Cervical Radiculopathy a Case Study

CLINICAL CASE STUDY

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Case # 4842: The patient is a 54 year-old female who experienced severe cervical spine pain and severe right upper extremity pain, numbness, and tingling resulting from lifting objects in her home. Patient has been diagnosed by primary physician and emergency room physicians as cervical radiculopathy. Medication was rendered consisting of Vicodin with mild relief. Patient presented to Batson Chiropractic with complaints of cervical spine pain, pain into the upper bilateral shoulder and scapular region with pain radiating to the right shoulder, right upper extremity region 8/10 in severity. Patient described numbness, tingling, and pain throughout the entire right upper extremity region extending into the hand and fingers consisting of the first, second, and third digits. Patient describes cervical crepitus, pain in all ranges of motion, muscle spasm and tension into the shoulders bilaterally, loss of strength of the right upper extremity region as well as pain into the right shoulder and scapula region.

Physical Examination: reveals a 54 year-old female, presenting with pain to the cervical spine and right upper extremity. Patient presents with positive orthopedic and neurological findings consistent with the diagnosis of cervical radiculopathy.

X-ray Examination: consisted of static A-P, Lateral, Flexion, Extension views of the cervical spine revealing loss of cervical lordosis with mild kyphosis of the lower cervical region measuring 34 cm, gross anterior head translation measuring 45 mm as measured from the anterior superior endplate of C7 to a perpendicular plum line from the anterior aspect of the C1 tubercle, C5 zygapophysis angle of 37 degrees, C2 angle of -30 degrees, and C1 angle of 22 degrees, degenerative joint and disc disease with disc space thinning C5-C6 with large osteophytic formation and vacuum phenomenon, milder vertebral and disc degeneration at the C4-C5, and C6-C7 segmental levels with mild osteophytic formation. Facet sclerosis noted at multiple levels. Flexion-extension views of the cervical region revealed subluxation: C0 in flexion, C1 flexion, C2 flexion, C6 flexion, C3 extension, C4 extension, C5 extension, C6 extension.

MRI examination: revealed mild atlantodental joint degeneration, minimal posterior disc bulge at C3-C4 right of midline, mild circumferential disc annual bulge C4-C5 with mild impression upon the thecal sac without evidence of spinal cord impingement or neuroforaminal or canal stenosis. C5-C6 revealed degeneration of the intervertebral disc with circumferential annular bulging approximately 3.5 mm posteriorly. There was effacement of the CSF space and slight flattening of the surface of the cord by the bulging disc annulus without evidence of cord compression. Moderate bilateral neuroforaminal narrowing due to the bulging of the intervertebral disc and adjacent posterolateral uncovertebral joint osteophytes. There was impingement of the C6 nerve root bilaterally. C6-C7 disc degeneration with eccentric right posterolateral annual bulging of approximately 2 mm. Moderate to marked right neuroforaminal narrowing due to the posterolateral soft disc protrusion with possible impingement of the right C7 nerve root and foramen.

Patient received twenty therapeutic chiropractic treatment sessions as outlined above and twelve cervical traction sessions over a nine week period of time. Patient responded to chiropractic procedures with positive outcome, experiencing complete resolution of all subjective symptomatology, normal findings of all objective findings, marked improvements in post radiographic findings. Patient returned to normal daily living status with mild restrictions.

Post static lateral radiographic findings after nine weeks of care demonstrated improvements in line analysis as: C1 angle 16 degrees (prior 22 degrees), C2 angle -17 degrees (prior -30 degrees), C5 zygapophysis angle 34 degrees (prior 37 degrees), lordosis angle -58 degrees (prior -34 degrees), measurement of anterior head translation of 16 mm (prior 45 mm).

Conclusion: Patient responded to chiropractic spinal care with complete resolution of cervical radiculopathy, and all subjective symptomatology. Resolution and restoration of proper objective findings are demonstrated by examination and post radiographic findings. Continued care was recommended for further structural spinal restoration.

