The Four Phases of the Whiplash Injury

Whiplash injuries are not confined to auto accidents and often occur during a slip, fall or while playing sport. However, we’ll look at what typically occurs in an auto accident, which is the most common and most severe cause of whiplash.

As a vehicle hits the rear of your car, your body goes through an extremely quick and violent acceleration and deceleration, and all four of the phases described below happen in less than half a second. Each phase involves a different force acting upon your body, which contributes to the overall injury, bringing vertebrae, nerves, discs, muscles, and ligaments into the fold.

• Phase 1: Your car is shunted at great speed from underneath you. Your mid-back is flattened against the back of the seat, creating an upward force in your neck, which compresses your discs and joints. As your momentum continues forward with the car, your head flies backward, and this whips violently at your neck. Only a well-adjusted head rest can help minimize the damage this causes, lessening the backward travel of your head. However, the majority of damage to the spine will already have occurred before your head hits the head rest, as studies show that head rests only reduce injury by 11% to 20%.
• Phase 2: Your torso reaches its peak forward acceleration at twice the speed of the impacting vehicle, while your head continues moving backwards. Your neck goes through an abnormal S-curve as your seat back springs your torso forward. This moment causes extreme compressive forces on the neck and significant damage to bone, joint, nerve, and discs.
• Phase 3: Your torso is now settling back down in your seat, and your head and neck are both accelerating forward at their peak speed. This happens as the car is slowing anyway, but this deceleration is aided by your foot planting itself firmly on the brake pedal after possibly lifting off at the moment of impact. This sudden braking severely increases the flexion injury of your neck. Assuming a seat belt is being worn, it now takes the strain of your forward movement.
• Phase 4: The most damaging part of the whiplash sequence now occurs. The seat belt stops your torso but your head continues forward. The neck bends violently forward, straining muscles and ligaments, tearing fibers in the spinal discs, and forcing vertebrae beyond their normal movement. Your spinal cord and nerve roots are stretched and damaged, and your brain hits your skull, potentially causing mild to moderate brain injury. Where a seat belt has not been used, your head is free to move forward and strike the steering wheel, dash or windshield, causing even more severe brain injuries.

Injuries from Whiplash Trauma

There are so many variables involved in how an accident occurs, as there are with the individual victim, so it is impossible to predict them all. Injuries are sometimes felt immediately or within an hour of the accident but more often due to the immediate shock, which causes the body to release endorphins and adrenaline, the true symptoms surface weeks or even months later. Generally, though, there is an array of conditions that are often seen following a whiplash:

• Neck Pain: the single most common complaint as reported by over 90% of people. Pain often radiates into the shoulders, between the shoulder blades, and into the head. All the tissues in the neck tend to be affected by whiplash, including the muscles, ligaments and nerves, and the facet joints and discs between the vertebrae.
• Headaches: following neck pain this is the second most common complaint, affecting over 80% of sufferers. Although headaches occasionally result from direct brain injury, most are triggered by injured muscles, ligaments and facet joints in the cervical spine, referring pain into the head. It is therefore vital to treat the supporting structures of your neck in order to combat headaches.
• TMJ: Temporomandibular Joint Dysfunction (TMJ) is a less common disorder that follows whiplash, but can be debilitating if it occurs. TMJ manifests as pain, clicking and popping noises in the jaw when moved. Untreated, TMJ can worsen and cause headaches, facial pain, ear pain and difficulty eating. This is a condition for which chiropractors are specially trained, or you may be referred to a TMJ specialist depending on the severity.
• Brain Injury: Mild to moderate brain injury is fairly common after whiplash, due to the movements as described in the four phases. The brain is very soft and suspended in cerebrospinal fluid, so that when the brain is jolted within the skull, it can be bruised or bleed. Whiplash victims may temporarily lose consciousness or have mild concussion, but more common is a feeling of mild confusion or disorientation following the crash. Long term effects include mild confusion, difficulty concentrating, sleep disturbances, irritability, forgetfulness, loss of sex drive, emotional upset and depression. In certain cases, the nerves that feed your senses of smell, taste and even sight may be affected.
• Dizziness: following a whiplash this is usually temporary and can improve with chiropractic care. It is the result of injury to the facet joints of the cervical spine, but in some cases it may be due to damage to the brain or brain stem.
• Low back Pain: Despite the neck bearing the brunt of the damage, your low back can also be easily injured by whiplash, and this is reported by over 50% of those involved in rear impact collisions, and in nearly 75% of those in side impact accidents. Although the low back does not suffer the same extent of flexion-extension injury as the neck, it still experiences a great compression during the first two phases of the whiplash process.

Recovery from Whiplash

Mild whiplash injuries treated correctly usually heal within six to nine months. However, 20% of victims will still be suffering pain, weakness or restricted movement two years after their accident, and it is likely that some degree of disability or pain will afflict theses people for many years more, if not for life.

Whiplash injuries need to be treated by specially trained professionals who know and understand the condition. The most effective treatment combines chiropractic care with rehabilitation of the soft tissues, and a self-care routine.

