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Conditions We Treat Knox County, ME
The following are common conditions we treat but are not limited to
Back Pain
The back is a complicated structure of bones, joints, ligaments and muscles. You can sprain ligaments, strain muscles, rupture disks, and irritate joints, all of which can lead to back pain. While sports injuries or accidents can cause back pain, sometimes the simplest of movements—for example, picking up a pencil from the floor— can have painful results. In addition, arthritis, poor posture, obesity, and psychological stress can cause or complicate back pain. Back pain can also directly result from disease of the internal organs, such as kidney stones, kidney infections, blood clots, or bone loss.
Either of the following conditions can occur in your neck, mid back, or low back. They tend to be most common in the lower back because the lower back bears the most torque and force on a day-to-day basis.
It should be kept in mind that all the terms – herniated disc, pinched nerve, bulging disc, slipped disc, ruptured disc, etc. – refer to radiographic findings seen on a CT scan or MRI scan. While these test results are important, they are not as meaningful in determining the cause of the pain as the patient's specific symptoms and the doctor's physical exam results.
Either of the following conditions can occur in your neck, mid back, or low back. They tend to be most common in the lower back because the lower back bears the most torque and force on a day-to-day basis.
It should be kept in mind that all the terms – herniated disc, pinched nerve, bulging disc, slipped disc, ruptured disc, etc. – refer to radiographic findings seen on a CT scan or MRI scan. While these test results are important, they are not as meaningful in determining the cause of the pain as the patient's specific symptoms and the doctor's physical exam results.
Disc Pain
• When a patient has a symptomatic degenerated disc (one that causes low back pain and/or leg pain), it is the disc space itself that is painful and the source of pain. This type of pain is typically called axial pain often referred to as degenerative disc disease.
Sciatica
• When a patient has a symptomatic herniated disc, the disc itself is not painful, but rather the disc bulge is pinching a nerve. This produces pain called radicular pain (e.g., nerve root pain) leading to pain that may be referred to other parts of the body, such as from the low back down the leg or from the neck down the arm. Leg pain from a pinched nerve is often referred to as Sciatica.
Neck Pain
There are many treatment options for those suffering from neck pain. There is conventional medical care where the family doctor will usually prescribe a muscle relaxant, anti-inflammatory, and/or painkiller to help patients through episodes of acute neck pain. However, many patients with neck pain have been through the process of treatments associated with medications and simply cannot tolerate the adverse side effects of stomach pain common with anti-inflammatory drugs such as ibuprofen (Advil, Nuprin, Mediprin, etc.), Aleve (Naproxen), or aspirin. Others don't like the groggy, drunk-like feelings associated with painkillers or the sleepiness associated with muscle relaxants. Therefore, these patients often turn too complementary / alternative care. In a 2009 issue of Consumer's Report for low back pain, chiropractic was the most sought after form of treatment. In 2008, an international "team" representing 9 countries screened over 31,000 titles of articles published between 1980 and 2006, reviewed more than 1200 articles and eventually reported on 552 studies in their final report. Their findings included the following:
• In the US, 54% utilized complementary (alternative) treatment approaches compared to 37% that obtained conventional medical care.
• Neck pain was the 2nd most common reason Americans obtained chiropractic care.
• Chiropractic was found to be the most frequently reported form of treatment for upper back or neck pain (ahead of massage therapy, relaxation therapy, acupuncture).
• Those who obtained complementary AND conventional medical care were much more likely to perceive the complementary/alternative therapy as being helpful (61% vs. 6.4% for neck conditions and 39.1% vs. 19% for headaches).
• Manual therapy (mobilization, manipulation, stretching) was associated with greater pain reduction in the short-term among patients with acute whiplash when compared with usual medical care, soft collars, passive modalities, or general advice.
• For non-whiplash neck pain (without arm radiating pain), manipulation or mobilization, exercise, low level laser therapy (LLLT), and "...perhaps acupuncture..." were reported as more effective than no treatment, sham, or other alternative interventions.
• In the US, 54% utilized complementary (alternative) treatment approaches compared to 37% that obtained conventional medical care.
• Neck pain was the 2nd most common reason Americans obtained chiropractic care.
