Back pain is the most common SECONDARY CONDITIONS generated by structural abnormalities of the spine...maybe, according to this story, you DON'T want to try everything before checking out Structural Correction Chiropractic here at Corrective Chiropractic.
Back surgery may backfire on patients in pain
Patients who had spinal fusion were less likely to return to work and needed more opiates, study says
By Linda Carroll
msnbc.com contributor msnbc.com contributor
updated
10/14/2010 8:55:44 AM ET 2010-10-14
Just a month after
back surgery, Nancy Scatena was once again in excruciating pain. The medications her doctor prescribed barely took the edge off the unrelenting back aches and searing jolts down her left leg. “The pain just kept intensifying,” says the 52-year-old Scottsdale, Ariz., woman who suffers from spinal stenosis, a narrowing of the chanel through which spinal nerves pass. “I was suicidal.”
Finally, Scatena made an appointment with another surgeon, one whom friends had called a “miracle worker.” The new doctor assured her that this second operation would fix everything, and in the pain-free weeks following an operation to fuse two of her vertebrae it seemed that he was right. But then the pain came roaring back.
SECONDARY CONDITIONS…were do headaches come from?
A PRIMARY STRUCTURAL ABNORMALITY such as AHS or SLS can result in several SECONDARY CONDITIONS, including a variety of headaches that, according to Nikoli Bogduk, all have a single source…the trigeminocervical nucleus…which resides in your brainstem, but has connections that go down to as low as your middle neck (C4). Translated, this means…if you have a structural abnormality that affects this thing (trigeminocervical nucleus), you might experience a problem with headaches.
Study the following abstract if you prefer the technical explanation.
Ultimately the question is…which do you treat???? The headache or the PRIMARY spinal problem?
The Corrective Chiropractic “way” is different. Let us know if you would like to take a closer look.
Anatomy and Physiology of Headache.
Biomedicine and Pharmacotherapy: 1995, Vol. 49, No. 10, 435-445
Nikoli Bogduk MD, PhD, DSc
FROM ABSTRACT:
All headaches have a common anatomy and physiology.
All headaches are mediated by the trigeminocervical nucleus, and are initiated by noxious stimulation of the endings of the nerves that synapse on this nucleus, by irritation of the nerves themselves, or by disinhibition of the nucleus.
DR. BOGDUK ALSO NOTES:
The brainstem contains a region of grey matter called the trigeminocervical nucleus. This nucleus is causally continuous with the grey matter of the dorsal horn of the spinal cord. The trigeminocervical nucleus is “defined by its afferent fibers.” [Key Point]
The trigeminocervical nucleus receives afferents from the following sources:
1) Trigeminal Nerve (Cranial Nerve V)
2) Upper three cervical nerves
3) Cranial Nerve VII (Facial Nerve)
4) Cranial Nerve IX (Glossopharyngeal Nerve)
5) Cranial Nerve X (Vagus Nerve)
All of these afferents terminate on common second-order neurons in the trigeminocervical nucleus.
Trigeminal Nerve afferents will descend to the level of C3 and perhaps as low as C4. The trigeminocervical nucleus is the sole nociceptive nucleus of the head, throat and upper neck. “All nociceptive afferents from the trigeminal, facial, glossopharyngeal and vagus nerves and C1-C3 spinal nerves ramify in this single column of grey matter.”
Because the ophthalmic branch of the trigeminal nerve extends the farthest into the trigeminocervical nucleus, cervical afferent stimulation is most likely to refer pain to the frontal-orbital region of the head.
The stimulation of any neurons that activate the trigeminocervical nucleus can cause headache, which includes cranial nerves V, VII, IX, X, and C1-C3. “Any structure innervated by these nerves is capable of causing headache.”
“The C1 and C2 spinal nerves are distinctive in that they do not emerge through intervertebral foramina.”
The C1 spinal nerve passes across the posterior arch of the atlas behind its superior articular process, descending in front of the C1 transverse process to descend as a part of the cervical plexus.
