One of the most common reasons people seek care at our office is chronic musculoskeletal pain.

More often than not, they have been around the block. The physical therapist said it’s muscle imbalance; The chiropractor said it’s bone misalignment; The massage therapist said it’s tight muscles; The general practitioner said everything looked fine, and take this pill.

Still, the patients have chronic pain.

The traditional healthcare model is stuck in a structural pathology paradigm

Healthcare providers who treat musculoskeletal problems are trained to understand human STRUCTURES—bones, joints, ligaments, muscles, and fascia—NOT human neurology.

A structural problem, such as a fracture, a tear, and a bone spur, is easy to identify and easy to comprehend… but not always the cause of pain, especially in the case of chronic pain.

The structural-pathology paradigm fails to explain why diagnostic findings match up poorly with people’s pain and dysfunction. It also fails to explain why pain persists in some individuals, when the tissues had already healed.

Pain is a neurological phenomenon

By definition, pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage.

What that really means is that pain is an experience that can happen without structural damage. In this case, understanding human neurology becomes imperative in dealing with chronic pain clinically.

We now know that, BOTH the central and peripheral nervous system play an important role in facilitating pain. This article focuses only on the central mechanism.

What happened to the brains of those who are chronically in pain?

1. More sensitive to pain

What may seem like a benign stimulus to others can be painful to those suffering from chronic musculoskeletal pain. This is called central sensitization.

2. Sensory processing issues

Chronic neck pain, back pain, wrist pain, knee pain and tendinitis can change how the brain processes sensory information for the worse. The brain processes sensation slower, locates it incorrectly, and loses its accuracy in identifying some sensations.

3. Motor control issues

When pain changes areas of the brain that deal with sensation, spatial orientation and motor control, it also affects how well the brain controls the muscles. It is well known that the brain loses proper activation of the deep spinal stabilizers in chronic low back pain patients.

4. Blurry brain map

The part of the brain representing the body part that is in pain literally shrinks, and blurs together with adjacent parts of the brain. In short, there is a distortion of body image.

5. Perception and behavioral changes

Significant structural changes are found in brain areas that deal with behaviors and psychological processes. These changes result in a vicious cycle where pain, behavioral changes, and fear-avoidance feed off one another and eventually lead to disability.

Take Home Message

1. Central sensitization is reversible.

2. Surgeries are not the best option for those who are hypersensitive to pain.

3. Distortion of body image found in chronic low back pain and carpel tunnel patients is also associated with more severe pain conditions, such as phantom limb pain and complex regional pain syndrome.

4. Specific exercises can normalize brain activation of low back muscles, while walking is not beneficial.

5. Repetitive unskilled exercises do nothing to rehab the brain.

6. Rehabilitation for both the brain and the body may improve treatment success.

About the Author

Dr. Lily Semrow is a Board Certified Chiropractic Neurologist who focuses on Neuro-Structural Correction. She has a B.S. in Nutrition and a doctorate in Chiropractic. She has a passion for serving families, and helping people who could not get better through traditional and alternative means.

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The post Your Brain May Be Causing Your Chronic Pain – Chiropractor in Holland appeared first on Holland, MI Chiropractors | Brain and Body Chiropractic.

Heroin addiction came up in the Democratic debate before the holidays. All three candidates acknowledged that prescription opioid pain medications, such as Vicodin and Oxycontin, often open the door to heroin abuse, and we need to tighten up regulations on opioid prescriptions.

Tighter regulation is a great start, but that only solves half of the problem. The thing is, people are in pain. They choose pain medications with serious side effects, because they are not aware of or are apprehensive about alternative methods for pain relief, including chiropractic adjustments.

Chiropractic Myth

Traditional chiropractors tell their patients that chiropractic works by realigning the spinal bones and removing pressure on the nerves. This statement is, at its best, an outdated and oversimplified view of human body.

Current research suggests that a mechanistic model does not adequately explain Chiropractic, and we ought to take neurophysiology into consideration.

The Force

Chiropractic adjustments introduce a mechanical force to a joint that, in turn, kick starts a chain of neurological reactions. (1) Think about a chiropractic adjustment as the force needed to activate certain sensors of the nervous system, rather than the force to move a bone. I know the mechanical, bone-aligning concept is much easier to grasp, but reality is more complicated.

3 Mechanisms Of How A Chiropractic Adjustment Relieves Pain

Our nervous system has a peripheral (yellow) and a central (purple) component. The long, skinny purple portion represents the spinal cord, and the rest of the purple part is the brain. Evidence has suggested that chiropractic adjustments affect ALL three parts of our nervous system.

