This history is classic for the diagnosis of a tension-type of headache (TTH).  As unemployment rates reach new highs and stress levels climb, it is no wonder more and more people are presenting with this condition.  Even prior to the recession, TTH was the most common type of headache experienced by adults affecting 10-65% of the population.  The impact on daily living by TTH is significant as it disrupts daily activities, quality of life, and work.  These types of headaches, according to the International Headache Society (HIS), can last from 30 minutes to 7 days, do not include nausea/vomiting but may include increased sensitivity to light or noise (rarely both at the same time).  The most common frequency is less than 15 TTH’s/month. 

Medication has been the primary medical form of treatment and some patients require the regular use of certain medications, even when headaches are not present – - as in some cases, it’s too late to start meds once the headache starts.  In these cases, Amitriptyline has been the most frequently prescribed medication and it’s considered the drug of choice for TTH.  Chiropractic spinal manipulation (CSM) has been reported to be helpful in a number of prior studies.  One reported equal benefit as Amitriptyline with 6 weeks of treatment.

A recent publication conducted a study using a new design where TTH sufferers with more than 10 headaches per month were randomly assigned to one of four groups: 1) cervical spinal manipulation (CSM) + amitriptyline, 2) CSM + placebo (fake) amitriptyline; 3) sham CSM + real amitriptyline; or 4) sham CSM + placebo amitriptyline.  That way, one can determine which of the two or, the combination of both is most beneficial.  An initial period of 4 weeks was followed by a 14 week treatment period. A headache diary was used to track headache frequency in the last 28 days of the treatment period.  Nineteen completed the study and the combined effect carried the most statistically significant result with a close second with CSM alone.  A larger sample size was recommended for a more statistically powerful evaluation.

This study is important as CSM by itself was found to be at least as (if not more) effective than Amitriptyline alone, which is the medication of choice for TTH.  Hence, if CSM or Amitriptyline alone are not found to be satisfying, the combination of the two is strongly supported by this study. 

If you, a family member or a friend require care, we sincerely appreciate the trust and confidence shown by choosing our service.  We are proud that chiropractic care has consistently scored the highest level of satisfaction when compared to other forms of health care provision and look forward in serving you and your family presently and in the future. 

YOU MAY BE A CANDIDATE FOR CHIROPRACTIC CARE FOR HEADACHES!

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To understand this better, a short “anatomy lesson” is appropriate. The spine can be divided into two halves, front and back. The structures in the front half include the larger, heavier bones called vertebral bodies and the shock absorbing cushions that lie between the vertebral bodies called the intervertebral disks.  The disk is like a jelly donut where the center is liquid-like and the outer portion is a tough, criss-cross pattern cartilage arranged like the rings on a tree stump. There are also ligaments that hold the vertebrae and disks tightly together. The back half of the spine includes the spinal cord, nerve roots, as well as the small joints of the back called facet joints.  Every movable joint has a joint capsule that helps lubricate the joint and limits the amount of movement, along with surrounding ligaments.  The larger, heavier vertebral bodies and shock absorbing disks carry the majority of the weight (approximately 80%) while the smaller facet joints carry much less weight (only 20%) but are more responsible for guiding the movements of our back.

When leg pain is present, it can be caused by either a pinched nerve, or, an inflamed facet joint.

When a nerve is pinched, the cause is usually from the intervertebral disk where the jelly-like center leaks out and presses on the nerve that goes down the leg, commonly referred to as a “herniated disk with sciatica.” This type of pain is quite specific, easy to describe and often extends below the knee to the ankle or foot.  It can include muscle weakness, numbness in certain areas of the leg, and bending forward increases low back and leg pain while bending backwards reduces the leg pain (and sometimes the LBP).

When a facet joint capsule tears (technically, called a “sprain”), the pain is “referred” down the leg in a generalized, non-specific manner, usually described as a “deep ache,” often hard to describe and usually does not go below the level of the knee. Here, it feels better to bend forward and worse to bend backwards, of which neither movement changes or affects the leg in a specific way.  Disk related leg pain carries a potential for surgery if all non-surgical approaches fail, while facet joint referred leg pain rarely requires invasive treatments or surgery.