Chiropractic Care

Chiropractic care involves the manual manipulation of the spine to restore normal movement and position to the vertebrae. This is the most important and effective treatment to ensure that whiplash damage is minimized. Your chiropractor may also use trigger point therapy, massage therapy, exercise rehabilitation, and other soft tissue rehabilitation treatments.

Soft Tissue Rehabilitation

‘Soft tissue’ refers to anything in the body that’s not bone, so that includes muscles, ligaments, tendons, nervous system, spinal discs and internal organs. It is these soft tissues that are damaged most by whiplash, with the muscles, ligaments and discs taking the majority of the impact. Unless the correct therapies are used to stimulate healing, the result may be permanent impairment and disability. Treatments include trigger point therapy, massage therapy, electro-stimulation, stretching, and specific exercises to boost strength and range-of-motion.

Home Care

How you behave outside the chiropractor’s office will significantly enhance or detract from the treatment given inside it. Your daily home and work routines must be guided by your recovery plan, so that the treatment sessions have maximum benefit. You should: apply ice packs, carefully limit daily activities, stretch, exercise, supplement nutritionally, and get plenty of rest.

Medical Intervention

Severe whiplash may require the input of a physician to complement your overall treatment. This may mean anti-inflammatory medications, muscle relaxants, trigger point injections, or even epidural spinal injections. The point of these is short-term pain relief; they are not intended as curative or long-term options. No drug will restore normal joint movement or stimulate muscle repair. Surgery may be necessary for a badly herniated discs, when a disc is impinging on the spinal cord, and in some cases with spinal fractures.

Are You Suffering from a Whiplash Injury?

Whether you have recently been involved in an auto accident, or if you had one several months or years ago and whether or not the symptoms are now starting to show up or not, in any case the sooner that you have your spine fully evaluated and begin a course of treatment the better your chances are for a maximum recovery. Be sure to provide as much detail about your injuries as possible to help your Chiropractor fully understand your condition.

Participation in sports or exercise is an important step in maintaining your health. Exercise strengthens your heart, bones, and joints and reduces stress, among many other benefits. Unfortunately, injuries during participation in sports are all too common. Often, these injuries occur in someone who is just taking up sports as a form of activity, doesn’t use proper safety equipment, or becomes overzealous about the exercise regimen.

The more commonly injured areas of the body are the ankles, knees, shoulders, elbows, and spine. Remember that you should discuss any exercise program with your doctor of chiropractic before undertaking such activities.

Strains and Sprains

Although bones can sometimes be fractured with acute sports injuries, the most commonly injured structures are the muscles, tendons, and ligaments. Tendons attach muscles to bones, and ligaments attach one bone to another.

An acute twisting or overextension of a joint can lead to tears of muscles and tendons, called “strains,” and tears of ligaments result in “sprains.” These tears range from mild to severe. In mild injuries, just a few fibers are torn or stretched. Severe injuries, where there is a tear through the full thickness of the structure, are most often considered unstable injuries and frequently require surgical intervention. The intervertebral disc, a ligament between the vertebrae of the spine that works as a shock absorber, can also be torn, resulting in a disc bulge and/or herniation.

Ankle sprains most often involve tears of one or more of the ligaments along the outside of the ankle. Knee ligaments, including the larger external supportive ligaments and the smaller internal stabilizing ligaments, can also be torn. The cartilage on the back of the patella (knee-cap) can also become eroded from overuse, leading to a condition termed chondromalacia patella.

Tendinosis

In those who are training too much, overuse of a particular joint or joints in the body can result in pain and dysfunction. These injuries are called “overuse syndromes.” A common overuse injury is tendinosis, also called tendinitis. In this condition, the tendon becomes inflamed from repetitive use. In the shoulder, the rotator cuff (a complex of muscles that stabilizes and moves the shoulder) becomes inflamed, resulting in rotator cuff tendinitis. Tennis elbow is another form of tendinitis that occurs along the outside of the elbow, most commonly in tennis players. In golfer’s elbow, the tendons on the inside of the elbow are affected.

Stress Fractures

Some athletes may experience a stress fracture, also called a fatigue fracture. This type of fracture occurs when an abnormal amount of stress is placed on a normal bone. This might occur in a runner who rapidly increases the amount of mileage while training for a race. Stress fractures also occur in people who begin running as a form of exercise but overdo it from the start, rather than gradually progress to longer distances.

One final common injury is worth mentioning, and that is shin splints. This overuse injury is caused by microfractures on the front surface of the tibia (shin bone). This is most often seen in runners, although other athletes can also be affected.

Diagnosis and Treatment

Sports injuries are most often diagnosed from the history of the activity that brought on the pain, along with a physical examination. In some cases, x-rays are necessary to rule out a fracture. Magnetic resonance imaging (MRI) and diagnostic ultrasound are also used in finding soft-tissue injuries, like tendinitis and sprains.

