Many people ask if TMJ disorders and and stress are linked. The answer is absolutely. Stress and TMJ disorders can go hand in hand. At Lehigh Valley Chiropractic, our chiropractors understand this stress and TMJ connection and can give you simple yet effective strategies for managing the physiologic effects of stress.

TMJ and Stress Hormones

When you feel stressed (work, home, kids, house, family, friends, the list goes on and on…), your body pumps catecholamines (stress hormones like epinephrine, norepinephrine). These are your fight or flight hormones. In other words, when if you needed to run from or fight a bear, these are the hormones that will give you a boost of power to make that happen. Now, in our every day lives, it’s rare that we are actually up against a bear. Instead, we are up against stresses like a bear-like boss, traffic or a toddler tantrum. Our body will pump those catecholamines regardless and our body will physiologically respond.

So you might be wondering okay, how does this stress affect my TMJ disorder? Well two of the effects of stress hormones are vasoconstriction (blood vessels tightening up) and hypermyotonicity (muscles tightening up). This combination is a like a ticking time bomb for people prone to TMJ tightness and pain.

Chiropractic and Stress Relief

So how can you best manage that stress so you can manage your TMJ disorder? Chiropractic adjustments in combination with myofascial (manual (hands-on) muscle therapy) is incredibly effective for treating muscle and joint tightness and tension. You’ll be amazed at how much more relaxed those muscles in your head, neck and shoulders feel after chiropractic treatments. The chiropractors at Lehigh Valley Chiropractic provide specific chiropractic techniques that are designed to manage those physiological effects of stress like TMJ tightness and pain.

Get a chiropractic adjustment and feel the difference in your head, neck and TMJ pain.

Many cases of TMJ are caused by hypertonic (too tight) muscles, joints and ligaments. Chiropractic care and manual therapy (like myofascial release) is a safe and effective way to treat TMJ Disorders and TMJ Dysfunction. The chiropractors at Lehigh Valley Chiropractic have successful worked with TMJ sufferers to alleviate their pain and related TMJ symptoms with an effective hands-on approach.

TMJD Relief and Chiropractic

There are many studies that link tightness in the head and neck and dysfunction in the cervical spine to TMJ disorders and dysfunction. Treatments like chiropractic adjustments (spinal manipulation), manual therapy (like myofascial release) to structures in the head and neck (like the masseter, ptyergoid, suboccipital, and temporalis muscles and/or the temporomandibular joint itself), and intra-oral (inside your mouth) myofascial (muscle) release, in addition to lifestyle related changes like avoidance of hard foods, stress management, and muscle relaxation exercises has “worked wonders” for our TMJ patients.

We encourage TMJ sufferers to try safe alternatives like chiropractic care for the management of their TMJ symptoms before taking medications, undergoing invasive dentistry procedures, Botox injections or prior to undergoing surgery. Chiropractic and myofascial therapy TMJ solutions can be just the answer you’ve been looking for.

References

1. Myofascial pain of the jaw muscles: comparison of short-term effectiveness of botulinum toxin injections and fascial manipulation technique. Guarda-Nardini L, Stecco A, Stecco C, Masiero S, Manfredini D.
2. Cranio. 2012 Apr;30(2):95-102.
3. Physiotherapy in the management of disorders of the temporomandibular joint–perceived effectiveness and access to services: a national United Kingdom survey.
4. Rashid A, Matthews NS, Cowgill H. Br J Oral Maxillofac Surg. 2013 Jan;51(1):52-7.
5. Intraoral myofascial therapy for chronic myogenous temporomandibular disorder: a randomized controlled trial.
6. Kalamir A, Bonello R, Graham P, Vitiello AL, Pollard H. J Manipulative Physiol Ther. 2012 Jan;35(1):26-37.
7. Referred pain from muscle trigger points in the masticatory and neck-shoulder musculature in women with temporomandibular disoders.Fernández-de-Las-Peñas C, Galán-Del-Río F, Alonso-Blanco C, Jiménez-García R, Arendt-Nielsen L, Svensson P. J Pain. 2010 Dec;11(12):1295-304.
8. The immediate effects of atlanto-occipital joint manipulation and suboccipital muscle inhibition technique on active mouth opening and pressure pain sensitivity over latent myofascial trigger points in the masticatory muscles.
9. Oliveira-Campelo NM, Rubens-Rebelatto J, Martí N-Vallejo FJ, Alburquerque-Sendí N F, Fernández-de-Las-Peñas C. J Orthop Sports Phys Ther. 2010 May;40(5):310-7

What is fibromyalgia?

