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Commonly Treated Conditions

Below are some of the reasons people might seek chiropractic care. Not all chiropractors treat all these conditions and in some cases there may be causes for these conditions which are beyond the scope of the chiropractor. The best way to determine what is wrong and whether it can be treated by the chiropractor is through a thorough history and examination.

Acid Reflux (Heartburn) - Heartburn is the feeling of pain in the center of the chest. Because of its similarity to heart pain it is often mistaken for a cardiac event and therefore a proper diagnosis is essential. Acid reflux can be aggravated by subluxation of the mid to upper thoracic spine which seems to cause a softening of the lower esophageal sphincter. This results in acid from the stomach being allowed direct contact with the unprotected walls of the esophagus. Adjustments as well as dietary modifications and modifications to activities of daily living can be made to ameliorate symptoms. Some heartburn pain is caused by hiatal hernia, which is a condition where the lower esophagus and upper stomach slide up through a hole in the diaphragm causing the upper portion of the stomach to become strangled and narrowed in the diaphragmatic opening. This results in direct trauma to the stomach musculature and also results in the pooling of acid near the top of the stomach which results in heartburn. In non-severe cases, a skilled chiropractor can grasp the stomach and traction it downward, releasing the upper stomach from diaphragmatic strangulation.

Abdominal Pain - Abdominal pain is one of those symptoms that is not frequently considered a chiropractic malady. The reason for this is quite simple; it mostly is not, however there are incidences when chiropractor is the right choice to manage abdominal pain.

1) Some abdominal pain is caused by strained, spasmed, or scarred musculature in the abdominal wall or diaphragm.

2) Perceived abdominal pain can also be transmitted from the back (referred pain) via intercostal and other nerves emanating from the spine.

3) Some patients experience abdominal discomfort, "queasiness", due to subluxations in their mid-spine region.

4) Abdominal pain can be a result of food allergies or sensitivities.

Arthritis - There are dozens of types of arthritis and even more subtypes. All arthritis has 3 commonalities: they produce some level of inflammation in the joints (some more than others), they result in some form of deterioration in the joints, and they result in some aberrant motion in the joint. A knowledge of how the arthritis is affecting these three elements guides the chiropractor in the proper application of treatments. Some arthritities or their sequelae are contraindications to manipulation to some localities, however, adjustments properly performed can be enormously helpful to the arthritic patient in pain control, enhanced movement, and slowed progression.

Asthma - Asthma is disease with many different causes and triggers and presents in a spectrum of severities. Some asthma patients respond well to chiropractic adjustments. Adjustments to the lower cervical and thoracic spine produce a neurologic effect which assists in the opening of bronchial airways and a mechanical effect which frees up the costal-vertebral joints allowing enhanced chest expansion and increased total lung capacity.

Bell's Palsy - Bell's Palsy can be a scary disorder because of its similarity to a stroke. Differentiating the two can typically be discerned by looking for forehead sparing in the stroke patient and effects beyond the innervation of the facial nerve in the stroke patient. Research shows that aggressive treatment of Bell's Palsy with conservative interventions can shorten the duration and reduce the lasting effects versus treatment with pharmaceuticals alone. Bell's Palsy is thought to be caused by an irritation and swelling of the facial nerve as it exits a bony hole through the skull on its way from the brainstem to the muscles of the face. Conservative management focuses on sensory feedback loops through the trigeminal nerve (scraping the affected area) and external stimulation of musculature through the application of TENS. Adjustments to the cervical spine seem to assist and the prescription of exercises for the afflicted muscles is crucial.

Bursitis - A bursa is a thin fluid filled sac that can be found between two tissues which might otherwise be subject to friction. The bursa reduces the incidence and impact of any friction. Sometimes the bursa becomes irritated and inflamed causing the sac to fill with excess inflammatory fluids making the area painful to touch and movement. Treatment focuses on reducing the inflammation through the use of physiotherapeutics, adjustments, supplemental products, exercises and correction of the problem that may have allowed the bursa to swell originally.

Buttock Pain - Buttock pain can be caused by muscular strain or injury to the large muscles of the area. It can also be referred from a low back injury. Some sciatica pain refers to the area. Piriformis syndrome causes lower buttock pain.

Car accident injuries - Chiropractors are fully licensed to treat car accident injuries through the no-fault system.

Carpal Tunnel Syndrome - Carpal tunnel syndrome is caused by a narrowing of the space/tunnel in the wrist where nerves and blood vessels pass. Because this tunnel is completely full any inflammation will have a crushing and chemotactic (direct chemical irritation) effect on the median nerve which travels through. In most incidences the patient will experience pain, numbness and/or tingling in the 1st through the 3rd digits though the lateral portion of the 4th digit can also be involved. The palm is spared in the majority of the population. Treatment consists of electric stimulation across the tunnel, inflammation reduction regimens, the stretching of the tunnel, cervical and upper thoracic adjustments, and exercises.

