What Triggers Headaches?

Whether you’re a headache sufferer or not, you probably know someone who is. Many simply reach for a pain reliever and try to put their headache behind them. Headaches may be common, but they’re not normal! In my chiropractic office in Greenbelt, MD our patients benefit from safe, natural chiropractic care.

Common Headache Triggers

Stress – Hectic lives, work schedules and insufficient sleep are common culprits

Sleep – Either too much or too little can trigger headaches in some people. Try to keep a regular sleep schedule.

Diet – Certain foods, such as chocolate, red wine, MSG, aged cheeses, caffeine and processed foods can bring one on.

Smells – Strong odors, such as nail polish, smoke, paint, perfume, and cleaning products can cause headaches in certain people.

Injury – Headaches are a primary symptom of whiplash and whiplash associated disorder (WAD).

Eyestrain – If you stare at a computer monitor all day or squint because you need glasses, you might experience frequent headaches.

Subluxation/Joint Fixation – If you have hunched shoulders, a restricted cervical curve, restricted movement in your neck or hear grinding sounds, it may be the underlying cause of your headaches.

Chiropractic care has shown impressive results in helping those who get frequent headaches.

Dr. Louis S. Crivelli II
Chiropractor
Greenbelt, MD

Effectiveness of manual therapy for chronic tension-type headache

Chronic tension-type headache has a considerable impact on daily functioning and work participation, it is also a risk factor for overuse of analgesic medication. Only about 20% of the chronic tension-type headache patients seek medical care for their headache. This low consultation rate may be explained by insufficient information on the effectiveness of treatments or by previous negative health care experiences.

The pathogenesis of chronic tension-type headache remains unclear, however, in recent research a correlation between chronic tension-type headache and impairment of the cranio-cervical musculoskeletal function (forward head position, trigger points trapezius muscle, neck mobility) has been demonstrated. In combination with results obtained in previous studies the present data support the hypothesis that improvement of the cranio-cervical musculoskeletal function by a manual therapy intervention (postural correction, mobilization of cervical spine, and training of cervical muscles) may be an important factor to modify central or peripheral pain mechanism in chronic tension-type headache.

The purpose of this study in Cephalgia was to evaluate the effectiveness of manual therapy in participants with chronic tension-type headache, the authors of this study conducted a multicenter, pragmatic, randomised, clinical trial with partly blinded outcome assessment. Eighty-two participants with chronic tension-type headache were randomly assigned to manual therapy or to usual care by the general practitioner. Primary outcome measures were frequency of headache and use of medication. Secondary outcome measures were severity of headache, disability and cervical function.

After 8 weeks (n = 80) and 26 weeks (n = 75), a significantly larger reduction of headache frequency was found for the manual therapy group. Disability and cervical function showed significant differences in favour of the manual therapy group at 8 weeks but were not significantly different at 26 weeks. Manual therapy is more effective than usual general practitioner care in the short and longer term in reducing symptoms of chronic tension-type headache.

Reference: Castien RF, van der Windt DA, Grooten A, Dekker J. Effectiveness of manual therapy for chronic tension-type headache: A pragmatic, randomised, clinical trial. Cephalalgia. 2010 Jul 20.

Dr. David P. Chen
Chiropractor in Laurel, MD 20708
Laurel Regional Chiropractic

Electric Muscle Stimulation and Rehab

Effects of Neuromuscular Electrical Stimulation After Anterior Cruciate Ligament Reconstruction on Quadriceps Strength, Function, and Patient-Oriented Outcomes: A Systematic Reviewfrom Journal of Orthopaedic & Sports Physical Therapy - JOSPT Site-Wide RSS
Kyung-Min Kim, Ted Croy, Jay Hertel, Susan Saliba

STUDY DESIGN: Systematic literature review.

OBJECTIVE: To perform a systematic review of randomized controlled trials assessing the effects of neuromuscular electrical stimulation (NMES) on quadriceps strength, functional performance, and self-reported function after anterior cruciate ligament reconstruction.

BACKGROUND: Conflicting evidence exists regarding the effectiveness of NMES following anterior cruciate ligament reconstruction.

METHODS: Searches were performed for randomized controlled trials using electronic databases from 1966 through October 2008. Methodological quality was assessed using the Physiotherapy Evidence Database Scale. Between-group effect sizes and 95% confidence intervals (CIs) were calculated.