C1 spinal nerve does not supply the skin, but does supply sensory innervation to the suboccipital muscles. The sensory root of C1 can be found with the motor roots of the spinal accessory (cranial nerve XI) nerve.
The C2 spinal nerve crosses the posterior aspect of the C1-C2 facet joint; its dorsal root ganglion is opposite the midpoint of the C1-C2 facet joint.
The anterior primary rami of C1-C2-C3-C4 join and form the cervical plexus to innervate the prevertebral muscles: longus capitis, longus cervicis, rectus capitis anterior, rectus capitis lateralis, sternocleidomastoid and trapezius.
The anterior primary rami of C1-C2-C3 form the recurrent meningeal branches of the sinuvertebral nerves. These nerves innervate the anterior surface of the upper cervical dura mater, and then pass through the foramen magnum to innervate the dura mater between the pituitary gland to the anterior occiput (the clivus). They also innervate the medial portion of the C1-C2 joint capsule, the transverse and alar ligaments.
In the posterior cranial fossa, C1-C3 sinuvertebral nerves add components to cranial nerve X (vagus) and XII (hypoglossal). [Important]
The anterior primary rami from C1-C3 join the vertebral nerve, the plexus of nerves that travels with the vertebral artery, and supplies sensory branches to the fourth part of the vertebral artery.
The posterior primary rami of C1 innervate the 4 suboccipital muscles: inferior oblique, superior oblique, rectus capitis posterior major, rectus capitis posterior minor.
The motor component of the C2 posterior primary rami innervates the longissimus capitis and splenius.
The sensory component of the C2 posterior primary rami becomes the greater occipital nerve. It winds under the inferior oblique muscle, ascends and pierces the shared aponeurosis of the trapezius and sternocleidomastoid muscle to supply the posterior scalp.
The motor components of the C3 posterior primary rami also innervate the longissimus capitis and splenius muscles as well as the C2-C3 multifidus muscle.
The sensory component of the C3 posterior primary rami runs across the posterior aspect of the C2-C3 facet joint (which it innervates) and ascends as the third occipital nerve to supply the suboccipital region.
The posterior cranial fossa and its contents are innervated by cervical nerves. Stretch on the dura mater can initiate mechanical pain. [Important]
“Vertebral artery disease, such as an aneurysm becomes an important differential diagnosis of what otherwise might seem to be neck pain with referred pain to the head.”
Arthritis of the upper cervical synovial joints (including C2-C3) can cause neck pain and headache.
Injury and damage to the alar ligaments can cause upper cervical pain and headache. The diagnosis is made with upper cervical rotational CT scanning, showing significant greater unilateral rotation. [Suncoast Healthcare orders FLAR study MRI sequencing of the upper cervical spine when alar or transverse ligament injury is suspected: the techniques has good visualization of the damage]
**Posterior cervical muscle tears are not a cause of chronic headache.**
C2 neuralgia is a neurogenic headache that can be caused by “scar tissue following trauma to the lateral atlanto-axial joint.” [Important] [Fibrosis of the C1-C2 facet joint affecting the adjacent C2 root]
KEY POINTS
1) All headaches have a common anatomy and physiology.
2) All headaches are mediated by the trigeminocervical nucleus, and are initiated by noxious stimulation of the endings of the nerves that synapse on this nucleus, by irritation of the nerves themselves, or by disinhibition of the nucleus.
3) The brainstem and upper cervical spinal cord contains a region of grey matter called the trigeminocervical nucleus.
4) The trigeminocervical nucleus is “defined by its afferent fibers.” [Key: Chiropractic adjustments stimulates mechanoreceptive afferent fibers]
5) The trigeminocervical nucleus receives afferents from the following sources:
A) Trigeminal Nerve (Cranial Nerve V)
B) Upper three cervical nerves
C) Cranial Nerve VII (Facial Nerve)
D) Cranial Nerve IX (Glossopharyngeal Nerve)
E) Cranial Nerve X (Vagus Nerve)
**All these afferents terminate on common second-order neurons in the trigeminocervical nucleus.
6) Trigeminal nerve afferents will descend to the level of C3 and perhaps as low as C4.
