One of the most asked questions I get everyday from my patients is what kind of pillow should I buy.  The folks at Good Houskeeping tested 34 pillow and this is what they came up with.

Best for Side Sleepers

Pacific Coast Double DownAround Firm

($44 to $80, amazon.com)

Testers found the dense feather-and-down stuffing in this plush option dreamy.

“The perfect height,” one said.

Cuddledown Sateen Synthetic Fill Contour Cradle Gusseted

($69 to $89, cuddledown.com)

A special shoulder cutout makes this comfy pillow perfect for propping up dedicated side snoozers.

JCPenney Signature Collection Side Sleeper

($55, jcpenney.com)

The foam sprang back into shape after we stacked on 30 pounds for eight hours, a sign of good durability. Testers deemed it comfortable and substantial.

Best for Back Sleepers

Garnet Hill Signature Jacquard Down

($130 to $178, garnethill.com)

Its lofty down fill explains the price. This kept its shape — no lumps! — and easily slid into a case after five washings.

The Company Store Black Label Primaloft Medium

($49 to $59, thecompanystore.com)

Looked as good as new even after laundering, and its synthetic filling held up well: “Loved how it cradled my head,” one sleepy volunteer observed.

Tempur-Pedic Tempur-Neck

($89 to $159, tempurpedic.com)

A curved design cushions the head and neck. Most found the foam’s shape and firmness supportive; a few pronounced it “too hard.”

Best for Stomach Sleepers

Pacific Coast Double DownAround Soft

(44 to $80, amazon.com)

Aced all lab tests, from multiple washings to withstanding weight, but testers were split on whether it was soft enough.

Wamsutta Comfort Medium Support

($16 for King, bedbathandbeyond.com)

At this price, it was impressive how well this pillow both maintained its appearance after laundering and held up to our durability test; it also struck the ideal balance of cushiness and support, dozers reported.

• Simple test asked 50 to 80-year-olds to sit on the floor and stand up with as little support as possible
• Adults who needed to use a number of aids such as their hands and knees were six times more likely to die than those who didn’t

By Claire Bates

PUBLISHED: 04:39 EST, 13 December 2012 | UPDATED: 20:26 EST, 13 December 2012

If getting up from a game of Scrabble on the floor this Christmas requires both hands, a lot of sighing and a helpful tug from a grandchild, beware.

For the gloomy message from scientists is that you may not live as long as your flexible counterparts.

Those who can sit down and get up using only one hand – or no hands at all – are likely to live for longer, a study found.

But those needing extra assistance, such as getting up on their knees or using two hands, are up to six times more likely to die prematurely.

The study found a simple two-minute test could predict the level of overall fitness in middle age that earmarks those likely to enjoy a longer life.

Researchers said the ease with which someone could stand up from a sitting position on the floor – and vice versa – was linked to a reduced risk of dying early.

Dr Claudio Gil Araújo, who carried out the study with colleagues at the Clinimex-Exercise Medicine Clinic in Rio de Janeiro, said it was ‘remarkably predictive’ of physical strength, flexibility and co-ordination at a range of ages.

He said: ‘If a middle-aged or older man or woman can sit and rise from the floor using just one hand – or even better without the help of a hand – they are not only in the higher quartile of musculo-skeletal fitness but their survival prognosis is probably better than that of those unable to do so.’

The study involved more than 2,000 men and women, aged 51 to 80, who were asked to sit and then rise unaided from the floor.

After the sitting-rising test, they were followed until the date of their death or October 31, 2011 – for 6.3 years, on average. Before starting the test, they were told: ‘Without worrying about the speed of movement, try to sit and then to rise from the floor, using the minimum support that you believe is needed.’

Each of the two basic movements was assessed and scored out of five, making a composite score of ten, with one point subtracted from five for each support used such as a hand or knee.

Over the study period 159 participants died, a death rate of about 8 per cent, according to a report in the European Journal of Cardiovascular Prevention.

The majority of these deaths occurred in participants with low test scores – indeed, only two of the deaths were in subjects who gained a composite score of ten.

Survival was strongly linked to the number of points scored.

The researchers took account of age, gender and body mass index and found the sitting-rising test score was a significant independent predictor of the likelihood of dying from any cause.

Those who scored three points or fewer had a five to six times higher risk of death than those scoring more than eight points.

A score below eight was linked with two to fivefold higher death rates over the 6.3 year study period.

Dr Araújo said: ‘Our study also shows that maintaining high levels of body flexibility, muscle strength, power-to-body weight ratio and co-ordination are not only good for performing daily activities but have a favourable influence on life expectancy.’

In the October 2009 issue of The Spine Journal,WesternStatesChiropracticCollege, Center for Outcomes Studies, reported benefits are obtained with the utilization of spinal manipulation in the treatment of chronic cervicogenic headaches. The word “chronic” means at least 3 months of headache pain has been present. This new study compared 2 different doses of therapy using several outcome measures including the pain grade, the number of headaches in the last 4 weeks and the amount of medication utilized. Data was collected every 4 weeks for a 24 week period and patients were treated 1-2 times/week and separated into either an 8 or a 16 treatment session with half the group receiving either spinal manipulative therapy or a minimal light massage (LM) control group.

The results of the study revealed the spinal manipulation group obtained better results than the control group at all time intervals. There was a small benefit in the group that received the greater number of treatments with the mean number of cervicogenic headaches reduced by 50% in both pain intensity and headache frequency.

