Chiropractors
NECK PAIN
By Stephen Ducker, MD with Chambers Medical Group Neck pain can be from a multitude of causes such as acute trauma, disease, or chronic degenerative changes such as osteoarthritis. To fully understand the causes of neck pain, it is important to have some basic understanding of the anatomy of the cervical spine, the surrounding connective tissue, and the associated musculature. Each of the anatomic entities of the neck can be a source of disease and pain either independently or in conjunction with other structures. The cervical (C) spine is composed of 7 vertebrae (C1-C7), with an intervening disc in between each vertebral body. The cervical vertebrae are much smaller and more fragile than the remainder of the spinal column for various functional and anatomic reasons. Functionally, the cervical spine has greater range of motion than the remainder spinal column and structurally it is required to support less weight than the lumbar spine by comparison. Overall, the neck is responsible for support and movement of the head throughout rotation, flexion, extension, and lateral bending. As a result of these functional and structural attributes, the cervical spine is often the source of injury during even relatively minor trauma.
What Are The Best Chiropractic Techniques?
A chiropractic adjustment is a procedure in which trained specialists use their hands or a small instrument to apply a controlled, sudden force to a spinal joint. The goal of this procedure, also known as spinal manipulation, is to improve spinal motion and improve your body's physical function (definition from the Mayo Clinic). Chiropractic adjustments have been a common approach to health care for over 100 years and have shown to be effective for a wide range of health complaints. Some chiropractors utilize a variety of adjusting techniques while others may utilize only one or two techniques. Below is a brief review of some of the most common chiropractic adjusting techniques. Diversified Technique- This classic chiropractic technique was developed by D.D. Palmer. This is the most common of all chiropractic techniques and probably most familiar to patients. The Diversified adjustment entails a high-velocity, low-amplitude thrust that usually results in a cavitation of a joint (quick, shallow thrusts that cause the popping noise often associated with a chiropractic adjustment). Thompson Technique- The Thompson technique uses a precision adjusting table with a weighing mechanism which adds only enough tension to hold the patient in the ``up`` position before the thrust is given. The patient lies on a special table with sections that drop down. The chiropractor applies a quick thrust at the same time the section drops. The dropping of the table allows for a lighter adjustment without the twisting positions that can accompany other techniques. The object of the drop is to distract (open) the joint during the adjustment. The drop pieces assist the thrust, while minimizing the force required for the adjustment. Cavitation of the joint may or may not occur. Activator Method- This is a hand-held, spring-loaded instrument-based manipulation/adjustment protocol. Instead of forces being delivered by hand, force is generated with the small appliance that delivers a lighter, but quicker thrust than can be delivered by hand. Activator can be used as a primary treatment protocol for all patients or a selective method for patients who may not desire manual adjustment or where manual adjustments may be contraindicated. Instrument Adjustments- There are techniques, other than Activator, that include the use of adjusting instruments to deliver the adjustment to the patient. The objective of using an instrument is that you can apply an accurate ``line of correction`` and a controlled force with greater precision. Cox Flexion/Distraction Technique- This is a specific chiropractic technique that uses mechanical and hands-on adjustment utilizing a special table where the spine is tractioned and flexed forward. This technique is primarily utilized to treat cervical and lumbar disc herniations, non-disc spinal disorders, and to increase mobility of spinal joints. Extremity Adjustments- This is the application of chiropractic manipulation/adjustment to joints other than those of the spine, i.e., shoulder, elbow, wrist/hand/finger, hip, knee, ankle/foot/toe. Examples of conditions treated by extremity manipulation/ adjustment: carpal tunnel syndrome, joint impingement, gait dysfunction, or posture-related problems. Cavitation of the joint may or may not occur. Sacral Occipital Technique (SOT)- This is a specific chiropractic technique that uses triangular-shaped blocks usually placed under the pelvis of the prone patient to treat problems identified in the low back. Low force, slow pressure types of manipulations may be used to address joint problems identified in the skull. SOT may be used as an exclusive treatment technique or as an adjunct method of patient management. Gonstead Technique- Clarence Gonstead developed this technique which utilizes a very specific method of analysis utilizing nervoscopes (temperature gradient device), full spine x-rays, and palpation to aid the clinical decision-making process in deciding which segments to adjust. These precise adjusting techniques are done by hand, primarily in the P-A (posterior to anterior) plane, usually resulting in cavitation. Toggle Recoil or Palmer Upper Cervical Technique- This technique involves a quick thrust and release to the upper cervical vertebra (C1 and C2). The resulting recoil allows the vertebra to oscillate into its proper position. This original upper cervical specific approach is the basic template for other upper cervical techniques that apply high-, low- and no-force thrusts, or instrument-delivered forces for correction. These various techniques focus on joint dysfunctions in the upper cervical spine. The theory is that treatment of this area may also address problems throughout the entire body by decreasing pressure on the brain stem and spinal cord. Usually, no cavitation occurs. X-ray analysis, static and motion palpation, and nervoscopes are commonly used for making clinical decisions or which segment to adjust. -- Dr. Deryk Harting Florida Licensed Chiropractic Physician
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