Revolutionary Back Pain Relief Treatment for Schuylkill County

March 5, 2010 by 1 Comment

Pottsville PA:  In this video, we will demonstrate a neuromuscular re-education treatment for back pain relief to help correct a loose or sprained sacroiliac joint.  In a previous post, we showed you a screening procedure for this problem.  The key to the treatment for back pain relief is lock and neutralize the sacroiliac joint into its normal functional position and then perform a previous painful movement, pain free.

The patient in the video has limited motion with low back and buttock pain bending forward.  Once the patient is in the Active Therapeutic Movement equipment, straps are adjusted to neutralize and lock the sacroiliac joints.  Once the sacroiliac joints are locked and neutralized the patient performs bending forward movements pain free.  This treatment starts to “wake-up” or stimulate the brain, nervous system, and muscles to function properly.  When your body is functioning normaly, you experience pain relief.

The treatment is very similar to learning how to ride a bike.  At first, it was very hard to keep your balance, but as you kept practicing it became easier.  Then one day your brain, balance center, nervous system, and muscles all were connected and you were able to balance on your bike and ride it.

Obtaining back pain relief with this treatment is just like the learning that occured when you learned how to ride a bike.  The same type of nerve-muscle learning occurs with this treatment.  Only this time, you can now perform a previous painful movement, pain free.

Not all back and buttock pain patients have this problem, but a great majority do.

If you have any comments or quesitons about this video or treatment and how you may achieve back pain relief, just fill out the comment box below.

 

Doctors’ Choice Physical Medicine and Rehab

Dr. David Novatnak

Glee Pascual, Physical Therapist

Pottsville, Schuylkill, PA

This information is solely advisory, and should not be substituted for medical or chiropractic advice.  Any and all health care concerns, decisions, and actions must be done through the advice and counsel of a health care professional who is familiar with your medical history.

Filed Under: Back Pain, Health Tips, Work Injury Tagged With: , , , , , , , , , , , , ,

Schuylkill County: Neck and Jaw Dysfunction Can Cause Headaches

October 30, 2009 by Leave a Comment

Pottsville PA: If you are a neck pain or headache sufferer, you know that they can be very disabling.  They can alter your normal pattern of living, sometimes from days to weeks at a time.  Simple things like reading the newspaper, cooking, driving a car, and/or looking down, can become almost intolerable.  Canceling plans for the day or saying “no” to activities that you enjoy can be very frustrating.

Headaches from your neck

There can be many “triggers” of headaches.  However, recent studies have headache researchers claiming that all headaches are the similar and stem from the neck.  In other words, tension headaches and migraines are the same disease or at least very closely related.  They are different mainly in severity and location.

Almost all headaches have tight neck muscles.  Sometimes the tight neck muscles can cause the headaches.  Other times the tight neck muscles are the result of the headache.

Neck pain affects approximately two thirds of the population at some point during their lifetime.  Headaches, in the absence of neck pain, are quite uncommon. 

Headaches from your jaw

Another interesting and lesser-known relationship to neck pain and headaches is the jaw (frequently referred to as the TMJ).  There is a strong association with upper neck dysfunction as well as headaches.  The muscles that move the jaw are largely innervated by the Trigeminal Nerve.  Several studies have found that when structures innervated by the trigeminal nerve were irritated neck and/or jaw pain was produced and vise versa. 

Similarly, patients with jaw problems (called temporomandibular dysfunction or, TMD) often report neck pain. 

When we open our mouth wide, head-neck extension always occurs followed by head-flexion when we close the jaw.  Hence, the neck is always moving when we chew, yawn, talk, and clench our teeth. 

In fact, all of these every day activities result in jaw, head, and neck motion extending from the base of the skull down through the entire cervical spine. 

Manipulation eases pain, improves jaw function

In one study, 37 female patients with neck pain were randomly assigned to a control or experimental group.  Mouth opening and pressure pain levels were recorded to a region innervated by the Trigeminal Nerve.  The experimental group received a spinal manipulation to the upper neck region the other a fake manipulation.  After the manipulation, the mouth opening measurements and pressure pain levels were repeated.  The group receiving the upper neck manipulation showed a significant increase in active mouth opening motion as well as improved pressure pain tolerance compared to the control/non-manipulation group.

One simple screening test we use is the three-knuckle test.  You should be able to insert the middle knuckles of your middle three fingers vertically between your front teeth.  We have found very few headaches suffers can do this.  It is an indication of jaw dysfunction.

This study is very important as many people suffer from neck pain, headaches, and jaw joint dysfunction. 

It has been demonstrated when we bite down, there is a corresponding tightening of two important muscles in the neck and upper back region.  Similarly, studies show relaxation of muscles in the neck, upper back, and TMJ after spinal manipulation to the neck is applied. 