7) The trigeminocervical nucleus is the sole nociceptive nucleus of the head, throat and upper neck. “All nociceptive afferents from the trigeminal, facial, glossopharyngeal and vagus nerves and C1-C3 spinal nerves ramify in this single column of grey matter.”
Pain in the forehead can arise as a result of stimulation by cervical afferents of second-order neurons in the trigeminocervical nucleus that happen also to receive forehead afferents.
9) Pain in the occiput (primarily innervated by C2) may arise from trigeminal nerve stimulation.
10) Because the ophthalmic branch of the trigeminal nerve extends the farthest into the trigeminocervical nucleus, cervical afferent stimulation is most likely to refer pain to the frontal-orbital region of the head.
11) The stimulation of any neurons that activate the trigeminocervical nucleus can cause headache, which included cranial nerves V, VII, IX, X, and C1-C3. “Any structure innervated by these nerves is capable of causing headache.” [Key Point…addresses the joints of the neck]
12) Structures innervated by C1-C3:
A) Dura mater of the posterior cranial fossa
B) Inferior surface of the tentorium cerebelli
C) Anterior and posterior upper cervical and cervical-occiput muscles
D) OCCIPUT-C1, C1-C2, and C2-C3 joints
E) C2-C3 intervertebral disc
F) Skin of the occiput
G) Vertebral and Carotid arteries
H) Alar and transverse ligament
I) Trapezius and Sternocleidomastoid muscle
13) “The C1 and C2 spinal nerves are distinctive in that they do not emerge through intervertebral foramina.”
14) C1 spinal nerve does not supply the skin, but does supply sensory innervation to the suboccipital muscles.
15) The C2 spinal nerve crosses the posterior aspect of the C1-C2 facet joint and innervates it.
16) The anterior primary rami of C1-C2-C3-C4 join and form the cervical plexus to innervate the prevertebral muscles: longus capitis, longus cervicis, rectus capitis anterior, rectus capitis lateralis, sternocleidomastoid and trapezius.
17) The anterior primary rami of C1-C2-C3 form the recurrent meningeal branches of the sinuvertebral nerves. These nerves innervate the anterior surface of the upper cervical dura mater, and then pass through the foramen magnum to innervate the dura matter between the pituitary gland to the anterior occiput (the clivus). They also innervate the medial portion of the C1-C2 joint capsule, the transverse and alar ligaments.
18) In the posterior cranial fossa, C1-C3 sinuvertebral nerves add components to cranial nerve X (vagus) and XII (hypoglossal). [WOW! Anatomical proof there is a direct connection with chiropractic adjustments and improvements with abdominal organ system!]
19) The anterior primary rami from C1-C3 join the vertebral nerve, the plexus of nerves that travels with the vertebral artery, and supplies sensory branches to the fourth part of the vertebral artery.
20) The posterior primary rami of C1 innervate the 4 suboccipital muscles: inferior oblique, superior oblique, rectus capitis posterior major, rectus capitis posterior minor.
21) The motor component of the C2 posterior primary rami innervates the longissimus capitis and splenius.
22) The sensory component of the C2 posterior primary rami becomes the greater occipital nerve. It winds under the inferior oblique muscle, ascends and pierces the shared aponeurosis of the trapezius and sternocleidomastoid muscle to supply the posterior scalp.
23) The motor components of the C3 posterior primary rami also innervate the longissimus capitis and splenius muscles as well as the C2-C3 multifidus muscle.
24) The sensory component of the C3 posterior primary rami runs across the posterior aspect of the C2-C3 facet joint (which it innervates) and ascends as the third occipital nerve to supply the suboccipital region.
25) Nociception pain can be initiated by the accumulation of inflammatory chemicals.
26) Nociception pain can be caused by mechanical stimulation following a “distortion of a network of collagen” such as ligament or dura mater. [Important: this supports the mechanics of subluxation]
27) Central pain involves no tissue damage but results from dysfunction of the descending pain inhibitory pathways. [Important: the journal Pain in November 1996 suggests that spinal adjusting relieves pain because it activates the descending pain inhibitory system.]
