Whiplash 101

Pool Spine Workout

By Amy Price PhD

Chronic pain and balance can be improved with water exercise. Exercise releases feel good chemicals in the brain that are powerful mood booster and pain fighters. These neurochemicals help balance mood swings and the other benefits are looking better and having a body that burns fat more effectively. Many spinal patients can’t get the exercise they need because they find exercise painful torture so they lied down on the couch with a snack until feelings (mostly guilt) about exercise go away. This perpetuates the cycle as muscles and joint get stiff and lose flexibility, loss of muscle means less fat is burned and guilt and low energy levels steal that feel good feeling.  

Water provides a safe medium for joints and working in water improves balance. Be sure to choose a warm place for your water workout to avoid muscle spasms.  Afterwards a hot bath with a couple of cups of epsom salts included can provides an inexpensive muscle soothing experience. The NCPAD  has some great information on how to get started and exercise in water safely. Here are more aquatic exercises   . If you are a swimmer add some power to your water workout with swim fins for the feet and  hands.  

The buoyancy of water reduces the “weight” of a person by about 90%, (at least while in the water!) which means that the stress on weight bearing joints, bones and muscles is lessened. That’s why aqua exercies are good for people with arthritis or back problems. You still get a great work out, it just doesn’t hurt! Water exercise can encompass all of the components of fitness: cardiovascular fitness, muscular strength and endurance, and flexibility. And, when done regularly, water exercise can help reduce body fat 

Need some help with diet too? Check out this information on diet for pain relief and clear thinking here 

By Amy Price PhD

SI Pain is often caused by sacroiliitis (inflammation of the SI Joint) and can cause low back pain which often hurts on one side. The pain can be extreme aching sensation which is referred to the low back, buttock or thigh.  This is called  sacroiliac joint (SI) dysfunction The reason it hurts is because there is too much or too little movement in the joint which  causes strain because the bones are not adequately supported and the anatomy becomes  asymetrical. It is estimated this area is painful for as much as 15% of the population at any one time. 85 % of us will experience significant back pain in our life times

The sacroiliac joint or SI joint is the joint in the bony pelvis between the sacrum and the ilium of the pelvis. The joint is a strong, weight bearing synovial joint. These joints are shaped much like kidney beans.The joints are covered by two different kinds of cartilage; the sacral surface has hyaline cartilage and the ilial surface has fibrocartilage.  Prolotherapy is often used to strengthen the cartilege and provoke a healing process, it is important that the joint is mobilized and positioned correctly before prolotherapy and that prolotherapy be guided by flouroscopy so that treatment is accurately placed. The dermatome map can show pain patterns   Cortizone  injections are sometimes used to treat this area but release can be short lived unless the structural problem is addressed.

There are other conditions such as disk herniations, lumbar nerve compression,  hip degeneration or sensory  motor  proprioception deficits that can mimic this difficulty so it is important to be examined and treated by a qualified medical professional.  With an SI joint dysfunction present it is not a good idea to do psoas stretches as this can increase movement and instability.

 Richard Don Tigny has developed some excellent methods for treating this problem through correct positioning and strengthening exercises. I have personally found this method very beneficial. I was erroneously treated for piriformis syndrome and other things for years before I finally found relief using these simple effective corrections I could do myself. I know of several individuals who were recommended for surgical procedures, tried this method instead and became pain free without surgery. Don Tigny has validated his method with research. There is a video available for purchase by patients and professionals which is well worth the investment. He has granted permission to show three corrections and there is also a link  supplied to his website. He has made available multiple materials, research links, explanations and solutions. A link to his site and some useful corrections are available here.

cold light laser

 By Amy Price PhD

Laser  therapy has been reported helpful in wound healing and chronic pain. It is a fast, painless modality which can be administered by a medical professional or self administered in some localities by a patient trained and licensed in laser protocol. The light that the laser uses is not visible to the naked eye and special laser light spectrum goggles are needed. They are sensitive to the spectrum of the laser used. According to the Cochrane report results for wound healing and chronic pain relief are evident however more study is needed to determine protocols for effectual wave lengths and time exposure 

What is a cold light laser?

Low-level laser light is compressed light of a wavelength from the cold, red part of the spectrum of electromagnetic radiation. It is different from natural light in that it is one precise color; it is coherent (it travels in a straight line), monochromatic (a single wavelength) and polarized (it concentrates its beam in a defined location or spot). These properties allow laser light to penetrate the surface of the skin with no heating effect, no damage to the skin and no known side effects. Rather, laser light directs biostimulative light energy to the body’s cells which the cells then convert into chemical energy to promote natural healing and pain relief. 