Chest Pain - Because chest pains can be caused by cardiac structures a thorough and frequently cooperative evaluation with medical professionals is carried out. If the condition is non-cardiac and non-organic then an evaluation of other causes can proceed. These other causes include hiatal hernia, acid reflux, thoracic subluxation complex, and strained musculature or trigger points in the pectoral or sternal muscles.

Disc Bulges - Disc bulges occur both naturally as part of the aging process and following trauma. A disc has a gelatinous center (nucleus pulposus) surrounded by a concentric arrangement of ligaments (annular ligaments). For the purpose of describing a disc bulge think of the disc as a shock absorbing balloon between the bones (vertebrae) of the spine. As degeneration occurs with age, there is some loss of height in the disc because of a redistribution of the volume of the gelatinous center of the disc. This causes the horizontal margins of the disc to bulge out like a balloon being squeezed by two hands pushing together. The redistribution of the disc material causes a slackening of the outer ligaments reducing their effectiveness at limiting translatory movement between vertebrae and resulting in a fixating response by the body. This fixating response manifests early on as muscle tightness and ultimately leads to bone spurs and osteoarthritis. Sometimes the disc bulge causes direct pressure on nerves or the spinal cord resulting in local back pain and occasionally sciatica. A second type of disc bulge is caused by repetitive strain to the disc complex usually a result of repetitive lifting and twisting. This results in multiple micro-tears to the concentric annular ligaments which allows the horizontal plane of the disc which is unencumbered by bony limits to lose its tensile strength. As the nucleus pulposus radiates and redistributes central pressures to the surrounding annular ligaments those ligaments begin to fray allowing an overall expansion of the annular circumference; a bulging. Depending on the extent of the process at the time of intervention different treatments can be employed. Stable disc bulges are good candidates for low rotational manipulation because the adjustment induces a controlled movement which enhances disc imbibition and limits the encroaching limitations of arthritis. They are also good candidates for axial traction because the traction induces imbibition and movement but also cause negative pressure in the central disc and thus can result in reformation/restoration of the disc as a whole. Sequelae of the disc bulge (muscle spasm, pain, weakness, paresthesias) can be managed through adjustments, physiotherapeutic interventions such as electric muscle stimulation, heat, and ultrasound, massage, and rehabilatory exercises. Surgery is an option in severe cases. The accepted criteria for surgical intervention are discussed under the disc herniation heading.

Disc Disorders - see disc bulge, disc herniation, extruded disc or sequestered disc.

Disc Herniations - The entirety of the explanation offered above in disc bulges applies to disc herniations but the final outcome differs and the appropriate interventions vary. Disc herniations may begin in much the same way as disc bulges but as they progress they exploit an area of enhanced weakness in the annular ligaments. The disc herniation eventually bubbles out away from the rest of the disc. This can happen insidiously or it can happen suddenly following a trauma. There are two common areas for this to happen: 1) left and right of the anterior longitudinal ligament. This is rarely discussed because the chances or severity of problems resulting from herniation in this direction is minimal because the area is not confined and the neurologic structures in the area are not so easily compressed. 2) left and right of the posterior longitudinal ligament. A herniation in this area can compress the spinal cord or more frequently the left or the right nerve root as it exits the neural foramen, a bony and unforgiving space, whose simultaneous occupation by a disc herniation results in compression of the nerve root and pain (often referred in to the leg). Adequate assessment of disc herniations is essential to ensuring appropriate treatment. Mild to moderate disc herniations which are still contained can be treated with traction and non-rotary manipulation and sequelae can be treated as defined under disc bulges. Large disc herniations which put direct pressure on the spinal cord, cauda equina, or nerve roots have little hope of resolving using traction and are contraindicated to manipulation. The accepted criteria for surgical referral and intervention are paresis, paralysis, increasing neurologic deficit, and intractable pain which results in significant dysfunction or alteration of the patient's lifestyle. Paralysis is a no-brainer. Paresis is often missed. A rapid onset of footdrop is a form of paresis as well as an increasing neurologic deficit and requires immediate referral (It is accepted that from the moment of onset of footdrop the patient has a brief window of opportunity for muscular restoration that begins to close at 24 hours depending on numerous variables). A local area of numbness or paresthesia does not necessarily warrant a surgical referral but an increasing distribution or increasing loss of neurologically modulated modalities is. Further diminuition of reflexes from a post trauma baseline represents an increasing neurologic deficit. The presence of mild to moderate back pain in and of itself does not represent a surgical interventive trigger. Anyone whose surgeon states that mild to moderate pain is reason enough to undergo surgery should seek a second, objective opinion because this level of pain often returns post surgically. It is neurologic deficits which are most responsive to surgery. However, there are unique instances where these guidelines become flexible. If an MRI demonstrates a disc herniation or sequestration which currently is causing only minimal problems for the patient but which will clearly, undoubtedly become a problem in the near future then surgery may be indicated. Also, the patient's age, occupation, lifestyle, and physical fitness may affect the decision. A young professional football player with a disc herniation that gives him only mild pain but prevents him from continuing to play football might be recommended for surgery despite a lack of increasing neurologic deficits because of a high reward to risk ratio, where a similarly aged white collar worker might not opt for surgery because of a low reward to risk ratio. As with all surgeries the patient's own health history (age, risk of cardiac event, infection risk, etc.) may modify if and when surgery is attempted. The rule that I pass on to patients when they are unsure as to whether or not they should have surgery is this: Surgery is a risk, a gamble, "When in your mind, based upon the collective information provided to you by your healthcare team, the potential benefits of the surgery outweigh the potential risks that is appropriate time to have surgery." For example, the risk of death during a particular surgery might be .5%, but one person might give that a 25% level of importance whereas another might give it an 80% level of importance.

