Conditions We Treat

Neck Pain:

Chiropractic and Neck Pain: Conservative Care of Cervical Pain, Injury Technically your neck is called the cervical spine, which begins at the base of the skull. It contains 7 small vertebrae. Incredibly, the cervical spine supports the full weight of your head, which is on average about 15 pounds. The cervical spine can move your head in nearly every direction, but unfortunately, this flexibility makes the neck very susceptible to pain and injury.

The neck's susceptibility to injury is due in part to biomechanics. Activities and events that affect cervical biomechanics include extended sitting, repetitive movement, accidents, falls and blows to the body or head, normal aging and everyday wear and tear.  Neck pain can be very bothersome and it can have a variety of causes.

Here are some of the most typical causes of neck pain:

Injury and Accidents: A sudden forced movement of the head or neck in any direction and the resulting “rebound” of the head or neck in the opposite direction is known as whiplash. The sudden “whipping” motion causes injury to the surrounding and supporting tissues of the neck and head. Muscles react by tightening and contracting, creating muscle fatigue, which can result in pain and stiffness. Severe whiplash can also be associated with injury to the intervertebral joints, discs, ligaments, muscles, and nerve roots. Car accidents are the most common cause of whiplash.

Growing Older: Degenerative disorders such as osteoarthritis, spinal stenosis, and degenerative disc disease directly affect the spine.

Daily Life: Poor posture, obesity, and weak abdominal muscles often disrupt the spine’s balance, causing the neck to bend forward to compensate. Stress and emotional tension can cause muscles to tighten and contract, resulting in pain and stiffness. Postural stress can contribute to chronic neck pain with symptoms extending into the upper back and the arms.

Chiropractic Care of Neck Pain

During your visit, your doctor of chiropractic will ask you questions and perform exams to locate the source of the pain. Your chiropractor will ask you questions about your current symptoms and remedies you may have already tried, for example:

Your doctor of chiropractic will also do physical and neurological exams. In the physical exam, your doctor will observe your posture, range of motion, and physical condition. Movement that causes pain will be noted. Your doctor will feel your spine, note its curvature and alignment, and feel for muscle spasm. A check of your shoulder area is also in order. During the neurological exam, your doctor will test your reflexes, muscle strength, other nerve changes, and pain spread.

In some instances, your chiropractor might order diagnostic tests to help diagnose your condition. An x-ray can show narrowed disc space, fractures, bone spurs, or arthritis. A Computerized Axial Tomography scan (a CT or CAT scan) or a Magnetic Resonance Imaging test (an MRI) can show bulging discs and herniations. If it’s possible you have nerve damage, your doctor may order a special test called an electromyography (an EMG) to measure how quickly your nerves respond.

Chiropractors are conservative care doctors; that is, their scope of practice does not include the use of drugs or surgery. If your chiropractor diagnoses a condition outside of this conservative scope, such as a neck fracture or an indication of an organic disease, he or she will refer you to the appropriate medical physician or specialist.

What is a Neck Adjustment?

A neck adjustment (also known as a cervical manipulation) is a precise procedure, usually applied by hand, to the joints of the neck. Your chiropractor has received extensive training to perform this procedure. Neck adjustment works to improve the mobility of the spine and to restore range of motion, and to increase movement of the adjoining muscles to relieve pressure and tension. Patients typically notice a reduction of pain, soreness and stiffness, and improved ability to turn and tilt their head.

Research Supporting Chiropractic Care

A recent literature review found evidence that patients with chronic neck pain enrolled in clinical trials reported significant improvement following chiropractic spinal manipulation, according to a March/April 2007 report in the Journal of Manipulative and Physiological Therapeutics. According to Howard Vernon, DC, PhD, the review’s chief author, “The results of the literature review confirm the common clinical experience of doctors of chiropractic: neck manipulation is beneficial for patients with certain forms of chronic neck pain.”

As part of the literature review, Dr. Vernon and his colleagues reviewed nine previously published trials and found “high-quality evidence” that patients with chronic neck pain showed significant pain-level improvements following spinal manipulation. No trial group was reported to remain unchanged, and all groups showed positive changes up to 12 weeks post treatment.  No trial reported any serious adverse effects.