1. Peripheral mechanism:

An animal study (2) had found that one single adjustment was able to significantly reduce inflammatory proteins (cytokines) in the blood. These cytokines stimulate sensors on nerve fibers that cause one to have pain and increase sensitivity to pain. (3)

2. Spinal mechanism:

Chiropractic adjustments activate sensors in the muscles (Golgi organs and muscle spindles) (1) that send signals through large sensory fibers. These large sensory fibers are thought to inhibit pain fiber signaling at the spinal cord level. (4)

3. Brain-based mechanism:

Advancing technology has allowed us to directly observe brain activity by measuring blood flow. This gives us direct evidence of how a specific therapy affects the brain. A recent study (5) using functional magnetic resonance imaging (fMRI) had observed that chiropractic adjustment changed the connectivity between brain regions that process pain.

Why Do We Care

1. Manual therapists often depend upon an alleged biomechanical mechanism in evaluation and treatment. (1) Unnecessary effort may be spent to correct the biomechanical fault (e.g. a disc bulge), while it has little to do with what the patient is experiencing. More on this topic in my previous blog post on spinal degeneration.
2. The neurophysiological model allows the clinicians to consider other potential mechanisms in the treatment of pain.
3. Understanding the mechanisms behind the treatment help build patient confidence and trust in their chiropractors.

References:

1. Bialosky JE, Bishop MD, Price DD, Robinson ME, George SZ. The mechanisms of manual therapy in the treatment of musculoskeletal pain: a comprehensive model. Man Ther. 2009 Oct;14(5):5310538. [PubMed]
2. Teodorczyk-Injeyan JA, Injeyan HS, RueggR. Spinal manipulative therapy therapy reduces inflammatory cytokines but not substance P production in normal subjects. J Manipulative Physiol Ther. 2006;29:14-21. [PubMed]
3. Sommer C, Kress M. Recent findings on how proinflammatory cytokines cause pain: peripheral mechanisms in inflammatory and neuropathic hyperalgesia. Neurosci Lett. 2004 May 6;361(1-3):184-7. [PubMed]
4. Moayedi M, Davis KD. Theories of pain: from specificity to gate control. J Neurophysiol. 2013 Jan;109(1):5-12. [PubMed]
5. Gay CW, Robinson ME, George SZ, Perlstein WM, Bishop MD. Immediate changes following manual therapy in resting state functional connectivity as measured by magnetic resonance imaging (fMRI) in subjects with induced low back pain. J Manipulative Physiol Ther. 2014 Nov-Dec;37(9):614-627. [PubMed]

About the Author

Dr. Lily Semrow is a Board Certified Chiropractic Neurologist who focuses on Neuro-Structural Correction. She has a B.S. in Nutrition and a doctorate in Chiropractic. She has a passion for serving families, and helping people who could not get better through traditional and alternative means.

Want to keep up with future posts?

The post How Do Chiropractic Adjustments Relieve Pain? – Chiropractor in Holland appeared first on Holland, MI Chiropractors | Brain and Body Chiropractic.

The patient was a 56-year-old woman who presented with elbow pain on both sides. The pain had been constant since a fall 6 months prior. She braced herself from the fall with both hands and was left with constant pain on the outside of her elbows.

She had consulted a couple other chiropractors. One of them suggested that she had tennis elbow, and gave her specific stretching exercises to perform at home.

Something Does Not Add Up

Tennis elbow is damage of the tendons on the outside of the elbow. It is commonly due to overuse, but trauma can be a major player, too.

Although what this patient described was almost just like tennis elbow, the exam findings were inconsistent. She did not have pain exactly over the tendons, and we weren’t able to reproduce the pain with any orthopedic tests, either.

In fact, the pain she was experiencing followed the pattern of an inflamed nerve.

Results

Immediately after the first treatment, the patient was pain free for the first time in 6 months.

Since the patient lives on the other side of the state, we have not seen her again since. However, we did follow up with her 6 months after her initial visit to our office, and she wrote back, “Elbows are fabulous and have never had another problem!”

Things To Think About

1. Musculoskeletal injuries like this can affect the joint, muscle or nerve. Traditionally, chiropractors focus on the joints, and physical therapists focus on the muscles. Seldom does anyone pay attention to the nerves.
2. The immediate and lasting result this patient has experienced also confirms that she did NOT have tennis elbow. True tendon injuries take more time to treat and heal.
3. This patient responded great to the treatments and had a complete resolution, but it may take more work for others.
4. When peripheral nerve irritation is the cause of the problem, patients typically see great results within 3-5 visits. If this doesn’t work for you within that time frame, this treatment is not for you and we need to explore other options.

