Protect your lower back in standing forehead to knee Pose

Standing poses are fantastic for improving balance and as an added benefit, this pose stretches those often too tight hamstrings.  Yet the standing forehead to knee pose is one that I see done incorrectly the most.  The chiropractor in me winces because I know how easy it is to compromise the lower back when this one is done incorrectly.  

If you are holding up that outstretched leg with your arms, and you know who you are, then you are at risk for straining your lower back.  With the weight of the leg in the arms and your lower back folded over, you're putting a lot of pressure on your spine, and the muscles in the lower back.  The group of muscles at risk is called your erector spinae muscles.  In an ideal world, the leg should actually be held up by its own strength and supported with the abdomen. 

Test yourself to see if you can stand on one leg and extend the other out without using your hands for support.  If you can, you're ready for this pose.  If not, then back off a bit: standing up right with the leg outstretched just at a lower angle or even with the knee bent.  In these modified versions you will still get the benefit of improved balance and increase muscle strength, all while your lower back is being protected! 

Help with Daily Headaches

Gail was referred to our office by another doctor who she had been seeing for chronic daily headaches.  Every morning Gail would wake up with a headache, and depending on how severe her head pain was she would plan her day around it.   When she came in, we identified a misalignment in her upper neck.  Her C1 vertebra, called the Atlas bone, was out of alignment and compromising the nerves at the skull base.  She was struggling with this problem for over 8 years!  After careful analysis and gentle correction, Gail is no longer waking up with headaches.   

Our favorite part is when Gail shared that she is allowing herself to look forward to her son's wedding.  She said that before care she didn't let herself look forward to his wedding because "what if she woke up with a bad headache that day".  Now she can confidently look forward to that day with her family.  

Reverse Warrior: Engage your abdominal muscles to spare your spine!

Reverse warrior posture is one of the foundation poses for many yoga practices and is one of my favorites.  It just feels so good to get that deep stretch through the side body while strengthening your legs.  Although as with all yoga poses, alignment is crucial for this posture or lower back injuries can be created or exacerbated.  There is so much going on in this posture that it can be easy to forget to engage your abdomen as you lean back and yet it is crucial to remember this to protect your lower back.    

In this posture you are not just leaning to one side but your also leaning back.  This oblique movement can be compromising to your lower back and should be avoided if you have a recent injury.  Even with the healthiest backs, remember that this movement starts and ends in your abs! 

Low Back Pain and Headaches Improved with Upper Cervical Care

We all know that pain and fear of injury can stop us from doing the things in life that we really want to do and make us feel...well...just not like ourselves. Ryan came to us experiencing low back pain, which was keeping him from exercising. Ryan was becoming frustrated because when he would exercise, his low back would flair up. He was also getting headaches two to three times a week and neck pain. Ryan’s upper cervical spine was corrected and immediately he felt the pressure off his low back. He has now had four upper cervical corrections and his low back pain, neck pain and headaches are all dramatically improved just by getting his head on straight! Is your head on straight?

Whiplash Relief with Upper Cervical Care

Craig was in a bad head-on motor vehicle accident about five years ago, which had suffered from bad whiplash.  When he first came in about eight months ago, he felt unstable in his spine, he had left arm pain, numbness and tingling, as well as low back and neck pain.  Also after the accident, he found that he couldn't work out with being in pain or injuring himself. After the first four weeks of corrections, Craig was reporting dramatic improvements and was able to get back in the gym. Now he has been holding his alignment for about six months - meaning he hasn’t needed to be adjusted! He has his confidence back and is feeling strong!

WARRIOR THREE POSE FOR A STRONGER CORE AND BACK

Warrior three pose or Virabhadrasana III is a more advanced posture and requires the practitioner to have a solid foundation and balance.  This is a pose that is wonderful for strengthening: ankles, legs, back, core, and shoulders.  It is also a pose that if done incorrectly can cause some problems in the body, especially for the hip of the standing leg and for the lower back.  For the ideal benefits of this pose make sure that your foot, knee, hip, shoulders, head and arm of the raised leg are in a straight line, and that the raised leg, toes, hip points, and fronts of the shoulder all point towards the ground.  

This pose also helps with focus, concentration and invigorating the body.   

Remember that keeping a body moving is an important part of keeping a body healthy! 

Happy Practicing. 

Surgery Cancelled after beginning Upper Cervical Care

Have you ever stopped being active because of pain?  Check out Lauren's story.    Being in constant pain is draining.  Regardless of if you have had specific head or neck trauma or if you are in the category of years of pore posture, neck pain runs the gamete from annoying to debilitating.  Pain in the neck can arise from many of the various structures in this complex part of the body.  One of the most common is due to degeneration of the vertebra and joints causing bone spurs or bony growths.  Here we're going to break that process down.  When a trauma occurs and a joint in the neck is locked out of place (most commonly the 1st cervical vertebra) it then changes how that joint and the rest of the joints in the neck move.  When there is altered movement at a joint it creates inflammation and instability.  The body's response to instability is quite brilliant in fact, it's going to lay down more bone to try to stabilize that area.  This response is a natural process in the body, and like we said it's pretty brilliant because it takes DECADES for bone to degenerate to the point where it is drastically affecting function.  When the human body was evolving and our life expectancy was 40 this process was not a problem.  However if we want to stay pain free and active into our 70's-80's or even 90's we need to restore that joint motion as best we can!  This is where gentle specific upper cervical chiropractic can help your body feel better and function better.  Just ask Lauren.  

