COMMON CHIROPRACTIC CARE
By: Brian Blunt
INTRODUCTION
INTRODUCTION During my co-op with
Dr.Wolfe at Wolfe Chiropractic Center, I had the chance to see many different injuries and treatments. All injuries had different causes, some due to accidents, while others due to poor treatment of the body. Some of the patients that I helped treat were there almost everyday, while others were there from once a month to once every 3 months.
INTRODUCTION
My Independent Study Project is an overall look at the top five injuries that I saw treated, including a description of what the injury is, how it may occur, how it can be treated, and the length of time it may take a person to recover from this injury.
INTRODUCTION
The top five injuries that I saw and will be speaking about today are:
1. Cervicogenic Cephalgia
2. Costoclavicular Syndrome
3. Cervical Spondylosis
4. Lumbar Facet Syndrome
5. Lumbosacral Strain/Sprain
CERVICOGENIC CEPHALGIA
WHAT IS IT? Steady, aching headache in
the suboccipital and temporal region of the brain
Pain described as steady and aching and may last from 4 hours to 2 days
May encircle the entire head, beginning in the occipital region and moving to the frontal region of the brain
Pain may increase with forward flexion of the neck
WHAT IS THE CAUSE?
There are several different causes for cervicogenic cephalgia. They include:
Cervical subluxations (partial dislocations of cervical vertebrae)
Trauma Postural strain Myofascial trigger points TMJ (temporomandibular joint) syndrome Tension
Stress, fatigue, noise, and glare can all make the headaches worsen.
HOW CAN IT BE TREATED?
First the case must be diagnosed as cervicogenic cephalgia. This is done by :
Checking tension of masticatory and submandibular muscles
Ruling out TMJ involvement Look for hyperalgesia of skin zones in the cervical
region and trigger points on the neck and thorax Check cervical and thoracic spine, AC joint, and
sternoclavicular joint for impaired function Check for anterior weight bearing
HOW CAN IT BE TREATED?
Once diagnosed, cervicogenic cephalgia can be treated using the following methods:
Massaging of the occipital and paraspinal muscles
Ultrasound of upper trapezius and lower cervical paraspinal muscles, following with moist heat
HOW CAN IT BE TREATED? Icing the neck Adjustments of cervical
and thoracic subluxations Check for food allergies
and remove those foods from the diet
Valerian root, Passion flower,Magnesium, and Calcium may also help
HOW LONG WILL THE TREATMENT TAKE?
The length of treatment depends on who is being treated and how sever the headaches are. Treatment length varies from case to case.
COSTOCLAVICULAR SYNDROME
WHAT IS IT? Neurovascular compression
of the shoulder girdle Pain is increased by
abduction and retraction of the shoulder as is paresthesia
Pain is most severe during the night and early morning
Effects include pain, numbness, and paresthesia of the neck, upper extremities, and anterior chest wall
WHAT IS THE CAUSE? Narrowing of the
space between the first rib and the clavicle
Compression of the subclavian artery and brachial plexus
Poor posture, trauma, fatigue, or emotional stress can all be relating factors
HOW CAN IT BE TREATED?
First the injury must be defined as costoclavicular syndrome. This is done by checking for:
Trigger points around the neck and clavicular region
Diminished or absent pulse unilaterally or bilaterally of the neck and clavicular regions
Sensory impairment over the regions of C8 to T1 Cyanosis, edema, Raynod’s phenomenon, and
distal gangrene of the upper limbs
HOW CAN IT BE TREATED?
Once diagnosed, costoclavicular syndrome can be treated using the following methods:
Moist heat and ultrasound Muscle stripping Stretching of the involved muscles Trigger point therapy to reduce muscles spasms Check for impaired function and anterior weight
bearing of the cervicothoracic spine, AC joint, and sternoclavicular joint
HOW CAN IT BE TREATED?