28) Stretch on the dura mater can initiate mechanical pain. [Important: there exists a connective tissue bridge between C1-C2 that attaches to the inferior oblique muscle and attaches to the dura mater. Biomechanical problems in this region can stretch the dura mater, initiating mechanical pain.]
29) The posterior cranial fossa and its contents are innervated by cervical nerves.
30) “Vertebral artery disease, such as an aneurysm becomes an important differential diagnosis of what otherwise might seem to be neck pain with referred pain to the head.”
31) Arthritis of the upper cervical synovial joints (including C2-C3) can cause neck pain and headache.
32) Injury and damage to the alar ligaments can cause upper cervical pain and headache.
33) Posterior cervical muscle tears are not a cause of chronic headache.
34) C2 neuralgia is a neurogenic headache that can be caused by “scar tissue following trauma to the lateral atlanto-axial joint.” [Important: Fibrosis of the C1-C2 facet joint affecting the adjacent C2 root]
The majority of chiropractors in the Boca Raton area are best described as "traditional" chiropractors. Corrective Chiropractic is different because its focus is Structural Correction of the spine. So to determine what kind of chiropractor you need to see at this time, please take the time to understand the difference...beginning with "traditional" chiropractic...
According to the ACA, "Traditional" chiropractic has the following goals:
1. Decrease Muscular Spasm
2. Increase Ranges of Motion
3. Reduce Pain
This is what MOST chiropractors in the Boca area offer and I believe that most of them do a great job at what they do.
Unlike "Traditional" chiropractors, Corrective Chiropractic East Boca focuses on
Structural Correction of the spine by utilizing Structural Corrective Chiropractic Technique in an effort to correct the following structural abnormalities:
1. Short Leg Syndrome
2. Compensatory Lumbar Scoliosis
3. Anterior Head Syndrome
NORMAL STRUCTURE
To recognize "abnormal", you must first be aware of what's normal. How do you know if you have a fever? How do you know if you have high blood pressure? How do you know if you are near sited? You know what is abnormal only because you know what's normal.
Whether you are familiar with them or not, there are in fact "normals" in all aspects of life. When it comes to the spine there is indeed a normal structure that is considered ideal. Of course we are not expecting perfection. However if your head is displaced 30mm beyond what is considered acceptable, you have Anterior Head Syndrome (AHS). Your head shifting forward is no different than your care being forced out of alignment, or the foundation of your house sinking on one side by just a couple inches.
Because the underlying structure has been shifted, regardless of the reasons, this deviation of your skull puts abnormal stress on your muscles, tendons, ligaments, discs and spinal bones- forcing them to compensate and inevitably degenerate, possibly producing pain and loss of function.
SECONDARY CONDITIONS...WHAT IS YOUR BODY TELLING YOU?
Fortunately, like your car, life gives us warning signals so that we know when there is a problem. Just look at your dashboard in your car and you'll see a variety of warning indicators that let you know when things aren't right (aka "normal").
In the human body, our warning indicators are a number of
secondary conditions. As you are probably aware, a secondary condition suggests the presence of a more serious
primary condition - typically the underlying cause of your symptoms. Here are a few of the secondary conditions that may require your attention:
- Neck & Back Pain
- Sciatica & Hip Pain
- Numbness & Tingling
- Muscular Spasm & Tension
- Headaches (Variety including Migraines)
- Pinched Nerve
- Herniated Disc
- Canal Stenosis
- Rotator Cuff & Shoulder Pain
- Degenerative Disc Disease
- Degenerative Joint Disease
- Decrease Ranges of Motion
- Poor Posture
- Granny Hump (Dowager's)
- Muscular Imbalance
- Dizziness/Vertigo
- C arpal Tunnel Syndrome
THE PRIMARY CONDITION...THE UNDERLYING CAUSE OF YOUR SECONDARY CONDITION?
An
ABNORMAL spinal structure creates continuous strain on the muscles, tendons, ligaments, discs and even nerves. This stress can result in a variety of the secondary conditions as described.
