Is it Sciatica or Piriformis Syndrome?

Tell someone you have sciatica and chances are they will know you have shooting leg and buttock pain.  Tell someone you have piriformis syndrome and they don’t know what you’re saying.

 

The term “Sciatica” is so over used and common that to some people the first sign of buttock pain automatically means it is sciatica.   The term sciatica is more of a description than a clinical diagnosis but it is so common doctors have accepted the term and use it freely.   “Sciatica” is actually an irritation of the sciatic nerve.  This large nerve runs from the back through the buttock muscle and continues down into the back of the leg, splitting when it gets to the back of the knee cap.   True sciatica is irritation of this nerve. The nerve can be irritated by joints in the low back, a disc herniation, or a muscle entrapement.   Each one of these scenarios has its own proper clinical term which accurately defines the reason for the “sciatica”.  

When the sciatic nerve becomes entraped in the piriformis muscle the resulting pain is called  Piriformis Syndrome.  Piriformis syndrome, in addition to causing gluteal pain that may radiate down buttocks and the leg, may also present with pain that is relieved by walking with the foot on the involved side pointing outward. This position externally rotates the hip, lessening the stretch on the piriformis and relieving the pain slightly. Piriformis syndrome is also known as “wallet sciatica” or “fat wallet syndrome,” as the condition can be caused or aggravated by sitting with a large wallet in the affected side’s rear pocket

There are several ways a doctor or chiropractor can assess where the sciatic pain is coming from.  Often that means ruling out conditions like joint problems, disc herniations, spinal stenosis and lumbar muscle strain and performing tests that stress and stretch the piriformis muscle.

Below are a few of the tests for piriformis syndrome:

Freiberg’s maneuver of forceful internal rotation of the extended thigh elicits buttock pain by stretching the piriformis muscle, and

Pace’s maneuver elicits pain by having the patient abduct the legs in the seated position, which causes a contraction of the piriformis muscle.

Sciatic notch tenderness elicits pain by manual pressure on the sciatic nerve where is exits at the back bony pelvis (ilium bone) and passes under the piriformis muscle. 

Dr. Beatty, in a 1994 journal article,  proposed another test, where the patient is lying with the painful side up, the painful leg flexed, and the knee resting on the table. Buttock pain is produced when the patient lifts and holds the knee several inches off the table.  It relies on contraction of the muscle, rather than stretching, which the author believes better reproduces the actual syndrome.

 

 

Meralgia Paresthetica – a possible reason for thigh pain

Recently I had a patient come in with a 15 year plus complaint of chronic low back pain, with associated posterior thigh and buttock pain.  However the patient also stated he has constant numbness in the front outside area of his thigh.  The thigh wasn’t painful it just felt numb all the time.  The man was middle aged and obese with a large protuberant abdomen wearing his jeans low and belted under his belly.

After the history and physical exam I diagnosed the numbness in the thigh as Meralgia Paresthetica. 

What is Meralgia Paresthetica?

It is a mononeuropathy (injury to one nerve) which causes numbness or pain in the outer thigh not caused by injury to the thigh, but by injury to a peripheral nerve that travels from the spinal cord to the thigh.  This nerve is called the lateral femoral cuntaneous nerve. 

 

The nerve most often becomes injured by entrapment or compression where it passes between the upper front of the hip bone (ilium) and the inguinal ligament near the attachment of the anterior superior iliac spine (the upper point of the hip bone).   Less commonly it could be entrapment by other muscles or structures like the psoas muscle or the tensor fascia latae, or damaged by diabetic or other neuropathy. 

What the causes of Meralgia Paresthetica?

The most interesting aspect of meralgia paresthetica is the multiple different causes. MP has been reported to be caused by obesity, pregnancy and compression from tight pants, belts, uterine fibroids and tumours. Furthermore, MP can be due to direct trauma, like seat belt incidents, surgery complications and even associated with disorders such as diabetes and leprosy.   Recent reports have also surfaced regarding MP being caused by exercise or even prolonged periods of standing that increase compression on the inguinal ligament.

The Pelvic Compression Test

 Nerve conduction studies can often help confirm one’s diagnosis but aren’t easily accessible to manual therapists, like chiropractors.  The following is a fairly new test which can be used by manual therapist to help diagnose Meralgia Paresthetica

This test is based on the premise the LFCN is compressed by the inguinal ligament and by relieving this compression symptoms will temporarily be alleviated. With the patient focusing on their symptoms the examiner attempts to apply a downward and lateral compressive force on the pelvic. The pressure is held for 45 seconds and a positive result is when patients report an alleviation of their symptoms. By compressing the pelvic in this manner the two attachments of the inguinal ligament are brought closer together causing the ligament to become slacker.

 

Treatment Options 

 Conservative manual therapy from a chiropractor or other trained manual therapist should be tried before seeking drugs or surgery.   A chiropractor can manually release (or stretch) the muscles and ligaments that may be entrapping the lateral femoral cutaneous nerve. Soft tissue therapy such as Active Release Techique, Graston therapy, or deep tissue massage may provide relief of symptoms.   However proper education and at home advise must be followed to ensure the benefits of in clinic treatment have a longer lasting effect.    Chiropractic assessment of the pelvis and ilium bone can detect any bony misalignments where adjustments may have an effect.  If conservative treatment is not effective speak to your medical doctor about other options like NSAIDs for pain, or surgical nerve block or release.

 

 

 

Sources:

 

Shimizu, S. (2008). A Novel Approach to the Diagnosis and Management of Meralgia Paresthetica Neurosurgery, 63 (4) DOI: 10.1227/01.NEU.0000325683.55646.90

Dr. Wayne Button DC.  Sports Injuries and Wellness Ottawa. 

