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My Approach to Neck Tightness

12/16/2013

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As would hopefully be a no-brainer at this point (you ARE on a chiropractor's blog, after all), chiropractic works marvelously for many types of back and neck pain. But what about the scenario I hear all too often?

"I go to the chiropractor and my neck feels better for a few hours/days... but then it always comes back."

I've seen this numerous times, and in my experience it almost always means that there is a neurological reason for the neck tightness. Don't worry- this usually doesn't mean anything scary like a tumor or neurological disease. This type of problem is all too common and often arises from one part of the brain not communicating effectively with the other parts. In the case of chronic neck tightness it's usually the cerebellum or the vestibular system that is not communicating properly.

The three main sensory systems that tell you where your head is in space are the muscles of the neck, the eyes, and inner ear (vestibular system). These three systems are very much connected and work in perfect unison most of the time. However, when one of those three systems is not working quite properly you are forced to rely more heavily on the other two. In this case, I often see weakness in the ability of the eyes to track smoothly and/or the vestibular system that produces neck stiffness. Your brain figures "I'd rather have a tight neck than be dizzy", and by tightening the muscles of your neck you are better able to perceive where your head is in space. The down side is that neck tightness is very unpleasant.

In my office I do neurological testing to determine where these areas of weakness are so that I can better tailor my treatment plan. My testing includes things like different eye movements, head movements, balance exercises, coordination tests, and eye reflexes. Once I identify the area(s) of the brain that need stimulation treatments include things like eye exercises, chiropractic adjustments, and coordination exercises.

The thing that makes my approach special is:

1. Specificity. With the functional neurological exam, I am able to identify the areas of the brain that need stimulation the most. This differs from most chiropractic treatments, in that the treatment goal in most chiropractor's offices is to simply get the neck to move better, not stimulate the brain.

Most of the time chiropractors will find and adjust at least one subluxation on each side of the neck. This works great for most people, however I have seen that cases like this often respond better to a more brain-specific approach. This may mean adjusting only one side of the neck is merited, despite the presence of subluxations on both sides.

2. Strength of the stimuli used is always taken into consideration at my office. Neck adjustments are powerful sensory stimuli for the brain and must be used with caution in potentially neurologically compromised individuals. Honestly, sometimes people with this type of neck tightness benefit from doing neurological exercises before or in lieu of
adjusting in the beginning.

3. Stimulation and nutrition are both crucial for proper brain function and are addressed in my office. The forces that age your body also age your brain, but they hit the brain much faster and harder and are often overlooked.


If you or somebody you know is interested in working with a functional medicine doctor please call my office at (919) 238-4094 and see if we are the right fit for you. Infinity Holistic Healthcare is located in Chapel Hill, North Carolina, part of the Raleigh-Durham "triangle" area.

In health,
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My Approach to Chronic Pain

9/17/2013

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This is part of a series I call "My Approach Mondays" where I discuss how I approach different symptoms and diseases. I hope you find this information helpful!

Chronic pain affects more Americans than diabetes, heart disease and cancer combined [1]. This means that nearly 1/3 of the people in this country suffer from some form of chronic pain!
Six of the top ten most prescribed drugs in the US in 2005 were pain medications and four of them are used to treat depression [2]. Coincidence? I think not. It's not surprised we're all bummed out- many of these people go to doctor after doctor and never really get an answer. When x-rays and MRIs come back clean the patient almost always gets told that they are fine (translation: I think it's all in your head because on film you look fine) despite being in chronic, often times debilitating pain.

The thing that is absolutely critical for you to understand is that pain is a cortical event- it takes place in the brain. The only thing that needs to happen for you to feel pain is those neurons in your brain that perceive pain need to come to threshold. The thing that makes pain so tricky (and fascinating) is that those neurons can be brought to threshold for a million reasons.
- Receptors in the skin or tissue get activated by tissue damage* or other processes
- Mechanical receptors in the tissues stop firing**, and thus, stop inhibiting pain neurons
- Neurons in the spinal cord that normally inhibit (stop) pain pathways stop firing
- Neurons in the brain stem that normally inhibit pain stop firing
- Neurons in the brain that produce the perception of pain fire
- Neurons in parts of the brain that normally inhibit pain stop firing

*The underlying assumption in almost all conventional methods for diagnosing and treating chronic pain is that there is tissue damage. I would argue, however, that this is often not the case.
**This is why movement in the form of exercise and spinal adjustments are so critical to any pain management protocol.

We could break this list down further and examine reasons why various neurons either stop doing their job or start firing when we don't want them to... but that would make for far too long of a post. Just know that anything that causes inflammation, disease, or imbalance in the body affects every single cell in your body including the neurons involved in pain perception. Examples could include diabetes or blood sugar problems, anemia, hypothyroidism, concussion, leaky gut syndrome, autoimmune disease, food sensitivities, hormonal imbalances, or lack of quality sleep.