RESULTS: Eight randomized controlled trials were included. The average Physiotherapy Evidence Database Scale score was 4 out of possible maximum 10. The effect sizes for quadriceps strength measures (isometric or isokinetic torque) from 7 studies ranged from –0.74 to 3.81 at approximately 6 weeks postoperatively; 6 of 11 comparisons were statistically significant, with strength benefits favoring NMES treatment. The effect sizes for functional performance measures from 1 study ranged from 0.07 to 0.64 at 6 weeks postoperatively; none of 3 comparisons were statistically significant, and the effect sizes for self-reported function measures from 1 study were 0.66 and 0.72 at 12 to 16 weeks postoperatively; both comparisons were statistically significant, with benefits favoring NMES treatment.

CONCLUSION: NMES combined with exercise may be more effective in improving quadriceps strength than exercise alone, whereas its effect on functional performance and patient-oriented outcomes is inconclusive. Inconsistencies were noted in the NMES parameters and application of NMES. LEVEL OF EVIDENCE: Therapy, level 1a–.

Dr. Joshua Brooks
Chiropractor Fairfax, VA 22031
Chiropractor Alexandria, VA 22304

Ginger may reduce pain associated with muscle injury after exercising

For centuries, ginger root has been used as a folk remedy for a variety of ailments such as colds and upset stomachs. But now, researchers at the University of Georgia have found that daily ginger consumption also reduces muscle pain caused by exercise. Muscle pain generally is one of the most common types of pain and eccentric exercise-induced muscle pain specifically is a common type of injury related to sports and/or recreational activities.

While ginger had been shown to exert anti-inflammatory effects in rodents, its effect on experimentally-induced human muscle pain was largely unexplored. It was also believed that heating ginger, as occurs with cooking, might increase its pain-relieving effects. Two studies are directed to examine the effects of 11 days of raw and heat-treated ginger supplementation on muscle pain. The researchers recruited 74 volunteers, 34 and 40 respectively, randomly assigned them to consume capsules containing two grams of either raw or heat-treated ginger or a placebo for 11 consecutive days. On the eighth day they performed 18 extensions of the elbow flexors with a heavy weight to induce moderate muscle injury to the arm. Arm function, inflammation, pain and a biochemical involved in pain were assessed prior to and for three days after exercise.

Results showed that supplementation with both raw and heat-treated ginger attenuated muscle pain intensity 24 hours after eccentric exercise. Exercise-induced pain was reduced by 25 percent after daily supplements of raw ginger, and by 23 percent after supplementation with the heat-treated form. The study suggests that ginger may have anti-inflammatory and analgesic properties similar to that of Non-Steroidal Anti-Inflammatory drugs (NSAID’s).

Reference: Black CD, Herring MP, Hurley DJ, O'Connor PJ. Ginger (Zingiber officinale) Reduces Muscle Pain Caused by Eccentric Exercise. J Pain. 2010 Apr 23; DOI: 10.1016/j.jpain.2009.12.013

Dr. David P. Chen
Chiropractor in Laurel, MD
Laurel Regional Chiropractic

Gait Biomechanics, Spatial and Temporal Characteristics, and the Energy Cost of Walking in Older Adults With Impaired Mobilityfrom Physical Therapy current issue by Wert, D. M., Brach, J., Perera, S., VanSwearingen, J. M.

Background
Abnormalities of gait and changes in posture during walking are more common in older adults than in young adults and may contribute to an increase in the energy expended for walking.

Objective
The objective of this study was to examine the contributions of abnormalities of gait biomechanics (hip extension, trunk flexion, and foot-floor angle at heel-strike) and gait characteristics (step width, stance time, and cadence) to the energy cost of walking in older adults with impaired mobility.

Design
A cross-sectional design was used.

Methods
Gait speed, step width, stance time, and cadence were derived during walking on an instrumented walkway. Trunk flexion, hip extension, and foot-floor angle at heel contact were assessed during overground walking. The energy cost of walking was determined from oxygen consumption data collected during treadmill walking. All measurements were collected at the participants' usual, self-selected walking speed.

Results
Fifty community-dwelling older adults with slow and variable gait participated. Hip extension, trunk flexion, and step width were factors related to the energy cost of walking. Hip extension, step width, and cadence were the only gait measures beyond age and gait speed that provided additional contributions to the variance of the energy cost, with mean R2 changes of .22, .12, and .07, respectively.

