Spondylolisthesis – What Is That?
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Bay Area Chiropractor Comments: Ashley was competing in a gymnastics tournament last year and during one of her floor routines, noticed a sharp pain in her low back after performing a series of back hand springs. She said she landed crooked on the last of four back hand springs which resulted in immediate pain in the middle of the low back at the beltline. She has had pain in the low back before and initially, didn’t think this was any different from past episodes but when the pain didn’t improve after a week, she asked her parents if she could see their chiropractor for an adjustment. Her chiropractor took her history and was alerted by the mechanism of injury – the rapid onset of pain after bending backwards and landing crooked during her routine. The low back was carefully examined and during the range of motion testing, Ashley’s backward bending test was very painful and limited in motion. When bending backwards at an angle with pressure applied in the low back, sharp pain stopped the test immediately. Her neurological tests were normal and she could bend over and touch her toes – in fact, that felt good. Her chiropractor had a strong suspicion of what had happened and ordered an x-ray to see if the preliminary diagnosis was accurate. The x-rays looked normal but with the history of extreme backward bending and immediate pain onset, a bone scan was ordered which was positive for a stress fracture in the back part of the vertebra. Unfortunately, this meant no gymnastics for 3 months and the use of a low back brace was recommended. The good news is that the back pain was gone within a month and follow-up x-rays 3 months later did not reveal a visible fracture line in the vertebra. Ashley was able to resume gymnastics and competed with success and no low back pain in Houston.
So, what is spondylolisthesis? As depicted in the side view low back x-ray (left), it is the sliding forward of one vertebra over another (see arrow). It occurs in about 7% of the western population and up to 30-50% in cultures that carry their young on their back (like a back pack). It is reported that most people who develop spondylolisthesis acquire this between ages 6 and 16 due to a developmental weakness in that part of the spine, though the cause can be traumatic, like in Abby’s case where rapid, uncontrolled backward bending occurs. It can also gradually occur over time (called “degenerative”), usually not found before age 50-60, where no single event can be recalled by the patient. There is also a congenital type that can be hereditary where one is born with it, though most authorities feel it is acquired at an early age. The good news is that it is often stable and does not require surgery. In the more severe case, the nerves and/or spinal cord can get pinched in which case surgery is necessary. The symptoms would then include leg pain, weakness, and/or numbness with or without significant low back pain. Most cases however, can be successfully managed without surgery and do not compromise the nerves or cord.
Chiropractic has been found to be very successful in managing patients with spondylolisthesis as the pain generator is often above or below the slipped vertebra. In fact, in one report, chiropractic was found to be more beneficial than medical care for this condition (Mierau D, et.al., J Manip Physiol Therap 1987;10:49-55).
Dr. Ward Beecher practices at Beecher Chiropractic Clinic at 1001 Pineloch, Ste 700 Houston, TX 77062. You can schedule an appointment at BeecherChiropractic.com or by calling (281) 286-1300. If you have any questions regarding this blog, please comment below!
Is It Really Neck Pain?
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Houston Area Chiropractor Comments: A 48-year-old male had left sided neck pain with intermittent left arm tingling, numbness, and aching for 2.5 months. The pain was described as a deep nagging ache on the left side of the neck with a more intense pain in the left shoulder blade that occurred without any specific activity. Also, no particular position of the neck or head changed the symptoms in the neck or left arm. The patient described having periodic episodes of neck and left arm pain/numbness 4 or 5 times over the last 10 years, and he felt that this episode was similar to the previous episodes. He had utilized chiropractic treatment previously with good results and was considering calling for an appointment once again.
Everything “looks and sounds” like a neck condition with an associated pinched nerve causing pain and tingling radiating down the arm – but is it?
After carefully questioning, it was discovered that no specific date of onset could be tied to a trauma (specific injury), over-use activity, or any other identifiable cause. Similarly, he stated that no specific position of the head/neck or arm changed the intensity or length of time the pain lasted. This is unusual for a pinched nerve in the neck as the nerves are stretched when the arm hangs down at the side increasing the pain, and less stretched when the arm is raised over the head resulting in less arm symptoms. Another inconsistent finding was that the whole arm rather than a specific part of the arm was symptomatic. Usually, a pinched nerve follows a specific course down the arm affecting either the 4th and 5th fingers or the thumb side of the hand, but not the whole arm and hand. The physical examination was fairly typical for neck pain sufferers – limited ranges of motion of the neck, neck pain reduction with manual traction and increased with compression tests. However, there were no arm symptom changes during the neck ranges of motion tests, compression tests, or elevating the arm.