About the Author

Dr. Lily Semrow is a Board Certified Chiropractic Neurologist who focuses on Neuro-Structural Correction. She has a B.S. in Nutrition and a doctorate in Chiropractic. She has a passion for serving families, and helping people who could not get better through traditional and alternative means.

Want to keep up with future posts?

The post Case Study: Chronic Elbow Pain And Nerve Entrapment – Chiropractor In Holland appeared first on Holland, MI Chiropractors | Brain and Body Chiropractic.

In the case of spine pain, not only do patients love to see structural evidence of spinal degeneration, so do most of their doctors. Despite what the scientific evidence shows, they put two and two together, and voila! problem solved… or is it?

But… My Doctor Said I Have Spinal Degeneration.

First, I want you to take a deep breath and relax. A recent review shows that 37% of 20-year-olds and 96% of 80-year-olds walk around with spinal degeneration and don’t even know it. If your age is between 20 and 80, then your chance of having some kind of spinal degeneration falls between 37%-96%. This leads the researchers to conclude that what your doctor sees on your films probably has NOTHING to do with your pain.

Not convinced? Let me further elucidate the idea. Most patients seek care because of an initial severe acute event. This is often when they find out, for the first time, how messed up their spines look. Being vulnerable and scared, some end up paying for a yearlong treatment plan for chiropractic care, and some opt for surgery. What the patients, their chiropractors, and their surgeons don’t realize is that findings on their imaging are highly unlikely to represent any new structural change. In other words, most of what they see has been there for a long time and has NO association to acute events.

I often ask my patients, if you think the “bone spur” is causing your pain, how is it that you didn’t have pain the day before? As they know, the “bone spur” couldn’t possibly grow overnight, they realize it is not the source of their pain. They then understand why our treatments often focus on neurology and function, rather than on structure.

What about chronic pain, you say? It is fairly well-established that cognitive-behavioral problems play a big role in chronic pain patients. In other words, attention seeking mentality, medication dependency, fear, anxiety, and depression can all perpetuate pain. Furthermore, your brain gets darn good at sensing pain when the pain circuits get activated again and again. It is a vicious cycle that eventually turns into what we call central sensitization. That’s when a little stimulation causes disproportionate pain, just as it doesn’t take much to tick off a woman affected by PMS. Chronic pain certainly cannot be narrowed down to a simple structural cause.

What Then Is Causing My Pain?

One cannot really answer this question fully without explaining what “pain” is, but that’s for another time. For the time being, we need to understand that pain is a complex phenomenon. It is more a neurological problem than a structural problem. It is confounded by emotional factors, medication used, and compensation issues, just to name a few.

“One may realize that chronic low back pain illness may not stem from a mechanical spinal disorder alone…It would follow that expecting to identify a single cause for this symptom complex is impractical and any single test may not be a reasonable approach.”

A Good Old Physical Exam Over X-rays

If you truly understand spinal degeneration and pain as I understand them, then you will never go to a chiropractor, or any doctor for that matter, who replaces a thorough history and physical exam with a few X-ray films. Available evidence clearly shows that routine spinal x-ray/CT/MRI does NOT improve clinical outcomes. On top of lacking clinical benefits, these x-ray and CT scans subject patients to unnecessary radiation exposure. To avoid unnecessary imaging procedures, clinicians and patients ought to stop looking at pain and dysfunction from a pure mechanistic perspective. It is time to embrace functional and neurological testing and rehabilitation.

Degeneration can certainly lead to problems. When your spine lacks movement and becomes degenerated, the signals that feed your brain become distorted, but that’s another story. The take home message is that degeneration is rarely the sole cause of your pain. Don’t let anybody lead you to think otherwise.

References:

1. http://www.ncbi.nlm.nih.gov/pubmed/25430861
2. http://www.ncbi.nlm.nih.gov/pubmed/17088193
3. http://www.ncbi.nlm.nih.gov/pubmed/20332288
4. http://www.ncbi.nlm.nih.gov/pubmed/25180773
5. http://www.ncbi.nlm.nih.gov/pubmed/15062713
6. http://www.ncbi.nlm.nih.gov/pubmed/21214357

About the Author

Dr. Lily Semrow is a Board Certified Chiropractic Neurologist who focuses on Neuro-Structural Correction. She has a B.S. in Nutrition and a doctorate in Chiropractic. She has a passion for serving families, and helping people who could not get better through traditional and alternative means.

Want to keep up with future posts?

The post Is the “Bone Spur” Causing My Pain? – Chiropractor in Holland appeared first on Holland, MI Chiropractors | Brain and Body Chiropractic.