Probably one of the most common postural distortions we see is the forward head, forward shoulders posture. This distortion often appears in teenagers and progresses to old age. Porterfield and DeRosa¹ have provided some important information regarding this problem.

They state¹ that while lengthening or weakness of the scapular retractors is often blamed, a major cause is weakness and lengthening of the abdominal muscles, allowing the chest to descend and shifting the weight of the upper trunk anteriorly. This causes the chest to descend with the scapula shifting forward around the rib cage, pressing the clavicle to the first rib. In this position, the humerus internally rotates and the head and neck are brought forward.

As the head and neck are brought forward, the patient is forced to extend the occiput to keep the eyes horizontal, resulting in overactivity of the suboccipital muscles. With the head in a forward position, a passive tensile force is created in the hyoid muscles resulting in hyoid muscle tension, causing the mandible to be depressed and translated posteriorly. The patient is therefore forced to contract the temporalis and masseter muscles to keep the mouth closed.

This abnormal mandibular positioning can cause myofascial stress to the masseter and temporalis and temporomandibular problems. Porterfield and DeRosa¹ state that symptoms such as excessive dry mouth due to mouth breathing, dysphagia, suboccipital headaches, teeth clenching, pain in the head and face over the temporalis area, and tightness over the throat region may occur.

A particular problem with the anterior sagittal glide of the head is the effect on the cervical facet joints. The facets are forced to go into extension and become impacted.² Impacted facet joints prevent the hyaline cartilage compression and decompression necessary for normal nutrition, resulting in increased facet degeneration. The internally rotated shoulders increase the axial compression of the acromioclavicular joints to the sternoclavicular joints. There is usually a shortening of the pectoral fascia. Internally rotated shoulders can cause scapular protraction, narrowing the thoracic outlet and thereby compressing the neurovascular bundle. The forward shoulders may also narrow the subacromial space predisposing to subacromial impingement.

Treatment of the forward shoulders and neck therefore requires strengthening of the abdominal muscles and balancing of the anterior and posterior scapular muscles.¹ Having patients stand in a doorway with the arms supporting them while they allow themselves to fall forward for several minutes at a time helps in stretching the fascial component. Using fascial release to restore pelvic torsion and free the pectoral areas is essential for long-term effect. The forward head posture forces the levator scapulae to eccentrically contract on a continuous basis, which is the reason these patients usually have pain and trigger points at the superior medial border of the scapulae. The posterior cervical superficial investing and prevertebral cervical fascia must be evaluated and treated along with the thoracodorsal and thoracolumbar fascia to which the prevertebral fascia is connected.

Kenneth Fine, D.C.

Call for appointment to get your spine checked out at the Chiropractic Centre of West Hills (818) 704-7211

Elastic therapeutic taping is a valuable chiropractic tool in treating many different conditions. These include muscle sprain and strain; shoulder tension; headaches; dizziness; thoracic outlet syndrome; herniated disc; sacroiliitis; arthritis in the hip; fractured ribs; whiplash and associated disorders; degenerative joint disease; and a whole range of sports injuries.

Taping is utilized in addressing any musculoskeletal pain conditions. Chiropractors adjust the spine and extremities; therapeutic taping can be a particular asset in treating pain conditions such as neck pain, back pain, leg pain, hand pain, shoulder pain, knee pain – just about any area of the body. It is also used in treating postural, foot and gait issues.

When to Use Tape

In practical terms, there is a variety of instances in which applying therapeutic tape can improve outcomes. Applying tape prior to adjustment provides a range of benefits. Taping before the adjustment can balance the soft tissue, especially muscles, and thus make the adjustment easier for both the patient and the physician. Applying the tape to the painful site on the spine prior to adjustment can decrease pain and make it more comfortable for patients to receive the adjustment, as well as easier for the doctor to perform the adjustment. The application can also prevent possible further tissue damage to a site that may already have been injured.

When taping for whiplash and related conditions, we would begin at intake. Specific taping strategies may be utilized in combination or as appropriate for a given assessment. In the assessment of sprain or strain in cervical muscles and ligaments, the taping may be quite beneficial. Therapeutic taping provides comfort and support by stimulating mechanoreceptors, while the tape's lifting effect helps create "space" to increase circulation. Therapeutic taping is also used to inhibit hypertonic muscles resulting from a hyperextension or hyperflexion injury. Fascial taping supports injured muscles such as upper trapezius, scalene and SCM. Applying tape after an adjustment can prolong the effect of the adjustment by balancing the muscle. Applied after the adjustment, therapeutic taping can speed up healing by increasing circulation of bodily fluid at the pain site. Applying tape after the adjustment can also prevent further injury of the site, because it stimulates the patient's awareness of their own alignment and posture. In such instances, after performing manual techniques to improve thoracic mobility and neuromuscular re-education techniques to facilitate postural muscles, the tape may be used to apply a mechanical correction or muscle facilitation technique to help augment what is done in the clinic.