Chiropractic Care for Whiplash

Whiplash is an injury to the neck muscles from rapid forward and backward motion of the neck caused by a trauma (eg, a car accident). It can cause acute (short-term) neck pain as well as restricted movement in your neck.

How Does a Chiropractor Diagnose a Whiplash Injury?
The chiropractor evaluates your spine as a whole—even if you go to the chiropractor complaining of neck pain following a trauma. He or she will examine the entire spine because other regions of the spine may be affected (not just your neck).

The chiropractor identifies any areas of restricted joint motion, intervertebral disc injury, muscle spasm, and ligament injury. He or she may use a technique called motion and static palpation—diagnostic techniques that involve touch. Your chiropractor will also feel for tenderness, tightness, and how well your spinal jointsmove.
Whiplash is an injury often affecting the soft tissues of the cervical spine. Sudden and rapid backward (hyperextension) and forward (hyperflexion) of the head and neck can cause acute pain.He or she will also analyze how you walk and take note of your posture and spinal alignment. These details will help the chiropractor understand your body's mechanics and how your spine works, helping with the diagnosis process.

In addition to the chiropractor’s evaluation of your spine, he or she may order an x-ray or an MRI of your spine to evaluate any degenerative changes that may have existed before your whiplash injury. The diagnostic images and results of your physical and neurological evaluation are compared to develop the best treatment plan.

Stages of Whiplash Treatment 
Soon after whiplash occurs—in the acute phase—the chiropractor will work on reducing neck inflammation using various therapy modalities (eg, ultrasound). He or she may also use gentle stretching and manual therapy techniques (eg, muscle energy therapy, a type of stretching).

The chiropractor may also recommend you apply an ice pack on your neck and/or a light neck support to use for a short period of time. As your neck becomes less inflamed and the pain decreases, your chiropractor will perform gentle spinal manipulation or other chiropractic techniques to restore normal motion to your neck's facet joints.

Chiropractic Whiplash Treatments
Your treatment plan depends on the severity of your whiplash injury. The most common chiropractic technique is spinal manipulation. Some spinal manipulation techniques commonly used are:

• Flexion-distraction technique: This hands-on technique is a gentle, non-thrusting type of spinal manipulation to help treat herniated discs with or without arm pain. Your whiplash injury may have aggravated a bulging or herniated disc. The chiropractor uses a slow pumping action on the disc instead of direct force to the spine.
• Instrument-assisted manipulation: This technique is another non-thrusting technique chiropractors often use. Using a specialized hand-held instrument, the chiropractor applies force without thrusting into the spine. This type of manipulation is useful for older patients who have a degenerative joint syndrome.
• Specific spinal manipulation: The chiropractor identifies spinal joints that are restricted or show abnormal motion (called subluxations). Using this technique, he or she will help restore motion to the joint with a gentle thrusting technique. This gentle thrusting stretches soft tissue and stimulates the nervous system to restore normal motion to the spine.

In addition to spinal manipulation, the chiropractor may also use manual therapy to treat injured soft tissues (eg, ligaments and muscles). Some examples of manual therapies your chiropractor may use are:

• Instrument-assisted soft tissue therapy: Your chiropractor may use the Graston technique, which is an instrument-assisted technique used to treat injured soft tissues. He or she will perform gentle repeated strokes using the instrument over the injured area.
• Manual joint stretching and resistance techniques: An example of a manual joint therapy is muscle energy therapy.
• Therapeutic massage: The chiropractor may perform therapeutic massage to ease muscle tension in your neck.
• Trigger point therapy: Your chiropractor will identify specific hypertonic (tight), painful points of a muscle by putting direct pressure (using his or her fingers) on these specific points to alleviate muscle tension.