Reduce subluxations in the occipital, cervical, and thoracic regions
Posture and shoulder elevation exercises Stretching of involved muscles Ischemic pressure techniques applied for 5 to7
seconds on myofascial trigger points in the cervical, upper thoracic and shoulder muscles
Valerian root, passion flower, magnesium and calcium may help to stop muscle spasms
HOW LONG WILL TREATMENT TAKE?
Depending on the severity of the case, treatment time for costoclacivular syndrome is always different.
LUMBAR FACET SYNDROME
WHAT IS IT?
Rotational and compression injury of the facet joints in the lumbar spine
Also known as posterior joint syndrome or acute locked back
WHAT IS IT?
Characterized by low back pain that is relieved by motion but aggravated by lumbar extension and rotations, prolonged sitting, and repetitive movements
Pain may move to , upper thighs, groin, hip and buttocks.
Pain may also move to sacroiliac joints and superior iliac spine.
WHAT IS THE CAUSE?
Trauma Microtrauma Obesity causing excessive weight bearing
by lumbar spine Decreased disk height
HOW DOES IT OCCUR?
Increased lumbosacral lordosis (forward curvature of the lumbar spine)
Disk degeneration Poor posture Tear or pinch of facet capsule caused by
hyperextension of hyperflexion of lumbar spine
HOW CAN IT BE TREATED?
The injury must first be diagnosed as Lumbar Facet Syndrome. It can be identified mostly by the pain it is characterized by, but also by tenderness of the lumbar spinous processes and transverse processes when touched.
HOW CAN IT BE TREATED?
Once diagnosed, lumbar facet syndrome can be treated in two fashions, one for an acute case, and another for chronic or subacute cases.
ACUTE TREATMENT
Icing the lumbar region
Ice massage of the lumbar region
High-volt sinusoidal interferential current
Ultrasound
SUBACUTE OR CHRONIC TREATMENT
Moist hot packs TENS machine used to
block pain Short wave diathermy Manipulation Flexion/ distraction and
traction Pelvic flattening and
strengthening of the abdominal muscles to correct the anterior pelvic tilt and to flatten the lumbar curve
SUBACUTE OR CHRONIC TREATMENT McKenzie exercises to help strengthen
stabilize the lumbar spine Proteolytic enzymes, Bioflavanoids, and
various herbals to relieve acute pain and inflammation
Amino acids, Glucosamine sulfate, Vitamin C, Alpha-ketoglutaric acid, calcium, Vitamin E, Zinc, Copper, and Manganese can be taken to help with tissue healing.
HOW LONG WILL TREATMENT TAKE?
Treatment time varies from person to person, depending on the severity of the case and whether or not it is acute or subacute/ chronic.
LUMBOSACRALSTRAIN-SPRAIN
WHAT IS IT?
Injury involving the combination of stretching, rupturing, or separating the muscles and supporting ligaments of the lumbosacral spine.
WHAT IS IT?
Pain is immediate Pain begins as transitory and is followed by
pain free intervals Pain is localized to the lumbosacral region
but may move to the buttocks and thoracic spine
WHAT IS IT?
Accompanied by stiffness, muscle spasms, and restricted motion in all planes
Pain may worsen with forward flexion Strains painful with active and isometric
movements Sprains painful in active and passive ranges
of motion
WHAT IS THE CAUSE? Work injuries Sports injuries Car accidents Continuous use Microtrauma Leg length Muscle imbalance Excessive foot
pronation
HOW CAN IT BE TREATED?
Before treatment a patient must be diagnosed as having a Lumbosacral Strain-Sprain. The following are signs used to diagnose:
Slow,guarded gait Antalgic posture Tenderness of the involved muscles, spinous tips
and transverse processes Edema Joint fixation Tenderness over the paravertebral muscles
HOW CAN IT BE TREATED?
Lumbosacral strains-sprains must be treated in two different fashions, one being for acute cases and the other being for subacute cases.