Warrior Two Pose for Strong legs, Open Hips and Engaged Core

Warrior two pose or Virabhadrasana II is one of the most common yoga poses you might see at your local class.  Yet often I see this pose done slightly incorrectly that can cause significant aches and pains in time.   One of the most common mishaps is when the knee tracks two far over the ankle.  This causes sheering forces on the knee and can create strain.  Also if your torso is not balanced over the hips this is going to increase strain in the lower back and looses a huge benefit of the posture.  The biggest benefit of this posture is to create a strong foundation with your legs. 

This posture will tone and increase the strength in your legs and thighs.  It also is a great posture to open up and stretch the hip and groin muscles.  Additionally with the torso over the hips and the chest open it will strengthen the back muscles and open the front of the chest.  All of us on computers drastically need that these days!  So next time your getting into this pose be mindful of these tips to get the maximum benefit and prevent injury.

Imaging of the ligaments in the Upper Neck

Follow-Up MR Imaging of the Alar and Transverse Ligaments after Whiplash Injury:

A Prospective Controlled Study

Vetti N., Krakenes J. et al. American Journal of Neuroradiology 32: 1836-41, Nov 2011

Why do we do research? To answer questions?  Yet, how often do we seek out research that validates our paradigm?  My guess would be almost always.  Therein is the problem.  To be a true question, we must not think we already know the answer or outcome.  That was the reason that this study caught my eye.

This study was a prospective case controlled study that followed 91 symptomatic whiplash patients and 52 neck pain control patients for 1 year.  MR Imaging was done at baseline on neck pain patients and after the accident and on a 1 year follow up, results were also correlated with the neck disability index. 

The inclusion criteria for the whiplash included: MVA in the past 7 days with onset of neck pain within 48 hours.  No previous history of neck pain, and classified as WAD 1-2 (Whiplash Associated Disorders without any neurological signs, factures or dislocations).

The symptomatic control patients were included when they reported to an outpatient spine clinic with a history >3 months of neck pain with a non-traumatic onset.

The researchers concluded that the areas of high signal intensity (indicating inflammation/fibrosis/fat replacement) in the alar and transverse ligaments did not change significantly at baseline or at 1 year follow up for WAD patients.  Further the prevalence of the alar and transverse ligament high signal intensity did not differ significantly between traumatic and non-injured neck pain controls.

What the researchers concluded is that the alar and transverse ligament high signal intensity in patients with WAD1-2 observed in the first year after injury cannot be explained by the trauma.

Clinical Pearls:

“High signal intensity could theoretically be due to altered ligament function cause by neck pain.”

“Pain induced immobility causes morphologic changes in muscles, tendons and ligaments.”

“High signal intensity of the alar and transverse ligaments is also reported to be frequent in healthy non-injured persons without neck pain.”

Author’s Note: This study is a bit confounding however provides an interesting observation on neck pain related MR imaging. 

Grip Strength in Athletes improve with Cervical Adjusting

The Effects of Cervical Spine Manipulation on Judo Athlete’s Grip Strength

Botelho, M.B., DC, Andrade B. B. MD, PhD. JMPT, November 2011

This article is straight forward and provides an excellent reference for those Upper Cervical chiropractors interested in athletics.  The test population didn’t suffer from any particular condition, in fact they were male and female athletes from a nationally competitive judo team and cervical spinal manipulative therapy (or adjustments to the chiropractic community) made a statistically significant difference in their grip strength! 

The study includes 18 athletes randomly assigned to either a treatment group or a sham adjustment group.  The subjects where given 3 SMT within 3 weeks with a minimum of 36 hours between treatments.  Grip strength was tested using a hydraulic dynamometer immediately before and after treatment.   Grip strength improved in each hand pre and post intervention each time, the level of improvement was statistically significant, while no statistically significant difference was noted in the sham treatment group. 

Fibromyalgia responds to upper cervical care: A Case Study

Alibhoy N. Resolution of Fibromyalgia Following Upper Cervical Chiropractic Care: A Case Study. J. Upper Cervical Chiropractic Research; June 20, 2011.

The case follows a 45 year old fibromyalgia patient with additional complaints of migraines, neck, upper back and low back pain, numbness in her fingers, bilateral sciatica, right knee pain, depression and duodenal ulcer.   She had a history of two major cervical traumas and 11 car accidents, and had seen 5 different chiropractors in 12 years.  Her activity levels were severely limited and she frequently used a wheel chair. 

Knee Chest protocol was used and the patient was seen 79 times in 17 months with 47 adjustments performed to both atlas and axis. 

At resolution of care the patient did not need the use of her wheel chair and self-reported fibromyalgia and left leg sciatica, right knee pain, chronic back pain and migraines had completely resolved.  Right leg sciatica improved 98%.  The patient was also no longer taking any of her previous routine medications. 

