When Are Headaches Dangerous?

This month’s topic will address dangerous headaches. To keep this in perspective, most headaches are NOT dangerous. In fact, tension-type headaches and migraines are very common and remain the focus of most health care providers and patients who suffer from headaches.  With that said, it’s important to discuss the signs and symptoms that might help all of us differentiate between headaches that are safe versus those which are not safe.

The most important factor to consider is when the “typical” headache is suddenly “different.” Some of these “different” symptoms may include slurred speech, difficulty communicating or formulating thought, seizures, fainting or loss of consciousness (even for a few seconds), memory lapses, double or blurred vision, profound dizziness, numbness in the face or half of the body, an “alarm” should sound off telling you to get this checked ASAP. These symptoms deviate from “the norm” and may be indicative of a more serious condition.

Signs of a dangerous headache include:

1. A headache that starts suddenly, especially if it’s of a severe degree.
2. Headaches that start later in life, especially after the age of 50.
3. A change in the quality of headaches.
4. Visual changes, including double vision or loss of vision.
5. Weakness, numbness, or any other neurological symptoms.
6. Fevers – especially of rapid onset.
7. Change in mental status including sleepiness, hallucinations, speech changes or confusion.
8. Weight loss.

If there is ever ANY doubt about a dangerous headache, your physician should be contacted.

Typically, the migraine patient will notice a fairly consistent set of symptoms and even though the headaches can vary in intensity, the sequence of events is fairly consistent.  Dangerous headaches are the ones that deviate significantly from that migraine sufferer’s “norm.”  For example, suppose a patient’s “typical” migraine is: aura (bright, flashy lights in the visual field or, a strange odor precedes the migraine about 30 min. before the headache strikes), followed by a gradually increasing pain in half of the head which worsens to a point of nausea and sometimes vomiting if something isn’t done to stop it (such as a chiropractic adjustment and/or some form of medication).  If this is that patient’s “usual,” than when any of the 8 items previously listed above accompany the headache, it should be further evaluated.  Evaluation will often require an EEG (electroencephalogram) and/or MRI (Magnetic Resonant Image). The EEG will test for any electrical signal changes in the brain and the MRI will show space occupying structures such as tumors, bleeding, infection, aneurism, and if performed with a contrast agents, arterial malformations (that is, abnormal networks of blood vessels).

YOU MAY BE A CANDIDATE FOR CHIROPRACTIC CARE FOR HEADACHES! LOG ON TO: http://www.painfree-greatposture.com

Neck Pain – Can Chiropractic Really Help?

Neck pain is a very common problem affecting up to 70% of the adult population at some point in life.  Though there are specific causes of neck pain such as arising from a sports injury, a car accident or “sleeping crooked,” the vast majority of the time, no direct cause can be identified and thus the term nonspecific is applied. There are many symptoms associated with patients complaining of neck pain and many of these symptoms can be confused with other conditions.  Wouldn’t it be nice to know what neck related symptoms are most likely to respond to chiropractic manipulation before the treatment has started?  This issue has been investigated with very favorable results!

The ability to predict a favorable response to treatment has been termed, “clinical prediction rules” which in general, are usually made up of combinations of things the patient says and findings from exams. In a large study, data from about 20,000 patients receiving about 29,000 treatments, was collected and analyzed to find out what complaints responded well to chiropractic treatment.  The results showed that the presence of any 4 of these 7 presenting complaints predicted an immediate improvement in 70-95% of the patients: 1. Neck pain; 2. Shoulder, arm pain; 3. Reduced neck, shoulder, arm movement; 4. Stiffness; 5. Headache; 6. Upper, mid back pain, and 7. None or one presenting symptom.  Items not associated with a favorable immediate response included “numbness, tingling upper limbs,” and “fainting, dizziness and light-headedness in 4-12% of the patients.  The “take-home” message here is that was far more common to see a favorable response (70-95%) of the patients compared to an unfavorable response (4-12%), supporting the observation that most patients with neck complaints will respond favorably to chiropractic treatment.

So, what do we do as chiropractors when a patient presents with neck pain?  First, after gathering preliminary information such as name, address and insurance information, a history of the presenting complaint is taken. This consists of information including what started the neck complaint (if you know), when it started, what makes it worse, what makes it better, the quality of pain (aches, stiff, numb, etc.), the location and if there is radiating complaints, the severity (0-10 pain scale), timing (such as worse in the morning, evening, etc.), and if there have been prior episodes. Various questionnaires are included that are scored so improvement down the road can be tracked and a past history that includes a medication list, past injuries or illnesses, family history and a systems review are standard.  The exam includes vital signs (BP, pulse, height, weight, temperature and respiration), palpation, range of motion, orthopedic and neurological examination.  X-ray and/or other “special tests” may also be included, when needed. A review of all the findings are discussed and after permission to treat is granted, a chiropractic adjustment may then be rendered.