ACUTE TREATMENT
Ice packs to reduce pain, edema and muscle spasms
Interferential current to manage pain and edema
TENS machine used to control pain
Lumbosacral support
SUBACUTE TREATMENT
Manipulation of locked joints to promote pain-free ranges of motion , prevent fibrotic adhesion, decrease pain, and increase facet joint movement.
SUBACUTE TREATMENT
Moist hot packs Ultrasound Electric muscle
stimulation Whirlpool/ hot soaks
to reduce muscle spasms and relieve tension
SUBACUTE TREATMENT
TENS machine to diminish pain To prevent fibrotic adhesions and to
recondition muscles, muscles may be worked using trigger point therapy, myofascial release, stretching, and massage.
Abdominal muscles, low back, and hamstring muscles must be reconditioned using McKenzie exercises and stretching.
SUBACUTE TREATMENT
Proteolytic enzymes, Bioflavanoids, and various herbals to relieve acute pain and inflammation
Amino acids, Glucosamine sulfate, Vitamin C, Alpha-ketoglutaric acid, calcium, Vitamin E, Zinc, Copper, and Manganese can be taken to help with tissue healing.
Valerian root, passion flower, magnesium, and calcium and be used to relieve acute muscles spasms.
HOW LONG WILL TREATMENT TAKE?
Mild strains:7-10 days Mild sprains:
1-4 weeks Moderate strains:
2-4 weeks Moderate sprains:
1 month – 1 year Sever sprains-strains
may require surgery
CERVICAL SPONDYLOSIS
WHAT IS IT?
Osteoarthritic changes of the facet joints including the narrowing of space between disks, the formation of osteophytes, sometimes neurological symptoms.
WHAT IS IT?
Pain may be limited to the posterior neck or can radiate to the occiput, anterior chest wall, shoulders, arms, and/ or hands
Diminished ranges of motion in the neck Can be associated with cervicogenic headaches Patient may have abnormal disk degeneration
which may cause vertebrobasilar ischemia, ataxia, and vertigo.
WHAT IS THE CAUSE?
Cervical strains/sprains Repetitive trauma Metabolic disorders of articular cartilage Postsurgical changes
HOW CAN IT BE TREATED?
First the condition must be diagnosed as cervical spondylosis. This is most easily done by taking x-rays which will show:
Decreased cervical lordosis Decreased disk height Osteophytosis Osteophytes (posterior and anterior)
HOW CAN IT BE TREATED?
Sclerosis Eburnation of the uncovertebral joints Subchondral osteoporosis IVF encroachment
HOW CAN IT BE TREATED?
Once diagnosed, cervical spondylosis can be treated by:
Wearing a cervical collar for the majority of the day for up to two weeks to separate the spaces between joints
Cervical traction Myofascial stripping
techniques may be used on involved muscles
HOW CAN IT BE TREATED? Ultrasound may be used to
breakup fibrotic adhesions, reduce muscle spasms, and increase the range of motion of the neck
Adjustments of subluxations in the cervical and thoracic spine
ROM exercises Trigger point therapy
HOW CAN IT BE TREATED?
Glucosamine sulfate, vitamin C, iron, and alpha-ketoglutaric acid may be taken to improve the production of collagen
Calcium, vitamin E, zinc, copper, and Manganese may be taken to act as free radicals and remove cellular debris and promote healing
HOW LONG WILL THE TREATMENT TAKE?
The treatment time for Cervical Spondylosis varies from patient to patient, depending on the severity of the case and how long it has gone untreated.
CONCLUSION
CONCLUSION
As you can see, I saw a variety of different injuries and treatments while working at Wolfe Chiropractic Center. Although not all of these injuries can be prevented, some can. Proper diet, good exercise, and an ergonomic life style can help you prevent some of these injuries. For the people that chose not to do this, there will always be chiropractic care there to help them, but it can only do so much and cannot be expected to work miracles for everyone.