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Nerve compression, or nerve entrapment, “is a condition caused by direct pressure on a nerve” [5], often occurring in the wrists, elbows, feet, or spine. Symptoms may include “pain, weakness, or paresthesia (“pins and needles”) [5], ranging from mild to severe, and can develop suddenly or gradually [7]. Patients suffering from nerve compression may also experience a dull, aching sensation radiating from the origin of the compressed nerve, while others may experience numbness [1,3,7]. For patients presenting with these symptoms, especially in the “absence of a known bone, soft tissue, or vascular injury,” researchers have suggested that nerve entrapment syndromes be considered [5].

Nerve entrapment syndromes tend to affect those whose occupations involve repetitive movements or the lifting of heavy objects, such as athletes, office workers, and musicians [1]. Common nerve entrapment syndromes include carpal tunnel syndrome, radial nerve entrapment, ulnar entrapment, and spinal cord compression.

Carpal tunnel syndrome is produced by compression of the median nerve at the wrist [1]. Affected patients report numbness, tingling, and pain in the hand, which often worsens at night or after use of the hand [1]. Similarly, patients with ulnar nerve entrapment or radial nerve entrapment, resulting from compression of the ulnar and radial nerves, respectively, generally describe numbness or pain along the forearms, hands, and fingers [1,3,5]. Symptoms of spinal nerve compression, caused by pressure on the spinal cord, typically resulting from general wear and tear or osteoporosis, may consist of pain and stiffness in the back or neck; “numbness, cramping, or weakness in the arms, hands, or legs; intense pain spreading to the arms, buttocks, or legs (sciatica); and loss of sensation in the feet” [7].

Surgical methods for treating nerve compression, such as decompressions [2,4,6] and the sectioning of ligaments [1], have shown strong success rates and, as advised by Jacobsen et al., “should be considered in patients with persistent pain and identifiable sources of entrapment” [4]. However, while surgical treatments for nerve compression typically yield positive results, some experts consider it to be a last resort, as nonsurgical treatments have proven to be effective in many situations [4,7].

Non-surgical treatments for managing nerve compression may involve splints, pharmacological interventions (NSAIDs), ultrasound therapy, steroid injections, physical therapy, and rest [1]. A study on entrapment neuropathies in the upper extremities recommends rest, splints, and anti-inflammatories, specifically for patients with carpal tunnel syndrome who experience “acute flare-ups, and in those with minimal to intermittent symptoms” [1]. Another study, citing research on the efficacy of splinting when combined with local steroid injections, reports that “22 percent [of patients] were free of symptoms at the end of a year-long trial.”

Chiropractic techniques have also been used to help manage nerve compression. A 2008 study noted a patient with carpal tunnel syndrome who, upon receiving chiropractic manipulation therapy in combination with other techniques over a period of nine months, was able to “return to occupational and social activities” [6]. The research performed by Jefferson-Falardeau et al., focusing on chiropractic management of a patient with radial nerve entrapment syndrome, found that the patient benefited from chiropractic management using standard chiropractic, applied kinesiology, and neural mobilization techniques” [5]. Similarly, the study performed by Illes et al. concluded that “chiropractic treatment consisting of manipulation, soft tissue mobilizations, exercise, and education of workstation ergonomics appeared to reduce the symptoms of ulnar nerve compression symptoms” [3]. Chiropractic techniques have also been said to help treat spinal cord compression.

Treatments for managing nerve compression may be prescribed individually. However, research suggests that a multimodal therapeutic approach may improve results [6].

References

1. Dawson, D. M. (1993). Entrapment Neuropathies of the Upper Extremities. New England Journal of Medicine, 329, 2013–2018. DOI: 10.1056/NEJM199312303292707
2. Dhinsa, B. S., Hussain, L., et al. (2018). The Management of Dorsal Peroneal Nerve Compression in the Midfoot. The Foot, 35, 1–4. DOI: 10.1016/j.foot.2017.12.005
3. Illes, J. D., & Johnson, T. L. Chiropractic Management of a Patient With Ulnar Nerve Compression Symptoms: A Case Report. Journal of Chiropractic Medicine, 12(2), 66–73. DOI: 10.1016/j.jcm.2013.03.002
4. Jacobson, L., Dengler, J., et al. (2020). Nerve Entrapments. Clinics in Plastic Surgery, 47(2), 267–278. DOI: 10.1016/j.cps.2019.12.006
5. Jefferson-Falardeau, J., & Houle, S. Chiropractic Management of a Patient With Radial Nerve Entrapment Symptoms: A Case Study. Journal of Chiropractic Medicine, 18(4), 327–334. DOI: 10.1016/j.jcm.2019.07.003
6. McHardy, A., Hoskins, W., et al. (2008). Chiropractic Treatment of Upper Extremity Conditions: A Systematic Review. Journal of Manipulative & Physiological Therapeutics, 31(2), 146–159. DOI: 10.1016/j.jmpt.2007.12.004
7. Spinal Cord Compressions. Johns Hopkins Medicine. https://www.hopkinsmedicine.org/health/conditions-and-diseases/spinal-cord-compression