Fibromyalgia is a condition that is characterized by widespread musculoskeletal pain and fatigue. It affects approximately 2% of the US adult population. There are roughly 6 million diagnosed cases making fibromyalgia the third most common rheumatologic disorder. It is usually a chronic condition that is a multi-system disorder. Fibromyalgia is often classified as a syndrome meaning there are frequently a host of symptoms that are common among sufferers. In addition to widespread pain and fatigue, patients who have fibromyalgia also complain of sleep disturbance, headache, dizziness, irritable bowel, genitourinary symptoms, depression, abnormal skin sensations such as numbness and tingling (paresthesia), predisposition to allergic reactions, morning stiffness, ocular sensitivity, and loss of balance (poor proprioception). Talk to your health care provider about other symptoms that you are experiencing as they may be related to the syndrome. Although the exact etiology (origin of the condition) is unknown, there are certain factors that are often attributed to the cause. These include disrupted sleep pattern, history of trauma or infection, immune abnormality, endocrine aberration, reduced blood flow to muscles, and/or altered serotonin levels. It is important to remember that fibromyalgia may be secondary to an underlying disease state; it is important to discuss this with your doctor making him or her aware of all of the symptoms you are experiencing.

How is fibromyalgia diagnosed?

Currently there are no tests that definitively diagnose fibromyalgia; research is being conducted in order to determine biochemical markers that detect metabolic anomalies. Additionally, there are several preliminary studies that indicate that brain imaging studies may support the diagnosis; however, neuroimaging is not yet widely accepted. Generally the condition is diagnosed via clinical examination (based on history, physical examination and palpation) performed by a qualified health care provider.

What are the options for treating fibromyalgia?

Effectively treating fibromyalgia requires a multimodal approach. When at all possible, find a treatment plan that is minimally invasive without drugs or surgery. More invasive options should only be entertained after the conservative methods fail to produce the desired result. Our clinic offers an evidence based treatment strategy that consists of exercise programs, soft tissue techniques, physiotherapy, massage, behavior modification counseling, nutritional counseling, and joint adjustments (also known as joint manipulation). Acupuncture is an alternative treatment method not provided in our clinic. On the more invasive end of the spectrum are pharmacotherapeutic options such as muscle relaxants (cyclobenzaprine), antidepressants (amitriptyline and nortriptyline), selective serotonin-reuptake inhibitors, benzodiazepines and analgesics. Certain individuals may experience temporary reduction in pain from trigger point injections. Talk to your health care provider about the strategy that will best suit your needs. The best approach to treating fibromyalgia is one that is individualized.

References

1. Mease P. Fibromyalgia syndrome: a review of clinical presentation, pathogenesis, outcome measurements, and treatment. J Rheumatol Suppl. 2005 Aug; 75:6-21.
2. Peterson EL. Fibromyalgia-management of a misunderstood disorder. J Am Acad Nurse Pract. 2007 Jul; 19(7):341-8.
3. Clauw DJ. Fibromyalgia: more than just a musculoskeletal disease. Am Fam Physician. 1995 Sep 1; 52(3):843-854.
4. Buskila D et al. Biology and therapy of fibromyalgia. Genetic aspects of fibromyalgia syndrome. Arthritis Res Ther. 2006; 8(5): 218.
5. Katz DL et al. The pain of fibromyalgia is due to muscle hypoperfusion induced by regional vasomotor dysregulation. Med Hypotheses. 2007; 69 (3): 517-24.
6. Cook DB et al. Imaging pain in fibromyalgia. Curr Pain Headache Rep. 2007 Jun; 11(2): 190-200.
7. Maquet D et al. Benefits of physical training in fibromyalgia and related syndromes. Ann Readapt Med Phys. 2007 Jul; 50 (6): 363-8, 356-62.
8. Citak-Karakaya I et al. Short and long-term results of connective tissue manipulation and combined ultrasound therapy in patients with fibromyalgia. J Manipulative Physiol Ther. 2006 Sep; 29 (7): 524-8.
9. Field T et al. Fibromyalgia pain and substance P decrease and sleep improves after massage therapy. J Clin Rheumatol. 2002 Apr; 8(2): 72-8.
10. Morris, CR et al. Integrative Therapy for Fibromyalgia: Possible strategies for an Individualized Treatment Program. Southern Medical Journal. Feb 2005; 98(2);177-184.
11. Hains, G et al. A combined ischemic compression and spinal manipulation in the treatment of fibromyalgia: a preliminary estimate of dose and efficacy. J Manipulative Physiol Ther. 2000 May; 23 (4): 225-30.
12. Staud R. Are tender point injections beneficial: the role of tonic nociception in fibromyalgia. Curr Pharm Des. 2006; 12 (1): 23-7.

What is Chronic Fatigue Syndrome?

