Posts Tagged "spinal facet joints"

Dizziness

Posted by Marc Croker | 0 comments

Dizziness, or vertigo, is a very debilitating symptom to suffer from. Many people with pain can simply put up with it and get on with their day however the feeling of dizziness can stop you dead in your tracks.  It is not easily ignored and many people are left to suffer with it for many years.

The most common causes of vertigo are middle ear infection, Meniere’s disease, and positional vertigo.  It is this latter cause that is the most responsive to chiropractic care.  Positional vertigo (also called Benign paroxysmal positional vertigo) is triggered when the head is placed in a particular position and severe dizziness is felt until the head is moved into a different position.  Nystagmus (rapid involuntary movements of the eyes) also occurs with positional vertigo. It is often the result of head or neck injury that may not necessarily be traumatic in nature.  Anything that causes inflammation to arise in the upper cervical spine has the potential to cause dizziness.  It is thought that the reason for this is that there is irritation to the proprioceptors of muscles, tendons and joints in the neck which causes abnormal positional messages back to the brain effectively confusing the brain as to where the head is in space.

As the vertigo is triggered by neck movement, chiropractors find that restoring normal neck function by way of manipulation, massage and stretching, can significantly alleviate the dizziness symptoms.  The most common tissues involved in patients presenting with vertigo are the suboccipital muscles which are taut and tender to touch, and the facet joints of C12 and C23.  Of course the biggest concern that chiropractors have with regards to dizziness is that a rare cause of this disorder is vertebral artery insufficiency.  In this condition sudden strong rotational or extension movements of the neck can cause vertigo by reducing blood flow to the brain.  This can also give rise to stroke or stroke like symptoms.  As such it is imperative that vascular insufficiency be ruled out as a cause of vertigo.  This can be done by doppler ultrasound or to a lesser extent by a vertebral artery occlusion test.

Clinically many patients with vertigo respond very well to chiropractic care and are grateful for being able to live without this debilitating condition.  Positional vertigo does tend to recur in much the same way that headaches or general neck pain recurs due to the activities of daily living.

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Neck spur and MVA

Posted by Marc Croker | 0 comments

In November 2002 a 55 year old woman suffered a car accident on the way home from work. She was sitting in the rear of a stationary car with her head turned slightly to the right. The car was rear ended and she had to have the next three weeks off work as she was experiencing neck pain and severe headaches. Her headaches were felt around her forehead on both sides and she had some light-headedness. She saw a physiotherapist three times a week for the next six months.

In May 2003 this woman started to feel severe pain around her right shoulder blade and pain into her right arm. She reported a tingling sensation in the 4th and 5th fingers and numbness in her right index finger. She was unable to turn her head fully to the right and was starting to get some lower back pain and pain in her right hip. She was still suffering from neck pain and headaches.

She presented to this clinic seven months after the accident. On examination this woman could not turn her neck to the right hand side and felt pain in her arm whenever she tried. The examination revealed that she had inflammation of the facet joints of C23, C67, T23 and the rib on the right at the same level, and L5S1. She had limited movement of her neck in all directions together with neck pain and pain in her right arm on most movements.

X rays and CT scans revealed disc degeneration at C45, C56 and C67 with bony narrowing of the foramina where the nerves exit the spine at C56. There were large bone spurs narrowing the spinal canal, the lateral recesses and the exit foramina on both sides. She had recently been told that an operation was needed to remove one of the spurs in her neck.

Chiropractic manipulation was initially performed on the joints below the level of the degeneration, at C67 and some soft tissue massage was also utilised. Her treatments were initially 2-3 days apart and after 6 visits this patient reported feeling pain free for the first time in 7 months. After 11 visits she found that the pins and needles and numbness also went away and that she did not feel the need to have an operation to remove the spur in her neck. Her treatments at this stage were only once per month and incorporated treatment for her upper neck pain and headaches which also subsided quickly.

This woman has continued her chiropractic care for the purpose of good spinal health and to prevent any recurrence of symptoms that may arise due to the degeneration in the lower neck. As of her most recent visit in May 2010 she continues to do well without any of the symptoms that she had sustained from the car accident.

It is important to note that having degeneration or arthritis anywhere in your spine is not necessarily a contra indication to having chiropractic treatment. In many cases the degeneration is not severe and can be successfully treated. In severe cases the arthritis is not the level of the spine causing the pain. It is often a level above or below the level of the arthritis responsible for the symptoms as the degenerated level is simply not moving at all and not capable of being strained. This is unlike the levels above and below that are now working harder than they should be to compensate for the arthritis. It is a common experience for a patient to present with lower back pain without any evidence of arthritis in their lower back but have severe arthritis in the neck without any neck pain.

In summary arthritis should give you a sense of stiffness or a lack of ability to move fully in one or more directions but it shouldn’t be painful. If there is pain associated with spinal arthritis then the painful joints can be treated with manipulation and the patient returned to a pain free state. Joints can only be inflammed if they still have some function left in them.

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Arthritis

Posted by Marc Croker | 0 comments

Most people suffering from back or neck pain are suffering from arthralgia (pain in the joints). Arthralgia is caused by inflammation in these spinal joints. If inflammation remains in a spinal joint over many years it erodes the joint surfaces and results in spinal arthritis (or spinal degeneration). Arthritis literally means “joint inflammation”.

Inflammation in the spinal joints ->  Arthralgia ->  Intermittent back pain + TIME  = ARTHRITIS

Chiropractors identify inflamed spinal joints and endeavor to restore normal function to that segment with the intention of minimising the arthritic process. Arthritis will cause recurring pain and stiffness of that part of the spine.

Spinal arthritis is not reversible. Chiropractic care and a lifetime of healthy living can prevent the arthritic process in the spine.

Many patients of this clinic have come in and told me that they have arthritis and that nothing can be done. This couldn’t be further from the truth. Most people with severe arthritis will not complain of pain at the same level as their arthritis. In fact most of the pain that they suffer from is usually a few vertebral segments away from the degenerated level. The reason for this is that the degenerated level is not moving very much and it passes the strain onto neighboring joints. These joints become inflamed because they are doing more work than they should be. Treatment to the degenerated level will depend upon the severity of the arthritis. If there is only mild to moderate arthritis chiropractic manipulation can restore some movement to the degenerated level thus relieving pain and restoring movement. In severe arthritis the pain is usually coming from a different level of the spine and it is this level that is treated and not the arthritis. The take home message is that you can usually get people out of pain regardless of the amount of arthritis. However the greater the amount of degeneration the greater the time it takes to alleviate the pain.

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