• Chiropractic was found to be the most frequently reported form of treatment for upper back or neck pain (ahead of massage therapy, relaxation therapy, acupuncture).
• Those who obtained complementary AND conventional medical care were much more likely to perceive the complementary/alternative therapy as being helpful (61% vs. 6.4% for neck conditions and 39.1% vs. 19% for headaches).
• Manual therapy (mobilization, manipulation, stretching) was associated with greater pain reduction in the short-term among patients with acute whiplash when compared with usual medical care, soft collars, passive modalities, or general advice.
• For non-whiplash neck pain (without arm radiating pain), manipulation or mobilization, exercise, low level laser therapy (LLLT), and "...perhaps acupuncture..." were reported as more effective than no treatment, sham, or other alternative interventions.
Sports Injuries
Chiropractic is beneficial to professional, amateur and weekend athletes, maximizing athletic performance and preventing and managing injuries. The growing reliance on chiropractic care among American professional sports teams has both raised awareness about the many benefits of chiropractic and helped many DC's apply and improve knowledge of biomechanical injuries and their treatment.
With growing awareness of the role of chiropractic care, practitioners will find themselves in community leadership roles, imparting a positive impact on student sports and expanding their skills to further affect athletic performance. They may be called upon to provide nutritional expertise and other approaches for enhancing pre-competition preparation, competition endurance and all aspects of injury prevention and care coordination.
With growing awareness of the role of chiropractic care, practitioners will find themselves in community leadership roles, imparting a positive impact on student sports and expanding their skills to further affect athletic performance. They may be called upon to provide nutritional expertise and other approaches for enhancing pre-competition preparation, competition endurance and all aspects of injury prevention and care coordination.
Carpal Tunnel Syndrom (CTS)
Carpal tunnel syndrome (CTS) is the most expensive of all work-related injuries. Over his or her lifetime, a carpal tunnel patient loses about $30,000 in medical bills and time absent from work.
The dominant hand is usually affected first, and the pain is typically severe. CTS is especially common in assembly-line workers in manufacturing, sewing, finishing, cleaning, meatpacking, and similar industries.
What Is CTS?
CTS is a problem of the median nerve, which runs from the forearm into the hand. CTS occurs when the median nerve gets compressed in the carpal tunnel—a narrow tunnel at the wrist—made up of bones and soft tissues, such as nerves, tendons, ligaments, and blood vessels. The compression may result in pain, weakness, and/or numbness in the hand and wrist, which radiates up into the forearm. CTS is the most common of the “entrapment neuropathies”—compression or trauma of the body’s nerves in the hands or feet.
What Are the Symptoms?
Burning, tingling, itching, and/or numbness in the palm of the hand and thumb, index, and middle fingers are most common. Some people with CTS say that their fingers feel useless and swollen, even though little or no swelling is apparent. Since many people sleep with flexed wrists, the symptoms often first appear while sleeping. As symptoms worsen, they may feel tingling during the day. In addition, weakened grip strength may make it difficult to form a fist or grasp small objects. Some people develop wasting of the muscles at the base of the thumb. Some are unable to distinguish hot from cold by touch.
Why Does CTS Develop?
Some people have smaller carpal tunnels than others, which makes the median nerve compression more likely. In others, CTS can develop because of an injury to the wrist that causes swelling, over-activity of the pituitary gland, hypothyroidism, diabetes, inflammatory arthritis, mechanical problems in the wrist joint, poor work ergonomics, repeated use of vibrating hand tools, and fluid retention during pregnancy or menopause.
What Is the CTS Treatment?
Initial therapy includes:
• Resting the affected hand and wrist
• Avoiding activities that may worsen symptoms
• Immobilizing the wrist in a splint to avoid further damage from twisting or bending
• Applying cool packs to help reduce swelling from inflammations
Some medications can help with pain control and inflammation. Studies have shown that vitamin B6 supplements may relieve CTS symptoms.
Chiropractic joint manipulation and mobilization of the wrist and hand, stretching and strengthening exercises, soft-tissue mobilization techniques, and even yoga can be helpful. Scientists are also investigating other therapies, such as acupuncture, that may help prevent and treat this disorder.