Fractures require the application of some stabilizing device, such as a cast, after the bone is put back into position. Rarely, surgical intervention is required. There is a relatively standard treatment protocol for most of the other overuse types of injuries. This protocol involves the following:

Rest

Generally no more than 48 hours of rest and/or immobilization is needed, depending on the severity of the injury. In most cases, the sooner the person becomes active after an injury, the more rapid is the recovery. In fact, long-term immobilization can sometimes be harmful to recovery. Your doctor of chiropractic will guide this process, as too early a return to activity, choosing the wrong type of activity, or excessive activity can be detrimental.

Ice or heat

Ice or heat can be helpful with pain reduction and tissue healing.

Compression

Compression of the area may reduce the amount of swelling from the injury. Your doctor of chiropractic will determine if this will be beneficial in your case.

Elevation

Elevation of the injured arm or leg above the level of the heart is thought to be helpful in reducing swelling.

Pain relievers

Recent research has demonstrated that some nonsteroidal anti-inflammatory drugs may actually slow the healing process by restricting the body’s natural healing mechanisms, so they should be used sparingly.

Joint manipulation

Recent research has shown us that, in some cases, joint manipulation can be helpful with pain reduction and more rapid recovery. Your doctor of chiropractic will determine if this procedure will be helpful in your case.

A Word about Prevention

In many cases, sports injuries can be prevented. Proper conditioning and warm-up and cool-down procedures, as well as appropriate safety equipment, can substantially reduce injuries. Understanding proper techniques can also go a long way toward preventing injuries. Sufficient water intake is also an important preventive measure.

For decades, osteoarthritis has been considered a part of aging. But not anymore. Recent research points out that older people don’t have to suffer from osteoarthritic pain. And, surprisingly, people much younger than 65 can develop osteoarthritis.

What Is Osteoarthritis?

Osteoarthritis (OA), or degenerative joint disease, affects more than 20 million Americans and is more common in women than in men. The disease affects the cartilage, which is a slippery tissue on the ends of bones that meet in a joint. Normally, cartilage helps bones glide over one another. In an OA patient, however, the cartilage is broken down and eventually wears away.

As a result, instead of gliding, bones rub against each other, causing pain, swelling, and loss of motion.¹ Although the majority of patients with OA are 65 and older, recent research shows that osteoarthritis is not a by-product of aging. Family history of OA, being overweight, lack of exercise, and prior joint injuries are suggested as OA risk factors.

How Is Osteoarthritis Diagnosed?

OA is diagnosed through a combination of clinical history, patient examination, and x-rays. Other tests, such as drawing fluid from the joint, are sometimes used.

The signs of OA include:

• Steady or intermittent joint pain
• Joint stiffness after sitting, sleeping, or otherwise not moving for a long time
• Swelling or tenderness in the joints
• A crunching feeling or the sound of bones rubbing against each other.

If you experience any of these signs, consult your health care provider. While the diagnosis is relatively easy to make, it is often harder to establish whether or not OA causes the patient’s symptoms. That’s why the treating doctor needs to not only make the diagnosis, but also rule out other disorders and conditions that can make the symptoms worse.¹ Timely diagnosis and treatment can help manage pain, improve function, and slow the degeneration.

Should Osteoarthritis Patients Exercise?

Exercise is one of the best forms of OA treatment and prevention. It strengthens the muscular support around the joints and improves and maintains joint mobility and function. In addition, exercise helps control weight and improves the patient’s mood and outlook, which are important factors influencing the severity of the symptoms.

If you suffer from OA, consider the following exercise tips:

• Low impact or non weight bearing activities, such as walking, stationary training, and light weight training work best for OA patients.
• Use strengthening exercises if the key muscle groups that relate to the function of the joints are weakened by the degeneration.
• If you are overweight, start exercising carefully, so as not to put too much stress on the knee and ankle joints.
• Stair climbing, water aerobics, Theraband workouts, and similar exercises will help to keep the joints mobile without straining them.
• Learn to read the body’s signals and know when to stop, slow down, or rest.

How Can Your Chiropractor Help?

Doctors of chiropractic, by the nature of their work, can detect the earliest degenerative changes in the joints. They see the impact of degenerative changes in the spine, as well as in the hips, knees, and other weight bearing joints. Doctors of chiropractic are also trained to relieve the pain and improve joint function through natural therapies, such as chiropractic manipulation, trigger-point therapy, or some massage techniques.

Doctors of chiropractic can provide exercise counseling, helping you choose exercises that are best for you. If a sore or swollen joint prevents you from exercising, talk to your doctor of chiropractic about other drug free pain relief options, such as applying heat or cold to the affected area. In addition, your doctor of chiropractic can help you choose proper supplements that play important roles in OA prevention and treatment.

References

1. Osteoarthritis: Handout on Health. National Institute of Arthritis and Musculoskeletal and Skin Diseases. July 2002.

A healthy spine is an often overlooked and essential part of a healthy lifestyle. People who suffer from back pain, particularly if it is long-term, are generally less healthy than those who do not. In fact, back pain costs are staggering not only financially, but also in terms of lost time from work and because of psychosocial problems that arise during the healing process associated with long-term back pain.