These history and examination findings should alert the health care provider of a possible “organic” cause for the symptoms rather than the “pinched nerve” diagnosis. When considering a list of possible “organic” causes, heart disease must be first on the list since it has life threatening potential. In the case presentation above, the patient was indeed having a heart attack where the blood vessels to part of the heart wall were blocked and the blood carrying oxygen to the heart muscle couldn’t get through, thus was causing the “referred pain” to the left side of the neck, shoulder blade and down the left arm. It is important to know that this heart related referred pain pattern never involves the right arm – only the left. Other potential symptoms can include left jaw (TMJ) pain, and the more obvious left sided chest pain, even though these were not present in this case.
We welcome you to contact our office for a thorough evaluation or to answer any questions concerning you, your loved ones, or friends concerning neck pain, with or without arm complaints. The good news is that it is probably your neck and not your heart that is causing the symptoms. Most importantly, rest assured that we ALWAYS consider all possibilities.
Dr. Ward Beecher practices at Beecher Chiropractic Clinic at 1001 Pineloch, Ste 700 Houston, TX 77062. You can schedule an appointment at BeecherChiropractic.com or by calling (281) 286-1300. If you have any questions regarding this blog, please comment below!
Carpal Tunnel and Computer Work
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Clear Lake Chiropractor Comments: Approximately 2/3rds of employees from industrialized countries use a computer on a daily basis and one of five spend at least 75% of their total work time behind a computer. It’s no wonder so many suffer from neck, shoulder, arm pain, including carpal tunnel syndrome (CTS). There are many reasons for the presence of CTS in office workers who utilize a computer. The following is a partial list of causes:
- The computer screen is not positioned correctly in front of the worker forcing the neck to be rotated to the side or the head has to look up or down too far.
- The mouse and/or keyboard is placed on top of a counter, too high to operate without significant bending of the wrist, often against the sharp edge of the counter.
- The shape of the keyboard is flat, forcing the hands and wrists to pronate (roll inwards) too far. This places more pressure on the nerves in the forearms.
- The use of a mouse usually requires the entire arm to move, frequently running off the mouse pad requiring repositioning.
- Paper work data that needs to be entered in the computer is placed too far off to the side and sustained neck rotation is required during the data entering process.
- The chair and computer desk do not fit the person’s height (either too high or too low) and/or the feet don’t touch the floor.
- There is too much glare from windows or overhead lighting making it difficult to see the screen.
- In the aging worker, poor eye sight requires the use of magnifiers which can be quite distorting when the head is moved, even a small amount.
- There are often other medical conditions that the computer operator may have that increase the likelihood of developing CTS such as obesity, hormone replacement therapy, diabetes mellitus, hypothyroid, the use of birth control pills, and others.
Blogging? flickr photo by Anonymous Account shared under a Creative Commons (BY) license
Therefore, the treatment of CTS must be multi-factorial and sometimes address one or more additional health issues that may co-exist. There are also frequently, many similar overuse types of conditions present in addition to CTS such as neck strain, thoracic outlet syndrome, nerve compression at one or more locations such as the neck, shoulder, elbow, forearm as well as at the carpal tunnel of the wrist. Each patient’s case is unique and a careful history is usually needed to uncover these potential contributing conditions so they can all be properly managed in addition to CTS. Because we spend a lot of our daytime hours at work, a careful work related history is important to identify potential “ergonomic” (design) culprits that can be fixed with simple workstation adjustments. These may include mouse/keyboard placement to an under the desk pull out tray to eliminate the need to overly bend the wrists and eliminate the pressure from the counter top edge. Raising a chair and placing a box under the feet while sitting (for shorter workers), switching to a track ball mouse so only thumb movement is needed to move the pointer (or a touchpad as found on most laptops), an ergonomic keyboard (curved, not flat), moving the screen in front and slightly down from eye level, prop paperwork on a stand-up tray close to the screen so only eye movement is needed, wearing appropriate quality eye glasses possibly with bi- or trifocals, are some potential work station remedies. Treatment that addresses all the contributing issues frequently includes neck, mid-back, shoulder, elbow, forearm, and wrist/hand. Chiropractic care is especially well suited to address these issues because of the whole body treatment approach utilized. We are also well trained in evaluating the work related and will work with your employer to cooperatively improve problems that may be perpetuating the condition. If you or a loved one is suffering with carpal tunnel syndrome, sharing this information may be one of most significant acts of kindness that you can give to those that you care about.
Dr. Ward Beecher practices at Beecher Chiropractic Clinic at 1001 Pineloch, Ste 700 Houston, TX 77062. You can schedule an appointment with your houston chiropractor by calling (281) 286-1300. If you have any questions regarding this blog, please comment below!
Does the Use of a Low Back Support or Brace Really Make a Difference?
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Clear Lake Chiropractor Comments: “Do you think a back brace will help my condition?” This is a question that is frequently asked of many health care providers who treat low back pain. The answers typically vary, as there is support for and against the use of a brace when low back pain is present.