Your chiropractor may also use other therapies to help reduce neck inflammation caused by whiplash. Examples of other therapies your chiropractor may use are:

• Interferential electrical stimulation: This technique uses a low frequency electrical current to help stimulate muscles, which can ultimately reduce inflammation.
• Ultrasound: By increasing blood circulation, ultrasound can help decrease muscle spasms, stiffness, and pain in your neck. Ultrasound does this by sending sound waves deep into muscle tissues. This creates a gentle heat that increases circulation.

Chiropractors look at the whole person—not just the painful problem. They view neck pain as unique to each patient, so they don’t just focus on your neck pain. They emphasize prevention as the key to good long-term health. In addition to these treatments, your chiropractor may also prescribe therapeutic exercises to help restore normal motion in your spine and reduce whiplash symptoms.

Using these chiropractic techniques, a chiropractor will help you increase your daily activities. He or she will work hard to address any mechanical (how the spine moves) or neurological (nerve-related) causes of your whiplash.

Treatment of Adult Neck Pain Not Due to Whiplash

“WHIPLASH, A SOFT TISSUE INJURY TO THE NECK, is also called neck sprain or neck strain. It is characterized by a collection of symptoms that occur following damage to the neck, usually because of sudden extension and flexion,” according to the National Institutes of Health.

Approximately two-thirds of people involved in motor vehicle accidents develop symptoms of whiplash. The symptoms usually do not develop until two to 48 hours after the injury. Whiplash can also occur from falls, sports injuries, work injuries and other incidents.

Patients with whiplash injury may complain of pain and stiffness in the neck, extending into the shoulders and arms, upper back and even the upper chest. Two-thirds of patients suffer with headaches, especially at the base of the skull. Patients may also experience dizziness, difficulty swallowing, nausea and even blurred vision after injury, but these symptoms tend to resolve quickly.

According to Marshall, 45 percent to 85 percent of people who suffer a whiplash injury have the symptoms five years after the accident, and 82 percent had a straightening or reversal of their cervical curvature.2 "Many authors regard a straightening or reversal of the normally lordotic curvature to be one of the most significant changes of a whiplash injury.” 

“The initial injury is due to damage of cervical muscles, ligaments, disks, blood vessels and nerves. The actual injury to soft tissues happens so rapidly that normal protective muscle reflexes cannot respond in time to decrease or prevent the injury,” according to a 2006 case report in the Journal of the American Chiropractic Association.

The Diagnosis

To diagnose whiplash, a DC must first take a thorough history of the injury and the patient’s previous medical history. Pre-existing conditions, such as arthritis, may increase the severity of the whiplash. The DC should give the patient an in-depth physical examination with concentration on the neuromusculoskeletal system.

Similar to asking about whiplash injuries from motor vehicle accidents, DCs should ask the patient questions that reveal the details of a sports-related incident. DCs must ask patients with vehicular accident injuries, “Where was the impact from? Were you moving at the time? Did you have a seatbelt on? What type of seatbelt? Were you braced for impact? Did you hit anything in the vehicle?” says Dr. Alan Sokoloff, team chiropractor for the Baltimore Ravens. “You have to do the same for sport-related neck injuries, too,” he says.

Dr. Sokoloff explains that he “encounters doctors that say, ‘I do not treat sports injuries,’ but if you are treating injuries from auto accidents and really dig into the mechanism of the injury with all of its details, it’s pretty much the same.”

Advanced Imaging

In some cases, advanced imaging may be necessary to make a proper diagnosis. A cervical CT scan is ordered if a DC suspects cervical spine trauma, such as a vertebral fracture, if the patient complains of paresthesia of the hands, if the patient is unconscious or has severe pain together with neurological deficits, explains Jerrold Simon, DC, president of the ACA Rehab Council.

“A cervical MRI is ordered when the whiplash patient complains of neck pain with radicular symptoms, such as a tingling sensation radiating down the arms or if there is suspected cervical spine trauma and the clinical findings suggest ligamentous damage. A cervical MRI may be ordered as a follow-up to normal cervical CT scan if the above symptoms are present,” says Dr. Simon.

