Cervicogenic Headache

By Dr. John A. Papa, DC, FCCPOR(C)

Cervicogenic headache is defined as a headache which has its origin in the area of the neck.  The source of pain arises from biological tissues such as muscles, ligaments, joints, and nerves that have become injured and/or irritated.  When these structures become stimulated, their nerve endings send pain signals from nerves in the neck to the head.

Cervicogenic headache is a relatively common cause of chronic headache and has symptoms similar to those seen in other well known headache disorders such as migraine and tension type headaches.  For example, both migraine and cervicogenic headaches affect females more than males, with headache symptoms generally located unilaterally (on one side of the head).  These headache sufferers may complain of severe pain, head throbbing, sensitivity to light and sound, and nausea.  Neck pain and muscular tension are also common symptoms in tension headaches, migraine attacks, and cervicogenic headaches.  The problem of symptomatic overlap in these common and frequent headache types makes the accuracy of precise diagnosis difficult.  Furthermore, the fact that an individual may have two or more headache types
co-existing at any one time further elevates the diagnostic challenge.

Cervicogenic headaches are usually unilateral (occasionally bilateral), and can be experienced in several different regions of the head including the base of the skull, the forehead, or behind the eyes.  The intensity of pain may fluctuate from mild to moderate to severe on a daily basis.  Individuals with cervicogenic headache may also exhibit physical signs of altered neck posture and restricted range of motion of the neck.  Headache symptoms can be triggered or reproduced by active neck movements or passive positioning.  Tenderness can also be palpated in the neck and upper shoulder region with muscular trigger points spreading pain upwards into the head.

The cause of cervicogenic headache may be singular or multi-factorial.  This may include a whiplash injury, sports injury, arthritic changes, chronic postural strain, stress, and fatigue.  The evaluation and assessment of headaches should include a proper medical history and physical examination.  Serious causes of headache symptoms must be ruled out before appropriate treatment can be administered.

After a diagnosis of cervicogenic headache is made, the goal of therapy is to minimize headache frequency and diminish levels of pain associated with each episode.  Treatment and management options that have demonstrated effectiveness include: postural correction, joint mobilization and manipulation, acupuncture, soft tissue therapy, and rehabilitative exercises.  Trying a variety of therapies or combination of therapies may be required to find relief.  It should be remembered that many patients who are diagnosed with migraine and tension headaches may also respond to these treatment strategies.

For those suffering from headache symptoms that may be interfering with their activities of daily living, a qualified health professional can prescribe appropriate therapy, rehabilitation, and self-management strategies specifically for your circumstance.  For more information, visit www.nhwc.ca.

This article is a basic summary for educational purposes only.  It is not intended, and should not be considered, as a replacement for consultation, diagnosis or treatment by a duly licensed health practitioner.

Repetitive Strain Injury

By Dr. John A. Papa, DC, FCCPOR(C)

Repetitive strain injury (RSI) is a type of disorder that primarily affects muscles, tendons, nerves and joints.  This includes conditions such as rotator cuff and achilles tendinopathy, carpal tunnel syndrome, neck tension syndrome, bursitis, golfer’s elbow, tennis elbow, and plantar fasciitis.

Symptoms of RSI may include restricted mobility, weakness, numbness, tingling, burning sensations, swelling, redness, sharp and/or aching pain.  In its severest form, RSI can significantly limit physical functioning and render people incapable of carrying out even simple tasks.

RSI can affect anyone involved in activities that require rapid and/or repetitive motion of muscles and joints in work, sport, or leisure activities.  It is more likely to happen if these movements are combined with awkward posture(s), excessive or prolonged force, poor technique, and using the wrong equipment or tool.  Physical deconditioning can also make individuals susceptible to RSI.  As a result, RSI can affect a broad variety of people including:  trade workers such as electricians, painters, and carpenters; recreational athletes such as tennis players and golfers; and labourers such as cleaners and assembly line workers.  Video gaming, computer use, holding one's phone between the neck and shoulder, and even hobbies like knitting and playing a musical instrument are associated with RSI.

While most cases of RSI are treatable, it can recur and may become chronic without appropriate management.  Pain in one area of the body may also spread to other areas as the body tries to compensate.  For example, pain in the wrist can move to the forearm, shoulder joint and neck muscles as an individual attempts to avoid pain and symptoms while continuing to perform the offending activities.  Therefore, prevention is key to managing RSI.  This is accomplished through identifying and then altering or eliminating the situations that contribute to the cause of RSI.  This may include making changes to a work station, using the correct tools/equipment, taking breaks to relax overworked muscles and joints, and performing exercises to relieve stress and strengthen the affected parts of your body.