Back Pain:

Does Back Pain Go Away on Its Own?

Eighty percent of people suffer from back pain at some point in their lives. Back pain is the second most common reason for visits to the doctor's office, outnumbered only by upper-respiratory infections. Most cases of back pain are mechanical or non-organic, i.e., not caused by serious conditions, such as inflammatory arthritis, infection, fracture, or cancer.

What Causes Back Pain?

The back is a complicated structure of bones, joints, ligaments, and muscles. You can sprain ligaments, strain muscles, rupture disks, and irritate joints, all of which can lead to back pain. While sports injuries or accidents can cause back pain, sometimes the simplest of movements-for example, picking up a pencil from the floor-can have painful results. In addition, arthritis, poor posture, obesity, and psychological stress can cause or complicate back pain. Back pain can also directly result from disease of the internal organs, such as kidney stones, kidney infections, blood clots, or bone loss.

Back injuries are a part of everyday life, and the spine is quite good at dealing with these often "pulled" muscles. These very minor injuries usually heal within 1 or 2 days. Some pain, however, continues. What makes some pain last longer is not entirely understood, but researchers suspect that the reasons may include stress, mood changes, and the fear of further injury that may prevent patients from being active. In addition, sometimes a painful injury or disease changes the way the pain signals are sent through the body, and, even after the problem has gone away or is inactive, the pain signals still reach the brain. It is as if the pain develops a memory that keeps being replayed.

Will Back Pain Go Away on Its Own?

Until recently, researchers believed that back pain will "heal" on its own. We have learned, however, that this is not true. A recent study showed that when back pain is not treated, it may go away temporarily but will most likely return. The study demonstrated that in more than 33% of the people who experience low-back pain, the pain lasts for more than 30 days. Only 9% of the people who had low-back pain for more than 30 days were pain free 5 years later.1

Another study looked at all of the available research on the natural history of low-back pain. The results showed that when it is ignored, back pain does not go away on its own.2 Those studies demonstrate that low-back pain continues to affect people for long periods after it first begins.

What Can I Do to Prevent Long-Term Back Pain?

If your back pain is not resolving quickly, visit your doctor of chiropractic. Your pain will often result from mechanical problems that your doctor of chiropractic can address. Many chiropractic patients with relatively long-lasting or recurring back pain feel improvement shortly after starting chiropractic treatment.3 The relief they feel after a month of treatment is often greater than after seeing a family physician.

Chiropractic spinal manipulation is a safe and effective spine pain treatment. It reduces pain, decreases medication, rapidly advances physical therapy, and requires very few passive forms of treatment, such as bed rest.

How Can I Prevent Back Pain?

What Should I Tell My Doctor of Chiropractic?

Before any treatment session, tell your doctor of chiropractic if you experience any of the following: Pain goes down your leg below your knee.

References

1.Hestbaek L, Leboeuf-Yde C, Engberg M, Lauritzen T, Bruun NH, Manniche C. The course of low-back pain in a general population. Results from a 5-year prospective study. J Manipulative Physiol Ther 2003 May;26(4):213-9.

2.Hestbaek L, Leboeuf-Yde C, Manniche C. Low-back pain: what is the long-term course? A review of studies of general patient populations. Eur Spine J 2003 Apr;12(2):149-65.

3.Stig LC, Nilsson O, Leboeuf-Yde C. Recovery pattern of patients treated with chiropractic spinal manipulative therapy for long-lasting or recurrent low back pain. J Manipulative Physiol Ther 2001 May;24(4):288-91.

4.Nyiendo J, Haas M, Goodwin P. Patient characteristics, practice activities, and one-month outcomes for chronic, recurrent low-back pain treated by chiropractors and family medicine physicians: a practice-based feasibility study. J Manipulative Physiol Ther 2000 May;23(4):239-45.

5.Time to recognize value of chiropractic care? Science and patient satisfaction surveys cite usefulness of spinal manipulation. Orthopedics Today February 2003;23(2):14-15.

Arthritis:

Years ago, doctors hardly ever told rheumatoid arthritis patients to "go take a hike" or "go for a swim." Arthritis was considered an inherent part of the aging process and a signal to a patient that it's time to slow down. But not so anymore. Recent research and clinical findings show that there is much more to life for arthritis patients than the traditional recommendation of bed rest and drug therapy.