Treatment

In treating whiplash injury, patients should be reminded to stay active, unless immobilization is necessary due to serious injury. “A cervical foam collar may be needed during the first few days following the incident if the cervical trauma is severe. However, in general, cervical collars are not recommended,” says Dr. Simon.

Immediately after the whiplash injury, Dr. Simon applies an ice compress to the posterior para-cervical spine musculature for about 10 minutes on a periodic basis. Ice compresses are generally only used for the first 48 hours after an injury.

In addition, chiropractic care is beneficial. A retroactive study by Woodward et al. published in Injurydemonstrated that chiropractic treatment benefited 26 of 28 patients suffering from chronic whiplash syndrome.5 Chiropractic care in this study included spinal manipulation, proprioceptive neuromuscular facilitation stretching and cryotherapy [ice-pack therapy].

A neck adjustment works to improve the mobility of the spine to increase range of motion, while also enhancing movement of the adjoining muscles. This will eventually eliminate pain, soreness and stiffness and allow a patient to painlessly turn and tilt the head. In addition to adjustments, a treatment plan of mobilization, massage or rehabilitative exercises may speed up the recovery process.

“Cervical rehabilitation procedures should be considered after the initial pain and inflammation have substantially subsided,” says Dr. Simon. “Then a functional capacity evaluation with focal attention to the cervical spine should be performed to assess the magnitude and degree of upper spinal functional deficiency.”

Following this test, a DC can decide if the patient should receive a treatment of isometric cervical flexion, extension and lateral flexion against resistance exercises, a proprioceptive rocker board, wobble board and/or gym ball exercises and vibration therapy.

“Every person is different, and everyone’s ability to heal is different, so how we treat patients is very individualized,” says Dr. Sokoloff. “We will use modalities initially, if indicated. We will use soft-tissue techniques, if indicated. We will usually use a chiropractic adjustment, if indicated. But the one procedure we always use is progressive rehabilitative exercises, in office and home recommendations.”

Home recommendations include proper computer and phone ergonomics, range-of-motion exercises and icing, to name a few.

“Treatment plans that do not hold the patient responsible for helping themselves cheat everyone,” says Dr. Sokoloff. “The more a patient is informed about home icing instructions, home exercise and activity of daily living modifications, the better the outcomes are for everyone.”

Effectiveness of Chiropractic Manual Therapy

Evidence-Based Practice Skills

Although all 4 institutions have followed different approaches to implementation, the overall strategies share some common principles. (a) Course work should incorporate journal club formats, checklist reviews of current studies, and student construction of critical appraised topics. (b) Informational literacy assignments should span all 4 years, be relevant, and relate to other course content. (c) The language and concepts of evidence-based practice must permeate all diagnosis and management courses and, where feasible, basic science courses as well. (d) Focused and ongoing training must target a large proportion of classroom and clinical faculty across the entire school curriculum. (e) Application of these skills must be patient based and become part of the clinic culture as opposed to an endeavor segregated to a journal club activity.

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Effectiveness of Manual Therapies

The goal of evidence-based practice is to incorporate the best-quality evidence into the clinical decision-making process to provide timely, appropriate care.11,12 The results of randomized controlled trials (RCTs) on manual therapies have been published in more than 200 peer-reviewed articles, and many of these have been synthesized in systematic reviews and evidence-based guidelines.13

Below we present a brief evidence synthesis based predominantly on the United Kingdom Evidence Report by Bronfort et al,13 currently the most comprehensive review of the evidence for the efficacy of manual therapies.14 The report was commissioned by the UK General Chiropractic Council in response to media concerns about scope of practice and claims of effectiveness in advertising. The report summarized the scientific evidence regarding the effectiveness of manual treatment as a therapeutic option of the management of 26 musculoskeletal and nonmusculoskeletal conditions. The authors based their conclusions on the results of systematic reviews of randomized controlled trials, widely accepted evidence-based guidelines, and randomized controlled trials not yet included in the former.