Chronic fatigue syndrome (CFS) is a condition that is characterized by profound fatigue, muscle pain, decreased concentration and cognitive function, swollen and painful lymph nodes, headache, sleep disturbance, low grade fever, and sore throat. According the Centers for Disease Control, approximately 1 million Americans are afflicted. The condition affects women more than men. It is seen most commonly in individuals between the ages of 40 and 59. Although it is found in all ethnic groups and countries, Caucasians are most commonly affected. Studies suggest that people who suffer from chronic fatigue syndrome may improve over time; however, every patient responds differently. Although the cause of chronic fatigue is not presently understood, there are several theories that have been proposed. Some researchers suggest that patients with CFS have dysfunction of their autonomic nervous system and alterations of the cardiovascular response to mental, environmental and/or physical stress. The onset of this dysfunction may be due to a virus or other stresses. One study published in January 2009 indicates that there is an association between a gastrointestinal virus (enterovirus) and CFS. Other suggested causative factors include oxidative stress, hormonal imbalance, nutritional deficits, immune dysfunction, and chronic infection.

How is Chronic Fatigue Syndrome diagnosed?

Although CFS may be debilitating, it is not life-threatening. It is important to ensure there is not a serious underlying condition; profound fatigue is common to many disease processes. Unfortunately, there is no biochemical marker or specific test that confirms the diagnosis. Doctors determine whether a patient has CFS by listening to a patients symptoms and excluding the presence of other conditions.

What are the options for treating Chronic Fatigue Syndrome?

Effectively treating CFS requires a multimodal approach. When at all possible, find a treatment plan that is minimally invasive without drugs or surgery. More invasive options should only be entertained after the conservative methods fail to produce the desired result. Our clinic offers evidence based treatment strategies that consist of nutritional counseling, exercise programs, soft tissue techniques, physiotherapy, behavior modification counseling, biofeedback, and chiropractic joint adjustments (also known as joint/spinal manipulation). Other conservative methods that are not provided in our office are acupuncture and cognitive behavioral therapy. On the less conservative end of the spectrum are pharmacotherapeutic options such as Tricyclic drugs or Selective Serotonin Re-uptake Inhibitors. Talk to your health care provider about the strategy that will best suit your needs. The best approach to treating CFS is one that is individualized.

References

1. https://www.cdc.gov/cfs/cfssymptomsHCP.htm
2. Fukuda K, Straus SE, Hickie I, et al. The chronic fatigue syndrome: a comprehensive approach to its definition and study. International Chronic Fatigue Syndrome Study Group. Ann Intern Med. Dec 15 1994;121(12):953-9.
3. Freeman R, Komaroff AL. Does the chronic fatigue syndrome involve the autonomic nervous system? Am J Med. 1997 Apr;102(4):357-64.
4. Peckerman A, LaManca JJ, Qureishi B, Dahl KA, Golfetti R, Yamamoto Y, Natelson BH. Baroreceptor reflex and integrative stress responses in chronic fatigue syndrome. Psychosom Med. 2003 Sep-Oct;65(5):889-95.
5. Chia JK, Chia AY. Chronic fatigue syndrome is associated with chronic enterovirus infection of the stomach. J Clin Pathol. 2009 Jan;61(1):43-8. Epub 2007 Sep 13.
6. Shephard RJ. Chronic fatigue syndrome. A brief review of functional disturbances and potential therapy. J Sports Med Phys Fitness. 2005 Sep;45(3):381-92. Review.
7. Logan AC, Wong C. Chronic fatigue syndrome: oxidative stress and dietary modifications. Altern Med Rev. 2001 Oct;6(5):450-9. Review.
8. Moss-Morris R, Sharon C, Tobin R, Baldi JC. A randomized controlled graded exercise trial for chronic fatigue syndrome: outcomes and mechanisms of change. J Health Psychol. 2005 Mar;10(2):245-59.
9. Yao F, Ji Q, Zhao Y, Feng JL. Observation on therapeutic effect of point pressure combined with massage on chronic fatigue syndrome Zhongguo Zhen Jiu. 2007 Nov;27(11):819-20. Chinese.
10. Nijs J, Meeus M, De Meirleir K. Chronic musculoskeletal pain in chronic fatigue syndrome: recent developments and therapeutic implications. Man Ther. 2006 Aug;11(3):187-91. Epub 2006 Jun 14. Review.
11. Ryan M, Gevirtz R. Biofeedback-based psychophysiological treatment in a primary care setting: an initial feasibility study. Appl Psychophysiol Biofeedback. 2004 Jun;29(2):79-93.
12. Budgell B, Polus B. The effects of thoracic manipulation on heart rate variability: a controlled crossover trial. J Manipulative Physiol Ther. 2006 Oct;29(8):603-10
13. Zhang J, Dean D, Nosco D, Strathopulos D, Floros M. Effect of chiropractic care on heart rate variability and pain in a multisite clinical study. J Manipulative Physiol Ther. 2006 May;29(4):267-74.
14. Guo J. Chronic fatigue syndrome treated by acupuncture and moxibustion in combination with psychological approaches in 310 cases. J Tradit Chin Med. 2007 Jun;27(2):92-5.
15. Malouff JM, Thorsteinsson EB, Rooke SE, Bhullar N, Schutte NS. Efficacy of cognitive behavioral therapy for chronic fatigue syndrome: A meta-analysis. Clin Psychol Rev. 2007 Nov 1;
16. Thomas MA, Smith AP. An investigation of the long-term benefits of antidepressant medication in the recovery of patients with chronic fatigue syndrome. Hum Psychopharmacol. 2006 Dec;21(8):503-9.

