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Is My Headache Coming From My Neck?

There are various causes to headaches, but there is a specific type of headache called ‘cervicogenic headache’ that is caused by a problem in the upper cervical spine (neck).

Pain usually arises from the suboccipital region, with is under the base of the skull, at the back of the neck, and typically spreads up over the head. In some cases it can refer to behind the eye. Often symptoms will be exacerbated with certain neck movements of postures, such as leaning forward to read a computer screen. Often there will also be some associated neck pain, especially at the upper levels, as well as a reduction in range of motion in the neck.

There is some evidence that multiple structures in the neck (cervical spine) can be the source of pain referral to the head, and is generally centred around the C1, C2 and C3 vertebral levels. Such structures may include the various joints, discs, ligaments and musculature. Studies have shown that the C2/3 facet joints are the most common pain generators with cervicogenic headaches, and the incidence is higher in those with a previous whiplash injury.

Treatment depends on the specific pain generator, but cervicogenic headaches often respond well to usual chiropractic treatment, including spinal manipulation and mobilisation, trigger point therapy, and rehabilitation exercises to correct postural changes that may be aggrevating symptoms. Pain medication may also be of assistance to in the short term to control symptoms. In more severe, chronic cases, that are no responding to standard treatments, nerve blocks and facet joint injections may be required.

Is My Sleep Position Aggravating My Shoulder Pain?

I see a lot of patient’s in the clinic for treatment and rehabilitation of shoulder pain and this is a question I am often asked. In a lot of people, shoulder pain can arise from the rotator cuff, which is a group of muscles around the shoulder, that stabilise the ball and socket joint in a ‘cuff’.

If you are always laying on the same side (which we often do), then this constant pressure of the muscle tendons against the underlying bone can cause fraying and inflammation. This is known as rotator cuff tendonitis and can lead to impingement syndrome.

Symptoms often start off as pain in the front of the shoulder that can refer down as far as the elbow. Over time this can progress to weakness in the shoulder and difficulty perform tasks above 90 degrees.

Thankfully, in most cases, it can be treated quite effectively with a combination of manual soft tissue therapy, joint mobilisation and rehabilitation exercises to restrengthen the rotator cuff.

If you have shoulder pain that is not resolving, feel free to book an appointment at the clinic for a full assessment and treatment.

I’ve Been Told I Need Back Surgery – Can Chiro Help?

This is a question often asked by patients, and your chiropractor will need to do a full assessment on you to answer it accurately. If your specialist has told you that you will need surgery, then there is very good chance you will (at some point in time).

It is often helpful to categorise spinal surgery into two groups:

(1) Urgent surgery or where other treatment options are not an option

(2) Conditions where surgery will likely be needed at some point in time, but not urgent.

The second category is where chiropractic treatment may be beneficial in relieving your symptoms, improving function and perhaps reducing the need for surgery.

If we use low back pain as an example, in the absence of any severe neurological deficits or sinister causes for the pain, it is generally recommended to trial conservative, non-invasive treatment options first. Such treatment might include manual therapies (joint mobilisation, manipulation, soft tissue techniques), rehabilitation exercises to improve core stability and improve movement mechanics in the lower back, changes to workplace ergonomics and day-to-day activities, and also lifestyle modifications.

Depending on the nature of your condition and level of disability, many specialists will require that you do this prior to considering surgery.

There are several instances where prompt spinal surgery is indicated, these include:

* Cauda Equina Syndrome – this is a severe compression at the base of the spinal cord, often due to a very large disc herniation, and can cause bowel and bladder incontinence, along with numbness in the groin (saddle type distribution). This is a medical emergency, and people experiencing these symptoms should present to ED immediately.

* Severe spinal nerve root compression causing profound weakness in one of the limbs – when there is a large disc bulge in the spine, it can sometimes compress one of the nerves that travel down the arms and legs that control your muscles.

* Unstable spinal fractures

* Spinal cord injuries

If your surgery falls into the non-urgent category, it is worthwhile consulting your local chiropractor to discuss whether non-surgical treatments may be suitable for you, or at least help with pain relief for your injury before or after any scheduled surgery.

5 things you want to know about chiro, but are too afraid to ask!

1. What is the ‘cracking’ noise with joint manipulation?

Although as chiropractors we provide a variety of different treatments, perhaps the one technique we are most identified by is spinal manipulation. This is a technique whereby a shallow but fast force is applied to a joint to restore joint movement and relieve pain in the region.

When spinal manipulation is performed, the applied force causes a small seperation or gapping of the fully encapsulated synovial joint. This in turns causes a reduction in pressure in the joint cavity, and gases dissolved in the synovial joint fluid form bubbles. These bubbles rapidly collapse back on themselves and result in a ‘clicking’ noise

2. What training do chiropractors do?

Chiropractors complete a 5-year university degree, and are required to continue yearly continued professional training and education, in order to maintain their government registration.

3. What is the difference between chiropractors and physiotherapists?

In terms of musculoskeletal treatment, the gap between the modern chiropractor and physiotherapist is becoming quite small. In general, chiropractors tend to use more ‘hands-on’ manual therapy techniques such as joint manipulation, mobilisation and soft tissue techniques, whereas physiotherapists tend to focus more on rehabilitation exercise training.

This is by no means a hard and fast rule and any good musculoskeletal practitioner (no matter what profession they belong to) should use a variety of treatment interventions to get you better. Neither profession owns any specific type of treatment, and your chiro or physio should use the recommended treatments based on the latest available research and clinical guidelines for your condition or injury.

4. Does it hurt?

This is a common concern amongst patients prior to any for of treatment from a health practitioner. Patients sometimes have concern in relation to spinal manipulation and whether it will be painful, but in most cases it is surprisingly gentle and pain-free. Some soft tissue techniques can cause mild discomfort during and immediately after treatment, but this generally settles over a short period of time. Your chiro should discuss any possible side effects of treatment with you prior to commencing.

5. Do I need a referral to see the chiro?

No, you do not need a referral, simply call the clinic for an appointment.

In some cases however, your GP may provide you with a referral to see the chiro for up to 5 visits covered by Medicare. If it is a Worker’s Compensation Claim then your GP may also provide you with a written referral to see the chiro with treatment expenses to be covered by your claim.

What is Sciatica?

I often see patients at the clinic complaining of sciatica, which is commonly described as a shooting pain originating in the lower back or buttock and traveling down the leg to the foot. Sciatica is not a diagnosis itself, but more a symptom of an underlying condition, causing compression or irritation of the sciatic nerve.

The sciatic nerve is the largest nerve in the body, and is made up of a number of nerve roots that branch out from the spine in the lower back, and connect to form the sciatic nerve that runs down the back of the leg.

The most common causes of sciatica is a herniation or bulging of one of the discs in the lower back. As the disc bulges backwards it can compress or irritate one of the close lying nerve roots. Other causes include degenerative disc disease whereby bone spurs can compress the nerve root, spondylolisthesis which is a slippage of one vertebra on another secondary to a stress fracture, and spinal stenosis which is a narrowing of the spinal canal over time, often due to arthritic changes.

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​If you are suffering from sciatica, the treatment will vary depending on what is causing it. Chiropractors are well trained in the diagnosis of these conditions, and following a thorough physical examination be able to provide appropriate treatment and further testing or imaging/scans as necessary. In most cases symptoms will settle with a course of manual treatment and exercises. Depending on the severity, co-management with your GP will be needed if symptoms fail to improve.