The importance of this study is significant as there are many side effects to medications frequently utilized in the treatment of headaches. Many patients prefer not taking medications for this reason and spinal manipulation therapy (SMT) offers a perfect remedy for these patients. Couple SMT with dietary management, lifestyle modifications, stress management, and a natural, vitamin/herbal anti-inflammatory (such as ginger, turmeric, boswellia) when needed, a natural, holistic approach to the management of chronic headaches is accomplished.

Lance Armstrong came back almost literally from the death bed having been diagnosed with testicular cancer than had spread to his lungs and brain.  Just surviving cancer at this stage is a miracle but he was not done, he went on to win the most grueling athletic event in the world, The Tour de France, not just once but 7 times!  He shattered the previous record of 5 times.  An article from Nike.com explores the relationship Lance has with his chiropractor, Dr. Jeff Spencer it states, “Jeff has been working with Lance since January of 1999, helping him to keep his body together for the harsh demands of the Tour de France. After last year’s Tour de France, Lance said that he could not have won without Jeff’s help.” 

The Super Bowl is one of the biggest sporting events in the world. Many of the players who will be participating in the big game this year receive chiropractic care, including future Hall of Famer Tom Brady of the New England Patriots. In fact, players from all four championship teams utilize chiropractic care.  Tom Brady who will be leading his team to the Super Bowl in 2 weeks had this to say, “Chiropractic just makes you feel so much better. When I walk out of the clinic, I feel like I’m about three inches taller and everything’s in place. And as long as I see the chiropractor, I feel like I’m one step ahead of the game.”

Jerry Rice is considered the greatest receiver in the history of the NFL.  His durability and work ethic is legendary. He initially sought chiropractic care because of a crisis after being injured on the field. After learning about the benefits of Chiropractic from his teammates he made chiropractic care a regular part of his training routine and lifestyle. He is a three time Super Bowl Champion and today he is an official spokesperson for the Foundation for Chiropractic Progress.

Another chiropractic advocate, 2012 Hall of Fame Semi-finalist Roger Craig, was a pioneer in the NFL. He is the only player to ever make the Pro Bowl as a fullback and a halfback, the first player to rush and receive for over 1,000 yards in a single season , a feat that took fourteen years to be duplicated – and he is the only running back in NFL history to ever lead the league in receptions. He is a three time Super Bowl Champion and is the only NFL player to make the playoffs for eleven straight years.  Like many children, Roger began receiving chiropractic care at an early age and today, like the others, still receives Chiropractic care.   

These athletes have learned that chiropractic care can help you recover from an injury but even more important can help you from getting injured.  If you are a weekend athlete or more serious chiropractic should be a part of your routine health care plan.

            The prevalence of low back pain (LBP) is common, as 70-85% of ALL PEOPLE have back pain that requires treatment of some sort at some time in life.

1. On a yearly basis, the annual prevalence of back pain averages 30% and once you have back pain, the likelihood of recurrence is high.
2. Back pain is the most common cause of activity limitation in people less than 45 years of age.
3. Back pain is the 2nd most frequent reason for physician visits, the 5th ranking reason for hospital admissions, and is the 3rd most common cause for surgical procedures.
4. About 2% of the US workforce receives compensation for back injuries annually.
5. Similar statistics exist for other countries, including the UK and Sweden.

             So, what are the common links as to why back pain is so common?  One reason has to do with the biomechanics of the biped – that is, the two legged animal. When compared to the 4-legged species, the vertically loaded spine carries more weight in the low back, shows disk and joint deterioration and/or arthritis much sooner, and we overload the back more frequently because, well, we can! We have 2 free arms to lift and carry items that often weigh way too much for our back to be able to safely handle. We also lift and carry using poor technique. Another reason is anatomical as the blood supply to our disks is poor at best, and becomes virtually non-existent after age 30.  That makes healing of disk tears or cracks nearly impossible. Risk factors for increased back injury include heavy manual lifting requirements, poor or low control of the work environment, and prior incidence of low back pain. 

            We see patients with lower back pain for all sorts of reasons, many people just begin developing lower back pain with no specific injury.  Reasons for back pain vary from unstable joints in the spine, to muscle spasm and even injured disks.  If you are suffering with low back pain see your chiropractor.  Your chiropractor should properly diagnose your condition and offer you a course of therapy that will allow your back to heal in a short period of time.  If you are told that it will require months or years to heal get another opinion, back pain will often self-resolve in 6n weeks or less, if the therapy you choose is not getting the job done sooner than that then you should find out why.

•  The first 3 nerves exiting the spine in the upper neck go directly into the head.  They penetrate the muscles at the top of the neck near the attachments to the skull and therefore, any excess pressure on these nerves by the muscles or spinal joints will result in irritation and subsequent pain.
• The origin or nucleus of the 5^th cranial nerve called the Trigeminal, innervates the sensation to the face and is located in the upper cervical region near the origin of the 2^nd cervical spinal nerve, which innervates sensation to the back of the head up to the top.  Therefore, problems located in the upper neck will often result in pain radiating up from the base of the skull/upper neck over the top of the skull to the eyes and /or face.
• The 11^th cranial nerve that innervates the upper shoulders and muscles in the front of the neck arises from the top 5 to 7 spinal cord levels in the neck.  Injury anywhere in the neck can result in spasm and pain in these large muscle groups.
• Other interconnections between the 2^nd cervical nerve and trigeminal/5^th cranial nerve include communication with the 7^th cranial / facial nerve, the 9^th cranial / glossopharyngeal nerve, and the 10^th cranial / vagus nerve.  These connections can affect facial muscle strength/movements, taste, tongue and throat movements, and stomach complaints such as nausea from these three cranial nerve interconnections, respectively.