Occasionally, patients whose symptoms fail to respond to conservative care may require surgery. The surgeon releases the ligament covering the carpal tunnel. The majority of patients recover completely after treatment, and the recurrence rate is low. Proper posture and movement as instructed by your doctor of chiropractic can help prevent CTS recurrences.
Other possibilities for wrist pain:
In some cases the source of the wrist pain may be coming from the neck. The nerves from your neck and upper back travel into your shoulders, arms, and hands and there are numerous entrapment sites that can cause the symptoms of carpal tunnel syndrome. I have successfully treated numerous cases of carpal tunnel syndrome to help prevent surgery and for those that continue to suffer from the condition after surgery. Go to our website to read personal testimonials from people suffering from carpal tunnel syndrome. For more information call Coastal Mountain Chiropractic and schedule an appointment to see if this successful non-invasive treatment is for you!
The dominant hand is usually affected first, and the pain is typically severe. CTS is especially common in assembly-line workers in manufacturing, sewing, finishing, cleaning, meatpacking, and similar industries.
What Is CTS?
CTS is a problem of the median nerve, which runs from the forearm into the hand. CTS occurs when the median nerve gets compressed in the carpal tunnel—a narrow tunnel at the wrist—made up of bones and soft tissues, such as nerves, tendons, ligaments, and blood vessels. The compression may result in pain, weakness, and/or numbness in the hand and wrist, which radiates up into the forearm. CTS is the most common of the “entrapment neuropathies”—compression or trauma of the body’s nerves in the hands or feet.
What Are the Symptoms?
Burning, tingling, itching, and/or numbness in the palm of the hand and thumb, index, and middle fingers are most common. Some people with CTS say that their fingers feel useless and swollen, even though little or no swelling is apparent. Since many people sleep with flexed wrists, the symptoms often first appear while sleeping. As symptoms worsen, they may feel tingling during the day. In addition, weakened grip strength may make it difficult to form a fist or grasp small objects. Some people develop wasting of the muscles at the base of the thumb. Some are unable to distinguish hot from cold by touch.
Why Does CTS Develop?
Some people have smaller carpal tunnels than others, which makes the median nerve compression more likely. In others, CTS can develop because of an injury to the wrist that causes swelling, over-activity of the pituitary gland, hypothyroidism, diabetes, inflammatory arthritis, mechanical problems in the wrist joint, poor work ergonomics, repeated use of vibrating hand tools, and fluid retention during pregnancy or menopause.
What Is the CTS Treatment?
Initial therapy includes:
• Resting the affected hand and wrist
• Avoiding activities that may worsen symptoms
• Immobilizing the wrist in a splint to avoid further damage from twisting or bending
• Applying cool packs to help reduce swelling from inflammations
Some medications can help with pain control and inflammation. Studies have shown that vitamin B6 supplements may relieve CTS symptoms.
Chiropractic joint manipulation and mobilization of the wrist and hand, stretching and strengthening exercises, soft-tissue mobilization techniques, and even yoga can be helpful. Scientists are also investigating other therapies, such as acupuncture, that may help prevent and treat this disorder.
Occasionally, patients whose symptoms fail to respond to conservative care may require surgery. The surgeon releases the ligament covering the carpal tunnel. The majority of patients recover completely after treatment, and the recurrence rate is low. Proper posture and movement as instructed by your doctor of chiropractic can help prevent CTS recurrences.
Other possibilities for wrist pain:
In some cases the source of the wrist pain may be coming from the neck. The nerves from your neck and upper back travel into your shoulders, arms, and hands and there are numerous entrapment sites that can cause the symptoms of carpal tunnel syndrome. I have successfully treated numerous cases of carpal tunnel syndrome to help prevent surgery and for those that continue to suffer from the condition after surgery. Go to our website to read personal testimonials from people suffering from carpal tunnel syndrome. For more information call Coastal Mountain Chiropractic and schedule an appointment to see if this successful non-invasive treatment is for you!
Chronic Headaches
If you have a headache, you’re not alone. Nine out of 10 Americans suffer from headaches. Some are occasional, some frequent, some are dull and throbbing, and some cause debilitating pain and nausea. What do you do when you suffer from a pounding headache? Do you grit your teeth and carry on? Lie down? Pop a pill and hope the pain goes away? There is a better alternative.