Unfortunately, approximately 80-90% of the population suffers from spinal pain at some point. People who are overweight or obese, and who smoke, lift heavy objects, or had a previous episode of back pain, are more likely to experience back pain.

Because so many people suffer from spine pain, it’s important for you to try to keep your spine as healthy as possible. Following simple posture, lifting, and healthy lifestyle guidelines can help you keep your back in good shape.

The American Chiropractic Association recommends the following spinal health tips:

Standing

• When standing, keep one foot slightly in front of the other, with your knees slightly bent. This position helps to take the pressure off your low back.
• Do not stand bent forward at the waist for prolonged periods of time. The muscles in your low back become deconditioned in this position, which may lead to pain.

Lifting

• At all times, avoid twisting while lifting. Twisting is one of the most dangerous movements for your spine, especially while lifting.
• If the item is too heavy to lift, pushing it is easier on your back than pulling it. Whenever possible, use your legs, not your back or upper body, to push the item.
• If you must lift a heavy item, get someone to help you.

Sitting

• Keep your knees slightly higher than your hips, with your head up and back straight.
• Avoid rolling your shoulders forward (slouching).
• Try to maintain the natural curve in your low back.

Reaching and Bending

• When reaching for something above shoulder level, stand on a stool. Straining to reach such objects may not only hurt your mid-back and neck, but it can also bring on shoulder problems.
• Do NOT bend over at the waist to pick up items from the floor or a table.
• Instead, kneel down on one knee, as close as possible to the item you are lifting, with the other foot flat on the floor and pick the item up.
• Or bend at the knees, keep the item close to your body, and lift with your legs, not your back.

Carrying

• When carrying objects, particularly if they are heavy, keep them as close to your body as possible.
• Carrying two small objects—one in each hand—is often easier to handle than one large one.

Healthy Diet and Exercise

• While the proverbial jury is still out, we suspect that extra weight puts undue strain on your spine. Keep within 10 lbs. of your ideal weight for a healthier back.
• “Beer belly” is likely the worst culprit, as it puts unwanted pressure on the muscles, ligaments and tendons in your low back.
• The most efficient and effective way to reduce weight is by eating a sensible diet and exercising regularly.
• Consult with your doctor before beginning any exercise program, particularly if you have a health condition.

Sleeping

• Sleeping on your back puts approximately 50 pounds of pressure on your spine. Other positions may be better.
• Placing a pillow under your knees while lying on your back cuts the pressure on your spine roughly in half.
• Lying on your side with a pillow between your knees may also reduce the pressure on your back.
• Never sleep in a position that causes a portion of your spine to hurt. Most often, your body will tell you what position is best.

Quit Smoking

Smokers have more spine pain than nonsmokers, and they also heal more slowly when they have an episode of back pain because the chemicals in tobacco smoke restrict the flow of blood to the tissues in and around your spine.

While following these instructions is no guarantee that you’ll be free from back pain for your entire life, it can certainly reduce your risk of developing it. These simple steps will help you keep your spine in good shape, making you a healthier, happier person.

Stress has been called the spice of life, the common cold of the psyche, and even a socially acceptable form of mental illness. No doubt, stress can be beneficial for example, a deadline can help us focus and become more alert and efficient. Persistent or excessive stress, however, can undermine performance and make us vulnerable to health problems, from cancer and heart disease to substance abuse and obesity.

Stress is a physical and mental response to the difference between our expectations and our personal experience, real or imaginary. While reacting to stress, the body goes through alarm, resistance, and exhaustion. Released hormone epinephrine, or adrenaline, prepares the body for physical action (“fight or flight”) by increasing heart rate, blood pressure, and blood glucose levels. Then, the body releases glucocorticoid cortisol, or hydrocortisone, producing anti-inflammatory and immunosuppressing effects.

Consequences of Chronic Stress

Although occasional stress can be of benefit, too much stress is taxing on the body. Excessive levels of glucocorticoids can hinder growth, delay wound healing, and increase risk of infection. Chronic stressors or their constant anticipation can make us believe that we must always be on guard, leading to anxiety. Feelings of hopelessness or avoiding solving our problems can spark depression.

Past or present psychological distress can also lead to pain, particularly low back pain, which often comes with leg pain, headaches, sleep problems, anxiety, and depression. Stress may even be a more powerful pain generator than strenuous physical activity or repetitive motion. Research shows, for example, that pain in adolescents is associated with depression and stress, but not with computer use or physical activity.

Stress is highly individual and depends on our circumstances. For example, we react to stress better if we can vent our frustrations, feel in control, hope that things will change for the better, and get social support.

Gender also determines how we handle stress. Women are easily stressed by household problems, conflicts with people, or illness in people they know. Men get more significantly affected by job loss, legal problems, and work related issues. Men are also more likely to get depressed over divorce or separation and work problems. Depression in women, however, is more likely to spring from interpersonal conflicts or low social support, particularly from family.

