All posts in Neck

Chiropractic & Sports Medicine

Chiropractic manipulation does not reposition a vertebra from a misaligned position to an aligned position. Rather, it is likely that manipulation breaks up adhesions present in the joints of the spine, which improves movement asymmetries and/or stimulates mechanoreceptors – thereby reducing spinal muscle excitability, enhancing proprioception and reducing pain.

While manipulation has been proven effective for the management of acute low back pain, a prospective placebo-controlled study by Senna and Machaly demonstrates that long-term chronic low back pain sufferers respond best to maintenance manipulations performed bimonthly for up to nine months. The authors suggest the occasional (Chiropractic) manipulations may allow for the “early treatment of any emerging problem, thus preventing future episodes of low back pain.”

My sports medicine and chronic pain therapy approach of using the DMS (vibration, percussion), EnPuls (radial shockwave), Piezowave (acoustic shockwave) and massage  in conjunction with chiropractic enhances the breaking up of disruptive and painful scar tissue.

  1. Tullberg T, Blomberg S, Branth B, et al. Manipulation does not alter the position of the sacroiliac joint: a roentgenstereophotogrammetric analysis. Spine, 1998;23:1124-1128.
  2. Cramer G, Tuck N, Knudsen J, et al. Effects of side-posture positioning anti-posture adjusting on the lumbar zygopophyseal joints as evaluated by magnetic resonance imaging: a before and after study with randomization. J Manip Phys Ther, 2000;23:380.
  3. Nansel DD, Peneff A, Quitoriano J. Effectiveness of upper versus lower cervical adjustments with respect to the amelioration of passive rotational versus lateral-flexion end-range asymmetries in otherwise asymptomatic subjects. J Manip Phys Ther, 1992;15:99-105.
  4. Nansel D, Waldorf T, Cooperstein R. Time course effect of cervical spinal adjustments on lumbar paraspinal muscle tone: evidence for facilitation of intersegmental tonic neck reflexes. J Manip Phys Ther, 1993;16:91-95.
  5. Lehman GJ, McGill SM. Spinal manipulation causes variable spine kinematic and trunk muscle electromyographic responses. Clin Biomech, 2001;16:293-9.
  6. Childs JD, Fritz JM, Flynn TW, et al. A clinical prediction rule to identify patients with low back pain most likely to benefit from spinal manipulation: a validation study. Ann Intern Med, 2004;141:920-928.
  7. Cleland J, Fritz J, Whitman J, et al. The use of a lumbar spinal manipulation technique by physical therapists in patients who satisfy a clinical prediction rule: a case series. J Orthop Sports Phys Ther, 2006;36:209-214.
  8. Senna M, Machaly S. Does maintenance spinal manipulation therapy for chronic nonspecific low back pain result in better long-term outcomes? Spine, 2011 Aug 15; 36(18):1427-37.
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My approach to chronic pain, muscle pain, joint pain, and  weight loss

Chiropractic. The goal of this treatment is to significantly decrease symptoms such as pain, tightness, stiffness, soreness, aches, and improve athletic performance, mobility, and your ability to perform general activities.

Laser. Evidence for the effectiveness of laser is strong. Patients feel the relief especially for knee pain and TMJ pain

Shockwave therapy. This form of medical treatment is acknowledged as a means for enhancing scar tissue mobility and breaking up muscle tightness and muscle and joint adhesions. It is also helpful for chronic pain reduction and improved mobility. It helps osteoarthritic symptoms with improved functional mobility and quality of life.

Along with laser, Deep Muscle Stimulator (DMS), shockwave therapy is effective for pain control of osteoarthritis of the knee, neck pain, low back pain, and increasing mobility.

Deep Muscle Stimulator Massage. Followed by hands on therapy, DMS is the most commonly utilized treatment in my office. Patients feel better after this type of massage than receiving a regular hand massage. They have significant improvements in pain, stiffness, and physical function.

Dietary supplements. I use a variety of products from Metagenics, Xymogen, Designs for Heath, and Standard Process for joint pain, arthritis, inflammation, and weight loss.

Widening the integrative approach to treatment

There is emerging evidence that integrating multiple conventional and alternative therapies such as chiropractic, exercise, laser, shockwave, DMS, lymph therapy provide the best results for patients.