In chiropractic, our major purpose is how best to care for the patient, who may come to us with spinal, neurological or muscular problems, or a combination of all three. Our treatment is associated with many different levels of complaint, especially cranial and spinal. The idea of chiropractic is how to manage spinal subluxation. This is associated with many complicated symptoms. The patient may show several different weak points or one major weak point.

Pain Is Often an Issue

We do not use and rely on pain medication. Still, many patients complain of pain. It may be hard for the person who is in pain to have the patience to trust or wait for the natural response. Chiropractic treatment is based on the body's natural healing; we know that pain medication can have side effects and complications which may be counterproductive in the healing process. We use manual adjustment and other modalities to manage symptoms, conditions and pain.

Therapeutic taping plays an important role in addressing pain. We work with the body's natural healing process. Pain will make the patient impatient; they start to worry and have trouble following the treatment protocols. It also causes more problems if they have more injury with soft tissues – or even injury to hard tissues. When there is dramatic pain we need more analgesic treatment; icing, hot pack and other methods may not be enough. Everyone has a pain threshold. At the most painful level, when pain is over the bearable threshold for that person, it may be hard to get a patient to cooperate. Higher-level pain tends to occur on the surface of body, in the dermis and epidermis. As I have often noted, the tape is on the surface of the skin and helps control muscles. On the skin, taping will provide gradually stimulation with a gentle, light stimulus to the epidermis, to the dermis, and to the fascia. This soft reaction provides a fast, effective analgesic effect so that treatment can begin or continue.

An example would be a patient who is in too much pain to be able to receive the adjustment. We would put tape on first. Then they are able to respond to the adjustment. If their pain is not so aggressive, go ahead and treat as indicated, and tape may be applied after the manual adjustment. Pain will cause different positioning of joint and muscle activities. This is why it is important to find out what muscle, ligament, even organs are triggering pain, whether the problem is with the muscular system, tendons, etc.; or whether a special type of treatment is needed. Therapeutic taping helps us to find this out and to adjust for the underlying cause.

Supporting Pain Studies

A 2009 study¹ of 41 patients with whiplash after car accidents was published in the Journal of Orthopaedic & Sports Physical Therapy (JOSPT). Researchers noted immediate pain relief and improvements in range of motion after the application of elastic therapeutic tape. The study concluded, "Patients with acute WAD [whiplash-associated disorders], receiving an application of [elastic therapeutic tape], applied with proper tension, exhibited statistically significant improvements immediately following application of the [tape] and at a 24-hour follow-up."

"It is possible that the tension applied by the real application might have provided neural feedback to the patients during neck movement, thus facilitating their ability to move the neck with a reduced mechanical irritation of the soft tissues," the 2009 study suggested. "The tension in the tape may have also created tension in the soft tissue structures when the patient returned the head to a neutral position. Further, it is also possible that tension in the tape provided afferent stimuli, facilitating pain inhibitory mechanisms (gate control theory), thereby reducing the patients' pain levels. Further, because increased mechanical sensitization is a feature of patients with acute WAD, it is possible that the tape decreased pain by way of inhibitory mechanisms. Finally, because fear of movement is associated with pain intensity in patients with acute WAD, it may be possible that the application of [therapeutic] tape provides a proper sensory feedback to the patients, decreasing fear of movement, thus improving neck pain and range of motion."

In Physiotherapy Theory and Practice, a 2004 case study² looked at traumatic patella dislocation. Diane J. Osterhues wrote: "A major focus of rehabilitation is improvement in post-dislocation strength, pain, and swelling. Although re-evaluation revealed muscle atrophy and pain with eccentric loading activities, the patient felt her pain, stability, and quadriceps activation were subjectively improved with tape application. [Functional evaluation] suggests [elastic therapeutic tape] application during rehabilitation may enhance strength, balance, coordination, mobility and control necessary for participation in sports or occupational activities safely and with reduced risk of injury."

"The tape may have had an indirect effect on the damaged retinacular tissue through local edema control as well as mediating pain responses. Elastic tape may also contribute to a reduction in pain resulting in higher functional activity levels," Osterhues concluded.