Chiropractors are healthcare professionals skilled in evaluating, maintaining and restoring physical function.  They can provide education to help prevent RSI and offer effective therapy to help relieve symptoms that have already developed.  This may include treatment options such as joint mobilizations, specialized soft tissue therapy, therapeutic laser, acupuncture, and electrotherapy.  In addition, a chiropractor can advise you on modifications to your work environment as well as assist you in improving work habits and postures. Specific rehabilitative exercise prescription that includes strengthening and stretching exercises, combined with aerobic conditioning, may also be part of your treatment plan to help with recovery and prevent recurrence of RSI.

If RSI is affecting your ability to get through the day and keeping you away from your favourite activities, consider chiropractic care.  A chiropractor will assess your symptoms, diagnose your condition, and recommend a treatment plan to put you on the road to recovery.  For more information, visit www.nhwc.ca.

This article is a basic summary for educational purposes only.  It is not intended, and should not be considered, as a replacement for consultation, diagnosis or treatment by a duly licensed health practitioner.

Bending Forward - A Common Factor In Persisting Low Back Pain

By Dr. R. Greg Lusk, DC

In my last article in January, I discussed the value of applying a "functional" diagnosis to a complaint such as low back pain. To refresh, it is the process of identifying movements and/or activities (i.e. functions) that produce or aggravate symptoms, as well as those that may reduce or even abolish symptoms. Aiming for this better understanding of factors that influence pain offers great value to patients, beyond the anatomical diagnosis, as they can independently modify behaviour and movement to modulate pain, in addition to the traditional approach of receiving a form of treatment to manage and/or mask the symptom of pain.

With respect to neck or low back pain, flexion (i.e. bending forward) is by far the most common direction which produces, aggravates, and perpetuates pain. This is not surprising as most of us have a posture that tends toward slouching versus sitting straight up and many of our activities of daily living involve spine flexion - sitting, driving, computer use, looking down at our phones, washing dishes, putting on socks, etc. Conversely, how many things do you do throughout the day or how much time do you spend in positions that involve bending your spine backward or extending your neck to look up? Not many and not much would be my guesses. If you consider that most clients that present to my office with neck or back pain also report no trauma or specific mechanism resulting in their pain, this points to a more repetitive, cumulative, or sustained source of strain as the culprit.

Ironically, although spine flexion can be implicated as a functional source of pain in many cases, patients will often describe prior relief efforts that have been largely flexion based. For example, for low back pain, I often hear people tell me that they've been bending forward or lying on their back and pulling their knees up to their chest, to stretch the "tightness" in their back. I understand the reasoning that led to this as those positions would stretch the muscles of the back by lengthening them as you bend away. However, other than a temporary sense of relief that is achieved by stretching the tissues, there is often no prolonged benefit noted. Similarly, many patients will report that resting in a recliner-style chair with their legs up is comfortable....until they go to stand up. The common denominator - the low back gets rounded forward in all of these positions and flexion stress can accumulate. I've heard Dr. Stuart McGill, a world-renowned spine researcher, comment previously that if spine flexion is what someone needed to get better then their daily life would simply make them better due to the volume of spine flexion done daily. There is wisdom there that demands considering a different approach.

Practicing "spine hygiene" is a valuable part of that strategy as it involves sparing the spine from aggravating loading patterns, by modifying how we move while bending, rising from a seated or lying position, brushing our teeth, etc. A future article will address these things in more detail so stay tuned. While flexion is commonly not well tolerated, I do want to stress that it isn't bad 100% of the time and will happen naturally during many activities. Sometimes we just do too much of it which results in degenerative changes over time and a sensitization to biomechanical forces in that direction. By limiting this sort of functional intolerance often a longer duration of pain relief can be achieved.

This article is for general information purposes only and is not to be taken as professional medical advice.

Knee Pain And Prevention

By Dr. John A. Papa, DC, FCCPOR(C)

Knee pain is often caused by either a one-time acute injury or repetitive motions that stress the knee, particularly as we age.  Included below are some of the conditions that commonly cause knee pain:

·   Osteoarthritis results from the protective layers of cartilage in the knee becoming worn over a period of time, leading to change in the composition of the bone underneath the cartilage.  This may result in a number of symptoms including:  joint pain and stiffness, decreased ranges of motion, weakness, swelling, inflammation, and instability.

·       Patellofemoral pain syndrome refers to knee conditions that involve the kneecap and/or the structures around it.  Pain can be generated by breakdown of the cartilage under the kneecap, tight or weak tissues around the kneecap, or misalignment of the kneecap.

