motion is limited — either the sacrum or the ilium is literally mal-positioned and stuck — or there is too much motion. Each joint works to transfer weight from the upper body to the lower body; they are designed to allow minimal movement and they have strong ligaments and tendons that support them. The dysfunction can occur as a result of a variety of things. We live in a society in which the average person sits far too much and carries too much weight. This lack of movement doesn’t encourage proper SI joint health and function. Dysfunction can also be a result of stress from overcompensation after prior spinal surgeries. Too much SI joint movement commonly occurs in pregnant women due to ligament-stretching and laxity.
Symptoms and Treatment
As with most conditions, symptoms vary from person to person. It’s common for SI joint dysfunction to present with low back pain or pain in the buttocks. Pain can radiate down the leg or even into the front of the thigh, but generally not past the knee. SI joint pain can mimic many other causes of low back pain. Chiropractors are experts at determining the source of spine pain in patients — and caring for them, too!
Through an adjustment, chiropractors help restore motion in the SI joint and/or associated joints contributing to the problem. I’ve found that SI joint dysfunction typically responds well to chiropractic care and that pain relief can occur quickly after an adjustment. The exact treatment duration and intensity will depend on the person, their lifestyle and the degree of the subluxation.
There really is no starting age for getting adjusted. I get asked all the time if I adjust children. That seems like a logical question since I way 200 lbs and sometimes have to put a significant amount of pressure on some vertebrae to move them. Rest assured child adjusting is drastically different than adjusting a 250lb man who does construction for a living. As you Chiropractor in the Woodbridge, Dale City VA area I want to give you some information that will help you understand the benefits of child adjusting.
According to Dr. David Sackett, the father of evidence-based medicine, there are three prongs to the evidence-based decision: clinical expertise, scientific research and patient preference. While chiropractic has more than 100 years of clinical expertise from which to draw, our profession is still quite young when it comes to its base of scientific research—a state that is even more so for one of our youngest subspecialties, chiropractic pediatrics. Dedicated researchers are working hard to fill in these gaps. Recent studies are beginning to confirm what our century of clinical experience has already shown—that chiropractic care for children is not only safe, but also effective for a variety of pediatric conditions.
Dr. Joyce Miller and her colleagues at the Anglo-European College of Chiropractic in the U.K. have contributed much to our knowledge of chiropractic pediatrics in the past few years. Here is a brief summary of some of their latest studies:
Safety study: Miller et al. examined 781 pediatric patients under three years of age (73.5 percent of whom were under 13 weeks) who received a total of 5,242 chiropractic treatments at a chiropractic teaching clinic in England between 2002 and 2004.¹ There were no serious adverse effects (reaction lasting >24 hours or needing hospital care) over the three-year study period. There were seven reported minor adverse effects, such as transient crying or interrupted sleep.
Nursing study: Miller et al. also performed a clinical case series of chiropractic care for 114 infants with hospital- or lactation-consultant-diagnosed nursing dysfunction.² The average age at first visit was three weeks. All infants in the study showed some improvement, with 78 percent able to exclusively breastfeed after two to five treatments within a two-week period.
Colic: Browning et al. performed a single-blinded randomized comparison trial of the effects of spinal manipulative therapy and occipito-sacral decompression therapy on infants with colic.³ Forty-three infants younger than eight weeks of age received two weeks of chiropractic care. Two weeks and four weeks after beginning treatment, the infants in both treatment groups cried significantly less and slept significantly more than prior to receiving chiropractic care.
Long-term sequelae of colic: Research has shown that children who were colicky as infants suffer from poor behavior and disturbed sleep as toddlers. Miller et al. performed a survey of parents of 117 such toddlers who had received chiropractic care as infants vs. 111 who had not received chiropractic care.4 They found the treated toddlers were twice as likely not to experience long-term sequelae of infantile colic, such as temper tantrums and frequent nocturnal waking. In other words, colicky infants who had received chiropractic care were twice as likely to sleep well and to experience fewer temper tantrums in their toddler years.
That is just a sampling of some of the great work that is being done by the dedicated and hard-working researchers focusing on chiropractic pediatrics.