Low Back Pain

Spinal manipulation is an effective care option for acute, subacute, and chronic low back pain. Massage was also found to be effective for chronic low back pain.13 Notably, these finding were based, in part, on the clinical practice guidelines developed for the American Pain Society and the American College of Physicians. Chou et al15,16 recommended these treatments in addition to medical care. The most recent meta-analysis was supportive in finding clinically meaningful differences in aggregate between manipulation and other treatment alternatives.17 A 2010 Cochrane review suggested that there is moderate evidence that exercise can prevent recurrences of back pain, although there was conflicting evidence as to its effectiveness as a primary treatment.18 Based on fewer studies than on exercise or manipulation, a Cochrane systematic review found benefit of massage for patients with subacute and chronic nonspecific low back pain, especially when combined with exercise and education.19 Research on most conservative treatments for low back pain, including drug therapy, have reported only modest benefits.20 It remains to be seen whether this is due to the limited effectiveness of the interventions or the heterogeneity of patient populations. Research continues in an attempt to identify potential responder and nonresponder subgroups currently under the generic label of nonspecific low back pain. Potentially better results can also be linked to combination therapies and interdisciplinary approaches.

Neck Pain

Spinal manipulation was found to be effective for acute and subacute neck pain. Effectiveness was also found for acute whiplash when spinal manipulation is combined with exercise. Spinal manipulation was shown to be effective for chronic neck pain when combined with exercise.13 However, a new study suggests the efficacy of spinal manipulation alone in patients with associated cervicogenic headache.21Massage is also effective for chronic neck pain. An influential systematic review on this topic was conducted by the Bone and Joint Decade 2000–2010 Task Force on Neck Pain.22

Mid Back Pain

The evidence to date is inconclusive in a favorable direction for the use of thoracic spinal manipulation for mid back pain. This is because there has been only 1 small placebo-controlled trial to date. On the other hand, thoracic spinal manipulation has been shown to be efficacious for the care of neck pain.13 The trends in the data thus suggest spinal manipulation for mid back pain is a promising therapy requiring further trials.

Headaches

Spinal manipulation is an effective option for migraine and cervicogenic headaches. The evidence was found inconclusive for tension-type headaches.13 There is little information available on other types of headache. A Cochrane systematic review by Bronfort et al is notable.23

Extremity Conditions

Manipulation of extremity joints is used for a variety of conditions. However, there are fewer trials than for back pain, neck pain, and headaches. Effectiveness was found for shoulder girdle pain, adhesive capsulitis, lateral epicondylitis, hip and knee osteoarthritis, patellofemoral pain syndrome, and plantar fasciitis. Inconclusive evidence in a favorable direction was observed for rotator cuff pain, shoulder pain, carpal tunnel syndrome, ankle sprains, Morton’s neuroma, hallux limitus, and hallux abductor valgus. The only definitive negative finding was for ankle fracture rehabilitation, while several other forms of post surgical rehabilitation had inconclusive evidence leaning in the negative direction.13

Nonmusculoskeletal Conditions

There was positive evidence for spinal manipulation for only 1 nonmusculoskeletal condition, cervicogenic dizziness. The evidence for the effectiveness of spinal manipulation was negative for asthma and dysmenorrhea; the addition of spinal manipulation to diet was also ineffective for hypertension. Evidence was inconclusive for pneumonia, stage 1 hypertension, pre-menstrual syndrome, nocturnal enuresis, and otitis media.13

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Safety

Manual therapies including spinal manipulation are generally safe. Side effects tend to be benign: minor and self-limiting with short duration (eg, mild postmanipulation soreness).24–26 Severe complications have been associated with spinal manipulation but are extremely rare.25 For example, cauda equina syndrome can be as rare as 1 in 100 million following lumbar manipulations.27 Cassidy et al28 reviewed approximately 100 million person-years of records to evaluate stroke risk associated with cervical spinal manipulation and medical care. The authors concluded that the risk was extremely small and there was no excess risk from chiropractic care compared with medical care for neck pain and headaches. They hypothesized that the equivalent risk for chiropractic and medical care suggests that a stroke prodrome can lead to care seeking for these conditions. It is unlikely that manipulation of the neck is causally related to stroke.