If you are a person who still has pain and diminished mobility who has already explored other therapies and doctors but have been disappointed, I would like the opportunity for you and I to meet. I continuously evaluate the increasing body of evidence in support of new therapies, and I am confident in offering my patients a wider range of choices than standard chiropractic care.

Call 310-444-9393 for an appointment

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Chronic Pain, Foot Pain, Hip Pain, Inflammation, Neck Pain, Shoulder Pain, & TMJ Pain

If you have any of the above, have you tried Pneumatic Lymphatic Pump Therapy?

One of the most neglected systems of the body is the Lymphatic system. An innovative treatment for chronic pain, foot pain, hip pain, inflammation, neck pain, shoulder pain, & TMJ pain is Lymph Drainage Therapy (DLT). In my office I use state of the art technology called LymphaTouch for DLT. Benefits of the LympaTouch Pump Therapy include reduction in limb circumference, pain, increase in range of motion, scar mobility and improved functioning of the immune system. The immune system is stimulated through increased lymph flow. The additional flow carries more antigens to the lymph nodes, thereby increasing antibody/antigen contact. This has been found to help with chronic or subacute inflammatory processes — chronic fatigue syndrome, autoimmune disease, bronchitis, sinusitis, tonsillitis, laryngitis, arthritis, acne and eczema.

Call 310-444-9393 to schedule an appointment

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Pain Relief with PiezoWave Shock Wave Therapy

We are the first office in Los Angeles to offer the PiezoWave therapy. The PiezoWave machine supplies an acoustic wave used to target tissues at varying depths (0 to 20 mm). It is a very focused, precise, deep tissue therapy. The device locates myofascial trigger points in the muscles. These are hyper-irritable spots located in a taut band of skeletal muscle. They generate pain, both locally and in referred pain patterns, and often accompany chronic musculoskeletal disorders. PiezoWave is being used for regional pain, especially in the neck, shoulders, low back and hip areas. If you know you have tension headaches, temporomandibular joint pain, decreased range of motion in the legs, and low back pain, even if you have tried other therapies like laser I would suggest a trial of PiezoWave.

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Kinesio-taping & Neck Pain

I was recently asked a question about neck pain and Kinesio-Taping. Gonzales-Iglasias et al. (2009) studied the short term effectiveness of Kinesio-Taping on reducing pain and increasing cervical ROM in patients that have suffered an acute whiplash injury. They used 41 patients (21 females) for this particular study, and the subjects were randomly assigned to 2 groups. The experimental group received a Kinesio-Taping application (applied with tension) to the cervical spine, and the control group received a Kinesio-Taping application (applied with NO tension). Baseline data for pain and for cervical ROM were collected, then data was collected immediately following the application of the Kinesio-Tape to the cervical spine, and data was collected 24 hours later by an individual who was not aware to who received which particular intervention. The results showed that statically the Kinesio-Tape intervention group showed improvements in pain and increases in ROM. It was noted, however, that the improvements were small and may not be clinically significant. (Gonzalez-Iglesias et al, 2009) The study recommends that future studies on the long-term effectiveness of the application of Kinesio-Taping. Also, it recommended that studies be conducted on the potential enhanced outcome when Kinesio-Tape and physical therapy are used together (Gonzales-Iglesias et al, 2009) which was one of the original intent of the use of Kinesio-Tape.

Chiropractors, PT’s, AT’s & coaches frequently use Kinesio-Taping techniques in there practices. The majority of patients that I use tape on notice immediate results of reduction of pain and an increase in their ability to move that particular body part. The typical time-frame for application is around 3-4 days. I typically apply the Kinesio-Tape in a fashion that facilitates muscular contraction in the desired muscle group, by theory that the Kinesio-Tape provides afferent stimuli, that reduces the effects of pain inhibition on muscle function.

Gonzalez-Iglasias, J., Fernandez-De-Las-Penas, Cleland, J., Huijbregts, P., del Rosario Gutierrez-Vega, M. Short-Term Effects of Cervical Kinesio Taping on Pain and Cervical Range of Motion in Patients with Acute Whiplash Injury: A Randomized Clinical Trial. (2009) Journal of Orthopedic and Sports Physical Therapy. 39 (7): 515-521

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Shoulder/Neck Pain

Aching and stiffness in the shoulders and neck are an extremely common problem, especially for those involved in desk and computer working. If you feel like you need a daily massage, the real cause tends to be postural. Whilst seated, staring at a screen for hours on end, it is easy to fall into a slumped position, with rounded shoulders and the neck protruding forwards. Assuming this position day-in, day-out can result in shortening of the chest muscles and weakening of the small, postural upper back and neck muscles which work to pull the shoulders back. This results in the larger back and neck muscles such as Trapezius and the Rhomboids working harder and becoming tight and achy. Working on correcting these imbalances, by stretching the chest muscles and building endurance strength in the postural muscles such as the lower Trapz and Serratus Anterior can result in a long-term fix.