What Is Rheumatoid Arthritis?

The word "arthritis" means "joint inflammation" and is often used in reference to rheumatic diseases. Rheumatic diseases include more than 100 conditions, including gout, fibromyalgia, osteoarthritis, psoriatic arthritis, and many more. Rheumatoid arthritis is also a rheumatic diseases, affecting about 1 percent of the U.S. population (about 2.1 million people.)1 Although rheumatoid arthritis often begins in middle age and is more frequent in the older generation, it can also start at a young age.

Rheumatoid arthritis causes pain, swelling, stiffness, and loss of function in the joints. Several features distinguish it from other kinds of arthritis:

Rheumatoid arthritis is highly individual. Some people suffer from mild arthritis that lasts from a few months to a few years and then goes away. Mild or moderate arthritis have periods of worsening symptoms (flares) and periods of remissions, when the patient feels better. People with severe arthritis feel pain most of the time. The pain lasts for many years and can cause serious joint damage and disability.

Should Arthritis Patients Exercise?

Exercise is critical in successful arthritis management. It helps maintain healthy and strong muscles, joint mobility, flexibility, endurance, and helps control weight. Rest, on the other hand, helps to decrease active joint inflammation, pain, and fatigue. For best results, arthritis patients need a good balance between the two: more rest during the active phase of arthritis, and more exercise during remission.2 During acute systematic flares or local joint flares, patients should put joints gently through their full range of motion once a day, with periods of rest. To see how much rest is best during flares, patients should talk to their health care providers.

The following exercises are most frequently recommended for patients with arthritis:*

Type of Exercise Benefits Frequency of Exercise
Range-of-motion exercises, e.g. stretching and dance Help maintain normal joint movement and increase joint flexibility. Can be done daily and should be done at least every other day.
Strengthening exercises, e.g. weight lifting Help improve muscle strength, which is important to support and protect joints affected by arthritis. Should be done every other day, unless pain and swelling are severe.
Aerobic or endurance exercises, e.g. walking, bicycle riding, and swimming Help improve the cardiovascular system and muscle tone and control weight. Swimming is especially valuable because of its minimal risk of stress injuries and low impact on the body. Should be done for 20 to 30 minutes three times a week unless pain and swelling are severe

Range-of-motion exercises, e.g. stretching and dance Help maintain normal joint movement and increase joint flexibility. Can be done daily and should be done at least every other day. Strengthening exercises, e.g. weight lifting Help improve muscle strength, which is important to support and protect joints affected by arthritis. Should be done every other day, unless pain and swelling are severe. Aerobic or endurance exercises, e.g. walking, bicycle riding, and swimming Help improve the cardiovascular system and muscle tone and control weight. Swimming is especially valuable because of its minimal risk of stress injuries and low impact on the body. Should be done for 20 to 30 minutes three times a week unless pain and swelling are severe.

* Adapted from Questions and Answers about Arthritis and Exercise.

If patients experience

they need to talk to their health care provider.3 Doctors of chiropractic will help arthritis patients develop or adjust their exercise programs to achieve maximum health benefits with minimal discomfort and will identify the activities that are off limits for this particular arthritis patient.

Nutrition for the Rheumatoid Arthritis Patient

Arthritis medications help suppress the immune system and slow the progression of the disease. But for those who prefer an alternative approach, nutrition may provide complementary support. Some evidence shows that nutrition can play a role in controlling the inflammation, and possibly also in slowing the progression of rheumatoid arthritis.

Some foods and nutritional supplements can be helpful in managing arthritis:

The benefits and risks of most of these agents are being researched. Before taking any dietary supplement, especially if you are using medication to control your condition, consult with your health care provider.

What Can Your Doctor of Chiropractic Do?

If you suffer from rheumatoid arthritis, your doctor of chiropractic can help you plan an individualized exercise program that will:

Doctors of chiropractic can also give you nutrition and supplementation advice that can be helpful in controlling and reducing joint inflammation.

References

Headache:

Headaches & Chiropractic

If you have a headache, you’re not alone. Nine out of ten Americans suffer from headaches. Some are occasional, some frequent, some are dull and throbbing, and some cause debilitating pain and nausea.