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Other Interventions

Other interventions commonly employed by the chiropractic profession have a similar evidenced-based foundation. A 2010 Cochrane review suggested that there is moderate evidence that exercise can help prevent recurrences of back pain, although there was conflicting evidence as to its effectiveness as a primary treatment.18 Based on fewer studies than on exercise or manipulation, a Cochrane systematic review found benefit of massage for patients with subacute and chronic nonspecific low back pain, especially when combined with exercise and education.19

Research on most conservative treatments for low back pain, including drug therapy, have reported only modest benefits.20 It remains to be seen whether this is due to the limited effectiveness of the interventions or the heterogeneity of patient populations. Research continues in an attempt to identify potential responder and nonresponder subgroups currently under the generic label of nonspecific low back pain. Potentially better results can also be linked to combination therapies and interdisciplinary approaches.

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Conclusion

Evidence-based practice has made significant inroads into the chiropractic profession by expanding clinical research into interventions commonly employed by chiropractors and by graduating more Evidence-based practice savvy practitioners. The most common conditions treated by chiropractors are back pain, neck pain, and headaches.9 The best available evidence supports manipulative therapy as a reasonable option for many of these complaints. Manipulative therapy also holds potential value for the treatment of a variety of extremity conditions. Chiropractic practice is far broader than spinal manipulation alone, typically including other evidenced-based interventions such as massage, exercise therapy, and activity modification advice. Chiropractic education, with the help of federal grants and partners in established medical schools, is aggressively addressing the need to create more Evidence-based practice savvy graduates. These efforts will hopefully lead to improved patient outcomes and offer a common language and perspective to facilitate greater interprofessional cooperation.

Surprise: Chiropractors Can Treat These 5 Conditions

Read on if you're stressed, have a migraine or struggle with flexibility.

By David Starr, Contributor Nov. 30, 2015, at 7:00 a.m.

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Surprise: Chiropractors Can Treat These 5 Conditions

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Chiropractors are trained as neuromusculoskeletal specialists, and one of the main focuses of chiropractic care is the positive impact it can have on a person's nervous system. (ISTOCKPHOTO)

YOU MIGHT THINK chiropractors are only able to help with back aches, stiff necks, slipped discs and whiplash injuries. If so, you're not alone – but you're missing out.

Chiropractic care – which is based on the understanding that, given the opportunity, the mind and body can heal itself – can treat many issues that might surprise you.

Here's a look at the top five most surprising conditions a chiropractor can treat:

1. Migraines and tension headaches

Nine out of 10 Americans suffer from headaches. Some are occasional. Some are persistent. Some are dull and nagging, while others cause debilitating pain and nausea. Taking a painkiller and hoping your headache goes away is one option. But there's a better one.

Research shows that spinal manipulation – the primary form of care provided by chiropractic doctors – is an effective way to treat tension headaches and headaches that begin in the neck.

In a clinical trial conducted at Macquarie University, 72 percent of migraine sufferers experienced either "substantial" or "noticeable" improvement after a period of chiropractic treatment.

In fact, most headaches are related to muscle tension in the neck, which is an increasingly common condition among Americans who spend hours in the same position or posture (such as in front of a computer or television), leading to joint irritation and tension in the upper back and scalp that cause headaches.

What Can a Doctor of Chiropractic Do?

• Perform spinal manipulation or chiropractic adjustments to improve spinal function and alleviate stress on your system.
• Provide nutritional advice, recommending a change in diet or the addition of vitamins.
• Offer advice on posture, ergonomics, exercises and relaxation techniques.

2. Stress and anxiety

We perceive stress from three basic sources: our environment, our body and our emotions.