Another study,³ published in JOSPT in 2008, found that "pain-free abduction ROM in the treatment group immediately improved."

In 1999, at the 15^th Annual Kinesio Taping Research Symposium, Bruce A. Franke Jr. reported: "As a national lecturer and specialist in the area of spinal rehabilitation, I very often deal with challenging chronic pain patients. The utilization of complementary treatment tools with benefits that can be carried forth beyond the therapy visit is a necessity to gain prompt and lasting changes. [Elastic therapeutic tape] has demonstrated consistent value as a tool to assist the patients' quicker return to self-management and relief from pain and undesirable movement patterns."⁴

These results are no surprise. I originally developed elastic therapeutic taping for use with the chiropractic adjustment, to allow patients to become more active during the course of treatment. It is difficult to address the patient's physical condition when they cannot move the body so fast after a lengthy period of inactivity. In some cases the suddenness of an adjustment can be somewhat shocking to a patient who has been inactive. If they are treated too often or too much at once, ligaments and joints may be hypermobilized. This is why I studied and applied principles of kinesiology, trying to find ways to retain the good, beneficial part of the adjustment, and to minimize the bad, stressful part. We find where muscles are too weak or too strong; if we inhibit or facilitate the too-strong or too-weak muscles, this results in a good spinal adjustment. This is one important role for therapeutic taping.

Clinical Taping Guidelines

Here are some chiropractic-specific guidelines for utilizing elastic therapeutic taping.

1. Whiplash

a. Intake to rule out severe trauma (e.g., fracture, herniated disc); take X-ray.

b. Assessment: sprain/strain cervical muscles and ligaments; application of elastic therapeutic tape is beneficial.

i

. Provides comfort and support by stimulating mechanoreceptors.

ii. Lifting effect that helps create "space" to increase circulation.

c. Specific taping strategies – in combination or as appropriate given assessment.

i. Acute: lymphatic taping to minimize swelling secondary to inflammatory cascade. Supports action of paraspinal muscles to cue spine to hold optimal posture (or provide cervical collar as needed).

ii. Inhibit hypertonic muscles resulting from hyperextension/hyperflexion injury: fascial taping supports injured muscles: upper trapezius, scalenes, SCM. Also allows patient to relax, facilitating a better adjustment.

iii. Ligament taping to stabilize joint or spinal segments: apply tape before adjustment to give extra support and hold the adjustment longer.

2. Lower Back

a. Sedentary lifestyle weakens core muscles; manipulation of restriction in lumbar spine releases stress on facet joint.

b. Elastic therapeutic tape supports weak abdominal muscles and inhibits hypertonic erector spinae muscles to ease compression of facet joints.

c. Provides somatic education for patient and reminds patient to stretch the hypertonic muscle; helps adjustment last longer.

3. Patellofemoral Syndrome

a. Look at entire body structure during assessment, including spine, extremities and myofascial system.

b. Addressing myofascial system with elastic therapeutic tape helps create optimal biomechanics of the patellofemoral joint.

i

. Inhibits hypertonic IT band from tracking the patella laterally.

ii. Supports weak vastus medialis oblique to prevent tracking

laterally.

c. Important to treat the extremity and myofascial system to provide a solid foundation for the pelvis and spine to function optimally.

Who Can Benefit?

The contemporary DC is apt to see patients from the very old to the very young who come in with complaints ranging from post-surgery rehabilitation to high-level sports injuries. Peter Zid, DC, CKTP, DACBSP, CSCS, commented on his recent work at the Olympic Training Center in Colorado Springs, where he has been working in the Performance Sports Medicine Center.

"We treat high-caliber Olympic athletes from around the world. [Elastic therapeutic tape] plays an important part in rehabilitation of the athletes coming to the center for treatment. One of my patients is a trap shooter who injured his right shoulder and thoracic spine during training. This athlete shoots a 12-gauge shotgun and shoots over 250 rounds per day. The recoil takes a toll on the shoulder and spine. I treat him with CMT, myofascial release, IFC and [therapeutic taping.] The tape helps hold the adjustments and the myofascial work while this athlete trains.

"By the way, these athletes do not take much time off unless there is a severe traumatic injury. This individual continues to train daily while being treated and will leave for nationals this coming week. [Elastic therapeutic tape] has played an integral part in his treatment and rehab."

