Rosser Chiropractic

When people speak of suffering on the bike, they usually are referring to pain in the legs from their efforts. For many, though, their suffering comes in a different form: Overuse injuries of the neck and shoulder. Recently, I was doing some research for articles that study the frequency of neck and shoulder pain in cyclists. Although I expected the numbers to be significant, I didn’t anticipate that they would be as high as the rates they report. Most of these studies were surveys given to recreational/amateur cyclists after long distance events of multiple days.

Frequency of neck/shoulder pain (survey results) 44.2% (male) 54.9% (female). Wilber, et al. 1995
Frequency of neck/shoulder pain (survey results) 66.4%. Weiss, et al. 1985.

Wilber CA, Holland GJ, Madison RE, et al. An epidemiologic analysis of overuse injuries among recreational cyclists. Int J Sports Med 1995: 16: 201-6.
Weiss BD. Nontraumatic injuries in amateur long distance bicyclists. Am J Sports Med 1985; 13(3): 187-192.

In my search, I came across a chapter in an old book (now online) called “A Doctor’s View of Bicycling” that was originally published in 1897. From it comes the great picture posted above of A.A. “Zimmy” Zimmerman in an early concept of bicycle positioning for racing. Times have changed… for the better!

“Manipulation of the Neck and Upper Back Leads to Quicker Recovery.”  So say the authors of a new study of neck pain treatment in the recent edition of the Journal of Orthopaedic and Sports Physical Therapy (JOSPT.)  The focus of their study was to see how manipulation of the neck compared to mobilization when it comes to treating neck pain.

“Manipulation” of spinal joints is performed by moving the joints up to their end range of motion and providing a light/fast thrust that may or may not cause a popping sound as the joint moves.  “Mobilization” is a similar treatment method but it doesn’t include the thrust at the end.

Without a question, both treatments helped the patients in the study.  Overall, both had improvements in range of motion, pain levels, and disability when follow-up measurements were made 48 hours after the initial treatment.  The manipulation group, however, had far greater improvements demonstrated with treatment.  Here’s a peek at some of the results:

As a clinician, this helps me when patients ask me if I think getting adjusted will help.  In my experience, people who get adjusted get more relief…  and quicker.  Just, as this study shows.  I know that some people still don’t like the sound of their joints when they pop, or the twisting movement, and that is exactly the reason that tools like the activator and impulse adjusting instrument were created.  I use both of those in my office, and consider them to be forms of manipulation.

What I REALLY love about this study is that it moves beyond the question of whether or not manipulation is helpful.  Clearly it is, and, in fact, it provides these great benefits without the use of medications.

Reference
Dunning J, DPT, MSc Manip Ther, Cleland J, PT, PhD, et al. Upper cervical & upper thoracic thrust manipulation versus non-thrust mobilization in patients with mechanical neck pain: a multi-center RCT. JOSPT 2012; 42(1):5-18.

Last July, I wrote an entry about concussions in cyclists.  Since then, I’ve seen more and more discussion of this topic in the media, especially regarding injuries in high school and college athletics.  But it’s not just in the realm of sports that concussions show up.  I have had enough occasions of having a patient walk in my office with signs of having had a brain injury that it’s one of the top things I have to screen for during my evaluation if someone has had an accident or fall.

Last fall, Kris Dielman of the San Diego Chargers suffered a concussion during a game, but was allowed to continue playing the rest of the game.  Later that night, he had a “grand mal” seizure on the plane while flying home.  Videos of the event clearly show that Dielman was disoriented and stumbled after taking the blow to the head.  Unfortunately, the coaching and referee staff did not pull him from the game, and, instead, left him in to play the rest of the game.  The coaching staff of the team, of course, has taken quite a bit of heat from their decision.

In my office, I have had a few patients who have come to me with concussions related to sports such as a fall off of a bicycle or while snowboarding.  They don’t just happen in sports, though.  I’ve also had patients come into the office with post concussion symptoms after automobile accidents.  In those cases, the patients were unaware that they’d had a concussion because it wasn’t obvious enough to be detected at the scene of the accident by emergency staff.

Hopefully, you won’t need the information, but in case you do, here are some of the signs of a concussion:

Becoming easily fatigued
Having difficulty sleeping
Headache
Vertigo/dizziness
Irritability/aggressive behavior
Anxiety/depression
Changes in personality
Apathy/lack of spontaneity

Neck pain is a very common cause for patients to seek treatment.  People will often choose chiropractic care, but they will also seek out care with others, including massage therapists, medical doctors, physical therapists, acupuncturists, and others.  It’s also not unusual for someone to come into my office having tried a few different approaches.

So, how do varying treatments compare?  A recent study looked at a group of 272 adults to find out.  The group was split into 3 smaller groups.  Group 1 had chiropractic treatment, Group 2 had prescription pain medication, and Group 3 had 2 visits with therapists with instructions for home exercises.

Although almost everyone improved, the group that had chiropractic treatment improved the most, with therapy exercise coming in as a close second, and last was the pain medication treatment group.  The group that had the highest satisfaction rating at 1 year was the chiropractic treatment group. Treatment for all groups lasted 12 weeks, and follow up was also completed at 1 year.  So this study took into account immediate and long-lasting benefits.

As a provider of chiropractic treatment, I’m happy to know how it fares against other options that my patients have before them.  I also think that it’s important for healthcare consumers know that options outside of medication prescription are readily available to them.

Spinal Manipulation, Medication, or Home Exercise With Advice for Acute and Subacute Neck Pain: A Randomized Trial, Gert Bronfort, DC, PhD; et.al. Annals of Internal Medicine 2012;156:1-10.

photo credit: http://www.owl-wise.co.uk/owlfacts.html

Throughout the year,  I’ve given many of my patients a new exercise called the “Founder.”  It’s a little bit yoga and a little bit pilates in its origin.  I’ve also been using a new series/progression of similar exercises in a core exercise class that I teach.  These exercises are inspired by the work of Dr. Eric Goodman and Peter Park in their book “Foundation,” which came out earlier this year.  For me, the book came out at the right time.  I was looking for a resource to offer to patients to learn more about creating a healthier back.  For that purpose, and more, I love this book.

For a chance to learn about the techniques offered in the book and to hear Dr. Goodman speak about the philosophy that drives his mission, I hope you’ll take the time to watch this 15 minute lecture he did for the TEDx Talk series. If you spend any amount of your day working in a chair, this is something you shouldn’t miss!

Be on the lookout as I will be doing more to incorporate these philosophies into the clinic, classes, and articles in the coming months. Til’ then… Do a founder!