References:
Miller JE, Benfield K. Adverse effects of spinal manipulation therapy in children younger than 3 years: a retrospective study in a chiropractic teaching clinic. J Manipulative Physiol Ther 2008;31(6):419-422.
Miller JE, Miller L, et al. Contribution of chiropractic therapy to resolving suboptimal breastfeeding: A case series of 114 infants. J Manipulative Physiol Ther 2009;32(8):670-674.
Browning M, Miller JE. Comparison of the short-term effects of chiropractic spinal manipulation and occipito-sacral decompression in the treatment of infant colic: A single-blinded, randomised, comparison trial. Clinical Chiropractic 2008;11(3):122-129.
Miller JE, Phillips HL. Long-term effects of infant colic: a survey comparison of chiropractic treatment and non-treatment groups. J Manipulative Physiol Ther 2009;32(8):635-638.
I see lots of headaches in my Woodbridge, Dale City VA Chiropractic office. They include migraines, tension headaches and cervicogenic headaches. One of the most common ones I see are cervicogenic headaches. This is that headache that starts at the back top of your neck and radiates into the back of your head. It sometimes makes it to the temples. This type of headache generally doesn’t respond to the common migraine medications. Patients generally notice relief from OTC pain medication but once it wears off the headache comes back. Here is some information on cervicogenic headaches and be sure to consult a chiropractor for them.
Cervicogenic headache is referred pain (pain perceived as occurring in a part of the body other than its true source) perceived in the head from a source in the neck. Cervicogenic headache is a secondary headache, which means that it is caused by another illness or physical issue. In the case of cervicogenic headache, the cause is a disorder of the cervical spine and its component bony, disc and/or soft tissue elements. Numerous pain sensitive structures exist in the cervical (upper neck) and occipital (back of head) regions. The junction of the skull and cervical vertebrae have regions that are pain generating, including the lining of the cervical spine, the joints, ligaments, cervical nerve roots, and vertebral arteries passing through the cervical vertebral bodies.
The term cervicogenic headache is commonly misued and does not simply apply to a headache associated with neck pain; many headache disorders, including migraine and tension-type headache, can have associated neck pain/tension. Rather there must be evidence of a disorder or lesion within the cervical spine or soft tissues of the neck, known to be able to cause headache. Such disorders include tumours, fractures, infections and rheumatoid arthritis of the upper cervical spine. There is debate as to whether cervical spondylosis (age-related wear and tear affecting the spinal disks in your neck) can cause cervicogenic headache.
People with cervicogenic headache often have reduced range of motion of their neck and worsening of their headache with certain movements of their neck or pressure applied to certain spots on their neck. The headaches are often side-locked (on one side only) and the pain may radiate from their neck/back of the head up and to the front of the head or behind the eye. The headache may or may not be associated with neck pain.
People suspected of having cervicogenic headache should be carefully assessed by their doctor to exclude other primary (migraine, tension-type) or secondary (vessel dissection, posterior fossa lesions) causes of headaches.
Nerve blocks are used both for diagnostic and treatment purposes. If numbing the cervical structures abolishes the headache that can confirm the diagnosis of cervicogenic headache and also provide relief from the pain.
Treatment for cervicogenic headache should target the cause of the pain in the neck, and varies depending upon what works best for the individual patient. A very successful type of treatment is chiropractic care. A chiropractor can properly diagnose and treat this type of headache.
I get tons of patients in my Woodbridge, Dale City VA Chiropractic office with neck and upper back pain. The crazy thing is a lot of the time it is coming from their chest muscles being too tight. Stretching the chest muscle can sometimes take the pressure off the upper back and allow those muscles to rest and decrease their waste production. That usually cuts down on the numb spot or that burning spot in the upper back area. Here is some great information from Kenneth Miller MS on upper cross syndrome.
If you’re like the millions of people who use electronic tools such as a cell phone, tablet, laptop or desk computer, you’ve probably spent hours upon hours looking at the screen with your head jutted forward. Other situations that might have you holding your head forward of your shoulders include reading books, significant time behind the steering wheel or watching TV. Whatever the cause, the migration of your head to this forward position can ultimately lead to overactive muscles and a complementing set of underactive muscles. This postural distortion pattern, known as upper crossed syndrome (UCS), can result in imbalances of muscle tone or timing, often leading to poor movement patterns, and in this tech heavy society, increased stress on the head, neck and shoulder joints.