Pelvic imbalance, also referred to as “pelvic tilt”, is a common condition affecting both men and women. Contributing factors include discrepancy between leg length, limited flexibility, lack of strength or muscular endurance, irregular posture, poor sitting habits, congenital scoliosis, flat feet, and improper footwear (Karp Rehabilitation 2018). Pelvic imbalance can be a minor issue and is even quite normal; many people have slight leg length discrepancies due to the random asymmetry of bilateral traits resulting naturally from the way an embryo develops. If, however, the degree of pelvic imbalance is too large, the body will try to correct itself by putting more pressure on certain areas; consequently, the strain placed on the back, stomach, pelvis region, and lower extremities can vary significantly from one side to the other. Pelvic imbalance may lead to severe issues such as joint misalignment, muscular imbalances, instability, abnormal posture, and pain in various parts of the body, including the knee (Karp Rehabilitation 2018). 

While pelvic misalignment is common in men, women are particularly vulnerable due to their larger and more mobile pelvises. A report funded by the National Institutes of Health found that nearly 24 percent of women in the U.S. are affected by one or more pelvic floor disorders and that the frequency of pelvic floor disorders increases with age (U.S. Department of Health and Human Services 2015). The imbalance is especially prevalent during pregnancy as a woman’s body releases hormones that relax ligaments to create space for the developing fetus. The increased width of the pelvis often destabilizes the spine and, due to the added pressure from the weight of the child, shifts the spine out of alignment. A 2019 study in which pelvic measurements were obtained from 201 women at 12, 24, 30, and 36 weeks of pregnancy, and 1 month after childbirth found significant differences in the measurements over time (Morino 2019). The anterior and posterior width of the pelvis—the distance between the bilateral anterior/posterior superior iliac spines—became significantly wider as pregnancy progressed. Furthermore, the degree of pelvic tilt of the anterior pelvis increased during pregnancy. The anterior width of the pelvis was not recovered even at one month post-childbirth. 

Knee pain is a common side effect of pelvic imbalance. A 2010 study examined the relationship between pelvis malposition and knee pain in 100 endurance runners, 50 with knee pain and 50 without knee pain, and concluded that there is a correlation between one-sided pelvic mispositioning and knee pain during activities such as endurance running (Siegele 2010). 

Understanding the causes of pelvic misalignment and devising a treatment plan may help avert knee complications or alleviate pain. One case report describes successful chiropractic treatment of a female patient’s knee pain stemming from pelvic imbalance (Bucek 2019). The patient complained of ongoing anteromedial knee pain when walking and a persistent feeling of her knee “giving out” after walking no more than a half mile. The patient was administered five treatments over the course of ten days, and in each treatment received chiropractic manipulation of the sacroiliac joint, kinesiology taping, and gluteus medius exercises to improve muscle strength. Following the treatments, she reported a resolution of her knee issues and experienced no pain while walking or performing other activities (Bucek 2019). 

As described, conservative measures to correct imbalance and resolve knee pain may be effective for patients experiencing knee complications stemming from pelvic misalignment. Chiropractic treatments may help increase muscle strength and flexibility as well as ease the tension on supportive tissues that are strained from misaligned or stiff pelvic joints. 

References 

Bucek, D. (2019). Reduction of Knee Pain in a 45-Year-Old Woman After Pelvic Manipulation and Kinesiology Taping: A Case Report. Journal of Chiropractic Medicine, 18(3), 236-241. https://doi.org/10.1016/j.jcm.2019.07.006. 

First Digital Solutions. (2016, October 14). Pelvic Imbalance. Chelsea Osteopathic Clinic. https://chelseaosteopaths.co.uk/pelvic-imbalance/.  

Karp Rehabilitation. (2018, February 20). Understanding Pelvic Injuries & How to Treat Them. Karp Rehabilitation. http://karprehab.com/pelvic-injuries/.  

Morino, S., et al. (2019). Pelvic alignment changes during the perinatal period. PloS one, 14(10), e0223776. https://doi.org/10.1371/journal.pone.0223776. 