Dizziness - While dizziness is a somewhat vague term, it is often lumped in with vertigo. See Vertigo for more information.

Ear Infections - Ear infections are common in children because at birth the Eustacian tubes are angled down from the mouth towards the middle ear. This allows bacteria from the mouth to drain towards the middles ear. As we age and grow the angle of that tube reverses so that the middle ear drains back towards he mouth. It has been shown that adjustments to the cervical spine in children prone to ear infections reduces the overall incidence and intensity of ear infections.

Extruded Disc - Extruded discs are very severe disc herniations which are not encapsulated. On MRI they appear to have unrestrained margins as opposed to the smooth bubble like margins of a typical herniation. Extruded disc are usually cause for a surgical referral and consultation.

Failed Back Surgery Syndrome - This was formerly called failed laminectomy syndrome. Traditionally, back surgery has had poor long term outcomes and required repeat procedures or ongoing post surgical care for 2 primary reasons: 1) the inherent and immediate dangers of surgery and 2) post-procedure sequelae including scar tissue formation, destabilization of the spine in non-fusion cases and enhanced deterioration of the joints above and below the surgical site in fusion cases. Most failed back surgery syndrome cases are not recorded by surgeons when discussing success rates because they tend to manifest beyond the time period after which the surgeon has performed their last follow-up with the patient.

Fibromyalgia - Fibromyalgia has long been a grossly misunderstood and maligned disorder. It is a constellation of symptoms with many instigating causes. The primary symptoms are diffuse ubiquitous pain similar to the aches of the flu, fatigue and bouts of sleeplessness, and psychological sequelae such as depression and/ or anxiety. Despite the major feature being pain in the muscles of the body it is actually caused by physio-chemical changes in the brain which sensitizes the brain to painful stimuli, misinterprets non-noxious stimuli as painful and reduces the effect of the pain dampening system in the brain. All of these things result in the pain phenomena described by fibromyalgia patients. Treatment of fibromyalgia patients in a chiropractic office must be an evolving process as each individual fibromyalgia patient tends to respond favorably or unfavorably to various treatment modalities in an unpredictable fashion. Massage tends to be a tried and true intervention and seems to work via a feedback loop to the brain.

Frozen Shoulder - Frozen shoulder or adhesive capsulitis must be treated with an aggressive stretching and exercise program that is facilitated by shoulder mobilization and adjustments to the thoracic and cervical spine. The frozen shoulder patient will always have motion maladies and trigger points in the interscapular and subscapular regions as the shoulder blade often succumbs to motion abnormalities as the normal 2:1 humerus to scapula movement ratio becomes disturbed in frozen shoulder cases.

Golfer's elbow (medial epicondylitis) - Medial epicondylitis is a form of tendonitis that occurs in the medial elbow. It is almost always caused by repetitive hand or arm activities effecting wrist flexor muscles. Treatment focuses on physiotherapeutics and massage along with some extremity adjustments when indicated.