Poor posture at any level may lead to muscle imbalances. This can have a trickle-down effect into the rest of the body, not just in the local areas of the neck and shoulders. An associated sequence of muscle imbalances in the hip region, referred to as lower crossed syndrome, can oftentimes be observed in conjunction with upper crossed syndrome. When looking for long-term success in relieving UCS, identifying and addressing postural issues that could exist elsewhere in the body will also be needed. This total-body approach will relieve tensions through the entire kinetic chain, while also enhancing desired results.
Crossed and Countercrossed
The “crossed” in upper crossed syndrome refers to the crossing pattern of the overactive muscles with the countercrossing of the underactive muscles. When viewed from the side, an X pattern can be drawn for these two sets of muscles. The overactive muscles form a diagonal pattern from the posterior neck with the upper trapezius and levators down and across to the anterior neck and shoulder with the sternocleidomastoid (SCM) and pectoralis major. The other side of the X now depicts the underactive muscles, with the deep cervical flexors down toward the mid/lower trapezius, rhomboids and serratus anterior. As we continually assume the seated, forward head postures driven by electronic devices or poor exercise selection and technique, this X pattern of muscle imbalances will increase.
Identify Imbalances
When working with clients or performing your own workout routine, attaining and maintaining ideal posture is paramount to a safe and effective program. In order to address postural or movement imbalances, the less-than-ideal posture has to be identified and a corrective exercise strategy developed. This corrective program can have two applications. First, it can serve as a stand-alone phase of training that will help the client achieve better postural control and endurance. Second, it can be applied as the movement preparation for a workout. In the first application, the client may be in a post-rehabilitation situation and need a program that incorporates flexibility with local and integrated strengthening. The second application will most likely be for the client looking to move better and improve coordination before applying speed and increased force during their workout session.
The first step to improving any postural distortion pattern is being able to identify the condition. Upper crossed syndrome can be observed from different vantage points with different motions. Some basic assessments that can be implemented to identify distortion patterns are gait observations, overhead squat, pushing and pulling motions, and static posture analysis. With any postural assessment—static, dynamic or transitional—UCS can be observed by watching head position relative to the shoulders, and the arms and shoulder blades relative to the ribs.
By using the landmarks of the ears, shoulders and the glenohumeral (GH) joint, a static posture assessment can identify UCS by observing if the ears are forward of the shoulder. You might even say that this person is slouching.
Observations for the shoulder blade and the upper arm can be seen from the front and side views with the overhead squat, pushing (pushup) and pulling (cable row) motions. The movements to note during an overhead squat assessment for possible signs of UCS include
Arms falling forward or to side during the descent
Head migrating forward
Elevating or elevated shoulder blades
Elbows flexed or challenged in keeping arms straight
Depending on the extent of the distortion, someone may exhibit one or more of the listed movement compensations. Combining the different assessments can also confirm findings. This helps in prioritizing the corrective strategies during program design. Call Doroski Chiropractic to have this problem evaluated and to get some possible home exercises to help it go away.
As your chiropractor in the Woodbridge, Dale City VA area I want to share this article with you. It is also fitting since I watched Sidney Crosby and the Pittsburgh Penguins make it to the Stanley Cup finals last night. This is a great article called Rebuilding Sidney Crosby’s brain by Cathy Gulli. It is about the comeback of Sidney Crosby from a brain injury. Dr Carrick is head of the Carrick Institute which is the school I got my Diplomate in Neurology.
Ted Carrick is listening to Sidney Crosby’s heart. The NHL superstar is strapped into a computerized rotating chair that has just spun him like a merry-go-round. It is, as Carrick likes to tell people who visit his lab at Life University near Atlanta, one of only three “whole-body gyroscopes” in the world, and it’s integral to his work as the founding father of “chiropractic neurology.” He uses it to stimulate certain injured and diseased brains.