Research shows that spinal manipulation – one of the primary treatments provided by doctors of chiropractic – may be an effective treatment option for tension headaches and headaches that originate in the neck. A 2014 report in the Journal of Manipulative and Physiological Therapeutics (JMPT) found that interventions commonly used in chiropractic care improved outcomes for the treatment of acute and chronic neck pain and increased benefit was shown in several instances where a multimodal approach to neck pain had been used1. Also, a 2011 JMPT study found that chiropractic care, including spinal manipulation, can improve migraine and cervicogenic headaches
Research shows that spinal manipulation – one of the primary treatments provided by doctors of chiropractic – may be an effective treatment option for tension headaches and headaches that originate in the neck. A 2014 report in the Journal of Manipulative and Physiological Therapeutics (JMPT) found that interventions commonly used in chiropractic care improved outcomes for the treatment of acute and chronic neck pain and increased benefit was shown in several instances where a multimodal approach to neck pain had been used1. Also, a 2011 JMPT study found that chiropractic care, including spinal manipulation, can improve migraine and cervicogenic headaches
Whiplash/Motor Vehicle accidents
“WHIPLASH, A SOFT TISSUE INJURY TO THE NECK, is also called neck sprain or neck strain. It is characterized by a collection of symptoms that occur following damage to the neck, usually because of sudden extension and flexion,” according to the National Institutes of Health.1
Approximately two-thirds of people involved in motor vehicle accidents develop symptoms of whiplash. The symptoms usually do not develop until two to 48 hours after the injury. Whiplash can also occur from falls, sports injuries, work injuries and other incidents.
Patients with whiplash injury may complain of pain and stiffness in the neck, extending into the shoulders and arms, upper back and even the upper chest. Two-thirds of patients suffer with headaches, especially at the base of the skull. Patients may also experience dizziness, difficulty swallowing, nausea and even blurred vision after injury, but these symptoms tend to resolve quickly.
According to Marshall, 45 percent to 85 percent of people who suffer a whiplash injury have the symptoms five years after the accident, and 82 percent had a straightening or reversal of their cervical curvature.2 "Many authors regard a straightening or reversal of the normally lordotic curvature to be one of the most significant changes of a whiplash injury.” 3
“The initial injury is due to damage of cervical muscles, ligaments, disks, blood vessels and nerves. The actual injury to soft tissues happens so rapidly that normal protective muscle reflexes cannot respond in time to decrease or prevent the injury,” according to a 2006 case report in the Journal of the American Chiropractic Association.3
Approximately two-thirds of people involved in motor vehicle accidents develop symptoms of whiplash. The symptoms usually do not develop until two to 48 hours after the injury. Whiplash can also occur from falls, sports injuries, work injuries and other incidents.
Patients with whiplash injury may complain of pain and stiffness in the neck, extending into the shoulders and arms, upper back and even the upper chest. Two-thirds of patients suffer with headaches, especially at the base of the skull. Patients may also experience dizziness, difficulty swallowing, nausea and even blurred vision after injury, but these symptoms tend to resolve quickly.