Headaches - 95% or more of all headaches are tension headaches. They are triggered by tightness in the suboccipital and occipital muscles of the posterior skull or from muscles in the neck. Often times trigger points build up in these areas and the headaches become chronic and are often mislabeled as migraine headaches. The occipital nerve which pierces the suboccipital musculature and innervates the back and top of the skull often becomes irritated by tightness or spasm in the suboccipital muscles resulting in unilateral headaches which hurt in the back of the head, on top of the head, and sometimes over the forehead. In some instances there is radiating pain that is felt in or behind the eye. Treatment for these types of headaches is often miraculous for patients who have often suffered for years. Massage, trigger point therapy, adjustments and a unique simultaneous application of heat and cold usually reduces the headaches in several visits.

Heart Disease, Cancer, and other Diseases - While these diseases and disorders cannot and should not be treated by chiropractors, it is helpful to maintain the chiropractor as part of the healthcare team. The chiropractor can provide pain management options (especially post-surgically), nutritional advice, exercise and rehabilitative prescriptions.

Hip Pain - Hip pain in younger people in usually muscular and can be remedied through a course of physiotherapeutic interventions, massage and rehab exercises. Adjustments are important to the sacroiliac region for the restoration of normal gait mechanics. Hip pain in the elderly must be thoroughly investigated to rule out fracture. The most common cause of hip pain in an older patient is arthritis. Again there are physiotherapeutic interventions that are effective and there are supplements and exercise recommendations that can be made.

Infantile Colic - Colic can be caused by any number of problems that may be giving the infant distress. After the infant has been carefully evaluated by the pediatrician and no serious defect is found, an infant who persists with colicky outbursts can be brought to the chiropractor for very gentle adjustments and massage.

Knee pain - Despite being a simple hinge joint, the knee is a complex joint and can suffer from a multitude of injuries. Significant tears to the ligaments and menisci of the knee should be handled by the orthopedist. These include ACL, PCL, MCL, LCL, patellar ligament, patellar tendon, medial and lateral meniscus tears and all fractures. In children a new onset of knee pain may be Osgood Schlotter's disease which can be managed by monitoring activities, anti-inflammatory interventions and bracing. Other causes of knee pain include patellar tracking problems due to injury or muscular imbalance. Usually, these are best handled by exercise prescription. Subluxation of the fibular head is easily handled with an extremity adjustment and muscular and mild ligamentous problems are taken care of through physiotherapeutic modalities and exercise prescriptions.

Low Back Pain - The causes of low back pain are numerous but can be categorized into muscular, ligamentous, joint, disc, neurological. Muscular causes include injury and strain to any of the large or small muscles of the lower back and pelvic region. Muscular injuries and imbalances are the predominant cause of lower back pain. Iliolumbar, iliosacral, lumbosacral and intersegmental ligaments are frequently involved in lower back pain syndromes. There are 2 facet joints between each vertebral pair. These, along with the discs, handle and/or distribute forces that are transmitted through the spine. Injured facets often produce a very local pain when turning toward the side of injury. Discs can produce local pain that can either be local or travel to other locations such as into the extremities. Disc pain is enhanced by loading. Simple orthopedic and chiropractic tests can usually differentiate the two.

Menstrual Cramps - Menstrual cramping due to contractions of the uterus and referred pain can be reduced by heat, electric stimulation and massage to the lumbar and posterior pelvic region. Trigger point therapy to the gluteal lumbar and gluteal region as well as to the psoas muscle on the anterior side can reduce symptoms. Finally, direct inferior anterior application of pressure over the sacrum is effective in reducing pain.

Migraines - Patients who come in with the diagnosis of migraine headaches have usually been misdiagnosed. Migraines are typically described as a vascular type headache often preceded by an aura (a subjective premonition of an ensuing headache). Classically described, the aura comes first when a temporary constriction of blood vessels to the brain creates a relative hypoxia resulting in abnormal function of the brain; zigzag lines across the visual field, lightheadedness, dizziness, scotomas, unusual odors, hypersensitivities, etc. The brain responds by dilating the blood vessels going towards the affected area. The rapid dilation stretches the nerve net that surrounds the blood vessel resulting in irritation and a headache. Migraines can be triggered by allergic reactions to foods or certain sensory sensitivities. They are often accompanied by nausea, vomiting and photophobia. Treating migraines in much the same way as tension headaches often results in a lessening of the frequency, intensity, and duration of the headaches which indicates that some migraines are actually misdiagnosed tension headaches or many migraines are comprised of multiple components with tension headaches mechanism being an important aspect. Nutritional and ADL counseling are important parts of migraine management.

Multiple Sclerosis - MS is not a disorder whose course has been shown to have any response (positive or negative) to chiropractic treatment, however gentle adjustments, massage, and some physiotherapeutics can give patients relief from some symptoms temporarily.