YOU MAY BE A CANDIDATE FOR CHIROPRACTIC CARE FOR LEG PAIN  FOR A FREE NO-OBLIGATION CONSULTATION CALL OUR CUMMING GEORGIA OFFICE  770-888-4288

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CTS symptoms include numbness, tingling, or half asleep sensations in the hand involving the palm and 2^nd, 3^rd, and thumb side of the 4^th fingers.  Sometimes, there is weakness in the grip strength with frequent dropping of objects or difficulty unscrewing jars commonly reported.  Waking at night and needing to shake or flick the fingers to “…wake them up” is common.  Driving due to holding onto the steering wheel with the wrist bent, holding a book or newspaper, buttoning a shirt, and threading a needle, can all become challenging when the median nerve which goes through the carpal tunnel is pinched.  Because there are 9 tendons along with the median nerve that travel through the tunnel, fast repetitive movements of the hands and fingers is frequently associated with the onset of CTS.  What makes treatment of CTS challenging is that most patients wait WAY TOO LONG before they go for help and nerve damage can occur as a result.

So, what happens when CTS does not respond to these or other treatment approaches?  Also, what can be done if, after CTS surgery, problems still persist?  The answer to these questions rests in obtaining a thorough evaluation of the condition including a detailed history and examination and, consideration of a different or concurrent condition.  For example, from an anatomy standpoint, a pinched nerve in the neck, thoracic outlet (shoulder) and/or elbow (pronator tunnel syndrome), may be the primary issue, not CTS alone or, sometimes at all.  If BOTH CTS and a pinched nerve above the wrist are present, the “double or multiple crush syndrome” must be addressed in order for a successful and satisfying outcome to occur. 

Another nerve called the ulnar nerve can create numbness and weakness in the hand and can be confused with CTS.  Because only about 50% of patients with hand numbness can accurately report the location of the symptoms, diagnosing compression of the ulnar nerve is essential as a CTS release will NOT help those with ulnar neuropathy.  The most common location for pinching the ulnar nerve is at the inner or medial elbow near the “funny bone,” referred to as the cubital tunnel.  It can also be compressed at the wrist, neck, or combinations of these resulting in a double or multiple crush syndrome.  We’ve had many patients present with “carpal tunnel” that were not CTS at all but rather, ulnar nerve compression conditions.

Therefore, when considering treatment options for CTS and/or other nerve compression syndromes affecting the upper limb, it is imperative that a thorough evaluation of the presenting patient be performed so time is not wasted treating an unrelated condition and to obtain a satisfying outcome.  We take pride in providing quality, evidence-based care and appreciate the opportunity to do so when patients choose our clinic for their care.  We realize there are many health care options available and truly appreciate the confidence shown by our patients when choosing our clinic for their health care needs.  If you, a friend or family member requires care for CTS, we would be honored to offer our services.

 YOU MAY BE A CANDIDATE FOR CHIROPRACTIC CARE FOR CARPAL TUNNEL SYNDROME!  FOR A FREE NO-OBLIGATION CONSULTATION CALL OUR CUMMING GEORGIA OFFICE 

 770-888-4288

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A study from Norway (Acta Neurol Scand 2007;Nov.20; Sjaastad O, Bakketeig LS) showed that about 4% of the population will have this type of headache. Taking medications to cover the pain will not ultimately correct a mechanical neck problem.

The symptoms of a cervicogenic headache are as follows: one-sided head pain and same side shoulder and arm pain. Patients also have limited mobility of the neck region. Rarely a patient may also have a migraine trait such as nausea, vomiting, or throbbing sensations. Because of these different signs from a typical migraine headache a physician may have overlooked the neck as a potential source for the cause of your head pain. Self-diagnosing your headache can be even worse since potentially serious causes of your head pain, such as high blood pressure may go undiscovered and left untreated. In any case it’s unlikely that your headache has been caused by a deficiency of pain pills in your diet. There are also unintended side effects that have to be considered when weighing any health care option.