These are ways laser treatment has been found to help

Speeds Up Tissue Repair:   Increased energy to the cells means increased cellular activity for all of the cell’s components that rely on this energy including collagen formation. Speeding up tissue repair  means less scar tissue formation. 

Increases Endorphins: Endorphins can  produce analgesia (pain relief) and feelings of well-being. They are known as the bodies natural  pain killers. 

Increased Lymphatic Drainage:  Studies have shown that cold laser therapy can increase the size of the lymphatic ducts thus facilitating protein waste removal. 

Increased Blood Flow: to the tissues because of increased capillary formation. This helps healing. The laser affects deeper tissues as well including  muscles and tendons. 

It appears Laser can generate  relief for chronic pain treatment

Relieve nerve pain and trigger points without surgery or chemicals

By Amy Price PhD

IMS is similar to acupuncture except that the treatment does not rely totally on meridians but is based on a physicians training in anatomy. trigger points and the central nervous system. It can be treatment orientated as well as a useful minimally invasive diagnostic tool for neuropathic muscle pain.

Trauma and chronic pain often produces muscle shortening. These shortened muscles can press on and irritate the nerve. Even though this pressure may seem slight and be difficult to measure it can be the source of excruciating pain. This pressure builds up over time causing all kinds of problems like making the nervous system super sensitive. This can cause sensitivity to pain in other areas of the body. To get an idea of how this works think about wearing a pair of slightly snug shoes. At first you feel nothing but as the day goes on that slight pressure becomes something that can not be ignored. With the shoes you can rip them off and toss them into the trash, but when pressure mounts inside the muscle pushing on the nerve there is nowhere for it to go.

IMS works on the premise that supersensitive area can be desensitized. IMS releases muscle shortening by dry needling the sensitive areas with tiny acupuncture needles. Penetration of a normal muscle is relatively painless however an afflicted muscle responds to the needle with a slight cramping sensation. This stimulates a ’stretch receptor’ which produces a reflex relaxation response resulting in a lengthening of that muscle fiber. The needle also causes an electric potential which travels to the nerve and potentially resets it to normal function. The other thing that happens is the needle produces a minute wound which causes increased blood flow to the area to enhance circulation and initiate healing. For FAQs about IMS or research links click here Does it work? The answer seems to be that for some people it does. For research links  New treatments with prolotherapy and adult stem cell treatment may produce results. Diet can help with pain Specific supplements can help ligaments and tendons heal to take the stress off overworked muscles

Psoas Muscle Location

By Amy Price PhD

 

Stretching Psoas can alleviate back and hip pain

                                       

The psoas muscle starts in the lower back at which point the paired psoas muscles act as anchors on either side of  the spine. These muscles wrap around the pelvic area attaching at the knobby part of the hip with several strong tendons. The psoas muscles are considered to be crucial among the hip flexor muscles. Hip flexors allow people to bend their bodies into their hips and to pull their hips into their bodies. Low back or hip pain can come from  contracted psoas muscles which fail to provide  support. They can gently stretch to elongate their muscles and make them more flexible, as well as seeking medical attention if the pain continues, grows worse, or changes. Engaging in a regular physical fitness routine which includes stretching such as Pilates or Yoga will help to keep the psoas muscle aligned, strong, and flexible, along with other vital muscles of the body.

  A gentle psoas stretch, involves lying on your back on the floor. Make sure that your pelvic position is neutral, your shoulder blades are flush with the floor, with your spine and head aligned, forming a straight, smooth line. Gently bring one knee up to your chest while extending the other leg along the floor, breathing deeply and evenly. Hold the position for 10 breaths before switching sides, and repeat 3 times. You should feel a gentle stretching action but not pain

 For a deeper psoas stretch, adopt a lunging position with one knee forward, forming a 90 degree angle, if possible, between the hip and the calf. Extend the other leg behind you, kneeling slightly, and lower yourself slowly into the stretch, which you will feel in the front of the hip. Make sure you don’t increase the curve in your back as you come forward (the Psoas connects the back with the front of the hip).  Sometimes it helps to tighten the stomach muscles as you come

Please Consult Your medical professional before stretching the psoas, In some cases psoas stretches can be counterproductive

Richard Don Tigney  referenced below states,  “Stretching the psoas is usually counter productive as a dysfunction of the SIJ will cause the psoas to become tight while correction of the dysfunction will loosen it.  If you stretch the psoas you will increase the dysfunction in anterior rotation of the psoas.