Siegele, J., et al. (2010). Relation between pelvis malposition and functional knee pain by long distance running. Sportverletzung Sportschaden, 24(3), 144–149. https://doi.org/10.1055/s-0029-1245638. 

U.S. Department of Health and Human Services. (2015, September 28). Roughly One Quarter of U.S. Women Affected by Pelvic Floor Disorders. National Institutes of Health. https://www.nih.gov/news-events/news-releases/roughly-one-quarter-us-women-affected-pelvic-floor-disorders.  

Shoulder pain is a common reason for people to seek medical care and is the third most common site of musculoskeletal pain, after the lower back and knee (1,2). In the United States alone, the direct cost of treatment for shoulder dysfunction in 2000 was estimated to be $7 billion. 1-2% of the population is estimated to experience shoulder pain each year. Beyond direct costs, regional pain in the shoulder can also evolve into more generalized pain syndromes, and pain can lead to limitations in range of motion (ROM), subsequently impairing functional activities (1,2). As a result, it is necessary to investigate whether existing treatments for improving shoulder range of motion and pain, such as spinal manipulation, are effective. 

Chiropractic care frequently draws on the theory of regional interdependence, which posits that deficiencies in one area of the body may be associated with primary symptoms in another area, despite being apparently unrelated (2). Previous studies found a decrease in shoulder pain immediately after thoracic manipulation but did not find changes in scapular kinematics or muscle activity (3). Due to the importance of shoulder ROM to daily life, a study by Silva et al. sought to investigate the effect of thoracic spinal manipulation (SM) on shoulder range of motion in people with chronic shoulder pain, with a secondary goal of decreasing pain levels (2). 

The study examined 60 participants who presented with shoulder pain for at least 6 months and who showed clinical signs of rotator cuff tendinopathy, through a combination of positive Hawkins, Neer, or Jobe tests; or pain/weakness with external rotation of the arm. The study excluded patients with contraindications to SM (such as a history of cancer, osteoporosis, or fracture), a pacemaker, or clinical signs of complete rotator cuff tear. On average, participants had experienced nearly four years of pain before entering the study (2). 

Participants were assigned to either the manipulation group or placebo group but were blinded to which group they belonged to. The manipulation group received two high-velocity low-amplitude thrusts between the T4 and T5 vertebrae, while the placebo group received a constant, low pressure contact while assuming the same prone position. Researchers evaluated three key metrics before and after the intervention: the degree of shoulder flexion, the degree of shoulder abduction, and self-reported shoulder pain (2). 

After thoracic spinal manipulation, participants demonstrated a statistically significant increase in both flexion and abduction range of motion in the painful shoulder, as well as a significant increase in abduction of the nonpainful shoulder. The improvement in abduction in the painful shoulder was also above the calculated minimal detectable change, giving this effect clinical significance as well. However, the placebo group also demonstrated a statistically significant improvement in shoulder ROM after receiving the placebo intervention. Both groups reported less pain after their respective interventions (p < 0.01), but this change was not clinically significant (2). 

This study demonstrated that thoracic spinal manipulation clinically improved abduction, one aspect of range of motion, in the painful shoulder, but that thoracic SM did not improve flexion or pain levels (2). Future research should include a true control group in order to test for a placebo effect, which is a potential explanation for changes experienced by the placebo group, as well as investigate other treatment techniques for shoulder pain. 

References 

1. Silva ACD, Santos GM, Marques CMG, Marques JLB. Immediate Effects of Spinal Manipulation on Shoulder Motion Range and Pain in Individuals With Shoulder Pain: A Randomized Trial. J Chiropr Med. 2019;18(1):19-26. doi:10.1016/j.jcm.2018.10.001 

2. Tekavec, E., Jöud, A., Rittner, R. et al. Population-based consultation patterns in patients with shoulder pain diagnoses. BMC Musculoskelet Disord. 2012;13(238). doi:10.1186/1471-2474-13-238 

3. Haik MN, Alburquerque-Sendín F, Silva CZ, et al. Scapular Kinematics Pre- and Post-Thoracic Thrust Manipulation in Individuals With and Without Shoulder Impingement Symptoms: A Randomized Controlled Study. J Orthop Sports Phys Ther. 2014;44(7):475-487. doi:10.2519/jospt.2014.4760

More than half of all adults will experience back pain in their lifetime [1,3], spurring the development and implementation of various techniques in chiropractic care. These may involve “pharmacological interventions, physical exercise, and modalities including electrotherapy, cold, and heat therapy” [3]. While each of these techniques may be prescribed on its own [2], some research suggests that there is greater efficacy when the therapy involved is multidisciplinary [6]. One popular supplement for chiropractic care is diathermy, “a therapeutic treatment most commonly prescribed for muscle and joint conditions, [which] uses a high-frequency electric current to stimulate heat generation within body tissues” [4]. The heat generated by diathermy is believed to help increase blood flow, mitigate pain, improve flexibility, and accelerate the healing process of damaged tissue [1,4,6].   