Stress on the Job

The workplace has become a major stressor, contributing to the risk of hypertension and heart disease. Recent studies have shown, however, that what stresses us out is not so much the job demands, but our attitude toward them. For example, people who react with anger to their high job strain or who are worried about their chronic work overload have much higher morning corsisol levels. Lack of a sense of control over a job is also associated with higher blood pressure, especially in women and in people with higher socioeconomic status.

Stress Relief Is Important

No matter what stresses you out, consider taking active steps to change your attitude toward stress and to reduce stress in your life.

Stress has become a fact of life, and for some, the daily norm. Although occasional stress can help improve our focus and performance, living with chronic stress can backfire by causing anxiety, depression, and serious health problems.

Understanding who we are, knowing our major struggles, putting them in perspective, and taking action can help us deal with stress. The following strategies can also improve stress tolerance and help lessen the effects of stress on our health.

Think Positively

“Adopting the right attitude can convert a negative stress into positive,” said Hans Selye, author of the groundbreaking work around stress theory. When optimism is hard to muster, cognitive-behavioral therapy, which trains people to recognize negative thinking patterns and replace them with more constructive ones, can also help reduce the risk of chronic stress and depression.

Get Out and Enjoy Nature

While modern civilization has made our lives more convenient, it has deprived us of an essential source of stress relief: our connection with nature. Studies show that interacting with nature can help lessen the effects of stress on the nervous system, reduce attention deficits, decrease aggression, and enhance spiritual well-being.

“Smell the Roses” for Better Mood

Aromatherapy, or smelling essential plant oils, recognized worldwide as a complementary therapy for managing chronic pain, depression, anxiety, insomnia, and stress-related disorders, can help you unwind. Orange and lavender scents, in particular, have been shown to enhance relaxation and reduce anxiety.

Relax with a Cup of Tea

During stressful times, coffee helps us keep going. To give yourself a break, however, consider drinking tea. Research shows that drinking tea for 6 weeks helps lower post-stress cortisol and increase relaxation. Habitual tea drinking may also reduce inflammation, potentially benefiting your heart health.

Laugh It Off

Humor relieves stress and anxiety and prevents depression, helping put our troubles in perspective. Laughter can help boost the immune system, increase pain tolerance, enhance mood and creativity, and lower blood pressure, potentially improving treatment outcomes for many health problems, including cancer and HIV. Humor may also be related to happiness, which has been linked to high self-esteem, extroversion, and feeling in control.

Build a Support System

Relationships are also key to health and happiness, especially for women. Women with low social support, for example, are more likely to increase blood pressure under stress. Loneliness may also contribute to stress in both men and women, also leading to poorer outcomes after a stroke or congestive heart failure. On the other hand, active and socially involved seniors are at lower risk for dementia and Alzheimer’s disease. Social support also helps cancer patients to boost the immune system and maintain a higher quality of life.

Employ the Relaxing Power of Music

Music, especially classical, can also serve as a powerful stress-relief tool. Listening to Pachelbel’s famous Canon in D major while preparing a public speech helps avoid anxiety, heart rate, and blood pressure, which usually accompany public speaking.

Singing and listening to music can also relieve pain and reduce anxiety and depression caused by lowback pain. Group drumming also showed positive effects on stress relief and the immune system. Music therapy can also elevate mood and positively affect the immune system in cancer patients and reduce fatigue and improve self-acceptance in people with multiple sclerosis.

To help people deal with stressful medical procedures, music can help reduce anxiety before surgery. When played during surgery, it can decrease the patient’s post-operative pain. Aiding recovery, a dose of calming music may lower anxiety, pain, and the need for painkillers.

Calm Your Mind

In recent decades, many forms of meditation have gained popularity as relaxation and pain relief tools. Focusing on our breath, looking at a candle, or practicing a non-judgmental awareness of our thoughts and actions can help tune out distractions, reduce anxiety and depression, and accept our circumstances. In cancer patients, meditation-based stress reduction enhances quality of life, lowers stress symptoms, and potentially benefits the immune system.

Guided imagery, such as visualizing pictures prompted by an audiotape recording, also shows promise in stress relief and pain reduction. Based on the idea that the mind can affect the body, guided imagery can be a useful adjunct to cancer therapy, focusing patients on positive images to help heal their bodies.

Enjoy the Warmth of Human Touch

Just as the mind can affect the body, the body can influence the mind. Virginia Satir, a famous American psychotherapist, once said that people need 4 hugs a day to help prevent depression, 8 for psychological stability, and 12 for growth. While asking for hugs may not work for some, massage can help us relieve stress and reduce anxiety and depression. Massage has also been shown to reduce aggression and hostility in violent adolescents, to improve mood and behavior in students with ADHD, and to lead to better sleep and behavior in children with autism.