What do you do when you suffer from a pounding headache? Do you grit your teeth and carry on? Lie down? Pop a pill and hope the pain goes away? There is a better alternative.

Research shows that spinal manipulation – the primary form of care provided by doctors of chiropractic – may be an effective treatment option for tension headaches and headaches that originate in the neck.

A report released in 2001 by researchers at the Duke University Evidence-Based Practice Center in Durham, NC, found that spinal manipulation resulted in almost immediate improvement for those headaches that originate in the neck, and had significantly fewer side effects and longer-lasting relief of tension-type headache than a commonly prescribed medication.

Also, a 1995 study in the Journal of Manipulative and Physiological Therapeutics found that spinal manipulative therapy is an effective treatment for tension headaches and that those who ceased chiropractic treatment after four weeks experienced a sustained therapeutic benefit in contrast with those patients who received a commonly prescribed medication.

Headache Triggers

Headaches have many causes, or “triggers.” These may include foods, environmental stimuli (noises, lights, stress, etc.) and/or behaviors (insomnia, excessive exercise, blood sugar changes, etc.). About 5 percent of all headaches are warning signals caused by physical problems.

Ninety-five percent of headaches are primary headaches, such as tension, migraine, or cluster headaches. These types of headaches are not caused by disease. The headache itself is the primary concern.

“The greatest majority of primary headaches are associated with muscle tension in the neck,” says Dr. George B. McClelland, a doctor of chiropractic from Christiansburg, VA. “Today, Americans engage in more sedentary activities than they used to, and more hours are spent in one fixed position or posture. This can increase joint irritation and muscle tension in the neck, upper back and scalp, causing your head to ache.”

What Can You Do?

The ACA suggests the following:

What Can a Doctor of Chiropractic Do?

Dr. McClelland says your doctor of chiropractic may do one or more of the following if you suffer from a primary headache:

“Doctors of chiropractic undergo extensive training to help their patients in many ways – not just back pain,” says Dr. McClelland. “They know how tension in the spine relates to problems in other parts of the body, and they can take steps to relieve those problems.”

Sciatica

Chiropractic Treatment of Sciatica

Doctors of Chiropractic medicine regularly treat sciatica. Sciatica is characterized by pain that originates in the low back or buttock that travels into one or both legs. Sciatic nerve pain varies in intensity and frequency; minimal, moderate, severe and occasional, intermittent, frequent or constant.

Pain is described as dull, achy, sharp, toothache-like, pins and needles or similar to electric shocks. Other symptoms associated with sciatica include burning, numbness and tingling sensations. Sciatica is also called radiating or referred pain, neuropathy, or neuralgia. A misconception is that sciatica is a disorder - however, sciatica is really a symptom of a disorder.

Caused by Nerve Compression

Sciatica is generally caused by sciatic nerve compression. Disorders known to cause sciatic nerve pain include herniated or bulging discs (slipped discs), pregnancy and childbirth, tumors, and non-spinal disorders such as diabetes, constipation, or sitting on one's back pocket wallet.

One common cause of sciatica is Piriformis Syndrome. Piriformis syndrome is named after the piriformis muscle. The piriformis muscle is located in the lower part of the spine, connects to the thighbone, and assists in hip rotation. The sciatic nerve runs beneath the piriformis muscle. This muscle is susceptible to injury from a slip and fall, hip arthritis, or a difference in leg length. Such situations can cause cramping and spasm to develop in the piriformis muscle, thereby pinching the sciatic nerve and causing inflammation and pain.

Sciatic nerve compression may result in the loss of feeling (sensory loss), paralysis of a single limb or group of muscles (monoplegia), and insomnia.

Proper Diagnosis

Since there are many disorders that cause sciatica, the chiropractor's first step is to determine what is causing the patient's sciatica. Forming a diagnosis involves a thoughtful review the patient's medical history, and a physical and neurological examination. Diagnostic testing includes an x-ray, MRI, CT scan and/or electrodiagnostic tests (nerve conduction velocity, electromyography). These examinations and tests help to detect possible contraindications to spinal adjustments and other chiropractic therapies.