Crosby, who plays for the Pittsburgh Penguins and has been famously sidelined with a concussion since January, is Carrick’s newest patient, and this day in August is the first time they’ve met. Carrick leans in close, his balding, tanned head looming inches from Crosby’s face, and rests the stethoscope on his chest. “Let’s make sure you’re not dead.”
Satisfied, Carrick turns to the others in this cramped blue room, who include Crosby’s agent Pat Brisson, trainer Andy O’Brien and several chiropractic neurologists or studentsin- training wearing white lab coats. “He’s fine,” Carrick says. “It’s going to be good.”
Nodding to his colleague Derek Barton, who usually operates the lab equipment, Carrick signals to restart the gyroscope—with one difference. This time Crosby will be turned upside-down while he is also spun around. He hasn’t experienced this dual action yet.
Barton and Carrick discuss the appropriate speed setting the gyroscope. Then Barton enters Carrick’s directions into a computer that controls the gyroscope (chiropractic neurology uses no drugs or surgery), and tells Crosby to keep his head pressed against the back of the black cushioned seat. Crosby, wearing a grey T-shirt, black shorts and white ankle socks, scans the crowd on the other side of the clear plastic cylinder surrounding the machine. The door clangs shut. Above it, a stack of red, yellow and green lights shines while 10 high-pitched beeps signal the gyroscope is about to start. Ding! Ding! Ding! Ding! Ding! Ding! Ding! Ding! Ding! Ding!
A low hum floods the room as the gyroscope begins its 20-second “montage” of rotations. With each flip, Crosby grips the black handles flanking his thighs, his face reddens and his jaw clenches. Before long, the gyroscope, called GyroStim, winds down. “Perfect,” Carrick concludes.
As the chair returns to its starting position, Carrick approaches the gyroscope, opens the door, steps in and stands in front of his patient. 6 2 “Still there?” he asks, as he plugs the stethoscope back into his ears. He listens to Crosby’s heart again, and checks his eye movements. “That’s much better,” Carrick informs Crosby. “Just sit there for a sec. Relax for a bit.” Carrick asks him a few questions, and then surmises, “That’s good. That’s good!”
Inside the Pittsburgh hockey arena, known as the Consol Energy Center, Sidney Crosby is sitting behind a long table littered with microphones and audio recorders. His name is typed in bold black letters on a white sign. But Crosby needs no introduction. On this day, Sept. 7, nearly 100 journalists, camera operators, publicists, agents and team executives have convened for a rare press conference updating his health status. Ray Shero, the Penguins’ general manager, sits to his left. On the end, farthest from Crosby, is Michael Collins, a neuropsychologist who has been treating him for months. And at Crosby’s right hand is Ted Carrick.
It’s only been weeks since they were in Georgia together, and 249 days since Crosby sustained the first of two head shots that caused his concussion. That hit, which happened during the annual Winter Classic on New Year’s Day, was a blow unlike any the hockey world had ever experienced: the best player since Wayne Gretzky was suddenly knocked out of the game indefinitely because of an invisible injury: no blood on the ice, no cracks on any X-rays and no way to know how bad was the damage done.
And yet Crosby has turned concussion into the most highly visible of sports injuries. Since January, Google searches of “Crosby” and “concussion” have moved in tandem as hockey fans in Canada, the United States and as far away as Finland, Sweden, Germany and the United Kingdom try to make sense of what has happened to their favourite player. Scientists, doctors and equipment makers have used Crosby as a talking point to raise awareness and as a case study in the complexity of concussion. One group at the University of Ottawa has gone so far as to reconstruct Crosby’s first head shot to see the link between hits, helmets and brain-tissue stress. The NHL is embroiled in a polarizing debate over fighting in hockey—how to keep it in, but make it safe?—and whether it contributed to the deaths of three players in the past six months. And nervous hockey parents everywhere are reconsidering whether their children should keep playing. How Crosby recovers will help them decide.