Muscle Pain - Muscle pain is usually caused by injury, spasm, or trigger point development. While acute injuries are handled differently, subacute and chronic injuries, spasm, and trigger points can all be managed with physiotherapeutics modalities like heat, electric muscle stimulation, and massage. For muscle problems to areas proximate to the spine adjustments are extremely helpful in reducing spasm. In addition these muscular problems can create nearby subluxation of the spine due to unbalanced pulling hence the need for adjustment.

Muscle Spasm - Local muscle spasm can be caused by direct injury or by nerve impulse from another injured structure. In either case the brain plays an intermediary role. The reason why a person has muscle spasm is important to delivering the correct therapy. Muscle spasm in the back or neck is always accompanied by vertebral subluxation. The most expedient remedy involved treating the muscle and the affected joints. Treating only one or the other allows the untreated one to facilitate reorganization of the other. A combination of electric muscle stimulation with heat, massage and adjustment is the best way to address spasm of local origin. Some spasms are more diffuse and may or may not be related to a known injury. These suggest either some systemic problem such as electrolyte imbalance or central nervous system disorder or trauma.

Muscle Strains - Muscle strains, often called pulled muscles, are minor tears in the fibers of muscles. They can be treated by managing the local inflammation, minimizing scar tissue formation and using physiotherapeutics, dynamic exercises and massage to orient healing fibers and eliminate cross fiber fibrosis. Because spasm is part of most muscle strains and that results in joint immobility concomitant adjustments that do not accentuate the strain are important to pain modulation and the restoration of normal motion.

Myofascial Pain Syndrome - Myofascial Pain Syndrome is a condition where a muscular area, either with or without injury, becomes chronically tight and sore. Treatment consists of physiotherapeutics, massage, heat and adjustments.

Neck Pain - Neck pain occurs for a variety of reasons all of which can be assessed by the chiropractor and the majority of which can be treated effectively and safely with chiropractic interventions.

Numbness or Tingling - Numbness and tingling, also known as paresthesias, are often a result of chemical irritation or direct pressure on a nerve. Chiropractic treatment can release that pressure and minimize the chemical irritation through a combination of physiotherapeutics, massage and adjustments. Some paresthesias are caused by trigger point referral. Expert recognition of referral patterns can lead to the treatment of trigger points which then results in abatement of the numbness and tingling.

Nutritional Disorders - Chiropractors make nutritional prescriptions for both clinical nutritional problems and for optimal health. These prescriptions vary greatly depending on the person's needs, disorders, medications, age, gender, etc.

Osteoporosis - Osteoporosis treatment consists of nutritional, supplemental and exercise recommendations.

Paralysis - Paraplegics and quadriplegics often receive chiropractic adjustments above and below their spinal cord injury sites. Adjustments above the level of involvement are performed for the purpose of optimizing neural flow to the intact neural structures. Adjustments to the levels below the injury site are aimed at removing facet and intervertebral irritations which may be going unnoticed due to a lack of sensation. Massage and lymphatic drainage techniques are commonly performed and facilitated limb motion is performed.

Paresthesias - see numbness and tingling.

Pinched Nerve - Pinched nerves can occur when the joints between vertebrae are out of alignment creating pressure on soft tissues that is translated to the nerves. Adjustments relieve these pressures and optimize nerve impulse flow. Some nerves become impinged as they pass through soft tissue defects or around ligaments or bones. Once diagnosed, these can be released through soft tissue and/or joint manipulation.

Piriformis Syndrome - Piriformis Syndrome typically begins as a pain in the lower buttock area. The piriformis muscle extends from the lower pelvis across to the hip. Sometimes it becomes chronically tight causing persistent buttock pain. In some instances the sciatic nerve becomes irritated secondary to the piriformis being contracted causing sciatica. Treatment consists of deep penetrating physiotherapeutics, deep massage and adjustments to the lumbar and sacroiliac areas. Exercises to stretch the area also prescribed.

Plantar Fascitis - Plantar fascitis can be treated by using corrective insole or orthotics and changing footwear. It can also be managed by stretching and massaging the arch of the foot. Adjustments to the bones of the foot can assist. Modifications of gait and changes to the activities of daily living have significant impact on the condition. Adjustments to modify the kinetic chain can also improve the condition.

Pregnancy related Back Pain - Pregnancy results in a change in weight distribution. As women gain significant abdominal weight there is an anterior displacement of center of gravity and often times a sway back postural change. This results in painful changes in the lumbar and thoracic paraspinal musculature, pain in the sacroiliac joints and compression of the facet joints. All of this can be safely managed with chiropractic adjustments and massage. Because of the increased elastin hormone that is produced in the later stages of pregnancy subluxation occurs more easily. Chiropractors can also direct exercise and stretching regimens which are helpful to the pregnant patients.