The three main types of diathermy are shortwave, microwave, and ultrasound [4]. Shortwave diathermy produces heat through electromagnetic energy, either pulsed or continuous [4]. Said to help reduce inflammation, shortwave diathermy is typically used in patients experiencing pain or muscle spasms caused by conditions such as kidney stones, osteoarthritis, sprains, and strains [4, 5]. Microwave diathermy, however, uses electromagnetic waves in the microwave range to generate heat. Because it does not penetrate as deeply as shortwave diathermy, though, it is often applied to more superficial areas of the body, since it warms tissue evenly without heating the skin [2,4]. Conversely, ultrasound diathermy is used more for deep tissue, generating heat through sound waves, which vibrate the tissue and, in turn, promote blood flow to the targeted area [4]. It may be prescribed to patients presenting with musculoskeletal sprains, joint contractures or adhesions, and muscle spasms [4]. 

“For ultrasound diathermy,” as described in a Healthline article, “the therapist applies a gel to the affected area of your body, [then] moves a wand continuously over the affected area” [6]. Shortwave and microwave diathermy, on the other hand, do not require gel, but instead are typically administered through electrodes placed over the affected area [6]. Sometimes a towel is placed between the electrodes and the skin to avoid direct contact [6].  

In a study examining the efficacy of diathermy treatment in patients with chronic low back pain (CLBP), Durmas et al. found that microwave diathermy combined with physical exercise was beneficial. However, they determined it was not superior to exercise alone [3]. Research performed by Ahmed et al., highlighted several studies that showed significant improvements in patients receiving shortwave diathermy treatment for CLBP and neck pain, concluding that “shortwave diathermy is an effective modality in the treatment of the patients with chronic low back pain” [1]. They also found that deep heat was more effective than superficial heat for the treatment of CLBP [1]. Similarly, a study done by Zati et al. determined that deep heating therapy, through medium-frequency (450–1000 KHz) waves diathermy, appears to be effective in patients with nonspecific CLBP, and thus suggested that it could be a positive addition to a patient’s therapeutic regimen.  

The research conducted by Andrade et al. aimed to observe the efficacy of microwave diathermy in patients presenting with nonspecific neck pain. Despite the rising popularity of microwave diathermy, their study suggests that it “provides no additional benefit to a treatment regimen of chronic neck pain that already involves other treatment approaches (e.g., exercise, TENS)” [2]. While they, like others, add that more research is needed to better understand the efficacy and benefits of diathermy treatment as an independent modality [2,4], most studies seem to suggest that it could potentially be a useful supplement for chiropractic care.  

References 

1.  Ahmed, M. S., Shakoor, M. A., et al. (2009). Evaluation of the Effects of Shortwave Diathermy in Patients With Chronic Low Back  Pain. Bangladesh Medical Research Council Bulletin, 35(1), 18–20. DOI: 10.3329/bmrcb.v35i1.2320 

2. Andrade Ortega, J. A., Cerón Fernández, E., et al. (2014). Microwave Diathermy for Treating Nonspecific Chronic Neck Pain: A Randomized Controlled Trial. The Spine Journal, 14(8), 1712–1721. DOI: 10.1016/j.spinee.2013.10.025 

3. Durmus, D., Ulus, Y. et al. (2014). Does Microwave Diathermy Have an Effect on Clinical Parameters in Chronic Low Back Pain? A Randomized Controlled Trial. Journal of Back & Musculoskeletal Rehabilitation, 27(4), 435–443. DOI: 10.3233/BMR-140464 

4. Giorgi, A. “Diathermy.” Healthline. (2017). www.healthline.com/health/diathermy 

5. Wu, C.-L., Yu, K.-L., et al. (2009). The Application of Infrared Thermography in the Assessment of Patients with Coccygodynia Before and After Manual Therapy Combined with Diathermy. Journal of Manipulative and Physiological Therapeutics, 32(4), 287–293. DOI: 10.1016/j.jmpt.2009.03.002 

6. Zati, A., Cavazzuti, L., et al. (2018). Deep Heating Therapy via MF Radiowaves v. Superficial Heating Therapy in the Treatment of Nonspecific Chronic Low Back Pain: A Double Blind Randomized Trial. Journal of Back & Musculoskeletal Rehabilitation, 31(5), 963–971. DOI: 10.3233/BMR-170944 

