Neurovascular Compromise

 A common example of neuromuscular compromise is Thoracic Outlet Syndrome (TOS), when the nerves and / or blood vessels (brachial plexus) coming from the neck and going down the arm are subjected to pressure or abrasion (impingement) that compromises their normal function. 

Symptoms include numbness & tingling, reduced or altered sensation, or pain in the arm or hand.

Causes can be impingement between the scalenes (vertical muscles on the sides of the neck), between the clavicle & 1st rib, or a posterior distal clavicle (result of a direct frontal blow). Sometimes this is a sequela of whiplash injury; or chronic stress & tension affecting the neck, including postural stress; or from repetitive motion / overuse syndrome.  

I have precise, gentle adjustments to relieve the impingement, and give the patient stretches, exercises, and ergonomic counseling.

5 Secrets of the Right Pillow

IT PROVIDES CONSISTENT, RESISTIVE SUPPORT

to maintain the normal curve of the neck,

IT KEEPS THE HEAD IN LINE WITH THE SPINE

not bent up, or bent down,

IT DOES NOT SQUASH FLAT OR DEFORM

with movement during the night,

IT IS ORTHOPEDICALLY DESIGNED

to normalize posture during sleep,

IT WORKS FOR BOTH SIDE OR BACK SLEEPING

so you can change position.

Rotator Cuff

  Sometimes mistakenly thought to mean bones in the shoulder, the Rotator Cuff actually consists of 4 muscles which help maintain shoulder mobility, stability, & function.

These muscles are called the “S.I.T.S.” muscles, an acronym for the 4 components---the Supraspinatous, Infraspinatous, Teres minor, and Subscapularis muscles.

Of these 4, the Supraspinatous is most commonly injured. It attaches across the top of the scapula to the top of the humerus, the upper bone of the arm. “Swimmer’s shoulder” is an injury to the Supraspinatous tendon, caused by repetitive forceful adduction of the arm against the resistance of the water.   

How To Get A Headache

Some very common postures can give you a headache!

        Here's what to watch out for:

Leaning your head back to look upward toward a TV or computer monitor, or tilting the head backward to see a monitor through the near-focus part of bifocals, are common postural producers of headache. 

These postures causes the occiput (the bone across the back of the head)  to be stressed inferiorly. This inferiority may be more on one side or the other (unilateral) or global (bilateral). 

When patients present with this in my office, it may be in combination with a superiority of the posterior part of the second cervical vertebra, an additional complication which makes the headache even worse.

I make gentle, focused, precise adjustments that correct the problems without discomfort to the patient, and I provide ergonomic counseling to help keep this from happening again.  

A Piriformis Predicament

When there is pain, or numbness / tingling going down the leg, a patient’s first thought is often, “Uh-Oh. It must be a disc.”

Impingement of nerve(s) by a bulging disc can be the cause of these symptoms, but in the absence of any history of injury, such as a lifting strain or a fall or accident, or of disc problems, it is not necessarily the first thing suspected.

A common cause of such symptoms is impingement of the sciatic nerve underneath the piriformis muscle in the buttock. The piriformis may be in spasm, or the patient may have been sitting for prolonged times, or on hard surfaces, causing pressure on the sciatic nerve.

I release a piriformis spasm with the Activator instrument, and give the patient home care instructions and stretches to alleviate the problem.  

When The Kneecap Goes Awry

The kneecap (patella), which is embedded in the tendon of the quadraceps (quads) muscle(s) on the front of the thigh, “tracks” in a groove on the front of the femur, or thigh bone. The quadraceps tendon attaches below the knee to the tibia.

As the knee bends back & forth, the kneecap, which effects a mechanical advantage of 30% increase in the power production of our quads, slides in the bony groove.

If the kneecap becomes misaligned, as it slides there is abnormal wear & tear against the groove, and this can be the beginning of arthritis in the knee. There may be an audible “crunch” in the knee with squats. 

As an Activator Chiropractor, I have an effective adjustment for this condition, and I give the patient exercises that will help the kneecap stay in alignment. 

5 Key Facts About the Shoulder

(1)  It is the most complex and most mobile part of the body.

(2)  It consists of 4 articulations---the glenohumeral joint (top of the arm connects at the shoulder), the sternoclavicular joint (the collarbone connects near the throat), the acromioclavicular joint (outer end of the collarbone connects with a bony projection off the shoulderblade, and the scapulothoracic articulation (the scapula, or shoulderblade, contacts the rear chest wall).          

(3)  Pain in the shoulder may not be a shoulder problem, but be referred pain from 3 common sites---the heart, the lungs, and the neck. 

(4)  Shoulder dislocation involving the humerus (bone in the upper arm) is common because of the shallowness of the “cup” holding the humeral head. 

 (5)   Bursitis is common in the shoulder, caused by inflammation due to repetitive motions (e.g. painting, drywalling, throwing sports).

Services Medicare Doesn't Cover

       As it currently stands for chiropractic services, Medicare only covers adjusting the spine.

No coverage is provided for extraspinal treatment, e.g., for knee, shoulder, wrist, ankle, etc., problems. This is expected to change; chiropractors anticipate Medicare will eventually cover extraspinal problems.

Other essential services provided by chiropractors, also not currently covered by Medicare, are exercises; supports; home care, nutritional, or ergonomic counseling; stretches; and supplements.

Your chiropractor may prescribe / provide these services for you because they are essential to resolving your problem(s), but Medicare will not reimburse; you are responsible for payment.

Sacral Vertebrae

  An occasional variant in the anatomy of the lower spine is the failure to fuze of the 1st sacral vertebra with its neighbor below.

This results in an additional vertebra inferior to L5, where normally the sacrum is one bone consisting of several fuzed, no longer separate, vertebrae.