·       Meniscal injuries directly involve tearing/damage to the cartilage cushioning in the knee.  This type of injury can result from a sporting event or fall where the knee undergoes a sudden twisting motion or impact.  It can also occur in older individuals who develop a chronic tear in a worn meniscus.

·       Ligaments are tough bands of fibrous tissue that connect one bone to another.  They help stabilize joints, preventing excessive movement.  Ligament injuries can occur when these structures become over-stretched or torn, often during activities where there is a direct blow to the knee or there is an awkward fall or twisting motion involving the knee.

·      Tendons are strong tissues that anchor muscles to bones, and these structures can become torn or inflamed around the knee joint leading to tendonitis and muscular strains.

·    Bursitis can involve several fluid-filled structures in your knee that help provide more cushioning in the joint.  Certain activities, such as kneeling on the floor, can cause a bursa to become irritated.

Below are some useful tips that can help individuals avoid or minimize the chance of knee pain and injury:

1.    Maintain a healthy bodyweight to decrease the overall stress on your knees.

 

2.    Wear appropriate footwear that supports your activities and helps maintain proper leg alignment and balance.

3.    Prepare your knees for physical activity by stimulating the joints and muscles, and increasing circulation.  This can be accomplished with a quick cardiovascular warm-up and gentle stretching of the muscles in the thighs and lower legs.

4.    Choose activities that are knee friendly for you.  This may include low impact activities such as walking or cycling.  Remember to start slowly and build up the intensity gradually.

5.    Strength, balance and flexibility exercises can train your leg muscles to better support your knees and avoid injuries.

In the event that you suffer a knee injury that does not subside, you should contact a licensed health professional who deals in the diagnosis and treatment of knee pain.  For additional information on knee pain and treatment of muscle and joint injuries, visit www.nhwc.ca.

This article is a basic summary for educational purposes only.  It is not intended, and should not be considered, as a replacement for consultation, diagnosis or treatment by a duly licensed health practitioner.

Air Travel Comfort Tips

By Dr. John A. Papa, DC, FCCPOR(C)

Comfort is not usually the first word that comes to mind when someone mentions flying.  Sitting cramped in a small space for a long plane ride can also lead to muscle and joint pain.  Here are some helpful tips for a more enjoyable voyage.

Choose the Correct Seat - Some airlines fill the plane from front to back, so ask for a seat in the back row to increase your chances of having an empty seat next to you.  If the arm rests lift up, you might even be able to lie down.  Aisle and emergency exit seats maximize leg room and are less claustrophobic.  If you are susceptible to motion sickness, request a seat over the wings and try to schedule flights on larger airplanes.

Keep Moving - Moving around is good for your circulation and helps to prevent swollen feet and ankles.  Wear loose clothing and walk about the cabin periodically every 60 to 90 minutes.  Wear shoes you can slip off easily.  Every so often, draw circles with your toes and contract your calves to help prevent blood from pooling in your legs.  Tapping your feet can also help increase circulation and reduce the chance of muscle cramping.

Stretch it out - Try not to place anything under the seat in front of you so you can stretch your legs out.  Quick and easy stretches also include standing up and raising your arms above your head, rotating your shoulders back and forth, and moving your head side to side.

Keep Good Posture While Seated - Position your lower back against the back of the chair to obtain the greatest amount of support for your spine.  A rolled sweater or blanket can also be used for added support.  Make sure that your weight is evenly distributed on your seat, your shoulders are not rounding forward, and you are not slouching.  Support your neck and head with a pillow if necessary and avoid awkward positions if trying to rest or sleep.  Try not to stay in one position for a long period of time.

Additional Tips

·     Eat Right - Eat a light, non-fatty meal just before you leave for the airport.  This can make handling turbulence a little easier.

·     Handling Pressure - Chewing gum, yawning or sucking on hard candies can help to relieve the pressure that builds up in your ears as the airplane ascends and descends.  This is not recommended for toddlers.  For young children, sipping a drink may help.

·      Prevent Dehydration - The air in most airplanes can dry out your skin and cause eye and nasal dryness.  Take a moisturizer with you for your skin and wear glasses instead of contact lenses to prevent eye dryness.  Drink enough water and steer clear of caffeine and alcohol as they further dehydrate you.  Alcohol can also interfere with your ability to sleep.

In the event that you suffer from ongoing muscle and joint pain following your trip, you should contact a licensed health professional.  For more information, visit www.nhwc.ca.  The author credits the CCA in the preparation of this educational information for use by its members and the public.

This article is a basic summary for educational purposes only.  It is not intended, and should not be considered, as a replacement for consultation, diagnosis or treatment by a duly licensed health practitioner.