Radiculopathy - A radiculopathy is a nerve impingement that occurs to a nerve root as it leaves the spinal cord

Referred Pain - Referred pain is pain in tissues that comes from trauma or irritation of muscles or organs that are not where the pain is. The important part of treating referred pain is locating the source of the pain. Trigger points in muscles are a common source of referred pain.

Rib Pain - Rib pain can be caused by fracture following a trauma or even after a hefty sneeze or coughing fit. The intercostal muscles, between the ribs, often become strained, and the rib head located on the back often becomes subluxated at its articulation with the spine.

Rotator Cuff Injuries - The rotator cuff is comprised of 4 muscles that attach the scapula and posterior rib cage to the humerus. The rotator cuff forms the posterior portion of the shoulder. Because the shoulder allows for great degrees of movement it is subject to greater potential injury during use. Rotator cuff injuries require early physiotherapeutic interventions to minimize inflammation and scar tissue formation. This should be followed by adjustments to optimize motion and by exercise prescription to foster strengthening muscular coordination.

Sacroiliac Syndrome - The sacroiliac joint (there is a left and right one) is an articulation found between the sacrum, the base of the spine, and the pelvis (each side of which is called an ilium). The joint surfaces slide as a person walks or changes position though the amount of movement that is allowed by the surrounding ligaments is minimal. It is believed that in sacroiliac syndrome the small amount of movement that should occurs either doesn't or occurs aberrantly resulting in pain on the afflicted side that sometimes radiates to the buttock or posterior thigh. Treatment consists of heat and massage to loosen the surrounding tissues followed by an adjustment which usually results in immediate relief.

Sciatica - Sciatica can be caused by disc maladies, arthritis, stenosis, and by soft tissue entrapment. It is a form of nerve impingement or pinched nerve. The nerve pain and irritation can be minimized with electric stimulation and/or ultrasound and the nerve impingement reduced through adjustment or trigger point therapy. Sciatica is often mistaken for the referred pain of sacroiliac syndrome.

Scoliosis - Scoliosis is lateral curvature of the spine that if left unchecked can result in significant deformity and organic compression. Early detection is accomplished via scoliosis screening of school aged children. Once an early case is recognized it is important to monitor any changes but also to institute immediate intervention. The interventions might include exercises, bracing, TENS utilization, mobilization and manipulation.

Sequestered Disc - Sequestered discs, despite some research that shows a rare spontaneous resorption, and regardless of the present neurologic deficits, should always be referred for surgical consultation because of the high probability of near future emergency distress. Adjustment to any area proximate to the sequestration is an absolute contraindication.

Shin Splints - Shin splints are caused by an inflammatory reaction at the attachment site of muscles along the anterior shin. It is common in runners and people who spend a lot of time on concrete surfaces. Treatment focuses on massage, some physiotherapeutics, orthotics, footwear modifications and bracing/taping.

Shoulder Pain - The shoulder is an open joint. There is very little in terms of bony restrictions which allows for great range of motion in the shoulder. This also makes the shoulder somewhat prone to injury and instability. Most shoulder problems are inflammatory in nature, biceps and triceps tendonitis, bursitis of multiple locations, strains and sprains of the surrounding musculature. Usually any one of these conditions spills into another because of the changes in dynamics following injury and the open setting. The deltoid muscle, biceps, the trapezius and the rotator cuff muscles (supraspinatus, infraspinatus, teres minor, and subscapularis) are frequently injured. Other common problems include frozen shoulder, shoulder impingement syndrome, AC joint maladies, arthritis, shoulder separation and dislocation. Most of these problems can be managed by the chiropractor or in some instances in conjunction with an orthopedist.

Sinus Problems - Sinus problems are often mistaken for referred headache pain. People assume they have sinus problems because the pain they experience is over the sinus but in fact this pain is referred from the back of the skull. Treatment for this would be the same as a treatment for headache. True sinus problems after being assessed by the ENT doctor can sometimes be managed by applying heat over the sinuses followed by acupressure point pressure and tapping over the sinuses. Adjustments seem to open the sinuses allowing for drainage. At home use of saline sprays and heat are also helpful.

Sleep Disruption - Sleep disturbances can be a result of restlessness, discomfort, poor eating habits, breathing abnormalities, mattress problems, noise and light issues, among other things. The chiropractor's role focuses on reducing any discomfort that may be affecting sleep and advising the patient of any activities or nutritional choices that may be making it difficult for the person to attain a restful refreshing sleep.