Injuries to the jaw joint are common but often not pursued by headache patients as often they will say, “My jaw clicks and snaps but I don’t think about it much.” 

What to do

Proper treatment of these patients must focus on multiple regions, not just the neck area.                                                                                          

If you, a friend, or a loved one is struggling with neck pain, headaches, or jaw pain, we will properly assess your condition and administer the appropriate care that is required.  We also coordinate services with other health care providers when necessary.  Sometimes the service of a dentist or orthodontist is required. 

 

Want To Know More?

http://www.chiropractorpottsville.com

Doctors’ Choice Physical Medicine and Rehab

Dr. David Novatnak

Glee Pascual, Physical Therapist

Pottsville, Schuylkill, PA

Filed Under: Headaches Tagged With: , , , , , , , , , ,

Schuylkill County: Whiplash—An Extraordinary Strain and Sprain Neck Injury

October 30, 2009 by Leave a Comment

Pottsville PA Whiplash Sufferers

Whiplash; What Is It? 

Whiplash is a rapid far-reaching strain to the muscles and sprain to the ligaments to the neck.  It usually also affects small ligaments around the small joints and discs between the vertebra.  It may cause “pinching” or irritation of the neck spinal nerves that can cause pain, numbness, and tingling down the arm into the fingers.

How does it happen? 

A rear-end car crash is the most common cause.  The sudden jolt to the neck from the crash happens so fast that you cannot brace yourself.  It a rear-end crash your head accelerates first back and then forward beyond the limits of the muscles and ligaments that hold our bones firmly together (often referred to as a “strain/sprain”). 

Your neck is very defenseless to this type of injury because your head, which weighs about 12 to 15 lbs, is attached at the top to a flexible neck.  This imbalance causes your neck to behave like a slingshot.  Whiplash injuries more commonly worse in women because women longer and weaker necks.  Older people may experience more extensive injuries because of preexisting conditions, like arthritis.

What are the symptoms? 

The primary symptom is neck or upper back pain.  Sometimes the pain develops immediately.  Most times the pain is delayed for hours or days.  Sometimes the onset of symptoms is delayed days, weeks, or months.  We have often seen patients with neck pain that they say happen for no reason or they just woke up with the pain.  The cause of this may be years earlier from a car cash.  We see evidence of the whiplash on x-rays.

Even if you do not feel pain after a car crash, a doctor that can recognize a whiplash injury should always examine you.

Each person’s symptoms may be different because of their own preexisting condition and their position at the time of the crash.  A partial list of possible symptoms includes: 

  • muscles spasms,
  • loss of movement,
  • headache,
  • dizziness,
  • concentration &/or memory loss,
  • difficulty swallowing, chewing &/or hoarseness,
  • burning or tingling,
  • shoulder/arm/hand radiating pain, and more.     

How is whiplash diagnosed? 

Usually by a doctor trained in the diagnosis and treatment of whiplash.  Even when symptoms are not present or seem insignificant, a doctor can take a careful history and perform a neurological and orthopedic exam.  The doctor may order special bending x-rays of your neck.  X-rays may show a change in the curvature or contour of your neck.  A MRI or CT scan to better assess the discs and nerve roots may be indicated when pain radiates down an arm.  When persistent concentration/memory loss is present, a consult by a neuropsychologist is helpful.

How is it treated? 

In most cases, non-surgical methods are usually appropriate.  If you go to a family medical doctor, typical approaches include a wait & watch approach.  This may be appropriate if you do not have symptoms.  If you do have symptoms he or she may order medications such as anti-inflammatory drugs, painkillers, &/or muscle relaxants.  Although helpful for pain, medications do nothing to help the physical mechanical problems of whiplash.

Some MD’s may refer you to a doctor of chiropractic or order physical therapy.  These types of therapy help the mechanical injuries.  Sometimes the muscle injuries may be so severe that a referral to a physiatrist or a doctor that performs trigger point injections is necessary.  If conservative treatment fails, surgery may be indicated.  Surgery may include repair for persistent disc herniation or spinal fusion.

Chiropractic care and physical therapy treatment may include:

  • modality use (electrical stimulation, traction/decompression, ultrasound),
  • spinal manipulation,
  • mobilization,
  • massage and other soft tissue release techniques,
  • exercise training,
  • activity modification training.

The goal is restore normal pain free neck function.  Care may also include a mix of provider approaches, when appropriate.

How can it be prevented? 

The degree of severity of whiplash can be decreased or maybe avoided completely by:

  • the use of seatbelts (especially in high speed collisions),
  • placing the headrest close to the head (less than1 inch),
  • placing the headrest high enough to avoid “ramping” over it. (slightly above the half way point)

I know from personal experience that this strategy has helped me.  I demolished my car a few years ago and the only injury I had was a half way torn fingernail.  I also have to credit the airbag.