             When patients seek treatment for their headaches, a thorough examination of the neck, upper back, and cranial nerves is routinely performed for the above reasons.  It is common to find upper cervical movement and vertebral alignment problems present in patients complaining of headaches. Tender points located between the shoulder blades, along the upper shoulders, on the sides of the neck and particularly, at the base of the skull are commonly found.  Pain often radiates from the tender point over the top of the skull when pressure is applied in the upper neck/base of the skull area. Tenderness on the sides of the head, in the temples, over the eyes, and near the jaw joint are also common. Traction or pulling the head to stretch the neck can ofer pain relief and this is often performed as part of the chiropractic visit and can also be applied at home with the use of a home cervical traction unit or with exercises prescribed by your chiropractor. Chiropractic adjustments applied to the fixated or misaligned vertebra in the upper neck often brings very satisfying relief to the headache sufferer.  Exercises that promote movement in the neck, as well as strengthening exercises are also helpful in both reducing headache pain and in preventing occurrences, especially with stress or tension headaches. 

 Over the years we have seen many people get relief from chronic headaches with chiropractic, it is a safe alternative to over the counter analgesics and other prescribed medications.  If you suffer from headaches give us a call, I bet we can help!

             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 palpation, range of motion, orthopedic and neurological examination.  X-ray and/or other “special tests” may also be included, but only when absolutely needed. A review of all the findings are discussed and after permission to treat is granted, a chiropractic adjustment may then be rendered.  A list treatment options may include: 

1. Chiropractic Adjustments;
2. Soft tissue therapy (trigger point stimulation, myofascial release);
3. Physical therapy modalities;
4. Posture correction exercises and other exercises/home self-administered therapies;
5. Education about job modifications;
6. Co-management with other health care providers if/when needed. 

 If you are suffering with neck pain and have decided it is time to do something about it give our office a call, let’s see if chiropractic can help you.

Insight: Firms to charge smokers, obese more for

By Jilian Mincer

(Reuters) – Like a lot of companies, Veridian Credit Union wants its employees to be healthier. In January, the Waterloo, Iowa-company rolled out a wellness program and voluntary screenings.

It also gave workers a mandate – quit smoking, curb obesity, or you’ll be paying higher healthcare costs in 2013. It doesn’t yet know by how much, but one thing’s for certain – the unhealthy will pay more.

The credit union, which has more than 500 employees, is not alone.

In recent years, a growing number of companies have been encouraging workers to voluntarily improve their health to control escalating insurance costs. And while workers mostly like to see an employer offer smoking cessation classes and weight loss programs, too few are signing up or showing signs of improvement.

So now more employers are trying a different strategy – they’re replacing the carrot with a stick and raising costs for workers who can’t seem to lower their cholesterol or tackle obesity. They’re also coming down hard on smokers. For example, discount store giant Wal-Mart says that starting in 2012 it will charge tobacco users higher premiums but also offer free smoking cessation programs.

Tobacco users consume about 25 percent more healthcare services than non-tobacco users, says Greg Rossiter, a spokesman for Wal-Mart, which insures more than 1 million people, including family members. “The decisions aren’t easy, but we need to balance costs and provide quality coverage.”

For decades, workers – especially with large employers – have taken many health benefits for granted and until the past few years hardly noticed the price increases.

But the new policies could not only badly dent their take home pay and benefits but also reduce their freedom to behave as they want outside of work and make them resentful toward their employers. There are also fears the trend will hurt the lower-paid hardest as health costs can eat up a bigger slice of their disposable income and because they may not have much access to gyms and fresh food in their neighborhoods.

“It’s not inherently wrong to hold people responsible,” says Lewis Maltby, president of the National Workrights Institute, a research and advocacy organization on employment issues based in Princeton, New Jersey. “But it’s a dangerous precedent,” he says. “Everything you do in your personal private life affects your health.”

Overall, the use of penalties is expected to climb in 2012 to almost 40 percent of large and mid-sized companies, up from 19 percent this year and only 8 percent in 2009, according to an October survey by consulting firm Towers Watson and the National Business Group on Health. The penalties include higher premiums and deductibles for individuals who failed to participate in health management activities as well as those who engaged in risky health behaviors such as smoking.

“Nothing else has worked to control health trends,” says LuAnn Heinen, vice president of the National Business Group on Health, which represents large employers on health and benefits issues. “A financial incentive reduces that procrastination.”

LACK OF JOBS

The weak economy is contributing to the change. Employers face higher health care costs – in part – because they’re hiring fewer younger healthy workers and losing fewer more sickly senior employees.

The poor job market also means employers don’t have to be as generous with these benefits to compete. They now expect workers to contribute to the solution just as they would to a 401(k) retirement plan, says Jim Winkler, a managing principal at consulting firm Aon Hewitt’s health and benefits practice. “You’re going to face consequences based on whether you’ve achieved or not,” he says.