We realize you have a choice in healthcare providers.  If you, a friend or family member requires care for low back pain, we sincerely appreciate the trust and confidence shown by choosing our services and look forward in serving you and your family presently and, in the future.

YOU MAY BE A CANDIDATE FOR CHIROPRACTIC CARE FOR NECK PAIN! FOR A FREE NO-OBLIGATION CONSULTATION CALL 262-251-8306

The Little Known Secrets to Treating Degenerative Discs

Degenerative disc disease is rampant in America.  It affects almost everyone to a certain extent, but roughly 65 million American get pain from it every year.  But, what is it ? and, what can be done about it ?

Degenerative disc disease (DDD) is really another term for arthritis of the spine.  The discs of the spine are located between the spinal bones (vertebra).  They are made of a tough outer layer (the annulus) and a soft inner layer (the nucleus).  The discs allow the spine to bend and give your body flexibility.  They also act like shock absorbers, which take the pressure off your bones when you jump run or walk.

Unfortunately, just like the shock absorbers in your car, discs wear out.  The process is called DDD.  It starts when bones of the spine get out of position and cause more pressure on weaker parts of the discs.  These parts will tear a little bit and swell.  This will cause some pain.  After a while, if left untreated, the swollen area will attract calcium and you will get arthritis in the area.  That leaves the area stiffer and more prone to injury.  The arthritis will progress throughout your life if left untreated.

The disc is just like a shock-absorber in your car that wears out faster, the harder you are on it.  Wear and tear on your spine, speeds up arthritis.  If you injure yourself often, have bad posture, lift heavy things, run with bad shoes, etc., you will wear out your discs faster.

You can wear out a disc at age 20 or age 90, it all depends on how badly it has been injured or mis-treated.  The pain from DDD is usually at its worst between ages 30 and 60.  After 60 elements of the disc that feel pain die off, as the bones fuse together.  The pain may lessen, but the stiffness remains.

A common comment I hear from patients is “ I went to see Dr. So and So, and he told me I have the spine of a 80 year old”.  I usually am polite when I hear this and nod my head.  But in the back of my mind I am thinking “Dr. So and So, doesn’t know much about DDD.”  I’ve seen 80 year olds with no DDD whatsoever and I’ve seen 25 year olds with discs that are completely destroyed.  DDD gets worse over time, but wear and tear is the biggest reason discs wear out.

What can be done if you have a degenerative disc ?  You will need to address the problem from multiple angles.  First,  the bones around the disc need to be in proper alignment.  If they are left mis-aligned the disc tissue will continue to be swollen and wear out.  So spinal and posture re-alignment is the key to helping the disc heal.

From there, dietary and lifestyle changes will need to be made to keep the disc healthy.  Adding anti-oxidants and omega-3 fatty acids to the diet help decrease inflammation.  Lifestyle changes like quitting smoking and heavy drinking definitely help.  Also, sleeping on the correct mattress, wearing good shoes and sitting in better chairs will help take pressure off the spine and help the area to heal.

For more information on degenerative disc disease, log on to: www.newbackpainreliefinfo.com

Fibromyalgia Syndrome & Whiplash Trauma

A number of studies have linked Fibromyalgia Syndrome to physical trauma, including whiplash injury.

In their 1992 book, Painful Cervical Trauma, Diagnosis and Rehabilitative Treatment of Neuromusculoskeletal Injuries, C. David Tollison and John Satterthwaite state:

“A particularly frustrating group of patients are those with a typical whiplash injury who, rather than gradually improving, actually seem to progressively develop a generalized chronic pain state identical to the fibromyalgia syndrome.”

Tollison and Satterthwaite state that fibromyalgia follows trauma approximately 22% of fibromyalgia patients.

In 1992, Greenfield and colleagues reviewed 127 cases of fibromyalgia and determined that 23% were triggered by a traumatic event. They also noted that patients suffering from trauma fibromyalgia were more disabled than those suffering from primary (non-traumatic) fibromyalgia.

In 1994, Waylonis and Perkins evaluated 176 patients who had been suffering from post-traumatic fibromyalgia. The traumatic cause was determined to be whiplash injury in 61% of the subjects. Years after the initial diagnosis, “eighty-five percent of the patients continued to have significant symptoms and clinical evidence of fibromyalgia.