I treat neck and shoulder pain with soft tissue therapy, mobilization of the stiff joints, corrective exercises, stretching, and posture training.

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Whiplash Trauma Exercises

By Jeffrey Tucker, DC, DACRB

When I was in chiropractic college more than 25 years ago, I was taught to use isometric exercises for whiplash trauma recovery. The technique was pretty simple: Place one hand on the back of your head and push the hand and the head against each other. Keep the neck in a neutral position and don’t let the head move backward. Build up to tension in 2 seconds, hold the tension for 6 seconds and gradually relax over 2 seconds, and then repeat for 10 reps. The exercise was also performed in flexion, rotation and lateral bending.

This form of exercise involves the static contraction of a muscle without any visible movement in the angle of the joint; the length of the muscle does not change. We’ll call that technique “old school” because the old German model (Hettinger and Muller) of 6-second actions was used in the original experiments and was adequate for strength gains, but was insufficient to cause hypertrophy in muscles. If you were looking to get big, this was not the technique.

 

In a rehabilitation practice, it is not our job to train muscles for the sole purpose of making them bigger. The contemporary approach is to help train clients to improve movement patterns. Patients notice benefits to strength and power of “movements” – this is called “functionality.” Functional training is any training that improves the ability to perform a target activity.

Enter “new school” isometrics or maximal intensity isometric training (1-5 reps with 90 percent to 100 percent of your max), using sets lasting 20-120 seconds. This will stimulate strength, endurance and hypertrophy. This technique can be used in the early stages of rehab and then combined with repetitive-effort isotonics (6-12 reps with 70 percent to 90 percent of your maximum).

As an example, consider a patient who was involved in a rear-end motor vehicle accident. We’ll say this patient is a 50-year-old female who sustained an injury to her neck, her right wrist is splinted due to carpal sprain, and she is deconditioned. In this case, there are numerous advantages of starting with isometrics in her rehab, along with a few disadvantages:

Isometrics: Advantages and Disadvantages

Advantages

  • An injured or immobilized extremity can be tensed while in a cast or in a splint after the immediate pain has subsided.
  • Ideal for people with no exercise experience.
  • Can be used early in a rehab program.
  • Great way to teach proper biomechanics.
  • Helps prevent muscle and strength losses.
  • Achieves maximum muscular contraction and increases strength faster than any other form of training.
  • Builds strength in isolated areas or muscle groups without moving the joints (It may increase muscle size and develop more efficient muscle contractions).
  • Works muscles with more intensity in a shorter period of time.
  • Prepares the musculoskeletal system for more advanced activities.
  • Increases neurological strength, recruits more muscle fibers for each movement.
  • Good for enforcing movement patterns (especially in youth).
  • Isometric workouts can be fast and can be done anywhere.
  • Safer than conventional training (doesn’t involve movement).
  • Dramatically improves conventional training; improves lifts by as much as 14 percent to 40 percent.

Disadvantages

  • Potential of reducing muscular endurance. (Progress patients to isometrics to avoid this.)
  • Potentially reduces speed of muscle response, which will slow you down.
  • Generally boring to perform.
  • Increases blood pressure, which could lead to ruptured blood vessels or irregular heartbeat.
  • Strength gains achieved occur only within 20 degrees of the angle; there is approximately a 10-degree overflow on each side of the muscle fibers being used.

This “everything old is new again” program still encourages active participation of the patient during recovery, provides patient education on proper posture and body mechanics, highlights proper nutrition, and teaches corrective exercise therapy the patient can do at home on her own.