And those that don’t are more likely to be punished. An Aon Hewitt survey released in June found that almost half of employers expect by 2016 to have programs that penalize workers “for not achieving specific health outcomes” such as lowering their weight, up from 10 percent in 2011

The programs have until now met little resistance in the courts. The 1996 Health Insurance Portability and Accountability Act (HIPAA) prevents workers from being discriminated against on the basis of health if they’re in a group health insurance plan. But HIPAA also allows employers to offer wellness programs and to offer incentives of up to 20 percent of the cost for participation.

President Barack Obama’s big health care reform, the 2010 Patient Protection and Affordable Care Act, will enable employers beginning in 2014 to bump that difference in premiums to 30 percent and potentially up to 50 percent.

Employers do, however, also need to provide an alternative for workers who can’t meet the goals. That could include producing a doctor’s note to say it is medically very difficult, or even impossible, to achieve certain goals, says Timothy Jost, a professor at the Washington and Lee School of Law. For example, a worker with asthma may not be able to participate in a company exercise program.

These wellness programs typically include a health risk assessment completed online, and on-site free medical screenings for things such as blood pressure, body mass index, and cholesterol.

The programs, while voluntary, often typically offer financial benefits – including lower insurance premiums, gift cards and employer contributions to health savings accounts. For example, workers at the railroad company Union Pacific get $100 in their health savings account for completing the health assessment, $100 if they don’t use tobacco and $100 if they get an annual physical (tobacco users also can get the $100 if they participate in a tobacco cessation program).

INCENTIVE TO EXERCISE

Like Wal-Mart, more employers are coming down harder on individuals who have voluntarily identified themselves as tobacco users, often during their health risk assessment. As yet, very few employers identify smokers through on-site medical screenings.

Veridian, which until now has not charged its employees for healthcare premiums, says increases to its health care costs have been unsustainable, climbing 9 percent annually for the past three years. Earlier this year, it rolled out a wellness program and free screenings, which 90 percent of workers have now completed.

As it starts charging, it will provide discounts to those making progress as it “wants to reward those who have healthy lifestyles,” says Renee Christoffer, senior vice president of administration for the credit union.

Mark Koppedryer, vice president of branches at Veridian, was one of the workers who participated in the screenings. The 37-year-old father of three initially participated to show his support but was shocked to find out that he had elevated blood pressure and cholesterol scores.

His colleague, Stacy Phillips, says she used the new wellness programs to exercise more. “I knew there needed to be a change in my life,” says the 35-year-old, who has lost 40 pounds since January. “This made me more aware that at some time there would be a cost.”

These changes come at a time when health insurance premiums are soaring. In 2011, the average-cost of an employer-provided family plan was more than $15,000, according to a survey by the Kaiser Family Foundation and the Health Research and Educational Trust. That’s 31 percent higher than five years ago. And the number is expected to climb another 5-8 percent next year, according to various estimates.

In contrast, the giant medical and research center Cleveland Clinic, which employs about 40,000 people, has seen these costs grow by only 2 percent this year because it has implemented a comprehensive wellness program that has dramatically improved the health of many workers.

The effort began several years when it banned smoking at the medical center and then refused to hire smokers. It later recognized that having a gym and weight loss classes wasn’t enough to get people to participate. It made these facilities and programs free and provided lower premiums to workers who maintained their health or improved it, typically with their doctor’s help.

“You don’t do this overnight,” says Paul Terpeluk, Medical Director of Occupational Health at the Cleveland Clinic. You have to develop a program and change the culture, he said.

INTRUSIVE

But not all programs are as well constructed and effective, says Mark A. Rothstein, a lawyer and professor at the University of Louisville School of Medicine. The wellness programs may be well-intentioned, he says, but there’s not strong empirical evidence that they work and getting a weekly call about your weight or smoking habits, which is offered by some programs, could be humiliating for participants.

“What might be seen as a question to one person may be an intrusion to another,” he says. That’s one reason that lower-paid janitors at his school participate but, “the professors on campus consider it a privacy tax so we don’t get some stranger calling us about how much we weigh.”

And there are also those that no matter how much they exercise or how healthy they eat can’t lose weight or lower their blood pressure or body mass index. “There are thousands and thousands of people whose paycheck is being cut because of factors beyond their control,” says Maltby from the National Workrights Institute.

The programs could be especially burdensome for low-income workers, who are more likely to fail health assessment tests and less likely to have access to gyms and healthier fresh produce, says Harald Schmidt – a research associate at the Center for Health Incentives and Behavioral Economics at the University of Pennsylvania.

“We want to use provisions to help people and not penalize people for factors beyond their control,” Schmidt says. “Poorer people are often less healthy and this constitutes a potential double whammy. They are likely to face a higher burden in insurance premiums.”

That’s the case for Barbara Collins, a 35-year-old Wal-Mart employee – who lives in Placerville , California. She says she’ll have to pay $127 every two weeks for health insurance next year, including a penalty of almost $25 because she’s a smoker.

“I’ll cut back on cigarettes and hopefully eventually quit,” says Collins, who earned $19,000 pretax, or about $730 every two weeks, last year. “Christmas will definitely be tight this year and for years to come if this lasts,” she says. “Family vacations, there’s no way I can afford that.”.

(Reporting by Jilian Mincer in New York. Editing by Martin Howell in New York.)