In his 1999 study,⁴ Franke noted, "In my practice I frequently deal with cervical mediated headaches. I also see many thoracic outlet patients or post-whiplash patients. The restoration of optimal circulation and normalizing muscle tone is an important component treating these patients. The cervical region of the body is typically highly sensitive and plays a large role in the patient's sense of emotional and physical 'well-being.' The tape is an effective and efficient tool to create a sense of support and stability to this often hyper-mobile and chronically guarded region. Postural sense is an important part of the rehabilitation of this region as well. Half the postural receptors are located in the upper cervical segments. The use of taping to alter postural control and muscle firing has in recent years become more readily appreciated. The inter relationship between skin receptors and the deeper muscle and joint receptors is an important relationship to consider as one chooses treatment strategies for any region in the body. Tape lasts well beyond the 45-minute treatment session and can continually calm and support the traumatized and nocioceptivally bombarded region of dysfunction.

"[Taping] has also been extremely helpful in restoring postural sense and scapular control for the upper quarter in the neck or shoulder patients. The ability to assist thoracic extension and scapular retraction and depression is significant in these patients. Additional tape placed on the long cervical extensions (applied in lengthened position) assists to relax these often hypersonic and compressive muscles. This has especially been beneficial in the post-whiplash patients where the myofascia and discs are disrupted or strained and therefore perpetuate muscle guarding and reversal of the normal cervical lordosis."

Call to make appointment 818 704-7211

Kenneth Fine, D.C.

It is extremely important to have testing done after an accident to find out if your body is suffering more serious consequences than you first thought. Imagine your head as a heavy ball, resting on a freely moving spindle (the neck), that is attached to the body, and what happens when a sharp sudden force is applied to the back of that body. It doesn’t take a rocket scientist to see that the head would snap backward and through the law of physics, would snap forward at an even greater speed. The sudden powerful force of one automobile striking another automobile in the rear end reproduces the “Whiplash” effect, whereby the body remains motionless, the head is thrown backward and snapped sharply forward. The head is being thrust forward at a greater speed than the backward thrust, hence the term “Whiplash”. And this is only one of the common problems associated with a car accident. The thrust of the seat belt on your right shoulder, the jamming of your foot/leg/hip on the brakes, the nagging headaches you have after a car trauma are also debilitating and painful.

At our Chiropractic Centre Clinic, we believe you deserve a thorough examination and history taken from the accident to determine where your pain and problems are coming from or may come from in the future do to damage at the scene. We are experts in treating and reducing pain and inflammation, structural and muscular damage, and neurological side effects like headaches. If you have been in an accident within the past year, and are worried about your health, call us today. WE can help. 818 704-7211 To Your Health,

Dr. Kenneth Fine, D.C.
 

The exercises below combine range of motion (ROM) against light/partial resistance in 4 directions (forwards, backwards, and L/R side bending). To do these correctly: Similar to an arm wrestling contest: 1. Push your head into your hand while moving the head to the end of the range, “…letting the head win” (See A, C, E, G). 2. Repeat this going back in the opposite direction by “letting the hand win” (see B, D, F, H), again, moving through the entire range of motion. ALWAYS push the head into the hands, Make sure you move the head against resistance in BOTH directions, 3 times each (A-B then B-A x3; C-D then D-C x3) then, (E-F then F-E x3, and lastly, G-H then H-G, x3 reps). The trick is doing this VERY slowly (to build motor control and coordination) and to move through the entire “comfortable” range of motion. Repeat 3x slowly. If pain worsens, lighten up on the amount of pressure used or, stop the movement just prior to the sharp pain onset. If you can’t make it to the end of the movement due to pain, make a note of how many reps it took before the onset or increase of pain and how far you could move your head. Do 3 slow reps and then move to the next exercise direction.

(The arrow represents the direction the head is moving and the hands are resisting, but not stopping, the movement; Use light pressure through the full ROM)

These exercises can be performed 1 to 3x/day, according to tolerance, and will increase ROM, increase strength, and build coordination, all at the same time. Feel free to contact our office for additional exercises or to answer any questions concerning you, your loved ones, or friends.

YOU MAY BE A CANDIDATE FOR CHIROPRACTIC CARE FOR YOUR NECK PAIN
FOR A FREE NO-OBLIGATION CONSULTATION CALL (818)704-7211

 

Here's another important reason to get kids off to bed: Too little sleep can lead to a bad habit: overeating.  According to a recent study published in the American Journal of Clinical Nutrition, reduced sleep time (less than six hours compared with more than eight) is associated with an increase in energy consumption - often in the form of snacks - without any increase in energy expenditure.  In other words, if kids sleep less, they tend to eat more, but don't expand energy during the extra time they're awake.

