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

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.

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.

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