Spondylolisthesis - A vertebra has a front portion and a back portion. These two parts are connected in the center by two horizontal pillars called pedicles. In some people these pedicles do not connect the front and back allowing the two parts to move independently. This condition is usually congenital and afflicts predominantly the L4 and/or the L5 segments. At the afflicted level it allows the anterior or body of the vertebra to slide forward creating a step phenomena on the spine and resulting in a sway back posture. More importantly, the sliding forward of the vertebral body causes a local narrowing of the central canal that transmits the spinal cord resulting a central stenosis. For low grade spondylolisthesis exercise and posture modifications are helpful and the management of any secondary pain or spasm is helpful. Stability assessment is important.

Sports Injuries - Chiropractors make an ideal health care and training partner for both the amateur and professional athlete. Chiropractors can help to minimize the risk of injury and manage injuries that do occur early enough that the athlete minimizes time lost and maximizes their potential. In addition, many athletes utilize chiropractic even when they are not injured to maximize their health potential and give themselves an edge on the competition.

Stenosis - Stenosis means narrowing. When referring to the spine there are two different types of stenosis, lateral and central. Lateral stenosis occurs because the neural foramen, out of which the nerve roots exit the spine, become occluded either with a bulging or herniated disc or with bone spurs, causing compression of the nerve root. Central stenosis can be caused by similar reasons but is commonly caused by congenitally short pedicles which reduce the size of the central canal. Central stenosis has the unique effect of causing symptoms on both sides of the body. Adjustments and traction can have a positive effect on stenosis of both types depending on the severity and cause. Exercises to straighten the lordosis in lumbar stenosis are crucial and the treatment of secondary problems like leg pain with massage can be helpful.

Stiffness - Stiffness can be caused by a variety of things but basically boil down to three possible entities: muscles, ligaments or capsules, and joints. Treatment might involve physiotherapeutics, massage, stretching and exercise or adjustments depending on the precise diagnosis.

Tendonitis - Tendonitis is a condition that can afflict many parts of the body. It occurs when the tendon of a muscle (the portion that attaches the muscle to the bone) becomes inflamed usually due to some repetitive irritation or trauma. Treatment may consist of physiotherapeutics and the application of ice and/or heat to reduce inflammation, massage to reduce the acidity of the area and reduce cross-bridging scar tissue, and adjustments to normalize joint mobility.

Tennis Elbow (lateral epicpondylitis) - Lateral epicondylitis is a form of tendonitis that occurs in the lateral elbow. It is almost always caused by repetitive hand or arm activities effecting wrist extensor muscles. Treatment focuses on physiotherapeutics and massage along with some extremity adjustments when indicated.

TFL Syndrome - See thigh pain.

Thigh Pain - Anterior Thigh pain is typically due to a strain or direct muscular trauma of some kind. Lateral thigh pain is often due to a condition known as tensor fascia lata syndrome or iliotibial band syndrome. These muscles are stabilizers when running, biking, or walking. Lateral thigh pain can also be experienced in trochanteric bursitis of the hip. Medial thigh pain is usually due to a strained muscle but can also be seen in hip disorders. Posterior thigh pain is sometimes seen in hip disorders or sciatica. Of course trauma and strains are common as well. In teenagers, non-trauma related pain is most commonly due to hamstring tightness caused by rapid bone growth (elongation of the femur) without similar lengthening of the hamstrings (This also results in back pain as the tight hamstrings rotate the pelvis, putting a stretch into the lumbar paraspinal muscles. All of these conditions can be treated with a combination of physiotherapeutics, massage and chiropractic adjustments.

Torticollis - Torticollis comes in 2 primary varieties: congenital and acquired. Congenital torticollis is secondary to a shortened or absent muscle at birth on one side of the body. The kind more commonly seen in chiropractor's offices is acquired. It can occur following trauma to one side of the neck causing unilateral spasm and subsequent unilateral rotation and flexion of the neck. It is often seen in the late Spring when people begin to use their air conditioners during sleeping hours or in the Fall when they begin to sleep with the windows open on cold nights. The cold air blowing on one side of the neck results in a unilateral tightening. Treatment consists of hotpacks, electric muscle stimulation, massage and adjustments.

TMJ Disorder- Temporomandibular Joint Disease is a condition of the jaw that causes popping and pain in the joint. There a various causes, some of which respond well to skilled chiropractic intervention which might include massage or trigger point therapy to the muscles surrounding the jaw, ultrasound, night bracing, exercises, and adjustments to balance the neck and thus the jaw hinge.