This is a very informative study that was done 7 years ago.  It is worth the read.  The bottom line of this study is something I have seen for years in my private practice in Rancho Santa Margarita.  Upper Crossed Syndrome is prevalent in our society.  This posture is created by our life style, we get in the car in the morning with our hands on the steering wheel putting our chest muscles (pectoralis muscles) in a shortened position.  After a short walk from the car we then sit at our desks, again with our arms out in front of us, putting those pectoralis muscles in a bad position.  Fifty years ago or better many people went to work and turned wrenches or used shovels, activities that naturally strengthened our back muscles, now most of us even hire gardeners to do our back yards.  So this life style that causes the front muscles to shorten and the back muscles to weaken puts our natural alignment out of whack, causing our head and shoulders to roll forward.  This puts extra stress on the muscles, ligaments and joints of the upper back and neck.  This article hypothesizes that this posture and the resulting stress on our bodies can lead to neck and back pain and especially headaches.  It goes on to show something that most chiropractors and many headache suffers already know and that is, chiropractic along with other physical therapies can relieve headache pain.  In addition a program of stretching and strengthening for the muscles in the upper body can prevent the headaches from coming back.

FROM: J Manipulative Physiol Ther 2004 (Jul); 27 (6): 414—420

Michele K. Moore, DC

Private practice of chiropractic, Canberra, Australia,
Diplomate Candidate in Chiropractic Rehabilitation, Austin, Tex USA drmoore@ev1.net

OBJECTIVE: To discuss the management of upper crossed syndrome and cervicogenic headache with chiropractic care, myofascial release, and exercise.

CLINICAL FEATURES: A 56-year-old male writer had been having constant 1-sided headaches radiating into the right eye twice weekly for the past 5 years. Tenderness to palpation was elicited from the occiput to T4 bilaterally. Trigger points were palpated in the pectoralis major, levator scapulae, upper trapezius, and supraspinatus muscles bilaterally. Range of motion in the cervical region was decreased in all ranges and was painful. Visual examination demonstrated severe forward translation of the head, rounded shoulders, and right cervical translation.

INTERVENTION AND OUTCOME: The patient was adjusted using high-velocity, short-lever arm manipulation procedures (diversified technique) and was given interferential myofascial release and cryotherapy 3 times weekly for 2 weeks. He progressed to stretching and isometric exercise, McKenzie retraction exercises, and physioball for proprioception, among other therapies. The patient’s initial headache lasted 4 days. He had a second headache for 1.5 days during his exercise training. During the next 7 months while returning to the clinic twice monthly for an elective chiropractic maintenance program, his headaches did not recur. He also had improvement on radiograph.

CONCLUSION: The principles of upper crossed syndrome and the use of exercise, chiropractic care, and myofascial release in the treatment of cervicogenic headache are discussed. A review of the literature indicates that analyzing muscle imbalance as well as vertebral subluxation may increase the effectiveness of chiropractic treatment for cervicogenic headache.

From the FULL TEXT Article:

Discussion

Upper crossed syndrome was originated by Vladimir Janda. Dr Janda was known as the “Father of Czech Rehabilitation.” [9] He graduated from Charles University in Prague in 1952, specializing in neurology and later in rehabilitation medicine. Janda was very interested in the functional role of muscles, and this led to testing his patients with surface electromyography. [9] This information demonstrated patterns of muscle contraction in relationship to particular limb movements and the timing of recruit patterns of synergists. [9] In 1979, he identified crossed syndromes of muscle imbalance for the upper and lower extremities based on research and clinical observations. [9]

The upper crossed syndrome is defined as tightness of the upper trapezius, pectoralis major, and levator scapulae and weakness of the rhomboids, serratus anterior, middle and lower trapezius, and the deep neck flexors, especially the scalene muscles. Janda named this syndrome “Upper Crossed” because when the weakened and shortened muscles are connected in the upper body, they form a cross. [10] This syndrome produces elevation and protraction of the shoulders, winging of the scapula, and protraction of the head. This atypical posture produces overstress of the cervical cranial junction, the C4-5 and T4 segments, and the shoulder due to altered motion of the glenohumeral joint. [10] Excessive stress on the T4 segment can occasionally cause chest pain of pseudoangina pectoris. [10] The change of direction of the axis of the glenoid fossa will cause rotation and abduction of the shoulder blades. [10] This will cause the levator scapulae and the upper trapezius to have additional muscle activity to stabilize the head of the humerus. [11] This will be accompanied by increased and constant activity of the supraspinatus, causing early degeneration of the muscle. [10]

Kim Christiansen, [11] a figure in chiropractic rehabilitation, concurred with Janda regarding the idea that different muscles tend to tighten or weaken consistently. These muscles were the same as those described by Janda in his upper crossed syndrome (See Fig 4). Christiansen [11] states, “Postural patterns are maintained by a complex arrangement of proprioceptive input modified by habits, somatotype, and even psychogenic factors such as self-esteem. Deviations from ideal, efficient alignment eventually result in production of chronic pain symptoms, which have been shown to be predictable.” [11] Christiansen [11] proposed that sustained misalignments result in some muscles becoming shortened and others developing constant overstretch. The eventual concern is malposition of the involved joints. This creates common postural patterning of forward shoulders, increases kyphosis, forward head posture, and loss of cervical lordosis. He proposes that muscle testing is an excellent methodology to determine which muscles are weak and strong and can help to identify which specific muscle groups are weaker and which have become shortened. He suggests that a successful treatment program should include individually determined exercises based on the findings of manual muscle testing to regain postural muscle balance.