According to Marshall, 45 percent to 85 percent of people who suffer a whiplash injury have the symptoms five years after the accident, and 82 percent had a straightening or reversal of their cervical curvature.2 "Many authors regard a straightening or reversal of the normally lordotic curvature to be one of the most significant changes of a whiplash injury.” 3
“The initial injury is due to damage of cervical muscles, ligaments, disks, blood vessels and nerves. The actual injury to soft tissues happens so rapidly that normal protective muscle reflexes cannot respond in time to decrease or prevent the injury,” according to a 2006 case report in the Journal of the American Chiropractic Association.3
Chiropractic & Pregnancy
A recent study found that more than 75 percent of pregnant women experience pregnancy-related low back pain, pelvic pain, or a combination; and that this pain increases as pregnancy progresses.1 Chiropractic care is a safe, effective, and drug-free way to manage these and other musculoskeletal symptoms during pregnancy.2,3
Normal biomechanical changes during this time can result in discomfort and pain during pregnancy and labor. These changes include weight gain, anterior shift in center of gravity, increased lumbar lordosis, and laxity of lumbopelvic ligaments; as well as postural changes and altered gait pattern.4 Many obstetric providers are unaware that the resulting musculoskeletal conditions and their related symptoms can be managed and improved with chiropractic care and patient education.5 Following are some of the musculoskeletal conditions that occur:
Low Back Pain
Low back pain during pregnancy is caused by increased stress on the lumbar spine by an anterior shift in center of gravity. Compensatory muscle tightness and altered gait patterns also contribute, and this pain ranges from mild to severe depending on the patient’s activity level, daily activities and work duties.2,6 Low back pain is also very common during the postpartum period.7
Sciatic Nerve Pain
Hypertonicity in the gluteal muscles and deep external rotators can irritate or compress the sciatic nerve during pregnancy. Some studies suggest the baby’s growth contributes to uterine pressure on supporting vasculature or direct compression of the sciatic nerve, which results in low back pain with radiation into the legs.8
Sacroiliac Pain
Ligament laxity caused by hormonal changes during pregnancy allows these traditionally stable and primarily weight-bearing sacroiliac joints to move and shift. This increased mobility puts stress on the surrounding ligaments and muscles, which may cause pain.4 Patients sometimes incorrectly describe their discomfort as “hip pain,” however they indicate the sacroiliac joint as the area of complaint.
Pubic Symphysis Pain
During pregnancy, the hormone Relaxin allows the ligaments stabilizing the pubic symphysis joint to relax, and therefore allows the joint to move and separate. Also called Symphysis Pubis Dysfunction, or SPD, this condition produces pain and limitation of mobility. It also may contribute to instability of the bony pelvis.9
Round Ligament Pain
The round ligaments of the uterus contain contractile fibers, and suspend and connect it to the anterolateral abdominal wall on either side. As the uterus grows, the round ligaments also stretch and can cause a sharp pain on either side of the abdomen or at the attachment sites of the ligaments near the pubic bones or labia.10
Normal biomechanical changes during this time can result in discomfort and pain during pregnancy and labor. These changes include weight gain, anterior shift in center of gravity, increased lumbar lordosis, and laxity of lumbopelvic ligaments; as well as postural changes and altered gait pattern.4 Many obstetric providers are unaware that the resulting musculoskeletal conditions and their related symptoms can be managed and improved with chiropractic care and patient education.5 Following are some of the musculoskeletal conditions that occur:
Low Back Pain
Low back pain during pregnancy is caused by increased stress on the lumbar spine by an anterior shift in center of gravity. Compensatory muscle tightness and altered gait patterns also contribute, and this pain ranges from mild to severe depending on the patient’s activity level, daily activities and work duties.2,6 Low back pain is also very common during the postpartum period.7
Sciatic Nerve Pain
Hypertonicity in the gluteal muscles and deep external rotators can irritate or compress the sciatic nerve during pregnancy. Some studies suggest the baby’s growth contributes to uterine pressure on supporting vasculature or direct compression of the sciatic nerve, which results in low back pain with radiation into the legs.8
Sacroiliac Pain
Ligament laxity caused by hormonal changes during pregnancy allows these traditionally stable and primarily weight-bearing sacroiliac joints to move and shift. This increased mobility puts stress on the surrounding ligaments and muscles, which may cause pain.4 Patients sometimes incorrectly describe their discomfort as “hip pain,” however they indicate the sacroiliac joint as the area of complaint.
Pubic Symphysis Pain
During pregnancy, the hormone Relaxin allows the ligaments stabilizing the pubic symphysis joint to relax, and therefore allows the joint to move and separate. Also called Symphysis Pubis Dysfunction, or SPD, this condition produces pain and limitation of mobility. It also may contribute to instability of the bony pelvis.9
Round Ligament Pain
The round ligaments of the uterus contain contractile fibers, and suspend and connect it to the anterolateral abdominal wall on either side. As the uterus grows, the round ligaments also stretch and can cause a sharp pain on either side of the abdomen or at the attachment sites of the ligaments near the pubic bones or labia.10
Pediatric Chiropractic
Look around your child’s or grandchild’s school, a playground, a carnival or an amusement park. For every 100 children you see, at least three of them have probably visited a doctor of chiropractic at least once. According to a report from the U.S. Centers for Disease Control and Prevention, approximately 3 percent of children have been treated with chiropractic or osteopathic manipulation.