Similarly the SIJ dysfunction will cause a vertical shear on the piriformis at the S3 segment. Correction of the dysfunction corrects and relieves the vertical shear.  The piriformis, the G. max and the iliacus all have origins on both the sacrum and the ilia.  The shear is the cause of the piriformis syndrome.   Similarly the sacral origin of the G. Max will tend to separate from its ilial origin and the ilial origin of the iliacus m will tend to separate from a small slip on the sacrum.(1)

Periarticular injections are superior to intra-articular injections for diagnosis of SIJ dysfunction.(2)Murakami

Fukushima (3) found that many times cervical strain will not release until the SIJ is corrected.”

References:

 1.   DonTigny, RL: A detailed and critical biomechanical analysis of the sacroiliac joints and relevant kinesiology: the implications for lumbopelvic function and dysfunction.  In Vleeming A, Mooney V, Stoeckart R: Movement, Stability& Lumbopelvic Pain: Integration of Research and Therapy. 2nd edition. Edinburgh, Churchill Livingstone, 2007, Chapter 18, pp 265-278

2.  Murakami E, Tanaka Y, Aizawa T, Ishizuka M, Kokubun S: Effect of periarticular and intraarticular lidocaine injections for sacroiliac joint pain: Prospective comparative study.J of Ortho Science  12(3):274-280, May 2007

3.  Fukushima M: Radiographic findings before and after manual therapy for acute neck pain. International Musculoskeletal Medicine, 30(1): 1-19, 2008

Nerve Glides can help relieve chronic spinal pain

Amy Price PhD

Nerve Glides can help release a lot of the pain that comes from trauma and even arthritis. A lot of the pain may be originating from the nerves in a cascading effect which inflames surrounding soft tissue. The peripheral nerves in your arms and legs are mobile structures  that can stretch when elongated. Injury and scar tissues can trap them but you can do special stretches called nerve glides to release these areas.

To see how your nerves move try this.  Take your finger and touch your nose.  Then bring your hand all the way out to your side and stretch it out as far as it will go.  Next tilt your head away from your outstretched hand (if it’s your left hand, bend your head right).  You will likely notice a pulling sensation in your hand and arm with your head bent.   Now try to bring the head towards the hand, does it go away?  This is a demonstration of  nerve tension. 

 There is no muscle that goes  all the way from your neck to the hand.   Since bending your head away from the hand tightens the nerves that go from your neck to your hand, you feel pulling. If you feel pain, numbness and tingling, this is a problem you should tell your doctor about. Nerve glides can be used in multiple body areas not just the hand and neck. Nerve pain is referred to other body areas and you can get an idea of the patterns  by looking at a dermatome map

Another example  is that the nerve when inflamed looks like a thick lumpy rubberband, but as you stretch and glide the nerves, they thin out making an easier passage through the channels they move theough. If you stretch a rubber band it “thins” out.

The nerves in your body have a normal range of motion like the joints.   Nerve glides are stretches that help get back that normal movement.  Nerve glides must be done gently and should never increase pain. The goal is to  free the area up and not to inflame it so in this case pain is not gain.  Technique is critical. It is best to have an occupational therapist that specializes in neural education who can show you how to do these nerve glides. They will give you a sheet with the instructions on how to do these right and you can watch as you perform the nerve glides in the mirror to make sure your form is correct. Nerve glides are also known as nerve flossing or nerve stretching.

Ligament injury refers pain see chart

 By Amy Price PhD

The ligaments act like duct tape to hold our bones and joints together.  When ligaments lose their elasticity the bones and joints move too much and irritate the structures around them. Ligaments provide boundaries for movement.  For example when we bend our fingers backwards the ligaments will stop us from pushing them too far back and breaking the bones. It is this way with most of the joints in our bodies. The ligaments cause them to work within a safe range of motion. When one of the ligaments is torn or stretched, the excess movement will cause pain and swelling. In an injured joint and you may notice more popping, cracking or even a grinding feeling.  The joint may have become unstable.