In some patients with this anatomical variant, it presents no problems, whereas in others the anomaly creates a vulnerability to low back stresses. 

These patients may need more frequent intermittent spinal balancing to maintain comfort and normal function. 

Is It the Meniscus??

  Pain in the knee may be due to any one or more of various possible misalignments or articular aberrances. 

The knee is a hinge joint, and as such it is not meant to move in other than an approximate sagittal plane.

However, slight rotation of the tibia at the joint with the femur, posteriority or anteriority of the proximal tibia, misalignment of the fibula, medial or lateral tibial-femoral joint compression, etc., can occur. These aberrances, even to the slight extent of millimeter(s), can cause discomfort or affect the knee’s range of motion.

If pain persists after all the “usual suspects” of misalignments / aberrances are screened & corrected, an Activator chiropractor looks to the medial and / or lateral meniscus. Often a carefully-vectored Activator adjustment on the inside or outside of the knee solves the problem and stops the pain.

Unilateral Head Pain

  Pain on just one side of the head, in the jaw region or near the ear or cheekbone, can be a simple headache, a TMJ problem, or a dental issue.

However, for these patients it is important to include a condition called vasculitis in the list of possible diagnoses.

Vasculitis is an inflammation of blood vessels. When this occurs in the side, or temporal, region of the head, it is called “temporal arteritis,”  an inflammation in the temporal artery. There may be swelling as well as pain, and the area may be tender to the touch. Often there is a fever.

This is a serious condition, and can have serious consequences. It can spread to the blood vessels of the eyes and possibly cause blindness. If suspected, the patient should immediately be referred to an M.D.

Medicare--Allowed # of Visits

  Medicare typically allows 12 chiropractic treatments (visits) per year.

However, certain things that often go along with aging are considered by Medicare to justify an extended, or longer term, of chiropractic care.

These conditions, called “co-morbidities,” may complicate, or impede healing, making the number of treatments necessary to resolve a chiropractic problem greater.

A common co-morbidity is spinal disc degeneration, usually associated with spondylosis, or bony spur formation around vertebral edges. Another term for this is DJD, or degenerative joint disease. 

Sciatica, spinal stenosis (narrowing of the spinal canal), and foraminal encroachment (narrowing of the opening(s) where the nerves exit the spine) are also co-morbidities, as are health conditions which may complicate or impede healing such as diabetes and osteoporosis.

Unrelenting Rib Pain

  Pain that starts in the front of the chest or in the back, near the spine, and develops along the path of a rib, and that is unresponsive to chiropractic treatment, may be an outbreak of shingles.

The patient will describe no injury or trauma, no upper respiratory infection or cough, which might be affecting the region. Yet the pain persistently worsens.

A shingles viral outbreak follows the path of the related sensory nerve, called a “dermatome.” Dermatomes wrapping around in the thoracic region resemble the paths of our ribs, so initial symptoms of shingles are often misinterpreted as rib pain.

Anyone who has had chicken pox carries the herpes zoster virus in the nerve ganglia alongside their spine. The virus is dormant until conditions such as hyperthermia or stress trigger an outbreak.

Low Back Compression

  Patients who present with central low back pain, especially if the lumbar curve is accentuated, often exhibit compression between the sacrum and the 5th, or lowest, lumbar vertebra.

The patient will often say they “just can’t get comfortable,” even in bed. Sometimes pulling the knees to the chest is relieving, but standing, as well as sitting, cause worsening of the pain.

I relieve the compression by appropriately-vectored adjustments with the Activator instrument, and give the patient stretches & exercises. 

Ergonomic counseling for correct sitting & standing postures is helpful to prevent recurrence of the compression.

OUCH!!--I've Got Gout!

  You wake up with severe, burning pain in the joint at the base of your big toe, and it’s swollen and red.

Chances are, you may have gout!

This is a type of arthritis that is of metabolic origin---too much uric acid in the blood causes sharp crystals to collect in a joint, usually the big toe, and more commonly in men than in women.

This happens because you consume too many foods high in purines, organic water-soluble compounds that oxidize to form uric acid. 

Meats are high in purines; so is beer, seafood such as scallops & sardines, beans such as garbanzos or lentils, vegetables such as asparagus or mushrooms, & wheat bran & wheat germ. Inflammatory foods such as sugar and wheat (all wheat in the U.S. is highly hybridized, thus containing foreign polypeptides that are highly inflammatory) are also culprits.

Your chances of getting gout are higher if you are overweight, drink too much alcohol, eat too many foods containing purines, or drink beverages sweetened with fructose (fruit sugar) or foods with high-fructose corn syrup (soft drinks, ice cream, sports drinks, breakfast cereals).

Gout is successfully treated by changing what you eat and drink. It is important to drink lots of pure (devoid of chlorine or other chemicals) water to help your body flush out waste products and toxins. 

Plantar Fasciitis

   Pain in the bottom of the foot, usually in the arch further back toward the heel, may be plantar fascitis. It is caused by injury or inflammation of the plantar (bottom of the foot) fascia. The plantar fascia is a band of fibrous connective tissue on the sole of the foot.

The pain may come on slowly, related to chronic pronation (a falling inward of the inside of the arch) combined with a “fallen” arch, or be more acute, due to an injury---landing hard on the sole of the foot, quick acceleration / deceleration when walking or running, or repetitive shock of hard heel strike during the gait cycle.

My treatment includes carefully aligning the bones of the foot with the Activator instrument, support of the arch with orthotics, exercises to strengthen the arch, stretches to maintain flexibility, and ice and other applications for inflammation.

The patient must not go barefoot---there must be NO weight-baring without orthotic support.