My passenger had a preexisting herniated disc and he did not even get a sore neck!

It is also makes sense to avoid distractive activities while driving – cell phone use, adjusting the radio, taking your eyes off the road (eye contact during conversation), dosing off, reading a book (this is more common than you think!). 

Important to know! 

If you would like us to look at your driving position in your car, just give us a call and ask us.  We would be happy to do so at no charge.

Doctors of Chiropractic have a unique advantage over other health care providers.  Studies show that spinal manipulation and other manual therapies have the highest levels of patient satisfaction and faster recovery rates compared to other forms of health care. 

If you, a loved one, or a friend is struggling with whiplash from a motor vehicle collision, you can depend on receiving a great examination from an experienced doctor trained in whiplash.  The therapeutic approach at this office will encompass all different doctor specialties that may be necessary to resolve your injury.

Want to know more?

We have a 12-page booklet I authored that explains whiplash, diagnostic tests, and treatment in much greater detail.  If you woujld like a copy, we can send it to you by e-mail.  Just go to “Contact Us” in the black bar above and request the “Whiplash” booklet in the “Message” box.

http://www.chiropractorpottsville.com 

 

Doctors’ Choice Physical Medicine and Rehab

Dr. David Novatnak

Glee Pascual, Physical Therapist

Pottsville, Schuylkill, PA

Filed Under: Car Accidents, Whiplash Tagged With: , , , , , , , , , , , , , , , ,

Schuylkill County: Whiplash…Why Do I Hurt So Much?

October 28, 2009 by 2 Comments

 There are many reasons why whiplash from a car accident can cause long-term pain.

There are ligaments in the neck that can give rise to pain.  The most intense pain comes from ligaments with the largest amount of pain nerve fibers.  Such as ligaments around the joints and the spinal ligaments that hold the neck bones together.  In a whiplash type injury, these ligaments are over-stretched. 

A “whiplash” injury in a rear-end accident is unique.  Upon impact, your car rapidly accelerates forward while your head remains in its original position.  This action results in an initial straightening of your neck followed by an extreme backward movement of your head.  The ligaments and muscles in the front of the neck become over stretched and tear.  Next your head is propelled forward into extreme flexion, which can then tear the ligaments and muscles in the back of your neck.  All this occurs in slightly more than one-half a second!  It is so fact that you cannot even remember that your head went backwards.  It is faster than your brain can record this trauma!

Damage to the ligaments and muscles is difficult to “prove” by x-ray.  Bending views or, flexion/extension x-ray methods help show the damage to the joints.  On the bending x-ray, we will see an abnormal forward and/or backward shifting of the vertebra.  The more abnormal shifting the worse the whiplash.  Sometimes there is permanent damage.  The abnormal shifting of the vertebra on bending x-rays may be present for years or a lifetime.  That is why whiplash pain may be so chronic. 

Recent technology advances can now record the trauma and long-term damage to muscles.  At our office, we use “dynamic surface EMG” to measure how the neck muscles are working compared to normal.  We can measure muscle spasm and abnormal muscle movements.  This can be a great aid in helping to treat your injury and help your attorney to “prove” your “whiplash” or soft tissue injuries. 

Not all car accidents occur from behind.  In fact, only about 1/3 occur from this direction.

One study that investigated which direction of impact created the greater degrees of injury found that 57% of the chronic pain patient group were in a rear-end collision.

They also found that women had more ligament injury compared to men.  They surmised it was because women generally have longer and weaker necks.  Frontal and rear end collisions result in significantly higher levels of ligament injury compared to side impacts.

Another well-published reason why neck pain can “hurt so much” after a car crash is that the pain message from the “pain nerves” becomes “memorized” by the brain and nervous system.  It also takes less stimulation of the “pain nerves” (something as simple as turning your neck) to trigger the pain.

This is similar to the “phantom limb” phenomenon that often occurs after leg amputation.  Some patients can still “fell” the leg pain after the limb has been removed. 

Other symptoms beside neck pain often occur with “whiplash” injuries.  They may consist of: 

  • headache,
  • TMJ / jaw pain,
  • dizziness,
  • coordination loss,
  • memory loss,
  • difficulty in formulating thought,
  • poor communication,
  • losing your place during conversation, and more.

At Doctors’ Choice Physical Medicine and Rehabilitation, we have a unique advantage over other health care providers in the treatment of whiplash. We have a Doctor of Chiropractic, a licensed physical therapist, and licensed massage therapist to perform manual therapies, including spinal manipulation. These types of therapies yield higher levels of satisfaction and faster recovery rates compared to other forms of health care. 