Another study from Norway (Funct Neurol 2007;22:145; Drottning M, Staff PH, Sjaastad O) looked at causes of cervicogenic headaches, specifically whiplash injuries of the neck. In this study, 587 whiplash patients were followed over a six-year period. About 8% of the whiplash sufferers developed a cervicogenic headache six weeks after the initial trauma. Thirty-five percent of these patients were still suffering six years later.

Our clinic specializes in the treatment spine-caused head pain especially cervicogenic headache. To determine this we have to perform a comprehensive examination of your spine to see if sprains of your cervical or thoracic joints are present and review whether you’ve suffered a trauma in years past that could have affected the posture and mobility of these delicate spinal structures.

For patients who do not go down the road of medications for treating their head pain chiropractic care can be a more healthful option.

To find out more or to scedule a Free consultation visit our website www.backsmarthealth.com  or call 770-888-4288

Another cause of low back pain can arise from certain medications.  In a July 2009 journal article, muscle fiber damage was found in 57% of patients taking drugs associated with lowering cholesterol, referred to as statins.  Typically, health care providers rely on a blood test that is suppose to detect the breakdown of muscle tissue called CPK (creatine phosphokinase) when statin-related muscle damage is suspect.  However, in their study, only one in 44 patients with muscle damage caused by statin drugs was abnormal!  According to the researchers, muscle pain associated with statin drug treatment has been dismissed as a “minor” side effect by both doctors and patients. In fact, the American College of Cardiology and the American Heart Association have published guidelines recommending continuing statin therapy, “…as long as circulating levels of CPK do not exceed 10 times the upper limit of normal (1,950U/L).”  To see if that is was a good recommendation, CPK was tested in 10 healthy volunteers who had never taken statins, 10 control subjects matched by age, 15 patients with clinically diagnosed myopathy from statins but had stopped the statin therapy at least 5 weeks prior to the study, 29 patients with a history of statin-associated myopathy who remained on statin therapy and 19 patients with long-term statin therapy but no muscle complaints.  Significant muscle damage (>2% of the biopsied muscle sample) was NOT seen in any of the control patients not taking statins. However, it was seen in 1 of the 19 patients on long-term statin therapy who reported no muscle symptoms as well as 25 of the 44 with myopathy (57%).  More importantly, all but 3 patients who quit statin therapy because of related muscle pain reported their symptoms disappeared within days of quitting the statin medication.  Also, the rate of significant muscle damage was about equal in those with myopathy still taking the statin meds (55%), and those who had quit the medication 60%.  The severity of muscle damage was not related to the length of time the statin med was used or, with higher doses of statins.

The point of this discussion is that low back pain may be related to causes other than an injury or trauma to the back and that a thorough history from the patient must be obtained, especially when the patient is non-responsive to typical care for low back pain.

At this clinic we strive to provide the highest quality care and follow “best practice” approaches.  We look forward to helping our patients and appreciate the confidence shown by our patients for choosing our practice to help manage their health related issues.

YOU MAY BE A CANDIDATE FOR LOW BACK PAIN TREATMENT! 

FOR A FREE NO-OBLIGATION CONSULTATION

CALL 770-888-4288  Or Visit

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There are many treatment options for those suffering from neck pain.  There is conventional medical care where the family doctor will usually prescribe a muscle relaxant, anti-inflammatory, and/or pain killer to help patients through episodes of acute neck pain.  However, many patients with neck pain have been through the process of treatments associated with medications and simply cannot tolerate the adverse side effects of stomach pain common with anti-inflammatory drugs such as ibuprofen (Advil, Nuprin, Mediprin, etc.), Aleve (Naproxen), or aspirin.  Others don’t like the groggy, drunk-like feelings associated with pain killers or the sleepiness associated with muscle relaxants.  Therefore, these patients often turn to complementary / alternative care. 