Treatment Approach

The type of chiropractic therapy provided depends on the cause of the patient's sciatica. A sciatica treatment plan may include several different treatments such as ice/cold therapies, ultrasound, TENS, and spinal adjustments - sometimes called manipulation.

Chiropractic's Limitations

Sciatica can be caused by other disorders beyond the scope of chiropractic practice. If the Doctor of Chiropractic determines the patient's disorder requires treatment by another type of doctor, then the patient is referred to another specialty. In some cases, the referring chiropractor may continue to treat the patient and co-manage the patient's care with the specialist.

Scoliosis:

Scoliosis affects 5 to 7 million people in the United States. More than a half million visits are made to doctors’ offices each year for evaluation and treatment of scoliosis. Although scoliosis can begin at any age, it most often develops in adolescents between the ages of 10 and 15. Girls are more commonly affected than boys. Because scoliosis can be inherited, children whose parents or siblings are affected by it should definitely be evaluated by a trained professional.

What is scoliosis?

Because we walk on 2 feet, the human nervous system constantly works through reflexes and postural control to keep our spine in a straight line from side to side. Occasionally, a lateral (sideways) curvature develops. If the curvature is larger than 10 degrees, it is called scoliosis. Curves less than 10 degrees are often just postural changes. Scoliosis can also be accompanied by lordosis (abnormal curvature toward the front) or kyphosis (abnormal curvature toward the back). In most cases, the vertebrae are also rotated.

In more than 80% of cases, the cause of scoliotic curvatures is unknown; we call this condition idiopathic scoliosis. In other cases, trauma, neurological disease, tumors, and the like are responsible. Functional scoliosis is often caused by some postural problem, muscle spasm, or leg-length inequality, which can often be addressed. Structural scoliosis does not reduce with postural maneuvers. Either type can be idiopathic or have an underlying cause.

What are the symptoms of scoliosis?

Scoliosis can significantly affect the quality of life by limiting activity, causing pain, reducing lung function, or affecting heart function. Diminished self-esteem and other psychological problems are also seen. Because scoliosis occurs most commonly during adolescence, teens with extreme spinal deviations from the norm are often teased by their peers.

Fortunately, 4 out of 5 people with scoliosis have curves of less than 20 degrees, which are usually not detectable to the untrained eye. These small curves are typically no cause for great concern, provided there are no signs of further progression. In growing children and adolescents, however, mild curvatures can worsen quite rapidly—by 10 degrees or more—in a few months. Therefore, frequent checkups are often necessary for this age group.

How is scoliosis evaluated?

Evaluation begins with a thorough history and physical examination, including postural analysis. If a scoliotic curvature is discovered, a more in-depth evaluation is needed. This might include a search for birth defects, trauma, and other factors that can cause structural curves.

Patients with substantial spinal curvatures very often require an x-ray evaluation of the spine. The procedure helps determine the location and magnitude of the scoliosis, along with an underlying cause not evident on physical examination, other associated curvatures, and the health of other organ systems that might be affected by the scoliosis. In addition, x-rays of the wrist are often performed. These films help determine the skeletal age of the person, to see if it matches an accepted standard, which helps the doctor determine the likelihood of progression. Depending on the scoliosis severity, x-rays may need to be repeated as often as every 3 to 4 months to as little as once every few years.

Is scoliosis always progressive?

Generally, it is not. In fact, the vast majority of scolioses remains mild, is not progressive, and requires little treatment, if any.

In one group of patients, however, scoliosis is often more progressive. This group is made up of young girls who have scolioses of 25 degrees or larger, but who have not yet had their first menstrual period. Girls generally grow quite quickly during the 12 months before their first period and if they have scolioses, the curvatures tend to progress rapidly. In girls who have already had their first periods, the rate of growth is slower, so their curves tend to progress more slowly.

What is the treatment for scoliosis?

There are generally three treatment options for scoliosis—careful observation, bracing, and surgery. Careful observation is the most common “treatment,” as most mild scolioses do not progress and cause few, if any, physical problems. Bracing is generally reserved for children who have not reached skeletal maturity (the time when the skeleton stops growing), and who have curves between 25 and 45 degrees. Surgery is generally used in the few cases where the curves are greater than 45 degrees and progressive, and/or when the scoliosis may affect the function of the heart, lungs, or other vital organs.