The numbers are rising. In 2000, a survey found that there were about 30 million pediatric visits to chiropractors1; by 2009, that figure had more than doubled, to 68 million.2 The National Board of Chiropractic Examiners’ most recent practice analysis, issued in 2010, found that about 17 percent of chiropractic patients were under age 18 — approximately 7.7 percent aged five years or younger and some 9.4 percent between ages six and 17.
The numbers are rising. In 2000, a survey found that there were about 30 million pediatric visits to chiropractors1; by 2009, that figure had more than doubled, to 68 million.2 The National Board of Chiropractic Examiners’ most recent practice analysis, issued in 2010, found that about 17 percent of chiropractic patients were under age 18 — approximately 7.7 percent aged five years or younger and some 9.4 percent between ages six and 17.
Fibromylagia
The best treatment for true fibromyalgia patients is a multidisciplinary approach at a specialty fibromyalgia clinic,” says Dr. Schneider.
This would include patient management among clinicians, chiropractors and physical therapists to ensure that patients receive the appropriate diagnosis and therapy, without resorting to a default diagnosis of fibromyalgia in all cases of widespread pain.(5)
In a 2011 study published in the Journal of Rehabilitation Medicine, researchers found that a long-term combination of aerobic exercise, strengthening and flexibility improves psychological health status and health-related quality of life in patients withfibromyalgia.(6)
According to the American Pain Society’s guidelines on fibromyalgia and discussed in the aforementioned study, patients are recommended to perform moderately intense aerobic exercise, especially as they are sensitive to movement and touch.6 Dr. Schneider reminds DCs that when a patient has true fibromyalgia, the body is tender all over. “They respond better to light-intensity exercise and a light touch,” he says, as opposed to only chiropractic spinal manipulation, for which there is inconclusive evidence for the treatment of fibromyalgia.(7)
Mind-body therapies (i.e., guided imagery, meditation and biofeedback) and balneotherapy (i.e., waterbased treatments) have also shown evidence of effectiveness in treating fibromyalgia pain, as discussed in a systematic review published in JMPT.(8)
DCs should know how to properly and accurately diagnose fibromyalgia. If a patient’s pain is not widespread and does not meet the ACR’s guidelines and criteria, it could be a musculoskeletal disease, a metabolic disorder or another underlying medical issue. It is important that the chiropractic physician know when to refer a patient to another clinician for treatment, especially when a musculoskeletal disease is ruled out.
This would include patient management among clinicians, chiropractors and physical therapists to ensure that patients receive the appropriate diagnosis and therapy, without resorting to a default diagnosis of fibromyalgia in all cases of widespread pain.(5)
In a 2011 study published in the Journal of Rehabilitation Medicine, researchers found that a long-term combination of aerobic exercise, strengthening and flexibility improves psychological health status and health-related quality of life in patients withfibromyalgia.(6)
According to the American Pain Society’s guidelines on fibromyalgia and discussed in the aforementioned study, patients are recommended to perform moderately intense aerobic exercise, especially as they are sensitive to movement and touch.6 Dr. Schneider reminds DCs that when a patient has true fibromyalgia, the body is tender all over. “They respond better to light-intensity exercise and a light touch,” he says, as opposed to only chiropractic spinal manipulation, for which there is inconclusive evidence for the treatment of fibromyalgia.(7)
Mind-body therapies (i.e., guided imagery, meditation and biofeedback) and balneotherapy (i.e., waterbased treatments) have also shown evidence of effectiveness in treating fibromyalgia pain, as discussed in a systematic review published in JMPT.(8)
DCs should know how to properly and accurately diagnose fibromyalgia. If a patient’s pain is not widespread and does not meet the ACR’s guidelines and criteria, it could be a musculoskeletal disease, a metabolic disorder or another underlying medical issue. It is important that the chiropractic physician know when to refer a patient to another clinician for treatment, especially when a musculoskeletal disease is ruled out.
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