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Posts Tagged ‘chiropractic’

Pain is one of the most common reasons that people visit my office for treatment. That said, I thought I’d write a little bit on the topic.

Interestingly, pain doesn’t occur where you “feel” it or believe it to exist. In fact, pain really isn’t a “thing”. Pain is a perception triggered by the activation of certain areas in the brain. These “pain centers” (the neurology can get quite complex, so I’ll keep it simple) in the brain receive signals from specific nerves that have pain receptors (nociceptors) on them. So in the case of low back pain, for instance, the nociceptors harbored in the spinal joints, muscles, etc. get stimulated which then send nerve transmissions to be interpreted by the brain as pain. It’s because of this reason that “nerve blocks” work; basically blocking the signal to the brain. Now, what do we do about pain (other than a nerve block)?

Well, that of course depends on the type of pain you’re talking about. You see, nociceptors can get stimulated in different ways. Specifically, they respond to mechanical forces, inflammatory chemicals, and temperature changes.

As far as mechanical forces go; compression or stretching of a nerve(s) causes the stimulation of nociceptors, and results in the perception of pain. This can be caused by any number of structural imbalances, whether acute or chronic. The treatment for this type of “pain” stimulation is to balance muscle and joint function in order to eliminate the compression or stretching of the nociceptor. Furthermore, balancing muscle and joint function results in the stimulation of nerves that harbor mechanoreceptors (sensitive to light touch, vibration, position-sense, etc.) which actually act to: a) directly block the transmission of nociceptor signals to the brain, and b) travel faster to the brain in order to allow for the perception of something other than pain. By the way, “a” and “b” are the reason we rub an area of pain in order to relieve it.

Chemical pain, on the other hand, results from the stimulation of nociceptors via various inflammatory mediators/chemicals. So why do inflammatory mediators get released? Simple, because of tissue damage. This can certainly result from a structural abnormality that causes damage; in addition to a “chemical assault” that results in inflammation such as a food allergen or sensitivity, infection, toxin, or nutritional deficiency. All of the above can (and usually do) cause an inflammatory reaction. The chemicals involved include the likes of histamine, prostaglandins, thromboxanes, leukotrienes, etc.. As a result, these chemicals need to be kept at bay in order to prevent pain from being perceived. This is the reason why you may still sometimes feel pain after a chiropractic treatment. The treatment is designed to balance the structural components of dysfunction, however if there are still inflammatory chemicals circulating in response to tissue damage, the pain will persist. Once the healing begins, the pain should diminish and ultimately resolve. Chemical mediators of pain can be controlled by balancing muscle and joint function in order to prevent further damage, in addition to being controlled by nutritional substances that assist in healing and reducing inflammation.

Thermal or temperature-related pain… To relieve this…take your hand off the stove and don’t play with matches!

This idea of mechanical and chemical-mediated pain can be of extreme importance in diagnosis. Let me explain. If the pain experienced can be fully relieved by holding your body in a certain position, then your pain is solely caused by mechanical insults. However, if there is no position you can get into that relieves the pain, your problem most definitely has an inflammatory chemical component to it. And of course, if a certain position relieves some of the pain but not all of it, then there is both a mechanical and chemical component involved (this is most often the case). Whenever there is a chemical component to the pain, your doctor needs to have methods that can easily determine why you are inflamed. Remember, this can be the result of the normal repair process from structural damage, a chemical toxin, a food allergen or sensitivity, and/or a nutritional deficiency.

Several decades ago, it was found out that the mind cannot be separated from the body (through the field of psychoneuroimmunology). Now, if we were to dismiss the chemical component of pain, we’d basically be trying to separate the body from the body. Hopefully this helps to explain why your doctor may ask you to avoid certain foods, change your diet altogether, and take supplements even though your primary complaint is “physical” pain.

Dr. Robert D’Aquila – NYC Chiropractor – Applied Kinesiology

some information in this article was sourced from: Chris Astill-Smith, DO, DIBAK – metabolics.com

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You may have heard of the condition known as plantar fasciitis. If not, the word “plantar” refers to the sole (or plantar surface) of the foot, and “fasciitis” means inflammation of fascia. Therefore, plantar fasciitis refers to inflammation of the fascia that covers the sole of the foot. Fascia is simply soft connective tissue that exists throughout the body. It covers every muscle, bone, joint, organ, blood vessel, nerve, lymphatic vessel, etc.. Essentially, it helps support the structure of the body and provide some protection due its ability to act as a shock absorber.

Symptoms

The main symptom of plantar fasciitis is pain on the sole of the foot, especially on the heel. Additionally, it tends to hurt the most just after stepping out of bed in the morning, and may get better as the day goes on. However, it may also get worse with walking.

Causes

The primary cause of plantar fasciitis is overpronation of the foot; which is also referred to as “flat feet” or “fallen arches” in lay terms. If you think of the foot and its (plantar) fascia as a bow and arrow, the fascia would be the string and the bow would be the bones of the foot. In a biomechanically-sound foot, an arch is present which gives it the bow-like structure. Now, imagine if the arch (or bow) “dropped” (or straightened) as in overpronation; then picture what happens to the string on the bow (i.e.: the fascia). Essentially, it will have to stretch to accommodate the “flattening out” of the bones of the foot. It is this stretching and excessive tension of the fascia that can lead to the painful condition known as plantar fasciitis. Other factors that can contribute to plantar fasciitis are excessive pounding on the foot (as in jogging or jumping) and a tight achilles tendon or calf muscle.

Treatment

Conventional treatment can include the use of orthotics, anti-inflammatory medication, and stretching exercises.

Chiropractic and applied kinesiology treatment consists of correcting the cause of the problem. If this relates to overpronation, the muscles and joints of the foot and lower leg need to be evaluated and treated appropriately. Certain muscles may need stretching and lengthening, while others need strengthening and shortening. Also, joint motion will most likely need to be restored in the foot and ankle with chiropractic adjustments. The integrity of the ligaments may need to be supported through specialized applied kinesiology treatment and possibly through nutritional supplementation. Also, supplements to assist with quelling inflammation and to speed healing may be warranted. If necessary, orthotics may be prescribed to assist in maintaining the structural integrity of the foot. Whether or not orthotics need to be used permanently depends on the severity of the problem. Most importantly, a treatment plan needs to be designed to fit each individual’s needs.

Dr. Robert D’Aquila – NYC Chiropractor – Applied Kinesiology


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The rotator cuff makes the headlines in shoulder pain as much as the sciatic nerve in low back and leg pain. It’s almost like referring to any brand of tissue as a “Kleenex®”, as if they are one and the same. Because it’s so popular, I thought I’d talk about it a bit.

The rotator cuff is a group of four different muscles that help stabilize and move the upper arm bone (humerus). Specifically, the rotator cuff helps stabilize the ball-and-socket (or gleno-humeral) joint of the shoulder to prevent a dislocation; as well as help raise and rotate the arm. The muscles of the rotator cuff include the supraspinatus, infraspinatus, subscapularis, and teres minor. Usually, injuries to the rotator cuff involve a tear or degeneration of the tendon(s), most often the supraspinatus tendon.

The supraspinatus tendon is tucked under the (acromio-clavicular or AC) joint formed between the collarbone and the tip of the shoulder blade (acromion). This joint is on the top of the shoulder where the strap of your bag may rest. The supraspinatus tendon often becomes compromised during activities that include prolonged overhead movements; such as in sports like baseball, volleyball, tennis, acrobatics, etc.. Essentially, the tendon continuously gets damaged (possibly leading to a tear) from being “impinged” under the AC-joint. This can result in pain, weakness, and/or limited range of motion of the arm. There are other ways that injuries to the rotator cuff muscles occur, but impingement is a common one.

Now, when an injury involves damage to the rotator cuff muscle(s), they are usually deemed to be the problem. Conventional treatments are often directed at exercises for rehabilitating the rotator cuff, therapeutic ultrasound, oral or injected anti-inflammatories, or surgery in severe cases.

My approach to rotator cuff syndrome is a bit different. I usually find that injuries to the rotator cuff muscles and tendons often do not stem from an inherent problem with the rotator cuff. Instead, I usually find that the main problem lies within the larger muscles of the other shoulder joints that help to prevent the humerus from “impinging” under the AC-joint; and that help stabilize the shoulder blade and collarbone. Usually, when I get the other, larger muscles firing properly and restored to their normal length, the rotator cuff muscle(s) will not become compromised and then allowed a chance to heal and function properly. Additionally, I evaluate the joints and correct the movement of the shoulder blade, collarbone, and humerus when necessary. Specialized treatments for ligaments, tendons, connective tissue (fascia), and even skin may also be employed. Lastly, evaluating the cervical spine for joint dysfunction is critical, as the nerves that exit the cervical spine control the muscles of the shoulder. Eventually, a rehabilitative program targeting the appropriate muscles causing the problem is undertaken. This is aimed at preventing a recurrence of the problem and a return to normal activities.

So even if you’ve been diagnosed with rotator cuff syndrome or impingement syndrome; it would be prudent to have your entire shoulder complex and cervical spine evaluated for dysfunction to determine the ultimate cause of the problem.

Dr. Robert D’Aquila – NYC Chiropractor – Applied Kinesiology

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The trigeminal nerve is the fifth cranial (originates in the cranium/brain) nerve. It is responsible for giving us sensation on our face. Trigeminal neuralgia (aka: tic douloureux) refers to a condition where there is pain over the area that this nerve supplies. There are three sections of this nerve that supply sensation to either side of the face; as a result pain can be experienced in the eye, lips, nose, forehead, scalp, cheek, and/or jaw. Click here for the trigeminal nerve’s distribution.

This condition has often been found to be instigated by a cold breeze on the face (such as sleeping or driving with a window open), shaving, chewing, brushing your teeth, extreme opening of the mouth (such as in yawning), or sometimes for no known reason. Other, more serious problems like multiple sclerosis and tumors may be a cause. The more common reasons for changes in the function of this nerve have been deemed to be due to inflammation from an infection or pressure of a muscle or blood vessel.

The standard medical treatment for this condition is typically anti-convulsants, muscle relaxers, or maybe antibiotics (if it’s secondary to an infection). If medication doesn’t work, surgery may be the next step in conventional treatment.

My personal approach to this disorder is to restore proper motion and function of the cranial bones that this nerve passes through. This would include gentle cranial bone and cervical spine adjusting, in addition to balancing the muscles of the head, neck, and TMJ. Other factors affecting the alignment of the cranial bones, cervical spine, and TMJ would definitely need to be considered as well; which may include correcting the biomechanics of the pelvis and feet.

Nutritional considerations might include supplements that help control inflammation, reduce muscle spasms, and/or up-regulate the immune system. The most important thing to consider is that we are all individuals and treatment is based on your specific needs.

Dr. Robert D’Aquila – NYC Chiropractor – Applied Kinesiology

sources: http://www.icakusa.com/ + http://www.mayoclinic.com/health/trigeminal-neuralgia/DS00446

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The temporomandibular joint (TMJ) can be considered the most important joint in the body. In the 1950’s, two neurologists, Penfield and Rasmussen, stated that almost half of the motor and sensory nerves in the brain relate to the dental area. With this much attention being devoted to the dental area, you can be sure the TMJ has a large effect on overall body function.

Symptoms of TMJ dysfunction typically include the following: jaw pain, clicking or popping in the joint, decreased mouth opening, headaches, neck pain, tinnitus (ringing in the ears), and vertigo or dizziness. However, because of its large representation in the brain, I check it in on almost all my patients. Other than musculoskeletal complaints, endocrine gland imbalances can also result. This is because the “master” endocrine glands, the pituitary, hypothalamus, and pineal reside in the skull. And because structure determines function, these glands can dysfunction (and affect other glands they control) if the cranium is distressed due to muscular imbalances in the TMJ. Symptoms can vary and include but are not limited to: infertility, insomnia, hypo/hyperthyroidism, adrenal stress syndrome, PMS, increased or decreased appetite, digestive disturbances, etc..