In 1997, Buskila and colleagues studied the relationship between cervical spine injury and the development of fibromyalgia syndrome. They assessed 102 patients with neck injury and a control group of 59 patients with leg fracture. Twenty-two percent of the neck injury patients developed fibromyalgia, while only 1.7% of those with leg fracture developed fibromyalgia. The authors concluded “fibromyalgia syndrome was 15 times more frequent following neck injury than following lower extremity injury.”

In 2002, Al-Allaf and colleagues stated that 25% to 50% of those with Fibromyalgia Syndrome have physical trauma immediately prior the onset.

In 2003, Neumann and colleagues evaluated the outcomes of 78 post-traumatic neck injury fibromyalgia cases. They determined that 60% were still suffering from their fibromyalgia symptoms at the three-year follow-up. They also determined that nearly all of the persistently symptomatic patients were women, indicating that whiplash fibromyalgia recovery is worse in women than men.

In 2005, Samuel McLean and colleagues from the University of Michigan Medical Center established the criteria to assign fibromyalgia to whiplash trauma. They state:

“To summarize, there are abundant data suggesting that it is biologically plausible that physical trauma, acting as a stressor, could lead to the development of chronic widespread pain, as well as a number of other somatic symptoms.”

“Using these above attribution elements, the association between fibromyalgia and motor vehicle collision meets criteria one (temporal association), two (lack of alternative explanations), three (biological plausibility), six (analogy), and possibly five (re-challenge). This meets or exceeds the recommended threshold for suspecting a causal relationship between an exposure and subsequent illness. To put the relationship between fibromyalgia and trauma in context, there are at least as much data supporting this relationship as there are for many other accepted environmentally associated rheumatic diseases.”

“Thus, trauma may be only one of many types of stressors capable of producing symptoms characteristic of fibromyalgia.”

For more information on how fibromyalgia can be treated log on to: www.stopyourfibronow.com

Arch Supports…“JUST SAY NO!”

Almost every doctor or foot expert in the country will tell you to pick shoes that have “good arch support”.  However, a study performed in the British Journal of Sports Medicine reviewed 35 years of research on footwear.  They concluded that there is no evidence whatsoever, that arch supports either treat or prevent injuries.  None.

They even contacted all the major shoe companies and asked for their research.  None replied.  What that means is, they either don’t have any research, or the research they have, shows their shoes don’t work.

The same goes for all the orthotics on the market.  Its all smoke and mirrors.  There is no evidence that these gadgets work.

From what I have observed over the last fifteen years in my office, arch supports actually make your body worse.  Arch supports tend to do the following:

1. They make your body posture slump forward.
2. Your breathing will be more restricted when wearing arch supports.
3. Your gait will be more restricted.
4. Your feet will tend to pound at the ground when you walk.
5. Arch supports limit your ability to change directions, causing decreased sports performance.
6. Your body will be more unstable when wearing arch supports.

You can test these things for yourself.  Do the following tests, first without shoes, then with shoes on.  (95% of shoes have arch supports in them)

1. Have someone stand in back of you and gently push on your shoulders.  See if you are more stable with shoes or without.
2. Have someone look at your posture, how does it look?
3. Take a few deep breaths see if you get restricted.
4. Walk around a little.  Do walk tall or do you slump over.  Do you pound the floor?
5. Shuffle around a little and see you change direction (move like playing tennis or shadowboxing)  Is you ability to change direction better, the same or worse with the shoes on.

Some of these tests, you may not notice a difference.  But, for most, you will.  Sometime it can be very dramatic.

What’s the best type of shoe ?  Time after time, when I have performed these tests with people, the best shoes turn out to be a flat, flexible shoe with a wide toe box.  A shoe with a small heel is good for most people, provided the back of the heel is the highest part of the shoe.

Vibram five finger shoes are the best by far, but they look weird and aren’t everyone’s style.  MUDD’s women’s shoes are perfect, I’ve never seen a bad shoe from them.  The have a nice size heel and women usually say they are the most comfortable shoe they own.  Cheap flat tennis shoes like Chuck Taylor’s or PF Flyers work out great.  I used to recommend Sketcher’s, however, in the past couple of years the company got sucked into the arch support vortex, and they are doing strange things with their shoes.  So I can no longer recommend them.  New Balance has some OK shoes, but all of them need to be altered slightly to make them work right.