Isometrics and Resistance Testing

Isometrics can easily become part of the exam process itself. You can test what you want to test and the tests are reproducible. The test and the exercise can involve the length of time the patient can hold a pose. As strength increases, time under tension will improve and this becomes an objective finding. For example, resistance in isometric exercises typically involves contractions of the muscle using the following (the neural patterns used in #2 below may have a bigger impact on concentric strength and #3 below on eccentric strength and muscle mass):

  1. The body’s own muscle (e.g., pressing the palms together in front of the body at varying heights).
  2. Fixed structural items (e.g., pushing against a door frame). You can push or pull against an immovable resistance (e.g., pushing against the pins in a rack). Thus, there is no actual external movement while you are attempting to move the resistance.
  3. The use of free weights, kettlebells, weight machines or elastic tubing (e.g., holding a weight in a fixed position). Hold a kettlebell weight in your hand with the weight at your side. Your objective is to prevent it from going down and avoid shifting your posture. Once again, there’s no external movement; however, your intent is no longer to move the load, but to prevent its movement.
  4. Pressure-type equipment that has a digital readout of maximal force (grip strength).

“Static hold” isometric exercises can also be included in patients’ isometric routines. For example, during a set of rows, I have some clients hold their shoulder blades together when the handles are closest to their chest to “squeeze” the interscapular muscle in an effort to further strain the muscle. Depending on the goal of the exercise, the exertion can be maximal or submaximal.

A Treatment Plan Based on “New School” Isometric

Let’s create a treatment plan for our 50-year-old patient involved in a rear-end motor-vehicle accident using “new school” isometrics. Here are some beginning exercises I use for cervical spine rehab patients who are deconditioned:

Stability Ball Bridge

  • Head and upper back on a stability ball.
  • Torso in a “table top” pose.
  • Contract the gluts to create a bridge.
  • The glutes should be the primary muscles recruited (also some abs and quads).
  • No low back discomfort and no hamstring cramps.
  • As the patient progresses, they can keep their head off the ball.
  • Build up to holding each “squeeze” from 10 seconds to 30 seconds. Perform five reps.

Supine Gut Contractions

  • Supine position, legs extended.
  • Contract the glutes to create a bridge.
  • The buttocks should be the primary muscles recruited.
  • No low back discomfort and no hamstring cramps.
  • Maintain the cervical spine in various angles of slight flexion and extension.
  • Build up to holding each “squeeze” from 10 seconds to 60 seconds. Perform five reps.

Sustained Wall Sit

  • Back/shoulders/head flat against wall.
  • Hip/knee/ankle flexed to 30 degrees. Progress to 60 degrees and then 90 degrees.
  • Progress to one-leg wall sit.
  • Maintain this position and add wall angels.
  • Build up to holding the wall sit pose with the thighs parallel to the floor for 2 minutes. Perform one rep.

Sustained Plank (Isolates pecs and core)

  • Use two 25-pound kettlebells or stands that are about 18″ off the ground. (Push-up bars work great.)
  • Slightly wider than shoulder-width apart.
  • Hands below the nipple line.
  • Keep back flat and cervical spine in neutral.
  • Keep body/torso in alignment.
  • Build up to holding the plank for 1 minute. Perform two reps.

Upper-Body Arm Hang (Advanced)

  • Pull up on the bar and keep eyes horizontal to bar.
  • Hand/wrist in neutral position.
  • Elbows at 90 degrees.
  • No movement in body.

Anterior Abdominal Wall

  • Supine, knees bent; strap legs in while leaning on bolster.
  • Must keep the ear/shoulder/hip in alignment.
  • Remove support.
  • Time begins when position can be maintained.
  • Make sure the lower back does not hyperextend and the cervical spine stays in neutral.

Other testing and exercise examples include: sustained side bridge (right and left)), sustain V sit (test) and sustained back extensor (test). Patients enjoy it when I instruct them to hold a weight at a certain position in the range of motion and time them for form; for example, holding a “heavy” kettlebell statically in the “rack” position (thumb pointing to the clavicle with the elbow into the body) for a certain amount of time. They then progress to walking around with the kettlebell in the rack position while maintaining good posture. The next progression is holding the kettlebell overhead and walking around. This builds core strength.

Other exercises include pushing or pulling against an immovable external resistance (e.g., heavy-band pulls/pushes). I try to get patients to hold the pose for 10 seconds and then 20 seconds, eventually getting to 60-plus seconds. Example exercises using bands or kettlebells include the following:

Overhead Reaching

  • Use a band with handles.
  • Stand in a staggered leg stance.
  • Grasp the handles at shoulder height with elbows bent.
  • Brace your abdominals as you push the band (tubing) upward, extending the elbows.The arms are angled in front of the ears.
  • Maintain proper cervical posture (do not allow forward head).