 Patients with whiplash injuries need a thorough history and physical examination.  We understand and can perform the special diagnostic tests that are necessary to demonstrate or “prove” whiplash.  We have prepared the necessary reports for many attorneys for successful settlements.

If you, a loved one, or a friend is struggling with whiplash residuals from a motor vehicle collision, you can depend on receiving high quality evidence-based therapeutic approach at this office.  

Want To Know More?

http://www.chiropractorpottsville.com

Doctors’ Choice Physical Medicine and Rehab

Dr. David Novatnak

Glee Pascual, Physical Therapist

Pottsville, Schuylkill, PA

 

Filed Under: Car Accidents, Whiplash Tagged With: , , , , , , , , ,

Schuylkill County: What You Need to Know About Steroid Injection in the Spine (Epidurals)

October 27, 2009 by Leave a Comment

Pottsville PA: Over the last few years, I have observed more and more of our patients coming into our office after they were to the “pain clinic” and had injections in their spine (Epidural is the medical term for this procedure). Not long ago in the Pottsville/Schuylkill county area, this treatment was almost unheard of for neck and back pain. Now it seems to be the recommendation of choice, even before more conservative treatment.

Before you subject yourself to epidural injection treatment for back or neck pain there are a few things you should know about it.

Acute Back and Leg Pain

In 1994, the Agency for Health Care Policy and Research of the U.S Department of Health and Human Services published a guideline titled Acute Low Back Problems in Adults: Assessment and Treatment. They defined acute to mean low back and leg pain from day 1 to less than 90 days duration.

In this study, they reviewed all the current literature and only took into consideration the most valid studies. There were 26 studies for epidural injections. What they published and recommend concerning epidurals may astonish you.

An epidural steroid injection was not a recommended treatment!

The report suggested an epidural injection for sciatica (nerve pain down the leg) as an option only to avoid surgery! (There was at least one adequate study.)

The report recommended against an epidural injection just for back pain without sciatica!

Their recommendations concerning epidural injections have not changed in 15 years.

Chronic Back and Leg Pain

Chronic back pain is typically defined as pain more than 90 days duration.

In 2007, WebMD published an article titled; Steroid Shots for Back Pain Don’t Work. The American Academy of Neurology’s Therapeutics and Technology Assessment Subcommittee reviewed four studies on epidural injections for back pain with sciatica. What they found was epidural injections:

  • did not relieve back pain more than a placebo 24 hours, 3 months, or 6 months after injection, 
  • did not appear to improve the patients’ average back function, and
  • did not help the patients avoid surgery.

There was a slight drop in pain 2 to 6 weeks after the injection compared with patients who got placebo injections, bit it was not “clinically meaningful”.

In short, the Subcommittee advised against epidural injections for chronic back pain.

Our Experience and Recommendation

All interventions have risk; epidural injections are no exception. Although small, one risk is spinal infection. Unfortunately, one of our patients experienced this adverse reaction. He was in Gesinger for an extended stay and was cut neck to his buttock. Eventually the infection was stopped but he had scarring all along the spinal cord. He was told he would never walk again. When he came to our office, he was walking with a walker. He told me he was considered lucky. He was not expected to improve.

In light of the above, I have seen a few patients that have had their pain reduced by epidural steroid injection, some for a few weeks, and some for a few months. We have even recommended epidural injections when we thought it might be helpful as the patient was going through rehab for their back pain and sciatica problem.

Now that you are armed, if your doctor recommends an epidural injection for your back or neck pain talk to him or her about this information…. And Think Again.

Our recommendations are:

  • If you have not failed conservative treatment for back and leg pain, such as anti-inflammatory medication with manipulation and physical therapy, do not do it. Do the conservative treatment before considering and epidural injection.
  • If you just have neck or back pain there is not any evidence in the peer reviewed literature that suggest an epidural would be helpful, do not do it.
  • If you have back and leg pain, failed at least 6 weeks of conservative treatment (no improvement in pain levels or function) and were told you need surgery, then there is some evidence that and epidural may provide some relief. The most recent consensus is that the epidural injection should be performed if you are also going through a exercise rehab program at the same time

I will talk about treatment recommendations in future blogs.

Want To Know More?

http://www.chiropractorpottsville.com

Doctors’ Choice Physical Medicine and Rehab

Dr. David Novatnak

Glee Pascual, Physical Therapist

Pottsville, Schuylkill, PA

 Sources

You can find the clinicians U.S Department of Health and Human Services guideline at: http://www.chirobase.org/07Strategy/AHCPR/ahcprclinician.html

The WebMD article can be found at:

http://www.webmd.com/back-pain/news/20070305/steroid-shots-for-back-pain-dont-work

Filed Under: Back Pain, Neck Pain Tagged With: , , , , , , , , , , , ,