Massage has other therapeutic properties, as well. Regular massage may reduce blood pressure in people with hypertension and may lead to less pain, depression, and anxiety and better sleep in patients with chronic low back pain. Compared to relaxation, massage therapy also causes greater reduction in depression and anger, and more significant effects on the immune system in breast cancer patients.

Give Exercise a Shot

To get the best of both worlds, affecting the mind through the body while getting into good physical shape, try exercise. In one study, a group of lung cancer patients increased their hope due to exercise. Exercise can also reduce depression and improve wound healing in the elderly. Tai chi, which works for people of all ages, may enhance heart and lung function, improve balance and posture, and prevent falls, while reducing stress.

No matter what stress-relief methods you choose, make it a habit to use them—especially if you feel too stressed out to do it. As someone once said, the time to relax is when you don’t have time for it.

Does it hurt when you chew, open wide to yawn or use your jaws? Do you have pain or soreness in front of the ear, in the jaw muscle, cheek, the teeth or the temples? Do you have pain or soreness in your teeth? Do your jaws make noises loud enough to bother you or others? Do you find it difficult to open your mouth wide? Does your jaw ever get stuck/locked as you open it?

If you answered “yes” to some of these questions, you may have a temporomandibular joint disorder, or TMD. TMD is a group of conditions, often painful, that affect the jaw joint.

Signs may include:

• Radiating pain in the face, neck, or shoulders;
• Limited movement or locking of the jaw;
• Painful clicking or grating when opening or closing the mouth;
• A significant change in the way the upper and lower teeth fit together;
• Headaches, earaches, dizziness, hearing problems and difficulty swallowing.

For most people, pain or discomfort in the jaw muscles or joints is temporary, often occurs in cycles, and resolves once you stop moving the area. Some people with TMD pain, however, can develop chronic symptoms. Your doctor of chiropractic can help you establish whether your pain is due to TMD and can provide conservative treatment if needed.

What Causes TMD?

Researchers agree that TMD falls into three categories:

• Myofascial pain: discomfort or pain in the muscles of the jaw, neck, and shoulders
• A dislocated jaw or displaced disc
• Degenerative joint disease, rheumatoid arthritis or osteoarthritis in the jaw joint.

Severe injury to the jaw is a leading cause of TMD. For example, anything from a hit in the jaw during a sporting activity to overuse syndromes, such as chewing gum excessively or chewing on one side of the mouth too frequently, may cause TMD.

Both physical and emotional stress can lead to TMD, as well. The once-common practice of sitting in a dentist’s chair for several hours with the mouth wide open may have contributed to TMD in the past. Now, most dentists are aware that this is harmful to the jaw. In addition to taking breaks while they do dental work, today’s dentists also screen patients for any weaknesses in the jaw structure that would make physical injury likely if they keep their mouths open very long. In that case, they may use medications during the procedure to minimize the injury potential, or they may send the patient to physical therapy immediately after treatment.  In less severe cases, they instruct patients in exercises they can do at home to loosen up the joint after the visit.

While emotional stress itself is not usually a cause of TMD, the way stress shows up in the body can be. When people are under psychological stress, they may clench their teeth, which can be a major factor in their TMD.

Some conditions once accepted as causes of TMD have been dismissed: moderate gum chewing, non-painful jaw clicking, orthodontic treatment (when it does not involve the prolonged opening of the mouth, as mentioned above), and upper and lower jaws that have never fit together well. Popular theory now holds that while these may be triggers, they are not causes.

Women experience TMD four times as often as men. Several factors may contribute to this higher ratio, posture and higher heels.

TMD Diagnosis and Treatment

To help diagnose or rule out TMD, your doctor of chiropractic (DC) may ask you to put three fingers in your mouth and bite down on them. You may also be asked to open and close your mouth and chew repeatedly while the doctor monitors the dimensions of the jaw joint and the balance of the muscles. If you have no problems while doing these things, then the problem is not likely to be TMD. Your DC can then look for signs of inflammation and abnormalities. Sometimes special imaging, an x-ray or an MRI may be needed to help confirm the diagnosis.

If you have TMD, your doctor may recommend chiropractic manipulation, massage, applying heat/ice and special exercises. In most cases, your doctor’s first goal is to relieve symptoms, particularly pain. If your doctor of chiropractic feels that you need special appliances or splints (with the exception of the “waterpack” and other guards against teeth grinding), he or she will refer you to a dentist or orthodontist for co-management.

In addition to treatment, your doctor of chiropractic can teach you how to:

• Apply heat and ice to lessen the pain. Ice is recommended shortly after the injury or after your pain has started. In the later stages of healing, you need to switch to heat, especially if you are still experiencing discomfort.
• Avoid harmful joint movements. For example, chomping into a hard apple is just as bad as crunching into hard candy (some hard candies are even called “jawbreakers” for good reason). And giant sandwiches can cause the mouth to open too wide and have a destabilizing effect on the jaw.