Maclean’s obtained exclusive access to the lab where Crosby saw Carrick, and learned about his unique methods of treating brain injuries. While the details of Crosby’s personal health data remain private, over the course of two days, the magazine was granted access to a range of information about the treatments used on patients, including him. During that time in late September and early October, an astonishing assortment of patients came through the clinic. A wealthy businessman and his son. A prominent NFL player. An NHL rookie and a teenage girl, each with a concussion. An aging biology teacher who’d had a stroke. A boy with brain damage sustained after a van ran him over. A middle-aged physician who’d lost his ability to talk or walk after a tick bite. In every case, Carrick ran through a version of the same evaluation, exercises and equipment he used on Crosby. “We saw something like nine MDs, neurologists, cardiologists,” says one patient’s relative. “I’ve seen nothing that compares to this.”
Nor had most of the people at the press conference now bracing to hear about Carrick’s involvement with Crosby. Staring out from behind gold-rimmed eyeglasses, Carrick surveyed the fidgety strangers. “Good day, people. I’m here because Sid asked me to be here to discuss with you some of the things that have been going on in his life over the last little while.”
But Carrick’s statements were more puzzling than clarifying: he took “a different type of approach” to brain injuries, one that looked at “physicality” and involved “specific measurements” to “make a very good diagnostic impression of what was happening in Sid’s brain.” Carrick alluded to Crosby’s compromised spatial awareness—“areas of space were not in an appropriate grid to where he would perceive them”—and described how he had fixed that. “We were able in our lab to quantify this, and then to develop strategies that allowed us to basically build him a new grid,” Carrick declared. “So at the present time he is able to embrace strategies with a new system where everything is in line.” And then he added: “It’s Christmas, I think, for Sid Crosby and for the people that care for him. And it’s a very good start.”
When question period finally arrived, the only thing any reporter could think to ask Carrick specifically was: “The Christmas line—I was a little confused by what that meant, so if you could maybe elaborate on that, please?”
For whatever vague or bewildering comments were made during that 40-minute press conference, a singular message came through loud and clear: Sidney Crosby was getting better, and this man, Ted Carrick, was a big reason.
Carrick started out as a chiropractor, but has since developed an encyclopedic understanding of the brain. But what Carrick practises goes far beyond alignment and adjustments or conventional medicine. He is a self-made man: Carrick invented his discipline, and then founded an educational institution, the Carrick Institute for Graduate Studies, devoted to growing it. He lectures and practises around the world, and has legions of earnest students and loyal graduates. Today, 2,700 individuals in the world are board-certified to practise chiropractic neurology or functional neurology, a related field that permits pharmacy and surgery and draws professionals from other backgrounds too.
The method used by Carrick and his colleagues is notably different from the current “rest and wait” approach endorsed by an international consensus group, which recommends patients refrain from any physical or mental activities until all symptoms have disappeared. Then they slowly reintroduce activity, but if symptoms resume, they revert to the “rest” stage again. Carrick encourages his patients to rest immediately after the injury occurs, but then incorporates stimulation into the treatment, based on a “thorough neurological exam” that pinpoints their particular problems or symptoms as well as what brain functions are most viable. The stimulations might include eye or balance exercises, multi-tasking activities or body rotations. “We tailor our treatments very specifically to the individual,” says Carrick. “When we have an area that’s not working right, we look at other areas that can compensate for that if we need to, or we look at mechanisms to make those areas work right.”
The wait list to see Carrick can be as long as three years, though in some cases, such as with Crosby, patients can be expedited. By the time they met in Georgia, the reality of what Crosby could lose if he didn’t get better soon was abundantly and uncomfortably clear: his career, his endorsements, the adoration of an entire nation. Yet in many ways, the NHL’s golden boy was just like many people stuck in a concussion vacuum where conventional medicine can’t readily cure the injury, leagues can’t easily curb it from happening and patients and their families can’t know how long symptoms will last and what life will be like once they’re gone, if they ever do go.