According to Kendall et al, [12] the ideal standing position viewed from the side is a plumb line passing through the earlobe, midway through the shoulder joint, midway through the trunk, through the greater trochanter, slightly anterior to the midpoint of the knee, and slightly anterior to the lateral malleoli. From the back, the plumb line should dissect the body through the midline with the alignment of symmetrical body parts on each side. The head is neutral, the shoulder and hips are even, and the feet are rotated slightly outward. [12] Lewit [13] delineates that the external auditory meatus is aligned vertically over the clavicle and slightly anterior to the lateral malleoli. The sternocleidomastoid forms an angle of 45° to 50°. [13] This patient had altered posture, which could be a major contributor to his cervicogenic headache. [5]

The pathophysiology of the cervicogenic headache has also been associated with degenerative changes in the upper cervical spine. [2] The most common origin of pain is typically in the upper cervical joints, namely the occiput through C1 and the C1 and C2 segments. [2] Degenerative processes cause lack of movement and dysfunction, which cause irritation to the pain-sensitive structures. [2] Many researchers believe that the cervicogenic headache actually emanates from the C2 nerve root and have found that a C2 blockade produces temporary to long-lasting relief. [2] Lower or middle segments can also produce cervicogenic headache. Operative fusions done in the C5-6 and C6-7 levels have relieved cervicogenic headache. [2]

The clearest definition of cervicogenic headache is described as “referred pain perceived in any region of the head caused by a primary nociceptive source in the musculoskeletal tissues innervated by the cervical nerves.” [1] The identifying factor for cervicogenic headache is that the actual source of pain originates not in the head but in the cervical spine joint complex. Some areas causing pain are the intervertebral disk annular fibers of C2 and C3, joints ligaments, muscles, the pain-sensitive dura matter, and C1 through C3 cervical nerve innervated structures. [1] In an article written by Alix and Bates, [1] they discuss a connective tissue bridge between the rectus capitis posterior minor muscle, which is perpendicular to the dorsal spinal dura at the atlanto-occipital junction. The purpose of this bridge is to resist movement of the dura toward the spinal cord. Spinal trauma affecting the rectus capitus posterior minor muscle causing atrophy would affect this connective tissue tension and could cause cervicogenic headache. [1] Because chiropractic has a direct effect on the motion and integrity of the upper cervical joint complex, it could help in maintaining this fibrous connective tissue balance.

Donald Murphy, DC, [14] in his article “Chiropractic Rehabilitation of the Cervical Spine” assessed patients’ cervical-related problems such as disk herniations, degenerative changes, and spinal stenosis, as well as other serious pathologic conditions such as tumor and infection. He stated that in most cases these were not major causes of symptoms of chronic headache. [14] He further proposed that movement patterns proposed by Janda when disrupted are a more typical cause for perpetual cervical pain.

Another area of concern is the radiograph perspective. In multiple cases of cervicogenic headache, the lack of cervical curve was evident. Gale [15] suggests that diagnosing cervicogenic headaches should include lateral cervical and flexion/extension views to determine joint mobility and other pathology at the occiput-atlas and the atlas-axis. He also suggests that the cervical gravitational line would be a good indicator of altered cervical biomechanics suggestive of cervical pathology. [15] The loss of cervical lordosis is evidence for hypertonicity of the levator scapula muscle and can cause occurrence of degeneration, especially at the C5-6 and C7 levels, according to Spierings, [16] who implicated that the lower cervicals also can have causative effect on cervicogenic headache.

Cervicogenic headache is similar to migraine headache due to the ipsilateral pain and the typical migraine-like symptoms such as nausea, vomiting, and ocular problems. [2] It differs from migraines, according to Pfaffenrath et al, [2] in that it never alternates sides and initiates in the neck. He describes the headache as dull, dragging, boring pain with fluctuating intensity lasting a few minutes or several days in duration. It can also radiate into the face and the ipsilateral shoulder and arm with no definite radicular pattern, and there is usually a painful overall restriction of head movement. [2] Other conjunctival symptoms, lacrimation, and lid edema can be seen with cervicogenic headaches but never Horner syndrome, which is occasionally found in cluster headaches. [2] Migrainelike symptoms such as nausea, photophobia, and visual blurring may occur, as well as difficulty swallowing, a sense of having a lump in the throat, or dizziness. The duration for cervicogenic headaches is typically longer. [2] In this patient’s case, he had headaches for several days at a time and his occurrence of headaches was 2 to 3 times weekly.

Pfaffenrath et al [2] discuss the use of C2 blockade for relief of cervicogenic pain, especially when the patient reported hypoesthesia in the C2 dermatome immediately after application of local anesthetic.

