Low back pain accounts for the majority of chiropractic patient visits in our clinic. Lower back pain can manifest as a mild and annoying ache or it can be severe and immobilizing.Common benign causes of back pain include facet syndrome or joint sprain, injury to a lumbar disc, muscle strain and spasm, sacroiliac joint dysfunction and spinal joint dysfunction. More serious causes of back pain like bone disease, cancer and fracture may require an x-ray or MRI to diagnose. The severity of pain is not a determinant of how serious the underlying cause for your pain and unless your history reveals "red flags", that suggests serious disease, most patients with lower back pain can receive a trial of care immediately.

Neck pain is most often related to poor posture, work ergonomics, muscle tension, muscle strength imbalances, sleeping conditions and age-related degenerative influences on joint health and function. While lower back pain is expected to resolve in 2 weeks, I find that the majority of acute neck complaints respond more quickly - typically within about 1 week. Patients with advanced arthritis and spinal degeneration will still receive benefit and experience pain relief from the treatments but are more likely to have symptoms that are chronic or recurrent. These patients often require periodic treatment to maintain improvement and pain control. Patient with acute neck pain following trauma like a car accident (e.g. whiplash) will require a longer interval for healing to occur.

Arm and hand pain or numbness can occur when a patient has a pinched nerve in the neck or anywhere along the course of the nerve. Cervical disc herniation or spinal degeneration are common reasons for a nerve to be pinched in the neck. Repetitive use syndromes, like carpal tunnel syndrome, cause the nerve to be entrapped by adhesion, tight bands or narrow canals through which the nerve passes. In some cases, a nerve may be pinched at more than one location along its course. A thorough neurological and orthopedic examination is helpful in locating the cause of the problem. Once identified, treatment will be applied to that specific region. This usually involves manual soft tissue release procedures as well as gentle manipulation of the joints from the neck to the hand.

When lower extremity pain has a radiating quality it is often associated with a pinched nerve in the lower back or beneath tight muscles in the pelvic girdle. Flexion distraction is an effective treatment to decompress an entrapped nerve in the lower back and manual release therapies are helpful if the nerve is entrapped beneath tight bands of muscle. Osteoarthritis of the hip is another cause of referred lower extremity pain. Your intake history and orthopedic examination will be helpful in determining hip joint involvement but x-ray is required to confirm the problem if your examination is suggestive of hip joint disease. Knee problems are common and include sprains, patellofemoral syndrome, meniscal tears, degenerative arthritis and IT-band syndrome. The most common foot problem that I treat is plantar fascitis which often causes severe heel pain. Foot and ankle manipulation, soft tissue release, low level laser therapy, home-exercises, therapeutic taping and icing can be helpful.

The shoulder girdle has a single attachment with the skeleton at the sternoclavicular joint. Other than this one bony attachment, the shoulder is free-floating - held in place by muscular and ligamentous restraints. As a result, shoulder injuries are very common and I evaluate and treat shoulder problems daily. Rotator cuff tears and tendinitis, bursitis and impingement syndrome are the most common causes for shoulder pain that I treat. Injuries suspected to involve the labrum (joint cartilage) will require MRI or arthrogram to diagnose. I refer patients for imaging procedures when the clinical picture does not warrant a trial of care. Most shoulder conditions, however, will respond to conservative treatment efforts using manual therapies. In addition to home exercise, modifying sleeping position can be critical. I tell my patients to avoid stomach sleeping and never sleep with the arms overhead. When lying on the side, reach the shoulder/arm forward so that pressure is on the shoulder blade - not the outer edge of the shoulder.

Headaches have many causes and sometimes will require a functional medicine evaluation in addition to chiropractic evaluation and treatment. Muscle tension headaches and stress are a common cause of headache that responds well to soft tissue release and gentle spinal manipulation. Muscle tension headaches often develop later in the day and produce the sensation of a tight band around the head and temple regions. Cervicogenic headache is another cause of headache that research has shown responds to chiropractic manipulation. Cervicogenic literally means, origin in the neck. This is often the result of joint dysfunction in the upper neck. Patients may experience broad referral of pain into the head, side of face or behind an eye with pain usually starting in the back of the head and radiating forward. Rarely, headaches can be the result of tumors or stroke. My training as a board certified chiropractic neurologist helps me recognize high risk headache. In these cases, you will be referred for MRI or CT scan.