Environmental stress includes noise, weather, physical threats, time pressures and performance standards. Body stress includes disease processes, organ malfunction, poor nutrition, poor sleepand physical injury. And emotional stress is more difficult to define, but it encompasses our reactions, in both thought and emotion, to environmental and physical stressors.

Jobs today are increasingly complex as the business world becomes more and more competitive. Physical stresses such as sound, air and water pollution have also grown worse over the last century – especially in the United States – and so have emotional and psychological stresses caused by an increasing awareness of troubles and tragedies around the globe, brought to our attention every hour by the Internet and its 24/7 news cycle.

Many illnesses are caused or worsened by stress, which activates our "fight or flight" reaction. This systemic reaction affects almost every part of the body, as the hypothalamus in the brain stimulates the sympathetic nervous system, which causes an increase in heart rate, blood volume and blood pressure, redirecting blood away from our digestive system and extremities.

When prolonged, the long-term effects of this state can be disastrous to good health and cause high blood pressure, muscle tissue damage, diabetes, infertility, damage to the immune system and slowed healing from disease and injury.

Chiropractors work primarily with the spine – the root of the nervous system through which nerve impulses travel between the brain and the rest of the body – and can help the body manage and process this stress in a healthier way.

What Can a Doctor of Chiropractic Do?

• Chiropractors can release muscle tension, one effect of chronic stress that leads to nerve irritation and creates uneven pressures on the body's bony structures, which can cause the spinal column to become misaligned. This, in turn, helps the body return to a more balanced, relaxed state.
• Chiropractic adjustments can reduce spinal nerve irritation and improve blood circulation, which can help signal the brain to turn off the "fight or flight" response and begin the healing process.
• A doctor of chiropractic can suggest nutritional supplements, like B complex vitamins, to help the body cope with stress.
• A chiropractor can also recommend relaxation techniques and discuss posture and environmental changes to help you recover from chronic stress.

3. Fibromyalgia

Fibromyalgia is a chronic disorder involving widespread pain and sensitivity throughout the entire musculoskeletal system. To be diagnosed with FM, a patient typically has a minimum of 11 out of 18 specific tender points on the body. In addition to pain, patients also report long-term fatigue and/or disturbed sleep and mood. Other disorders commonly associated with FM include irritable bowel syndrome, TMJ pain and dysfunction, psychological conditions and some autoimmune diseases.

Fibromyalgia is a widespread condition that affects about 2 percent of the United States, and medical science has yet to discover the cause of this condition.

Since those with FM often experience an altered mood, like depression, many experts focus on the psychological aspect of the disease. Others feel that FM is more physiological and has its origins in physical trauma or chronic postural alterations. Still others suggest that FM is a central nervous system disorder rooted in neurochemical imbalances, since those with FM are hypersensitive to even the slightest stimuli and often have a pain response to normally non-painful pressure or activity. Since all information from the outside world is collected and analyzed by the nervous system, it's logical to assume that if a person with FM is sensitive to a stimulus that others are not, there may be something wrong with this system.

It's often difficult for patients to find solutions for all of their symptoms, but recent studies show that chiropractic adjustments combined with a soft tissue technique called ischemic compression can help FM patients.

In one study, 60 percent of the subjects treated by a chiropractor experienced a significant improvement: reduced pain, improved sleep and decreased fatigue.

What Can a Doctor of Chiropractic Do?

• Chiropractors are trained as neuromusculoskeletal specialists, and one of the main focuses of chiropractic care is the positive impact it can have on a person's nervous system. Therefore, chiropractic adjustments can improve a FM patient's nervous system, which gives them a better chance for recovery.
• Chiropractic care can treat pressure points, back pain, neck pain, shoulder pain, headaches and pain from musculoskeletal injuries.
• Chiropractors can also reduce a patient's overall pain through spinal adjustments that increase the mobility between spinal vertebrae, which have become restricted, locked or slightly out of proper position, thereby increasing cervical and lumbar range of motion.