Back pain is one of the most common reasons for people to see a doctor or miss work [1]. Symptoms can range in intensity, affect people of all ages, and be caused by a variety of factors, including scoliosis, sprains, traumatic injuries, degenerative diseases, consistent poor posture, and inactivity [1,2]. In particular, the National Institute of Neurological Disorders and Stroke identifies extended periods of working at a desk as a risk factor for back pain [1]. Though “preventing all back pain may not be possible,” Dr. Daniel Park states that certain behaviors “help reduce our risk” [3]. These behaviors are related to the increasingly sedentary and inactive lifestyle of many Americans, which is “linked to approximately $117 billion in annual health care costs and about 10 percent of premature mortality” [4]. A major contributor to these trends is the prevalence of office jobs. Working at a desk can have significant effects on overall back and spine health. 

The spine, and back in general, is a complex system of 33 vertebrae, intervertebral discs that help absorb shock, ligaments, tendons, muscles, and nerves [1]. Maintaining the strength of the overall system and minimizing asymmetry is important for physical function. For example, weak core muscles weaken the back overall and also may drive forward slouching. A study in the European Spine Journal found that “slump posture” while using a computer or watching TV were associated with chronic low back pain [5]. In fact, the Occupational Safety and Health Administration has published recommendations for office workstations, such as using desk chairs that adequately support the back and positioning the computer monitor, keyboard, and desk at natural positions [6]. 

When seeking medical advice for back health, diagnosing the condition(s) underlying back pain usually involve a comprehensive medical history, physical exam, and occasionally further tests. However, it is not always possible to determine the cause, and pain that does not stem from a straightforward, acute injury may be more complicated to treat [1]. Such situations require a gradual approach, starting with less invasive and cost-effective treatments and only moving on to more aggressive options if needed. Self-management strategies include exercises to strengthen core muscles, which can balance out extended periods of relative inactivity in a desk job. Acupuncture, transcutaneous electrical nerve stimulation, and chiropractic spinal manipulation and mobilization can often provide relief; research demonstrates that chiropractic care is beneficial for chronic low back pain. Surgery, a more advanced care option, is not always successful, may involve long recovery time, and involves significant risks [1]. 

Prevention and proactive management of back health are critical for those who work at desks or in other sedentary jobs. Many work-related injuries are “caused or aggravated by stressors such as … awkward posture” [1]. The Mayo Clinic recommends workers to “pay attention to posture”, “modify repetitive tasks”, and “listen to your body” [2]. It is important to regularly strengthen muscles through exercise; maintain a healthy weight, as an imbalance between body weight and strength “puts added pressure on your spine and lower back”; use ergonomic equipment; periodically move and stretch to relieve tension; and maintain proper posture [1-3]. Dr. Park adds, “Make sure your working surface is the proper height so you don’t have to lean forward,” and, “Once an hour, stand and stretch” [4]. 

Back pain is a common condition that can impair daily activities and quality of life. Back and spine health is damaged by poor posture, inactivity, and muscle loss, all of which are common in desk jobs. 

References 

1. Office of Communications and Public Liaison. “Low Back Pain Fact Sheet,” (2020). National Institute of Neurological Disorders and Stroke, Disorders, Patient & Caregiver Education, Fact Sheets. Available: https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Low-Back-Pain-Fact-Sheet 

2. Mayo Clinic Staff. “Back pain at work: Preventing pain and injury,” (2019). Mayo Clinic, Health Lifestyle, Adult Health. Available: https://www.mayoclinic.org/healthy-lifestyle/adult-health/in-depth/back-pain/art-20044526 

3. Park DK. “Preventing Back Pain at Work and at Home,” (2017). American Academy of Orthopaedic Surgeons, OrthoInfo, Staying Healthy. Available: https://orthoinfo.aaos.org/en/staying-healthy/preventing-back-pain-at-work-and-at-home/ 

4. Olson RD, Piercy KL, Troiano RP, et al. “Physical Activity Guidelines for Americans,” (2018). U.S. Department of Health and Human Services. Available: https://health.gov/sites/default/files/2019-09/Physical_Activity_Guidelines_2nd_edition.pdf 

5. Filho NM, Coutinho ES, & e Silva GA. “Association between home posture habits and low back pain in high school adolescents,” (2015). European Spine Journal. Available: https://doi.org/10.1007/s00586-014-3571-9 

6. Occupational Safety and Health Administration. “Workstation components,” (n.d.). U.S. Department of Labor, Occupational Safety and Health Administration, Computer Workstations eTools. Available: https://www.osha.gov/SLTC/etools/computerworkstations/components_chair.html 

Asymmetry in body dimensions is not the exception but the norm for humans, and random deviations from perfect symmetry are to be expected (Einas, 2004). Depending on the type and degree of asymmetry, however, some individuals may develop spinal conditions that cause back pain and require intervention. Kyphosis, scoliosis, and spinal stenosis are three common conditions involving abnormal curvature of the spine. Other factors that researchers have found to contribute to lower back pain include asymmetry of the lower limbs, such as discrepancy in leg length (Einas, 2004).  