What is Frozen Shoulder?

Frozen Shoulder occurs when adhesions develop in the joint capsule of the shoulder; the medical term used to describe frozen shoulder is adhesive capsulitis. The condition is characterized by three stages: pain stage, frozen/stiff stage, and the thawing stage. Pain may develop as a result of a surgery, trauma or illness, or it may appear without cause; if you are suffering from this condition, you may notice pain that is often described as an ache in the shoulder joint which becomes worse at night. Over time, stiffness develops; you may be unable to lift your arm to the side or overhead. Activities that demand unrestricted shoulder motion may become increasingly difficult. Over time and with the appropriate management, the pain and stiffness associated with frozen shoulder should begin to thaw. Although researchers are unable to determine the exact cause of the condition, certain individuals (women, over the age of 40, injury to the arm that requires immobilization of the shoulder, diabetes, autoimmune diseases, and thyroid problems) are more prone to developing it. Although it is generally only seen in one shoulder, in certain cases, both shoulders area affected. If early interventions are instituted, you may be able to reduce the duration and severity of the condition; if you suspect that you have frozen shoulder, contact your chiropractor.

Our hands-on treatment methods can remove adhesions associated with frozen shoulder.

-Dr Scott Bentson

How is Frozen Shoulder Diagnosed?

Frozen shoulder is generally diagnosed by detailed history and physical exam. Your chiropractor will ask you questions like what makes it worse, what makes it better, how/when it began, and what it feels like. Next, an exam will be performed; your chiropractor will palpate (examine by touch) the anatomical structures of the shoulder. He/she will then assess the shoulder’s motion and perform specific orthopedic tests. Occasionally imaging will be ordered to rule out other conditions; however, frozen shoulder cannot be seen on an x-ray or MRI.

What Are the Options for Treating Frozen Shoulder?

Frozen shoulder is commonly evaluated and successfully treated at Lehigh Valley Chiropractic. In many cases, conservative management is successful and most people who suffer from frozen shoulder will not require invasive treatments like surgery. The chiropractors at Lehigh Valley Chiropractic will develop a treatment plan that will work for you. Joint manipulation and manual therapy (such as Active Release Technique), therapeutic strengthening/stretching exercises, and topical analgesics are often included in that plan. Looking for a drug, injection and surgery-free way to thaw that frozen shoulder?  The chiropractors at Lehigh Valley Chiropractic may be the alternative you have been looking for.

1. Diagnosis and management of adhesive capsulitis. Manske RC, Prohaska D.Curr Rev Musculoskelet Med. 2008 Dec;1(3-4):180-9. A rational management of tennis elbow. Kamien M. Sports Med. 1990 Mar;9(3):173-91. Review.
2. Comparison of the early response to two methods of rehabilitation in adhesive capsulitis. Guler-Uysal F, Kozanoglu E. Swiss Med Wkly. 2004 Jun 12;134(23-24):353-8.

What is Carpal Tunnel Syndrome?

Carpal tunnel syndrome (CTS) is a common entrapment neuropathy-meaning a common condition where a nerve is trapped somewhere along its course. It is characterized by pain, numbness and/or tingling felt in the wrist and hand (specifically the palm side of the hand into the thumb and fingers-but not the little finger) or radiating pain up into the arm. The pain may become increased when the wrist is flexed or bent. The cause of this discomfort is irritation or damage to the median nerve. Along its course to the hand, the median nerve passes through a narrow and rigid tunnel (called the carpal tunnel) made of bone and ligament. Overuse of the wrist (as in sewing, playing piano, or repetitive activity) or injury to this tunnel may result in damage or irritation to the median nerve producing carpal tunnel syndrome. Carpal tunnel is also common in pregnancy due to fluid retention and hormonal changes. The median nerve may be compressed or entrapped anywhere along its path; you may be interested to know that there are 7 locations (in addition to the carpal tunnel) where the median nerve could be compressed. For this reason, it is important to establish the location of entrapment before treatment (especially if you are considering surgery).

Through a combination of hands-on treatments we’ve enjoyed great success with carpal tunnel syndrome.

-Dr Scott Bentson

How is carpal tunnel syndrome diagnosed?