Perform TMD specific exercises. Depending on your condition, your DC may recommend stretching or strengthening exercises. Stretching helps to loosen tight muscles and strengthening helps to tighten muscles that have become loose. Special feedback sensors in the jaw can be retrained, as well, if needed.

Diagnosing fibromyalgia is not easy, and may take many years to properly identify. The American College of Rheumatology (ACR) defines fibromyalgia as a history of pain lasting more than 3 months in all four quadrants of the body; that is, on both your right and left sides, and above and below the waist. The ACR further details 18 tender points around the body that are characteristic of fibromyalgia, and diagnosis requires a person to have 11 or more. As well as pain and fatigue, fibromyalgia may also produce:

• Disturbed sleep
• Morning stiffness
• Headaches
• Irritable Bowel Syndrome (IBS)
• Painful menstrual periods
• Numbness/tingling in the extremities
• Restless legs syndrome
• Sensitivity to temperature
• Cognitive and memory problems (“fibro fog”)

To make diagnosis even more difficult, fibromyalgia can easily be mistaken for “myofascial pain syndrome” or “myofascitis”, as both can cause pain all over the body. However, the two conditions are very different. Myofascitis is the result of inflammation caused by overuse or injury to the muscles, is usually related to a specific activity or injury, and manifests quite suddenly. Fibromyalgia is the result of stress-induced changes to the metabolism and healing process, and appears in a slow, creeping fashion, most often starting in early adulthood. Correctly differentiating between the two is crucial as the relative treatments are nothing like the same.

What is fibromyalgia?

Fibromyalgia is a chronic condition that may never go away your entire life, although on the plus side, it does not cause any damage to your joints, muscles, or internal organs.

The most up-to-date research suggests that fibromyalgia is a stress-induced condition related to Systemic Lupus Erythematosis (usually just referred to as ‘lupus’) and Chronic Fatigue Syndrome. All of these conditions target women far more than men, and are marked by similar symptoms such as chronic fatigue, disturbed sleep, and IBS. The main difference is with lupus, which is an autoimmune reaction that attacks the healthy tissues of the body. With fibromyalgia, metabolic abnormalities are the primary issue, causing decreased blood flow to the pituitary gland in the brain. This then lowers certain important hormones, such as those responsible for releasing growth hormone and stimulating the thyroid. Muscle healing is adversely affected, memory and cognition are damaged, and full-blown hypothyroidism may even result.

Specifically, fibromyalgia causes a buildup in the muscle of a protein called “ground substance”. This is found in muscle, bone and connective tissues everywhere in the body, and serves to make these structures stronger and less prone to injury. The excessive amount of ground substance in a fibromyalgia sufferer means that the injured area does not heal properly, leading to the muscle knots characteristic of the condition.

While lupus can be definitively diagnosed with laboratory tests, there are no such surefire tests for fibromyalgia. However, there are a number of tests that can help to rule out certain other disorders, and a physical examination will identify if a person has the characteristic tender areas on the back of the neck, shoulders, sternum, lower back, hips, shins, elbows, or knees. Unfortunately, this lack of 100% certainty can lead some doctors to dismiss a patient’s suffering as “all in the mind”, or (not much better) to conclude that there is no effective remedy on offer.

This is not true. While fibromyalgia is certainly not easy to treat, a combination of chiropractic, trigger point therapy, massage, and lifestyle changes (diet and exercise) can prove effective in reducing the severity of the condition, and the duration of the associated pain and suffering. This obviously necessitates a team approach, therefore it is important that the sufferer locates professionals who understand the condition and are happy to work together.

Chiropractic treatment of fibromyalgia

Fibromyalgia causes muscles to tighten and lose their natural pliability, which triggers the spine to decrease its own flexibility, which leads the muscles to tighten even more. It is a vicious cycle that can get worse and worse, causing ever greater pain. Chiropractic care is therefore essential as it ensures that sufferers do not lose too much movement from their spine and muscles. The spine must be properly adjusted and kept moving to counter the insidious creep of fibromyalgia. Treatments should happen three to four times per month, and these sessions will be gentler than normal to take into account the muscles’ susceptibility to injury and their lack of healing ability. When seeking a chiropractor, you need to ascertain that he or she fully understands how the condition affects the muscles.

Trigger point therapy to treat fibromyalgia

Trigger points are tint knots in the muscle fibers, and they can easily be confused with “tender points”. They are not the same, though.

• A trigger point is painful under firm pressure, whereas it takes only very light pressure on a tender point to elicit pain
• Trigger points refer pain to other areas of the body, where tender points do not
• Trigger points can be painful without any pressure exerted on them, as they refer their pain elsewhere
• Trigger points are comprised of knotted muscle fibers that have gone into spasm, whereas tender points are knots filled with ground substance

Fibromyalgia sufferers will almost always have both trigger and tender points, and can benefit greatly from trigger point therapy, albeit a lighter form to ensure that the muscles are not injured.