My general approach with chronic pain is simply:
1. Evaluate weather or not the pain is coming from actual tissue damage through the use of orthopedic testing, X-ray or MRI
2. Take a holistic approach to finding the root cause(s) of imbalance or inflammation (such as those above) in that person and address those issues using as holistic and non-invasive approach as possible
3. Share in that person's joy when their pain magically gets better as their body gets healthier (often-times)

If you or somebody you know is interested in working with a functional medicine doctor please call my office at (919) 238-4094 and see if we are the right fit for you. Infinity Holistic Healthcare is located in Chapel Hill, North Carolina, part of the Raleigh-Durham "triangle" area.

Yours in health,
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Functional Neurology

7/4/2013

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Chiropractors have been boasting for years that we are neurology specialists- that we treat the spine, and therefore the nervous system. One classic explanation for this is because an important part of the central nervous system, the spinal cord, lies within the spinal canal that goes through each vertebrae. Another commonly used explanation for this is that subluxation, that "bone out of place" that chiropractors adjust, can put pressure on the spinal nerves and obstructs nerve flow or vital force that goes to each target organ. And while both of those theories may be true to some extent, there seems to be a better explanation.

More recently (since about the 80s or 90s) as our understanding of neurology has advanced, so has our understanding of chiropractic's affect on the nervous system. Simply put, adjustments are felt by the patient, which means that they are sensed and interpreted by the brain. Depending on the location of the adjustment, the type of adjustment, or the timing of the treatment, the brain will interpret that information a different way. This also calls attention to the very real, but all too forgotten reality that everything in our lives provides different stimulation to our brains. Whether it be the food we eat, the sensory information from our feet, or the thoughts we think, everything is perceived by the big guy upstairs- whether we are consciously aware of it or not. Furthermore, the brain has the remarkable ability to adapt to the stimulation it receives- or as we in the biz call it, neuroplasticity. This is the basis for neurological stimulation such as what we use in functional neurology. As the weak circuitry is stimulated, the pathways are strengthened and allowed to operate more smoothly.

As a clinician who wants to help the more "complicated" patients out there, I find it will be especially important for me to know not only how the body affects the brain, but how the brain affects the rest of the body. This is why I have chosen to study chiropractic neurology (also called functional neurology). Functional neurologist take extensive classwork in addition to their chiropractic degree coursework to further understand the nervous system. To get a diplomate in functional neurology one must complete a minimum of 300 hours of additional coursework in neurology and pass a rigorous clinically oriented test. Many chiropractic neurologists are also well versed in functional medicine- another critically important skill set when treating the so called "complicated" patients that are becoming increasingly common now.

Chiropractic neurology has received a lot of press in the last few months, mostly because of Dr. Ted Carrick's work treating hockey star Syd Crosby. Since then, Carrick and functional neurology has seen a lot of positive press, as well as a lot of skepticism. For example, one particularly rude reader commented on an article about Crosby that "last he knew, concussion was not caused by a subluxation"... And I agree, but we never claimed that it was! When applied in a specific way that is unique to the patient's neurological needs, chiropractic adjustments can be a very powerful and effective way to stimulate the brain. Furthermore, functional neurologists such as Carrick use a variety of treatments in conjunction with their adjustments including eye exercises, as well as balance and coordination exercises. That poster's comment not only reveals a clear lack of understanding of basic neurology and neuroplasticity, but an unawareness of what chiropractic neurology is all about!

Chiropractic neurology helps the brain function at it's very best. Certainly anybody could benefit from chiropractic neurology, but it is particularly great for people with neurological disease or symptoms. If you know of someone who's brain is not functioning at it's best, finding a qualified chiropractor near you may make a world of difference in that person's life. I encourage you to go on the American Chiropractic Neurology board's website and find a chiropractic neurologist near you!

If you or somebody you know is interested in working with a functional medicine doctor please call my office at (919) 238-4094 and see if we are the right fit for you. Infinity Holistic Healthcare is located in Chapel Hill, North Carolina, part of the Raleigh-Durham "triangle" area.

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Resources:
Doctor locator-
http://acnb.org/doctor-locator
*note, I am not on the doctor locator because I haven't taken my diplomate exam yet.

More on Crosby and Carrick-
http://video.ca.msn.com/watch/video/inside-hockey-sidney-crosby/16atihz31
http://prohockeytalk.nbcsports.com/2012/01/16/crosby-to-see-chiropractic-neurology-specialist/

More about Functional Neurology in the press-
http://vimeo.com/47787677 (Carrick on ABC's nightline)

Trailer and information about the functional neurology movie  Hope Restored-
http://www.myhoperestored.com/

A fun read on neuroplasticity and changing your thoughts for the better-
http://www.mysticmusingsandmeditations.com/2010/03/is-it-really-possible-to-rewire-your-brain-7-days-to-a-new-positive-you/
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    Nicole DiNezza

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Infinity Holistic Healthcare
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