In order to prevent permanent damage to the median nerve early diagnosis is essential.
The first (and perhaps most important) step is a thorough history and physical exam of the neck, shoulder, forearm, wrist and hand. Your chiropractors will also perform specific orthopedic and neurological tests that are effective in establishing a diagnosis. In order to confirm the diagnosis of CTS, a nerve conduction study may be performed. Other tests may include diagnostic your chiropractor might order include ultrasound and MRI.

What are the options for treating carpal tunnel syndrome?

Carpal tunnel syndrome is commonly treated at Lehigh Valley Chiropractic. Our chiropractors offer treatment strategies that consist of manual therapy (including Active Release Technique), therapeutic (stretching/strengthening) exercise, chiropractic manipulation, ultrasound and ergonomic assessment/advice. While at home, RICE (rest, ice, compression, elevation) is helpful. Also, your chiropractor may recommend a wrist brace to wear at night. Other conservative methods that are not provided at LVC (but may be worth trying) are acupuncture and yoga.  On the less conservative end of the spectrum, certain medications and local corticosteroid injections may be effective in reducing pain short term. The most invasive, last resort for pain resulting from carpal tunnel syndrome is surgery. Even when surgery goes well (it is estimated that about 60% of surgeries result in full recovery), symptoms may return within two years. Complications from surgery include scarring, infection, pain, stiffness, loss of motion, and nerve damage. That being said, if you are suffering from CTS, explore conservative options first. So many patients have experienced the lasting benefits of the treatments provided at Lehigh Valley Chiropractic. We want you to join them-It’s your turn to experience relief!!

1. Bilecenoglu B, Uz A, Karalezli N. Possible anatomic structures causing entrapment neuropathies of the median nerve: an anatomic study. Acta Orthop Belg. 2005 Apr;71(2):169-76. Review.
2. Burke J, Buchberger DJ, Carey-Loghmani MT, Dougherty PE, Greco DS, Dishman JD. A pilot study comparing two manual therapy interventions for carpal tunnel syndrome. J Manipulative Physiol Ther. 2007 Jan;30(1):50-61.
3. Brininger TL, Rogers JC, Holm MB, Baker NA, Li ZM, Goitz RJ. Efficacy of a fabricated customized splint and tendon and nerve gliding exercises for the treatment of carpal tunnel syndrome: a randomized controlled trial. Arch Phys Med Rehabil. 2007 Nov;88(11):1429-35.
4. Piazzini DB, Aprile I, Ferrara PE, Bertolini C, Tonali P, Maggi L, Rabini A, Piantelli S, Padua L. A systematic review of conservative treatment of carpal tunnel syndrome. Clin Rehabil. 2007 Apr;21(4):299-314. Review.
5. Napadow V, Liu J, Li M, Kettner N, Ryan A, Kwong KK, Hui KK, Audette JF. Somatosensory cortical plasticity in carpal tunnel syndrome treated by acupuncture. Hum Brain Mapp. 2007 Mar;28(3):159-71.

What is Piriformis Syndrome?

A small muscle located deep in the buttock, the piriformis is prone to spasm with overuse or injury. The sciatic nerve runs closely to the piriformis and in some cases, actually pierces the muscle. When the muscle is overused or injured it may cause compression or irritation of the sciatic nerve resulting in pain or tingling that radiates down the leg. This is often referred to as sciatica. Not every person with piriformis syndrome experiences sciatica; sometimes the only symptom is pain in the buttock. There are a few different causes of piriformis syndrome. Muscle imbalance, falling on the buttocks, sitting for long periods (especially with a wallet in the back pocket), and activities that result in overuse of the muscle such as running are all established causes of the syndrome. Piriformis syndrome is commonly treated by the chiropractors at Lehigh Valley Chiropractic.

…prior to injecting your buttocks with botulism, schedule your appointment at Lehigh Valley Chiropractic.

-Dr Bentson

How is Piriformis Syndrome diagnosed?

Piriformis Syndrome is generally diagnosed by history and physical exam. Your chiropractor will ask you questions like what makes it worse, what makes it better, how/when it began, and what it feels like. An exam will be performed that will consist of orthopedic and neurologic tests to determine the cause of the pain. If your pain is related to activity, your chiropractor may also provide a biomechanical assessment (watching you in action) to establish if there are any abnormalities of gait and movement. In some cases, further testing such as an x-ray or MRI will be ordered. Although piriformis syndrome cannot be seen on an x-ray or MRI, these types of tests may be helpful in ruling out other conditions.

What Are the Options for Treating Piriformis Syndrome?

Piriformis syndrome is commonly treated at Lehigh Valley Chiropractic. You may experience relief with the conservative treatments rendered by our chiropractors. For this condition, treatments such as myofascial release, therapeutic ultrasound, strengthening exercise, muscle energy techniques, stretching and application of heat are safe and effective. Other options including pain medication and botox/steroid injections may be beneficial in certain patients who don’t respond to conservative treatment. That being said, prior to injecting your buttocks with botulism, schedule your appointment at Lehigh Valley Chiropractic.