As noted in the May, 2009 issue of Consumer’s Report for low back pain, chiropractic was the most sought after form of treatment, but there has been no extensive review of neck pain regarding evidence-based treatment approaches – at least not until February, 2008.  An international “team” representing 9 countries screened over 31,000 titles of articles published between 1980 and 2006, reviewed more than 1200 articles and eventually reported on 552 studies in their final report.  Their findings included the following:

• In the US, 54% utilized complementary (alternative) treatment approaches compared to 37% that obtained conventional medical care.
• Neck pain was the 2^nd most common reason Americans obtained chiropractic care.
• Chiropractic was found to be the most frequently reported form of treatment for upper back or neck pain (ahead of massage therapy, relaxation therapy, acupuncture).
• Those who obtained complementary AND conventional medical care were much more likely to perceive the complementary/alternative therapy as being helpful (61% vs. 6.4% for neck conditions and 39.1% vs. 19% for headaches).
• Women more commonly obtained care than men for neck/shoulder pain (29% vs. 18% men) over a 4-6 year time frame.
• Manual therapy (mobilization, manipulation, stretching) was associated with greater pain reduction in the short-term among patients with acute whiplash when compared with usual medical care, soft collars, passive modalities, or general advice.
• For non-whiplash neck pain (without arm radiating pain), manipulation or mobilization, exercise, low level laser therapy (LLLT), and “…perhaps acupuncture…” were reported as more effective than no treatment, sham, or other alternative interventions.
• For both whiplash and non-traumatic neck pain, supervised exercise with or without manual therapy was favored over usual medical care or no care.

What does all this mean?  Simple!  Everyone who is suffering from neck or upper back pain should seek chiropractic care which includes manipulation, mobilization, exercise training, and activity modifying advice, as these approaches have been found to be more effective than usual medical care!  Why waste time with a “wait and watch” with or without drug intervention approach when the evidence favors chiropractic related interventions.  If you, a friend, or a loved one is struggling with neck or upper back pain, we will properly assess your condition and administer the appropriate care that is required.  We will coordinate care with other health care services when necessary.  This recommendation may represent one of most significant acts of kindness you can offer those that you truly care about.

YOU MAY BE A CANDIDATE FOR CHIROPRACTIC CARE

FOR NECK OR UPPER BACK PAIN!  FOR A FREE NO-OBLIGATION

CONSULTATION CALl 770-888-4288 or visit us at      www.backsmartchiropractic.com

Another interesting and lesser-known relationship is the jaw (frequently referred to as the TMJ) and its association with neck function, especially the upper cervical vertebrae, as well as headaches.  The muscles that move the jaw/TMJ are largely innervated by the 5^th cranial nerve, also called the trigeminal nerve.  Several studies have found that when stimulating structures innervated by the trigeminal nerve, neck and/or jaw pain was created 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, neck motion extending from the base of the skull and first cervical vertebra (occiput-C1) and continues down through the entire cervical spine.  This was investigated in a study where the relationship between neck symptoms, jaw function – specifically active mouth opening, and pressure pain sensitivity in a trigeminal nerve innervated region after a spinal manipulation was applied to the upper neck vertebrae.  Here, 37 female patients with neck pain were randomly assigned to 1 of 2 groups (control and experimental) and, before and after treatment, exams of mouth opening and pressure pain levels were measured.  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 in a sample of woman with neck pain.  This study is very important as many people suffer from neck pain, headaches and TMD.  In order to properly treat these patients, one must focus on multiple regions, not just the neck area.  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 TMJ are common but often not pursued by patients as often they’ll say, “my jaw clicks and snaps but I don’t think about it much.” 

If you, a friend, or a loved one are struggling with neck pain, headaches, or TMD/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.  This recommendation may represent one of most significant acts of kindness you can give to those that you truly care about.

Call our office now for a consultation 770-888-4288 or visit our website www.backsmarthealth.com

            FM can be primary (of unknown cause) or secondary (caused by a different specific condition). Because many conditions can give rise to FM, it’s not surprising that there is no one diet that works universally for all FM patients. However, many FM sufferers respond from eliminating one or more of several types of foods according to experts interviewed by WebMD, and utilizing these recommendations can prove highly effective.  They specifically identified 7 foods to avoid in the management of FM, which include the following:

1. Aspartame (NutraSweet): All of the experts interviewed by WebMD agreed a large majority of FM patients could worsen by eating or drinking foods sweetened by aspartame.

