However, a new study in Japan has identified a type of headache that may account for symptoms in some patients.

Research shows that some patients experience leakage of the cerebrospinal fluid (CSF) after whiplash. The phenomenon was reported in 2004 by Moriyama et al. and in 2007 by Ishikawa et al. These so called “dural leak headaches” are sometimes experienced by patients after epidural injections, and some post-whiplash headaches may have a similar cause.

The authors of this Japanese report studied 20 patients who were all experiencing chronic headaches after sustaining a whiplash injury. The goal of their research was to determine if leakage of CSF was a common cause of whiplash-induced headache.

The patients had symptoms indicating orthostatic headaches – headaches caused by low CSF or low blood pressure. They reported that “an upright position worsened the headache, whereas recumbency relieved it in all patients. Low atmospheric pressure worsened the headache in 17 cases and 17 patients noticed that taking a bath relieved the headache.”

The researchers checked the CSF in all the patients and it appeared normal in all but four of them. However, neuro-imaging tests showed “signs of epidural CSF leakage from the lumbosacral or lower thoracic levels in 10 patients – 50%.”

Each patient was given an epidural blood patch, where a doctor injects the patient’s blood into the epidural space to patch the hole in the dura.

While each patient continued to have other symptoms from their injuries, the study found that chronic headaches in the patients were resolved or diminished in all of them after being treated with the epidural blood patch.

The authors conclude, “This study spotlights a new aspect of whiplash injury caused by rear-end collision indicating that the head and/or neck injuries may cause abnormalities of CSF circulation by alterations of fluid dynamics that can result in long lasting neurological symptoms without visible damage of the CNS.”

Clearly, patients with orthostatic headache should be carefully examined for problems with CSF circulation.

If you’ve been injured in a car accident or are experiencing symptoms of whiplash, chiropractic can help. Contact Dr. Edwin Lipsitz, a chiropractor in Waldorf, MD and begin the road to wellness.

Takagi K, Bolke E, Peiper M, van Griensven M, et al. Chronic headache after cranio-cervical trauma: hypothetical pathomechanism based upon neuroanatomical considerations. European Journal of Medical Research 2007;12:249-254.

Ishikawa S, Yokoyama M, Mizobuchi S, et al. Epidural blood patch therapy for chronic whiplash-associated disorder. Anesthesia & Analgesia 2007;105:809-814.

Researchers first wanted to find out if there were detectable changes in the neck muscles of whiplash sufferers. Previous studies have shown that patients with spinal pain also show fatty infiltration of the muscles on an MRI. This study started with 79 female whiplash patients and 34 healthy control subjects, all between the ages of 18 and 45. Each subject underwent a neck MRI that focused on the cervical spine muscles.

The authors found that:

• Whiplash patients had significantly larger cross section of the deep multifidus muscles at the C3-C7 spinal levels.
• Other spinal muscles in the whiplash patients showed an increase in size as well.
• There was no correlation between fatty infiltration and BMI or age.
• Symptom duration or severity did not seem to affect the degree of muscle changes.

The researchers concluded that these “alterations in the deep muscles may provide valuable insight into the common functional impairments observed in patients with persistent [whiplash].” These deep muscles play a critical role in postural control and balance and if they are disrupted, other symptoms of whiplash can occur, such as dizziness or vertigo. In the study, the changes in muscle were found to occur as soon as three months after the injury.

Whiplash is Different from Other Neck Pain

The same group of researchers decided to perform another study that compared the difference between patients with whiplash and people with “chronic, insidious-onset neck pain.” They believed that if the disuse of neck muscles was responsible for the fatty deposits in the muscle identified in the first study, then it should be found in patients with non-traumatic neck pain as well as patients with whiplash.

23 women with chronic neck pain were studied. Each patient was imaged with an MRI and underwent pressure and thermal pain threshold tests.

The authors found that  “the results of this study provide preliminary data that female patients (18-45 years) suffering from persistent insidious-onset neck pain do not show quantifiable MRI changes in the fat content of the cervical extensor musculature and that their levels of fat mirror those with no history of neck pain. In addition to a lack of muscle changes, participants with insidious-onset neck pain did not demonstrate widespread sensitivity to sensory stimuli and the presence of these features is consistent with abnormal central pain-processing mechanisms; such as seen in some subjects with acute and chronic WAD.”

Both of these studies provide important insight into the problem of whiplash, in that:

• Motor vehicle collision patients show objective evidence of muscle changes on MRI.
• Whiplash injuries are different from non-traumatic neck pain.
• Because fatty infiltration occurs only in whiplash patients, the cause of this phenomenon may be damage to the nerves of the spine.

For more information on whiplash chiropractic care, contact our clinic. Dr. Edwin Lipsitz is a licensed chiropractor in Waldorf, MD and also offers chiropractic care to California, MD.