Spinal manipulation, therapeutic exercise, and electrical muscle stimulation have also been advocated in the treatment of scoliosis. None of these therapies alone has been shown to consistently reduce scoliosis or to make the curvatures worse. For patients with back pain along with the scoliosis, manipulation and exercise may be of help.

Most people with scoliosis lead normal, happy, and productive lives. Physical activity including exercise is generally well-tolerated and should be encouraged in most cases.

Fibromyalgia:

If you or your loved ones have been diagnosed with fibromyalgia, you may be wondering what the disorder means for you. The condition still remains a mystery, although an estimated 3 to 6 percent of Americans, predominantly women, have fibromyalgia syndrome. Even diagnosing the condition can be complex: according to the National Fibromyalgia Association, it can take a patient up to 4 years to be accurately diagnosed.

Fibromyalgia is typically diagnosed in patients with:

Some fibromyalgia experts say, however, that many people may still have fibromyalgia with fewer than 11 tender points if they have widespread pain and several other common symptoms, including:

Correct Diagnosis Is Key

Correct diagnosis of fibromyalgia is very elusive, so if you are diagnosed with the disorder—or suspect that you have it—seek the opinion of more than 1 health care provider. Other conditions may create fibromyalgia—like pain, fatigue, and other symptoms. Ruling other conditions out first is very important.

In addition to clinical evaluation that will assess possible causes of your pain, your doctor may need to order blood work to determine if you have:

If the tests show that you have 1 of these conditions, treatment will focus on addressing that problem first. If your pain is caused by a muscle or joint condition, chiropractic care may help relieve it more effectively than other therapies.

Treatment Alternatives

If no underlying cause for your symptoms can be identified, you may have classic fibromyalgia. The traditional allopathic approach includes a prescription of prednisone, anti-inflammatory agents, antidepressants, sleep medications, and muscle relaxants. These temporarily relieve the symptoms, but they do produce side effects. If you prefer a natural approach, the following suggestions may be helpful:

Your doctor of chiropractic has the knowledge, training, and expertise to help you understand your problem and, in many cases, to manage it successfully. Remember, however, that the treatment program can be successful only with your active participation. If your doctor of chiropractic feels that he or she cannot help you, you will be directed to another health care provider.

Temporomandibular Joint Disorder

Does it hurt when you chew, open wide to yawn or use your jaws? Do you have pain or soreness in front of the ear, in the jaw muscle, cheek, the teeth or the temples? Do you have pain or soreness in your teeth? Do your jaws make noises loud enough to bother you or others? Do you find it difficult to open your mouth wide? Does your jaw ever get stuck/locked as you open it?

If you answered “yes” to some of these questions, you may have a temporomandibular joint disorder, or TMD. TMD is a group of conditions, often painful, that affect the jaw joint.

Signs may include:

For most people, pain or discomfort in the jaw muscles or joints is temporary, often occurs in cycles, and resolves once you stop moving the area. Some people with TMD pain, however, can develop chronic symptoms. Your doctor of chiropractic can help you establish whether your pain is due to TMD and can provide conservative treatment if needed.

What Causes TMD?

Researchers agree that TMD falls into three categories:

Severe injury to the jaw is a leading cause of TMD. For example, anything from a hit in the jaw during a sporting activity to overuse syndromes, such as chewing gum excessively or chewing on one side of the mouth too frequently, may cause TMD.

Both physical and emotional stress can lead to TMD, as well. The once-common practice of sitting in a dentist's chair for several hours with the mouth wide open may have contributed to TMD in the past. Now, most dentists are aware that this is harmful to the jaw. In addition to taking breaks while they do dental work, today’s dentists also screen patients for any weaknesses in the jaw structure that would make physical injury likely if they keep their mouths open very long. In that case, they may use medications during the procedure to minimize the injury potential, or they may send the patient to physical therapy immediately after treatment. In less severe cases, they instruct patients in exercises they can do at home to loosen up the joint after the visit.

While emotional stress itself is not usually a cause of TMD, the way stress shows up in the body can be. When people are under psychological stress, they may clench their teeth, which can be a major factor in their TMD.