 In the neck and spine, ligaments are crucial for holding vertebrae together. Spinal ligaments are especially vulnerable to overstretching or tears in a car wreck.  If you experience these symptoms after a wreck you may want to be examined for a ligament injury:

•             popping, cracking, or grinding in the neck with movement

•             pain or spasms that get much worse with activity

•             Numbness or tingling into the hand(s) or feet that gets worse with activity or accompanied by popping, cracking, or grinding.

 Flexion-extension x-rays, or digital motion x-rays can be a good way to help diagnose ligament instability.  A good physician will want to test the spine segment by segment to test for stability and this is  an essential step for enabling accurate treatment. The diagram above shows some of the ways ligament pain is referred in the neck area. For referred pain in other body areas look at our dermatome pages

Treatment usually proceeds as follows:

•             Specially trained medical practitioners such as Chiropractors or Osteopaths can mobilize any stiff segments that may be overloading the unstable segment

•             Posture Training can improve stability, injury can increase tightening of muscle structures which can cause guarding of the painful area. This throws posture off balance and  can aggravate instability.

•             Strengthen any weak, deep supporting muscles (like multifidus) that may be allowing too much movement. Core strength exercise like modified Pilates with the guidance of a trained physiotherapist can be helpful

•             Don’t be talked into mobilizing or manipulating an unstable segment as this can bring a temporary improvement but over time can make things worse. Sometimes bracing is used and while this may seem like a good solution to reduce pain initially prolonged bracing can cause further weakening of the surrounding muscles and later slow recovery.

•             Prolotherapy may prove helpful, adult stem cell therapy using your own cells has been reasonably successful in initial trials.

•             Surgical stabilization is sometimes used when no other treatment brings improvement.

By Amy Price PhD

Radio Frequency Ablation (Denver Pain Management ,2009)

Radiofrequency (RF) and pulsed radiofrequency (PRF) neurolysis are techniques used to treat chronic pain that is transmitted through the sensory nerves. RF neurolysis utilizes heat to destroy selected nerve fibers, which block pain transmission through the neural pathway. These techniques are used when intermittent anesthetic injections no longer provide extended pain relief.

Chronic cervical, lumbar and sacral pain  can come from your facet joints.  These pain signals can be interrupted by blocking the nerve to the facet joint with an anesthetic injection  this is very temporary (facet block), For longer lasting relief the nerve can be  heated using a radiofrequency wave (radiofrequency ablation) . This can often prevent the neural transmission of pain. The nerve to the facet joint is sometimes referred to as the “medial branch” and therefore a facet nerve block is also referred to as “medial branch” block.  These blocks are performed as a part of a diagnostic workup for back or neck pain. Relief following a precise injection of local anesthetic confirms the facet joint as the source of pain.

 Radiofrequency neurolysis is a procedure in which sensory afferent nerve fibers are selectively destroyed with heat produced by radio waves delivered through an electrode.  Treatment objectives are to eliminate pain, reduce the likelihood of recurrence and prolong the time to recurrence by selectively destroying pain fibers without inducing excessive sensory loss, motor dysfunction, or other complications. Radiofrequency (RF) neurolysis carries  the potential risk of neuritis (nerve inflammation). Histological studies have revealed indiscriminate destruction of both small and large fibers following RF treatment.

 Pulsed radiofrequency  is thought to be a less destructive alternative to standard RF in that it applies RF energy with a pulsed time cycle that delivers short bursts of RF current instead of a continuous RF flow. By pulsing the electrical current, the needle remains relatively cool (up to 42 degrees celsius compared to temperatures of 60-69 degrees celsius with continuous RF) so that the tissue cools slightly between each burst, reducing the risk of destroying nearby tissue and preventing any long-term damage to the nerve. The reasoning behind this is transmission of impulses across small unmyelinated fibers is disrupted while larger fibers remain protected by the myelin sheath.

 Some researchers show short term success with pulsed radio frequency in comparison to radio frequency lesioning. However others are reporting success rate of over nineteen months. It would seem that results could be altered by the skill of the spine care practitioner it is crucial to choose carefully.

Medical Specialist visit

By Amy Price PhD

You have been sent to a specialist…what next? First of all sort out what you expect to happen as a result of this visit. What are your goals? Make sure they are realistic. If this was easy your primary care doctor could probably fix it.