2.  MSG (monosodium glutamine) and nitrates: MSG is a common additive to enhance flavor in many processed and frozen foods as well as in some Asian (eg., Chinese) foods.  Hence, lunchmeats like ham, bologna and bacon should be avoided.

3.  Sugar, fructose, and simple carbohydrates:  Though no study has clearly identified that these foods directly worsen the symptoms in FM patients, eliminating foods like cake, white bread and sugar in general, will decrease the risk of developing secondary conditions such as yeast infections that can give rise to FM.  Eliminating foods with high levels of fructose corn syrup has been reported to help some FM patients.

4.  Caffeine (coffee, tea, colas/soda, & chocolate):  After a brief stimulating effect (energy boost), there is a longer lasting sedative affect, which is amplified in FM patients.  The good news is that most of the caffeine is out of the body within a week of discontinuing use.

5.  Yeast and glutens:  These two are not related but are frequently used together in foods like cake, donuts and bread and both contribute to FM symptoms.  Yeast gives rise to yeast fungus where an overgrowth may cause or exacerbate FM symptoms resulting in joint and muscle pain.  Glutens can cause stomach and other GI problems, which in turn can give rise to fatigue.

6:  Dairy: Regardless if its low or high fat, some reports indicate that dairy products, particularly milk can increase the symptoms of FM and avoiding these can help.

7.  Nightshade plants: Tomatoes, chili and bell peppers, potatoes and eggplant can trigger flare-ups of FM and various forms of arthritis.

            Some GOOD diet approaches include a heart-healthy diet – that is, one that is low in saturated fat and includes lean meats & poultry, fresh fruits and vegetables. This diet improves one’s overall health, thus reducing the risk of secondary FM and allowing the body to better fight off other disease processes.  This diet is also anti-inflammatory, the common link found in many health conditions.  A vegetarian diet comprised of mostly whole foods was also reported as helpful.  High potency vitamin supplement and specifically Omega 3 fatty acids (main ingredients – EPA & DHA) included in fish oil, flax seed, walnuts, some fortified cereals, and eggs also help reduce inflammation. These recommendations are research supported and we can further discuss the nutritional approaches that benefit patients suffering with fibromyalgia. 

YOU MAY BE A CANDIDATE FOR CHIROPRACTIC CARE FOR FIBROMYALGIA! FOR A FREE NO-OBLIGATION CONSULTATION WITH DR KING  CALL 770-888-4288 OR FOR MORE INFORMATION ON OUR OFFICE VISIT   WWW.BACKSMARTHEALTH.COM

The low back is only so flexible and in reality, most of our ability to touch our toes comes from our hip joints.  In fact, after scoliosis surgery where metal rods are placed on both sides of the spine, these patients will often make up for the loss of low back movement by increasing hip motion and still be able to touch their toes!  This, however, can only be accomplished if the hamstrings are stretched to a point of allowing the hips and pelvis to rotate forwards when bending with the knees straight.

So, what happens if the hamstrings are too tight?  Think of a young sapling tree branch versus an old oak branch. When bending the two branches, the young sapling can easily bend, while the old oak branch breaks early into the process.  Similarly, as we bend over to lift a box, when the back and leg muscles, ligaments, and tendons are tight, something has to give or “break,” similar to the old oak branch. The “weak link” in the injured person bending over may be a disc that ruptures, ligaments and/or muscle tendons that overstretch and tear.  By keeping the hamstrings loose (like the young sapling branch), much less force is placed on the spine because the pelvis can rock forwards during the bending process, thus unloading the spine.  Another way to look at it is that when the hamstrings are too tight, something else has to be correspondingly loose to make up for the tight hamstrings or else the task of bending forwards and performing daily tasks will be limited. 