Some conditions once accepted as causes of TMD have been dismissed—moderate gum chewing, non-painful jaw clicking, orthodontic treatment (when it does not involve the prolonged opening of the mouth, as mentioned above), and upper and lower jaws that have never fit together well. Popular theory now holds that while these may be triggers, they are not causes.

Women experience TMD four times as often as men. Several factors may contribute to this higher ratio, posture and higher heels.

TMD Diagnosis and Treatment

To help diagnose or rule out TMD, your doctor of chiropractic (DC) may ask you to put three fingers in your mouth and bite down on them. You may also be asked to open and close your mouth and chew repeatedly while the doctor monitors the dimensions of the jaw joint and the balance of the muscles. If you have no problems while doing these things, then the problem is not likely to be TMD. Your DC can then look for signs of inflammation and abnormalities. Sometimes special imaging, an x-ray or an MRI may be needed to help confirm the diagnosis.

If you have TMD, your doctor may recommend chiropractic manipulation, massage, applying heat/ice and special exercises. In most cases, your doctor’s first goal is to relieve symptoms, particularly pain. If your doctor of chiropractic feels that you need special appliances or splints (with the exception of the “waterpack” and other guards against teeth grinding), he or she will refer you to a dentist or orthodontist for co-management.

In addition to treatment, your doctor of chiropractic can teach you how to:

Carpal Tunnel

Carpal tunnel syndrome (CTS) is the most expensive of all work-related injuries. Over his or her lifetime, a carpal tunnel patient loses about $30,000 in medical bills and time absent from work.

CTS typically occurs in adults, with women 3 times more likely to develop it than men. The dominant hand is usually affected first, and the pain is typically severe. CTS is especially common in assembly-line workers in manufacturing, sewing, finishing, cleaning, meatpacking, and similar industries. Contrary to the conventional wisdom, according to recent research, people who perform data entry at a computer (up to 7 hours a day) are not at increased risk of developing CTS.

What Is CTS?

CTS is a problem of the median nerve, which runs from the forearm into the hand. CTS occurs when the median nerve gets compressed in the carpal tunnel—a narrow tunnel at the wrist—made up of bones and soft tissues, such as nerves, tendons, ligaments, and blood vessels. The compression may result in pain, weakness, and/or numbness in the hand and wrist, which radiates up into the forearm. CTS is the most common of the “entrapment neuropathies”—compression or trauma of the body’s nerves in the hands or feet.

What Are the Symptoms?

Burning, tingling, itching, and/or numbness in the palm of the hand and thumb, index, and middle fingers are most common. Some people with CTS say that their fingers feel useless and swollen, even though little or no swelling is apparent. Since many people sleep with flexed wrists, the symptoms often first appear while sleeping. As symptoms worsen, they may feel tingling during the day. In addition, weakened grip strength may make it difficult to form a fist or grasp small objects. Some people develop wasting of the muscles at the base of the thumb. Some are unable to distinguish hot from cold by touch.

Why Does CTS Develop?

Some people have smaller carpal tunnels than others, which makes the median nerve compression more likely. In others, CTS can develop because of an injury to the wrist that causes swelling, over-activity of the pituitary gland, hypothyroidism, diabetes, inflammatory arthritis, mechanical problems in the wrist joint, poor work ergonomics, repeated use of vibrating hand tools, and fluid retention during pregnancy or menopause.

How Is It Diagnosed?

CTS should be diagnosed and treated early. A standard physical examination of the hands, arms, shoulders, and neck can help determine if your symptoms are related to daily activities or to an underlying disorder.

Your doctor of chiropractic can use other specific tests to try to produce the symptoms of carpal tunnel syndrome. The most common are:

Laboratory tests and x-rays can reveal diabetes, arthritis, fractures, and other common causes of wrist and hand pain. Sometimes electrodiagnostic tests, such as nerveconduction velocity testing, are used to help confirm the diagnosis. With these tests, small electrodes, placed on your skin, measure the speed at which electrical impulses travel across your wrist. CTS will slow the speed of the impulses and will point your doctor of chiropractic to this diagnosis.

What Is the CTS Treatment?

Initial therapy includes:

Some medications can help with pain control and inflammation. Studies have shown that vitamin B6 supplements may relieve CTS symptoms.