Elliott J, Jull G, Noteboom JT, Galloway G. MRI study of the cross-sectional area for the cervical extensor musculature in patients with persistent whiplash associated disorder (WAD). Manual Therapy 2008;13:258-265.

Elliot J, Sterling M, Noteboom JT, Darnell R, et al. Fatty infiltrate in the cervical extensor muscles is

A chiropractor can diagnose and treat tennis elbow, but the best route is prevention. Poor technique in sports is a key risk factor, but the more you play, the higher at risk you are too. Whether you play sports or not, strengthening the muscles of the forearm, staying in good physical shape, and decreasing play or work time if you feel pain are all ways to prevent tennis elbow.

For more information on the chiropractic treatment of tennis elbow or other arm pain, contact the Waldorf chiropractor Dr. Edwin Lipsitz. Dr. Lipsitz also offers chiropractic care to patients in the California area.

Symptoms of a herniated disk often include back pain or neck pain specific to one side of the body, and numbness. This condition occurs when all or part of the spine is forced through the weakened disk of cartilage between the vertebrae, placing pressure on the nearby nerves. A herniated disk requires a physician’s or chiropractor’s care.

Over 250,000 people a year undergo elective surgery to treat disk problems in the lower back. One study interviewed people who were considered candidates for back surgery but underwent chiropractic treatment first. 60% reported success with their chiropractic care. Another 40% ended up requiring surgery, but reported success. This suggests that while many patients required immediate surgery, more did not. Considering the cost, time, and invasiveness of surgery, chiropractic treatment is clearly the most viable first treatment option.

For more information on chiropractic treatment as an alternative to surgery, contact Dr. Edwin Lipsitz. Dr. Lipsitz is a licensed chiropractor who treats herniated disks and other causes of pain. He currently serves the California and Waldorf communities in Maryland.

http://www.uschirodirectory.com/index.php/patient-information/item/235-herniated-discs-radiating-pain-and-chiropractic / McMorland, Suter, Casha, du Plessis, and Hurlbert, 2010

Medial Tibial Stress Syndrome (MTSS), more commonly known as “shin splints,” causes pain behind or along the shins, and can be caused by overloading the muscles in the lower legs or a biomechanic imbalance. In addition, having poor muscle tone or having weak core and leg muscles can cause shin splints.

Biomechanical imbalances in the feet and knees can be treated by a chiropractor, who will make adjustments and attempt to return the biomechanics to their optimal function, allowing for the healing of the shin splints.

For other information on the chiropractic treatment of shin splints or Medial Tibial Stress Syndrome, contact Dr. Edwin Lipsitz. Dr. Lipsitz is a licensed chiropractor treating the California and Waldorf communities.

The study followed 688 patients who had been in a frontal or rear-end collision and exhibited whiplash symptoms within three days of the accident. The patients were evaluated for pain intensity, their cervical range of motion (CROM), and subjected to a comprehensive neurological exam. After the assessment, patients were identified as either high risk or low risk without their knowledge of being placed in either group. Patients were evaluated again at two weeks, three months, and twelve months after their initial injury.

The study found that there were indicators of which patients would likely experience chronic or long term pain. Patients with high neck pain and headache intensity, a reduced CROM, and fatigue, sleep disturbances, irritability, or concentration problems were ten times more at risk of developing chronic pain from their injury.

If you were recently in a car accident and need a chiropractor in Waldorf, or are seeking treatment for whiplash or other pain, contact Dr. Edwin Lipsitz. Dr. Lipsitz is a licensed chiropractor treating patients in Waldorf and California.

Kasch H, Qerama E, Kongstad A, et al. Clinical assessment of prognostic factors for long-term pain and handicap after whiplash injury: a 1-year prospective study. European Journal of Neurology 2008;15:1222-1230.

A chiropractor makes adjustments to the alignment of the neck and spine, reducing the pain of fibromyalgia throughout the body. Regular spinal manipulation can benefit sufferers of fibromyalgia by reducing pain and improving sleep quality and fatigue. A 2009 study fond that chiropractic adjustments resulted in instant relief of pain for fibromyalgia sufferers.

Aside from spinal manipulation, ischemic compression therapy is often used a method to treat fibromyalgia successfully. Ischemic compression therapy uses a sustained pressure that is applied to a tender area of the muscles. The tender spot is referred to as a “trigger point” and the ischemic compression deactivates the trigger. The compression stops the supply of blood to the affected area and ensures that when the pressure is released, the renewed blood flow will cleanse any toxins, bring a supply of oxygen , and allow the tissue to heal.

If you are experiencing the pain that comes with fibromyalgia, contact Dr. Edwin Lipsitz. Dr. Lipsitz is a licensed chiropractor who provides chiropractic fibromyalgia treatment to patients in the Waldorf and California communities.