Tissues in our back are injured when forces exceed their capacity to withstand the load.  By keeping our hamstrings stretched, we reduce the need for our spine to have to make up for the tightness; thus both preventing a new injury, as well as perpetuating a current problem.  The best way stretch the hamstrings is to lay on our back in an open doorway with one leg placed on the door jamb (edge of the doorway) and the other leg is kept flat on the floor (knee straight) through the door opening. Scoot as close as you can so that the hamstring muscles are stretched tightly to the point of a “good hurt.”  Maintain that position for at least 2 minutes and then switch legs.  Because the hamstrings tighten up during sleep, it’s usually best to perform the stretch in the morning.  Repeating this multiple times a day may be required to obtain proper hamstring muscle length.  Exercise training is a routine part of chiropractic care!

If you, your family, or a friend is struggling with low back pain, sharing this information may be one of the greatest acts of kindness you can give to that person. At this clinic, we strive to provide the highest quality care and follow evidence and “best practice” approaches.  We greatly appreciate the trust that our patients place in us and our services as we help them recover as well as teach ways to prevent future LBP episodes.

For A Free No-Obligation Consultation With Dr. Gregory King

 Call 770-888-4288

For More Information visit  www.backsmartchiropractic.com

    There are many causes of LBP. Some of the obvious include over lifting/carrying, performing a task for too long or with too many repetitions, and sitting or standing in one position for too long.  However, frequently LBP seems to occur for no apparent reason, or at least none that can be clearly identified.  One of the most basic causes of LBP is simply standing on two, rather than four legs.  When comparing a 4-legged to a 2-legged subject, arthritis of the spine and disc degeneration occurs much earlier in those of us with two legs.  This is due partially because 2/3rds of our weight is supported by the low back and pelvis.  In addition, vertical loading occurs in the 2-legged subject whereas the load is distributed between four legs in a horizontal fashion in the 4-legged species.  Other less obvious causes of LBP include physical characteristics such as flat feet (fallen arches), a short leg resulting in a tipped pelvis, carrying too much weight, being out of shape/weak muscles, as well as hereditary factors.  Non-physical characteristics include diet, exercise participation, lifestyle, stress and other psychological conditions such as depression, anxiety, bipolar disorders, and others.  Hence, treatment must address the entire person, not just the low back since often, several of the characteristics mentioned here are present and often participating in the cause for LBP.

 Because many of these characteristics are not properly attended to, LBP tends to be recurrent, where multiple episodes come and go over time.  In years past, health care providers would focus the majority of their attention on the physical characteristics of LBP and when treatment results was ineffective, the blame was placed on the psychological aspects for which little, if any, treatment was offered.  However, over the last 20 years, the shift towards treating the whole person or, adopting the biopsychosocial model (bio- = physical, psycho- = mental, and social = how LBP is perceived and affects daily social interaction) has been emphasized as the appropriate approach when managing patients with low back pain.  No longer should the psychological aspect be ignored but rather, identified and treated so that this significant barrier to recovery can be properly managed. 

  Regarding treatment, unless someone presents with a “red-flag” which, for LBP sufferers include cancer, fracture (especially unstable fractures), cauda equine syndrome (spinal cord pinching resulting in bowel / bladder control loss), or infection, immediate/emergent care is not required. A careful health history followed by appropriate tests can usually identify these “red flags.”  Otherwise, surgery for LBP is not recommended until at least 4-6 weeks of treatment with non-surgical approaches are first utilized and, an identifiable “lesion” can be identified that clearly is causing the presenting complaints and clinical findings.  Chiropractic has an obvious advantage over specialty care when considering non-surgical treatment of LBP.  Both physical and emotional issues are identified and a “team” approach with other health care providers when required is ordered.  Moreover, all the international guidelines published for treating LBP recommend spinal manipulation BEFORE most of the other non-surgical approaches are tried due to medication side-effects and, the successes reported in many studies where spinal manipulation is performed. 

YOU MAYBE A CANDIDATE FOR CHIROPRACTIC CARE  FOR A FREE NO-OBLIGATION CONSULTATION CALL 770-888-4288 or Visit www.backsmarthealth.com