 Cervicogenic headache (CGH) refers to headaches caused by dysfunction in the neck, and experts estimate that 18% of chronic headache patients have cervicogenic headaches. Spinal manipulative therapy (SMT) is a form of treatment most commonly provided by doctors of chiropractic, and several studies have demonstrated that SMT is highly effective for patients suffering musculoskeletal disorders of the neck, including those with cervicogenic headaches. However, there remains little consensus on the appropriate number of SMT treatments to achieve maximum benefits for CGH.
In a 2018 study, a team of researchers conducted a large-scale study involving 256 chronic CGH patients to determine how many treatments are needed to achieve optimum results using SMT for CGH. The investigators randomly assigned participants to one of four dose levels (0, 6, 12, or 18 visits) of SMT for six weeks. The type of SMT consisted of a manual high-velocity, low-amplitude (HVLA) thrust manipulation in the cervical and upper thoracic regions. The location of the spinal adjustment was determined by a brief, standard spinal palpatory examination from the occiput to T3 to assess for pain and restricted motion. For older patients and/or those in acute pain, the manual therapy was modified to a low-velocity, low-amplitude mobilization. To control for visit consistency and provider attention, patients continued to receive a light massage treatment once a patient’s assigned number of visits was satisfied, until the six-week treatment period ended. After the conclusion of the treatment phase of the study, the participants used a headache diary to keep track of their headaches for the next year. The results showed that the patients who received the most SMT treatments had fewer headaches over the following twelve months. More specifically, the researchers calculated that six additional SMT visits resulted in about twelve fewer days with headaches over the next year. If you suffer from headaches, consider consulting with Dr. Vice to determine if cervical dysfunction is a potential cause or contributing factor and whether you are a candidate for spinal manipulative therapy.
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 The hip is a very unique joint. The depth of the socket, the strength of the muscles and ligaments surrounding it, and the way it functions in weight bearing activities is unlike any other joint in the body. The focus this month is on the relationship between the hip and the rest of the body.
The hip joint is a synovial joint, meaning it moves freely. It is a ball-and-socket joint that is made up of the femoral head (the “ball”) and the acetabulum (the “socket”). The ball is largely contained within the cup or socket, though there are genetic and cultural differences with regards to the depth and shape of the hip joint in any one individual. The relationship between the hip and the surrounding joints is intimate in that each joint affects the next. For instance, ankle pronation—or the inward rolling of the foot and ankle—results in a knocked knee, which can then shift the hip outwards. The pelvis then drops down on that side, the tailbone or sacrum becomes unleveled or sloped, and the lower spine curves to compensate with the ultimate goal of keeping your eyes level. Hence, when your hip hurts, Dr. Vice will examine and treat the ENTIRE lower kinetic chain—the foot, ankle, knee, hip, pelvis, and spine—as ALL are so closely related to each other. When it comes to managing you and your hip pain, be prepared for management of any of the following:
We haven’t touched the subject of muscle imbalance, strengthening of commonly weak hip extensor muscles, or stretching of overly tight hip flexors and adductor muscles—topics for another day! The good news is that Dr. Vice can help you with this common problem!  Through their initial chiropractic college instruction, as well as continuing education and post-graduate training/certification, doctors of chiropractic are equipped with a variety of techniques and therapies to manage musculoskeletal conditions, including low back pain (LBP). Studies have found that a common contributory cause of LBP is dysfunction of the thoracolumbar fascia (TLF). The purpose of the TLF is to allow the various muscle groups between the lower rib cage and the pelvic brim on both sides of the low back to smoothly slide independently between each other during normal movement. When adhesions form in the fascia, they can restrict the ability of the muscles to move independently, which can increase the risk for pain and injury in the low back and associated areas of the body.
One treatment option to address issues in the TLF that can cause pain and disability in the lower back is myofascial release (MFR). Myofascial release is a hands-on treatment in which a doctor of chiropractic applies pressure with their hands, elbow, or a tool to stretch the muscles to knead out trigger points or adhesions that may inhibit the ability of the muscles to slide against one another during normal movements. In a 2021 study, 36 patients with non-specific chronic LBP received either a single 40-minute session of MFR or a sham treatment. The patients in the MFR group experienced improved muscle activity in the lower back (based on diagnostic testing), as well as a reduction in both self-reported pain and disability. In another study that included 109 patients with chronic LBP, researchers observed that those who received a single 40-minute session of MFR not only experienced improved muscle activity in the lower back immediately following treatment, but these improvements persisted up to one month later at a follow-up visit. No such improvements were recorded among participants who did not receive any treatment. Because a low back condition may have several underlying causes that need to be addressed together, a doctor of chiropractic will often adopt a multimodal approach to achieve the best outcome for the patient. In addition to MFR, a chiropractor may also employ spinal manipulative therapy, mobilization therapy, soft-tissue therapy, exercise training, activity modification, physiotherapy modalities, nutritional counseling and more. It all depends on the patient’s unique case, as well as their doctor’s training and treatment preferences. |
AuthorVice Lujan is a muscle and movement specialist in Bakersfield, CA. Vice specializes in reestablishing normal, pain-free range of motion of the body. Archives
May 2024
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