Back conditions can be either acute or chronic. Acute back pain, such as that resulting from sprains, strains, and spasms, is short-term and tends to resolve with self-care within a few days, weeks, or months. Chronic back pain, on the other hand, is pain that continues for longer than 12 weeks and is more difficult to treat. An estimated 20.4 percent of all adults experience chronic back pain (Dahlhamer et al., 2016) and about 20 percent of acute cases develop into chronic issues (NINDS, 2020). While chronic low back pain is sometimes successfully treated, it may persist in some patients despite medical and surgical treatment.  

Kyphosis is a forward rounding, or “hunching”, of the upper back that most often occurs in older women. Though mild kyphosis may not be a cause for concern, severe cases can affect the lungs, nerve roots, tissues, and other internal organs, in which case surgery may be needed to permanently join two or more vertebrae and reduce the degree of curvature (Cleveland Clinic, 2020). Though osteoporosis-related factors and degenerative diseases of the muscles are primary causes, hyperkyphosis may be induced by a variety other factors such as habitual poor posture (Wendy et al., 2010). 

Scoliosis is a lateral, rather than forward, curvature of the spine into an “S” or “C” shape. It most often occurs at a young age just before or during puberty, and while most cases are mild, some adolescents develop spinal deformities that increase in severity as they grow. Though the causes of scoliosis are still not entirely known, one prominent hypothesis is that changes during the growth process in the womb contribute to scoliosis present at birth. In older children and adolescents, scoliosis may be brought about by diseases such as cerebral palsy and muscular dystrophy (Janicki et al, 2007). In adults, osteoporosis and forms of arthritis can weaken the spine, leading to misalignment and potentially scoliosis. More recently, researchers have identified, through a defect in CHD7, a genetic link to scoliosis in cases where there is no other definite cause (Washington University in St. Louis, 2007). Further steps in understanding the genetic basis of the condition may allow doctors to identify those who are predisposed and intervene before the deformity develops. 

Unlike scoliosis, which generally appears in children, spinal stenosis usually occurs later in life as the vertebrae change with age. It is characterized by a narrowing of the spine that subsequently puts pressure on the spinal cord or nerves, causing pain or weakness in the back, neck, or shoulders. Though most cases of spinal stenosis produce bilateral symptoms, asymmetrical pressure on nerves can result in symptoms being more severe on one side of the body (Munakomi, 2020). Primary causes of spinal stenosis include osteoarthritis of the spine and spondylosis, a type of arthritis spurred by repetitive stress. Injuries, tumors, and other diseases may also be causes. Additional factors that contribute to stenosis of the spinal canal include lumbar disc degeneration and asymmetrical disc bulging, which occurs when the soft center of a disc between the bones that make up the vertebrae pushes through the exterior casing.  

Though back asymmetries can often be treated with surgery or noninvasive methods such as chiropractic and physical therapy, other cases are more difficult to treat and tend to result in chronic pain. It is important to realize, however, that the persistence of pain does not necessarily mean there is a medically serious underlying cause (NINDS, 2020). Oftentimes, simple changes to one’s diet, lifestyle, and stress management may help alleviate a variety of back-related symptoms. 

References 

Al-Eisa E, et al. “Fluctuating Asymmetry and Low Back Pain.” Evolution and Human Behavior, Volume 25, Issue 1, 2004, 31-37, ISSN 1090-5138, http://www.sciencedirect.com/science/article/pii/S1090513803000813. 

Dahlhamer J, Lucas J, Zelaya, C, et al. “Prevalence of Chronic Pain and High-Impact Chronic Pain Among Adults — United States, 2016.” Center for Disease Control and Prevention (MMWR Morbidity and Mortality Weekly Report), 2018, 67:1001–1006, https://www.cdc.gov/mmwr/volumes/67/wr/mm6736a2.htm. 

Janicki J, Alman B. “Scoliosis: Review of Diagnosis and Treatment.” Paediatrics & Child Health, 2007, vol. 12,9: 771-6, https://www.sciencedaily.com/releases/2007/06/070614100445.htm. 