Upper Back Pain - The majority of upper back pain is caused by either muscular strain or spinal subluxation and most frequently a combination of both. Since some organs can refer pain to the back, such as the gallbladder, a good history and exam are required to differentiate the cause and proper treatment. There are a host of causes including improper posture, repetitive use, and improper lifting such as when new parents injure their backs getting children out of car seats. Scoliosis can also result in upper back pain due to unequal distribution of forces through the curved spine and distorted rib cage.

Vertebral Subluxations - The correction of vertebral subluxations is what sets chiropractors apart from all other doctors and healthcare providers. A vertebral subluxation is a disturbance in the articulation between two vertebrae of the spine which results in pain, decreased range of motion, muscle spasm, trigger point development, nerve irritation and other phenomena. The disturbance is often detected by hypomobility and in some instances hypermobility of the intervertebral joints. Adjustments to these joints results in restored normal motion and abatement of symptoms. Sometimes vertebral subluxations are subclinical in nature, meaning there are no outward conscious symptoms, but there are effects which reduce the optimal function of the person despite the lack of symptoms. This is the reason why some people choose to have maintenance chiropractic care.

Vertigo - Vertigo or dizziness is a sense of spinning. It is often accompanied by lightheadedness, uneasiness, poor balance, nausea, and other symptoms. Our sense of the position of our body parts is known as proprioception. We have the ability to sense where our body parts in relation to each other and in relation to the world around us. This ability comes from fluid position in the semicircular canals in the inner ear, our visual recognition of vertical and horizontal lines, receptors in our cervical spine, and other receptors found throughout the body. The information from all of these structures is integrated in the brain which then determines our location in space allowing us to perceive the relationship. If the information being supplied by different receptors is contradictory then vertigo or dizziness is a possible outcome. The chiropractor can sort out what the cause of the dizziness is and can provide treatment for some of the causes with adjustments, trigger point therapy, and Epleys Maneuvers.

Weight Loss - Obesity is probably the number one cause of disease in the United States and simply being overweight can negatively impact a person's quality of life. Sometimes a person who wants to lose weight needs a knowledgeable professional to guide them or offer them an established system to facilitate their goals.

Whiplash - Whiplash is a complex of conditions unified by the mechanism of injury. A whiplash is a violent or rapid acceleration and then deceleration of a portion of the body, usually the neck. The deceleration is often followed by an involuntary muscular recoil. Whiplash results in the soft tissues (muscles, tendons, and ligaments) of the body exceeding their limits of elasticity causing tearing of the soft tissues and subsequent joint damage as a result of the excess motion. Whiplash treatment requires a multi-modal treatment regimen as there are multiple problems to be addressed. After assessing for and ruling out significant neurologic damage or threat the condition needs to be treated as an inflammatory one. This means little will be done over the first few days other then the utilization of ice. Careful low intensity adjustments might be attempted if they are clinically warranted. Electric muscle stimulation can be used to alleviate spasm. After the inflammatory component is controlled light massage and ultrasound can be utilized to facilitate healing. Eventually, deeper massage and adjustments can be employed. Strengthening and range of motion exercises will be incorporated as the pain abates.

Work Related injuries - Chiropractors are fully licensed to treat work related injuries through the worker's compensation system.


What About the Risk of Stroke?

An increased risk of stroke following an adjustment of the neck has been proven to be a false assumption when compared to a visit to a medical doctor's office visit. It has long been thought that because of the tortuous path of the vertebral artery through the bony confines of the cervical spine shearing forces could tear the vertebral artery or dislodge a plaque resulting in a stroke. This has been proven to be false. This is not to say that strokes don't happen post cervical adjustment just that the adjustment does not impact the likelihood of the stroke. In other words, the stroke was going to happen whether the person went to the chiropractor or not. It is possible for the chiropractic adjustment to hasten the onset of the stroke. In these cases, the precipitating factor is more often the impending stroke symptoms which are headaches and neck pain that bring the person to the chiropractor initially. These symptoms are generally indistinguishable from routine, non-stroke related headaches (99.99%+). The research has shown that had the same person gone to their primary care doctor with the same problem the likelihood of the stroke remains the same. So what's happening? Most strokes from the vertebral arteries are due to an arterial dissection, where the inner wall of the artery (there is an inner, middle and outer layer) separates from the middle layer. Blood then begins to fill between the middle and inner layers creating a bubble that occludes the arterial lumen. This has four potential effects: 1) pain which often leads the patient to the chiropractor, 2) reduced blood flow to the brain resulting in hypoxia though this is often insignificant because the other vertebral artery can supply both sides of the brain, 3) increased pressure behind the occlusion that can result in further tearing of the vessel and stroke, and 4) stagnated blood at the sight of the occlusion that can result in clot formation which if released will result in a stroke.