However strange and sickening that first day of treatment was for Crosby, it proved encouraging enough that he continued seeing Carrick for the whole next week. They’d meet as early as seven in the morning, and they’d go as late as six at night, says Carrick, running through a circuit of high-tech equipment and low-tech exercises in the lab and at the local hockey rink. By the time Crosby travelled back to Pittsburgh, Carrick says, “he was better than, you know, super-normal.” The Penguins’ medical team, who have been overseeing Crosby’s recovery, also saw an improvement: they ran computerized tests called IMPACT to compare his current neurocognitive abilities with what they were before the concussion. The results: not quite “super-normal,” but “the best we’ve seen” since Crosby got hurt, as Collins said at the press conference. (He declined interview requests.)
“Carrick had a very prominent role in Sidney’s current recovery status,” Brisson, Crosby’s agent, told Maclean’s. “He progressed extremely well under Carrick.” Just 10 days after the press conference, Crosby joined his teammates on the ice for the first day of training camp. Three-and-a-half weeks after that, Crosby was cleared for contact—the final step before returning to play. Now, after nearly a year of nagging symptoms that have included fogginess, light-headedness and nausea so paralyzing Crosby couldn’t drive or watch TV, and after a slew of setbacks each time he pushed too hard while exercising or skating, the greatest hockey player of this generation is verging on a comeback—perhaps because of a relatively unknown therapy he received at a relatively unknown university from a relatively unknown man who isn’t even a medical doctor.
Come what may, Carrick has set out to do what no amount of time or rest or other expert has managed to accomplish so far: rebuild Sid’s brain.
It’s just before 8 a.m. on the first Saturday of October. Carrick is about to give a four-hour lecture on chiropractic neurology at Life University in Marietta, Ga. He is standing beside a massive screen displaying the first slide of his PowerPoint presentation. It shows the Carrick Institute coat of arms, which features bees because “they represent work and continuous diligence as a team,” says Carrick, and the motto “seek wisdom” in Latin because it “is something that I have always ascribed to.”
The slide also lists Carrick’s professional titles, which include affiliations with Life, Logan and Parker universities, and president of the American Chiropractic Association’s Council on Neurology. After his full name, Frederick R. Carrick, there are several acronyms signifying various credentials—60 letters in all, mostly unrecognizable.
A large man stands in front of the slide, and the crowd hushes. John Donofrio, president of the chiropractic neurology board, introduces Carrick by describing the first time he heard him speak. “I was there for one hour when I said, ‘My whole life is now changed forever,’ ” says Donofrio. “He has no idea, okay, of how much of this world he has touched.” Carrick “basically is what D.D. and B.J. were back in the 1900s,” he says, referring to the Palmers, father and son, who founded the field of chiropractics. “He is really the father of chiropractic neurology.”
Carrick was born on Feb. 26, 1952, in Toronto, and raised in Calgary, Edmonton, Winnipeg—wherever work took his father, a career soldier with the Princess Patricias Canadian Light Infantry who fought in the Korean War. After finishing high school, Carrick says he “had a calling” to join the Princess Pats too, and served in Cyprus. While on leave in the Bahamas, he met his future wife, a New Englander on vacation. After three years in the army, Carrick quit. “I was really going to do it forever, except that I thought that I might be able to help people more in health care.”
The decision to pursue chiropractic rather than medical school was a “very calculated coin toss,” says Carrick, because, as a lifelong martial artist (he still does karate), it seemed more in line with his preference for natural means of healing and well-being. Carrick was also “more impressed” with the chiropractors he talked to than the medical doctors. “I like to do things with vibrancy,” he says over lunch at a Middle Eastern restaurant near his lab. “Not death and dying.”
Carrick wed in 1973, and after he graduated in 1979, the couple moved to New Hampshire to set up his practice. Over the years, he developed a clientele that included patients from overseas with “everything from strokes, low back pain, dystonia—you name it, I saw it,” recalls Carrick. “People would come to me when other things failed.” Carrick keeps on hand a state of New Hampshire resolution “honouring” his clinic in 1988 for “its contribution to the quality of human life and performance,” and for his ability “to afford his fellow man great relief from physical pain and disability.”
By the mid-1990s, Carrick and his family had relocated to St. Cloud, Fla., and he obtained a self-designed Ph.D. from Walden University in what he calls “brain-based learning.” Around this time, he gained attention for bringing comatose patients out of their vegetative states using stimulation. A program that aired on PBS, entitled Waking up the Brain: Amazing Adjustments, described Carrick as a “remarkable healer and teacher.”