The best way we know how to determine if you have one of the primary conditions we focus on correcting is to undergo a Complete Structural Examination. During the exam a series of x-ray images are taken to determine if you have any of the
FOUR SIGNS that are clear indicators of Short Leg Syndrome, Compensatory Lumbar Scoliosis and Anterior Head Syndrome. These indicators have nothing to do with age or genetics. They are a result of the wear and tear these structural abnormalities can cause. They include:
1. Thinning, compressed discs
2. Changes to the shape of the vertebral body
3. Loss of the spines natural curves
4. Significant spinal shifts to the side, forward or backward
These signs are not hard to miss. If they are there...they are there.
THE COMPLETE STRUCTURAL EXAMINATION
Just like you wouldn't buy a house without looking inside, we don't work on your spine without first looking inside. The Complete Structural Exam is just that...complete. We begin with the structure of the feet, analyzing their alignment with the ankle and knee. Any significant deviations from normal are corrected before we take the structural x-rays.
Short Leg Syndrome (anatomical difference in leg length) is the first thing we address before completing the radiographic examination of the entire spinal structure. Our new high frequency x-ray machine directly downloads the images into the computer. This not only saves time and the environment (no chemicals!), but also insures and excellent image for study. Digital Structural Analysis is then used to correlate the patient's posture with their structure. Finally, functional and necessary orthopedic and neurological tests follow to determine the extent of any damage that may exist.
COMMON SOLUTIONS
There's more than one way to skin a cat, and as the saying goes, there are a variety of ways for you to get treated outside this office. If you are not already on them, prescriptions pain killers, muscle relaxers and anti inflammatory medications are often times our first resort. If they don't work out, the next step is usually physical therapy. Cortisone injections are usually the next step and in many cases, when these other treatments don't work, more invasive procedures are recommended. Some patients have even taken a trip or two to the traditional chiropractor.
Regardless of your experience or level of success with these treatments, all of them have been known to be helpful to many people. We just want you to know what your choices are so that you make the best decision for you and your condition.
THE CORRECTIVE CHIROPRACTIC WAY...FOCUS ON THE PRIMARY CONDITION
As mentioned in the very beginning, here at Corrective Chiropractic East Boca we focus on structural correction of the spine including; Anterior Head Syndrome, Short Leg Syndrome and Compensatory Lumbar Scoliosis.
We do this by utilizing Structural Corrective Chiropractic Technique combined with pre and post adjustment spinal remodeling procedures and structural correction exercises. The goal is to direct your spine toward what is considered normal. By doing so this will relieve the abnormal stress and strains that contribute to your secondary conditions.
So after your Complete Structural Examination you will return to review the findings and receive our best recommendation to achieve maximum correction. This visit is included with the examination along with an opportunity to get a taste of what it is like to be a patient in this office. A taste means you will get a slightly toned down version of a Structural Correction session, so you know what to expect without being surprised on any subsequent visits.
As for "How long does it take?"...A young adult patient with moderate structural changes can expect to spend a
MINIMUM of 16 weeks under care. This includes up to 3 sessions per week as well as following the required complimentary recommendations which include sleep position, cervical and lumbar supports, nutritional supplements (just a few things), corrective insoles, heel lifts, shoes, etc...Everything and anything that can effect the outcome.
At the end of the initial phase of correction the Complete Structural Exam is repeated. Maybe you feel great, and all your secondary conditions are "all cleared up", but that isn't as important as confirming, objectively, if your spine is corrected structurally, on its way or if nothing happened. We can't x-ray you everyday, so, after the recommended plan is completed, we take a look. At this time we can see if more work is needed or not.
Finally, just like you would wear a retainer for your teeth after the braces came off, we offer all patients who have successfully completed their initial plan of correction, a Structural Protection Plan. For some, all the exercises, ergonomic recommendations and postural recommendations are not enough to keep their correction on their own. There are a number of Protection Plans which consist of periodic visits designed to protect your investment and make sure what we corrected stays corrected.