Overhead Pressing

  • Double-leg stance.
  • Grasp the handles at shoulder height with elbows bend.
  • Brace your abs as you push the tubing upward, extending the elbows.
  • Arms are hiding the ears (the movement is straight upward).
  • Maintain good cervical alignment.

Diagonal Lifting

  • Wide stance.
  • Grasp the handle with both hands.
  • Begin at the left knee level and rotate your trunk to the right.
  • Continue to look at the handles as you lift your trunk and rotate upward and to the right.
  • Stretch the tubing across your body.
  • Keep the elbows straight.
  • Keep your eyes and head turned upward.

Diagonal Chopping

  • Wide stance.
  • Grasp the handle above your shoulder by extending and rotating your trunk.
  • Continue to look at the handles as you pull the tubing downwards.
  • Rotate and bend your trunk.
  • Stretch the tubing across your body.

Dr. Jeffrey Tucker is a rehabilitation specialist, lecturer and healer best known for his holistic approach in supporting the body’s inherent healing mechanisms and integrating the art and science of chiropractic, exercise, nutrition and attitudinal health. He practices in West Los Angeles and lectures for the National Academy of Sports Medicine and the American Chiropractic Rehabilitation Board. For more information, please visit www.drjeffreytucker.com.

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Laser Treatments

Laser therapy has been around for a long time but it is considered cutting edge treatment for musculoskeletal injuries and pain.
Laser therapy stimulates cellular activity, expediting the healing processes to reduce inflammation and repair damaged tissue. 

You can feel the warm deep tissue penetration. This deep heat significantly increases the body’s cellular production of ATP (Adenosine-triphosphate) to reduce inflammation and heal the inflamed area.

Here are some of the benefits of using the deep tissue penetration that laser provides safely and effectively:

Healing and pain relief with no side effects, drug interaction effects, or invasive surgery.

Treats acute and chronic conditions as well as post surgical pain.

Pain relief is often felt immediately.

Most laser treatments take only 10-20 minutes.

Are you a potential candidate?

  • If you have pain that is of musculo-skeletal origin, laser therapy may be for you:
    This includes sports injuries, back and neck pain, any joint pain (knee, shoulder, ankle, etc), bursitis, tendonitis, tennis elbow, contusions, strains and sprains, carpal tunnel syndrome, chondromalacia patellae, arthritis, fibromyalgia, heel spurs, plantar fascitis, migraine headaches, neck pain/whiplash, nerve root pain, postoperative pain, repetitive stress injuries, TM joint pain and more.
  • If you have the wound that is slow to heal and has been resistant to treatment, you may be a candidate for laser therapy. This includes slow healing fractures, as well as soft tissue injuries and ulcers.
  • If you have multiple trigger points (sore spots in the muscles) that do not go away, you may be a candidate for laser therapy. This includes areas associated with fibromyalgia.
  • If you have had Prolotherapy or PRP, and wish to accelerate the response of healing, you may be a candidate for laser therapy. This includes any area that has been treated with Prolotherapy/PRP injections.
  • If you need Prolotherapy or PRP therapy but are afraid of needles, you may be a candidate for laser therapy.
  • Laser therapy stimulates the same areas that Prolotherapy targets. It does it without needles, but requires a lot more time and repeated treatments to gain the result that can be gotten from Prolotherapy and laser together.

Feel free to call me directly at 310-473-2911 or call my cell phone at 310-339-0442

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Neck Pain Exercises

Neck Flexors

With a rolled towel under neck, gently nod the chin without lifting the head.

Hold for 10 seconds.
Repeat 10 times per set.
One set per session.
Complete 3 sessions per day.

Neck Extensors

With hands grasping the base of the neck, extend the chin as far as possible.

Hold for 3-4 seconds.
Repeat 10 times per set.
One set per session.
Complete 3 sessions per day.

Neck/Pelvis Rotation

Feet and knees together with arms outstretched. Rotate knees to one side, turning head in the opposite direction until a stretch is felt. Repeat on other side.

Hold for 3-4 seconds.
Repeat 10 times per side, per set.
One set per session.
Complete 3 sessions per day.

Upper Trapezius Stretch

Gently grasp right side of head while reaching behind back with other hand. Tilt head away until a gentle stretch is felt.

Hold for 30 seconds.
Repeat 2 times per set.
One set per session.
Complete 1-3 sessions per day.

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