Chiropractic joint manipulation and mobilization of the wrist and hand, stretching and strengthening exercises, soft-tissue mobilization techniques, and even yoga can be helpful. Scientists are also investigating other therapies, such as acupuncture, that may help prevent and treat this disorder.

Occasionally, patients whose symptoms fail to respond to conservative care may require surgery. The surgeon releases the ligament covering the carpal tunnel. The majority of patients recover completely after treatment, and the recurrence rate is low. Proper posture and movement as instructed by your doctor of chiropractic can help prevent CTS recurrences.

How Can CTS Be Prevented?

The American Chiropractic Association recommends the following tips:

Asthma :

What Is Causing the Asthma Epidemic?

In the United States, asthma cases have increased by more than 60 percent since the early 1980s, and asthma-related deaths have doubled to 5,000 a year. What is causing the asthma epidemic and what can we do to stem the tide? A recent series of articles in the Journal of the American Chiropractic Association (JACA) delves into this question and offers advice from doctors of chiropractic and allergists who have helped control asthma symptoms in many patients.

People in their 30s and older can remember that when they were young, it was very unusual for even one child in school to have asthma. Schoolchildren now often know several kids with asthma in a single class. The rapid increase in the number of young people with asthma was brought home to Dr. Scott Bautch, past president of the American Chiropractic Association's (ACA) Council on Occupational Health, when he went to a football game with his 13-year-old son: "Someone on the field had a breathing problem. It was hard to see whose son it was, and 15 parents ran to the field with inhalers."

So far, researchers don't know why cases of asthma are increasing at such an alarming rate. They hypothesize that a combination of genetics and some non-hereditary factors — such as increased environmental exposure to potential allergens — play a role. "Thirty years ago, Windex was the only cleaning solvent used by a few people. Now, we have a special cleaning solvent for every object," says Dr. Bautch. "In addition, furniture and carpets are produced with formaldehyde as a preservative, and people breathe it," he says.

Decreased air quality is coupled with the allergy-friendly modern house design, says Dr. William E. Walsh, MD, FACC, an allergist practicing in Minnesota: "Fifty years ago we lived in old, drafty houses, and the breeze dried and freshened the air, and cleared out mold and other allergens. Nowadays, our super-insulated houses don't breathe adequately. Making basements into a living space increases mold exposure because mold grows in any basement."

Food has become another source of exposure to allergens. "Food manufacturers put more preservatives in foods now to store them longer," says Dr. Bautch. Researchers hypothesize that an increase in vaccinations, cesarean births, and antibiotic intake may be playing a role, too.

Asthma is a chronic disease; it can't be cured—only controlled. For best treatment results, both the primary care physician and an asthma specialist, such as an allergist or pulmonologist, should be involved. According to experts interviewed for the article, the treatment program, in addition to medication intake, should include reducing exposure to the substances that induce acute episodes and identifying specific allergens that affect the patient.

Allergens aren't the only culprit. Stress factors—such as moving to a new home, or changing jobs—may induce or aggravate asthma attacks. Even emotional expressions such as fear, anger, frustration, hard crying, or laughing can cause an attack as well. To reduce the patient's stress level and improve the patient's quality of life, alternative treatments should be incorporated into the treatment program. Various relaxation techniques, such as biofeedback, meditation, yoga, and stress management, as well as massage, chiropractic manipulation, breathing exercises, and acupuncture can be helpful.

A multi-site clinical trial on chiropractic management of asthma is underway in Australia. "The preliminary data are very encouraging. Chiropractic patients are showing decreases in physical asthma symptoms and cortisol levels," says Dr. Anthony Rosner, director of education and research for the Foundation of Chiropractic Education and Research.

"Doctors of chiropractic can give a full-scale evaluation to asthma patients; assess their physical and neurological status, their lifestyle, diet, and stressors; and help the patients increase motor coordination, and improve the work of respiratory and gut muscles to increase the quality of life," says Dr. Gail Henry, a chiropractic neurologist, who practices in Houston, Texas. "Doctors of chiropractic can be a great addition to the healthcare team treating the asthma patient."

Asthma experts offer the following tips for asthma patients: