Newsletter Blog

Understanding the Epidemic, and Rethinking Pain Management

By Dr. Michael Roney

 

Since 1999, deaths involving opioids have quadrupled. Just a few short years ago, more than 14,000 people died from overdoses involving these drugs. Another 2 million people mistreated or depended on opioids for their relief. Insufficient pain management paired with the epidemic of prescription opioid overuse and mistreatment has taken a stark toll on thousands of people across the United States, attempting to seek relief for their pain. According to the Centers for Disease Control and Prevention (CDC), as many as one in four patients prescribed opioids long term for non-cancer pain under their primary care struggle with addiction. In addition, more than 1,000 people are treated daily in the ER for abusing prescription opioids.

 

Beyond the perils of addiction and overdose, prescription drugs that help to dull, or numb, pain may persuade an individual that a musculoskeletal (muscle or joint/movement) related condition is less severe than it really is, or that it’s healed. This misperception often leads to overexertion, a delay in the healing process, or worse – permanent injury. I’m writing to tell you that there’s other, natural/alternative (non-drug) approaches to pain management and correction.

 

Recognizing the Value of Natural Pain Relief/Control – Understanding the Underlying Causes AND CORRECTION.

 

In 2017, the American College of Physicians (ACP) updated its guidelines for the treatment of short and long-term low back pain. They advocated first utilizing non-invasive, non-drug treatments before turning to drug therapies. Their guidelines, published in the Annals of Internal Medicine, were based on a review of the latest randomized controlled trials and observational studies, citing the effectiveness, and appropriateness, of specific chiropractic care, heat/ice, massage therapy or acupuncture. Only when these aforementioned treatments provide little or no relief, the guidelines recommend patients should resort to medicines such as ibuprofen or muscle relaxants. Even then, their research indicates that such medicines possess limited pain-relieving effects. Furthermore, the guidelines indicate that prescription opioids should be the last effort for those suffering from low back pain, to minimize the risk of addiction, long-term use, overdose, and further injury.

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In 2016, the CDC released guidelines in response to the opioid epidemic, promoting non-pharmacologic treatments for chronic pain.

 

In 2015, the Joint Commission, known for their accreditation of more than 20,000 health care systems in the U.S. (including every prime hospital), acknowledged the value of non-drug treatments by adding chiropractic and acupuncture to its pain management protocols.

 

The Take Home:

Your body has warning signs (indicators) of dysfunction. Unfortunately, pain is often the last or more severe indicator of a problem.  Masking the pain indicator is like taking the batteries out of a smoke alarm (even though the smoke alarm is going off because it senses smoke!).  Listen to your body’s indicators.

Indicators other than pain include: headache, dizziness, poor sleep, fatigue, digestive issues, numbness/tingling, decreased range of motion, poor concentration.  Structural Shifts within the spine and nervous system contribute greatly to these indicators, and many times can be the solution to achieving correction in these cases.  Only Structural Corrective Chiropractors can correctly evaluate for Structural Shifts, and apply the correct treatment for these PHYSICAL conditions (instead of masking them with chemicals – medications).

 

 

What Is Text Neck?! And What Can You Do About It?

 

By Dr. Michael Roney

 

Are you suffering from neck pain? You may be reading a hard copy of this article, but then again it’s possible you’re reading this on your smartphone. Do you know anybody that doesn’t have a smartphone? Given their increasing popularity, it’s no surprise that neck pain is becoming more common. Are you aware that “text-neck” is actually a diagnosis that many medical doctors, physical therapists, massage therapists, and chiropractors are using? Yes, you read that correctly. The term “text-neck” includes the process of repetitive stress being placed on the cervical spine (neck) as a result of a prolonged forward head posture. Because of the overuse of smartphones, computers, and texting, people are looking down for longer and longer periods of time. Eventually, this causes the head to jut, or protrude forwards, increasing the weight and load placed on the vertebrae/joints of the cervical spine (neck). If this particular posture is assumed regularly, and for prolonged periods of time without intervention, it can result in straightening or reversal of the natural curvature in the neck.

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At this point, you might be saying to yourself, “Doc, my neck doesn’t hurt from staring at my phone, it hurts from staring at my computer all day.” You’d be right in saying so, as the same is true for routine computer users. With prolonged sitting for 8+ hours/day, the head and cervical spine (neck) often translate forward as well as the shoulders. Consequently, the muscles of the neck and upper back become over stretched while the muscles of the chest are shortened and tightened. Ideally, the head should be in line with the neck, and directly over the shoulders, ensuring that the cervical spine evenly distributes the weight of the head evenly.

 

For example, visualize holding a bowling ball with two hands against your body. Picture holding that same bowling ball with your arms straight out in front of your body. Which is more difficult? Holding the bowling ball straight out in front of you is much more difficult than keeping it close, due to the torque generated by the increased distance. For every inch that the head is ahead of the shoulders, the weight of the head on the spine is increased by an additional 10lbs. When your head is in front of your neck and shoulders, the muscles of the neck and upper back have to compensate, which is one of the most widespread causes of neck, shoulder, and upper back pain.

 

I won’t tell you to quit your job or stop texting; it’s not that simple for most of us. It’d be very beneficial, at the very least, to cut back though. Here are some tips you can practice and perform instead.

 

  1. Limit your usage and time spent assuming poor posture – It sounds crazy, but it’s that simple. Give yourself time away from your computer, desk, or phone, and your neck will thank you! Social media isn’t going anywhere anytime soon, and at the very least, hold your phone up in front of you at eye level rather than in your lap. The rule of thumb, is the bottom of your monitor/screen should be at eye level. So raise your phone or monitor, and also check with your job to see if a standing desk is a possibility as well. Not only will your neck thank you, but your shoulders and mid-back will too.

 

  1. Take a break – If your job requires you to use your phone and computer, than it probably isn’t possible to limit your usage very much. For every hour you’re at your desk, take a 1-2 minute break to practice and reinforce proper posture. Try Bruegger’s exercise during each break (see below).

 

  1. Bruegger’s – For this exercise, you want to sit at the edge of your seat comfortably, with your legs hip width apart, and your feet turned out at a 45-degree angle. You want your palms facing forwards, with your arms at your sides, your shoulders drawn back and down slightly, and be sure to sit up in a neutral position with the crown of the head high. Make sure you don’t overextend (bend backwards too much), as to avoid putting too large a curvature in your low back. Take 5-10 deep breaths, making sure to fill the abdomen as you do so, avoiding any chest breathing. Repeat as needed (recommended 1-2minutes/each hour of sitting).

 

  1. Neck stretches – Cervical Range of Motion – You can stretch the muscles of the cervical spine and upper mid-back very easily, by performing cervical ranges of motion. When you feel restricted in a particular range of motion, don’t force it. Very, very gently apply some overpressure at the point of restriction, and be sure to perform them in the shower as well, as the hot water will help to loosen the muscles up. If you find yourself watching TV frequently, it’s also a great time to perform these. The ranges of motion you will want to perform include flexion (tuck the chin to the chest, bending forwards at the upper, not lower cervical spine), extension (looking straight up), lateral flexion (approximate ear to shoulder, not shoulder to ear), both sides, and rotation (look right, then left, and be sure to notice any differences in your ability to do so). The key is to go until you feel a restriction, but DO NOT force it! Hold for 10-15 seconds, and perform them 2-3x/day.

 

  1. Use a Cervical Roll – Towards the end of the workday, your neck needs a break. The natural curve of the neck resembles a C-shaped curve. As previously mentioned, it can become flattened or even reversed. An easy way to help restore the natural curvature is through the use of a cervical roll. Take a bath or kitchen towel, and roll it up length-wise. You can even use a few rubber bands, or duct tape to keep it rolled snuggly. Laying on your back, on a flat surface, place the towel-roll at the base of your neck, not under your head. If you find yourself with your head propped up, you need to move the roll towards the bottom of your neck. Next, the fun begins. Relax, for 15-30 minutes/day.

 

  1. GET ADJUSTED! – After low back pain, and before headaches, neck pain is the second most common reason people see a chiropractor. Chiropractic adjustments will help to naturally restore normal joint function, slow the progression of, and correct structural shifts, increase range of motion, and reduce/eliminate muscular tension.