1. Piriformis syndrome, diagnosis and treatment. Kirschner JS, Foye PM, Cole JL. Muscle Nerve. 2009 Jul;40(1):10-8. Review.
2. Treatment of an individual with piriformis syndrome focusing on hip muscle strengthening and movement reeducation: a case report. Tonley JC, Yun SM, Kochevar RJ, Dye JA, Farrokhi S, Powers CM. J Orthop Sports Phys Ther. 2010 Feb;40(2):1.
3. Diagnosis and management of posttraumatic piriformis syndrome: a case study. Mayrand N, Fortin J, Descarreaux M, Normand MC.

Lehigh Valley Chiropractic in Bethlehem PA utilizes the latest scientific literature to inform research-based diagnostic decision making and implement best practice into patient case management.
(we work hard so you feel better)

Disc Herniation with Radiating Leg Pain

Commonly patients with disc herniation also suffer from radiating leg pain. A study published in December 2009, looked at a non-surgical approach to managing patients with disc herniation and radiculopathy (common cause of radiating leg pain). Often, surgery is recommended for this disorder; however, only a small percentage of patients have indications for surgery. This means a non-surgical approach is generally the best approach. This particular study looked at conservative treatments such as distraction manipulation, neurodynamic techniques, end-range loading maneuvers, joint manipulation, and myofascial techniques. These are all treatment options offered at Lehigh Valley Chiropractic. The results of this study indicate the following: “Mean self-rated improvement at the end of treatment was 77.5%. Improvement was described as ‘good’ or ‘excellent’ in nearly 90% of patients…Clinically meaningful improvements in pain and disability were seen in 79% and 71% of patients, respectively. Mean number of visits was 13.2. After an average long-term follow-up of 14.5 months, mean self-rated improvement was 81!%.  ‘Good’ or ‘excellent’ improvement was reported by 80% of patients.” If you are suffering from radiating leg pain secondary to disc herniation, the evidence based approach offered at Lehigh Valley Chiropractic may be the non-surgical solution you need.

Spinal Manipulation for Low Back Pain in Pregnancy

Pregnant women often suffer from low back pain; chiropractic care is an effective non-pharmacologic way to control back pain in pregnancy. An article published in 2006 examined the efficacy of chiropractic for low-back pain in pregnancy. Researchers studied a group of pregnant women who were treated with spinal manipulation (chiropractic adjustment). Seventeen cases were evaluated. Participants in this study decreased their pain scale. On average, the time it took for participants to note relief was 4.5 days. Participants underwent (on average) 1.8 treatments. The researchers concluded the following: “No adverse effects were reported in any of the 17 cases. The results suggest that chiropractic treatment was safe in these cases and support the hypothesis that it may be effective for reducing pain intensity.”

Lisi AJ. Chiropractic spinal manipulation for low back pain of pregnancy: a retrospective case series. J Midwifery Womens Health. 2006 Jan-Feb;51(1):e7-10.

Low Back Pain Management: Chiropractic Pain Management vs. Pain Management Clinic

A study published in 2009 examined chiropractic management vs. pain clinic management for chronic low back pain. This pragmatic randomized, controlled trial was conducted in the United Kingdom at a National Health Service (NHS) outpatient clinic. For 8 weeks, 30 subjects were studied. Participants were randomized into two groups; 18 were placed into a chiropractic group, and 12 were assigned to a “pain clinic” group. Researchers discovered the following: “At 8 weeks, the mean improvement in RMDQ (a questionnaire used to assess improvement in back pain) was 5.5 points greater for the chiropractic group than for the pain clinic group. Reduction in mean pain intensity at week 8 was 1.8 points greater for the chiropractic group than for the pain-clinic group.” The authors concluded that “chiropractic management administered in an NHS setting may be effective for reducing levels of disability and perceived pain during the period of treatment.”

Wilkey A, Gregory M, Byfield D, McCarthy PW. A comparison between chiropractic management and pain clinic management for chronic low-back pain in a national health service outpatient clinic. J Altern Complement Med. 2009 Jun;14(5):465-73.

Hospital-Based Chiropractic Management of Low Back Pain

A 2007 study conducted at the Department of Orthopedics, Central Hospital of Sogn and Fjordane in Norway, evaluated chiropractic management of acute low back pain/sciatica. 44 subjects who presented with “sudden and painful low back pain” were followed for 2 years. The chiropractors who participated in the study had the “full support” of the orthopedic department staff. The results of this study showed, “All but two patients returned to work. The period of sick leave among patients was reduced by two-thirds as compared with that associated with conventional medical treatment.” The authors concluded the following: “The results support the initiative of the Norwegian government to increase reference to chiropractors in treating patients with neuromuscuoskeletal dysfunctions. Based on our experience, we believe that the inclusion of chiropractors within hospital orthopedic departments is feasible and provides a patient care resource that may benefit not only the patients but also the department as a whole.”