As Carrick’s practice has grown, so too has the Carrick Institute, which is headquartered in Cape Canaveral. Since the mid-’80s, it has evolved from teaching partnerships between Carrick and a few chiropractic schools into its own educational entity specializing in “clinical neurology.” It has more than a few dozen faculty members who teach courses such as “neuron theory and receptor activation” and a three-part series on “vestibular rehabilitation.” To become a chiropractic neurologist requires three additional years of studying, a residency and board certification exams.
Despite the buzz surrounding this burgeoning field, many people outside it aren’t sure what to think. Before the press conference in September, Blaine Hoshizaki, professor and vice-dean of the University of Ottawa’s school of human kinetics and director of the Neurotrauma Impact Science Laboratory, had never heard of this specialty, despite his extensive work in concussion research. He found it “strange” that a medical neurologist wasn’t included in the Crosby press conference, and is hesitant about Carrick’s approach, saying, “I’m not sure you want your chiropractor as your guide to the new frontier.”
Dr. Kevin Gordon, a pediatric neurologist in Halifax, finds Carrick’s approach intriguing and perplexing. “Are specific exercises targeted at particular parts of the brain likely to change the way in which the brain works? It is a possibility,” says Gordon, a professor at Dalhousie University. Still, he isn’t convinced. “The question is, what’s the science behind these interventions?”
This isn’t Carrick’s first brush with cynics: in 2007, he was the subject of online debate over his credentials and credibility on the website Chirotalk: The skeptical chiropractic discussion forum. “These people are chiropractic haters,” says Carrick now. He gets frustrated that the field is dismissed offhand. “It’s like saying, ‘Hey, what do you think of this curling iron?’ Well, I’m bald. I can’t tell you anything about it. It doesn’t mean it’s bad.” He’s also inflamed by any suggestion that his work is wacky. “To characterize what we do as some fringe science is crazy,” he says. “We don’t have Kool-Aid. We don’t have a little fire. We’re not dancing around naked. There’s no pins in the dolls, and there’s no dolls.”
In fact, Carrick argues that all of his diagnostic techniques, exercises and equipment, excluding the gyroscope, are used by medical doctors too. “There’s nothing we do that is different from anybody else. But the combinations that we do, the frequency that we do it, are often different,” he says. “If you can imagine, you’ve got some eggs, you’ve got some flour, you’ve got some sugar, you’ve got an oven, you’ve got a ramekin, you’ve got some butter. But your soufflé isn’t as puffy as mine,” Carrick continues. “We just put in our recipe a little bit different.”
One thing Carrick says skeptics fail to mention when comparing his methods to the current “rest and wait” approach, which is what Crosby adhered to during most of his recovery, is that “the gold standard people had him for eight months, you know?” he says. “That’s the gold standard, right?”
Before Crosby goes in the gyroscope, Carrick learns more about what problems he’s having. That involves another machine, the “computerized assessment of postural systems,” or CAPS. In a small white room, Crosby stands in his skates on a black foam platform while wearing sound-dampening headphones. Carrick and his colleagues surround him in case he gets unsteady; his agent and trainer watch from the doorway.
Crosby’s only objective is to stand still while his eyes are closed and his head points to the left, to the right and to the ground for 25 seconds at a time. Three sensors inside the platform detect motion and transmit the data into a system that calculates his stability and what is described as his fatigability ratio.
“Tuck your chin down to your chest,” instructs Barton, who is running the system. “And close your eyes.”
Crosby obliges. Carrick, standing nearby, responds with encouragement: “That is so helpful to what we’re going to do for you. Just putting those skates on there gives us exactly the information we wanted to get,” he says. “Now we’re going to fix it for you.”