Panton LB, Figueroa A, Kingsley JD, et al. Effects of resistance training and chiropractic treatment in women with fibromyalgia. Journal of Alternative and Complementary Medicine 2009;15(3):321-328.

The researches considered psychological factors like overall job satisfaction and fear of movement triggered by past pain experiences (kinesiophobia) as well as physical factors like age, gender, pain intensity, disability level, and the amount of heavy lifting their job required. The study followed up with patients one year later to determine which of them had developed chronic pain.

With this data, the researchers developed a short list of the most significant indicators that predict which people will develop chronic low back pain. Patients whose pain didn’t decrease or whose level of disability did not decrease within the first three months of onset of pain were more likely to develop chronic pain. People who started out with high pain intensity and those who had a higher kinesiophobia were also at a higher risk.

This study has important implications in the treatment of low back pain. Health practitioners and chiropractors should monitor pain intensity and disability level when treating a patient with acute low back pain. If patients don’t experience relief in the first three months of treatment may require more targeted treatment.

For more information on the chiropractic treatment of acute or chronic low back pain, contact Dr. Edwin Lipsiz. Dr. Lipsitz offers chiropractic care to patients in Waldorf and California.

Hemans MW, vanBuuren S, Knol DL, Anema JR, van Mechelen W, de Vet HCW. The prognosis of chronic low back pain is determined by changes in pain and disability in the initial period. The Spine Journal 2010 (10) 847-856.

High impact, low velocity spinal manipulation (SMT) is a confirmed method of reducing low back pain. Although SMT has a direct impact on spinal muscles and stimulates a patient’s nervous system, many questions remain about how SMT works. This study examined 48 subjects with low back pain from physical therapy clinics and through community advertisements. The subjects were evaluated for factors that may inhibit the success of their treatment, such as longer length of injury and fear avoidance.

Each participant in the study went through three SMT sessions over the course of a week. They rated their pain before and after the session from 1-10 and were measured for spinal stiffness. They were also subject to ultrasounds to assess the thickness of their back muscles.

The results demonstrated that after patients received SMT, there was an immediate a measurable improvement on stiffness. The patients also reported less disability from their low back pain after treatment. Researchers found that muscle thickness increased quickly in patients that were expected to have a positive outcome, suggesting that when combined with low back exercises, the benefits of SMT could be prolonged.

Although the sample size was small and the results preliminary, this study helps confirm that chiropractic care can have an immediate and beneficial impact for patients suffering from low back pain.

For more information on treating your low back pain, please contact Dr. Edwin Lipsitz. Dr. Lipsitz is a licensed chiropractor in California and Waldorf, providing care to patients in these areas.

Fritz JM, Koppenhaver SL, Kawchuk GN, Teyhen DS, Hebert JJ, Childs JD. Preliminary investigation of the mechanisms underlying the effects of manipulation: exploration of a multi-variate model including spinal stiffness, multifidus recruitment, and clinical findings. Spine. 2011 March 15.

The burning, numbness, tingling, and loss of strength that come with CTS can have a huge impact on every aspect of your life. Chiropractic care can offer a drug free, non invasive treatment option for your carpal tunnel syndrome.

For many CTS sufferers, conventional treatment can include NSAIDS, which have side effects and can interfere with other medications. Medical doctors often use cortisone injections to relieve pain and inflammation around the compressed nerve. These shots are unfortunately don’t last long and require repeated injections – a scary prospect for those afraid of needles or with limited funds for medical care.

However, a chiropractor will manipulate the joints and surrounding tissue to take pressure off the painful nerve. A chiropractor will also treat nerve pressure that originates in the back or neck. One major benefit of chiropractic care for carpal tunnel syndrome is that there are no drugs and no side effects, period.

If a patient is seeing a medical doctor and doesn’t respond well to the drugs therapy prescribed for his or her carpal tunnel syndrome, the patient is often subjected to invasive surgery. The surgical method of treating carpal tunnel syndrome is to relieve pressure on the nerve by cutting the ligament that runs through the carpal tunnel. This surgery is a $10,000 option per hand, and isn’t guaranteed to work.

On the other hand, a chiropractor can treat CTS without a single cut. In one study, sufferers of CTS who received 9 weeks of chiropractic treatment reported significant improvements in function, finger sensation, and comfort.

For more information on Carpal Tunnel Syndrome or treating other sources of pain, please contact Dr. Edwin Lipsitz. Dr. Lipsitz is a licensed chiropractor currently providing chiropractic care to the California and Waldorf communities in Maryland.

Davis PT, Hulbert JR, Kassak KM, Meyer JJ. Comparative efficacy of conservative medical and chiropractic treatments for carpal tunnel syndrome: a randomized clinical trail. Journal of Manipulative Physiological Therapeutics. 1998 June;21(5):317-26.