Orlin JR, Didriksen A. Results of chiropractic treatment of lumbopelvic fixation in 44 patients admitted to an orthopedic department. J Manipulative Physiol Ther. 2007 Feb;30(2):135-9.

Evaluation of CVA Risk

An interesting article published in Spine, evaluated the relationship between a visit to a chiropractor or a primary care physician and the risk of suffering from a stroke (specifically vertebrobasilar artery stroke-VBA).  Critics of cervical spine manipulation (neck adjustment) link the procedure to an increased risk of a rare form of stroke. However, data supporting this connection is sparse and not definitive. This study evaluated patient Ontario hospital records from April 1, 1993 to March 31, 2002. The authors of this study concluded the following: “VBA stroke is a very rare event in the population. The increased risks of VBA stroke associated with chiropractic and PCP (primary care physicians) visits is likely due to patients with headache and neck pain from VBA dissection seeking care before their stroke. We found no evidence of excess risk of VBA stroke associated with chiropractic care compared to primary care.”

Cassidy JD, Boyle E, Côté P, He Y, Hogg-Johnson S, Silver FL, Bondy SJ. Risk of vertebrobasilar stroke and chiropractic care: results of a population-based case-control and case-crossover study. Spine. 2009 Feb 15;33(4 Suppl):S176-83.

Chiropractic Manipulation for Neck Pain, a Prospective Observational Study

Neck pain is a common condition that, in many cases, responds favorably to chiropractic management. A 2007 study conducted in the Netherlands evaluated the benefits vs. the risks for chiropractic care in cases of neck pain. 529 subjects participated in this prospective, multicenter, observational cohort study. A total of 4891 treatments were provided to these 529 individuals. Although minor side-effects were recorded, no major incidence or adverse events were reported. The authors found, “Of the patients who returned for a fourth visit, approximately half reported to be recovered, whereas approximately two-thirds of the cohort were recovered at 3 and 12 months.” The researchers concluded the following: “…Most of the patients report recovery, particularly in the long term. Therefore, the benefits of chiropractic care for neck pain seem to outweigh the potential risks.”

Rubinstein SM, Leboeuf-Yde C, Knol DL, de Koekkoek TE, Pfeifle CE, van Tulder MW. The benefits outweigh the risks for patients undergoing chiropractic care for neck pain: a prospective, multicenter, cohort study. J Manipulative Physiol Ther. 2007 Jul-Aug;30(6):408-18.

Chiropractic Management of Headaches

In an Evidence Report published by Duke University Evidence-Cased Practice Research Center for Clinical Health Policy Research, the effects of drug-free options for headache are discussed. The authors concluded the following: “Cervical spine manipulation was associated with improvement in headache outcomes in two trials involving patients with neck pain and or/neck dysfunction and headache. Manipulation appeared to result in immediate improvement in headache severity when used to treat episodes of cervicogenic headache when compared with an attention-placebo control. Furthermore, when compared to soft tissue therapies, a course of manipulation treatments resulted in sustained improvement in headache frequency and severity.”

McCrory DC, Penzien DB, Hasselblad V, Gray RN. Evidence Report: Behavioral and Physical Treatment for Tension-Type and Cervicogenic Headache. Duke University Evidence-Cased Practice Research Center for Clinical Health Policy Research.

Conservative Management of Lumbar Spinal Stenosis

A study published in BMC Musculoskeletal Disorders evaluated the effect of distraction manipulation and neural mobilization on lumbar spinal stenosis. The study indicates that a combination of distraction manipulation and neural mobilization “may be a useful [safe and effective] approach for patients with lumbar spinal stenosis.” The practitioners at Lehigh Valley Chiropractic utilize both distraction manipulation and neural mobilization for the treatment of lumbar spinal stenosis.

A non-surgical approach to the management of lumbar spinal stenosis: a prospective observational cohort study. Murphy DR, Hurwitz EL, Gregory AA, Clary R. BMC Musculoskelet Disord. 2006 Feb 23;7:16.

The chiropractors at Lehigh Valley Chiropractic serve their patients by providing conservative management strategies with an integrative approach. We make every effort to collaborate with medical providers in order to offer the best possible therapeutic experience for each patient.

What are the types of treatments available to patients?

• There are many treatment strategies that are employed as a part of a management plan for the patients at Lehigh Valley Chiropractic. Manual therapies offered include manipulation, mobilization, soft tissue techniques (including Active Release Technique®), and distractive manipulation. Nutritional therapeutics including weight management and nutritional counseling are also available.

What is spinal manipulation?