 

As always, consult with a professional. It may take some persistence, especially if your pain is chronic (long-term) in duration, but stick with it, and be sure to stay properly hydrated as well, for optimal results.

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The Silent Killer…  9/10/2015

This week I want to talk about stress, and all that it can do to a body. It will be in two parts, so make sure you come back soon for the finale. Stress… a simple word we all know of; we’ve all used it as an excuse for a variety of things. Stress is when you feel pressure when your boss gives you a deadline to get something done. It is when your kids are in need and you are not sure how to help. It is when you have to pay a bill you are not sure you can pay off. It is when you get in an argument with your friends or family. It can also take on a physical form too, like when you sit too long, or when you stand too long. Any repetitive movement will put stress on the area that is repeatedly being used.

Stress can take on many forms and can have equally as many effects on you. When you are stressed, your Cortisol levels goes up telling your brain to switch to the sympathetic nervous system (or as we know it “fight or flight”) aspect of your automated nervous system. Cortisol imbalances due to stress also cause weight gain around the belly area, which is known as “dangerous” fat because it is an indicator of poor health and early death. When your brain is in its “fight or flight” response, your heart rate goes up, your adrenaline levels increase dramatically, more blood flows to the muscles (and away from your digestive tract) and pupils get dilated. The more important aspect of fight or flight response is what is ignored or slowed down. Digestion and absorption of nutrients slowed down significantly. Your immune system is ignored, and your healing of tissues stagnates.

The fight or flight response originated from cavemen times, when man had to hunt for their food and avoid predators, the response is a survival response when facing dangers of the wild. For ancient times, the fight or flight response ends when the hunt ends. For modern times, we hold this response from work, from our families and from life in general. Problems come when we don’t know how to drop this response and relax. When we hold this response for a prolonged time we build lactic acid in our cells and since the immune system doesn’t take priority, the lactic acid builds up in our bodies. This build up of lactic acid will cause joint stiffness and muscle soreness. Mental stress from constant sights of dramatic traumas is the primary cause of Post Traumatic Stress Disorder. When we are stressed, we are not in the best of moods resulting in negative thoughts. Accumulation of these negative thoughts will take its toll on our emotional health, which will result in psychological problems.

Stress effects all three phases of our lives physical, emotional and mental. When dealing with stress, we will have to take a three phase approach to relieving and treating stress. Stay in your comfort zone, there are different ways for different people to help relieve your stress. Yoga and meditation are good methods for the more mellow people. Jogging and hiking might fit the action/active types better. The most important part of these exercise is to drop the stressful thoughts. Keep in mind to do something fun and to have a change of pace from what stresses you out. Positive thoughts will help flip your nervous system to switch off the fight or flight response.

Hidden facts of Fascia – 8/24/2015

This week I would like to discuss a less known but very important part of your body. It is all over your body; it covers your organs and muscles. This covering layer is your fascia. Fascia is an elastic thin sheath like substance very similar to ligaments and cartilages in its structural components. It is used to wrap tissues together. It wraps around most major organs and holds it together. It wraps around every muscle cell, every bundle of muscle cells and around every individual muscle. It is used to hold muscles together and to separate different muscles. When it becomes tight or restricted, the muscle it wraps around in turn will tighten or tense up. When this happens, muscle will start pulling on vital structures such as the spine, hips, knees, shoulders, elbows, wrist, and even organs!

The two groups of muscles to the side of your spine is your lamina groove. These muscles wrap, move and protect your spinal columns. Tight and “ropey” lamina grooves will cause lower back pain and when untreated will pull and shift your spinal columns and each individual disc. When your spine is being pulled for a prolonged period of time, it will result in a shift in your spine such as scoliosis, kyphosis, and lordosis.

Fascial health is essential for both the upper extremities and the lower extremities. For the lower extremities, tight fascia will cause a shift by pulling on the hips and knees. When the hip is shifted, many problems will arise such as sciatica, pelvic tilts, and lower back pain. When the knees are shifted, you will have meniscus issues, ACL, MCL, LCL, PCL and patellar problems. Another common fascia issue in the lower extremity is plantar fasciitis; this is a result of tight fascia and muscles in the bottom of your feet and lower legs.

In the upper extremities, tight fascia will cause a shift by pulling on your neck, shoulders, elbows and wrists. Many rotator cuff and labrum issues are a result of tight fascia that is pulling on your shoulders. Shifts in the elbow will result in tennis elbow and bicep problems. A very common shift in the wrist causes carpel tunnel syndrome.

Most fascial problems originate from our poor posture and improper ways we use our bodies. When we have bad posture we hold our muscles and fascia in bad positions for a prolonged period of time. When this is repeated regularly, our fascia and muscle will contour our bodies to those bad positions. Many people will assume that fixing our muscles and adjusting our structures will fix these postural issues. It will work for a very short term basis, but because fascia is the wrapping of the muscles it will shift the muscle back to where the fascia was originally.

Fascia is very elastic so the best way to correct tight fascia is to manually stretch this fascia via myofascial release.  It is a slow process that requires a lot of patience, but when done correctly will have a prolonged effect and in many cases will solve your specific issue. This is why seeing a Licensed Massage Therapist that focuses on Structural Correction (and not just relaxation) is very important for getting these issues resolved.

Keep your back straight. Don’t sit for too long. When lifting either weights or for work, make sure you know your limit. These are all things you can keep and maintain proper posture, but remember when something goes wrong, make sure you address it as soon as possible. The longer you prolong your health problems such as shifts in your body, the more serious issues will arise. When you notice you have poor posture, make sure you come see me for a thorough myofascial release session.

You Shouldn’t Ignore That Pain In The Neck! 8/2/2015

In my previous two columns, I talked about breathing and how changing your breathing habits can help many aspects of your life and health. This week I want to talk about a region of our body that is crucial to our health and wellness. This vital part of our body is the neck. Your neck has many important tasks in your everyday life. You use it to hold up your most important organ – the brain and the skull.

It houses the cervical portion of our spine, where most bundles of nerves originate. Our trachea and esophagus passes along the front of it. Our arteries, veins, and nerves run along the side of our necks. We even have our thyroids sitting right behind the esophagus. For such a skinny region of our body, it sure is packed with vital parts.

From my experience as a massage therapist, the neck is by far the number one area of complaint that people have. Even if it’s not their primary complaint, their complaints will be related to some sort of neck problem (headaches, fatigue, digestive problems).

There are three main reasons people will complain about their necks. The first is a misalignment in the spine (a Structural Shift), second is tightness and tension with the muscles and third is we often hold our stress in our neck.

Structural Shifts happen as a result of sudden traumas such as a fall, car crash, or any kind of direct hit to the head and neck, micro traumas such as poor posture and ergonomics, and also stress. These Structural Shifts will cause an irritation in your nervous system and they can result in impinged nerves (sending and receiving bad signals) and blood vessels, put pressure on individual vertebrae, and lower your immune system. Your brain works by communicating to the body though your nerves, so when nerves are impinged your body is not getting the proper messages from the brain. This can result SECONDARY CONDITIONS: such as numbness and tingling, spastic movements, tight muscles, involuntary twitching, headaches, decreased range of motion, low energy and many many more symptoms.

Tightness and tension in the muscles can occur with poor posture, sleeping in poor positions, not breathing properly, and the way we move. When muscles are tight, they crunch up into balls or knots. When this happens in the neck, tight muscles will
impinge in the nerves and blood vessels. Impinged blood vessels will result in your brain getting less oxygen and other nutrients that are vital for your brain to function optimally. The result of this is that you can experience regular headaches and pain in the neck, trigger points and also pain.

Stress happens because our society is driven by negativity and we don’t take the time to let all of that go and think more positively. Stress will have physical, emotional, and mental effects on our bodies. When you are stressed your mind will be at a “fight or flight” mode and when your adrenalin and heart rate increase your muscles tense up. The more important aspect of “fight or flight” is that you draw focus of your brain
away from digestion, immunity and healing. The noticeable thing you can feel is pain and digestive issues.

Please treat you necks better and it will treat you better. Be mindful of your posture, ergonomics and sleeping positions. Also, be aware of your stress levels and the amount of tension in your muscles, as well as proper breathing. If you are experiencing any of these SECONDARY CONDITIONS you should consult with a Structural Correction Chiropractor or Massage Therapist. There is no better method
that can de-stress someone and address Structural Shifts like Structural Corrective Massage.  Remember, if you are taking Over The Counter medications to mask pain and tension, you are only covering up SECONDARY CONDITIONS and not addressing the PRIMARY CONDITION (Structural Shifts). The warning label on the bottle of drugs says that if you are taking this drug for more than two-weeks to consult an expert. The reason is that there is an underlying issue causing the pain that NEEDS to be addressed and not just covered up.

Exhale: The Art of Letting Go (continued from 7/6/15)

I just want to thank each and every one of you who took time to read my first segment of our blog.  We will have new material up every other week, and each topic is meant to open people’s eyes about health and wellness.  I will give tips along the way to achieve and maintain good health.

In my first segment, I showed the importance of using the proper muscles to take a breath in. I believe it would be a disservice of me to leave you off by talking about the proper way to inhale and not touch upon the other half of breathing which is the exhale. In my opinion the exhale is the more important part to breathing. What is an exhale? It is the completion to a breath. It is the release of gases from our body. It is the most natural and easiest way we can relax. It is the best and easiest way to swing our moods and thoughts.

When we exhale, we expel carbon dioxide from our bodies. This is the waste byproduct from the conversion of oxygen into energy that makes our body go. Another very important result of an exhale is reciprocal inhibition of all of our muscles or the relaxation of all our muscles. For the more advanced breathers an exhale can be a release of stress, worries and negative moods and thoughts. When you are breathing deeply, you are using your diaphragm to inhale. You are pushing your stomach out when you inhale; so when you exhale you suck your stomach back in. Make sure you release all the air in your lungs before you take your next breath. When you use your stomach to exhale, you are using six of the eight abdominal muscles in your body. Exhaling properly will give you a good work out on your abs too.

I will leave you with this thought, I want you to think of any problems that you might have. Now I want you to do a deep exhale, did that feel better? There is nothing in our world that a deep exhale can’t make better.

The Essence of a Breath                      7/6/2015

     Breathing, along with food and water, is one of our essential needs for survival. When we take a breath we inhale oxygen, nitrogen, and other important gases that our body needs. Our lungs use these gases and distributes it to every cell in our body. It gives our cells the appropriate energy to function properly.

When we finish using the energy, our cells produce waste byproducts in the form of carbon dioxide. Our exhale eliminates this byproduct along with relaxing your body – hence the importance deep breathes.

Along with the exchange of gases in our body, when we breathe our cranial bones move slightly to allow the cerebral-spinal fluid to flow.  Even though we do it every second of everyday, most of us are unaware of it. When we are told to take a deep breath it might seem foreign to some. When I tell people to take a deep breath, I notice that most people are breathing in a very shallow manner. I observe that when people breathe either their shoulder are moving up and down or their chest is expanding and contracting (versus diaphragmatic breathing). This is not the most efficient way to breathe. When our shoulders move, we are using our muscles from our necks and backs. When we breathe with our chest, we use the muscles from our ribs. All these muscles used are our secondary breathing muscles, which means that the muscle is either weak or has other movements it is responsible for. As a result these muscles can easily be overwhelmed. Also, we are not inhaling a full breathe of oxygen and other essential gases. Perhaps the more important impact of using our secondary muscles to breathe is that it will cause structural shifts. This will cause secondary symptoms such as fatigue, stress, irritability, light headedness, pain, digestive issues, immune disorders, and many more.

As we know, we have one primary breathing muscle in our body which is our diaphragm. The diaphragm is a long thin muscle that lies between our stomach and our lungs. It has only one function which is to make you breathe. So how we use our diaphragm to breathe is by pushing our stomach out when you inhale, and contracting our stomach when we exhale. This sounds easy enough, but when you try to do it may not come easily and will take some getting used to. I would recommend standing in front of a mirror when breathing to make sure your chest and shoulders are still when inhaling and exhaling. It might take some practice but work on it until it becomes second nature. It’s a small change that we can all do that can benefit us tremendously both in the short term and in the long term.

 John Feng, LMT

 John is a licensed Massage Therapist at Precision Chiropractic in Clifton Park, NY. John focuses on Structural Correction Massage.