4. Weak immune systems
The nervous system, endocrine system and immune system are inextricably linked. Together they share tiny messenger molecules that mediate communication between them, creating optimal responses for the body to adapt and heal appropriately.

Until recently, one of these messenger molecules, IL-2, was thought of as an immune system molecule. But recent studies have clearly shown its presence and activity in the nervous system, leading researchers to believe that neural dysfunctions due to spinal misalignments are stressful to the body and can cause abnormal changes that lead to a poorly coordinated immune response.

Subluxation is the term for misalignments of the spine that cause compression and irritation of nerve pathways, affecting the body's organs. Subluxations are an example of physical nerve stress that affects neuronal control. According to researchers, such stressful conditions lead to altered measures of immune function and an increased susceptibility to a variety of diseases.

It's important to note here how the endocrine system also impacts the immune system by producing cortisol in the adrenal glands – endocrine glands that are directly connected to the nervous system through the sympathetic nervous system – a stress hormone that inhibits the immune system.

If the sympathetic nervous system is too "switched on" due to stress and subluxation, it can increase the adrenal glands' synthesis of cortisol, in turn affecting the immune system.

What Can a Doctor of Chiropractic Do?

• Chiropractic care is the only way to detect and eliminate subluxation, and chiropractic adjustments have been shown to reduce the stress on the nervous system, thereby boosting the coordinated responses of the nervous and immune systems.
• One research group found that when an adjustment was applied to a subluxated area, the white blood cell count collected rose significantly.
• Another study measured the effects of six months of regular chiropractic care on the immune system function of HIV patients. At the end of six months of care, the patients who had received regular adjustments showed a 48 percent increase in the number of CD4+ T cells, whereas patients who had not been adjusted showed an 8 percent decrease in CD4+ T cells.

5. Flexibility

When we're younger, it's easy to take our extensive range of motion and flexibility for granted. As we age, a number of health conditions – and the cumulative effects of wear and tear – can affect our ability to move the way we used to.

But a decrease in range of motion and flexibility can result in a downward spiral of disability.

For example, an injury or degenerative condition that causes pain, swelling and stiffness, may limit our flexibility and range of motion. When this happens, we may avoid activities that involve the affected body parts, either consciously or unconsciously.

This then becomes a classic case of "use it or lose it." Without regular exercise, the muscles and joints stiffen, adhesions and scar tissue can form, and mobility may be further reduced. Eventually, a person can become completely incapacitated, and ordinary tasks such as picking up something off the floor or tying your shoes can become extremely challenging or painful.

Regular chiropractic can help increase both range of motion and flexibility.

A study performed by researchers at the Phillip Chiropractic Research Centre of RMIT University in Melbourne, Australia, and published in the Journal of Manipulative and Physiological Therapeutics found that chiropractic adjustments increased range of motion in the 105 patients who participated in the study. There were three phases of this study, in which each of the participants was given no adjustments, fake adjustments or true adjustments. In each phase, the patients who were given the true adjustments showed a significant improvement in range of motion, which was not the case for the other two groups.

What Can a Doctor of Chiropractic Do?

• A chiropractor uses spinal adjustments and manipulations to other parts of the body to realign the bones and joints so as to reduce pain, restore range of motion and improve flexibility, balance and coordination.
• Your chiropractor can also recommend specific exercises that can be done at home to increase your strength and flexibility so that you're able to maintain and build upon the gains from your chiropractic adjustments.
• Regular chiropractic care can reduce or eliminate the source of your back and joint pain, allowing you to resume your normal activities and to remain more flexible into your golden years.

Dr. David L. Starr is the founder of Starr Physical Therapy, Chiropractic and Acupuncture in New York City, where he has successfully practiced chiropractic for the past 18 years. A native New Yorker, Starr graduated from Life College in Atlanta, Georgia and donated his skills to Flying Doctors of American in the Dominican Republic before returning to New York City and establishing a successful, multidisciplinary office in Union Square.