Katzman W, et al. “Age-Related Hyperkyphosis: Its Causes, Consequences, and Management.” The Journal of Orthopaedic and Sports Physical Therapy, 2010, vol. 40,6: 352-60, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2907357/. 

“Low Back Pain Fact Sheet”. National Institute of Neurological Disorders and Stroke (NINDS), 2020, No. 20-NS-5161, https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Low-Back-Pain-Fact-Sheet. 

Munakomi S, Foris LA, Varacallo M. “Spinal Stenosis and Neurogenic Claudication.” StatPearls, 2020. https://www.ncbi.nlm.nih.gov/books/NBK430872/. 

“Spondylolisthesis.” Cleveland Clinic, 2020, https://my.clevelandclinic.org/health/diseases/10302-spondylolisthesis. 

Washington University in St. Louis. “First Gene Linked To Scoliosis Identified.” ScienceDaily, 15 June 2007, www.sciencedaily.com/releases/2007/06/070614100445.htm. 

Headaches affect nearly half of all adults in their lifetime [7]. Migraine headaches account for 69% of all primary headaches, which are defined by the International Headache Society as headaches “in which the pain is caused by independent pathologic mechanisms” [7]. An estimated 15% of people worldwide are said to have one-year prevalence of migraine [1,3], making it “19^th among all causes of years lived with disability,” according to the World Health Organization, and the seventh highest cause of disability in a study performed by the Global Burden of Disease [1].  Chiropractic techniques are an effective treatment for migraine.

As explained by Espí-López et al., migraine is considered a neurovascular disorder, originating “in the sensory fibers that convey pain signals from intracranial and extracranial blood vessels” [5]. Factors resulting in migraine sometime include “changes in atmospheric pressure, intake of certain foods, certain drugs, psychological factors, sleep disturbance, or stress” [5]. While multiple medications have been shown to help treat migraine (e.g., Amitriptyline), their many unwanted side-effects (fatigue, dizziness, low blood pressure, depression, and renal damage) [7] “has led to a growing demand for nonpharmacological prophylactic treatments to reduce the frequency of migraine” [1]. 

One nonpharmacological approach to migraine treatment is through chiropractic care. In fact, in a study performed in 2011 by Bryans et al., headache was listed as the third most common reason for patients seeking chiropractic care in North America [3]. Various studies find spinal manipulation therapy, in which “an examiner applies a manual force to a spinal joint to move the joint near its end range of motion” [8], as being equally effective for migraine treatment as Amitriptyline, but without the unwanted side-effects [2,3,6,7,8]. Occipital decompression, a chiropractic technique that involves “using the fingertips to manually stretch the paraspinal tissues at the base of the occiput,” has also been shown to help manage pain and discomfort from migraine [6].  

People with migraine disorder often show postural deficiencies and complain of tension and pain in the neck muscles associated with myofascial trigger points (MTrPs) [7]. In turn, researchers believe MTrPs contribute to the prevalence of migraine headaches [7]. Current non-pharmacological methods for mitigating MTrPs in patients with migraine include laser therapy, needling therapies (such as acupuncture), and soft tissue techniques [7,8]. Although soft tissue techniques focusing on MTrPs have been said to effectively treat migraine [7], the study performed by Espí-López et al. saw greater efficacy when they were combined with suboccipital soft tissue inhibition [5]. Several studies also examine the use of osteopathic therapy, such as soft tissue massage of the paraspinal tissues, for migraine relief [3,6]. One study cites that “the use of 8 osteopathic sessions over a 6-month period significantly reduced the use of drugs, pain, and disability” among patients with migraine [4].   

Research has demonstrated that soft tissue chiropractic techniques can indeed improve the quality of life for patients suffering from migraine and are an effective and safe alternative to pharmacological intervention. This is a promising research avenue to pursue in developing guidelines for headache prevention and treatment. 