Before your visit explain what records you have and ask which of these they would like you to copy and pre-send. Usually you can get copies of MRIs or other diagnostic tests on CD. They are easier to carry with you or send than bulky films. If you choose to send your diagnostic results and films call and confirm they arrived. Get a cost for a cash price unless you have medical insurance which will cover your visit so that you will know your costs and if you can absorb them.

If you are making a distance appointment insist on a phone consultation so you will know if your expectations are viable. If the staff you speak with don’t have information about a certain area make arrangements to call back when it is available. This way all the preliminary material is out of the way and your appt can focus on what is most important. Explain you are travelling from out of town and are in pain and request the best time of day to be seen promptly. Emergencies or office back ups can still happen but this step minimizes the possibility.

Write down what you consider to be the most important things you want covered in your visit. You may want to refer to a dermatome map The reason you may want to do this is because chronic pain and injury can cause us to be sidetracked by emotion. You may get a compassionate response but it may eat away at the time available.

This is the place to get your MRI and other diagnostic tests explained. The doctor that ordered the test is the one who needs to explain it. Get an advance copy of the report and ask about what you don’t understand. We get emails every day from people who want us to translate the MRI or other diagnostics. We cannot do this because the MRI is only part of the equipment needed for a diagnosis. It is your job to make sure you understand your diagnosis before you leave the doctor’s office. Here are more practical tips on making the most out of the doctor’s appointment

It is helpful to plan a nice dinner out or a treat for yourself for afterwards and if you can, take someone with you who will remember what the Doctor says. The reason for this is it will be difficult for you to reconcile yourself to a 40 minute appt when the injury has taken over your life 24/7. Even though your appointment time may be quite generous, logic and rational thought cannot always be counted on, when you just want it fixed.

Now relax and trust the specialist you have chosen!

DMX for diganostics

DIGITAL MOTION X-RAY® is a diagnostic test that records real time, full motion x-ray imaging of any body joint in motion. DMX® can often unlock the mystery of spinal pain. It is common knowledge among spinal care professionals including surgeons that damage to ligaments, tendons and underlying support structures can not be corrected with surgery or physiotherapy alone. Until now it has been difficult to diagnose these injuries objectively. Serious ligamentous and facet joint injuries are well documented at autopsy however this is not a working solution for live patients in need of care! Should you ask your doctor to order a DMX® exam for you?…. To find out ask yourself these questions:

• Do I have pain in one or more of my joints that increases with motion?

• Did I injure myself with a sudden jolt to one or more of my joints, as a whiplash injury, slip and fall or blow from a sporting activity?

• Do I have joint pain, the cause of which has not been determined by conventional x-ray, MRI or other diagnostic tests?

If you have answered yes to any of the above, consider a DMX® examination.

Stretched and torn ligaments can result in a condition called “kinesiopathology” or abnormal motion of the bones that make up the joint. This abnormal motion results in ongoing rubbing and grinding of the bone surfaces during motion, preventing normal healing, and leading to premature onset of degenerative joint disease, a wear and tear type of arthritis.  DMX® can fully evaluate internal joint motion, and properly screen for kinesiopathology

What Makes DMX® unique?

Good question! Auto accident injuries occur in milliseconds, too quick for the human nervous system to react and protect. This leaves only bones and ligaments to protect the body. Since cervical bones are rarely broken, the connective tissues are most commonly injured.

The Hidden Culprit – Ligaments

Ligaments are connective tissue that attach bone to bone. The purpose of ligaments is to keep bones in proper position, and work similar to hinges on a door. It has been suspected that ligaments are damaged easily, but until now, it has been difficult to diagnose ligamentous injuries. DMX® can demonstrate these injuries in as little as 15 minutes.

DMX® visually demonstrates aberrant movement of bones, allowing the radiologist to specifically determine which ligaments are injured. Treatment can then be tailored to the patient’s need and progress can be assessed with the help of DMX®. Promising solutions for tissue regeneration are currently in development at the Spinal Injury Foundation.

With the help of DMX® these injuries can be seen from the inside out

A perfect egg sample

Common sense will tell you that one cannot determine the injury an accident victim has suffered by merely looking at the outer shell of the car. When we buy eggs, how often do we open the carton to check if the eggs on the inside are broken? Every time!

Experience teaches that we cannot determine the condition of the egg by looking at the container. The same holds true for a person’s body – the evidence is in the person’s body, not the car.

Although high TESLA MRIs can pick up ligament damage they are sometimes less available that DMX. For information on MRIs see this link