The use of back braces had been considered a “standard” in the treatment of patients with LBP for many years. One argument against using back braces centers around becoming “dependent” either physically or mentally on its use and this has long been a concern among health care providers. Braces are particularly helpful when the patient cannot stop performing needed activities, such as work. The brace helps to reinforce proper bending and lifting by minimizing rotation and side bending. The patient needs to also take breaks from the brace when it is not needed or during periods of rest. Ultimately most people will not need the brace as the problem is resolved and supporting muscles are developed to prevent aggravation.
There are many types of back braces. Some are narrow and are particularly favored when frequent bending and/or twisting movements are required by a job, sport, or other daily activity. Other braces are taller in the back and taper in the front, which give better support but still allow some bending / twisting movements. Some braces are more rigid and can actually stop movement in certain directions. These types include a hard, rigid surface that is placed in the area of the back where movement is not desired. These are used at times when there are fractures of the spine, after spinal surgery and in scoliosis bracing. Some braces are to be worn low on the pelvis to support that area, while most are placed in the center of the low back region. There are also rib belts sometimes used when ribs fracture, soft and rigid neck braces sometimes used after car accidents, and braces for the arms or legs. The decision to use a brace rests on the degree of injury and the patient’s ability to avoid certain activities or positions. When the injury is significant and/or the patient cannot control his/her activities (such as work), then the use of a brace may be one of the most important treatment approaches for that patient. It’s similar to having stitches when a deep or wide cut occurs. Ask us about the use of supports, braces, or belts if you or your family or friends are suffering with low back pain.
Dr. Ward Beecher practices at Beecher Chiropractic Clinic at 1001 Pineloch, Ste 700 Houston, TX 77062. You can schedule an appointment at BeecherChiropractic.com or by calling (281) 286-1300. If you have any questions regarding this blog, please comment below!
The Neck and Headache Connection
The Neck and Headache Connection
Clear Lake Chiropractor Comments: Patients with headaches also commonly complain of neck pain. This relationship is the rule, not the exception and therefore, treatment for headaches must include treatment of the neck to achieve optimum results. The term, “cervicogenic headaches” has been an accepted term because of the intimate connection between the neck and head for many years. There are many anatomical reasons why neck problems result in headaches. Some of these include:
- The first 3 nerves exiting the spine in the upper neck go directly into the head. They penetrate the muscles at the top of the neck near the attachments to the skull and therefore, any excess pressure on these nerves by the muscles or spinal joints will result in irritation and subsequent pain.
- The origin or nucleus of the 5th cranial nerve called the Trigeminal, innervates the sensation to the face and is located in the upper cervical region near the origin of the 2nd cervical spinal nerve, which innervates sensation to the back of the head up to the top. Therefore, problems located in the upper neck will often result in pain radiating up from the base of the skull/upper neck over the top of the skull to the eyes and /or face.
- The 11th cranial nerve that innervates the upper shoulders and muscles in the front of the neck arises from the top 5 to 7 spinal cord levels in the neck. Injury anywhere in the neck can result in spasm and pain in these large muscle groups.
- Other interconnections between the 2nd cervical nerve and trigeminal/5th cranial nerve include communication with the 7th cranial / facial nerve, the 9th cranial / glossopharyngeal nerve, and the 10th cranial / vagus nerve. These connections can affect facial muscle strength/movements, taste, tongue and throat movements, and stomach complaints such as nausea from these three cranial nerve interconnections, respectively.
Headache flickr photo by Peter Hellberg shared under a Creative Commons (BY-SA) license
When patients seek treatment for their headaches, a thorough examination of the neck, upper back, and cranial nerves is routinely performed for the above reasons. It is common to find upper cervical movement and vertebral alignment problems present in patients complaining of headaches. Tender points located between the shoulder blades, along the upper shoulders, on the sides of the neck and particularly, at the base of the skull are commonly found. Pain often radiates from the tender point over the top of the skull when pressure is applied in the upper neck/base of the skull area. Tenderness on the sides of the head, in the temples, over the eyes, and near the jaw joint are also common. Traction or pulling the head to stretch the neck is often quite pain relieving and this is often performed as part of the chiropractic visit and can also be applied at home with the use of a home cervical traction unit. Chiropractic adjustments applied to the fixated or misaligned vertebra in the upper neck often brings very satisfying relief to the headache sufferer. Exercises that promote movement in the neck, as well as strengthening exercises are also helpful in both reducing headache pain and in preventing occurrences, especially with stress or tension headaches.
Dr. Ward Beecher practices at Beecher Chiropractic Clinic at 1001 Pineloch, Ste 700 Houston, TX 77062. You can schedule an appointment with a Clear Lake chiropractor by calling (281) 286-1300. If you have any questions regarding this blog, please comment below!