So, what could they possibly be doing that doesn't burn any energy? Perhaps they're studying for next week's exam or writing that long-overdue birthday card to grandma.  But probably not.  In fact, the chances are good that they're playing on the computer, watching television, "texting" their friends or pursuing some other sedentary activity, which is never a good thing, particularly when combined with additional caloric intake.  That's a bad combination that could lead to chronic overeating and weight gain, not to mention fatigue, irritability and reduced performance attribtable to lack of sleep.

Too little sleep equals too much snacking, simply put.  And by the way, that applies to adults, too.  So put away the remote, keep the chips in the pantry and get a good night's sleep.

For more information, please contact Dr. Kenneth Fine at the Chiriopractic Centre of West Hills (818) 704-7211.

2. In regard to respiratory dysfunction in chronic neck pain patients, a recent study "demonstrated a strong association between an increased forward head posture and decreased respiratory muscle strength in neck patients."

3. "For every inch of forward head posture, it can increase the weight of the head on the spine by an additional 10 pounds."

4."Loss of the cervical curve stretches the spinal cord 5-7 cm and causes disease."

5. "90% of the stimulation and nutrition to the brain is generated by the movemnet of the spine."

So, what can you do to get relief?  First of all, avoid any exercise that requires extreme movement of your hips and spine.  For activity, swimming or water aerobics are a good option to alleviate back pain.  Then, I suggest getting an exam from Dr. Kenneth Fine.  At the Chiropractic Centre of West Hills we offer treatments like trigger point therapy that relieve muscle tightness and ease the pain.  Dr. Fine, can relieve spine misalignments which stress your muscles and nerves.  Chiropractic has shown to reduce labor pain and complications.  

If you or someone you love is suffering from low back pain during pregnancy, call us today and schedule a free consultation.  The health of a pregnant mother is the defining factor in the health of her baby.  Take a step and improve the quality of your health.  Call us at 818-704-7211 or find us online at chiropracticcentre.net

Yours in Good Health,

Kenneth Fine, D.C.

LYING CHIN TUCK:  Gently lift your head off the floor with your chin tucked in.  You should be able to hold this position for 10 seconds.  If your chin goes up, head tilts back, or your head begins to shake and you are unable to hold the position, this indicates fatigue of deep neck muscles, which may be contributing to your pain.

SITTING CHIN TUCK:  Simply tuck the chin in.  Make sure you don't tilt your head forward.  Keep chin tucked in and head back.  This a good exercise to start with if you're suffering from chronic neck pain and are unable to perform lying chin tucks for a sustained period of time.

There are two basic causes of lower leg numbness & tingling.   One cause is poor circulation often found in diabetics, and the second, most common cause, is  Nerve Irritation.  To understand nerve irritation, you need to understand how your brain sends messages to the rest of your body.  Your brain is connected to your spinal cord which runs through your vertebral column.  Nerves branch off of the spinal column and carry vital messages to your limbs, organs, tissues, and cells.  If you are feeling a numbness or tingling in your legs, you most likely have a blocked signal from your spinal column to your nerves.  You’ve got a blocked signal from your brain causing irritation.  Most often the irritation happens in a movable joint like your vertebrae.  When this occurs, picture your spinal cord like a garden hose.  What happens when you put a rock on a garden hose?  The water cannot travel through at the same volume, sometimes, it may even stop water flow completely.  If your vertebrae become misaligned due to strain or trauma, those joints act like a “rock on a garden hose” by interfering with the signal traveling from your brain, causing irritation.  The good news is:  when you take a rock off the garden hose, the water flows again!  The same holds true of your nerves.  If the misaligned vertebrae is realigned, the irritation is removed, and flow of signals throughout your nervous system is repaired.

I feel the best way to locate the irritation or misalignment is to get a proper x-ray.  This allows you to see where the distortion is taking place.  After taking x-rays at our clinic, I hold a Report of Findings on each specific patient case.  From there, the I create a specialized treatment plan for each patient to relieve their symptoms, get them out of pain, and restore strength.  We offer a more well-rounded approach to helping our patients because we provide the expertise of Physical Therapy & Chiropractic under one roof.  If you have experienced this type of tingling & numbing, we can help.  Call us for a consultation today at 818-704-7211 or contact us at chiropracticcentre.net.  You don’t have to live with the pain.

Live life to its fullest,

It is you health that we are striving for, not just relief from pain, so make a commitment to get spinal checkups and advice for health from us on a regular ongoing basis.  We want you to live well with chiropractic care.  From all of us to you at the Chiropractic Centre of West Hills in Canoga Park/West Hills.

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