Limitations
Other factors not investigated in this study (interactions among variables, psychosocial factors, muscle strength [force-generating capacity], range of motion, body composition, and resting metabolic rate) may further explain the greater energy cost of walking in older adults with slow and variable gait.

Conclusions
Closer inspection of hip extension, step width, and cadence during physical therapy gait assessments may assist physical therapists in recognizing factors that contribute to the greater energy cost of walking in older adults.

Dr. Joshua Brooks,
Chiropractor Fairfax, VA 22031
Chiropractor Alexandria, VA 22304

The effects of a three-week use of lumbosacral orthoses on trunk muscle activity and on the muscular response to trunk perturbations

This recent study shows that wearing a lumbar spine orthosis (a type of back brace) can negatively effect the lumbar spine muscles. Although the effects were deemed not detrimental after 3 weeks, virtually every chiropractor or other type of spine physician will agree that strong muscles in the lower back provide the best stabilization. As a chiropractor, I regularly work with patients to strengthen their spines, not just provide symptomatic relief of pain.
-LC


Background
The effects of lumbosacral orthoses (LSOs) on neuromuscular control of the trunk are not known. There is a concern that wearing LSOs for a long period may adversely alter muscle control, making individuals more susceptible to injury if they discontinue wearing the LSOs. The purpose of this study was to document neuromuscular changes in healthy subjects during a 3-week period while they regularly wore a LSO.

Methods
Fourteen subjects wore LSOs 3 hrs a day for 3 weeks. Trunk muscle activity prior to and following a quick force release (trunk perturbation) was measured with EMG in 3 sessions on days 0, 7, and 21. A longitudinal, repeated-measures, factorial design was used. Muscle reflex response to trunk perturbations, spine compression force, as well as effective trunk stiffness and damping were dependent variables. The LSO, direction of perturbation, and testing session were the independent variables.

Results
The LSO significantly (P < 0.001) increased the effective trunk stiffness by 160 Nm/rad (27%) across all directions and testing sessions. The number of antagonist muscles that responded with an onset activity was significantly reduced after 7 days of wearing the LSO, but this difference disappeared on day 21 and is likely not clinically relevant. The average number of agonist muscles switching off following the quick force release was significantly greater with the LSO, compared to without the LSO (P = 0.003).

Conclusions
The LSO increased trunk stiffness and resulted in a greater number of agonist muscles shutting-off in response to a quick force release. However, these effects did not result in detrimental changes to the neuromuscular function of trunk muscles after 3 weeks of wearing a LSO 3 hours a day by healthy subjects.

-Dr. Louis S. Crivelli II
Chriropractor
Greenbelt, MD

Kinesio taping compared to physical therapy modalities for the treatment of shoulder impingement syndrome

The purpose of this study was to determine and compare the efficacy of kinesio-tape and physical therapy modalities in patients with shoulder impingement syndrome. 55 total patients were selected for the study, 30 were treated with kinesio-tape three times by intervals of 3 days, and 25 were on a daily program of local modalities for 2 weeks. Response to treatment was evaluated with the Disability of Arm, Shoulder, and Hand scale. Patients were questioned for the night pain, daily pain, and pain with motion. Outcome measures except for the Disability of Arm, Shoulder, and Hand scale were assessed at baseline, first, and second weeks of the treatment. Disability of Arm, Shoulder, and Hand scale was evaluated only before and after the treatment. Disability of Arm, Shoulder, and Hand scale and visual analog scale scores decreased significantly in both treatment groups as compared with the baseline levels. The rest, night, and movement median pain scores of the kinesio taping group were statistically significantly lower at the first week examination as compared with the physical therapy group. However, there was no significant difference in the same parameters between two groups at the second week. Disability of Arm, Shoulder, and Hand scale scores of the kinesio taping group were significantly lower at the second week as compared with the physical therapy group. No side effects were observed. Kinesio tape has been found to be more effective than the local modalities at the first week and was similarly effective at the second week of the treatment. Kinesio taping may be an alternative treatment option in the treatment of shoulder impingement syndrome especially when an immediate effect is needed.

Reference: Kaya E, Zinnuroglu M, Tugcu I. Kinesio taping compared to physical therapy modalities for the treatment of shoulder impingement syndrome. Clin Rheumatol. 2010 Apr 30.

Dr. David P. Chen
Chiropractor in Laurel, MD
Laurel Regional Chiropractic