Causes of TMJ dysfunction include muscular imbalances in the head and neck, faulty posture, malocclusion (irregular contact of the upper and lower teeth), grinding or clenching the teeth, chewing on only one side, pelvic imbalances, and even over-pronation in the feet.

Treatment of the TMJ generally includes leveling the head on the neck through chiropractic adjustments to the cervical spine, in addition to balancing the muscles of the neck and jaw. However, as stated above, the pelvis and feet can play a role in TMJ function as well.

The TMJ usually becomes dysfunctional because of other areas of the body that affect it; unless there has been direct trauma to it, as in boxing or a head injury. Therefore, I rarely go straight to the TMJ. But it is certainly worth checking no matter what the patient suffers from.

Dr. Robert D’Aquila – NYC Chiropractor – Applied Kinesiology

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The piriformis is a muscle that originates from the anterior (or front) part of the sacrum and inserts into the greater trochanter (the large “bump” on the outside of the upper thigh) of the femur. Its action is mainly to externally rotate (or “turn out”) the femur and hip.

The sciatic is a bundle of nerves composed of nerves from the lower spine (~levels L4-S3) and usually runs it course under the piriformis. Interestingly, it is believed that in roughly fifteen percent of the population, the sciatic nerve actually goes through the piriformis muscle.

Piriformis syndrome occurs when the piriformis is overly contracted, shortened, or tight and puts pressure on the sciatic nerve. The result of this is typically (the proverbial) “pain in the butt” and possibly down the back of the thigh, and sometimes pain that radiates into the low back.

Now, the question remains: “Why is the piriformis overcontracted, shortened, or tight in the first place?”. Well, realize that there are basically two muscles that cross and thus stabilize the sacroiliac (or pelvic) joint on either side. These are the gluteus maximus (or buttock muscle) and the piriformis. Typically when I encounter a patient with piriformis syndrome, I find the gluteus maximus to be under-functioning; i.e.: neurologically inhibited. As a result, the piriformis seems to be left to do the job of stabilizing the sacroiliac joint on its own. Obviously, by design, it was meant to have the help of the gluteus maximus muscle, and without it the piriformis may reflexively over-contract or shorten to give the most support possible. The result is then excessive pressure or irritation to the sciatic nerve. Bear in mind that there can certainly be other causes of piriformis tightening or contraction, however the example just mentioned seems to be the norm in what I’ve encountered.

Standard treatment is generally aimed at stretching the piriformis, in addition to deep massage and perhaps anti-inflammatory medication.

Typically, I’ll look to the reasons behind gluteus maximus muscle inhibition if I find that is the major cause of the tight piriformis. This can include pelvic joint dysfunction, ligament laxity in the pelvic joints, lumbar (low back) and sometimes cervical (neck) spine joint dysfunction, lower extremity (hip, knee, ankle, and/or foot) dysfunction, and in some instances nutritional deficiencies.

I aim to address the cause of the piriformis dysfunction in the first place. I have many patients who do not stretch their piriformis and still do not have piriformis syndrome; so we can be certain that the cause of piriformis syndrome is not a lack of stretching. If it was, everyone who didn’t stretch that muscle would have piriformis syndrome. Don’t get me wrong, stretching is often indicated, however my point is that the cause of the tightness needs to be addressed or this problem will generally recur and perhaps cause other complications.

There may also be a problem with an inhibited priformis on the opposite side or inhibited internal hip rotators contributing to or causing the problem. Because of the inter-relatedness of all parts of the body, there can be any number of primary causes for this condition. This article is meant to be a general introduction into the problem, so I’ll leave it there.