So begins a week of tests and exercises based on Carrick’s neurological exam of Crosby. Standing in front of him, Carrick pulls from his pocket a red-and-white-striped cloth ribbon called an optokinetic nystagmus strip. He moves it horizontally in front of Crosby’s eyes to check how smoothly he can track the stripes as they go by. Other times Carrick flicks his thumbs in front of Crosby to gauge how quickly and accurately Crosby targets objects. Occasionally Crosby lies on a chiropractic table while one of Carrick’s colleagues transmits high-frequency currents into the tympanic membrane in his ears. They put on graphite conductive gloves that are connected to a machine, and insert their thumbs in his ears. Often, Crosby does eye exercises on an iPad that challenge him to stare at a dot or follow a moving pattern.
Sometimes Crosby has to stare at or track red or green laser-beam dots as they appear or move across a wall. For this test, called videonystagmography, or VNG, he sits on a dusty-rose upholstered metal chair like those found in a banquet hall. He is wearing a pair of black goggles with cameras in each lens that transmit live video of his eyes onto a laptop. Carrick, the lab team and Crosby’s agent and trainer watch as two eyeballs dart from dot to dot or glide from side to side. After one such session, Crosby sees the footage of his own eyes.
As the days go on, Carrick incorporates ice time into the treatment. His colleagues have set up a mini lab in an office inside a nearby arena. Canadian and American flags hang at one end. Half a dozen local hockey players have been recruited to practise with Crosby, and it is easy to pick him out. After running through shooting and skating drills—dozens of pucks are strewn across the ice—Crosby is scuttled into the makeshift lab for more tests.
Crosby, who has on a black jersey like the Penguins wear, takes off his white helmet. He is dripping with sweat, breathing heavily and chugging from a cold bottle. Except for Carrick standing in front of him waiting to do the thumb test, it is easy to imagine that this is the same Crosby that fans have come to idolize. He puts down his drink and begins the eye exercise. Carrick catches a glimpse of the old Crosby too: “The reflex is back there, which is great.”
After their time in Georgia, Carrick says he set an alarm on Crosby’s iPad to go off every hour, reminding him to do various eye exercises. Since then, Carrick says he hasn’t seen Crosby, but they have been in frequent contact. “He’s excited about getting back into the game,” says Carrick, “and hopefully things will continue to go very, very well for him.”
Even medical professionals such as neurologist Kevin Gordon acknowledge that Crosby’s recent progress has been promising. “You’re dealing with a remarkable case report that says this holistic approach with multiple interventions has made somebody with a severe concussion improve on a time course which would seem remarkable compared to how they were recovering before,” he says. But Gordon is cautious about what this means for the future. “Is it going to change his ultimate recovery? We can’t tell yet. Is he completely recovered? We don’t know yet.” Having researched and treated concussions for many years, Gordon says that “if indeed this is the solution, then there are a lot of people this needs to be standardized and developed for. We can’t ignore it. But we have to study it.” At Life University, Carrick and his colleagues have begun a 400-person study to determine whether the gyroscope does improve balance. But he is also emphatic that because his approach is so patient-specific, it is difficult to study. “If you hurt your brain, I’m probably going to treat you differently than this person here. It’s hard to design a study like that, because studies like to say we’re going to give you this drug and we’re going to see what happens,” says Carrick.
For those close to Crosby, all that matters now is whether he is well enough to get back in the game. And there is only one person who can ultimately make that call: Crosby himself. “It’s like a race-car driver. The car could be fixed, the tires are perfect, the pipes are good, but if the driver isn’t mentally prepared to go 250 mph on the track, it outweighs” any expert opinion, says Brisson.
On one of his last days in Georgia, Crosby did another round of VNG. As the testing wrapped up, Carrick responded with unabashed enthusiasm about Crosby’s recovery: “This is so exciting for me,” he told him. “But for you and your brain, I mean, it’s perfect. We shouldn’t test you anymore, just send you home.”
And Carrick did just that. Crosby returned to Pittsburgh, to his team, to his fans, to the same rink where less than a year ago he was skating toward the best season of his life. He’s traded his white helmet for a black one, signalling he can take contact again. He’s goading his teammates into hitting him so he can prove his toughness—as much to himself as to them or to the world, which is analyzing his every move. In this way, nothing has changed: he is still the one hockey player everyone watches. Sidney Crosby is home, indeed.
There’s only one question left: when the time comes, will Sidney Crosby play as if he was never gone?