References 

1. Amons, A. L., Castien, R. F., van der Wouden, et al. (2019). Manual Therapy as a Prophylactic Treatment for Migraine: Design of a Randomized Controlled Trial. Trials, 20(1), 1–9. doi:10.1186/s13063-019-3937-8  

2. Biondi, D. M. (2005). Physical Treatments for Headache: A Structured Review Headache, 6, 738. doi:10.1111/j.1526-4610.2005.05141.x  

3. Bryans, R., Descarreaux, M., Duranleau, M., et al. (n.d.). (2011). Evidence-Based Guidelines for the Chiropractic Treatment of Adults with Headache. Journal of Manipulative and Physiological Therapeutics, 34(5), 274–289. doi:10.1016/j.jmpt.2011.04.008  

4. Cerritelli, F., Emanuele, C., Rina, G. L., Gabriella, M., Marcello, D. V., & Luca, M.. (n.d.). Is osteopathic manipulative treatment effective in migraine? International Journal of Osteopathic Medicine, 16(1), e15–e16. doi:10.1016/j.ijosm.2013.01.008  

5. Espí-López, G.-V., Ruescas-Nicolau, M.-A., Nova-Redondo, C., et al. (2018). Effect of Soft Tissue Techniques on Headache Impact, Disability, and Quality of Life in Migraine Sufferers: A Pilot Study. Journal of Alternative & Complementary Medicine, 24(11), 1099–1107. doi:10.1089/acm.2018.0048  

6. Keays, A. C., Neher, J. O., & Safranek, S. (2008). Is Osteopathic Manipulation Effective for Headaches? Journal of Family Practice, 57(3), 190–191. PMID:18321458  

7. Rezaeian, T., Mosallanezhad, Z., Ahmadi, M. et al. (n.d.). The Impact of Soft Tissue Techniques in the Management of Migraine Headache: A Randomized Controlled Trial. Journal of Chiropractic Medicine, 18(4), 243–252. doi:10.1016/j.jcm.2019.12.001  

8. Smith, M. S., Olivas, J., & Smith, K. (2019). Manipulative Therapies: What Works. American Family Physician, 99(4), 248–252. PMID:30763049 

The Activator Method for spinal mobilization is a well-established chiropractic technique for alleviating bodily discomforts which specifically stem from spinal or pelvic misalignment. Using the Activator Method is a common practice in the U.S. and internationally— for example, it is also prevalent in Canada and Australia.^[1]According to the National Board of Chiropractic Examiners, around fifty percent of all practicing chiropractors in the U.S. currently use or have used this method.^[2]

The Activator Method is utilized to treat a number of common ailments, including pain in the neck, back, and lower extremities. The Activator is a hand-held, spring-loaded machine that applies repetitive force to a selected area of the spine. While other spinal mobilization techniques involve the application of a high-velocity, low-amplitude (HVLA) thrust, the Activator provides a gentler pulse that is less likely to erroneously compromise joint positioning. It is consistent in its magnitude of force (approximately 0.3 Joules) and generally is operated at a frequency of approximately 3 milliseconds. 

There are a few ways in which a chiropractor may evaluate the ideal site for application. One method of assessment is a leg length evaluation, based on the theory that disparities in length between the two legs are telling of pelvic or spinal misalignments. This method is relatively contentious, given the lack of randomized clinical trials supporting its validity. Generally, static or dynamic spinal palpation is sufficient to determine where the Activator should be put to use.

Though quality studies on the long-term benefits of chiropractic methods are generally scarce, there is a non-negligible body of research supporting the use of the Activator Method for treating pain and misalignment. One study showed that the Activator Method was just as effective as other methods of spinal mobilization as far as long-term improvements in disability and pain in patients with sub-acute non-specific neck pain.^[3] Another study found that HVLA spinal mobilization and the Activator Method both resulted in statistically significant improvements in pain and disability in the treatment of cervical spine dysfunction both after therapy and in a one month follow-up.^[4] Therefore, while research supports that the Activator Method of spinal mobilization is generally effective at improving disability index and pain ratings, it may not necessarily be more effective than other methods of spinal mobilization.  

^[1] Huggins T, Boras AL, Gleberzon BJ, et al. Clinical effectiveness of the activator adjusting instrument in the management of musculoskeletal disorders: a systematic review of the literature. Journal of the Canadian Chiropractic Association 2012;56(1):49-57.

^[2] National Board of Chiropractic Examiners. Job Analysis of Chiropractic 2005: A project report, survey analysis, and summary of the practice of chiropractic within the United States. Greeley, CO. January 2005.

^[3] Gemmell, H., Miller, P. Relative effectiveness and adverse effects of cervical manipulation, mobilisation and the activator instrument in patients with sub-acute non-specific neck pain: results from a stopped randomised trial . Chiropr Man Therap 18, 20 (2010). https://doi.org/10.1186/1746-1340-18-20

^[4] Wood TG, Colloca CJ, Matthews R. A pilot randomized clinical trial on the relative effect of instrumental (MFMA) versus manual (HVLA) manipulation in the treatment of cervical spine dysfunction. J Manipulative Physiol Ther. 2001 May;24(4):260-71. https://doi.org/10.1067/mmt.2001.114365. PMID: 11353937.