For more information on shoes and other health topics, log on to: www.painfree-greatposture.com or if you have foot problems and want more info., log on to: www.stopyourfootpain.com

Whiplash: What Are The Odds of a Permanent Injury?

I’m sure you’ve heard someone claim, “…you’re not really injured – you’re just going for a big settlement!”  Or, “…that person isn’t really hurt, they’re just in it for the money!” Though there are cases that may fit this scenario, the majority of people who are injured in a motor vehicle collision would gladly forfeit any settlement to have their health and sometimes their life back. So, where in this process does the truth lie?  Do most people “fake” their complaints or, are they really in pain? And, is there a way to determine who is more likely to suffer with problems long after their case is settled?

To answer this question, the Quebec Task Force (QTF), published two studies to investigate what types of whiplash injuries, which they term “whiplash associated disorders” (WAD), sustained in a rear end or side impact motor vehicle collision might end up with no residual injury vs. those more likely to become permanently disabled or impaired. The first of the two studies published in 1995 introduced 3 categories of injuries:

1. Those with neck pain, stiffness or tenderness only – no clinical (exam) findings;
2. Neck complaints and clinical findings including decreased ranges of neck motion;
3. Neck complaints and loss of neurological function including numbness or weakness in arm strength and/or altered reflexes.

The QTF then set out to investigate whether this approach could indeed accurately predict those more vs. less likely to end up with significant disability with ongoing problems.  They published these results in 2001 and found if they broke down the 2nd category into two groups, those with vs. without neck motion loss, those patients who fell into the 2nd group (with neck motion loss) and the 3rd group (those with neurological signs) were more likely to suffer long term disability compared to those in groups 1 and 2a (without neck motion loss).  However, these conclusions have been challenged by many as being too simple because they do not include the psychological problems like depression, anxiety, and poor coping abilities, all of which play an important role in predicting long term disability.  Also, treatment strategies must include aspects to deal with the post-traumatic stress disorder, anxiety, depression and coping, not just the biological injury aspects. A convincing study published in 2008 looked at 226 studies on this subject and reported on 7 prognostic factors and found that 50-75% of people with current neck pain will report neck pain again 1-5 years later. Older age and psychosocial factors including psychological health, coping patterns, and the need to socialize were the strongest predictors.  Three other potential predictors that require more investigation include the presence of arthritis, genetic factors, and compensation policies.

The bottom line or best advice to minimize our chances of having chronic, disabling neck pain after a car crash is, don’t stop living!  That is to say, carry on with work and hobbies as much as you possibly can so that you don’t fall into the negative spiral of disability.  If you feel yourself slipping, get help sooner than later!  Pain relief and function restoration are strong goals and chiropractic has been found to be one of the first and most effective forms of treatment recommended by all treatment guidelines published on whiplash management. Comparing potential side effects, medications carry a significant list of negative effects while chiropractic carries very few and, a host of positive benefits.

We realize that you have a choice in where you go for your health care needs and we truly appreciate your consideration in allowing us to help you through that potentially difficult process.

YOU MAY BE A CANDIDATE FOR CHIROPRACTIC CARE FOR WHIPLASH! FOR A FREE NO-OBLIGATION CONSULTATION CALL 262-251-8306

Can Car Accidents Cause Fibromyalgia?

Fibromyalgia is one of those diagnoses that is pretty loose.  The name itself doesn’t mean much.  Fibromyalgia translated into English means muscle pain.  So if you have aches and pains all over, your doctor may tell you, “you have fibromyalgia.”

There is a diagnostic criteria that has been developed that says if you have 11 of 18 common tender points, you have fibromyalgia.  The problem is, you can have 11 of those points become tender for a variety of different reasons.  So fibromyalgia may not be the most accurate diagnosis.

This brings me to my point about car accidents and fibromyalgia.  Neck injuries sustained during car accidents can cause pain in the muscles all through the body.  It effects mainly the neck, but you can get pain in the back, arms, head and legs.  The pain can travel from day to day and it can vary in intensity.  If the injuries from the car wreck are not treated properly, they can lead to a lifetime of pain.(1)

Typically these neck injuries are called whiplash.  But that diagnosis is only made during the first few months after the injury.  This is because many doctors have been trained to think that whiplash will heal itself within a few months after the injury.  This idea is totally false according to the vast majority of scientific medical evidence.

So, you may show up at a doctors office years after your injury, telling him/her that you have pain that started after the crash.  Over the years it may have gotten progressively worse.  The doctor will diagnose you as having fibromyalgia, because there is no diagnosis code for chronic whiplash.  Even if there was, he/she wouldn’t look at it that way, because of their training.