Cold Laser Therapy for fibromyalgia

Laser therapy helps to stimulate tissues into healing and decreases pain sensations, and so is an important part of any fibromyalgia treatment plan. A study of 846 fibromyalgia sufferers carried out in 1997 and reported in the Journal of Clinical Laser Medicine and Surgery revealed that two-thirds of the group enjoyed less pain and more mobility following cold laser therapy. Another study in Rheumatology International in 2002 reported significant improvement in pain, fatigue and morning stiffness after cold laser therapy.

Self-care for fibromyalgia

Sufferers should not forget that lifestyle choices play a key role in how fibromyalgia affects them. Those who take care of themselves show hugely better outcomes than those who don’t. They suffer far less pain and manage to stay much more active, both of which have a great impact on quality of life. If you have fibromyalgia, the following advice should help:

• Get Sufficient Sleep: Getting enough good quality sleep is very important in combating the pain and fatigue of fibromyalgia, although this may be difficult when several symptoms of the condition prevent restful sleep. Insomnia is very common among sufferers. Alcohol may seem like a quick fix in getting you off quickly, but it is known to badly disturb a healthy night’s sleep pattern. 5-hydroxy tryptophan (5-HTP) is very useful for some people, and others may benefit from the prescription anti-depressant amitriptyline. The latter is not an ideal choice, but it may come down to the lesser of two evils: prescription meds or lack of sleep.
• Exercise: Although it may cause some pain, fibromyalgia sufferers should exercise to improve their fitness. Aerobic exercise has been shown to reduce symptoms, and, generally, exercise guards against the gradual slowing down of physical activity the condition can impose. Low impact exercises such as walking and swimming are the best ways to start out, gently easing sore, tight muscles into action. Anything more than this could create problems. When seeking to push further, always be careful and listen to your body.
• Look at Your Working Life: Fibromyalgia does not stop most people working, but changes may have to be made. Working hours may need to be reduced due to fatigue, a more flexible schedule may be needed, and less physically strenuous activities undertaken. Office ergonomics will also become important so that no undue stress is placed on the muscles, and an understanding employer will make all this very much easier to achieve.
• Eat Well: Food is fuel for the body, thus it follows that the wrong foods can degrade your system and stop it working optimally. For a fibromyalgia sufferer, eating well is even more important to feed the healing process. Foods that stress the body include dairy, eggs, wheat, corn, products containing monosodium glutamate (MSG), and those containing nitrates or nitrites, which are common in processed foods. Fish should be avoided for the environmental toxins it may contain. The best choices are fresh, raw, organically grown foods, which means plenty of whole foods such as brown rice, legumes, oats, spelt, rice milk, soy, hormone-free chicken or turkey, roots, nuts and berries.
• Supplement Your Nutritional Intake: So far, nothing touted to remedy fibromyalgia has proven its credentials in the long term. However, there are certain supplements that some find beneficial, including magnesium malate, ginkgo biloba, and various other herbal concoctions. Always be sure to consult your doctor of chiropractic before taking any supplement to make sure it is safe and will not impede your other treatment.

The most obvious signs of ADHD are:

• Inability to pay attention
• Hyperactive behavior
• Impulsive behavior
• Difficulty in concentrating

Between 3 and 5% of children in the United States (around 2 million kids) are thought to have ADHD, and more boys suffer than girls. That equates to at least one child in every class of 25 to 30 children, although many more are labeled as having ADHD who may simply be badly behaved. For this reason, proper diagnosis is recommended so that children are not needlessly treated and perhaps medicated for a condition they do not have.

Research is ongoing into the causes of ADHD, and current thinking suggests it is down to an overactive nervous system, combined with the brain’s failure to properly filter out unnecessary sights, sounds, thoughts and emotions. Chiropractors are not in the business of directly treating ADHD, but they are able to help rectify certain elements that may be stressing the nervous system, such as:

• Removing spinal subluxations that interfere with the nervous system
• Offering dietary advice to eliminate common trigger foods
• Testing for allergens that may stress the nervous system
• Suggesting ways to eliminate or reduce problem chemicals in the home

Conventional medicine tends to treat ADHD with a chemical called methylphenidate, commonly known as Ritalin. Although this is a stimulant that acts to speed up the nervous system, its net effect is to calm the sufferer, possibly because it activates the filtering out process in the brain. The problem is that Ritalin does nothing to cure ADHD; it only hides the symptoms. And when Ritalin is taken for an extended period, it can actually damage the brain’s proper functioning.

It is therefore important to look at less drastic options if your child has ADHD, and one of these is chiropractic treatment to de-stress the nervous system.

Common symptoms of CTS include wrist pain, weak grip, numbness, tingling, and burning. The pain may also cause problems sleeping. Treatments vary, and can include drugs and invasive surgery, but one that is both conservative and very effective is chiropractic. Adjustments made to the affected area can help resolve the issue, as can work on certain areas of the back or neck, where the nerves are being impinged upon and referring pain to the wrist. Chiropractic treatments may also include physical therapy, and stretching and strengthening exercises. Many people with CTS have found that they experience great relief from their symptoms after visiting a doctor of chiropractic.