Multiple headache studies have been done comparing chiropractic care and the use of medication. The Nelson et al [17] study analyzed the effects of spinal manipulation, amitriptyline, and the combination of both therapies on migraine headache. Outcome measures included the headache index scores derived from a daily headache pain diary during the last 4 weeks of treatment and the 4-week follow-up period. [17] The reductions in the headache index scores during treatment from baseline scores were 49% for amitriptyline, 40% for spinal manipulation, and 41% for the combined group. During posttreatment follow-up, the reductions from initial baseline scores were 24% for amitriptyline, 42% for spinal manipulation, and 25% for the combined group. [17] The conclusion by Nelson et al [17] was that there was no advantage in combining amitriptyline and spinal manipulation for the treatment of migraine headache. Spinal manipulation equaled the effectiveness of the well-established use of amitriptyline. [17] Some of the details regarding this study showed that in the spinal manipulation group, the patients were treated a total of 14 times over an 8-week period at 2 times per week. The amitriptyline patients had 3 visits within the 8-week period. This article demonstrates evidence that the cervical spine can act as a peripheral source of migraine headache pain. [17] They quote Bogduk et al, [18] who established an anatomical basis for the cervical spine contributing to headaches, the convergence of 2 somatosensory systems, and the trigeminal and the cervical spine nerves. [17] Nelson et al [17] speculate that nocioception from the cervical spine structures may act as a migraine trigger. Nelson et al [17] state that spinal manipulation could help these factors. Another concern in this study was that 58% of the amitriptyline group experienced medication side effects and 10% of the subjects had to withdraw from the study because of the intolerable side effects. Side effects for the spinal manipulation group were infrequent and usually mild. Another concern of this study is that patients receiving spinal manipulative therapy had considerably more attention than those who did not receive this therapy. They suggested perhaps the additional attention contributed to the patient improvement. [17]

Nilsson et al [19] studied the effect of diversified adjustments to the cervical spine for cervicogenic headache. They interviewed patients that responded to an article out of a newspaper. Fifty-three subjects were chosen from 450 headache sufferers who fulfilled the International Headache Society criteria for cervicogenic headache. Twenty-eight people in the group received diversified adjusting twice weekly for 3 weeks. Twenty-five people received low-level laser in the upper cervical region and deep friction massage including trigger point therapy for the same treatment frequency. Results showed that the use of analgesics decreased by 36% in the spinal manipulation group and was not changed in the soft tissue group. [19] Headache hours per day decreased in the manipulation group by 69% compared with 37% in the soft tissue group. [19] The intensity of headache per episode decreased by 36% in the manipulation group and 17% in the soft tissue group. They concluded that spinal manipulation had a significant effect on cervicogenic headache. [19]

Bronfort et al [20] evaluated various studies that provided spinal manipulative therapy for treatment of headache. Throughout their research of 22 original studies, they excluded 13 papers and the 12 studies that did not have comparison groups. They did reports on 9 research studies involving 683 patients. Of those, 386 patients received spinal manipulation with ages ranging from 15 to 17 years. The number of treatments ranged from 1 to 12, with an average of 6 over a period from 1 day to 8 weeks. [20] In 5 of the studies, spinal manipulation was performed by chiropractors The rest were performed by medical doctors and physical therapists. The comparison groups included amitriptyline studies, deep friction massage with placebos, mobilization, palpation with rest, cold packs, and azapropazone. Outcome measures extracted from 9 trials were pain intensity, frequency of headaches, medication use, and general health status. Their conclusion suggested that spinal manipulative therapy was more effective than massage for cervicogenic headaches and that it also had an effect comparable to commonly used first-line prophylactic prescription medications. [20]

A study was completed on migraine sufferers using only chiropractic spinal manipulation. The study done by Tuchin et al21 resulted in the use of 127 volunteers between the ages of 18 and 70 years. Twenty-two percent of the participants reported more than 90% reduction in migraines after 2 months of spinal manipulative therapy, and 50% of the participants reported significant improvement in the length of each episode. [21] Many participants reported stress as a major factor in their migraines. As a result of this study, the researcher states that it is probable that chiropractic care has an effect on the physiological conditions related to stress. [21]

Mootz et al [22] published a study in the Journal of the Canadian Chiropractic Association, which assessed the effectiveness of chiropractic care involving adjustments, myofascial release, and physical therapy modalities to male patients with headaches. The participants included 11 male outpatients between the ages of 18 and 44 years with a history of chronic headaches of at least 6 months duration and an average of at least weekly headache episodes. The chiropractic care provided was similar to the care the patient in this study received (the type of chiropractic adjustment, myofascial trigger point therapy, and physical therapy). The results of this study showed that the mean pretreatment to posttreatment headache frequency decreased from 6.4 episodes per week to 3.1. The pain scale intensity ratings changed from 5.05 to 3.37. The duration of the headache also changed from 6.7 hours per episode to 3.88 hours. The conclusion of the Mootz et al [22] study is that the chiropractic interventions of adjusting, muscle work, and moist heat significantly reduced the self-reported frequency and duration of headache episodes over an 8-week period with each patient receiving 12 visits.

Conclusion

Studies in this report have shown the relevance of treating cervicogenic and other headaches with spinal manipulation. Further study is needed on the relationship of postural patterns, such as muscle imbalance, to headache symptoms and other ailments. This case study was an attempt to offer a rehabilitation exercise approach as an adjunct to spinal manipulation in the treatment of cervicogenic headache. Doctors Janda, Christiansen, Murphy, Liebensen, and Harrison have researched the use of corrective exercise to treat muscular imbalance. [5, 8-11, 14] This patient was relieved from chronic headaches through the combination of chiropractic adjustments, interferential therapy, trigger point massage, exercise, and alteration of activities of daily living. The care this patient received is an example of a low-tech rehabilitation treatment protocol. The example this case presents is intended to help the reader understand Janda’s [10] principle of upper crossed syndrome and to review literature related to muscular imbalance and cervicogenic headache.