• Spinal Manipulation (also referred to as a chiropractic adjustment) is often used when a patient presents with a painful joint that is not moving properly; this is commonly referred to as joint fixation. In this type of manual therapy, a joint is moved beyond a passive range of motion with the goal of restoring proper motion, decreasing tenderness in the soft tissue surrounding the joint, increasing function and decreasing pain. There are many techniques used when performing manipulation. Often, with this type of treatment, you will hear a cavitation which is a slight popping noise. This is a benign release of a gas within the joint as it is moved through a rapid range of motion.

Is spinal manipulation safe?

• For most patients, spinal manipulation is a very safe and effective method of pain relief. However, like any therapeutic intervention, there is the potential for an adverse event to occur. Every effort is made to determine whether or not a patient will respond well to manipulation before a trial of care. The most common side-effect of manipulation is transient local soreness. Although the likelihood of serious complications such as fracture, vertebral basilar artery (VBA) injury and cauda equina syndrome are relatively small, patients are screened for contraindications such as infection, acute fracture or dislocation, malignancy, progressive neurologic deficit and osteoporosis in order to further minimize the risk. You may be interested in the latest report with regard to manipulation and stroke in the February 2009 issue of Spine. The authors of the article reached the following conclusion: VBA stroke is a very rare event in the population. The increased risks of VBA stroke associated with chiropractic and PCP visits is likely due to patients with headache and neck pain from VBA dissection seeking care before their stroke. We found no evidence of excess risk of VBA stroke associated chiropractic care compared to primary care (Cassidy, 2009).

What is Active Release Technique?

• Active Release Technique (ART) is a soft tissue technique that involves a gentle yet firm contact to a painful or injured tissue while it is moved either actively or passively through its full range of motion. There are specific protocols for muscle, fascia, many of body’s ligaments, and nerves designed to decrease pain and improve function. Conditions that commonly respond to ART include headache, back pain, neck pain, carpal tunnel, shoulder pain, knee pain, plantar fasciitis, and tennis elbow. Athletes and performing artists (dancer, actors, instrumentalists and singers) often perform repetitive movements which make them prone to muscle imbalances and repetitive stress injuries. ART is a unique system of treatment that provides for optimum performance whether on the field or center stage.

What types of patient conditions tend to respond well to chiropractic care?

• Consider referring patients with (non-surgical) spinal conditions including:
  • Stenosis
  • Facet syndrome
  • Sacroiliac pain
  • Sprain/Strain
  • Disc related pain
  • Stable radiculopathy
  • Myofascial pain
  • Costochondritis
  • Coccydynia
  • Cervicogenic Headache
  • Pregnancy related spinal pain
  • Non-specific spinal pain.
• Consider referring patients who suffer from
  • Carpal tunnel syndrome
  • Medial and lateral epicondylitis
  • Thoracic outlet syndrome
  • Temporomandibular joint dysfunction
  • Facial pain
  • Plantar fasciitis
  • Headaches
  • Neurally Mediated Hypotension
  • Upper extremity musculoskeletal pain
  • Lower extremity musculoskeletal pain

What types of patient conditions tend to respond well to nutrition programs at YouAnew Lifestyle Nutrition?

• Consider referring patients with the following conditions
  • Overweight
  • Obesity
  • Metabolic Syndrome
  • Dyslipidemia
  • Cholesterol imbalance
  • Pregnancy
  • Hypertension
  • Reactive Hypoglycemia
  • Celiac Disease
  • Polycystic ovarian disease
  • Food Intolerances
  • Irritable bowel syndrome
  • Chronic Fatigue Syndrome

How many treatments will a patient need before they notice results?

• It is difficult to predict the number of visits that will enable patients to achieve their health care goal. Some patients may respond to care within a few treatment sessions, while others may require a higher number of visits and a longer duration of care. We make every effort to release patients as quickly as possible, and we encourage them to employ lifestyle strategies that will enable independent management of their condition.

What type of training do Doctors of Chiropractic receive?

• Doctors of Chiropractic often hold a bachelor’s degree in a science related field and must complete a pre-chiropractic program before applying to Chiropractic College. Standard chiropractic education is typically 4-5 years of intense graduate level academic and clinical training. Students are required to pass 4 national board exams and a physiotherapy exam prior to licensure. Chiropractors are licensed in all 50 states, the District of Columbia and in countries worldwide.

What types of additional training have the chiropractors at LVC received?

• Dr. Scott Bentson holds a M.S. (Masters of Science) degree from New Jersey Institute of Technology in Biomedical Engineering. Dr. Kristen Bentson holds a M.S. in Human Nutrition from the University of Bridgeport and has biofeedback training from Widener University. Drs. Scott and Kristen Bentson are additionally certified in Active Release Technique®.

How can I contact the doctors at Lehigh Valley Chiropractic?

• Please feel free to contact the doctors at Lehigh Valley Chiropractic by calling 610-868-6800 or via email info@lehighvalleychiropractic.com. We welcome any questions and look forward to working with you.

References

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