All in all, the muscles that support the pelvis should be evaluated for dysfunction. And the alignment and motion of the pelvic joints and lumbar spine need to be restored. Specialized treatment for ligaments, tendons, and fascia (connective tissue) may also be required. A home stretching and strengthening program may be given to help support the treatment, while helping prevent a future recurrence. Nutritional supplements designed to increase healing and reduce inflammation may also be of benefit.

Strangely enough, doctors used to doubt that piriformis syndrome even existed, but that thinking seems to be obsolete now . Dr. Janet Travell, John F. Kennedy’s doctor certainly believed in the occurrence of piriformis syndrome; as she has been reported to say that it was more common than spinal disc herniations (or “slipped disc”) as a cause of back pain.

Dr. Robert D’Aquila – NYC Chiropractor – Applied Kinesiology

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Ankle sprains are a relatively common injury. This often happens when someone is playing sports, but can certainly occur during everyday activities. An inversion sprain is the most common and results from landing on the outside of the foot resulting in a sudden twisting injury.

Signs or symptoms
Swelling, bruising, and pain are typical after an ankle sprain.

Causes
Again, this can be caused by a sudden twisting of the ankle if your foot lands on the ground the wrong way. But if this happens during everyday activities, there was mostly likely an imbalance in the coordination of the ankle muscles to begin with.

Standard Treatment
Generally this includes rest, ice, and elevation of the ankle during the immediate or acute stage. Additionally, taping the ankle and anti-inflammatory medications may be used. After the acute stage calms down a patient may go through a physical therapy regimen of stretching and strengthening, and proprioceptive training such as the use of a balance or wobble board. If there is a complete tear of any ligament(s), surgery would be warranted.

Applied Kinesiology Treatment
Restoring proper muscle function is paramount in achieving immediate and lasting results. Usually the muscles on the outside of the lower leg (the peronei) are injured and neurologically inhibited or “weak”. Getting these muscles to function appropriately is essential, as it is often the initial reason the ankle got sprained in the first place. This can be done through treatment directly to the muscles as well as through restoring normal ankle joint function. Additionally, the skin overlying the ankle very often requires treatment; as the stretching of it during the injury causes the neurological receptors in the skin to adversely affect the function of the adjacent muscles. After the inhibited muscles have been treated, it is often necessary to correct imbalances in muscles that have reflexively tightened or shortened as a result of compensation. This is done through specific techniques that address trigger points in muscles. Foot, ankle, knee, hip, pelvis, and spinal joints should then be evaluated to ensure proper motion. Joint dysfunction is corrected through standard chiropractic adjustments. Techniques to help restore ligament function and integrity may also be warranted. And lastly, nutritional support to aid in healing and help control inflammation may be indicated.

As you can see, there are a number of different techniques that can be employed to treat people with this condition, and what is used will depend on the individual. In my experience working with patients, many people re-sprain the same ankle multiple times. This is usually because the original sprain was never treated effectively. Please understand that being out of pain does not mean that optimal function has been restored. So don’t ignore an old (or new) injury.

Before I finish, I’d like to share a case about a patient with an old ankle injury. A gentleman in his mid-40’s came in because of a lumbar (low-back) disc herniation he suffered from chopping wood. He couldn’t stand up straight because of the pain. After several treatments he was out of pain, however, he still wasn’t standing up straight. We continued treating him, but his posture just would not budge. Again, he was out of pain, but he really was like the crooked man living in the crooked house. At some I decided to look further; specifically to his feet. At that point he remembered having suffered a sprained ankle some twenty years earlier. I immediately addressed his ankle biomechanics and he finally straightened up. In fact, because his ankle had been distorted for so long, he needed a heel lift inserted in his shoe as well. It may have been possible to help him without a heel lift, but it would have taken quite a while to reverse the compensations that had set in after twenty years. I would have went for the “crutch” of a heel lift as well if I couldn’t stand up straight!

It’s very common to see old injuries cause problems later in life.

Dr. Robert D’Aquila – NYC Chiropractor – Applied Kinesiology

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