In my experience, in successfully treating fibromyalgia, a minimum of 2 out of 3 cases have been whiplashed.  It could be from a car wreck, a fall or even a sports injury.

To find out more about how I treat fibromyalgia log on to: www.stopyourfibronow.com
For more information regarding car accident injury treatment, go to: www.thechiropracticimpactreport.com.

(1) “The Fluctuation in Recovery Following Whiplash Injury”, Injury, Volume 36, Issue 6, June 2005, pages 758-761

Dr. Kramer on “What’s Cookin”

Last month I was on the local TV show called What’s Cookin’ with KC Thorson.  She interviewed me about nutrition.  It was a great little discussion filled with lots of information.

My son’s cub scout troop was there to watch and they had a blast sitting in the audience with big head phones on.

We talked about a variety of hot topics in nutrition and then KC made an excellent pizza.

To check it out, log on here!

Back School 101… 3 Ways To Prevent Making Your Back Pain Worse

Chiropractic care for patients with low back pain (LBP) not only includes spinal manipulation or adjustments but also patient education in regards to heat/ice, performing daily activities and exercise.

Heat vs. Ice: This topic is controversial, as often, patients will be told by their friends and family to use the opposite of what we may recommend to our patients. In general, when pain is present, there is inflammation… so use ice to reduce swelling and pain. When heat is inappropriately utilized during this inflammatory phase of healing, vasodilation or, an increase in blood supply to the already swollen injured area often results in an increase in pain. The use of heat may be safely applied later in the healing process during the reparative phase of healing, but as long as pain is present, using ice is safer and more effective.

Daily Activities: Improper methods of performing sitting, bending, pulling, pushing, and lifting can perpetuate the inflammatory phase, slow down the healing process, and interfere/prevent people from returning to their desired activities of daily living, especially work. Improperly performing these routine activities is similar to picking at scab since you’re delaying the healing process and you can even make things worse for yourself.

Exercise: There are many exercises available for patients with low back pain. When deciding on the type of exercise, the position the patient feels best or, the least irritating is usually the direction to emphasize.

When bending backwards results in pain reduction (referred to as “extension-biased”), standing and bending backwards, performing a sagging type of pushup (“prone press-up”), laying backwards on large pillows or on a gym-ball are good exercises. The dosage or duration exercises must be determined individually and it is typically safer to start with 1 or 2 exercises and gradually increase the number as well as repetition and/or hold-times. If sharp/”bad” pain is noted, the patient is warned to discontinue that exercise and report this for further discussion with their chiropractor. It is normal and often a good sign when stretching/”good” pain is obtained at the end range of the exercise.

We recognized the importance of patient education in our approach to managing low back pain cases, and look forward in serving you and your family presently and, in the future.

YOU MAY BE A CANDIDATE FOR CHIROPRACTIC CARE FOR LOW BACK PAIN!  FOR A FREE NO-OBLIGATION CONSULTATION CALL 262-251-8306

Why I Wear Vibram Five Fingers

A few months ago I started wearing Vibram Five Finger shoes after reading the book “Born to Run” by Christopher McDougall.

I’ve been an advocate of barefoot training for almost 8 years now and I have been working out in stocking feet or barefoot most of that time.  I started doing it in order to overcome metatarsal fractures to my right foot.

All of the experts told me I needed arch supports, but when I wore them, my feet hurt worse.  In fact, I broke the fifth metatarsal again while in my arch supported shoes.

Then I started working out barefoot and it was the only time my feet didn’t hurt.  In my office, I would wear a dress shoe that I had custom tailored to have no arch support.  It worked better than “off the rack” shoes, but I still had some pain in my feet and in my back after a long day of treating people.

In treating my patients, I and several doctors from around the country, have noticed that people who wear arch supports have bad posture.  This is contrary to what the experts tell you when you buy them.  We have suggested that our patients wear flat shoes with no arches and the results have been excellent.

A few months ago, I bought the Vibram Five Fingers and to break them in, I wore them to the office.  They looked funny with my white coat and tie, but my patients got a kick out of them.  At the end of the day, I was less tired and much less sore.  So I decided to make them a part of my daily wardrobe.  I love them.

It is not a totally easy transition.  I did notice that if I have to maintain good posture or my feet will start to hurt when I walk.  If I stand tall…no problems.

I ran two miles in them the other day and I feel really good.  I’m looking forward to doing some outdoor running this summer when the weather is nicer.

To find out more about how I treat patients with foot problems, log on to www.stopyourfootpain.com