 Case studies are an invaluable starting point for more in-depth research.    

Will how adjusting my neck affect my hip pain?

The Effect of Upper Cervical or Sacroiliac Manipulation on Hip Flexion and Range of Motion

Pollard, DC, MS, Ward, PhD.  JMPT 1998; 21(9);611-616

Your going to adjust my neck and it will help my hip feel better?   How often have you heard this question in your office?  The following study although a few years old points to a positive correlation and gives a compelling hypothesis for the connection.

This study compared the effectiveness of an upper cervical manipulation and a manipulation of the SI joint for increasing hip range of motion in 52 subjects ages 18-34.   Testing methods where performed using a hand held digital electrogonimometer.  The patients performed a straight leg raise before and after the treatment.  The three treatment groups included just cervical manipulation, just SI joint manipulation (side posture) and the third received a sham adjustment of pressure on the mastoid process.  Range of motion was tested prior to manipulation, the patient received one treatment and then range of motion was re-tested. 

Both spinal manipulation groups demonstrated increased flexion of the hip however only the upper cervical manipulation increased hip flexion range of motion significantly. 

The potential mechanism discussed is that of the tonic neck reflex.  Changes in the muscle spindle output of the suboccipital muscles may cause reflexive proprioceptive changes to centers that control posture.   The muscles of the pelvic girdle are some of our primary posture stabilizers.  

Is your neck pain affecting your balance?

Chronic neck pain, standing balance, and suboccipital muscle atrophy--a pilot study

 McPartland JM, Brodeur RR, Hallgren RC, JMPT 1997 Jan;20(1):24-9

This study was completed at the University of Michigan and looked at 7 chronic neck pain patients and 7 controls.

The purpose of the study was to examine the relationship between chronic neck pain, standing balance and sub-occipital (the base of the skull) muscle atrophy. 

Palpation was used to determine any somatic dysfunction (misalignment) of the upper cervical spine (top of the neck), a force platform was used to measure standing balance, and MRI was used to examine fatty infiltration (evidence of injury and disfunction) of the sub-occipital muscles.

The study found that chronic neck pain patients have almost twice the amount of somatic dysfunction (tenderness, asymmetry of joint position, restriction in range of motion, and tissue texture abnormality) as compared to normal subjects. 

The greatest changes where noted at C0-C1 (where your skull meets your neck) joints and the authors concluded that this area needed the greatest amount of consideration during evaluation.  (IE upper cervical chiropractic)

Further the study showed that chronic neck pain patients demonstrated a decrease standing balance using a force plate, and MR imaging indicated that they had increased atrophy of rectus capitus posterior minor and rectus capitus posterior major. 

The authors also have a wonderful discussion with a compelling hypothesis of the far reaching implications of chronic neck pain…

“Somatic dysfunction can cause a sustained facilitation of motor neurons and reflex contraction of muscles, which may lead to impaired circulation and localized tissue ischemia, followed by atrophic changes in muscles and fatty degeneration.  Muscle atrophy and degeneration have been associated with chronic pain.  Muscles in the cervical region also contain a high density of muscle spindles… Atrophy of these muscles might reduce proprioceptive input into the dorsal horn of the spinal cord and higher centers… A reduction of proprioceptive input might result in facilitation of neural activity which is perceived by the patient as chronic pain.”

In review:  Misalignment of the upper neck causes changes in the muscles and nerves in that area that affect your standing balance!  Standing balance influences your posture, your posture contributes to breathing, hormone production, blood pressure, and more because it’s all connected! Further, the longer you have the neck pain the more negative changes develop.  

Is your Back Pain shrinking your Brain?

Chronic Back Pain is Associated with Decreased Prefrontal and Thalamic Grey Matter Density

Apkarian V.A., et al.  Journal of Neuroscience, Nov 2004, 24(46):10410-10415

This research was out of Northwestern University in Chicago Illinois in 2004.  It was the first study to correlate chronic back pain (CBP) with decreased grey matter in the brain.  As we work with patients every day, people who have chronic unremitting back pain for 1 year or more have an accelerated neurodegenerative process underway in their brain.  If we are able to help them we are playing an active role in slowing that process!

The researchers studied 26 people with chronic back pain (unrelenting pain localized around lumbosacral area for greater than 1 year) and 26 control patients.  They performed 2 different types of analysis for estimating global grey matter in the brain and adjusted statistics for age, gender, and type of pain (musculoskeletal and neurogenic/radicular). 

Clinical Pearls:

Normal whole brain grey matter atrophy is 0.5% per year.

Atrophy caused by CBP was measured at 5-11% per year, the equivalent of 10-20 years of aging.

The reduction in grey matter was localized to the dorsolateral prefrontal cortex (DLPFC) and the thalamus.  The DLPFC is responsible for inhibition of the orbitofrontal activity of the brain.  The orbitofrontal area is responsible for perception of pain.  The researchers then extrapolated that with loss of inhibition of the orbitofrontal areas of the brain, chronic pain suffers perceive increased pain.

Patients with neuropathic pain showed a greater loss of cortical grey matter.