Feeling the burn after a workout is a great sign that you’ve done your job. That burn is a result of pushing your body past what it’s used to. Challenging yourself toward harder, more intense workouts over a period of time is called progressive overload. Progressive overload trains your body to adapt to the new conditions being put upon it.

The key, however, is making sure that along with the progressive overload you are also giving your body time to recover. Ever notice how most marathon training plans have you run a 20-miler followed by a day of rest and a shorter “long run” the following week? Or the plan may have you increase your long run mileage a little each week up to a certain point and then drop off and build back up again. That’s progressive overload or stress adaptation. Build up. Back off a little. Build up. Back off a little. Overloading the body and then giving it a chance to recover, adapt, and heal before placing more stress upon it, is a great way to train.

New runners and seasoned runners both can get caught up in the excitement of training. Before they know it, they’ve peaked, burned themselves out (physically and/or mentally) or worse, suffered an injury before race day. Below are some good tips to follow to get the most out of your training without overtraining.

1. Follow the 90 percent rule. When doing quality workouts (hill repeats, tempo runs, intervals, long runs), push yourself, but always leave something left in the tank. Think about pushing yourself up to about 90 percent of your maximum effort, but never give push it to maximum effort. After finishing a quality workout, you should feel tired. You should feel like you’ve worked hard, but you should also feel like, “Hmmm, I could have done a little more.” This should be a good feeling, not something to beat yourself up about. Knowing that you’ve worked hard (close to maximum effort), but not crawling away from the workout and needing three days to recover will greatly benefit you in the long run. Doing every quality workout at maximum effort is an injury waiting to happen. Just knowing that you have that “extra” in you can really help you beat mental and physical fatigue later in a race.

2. Enjoy the easy runs. Almost every training plan includes easy runs each week. These runs are usually designed to keep your base mileage going and to help keep you limber in between quality workouts. Problem is many runners blast through the easy weekly runs as if they were quality workouts. If every run is a hard run, you greatly increase your chances of injury, peaking early, or mentally burning out. Also, running your weekly easy runs at maximum effort can put a damper on your weekly quality workouts and so they’re not benefiting you as much as they should.

3. Respect your REST days. Forget the idea that rest is only for the weak. Rest is equally as important as that weekly tempo run or long run. Your body needs time to rebuild the muscle tissue that’s broken down with each workout. If you never let your body rest, your fitness level can begin to decline affecting all of your runs, easy and/or quality. No rest is basically a fast forward to overtraining and injury.

4. Follow the hard/easy rule. Overtraining can be a result of repetitive exercise. If you don’t vary your workouts and you’re constantly subjecting your body to the same stress over and over, those muscles can become over-trained. A good rule of thumb is to wait at least 48 hours before working the same muscle groups again. So for example, if your do a chest/triceps workout one day, you should wait at least two days before working those muscles again. Professional bodybuilders will often work a muscle group so hard in one workout, that they’ll wait an entire week before working that muscle group again.

In running, you should think more in terms of hard/easy. Hard (or quality) workouts can include speed workouts (intervals, repeats, tempo runs, hill repeats) that are run at about 80 to 90 percent of your VO2Max. Hard runs also include the weekly long run which is run at about 60 to75 percent of your VO2Max. Even though the long run is an easier pace, it’s considered a “hard-run” because of the distance. Easy workouts include short or mid-distance runs that are run at an easy to moderate intensity (60 to 75 percent of your VO2Max). So, if you do a hard run one day you should wait at least two days before running your next hard run.

5. Cross-train.  Adding a couple of cross-training days into your weekly training is a great way to maintain your conditioning without overworking the same muscles. On cross-training days, do anything aerobic that’s not running (i.e., elliptical, row machine, cycling, swimming, circuit resistance training, etc.). These activities will give you a great aerobic workout as well as conditioning other muscle groups helping to increase your overall fitness, while giving your “running muscles” a break.

6. Sleep.  Lack of sleep is a big cause of fatigue which can increase your chances of overtraining. Your body does most of its repair and rebuilding while you sleep. If you’re not getting enough sleep, then you’re not giving your body time to heal. Sleep requirements can vary from person to person. Teenagers need about 9 hours on average (mine seem to need about 15!). Most adults need seven to 8 hours of sleep a night, although some may need as few as five hours or as many as 10 hours of sleep each day. Fatigue can result when your normal sleeping hours are shortened for whatever reason–stress of a new job, a new baby, exercising too late at night, or that heartburn you got from the five-meat pizza you ate just before bed. If you’re not getting your normal amount of sleep, then you need to back off on your training until your sleep hours are back to normal.

7. Know the signs.  An elevated pulse is a good indicator of possible overtraining or even sickness such as a respiratory infection. If your waking resting pulse is elevated more than a few beats, you could have an infection or be suffering from overtraining. In either case, taking a day off may be the best thing. Rest is the best thing to avoid overtraining. If rest doesn’t do the trick, schedule an appointment with your doctor. Below are more over-training signs to look out for and respect if they occur.

• persistent achiness, stiffness, or pain in the muscles and/or joints (beyond the typical delayed onset muscle soreness felt after a workout)
• lack of energy
• fatigued and/or achy muscles
• frequent headaches
• feeling lethargic or sluggish
• drop in athletic performance
• not able to complete your normal workout
• depressed, moody, unmotivated
• nervousness
• lack of sleep and/or appetite
• weight loss
• lowered immune system