 

How autistic children can benefit from chiropractic care

As a Chiropractor, I often get ask questions from parents of autistic children on how a chiropractor can help?

During my time at the Canadian Memorial Chiropractic College, I had the opportunity to intern at the Muki Baum Treatment Centre for children with complex disabilities, in Toronto, ON.  At Muki Baum, the staff understood the importance and could see the benefits that chiropractic care had on these children, many of whom had autism. After treatment, teachers would report improvement in mood and attention levels, less aggression and more tolerance to physical stimulation and touch. In fact, chiropractic re-assessments showed improvements in physical strength, balance, mobility and coordination. 

The importance of chiropractic care is essential to children with disabilities.  These kids often have hypotonia (low muscle tone), poor posture, decreased body awareness and as a result have more pronounced musculoskeletal problems such as restrictions on movement and stiff joints.  Furthermore autistic kids are often have sensory stimulus deficits, either hypo (too little)  or hyper (too much) sensitive.  Receiving the proper chiropractic adjustments can be like hitting the information reset button on the nervous system.  Either calming or turning up the nervous system when the body requires.       

Children with developmental disorders can benefit from chiropractic treatment focused to improve joint mobility, gross motor training, core muscle strengthening, vestibular (balance) exercise and sensory stimulation.  However, chiropractic care is only part of the treatment puzzle.  Other avenues of care including biochemical, nutritional, cognitive and emotional components should be addressed to offer the best possible outcome for the patient.

Flat-Headed Babies – At a developmental disadvantage

Positional plagiocephaly is the medical term for flattening of the skull bones due to pressure on the back of the babies head.  Torticollis is the term for to muscle tightness and decreased range of motion in the neck.   These two conditions are often present together in infants.  Torticollis is typically there since birth and as the infant grows the head and neck movement has some restriction on turning to one side and there is a preference to keep the head tilted to one side more than the other.  The muscle and joint restrictions in conjugation with pressure on the back of the baby’s head can lead to positional plagiocephaly. 

Many times, infants will need an evaluation by a pediatric chiropractor who can assess muscle tone as well as joint placement.  The chiropractor can treat the infant as well as teach the parents neck stretching exercises to do at home. If torticollis is not treated, it will make the decrease the success of improving the positional plagiocephaly.  

Over the years there are been a dramatic increase in the number of babies with flat heads.  In the 1970’s doctors reported seeing 1 in 300 infants with this condition and now it is more like 1 or 2 in 10 babies.  

So what are we doing that our parents didn’t?

Sleep position

This flat head pattern is linked to the “back to sleep” movement that encourages parents to put infants on their backs to sleep as a way to protect babies from Sudden Infant Death Syndrome.  While SIDS deaths have decreased the plagiocephalgy has increased.  A small price to pay for reduction in SIDS.

Car seats and swings

The technology, comfort and style of new travel systems available today enable parents to easily transport their sleeping baby from his car seat to the stroller back the car seat and home without disturbing the precious little one’s sleep.  However, this trend is a contributor to positional plagiocephaly.  Think of the time spent during the day where the infants head is in contact with the back of a car seat or bouncy swing

Lack of touch

Babies left in car seats or swings are being deprived of the ultimate comfort and warmth of their parents.  Think of the potential for interaction and stimulation your baby is missing out on by being in the carseat during family visits or out shopping. Babies who were transported in a soft wearable baby carrier were significantly more likely to show a strong bond of attachment to the parents than those left in a car seat or swing during activities. 

Plagiocephaly is more than just comestic

A new study says that up to one-quarter of babies with flat heads may have “disadvantaged” motor skills compared to babies without flat heads.  It may be that these flat headed babies will simply catch up at one year of age with they are sitting up and moving but pediatricians should monitor closely the development of infants with this condition.  

What you can do at home

Frequent changes in your child’s position are recommended to improve your baby’s neck mobility and prevent or treat abnormal head shaping and torticollis. Most importantly try to limit the time the baby has pressure on the back of the head while he is awake.  Below are some tips.

• If your baby is diagnosed with plagiocephaly, ask the doctor to screen for developmental delays in both motor and cognitive skills.   Talk about the results.
• Always place babies to sleep on their backs: this remains the safest way to sleep. Place your baby’s head at one end of the crib and switch to the other end the next night.
• Encourage active supervised ‘tummy time’ when babies are awake: find ways to for baby to engage, play and move while on their tummy, several times each day building up from just one to two minutes at the beginning. Tummy time will help improve your child’s muscle and strength and development.
• Alternate the end of the changing table in which you place your infant’s head and stand to the side to encourage your baby to move his head.  Also perform neck-stretching exercises at each diaper chance, as prescribed by your doctor.
• Choose different positions and ways for babies to play and be held: variety of stimulation is important. Switch the arm you use to cradle your baby each feeding session; right one time, left the next.
•  Use strollers, car seats, infant seats, bassinets, cribs and play pens when necessary, but remember that babies need frequent lap time, cuddling, active play times and chances to move that aren’t limited to being in stationary positions. 
• Invest in and learn to use a good quality soft baby carrier to transport your baby when outside of the car.  The soft malleable material will exert less pressure of the baby’s head and the practice of baby wearing will strengthen the parent child bond.
• Develop motor skills: play with babies to get them moving. Encourage crawling, rolling, reaching, pushing, pulling, holding, grasping.
• Develop cognitive skills: play with babies to get them thinking and talking. Encourage interactions with their environment, looking, listening, imitating, babbling, singing, talking, reading.

 

 

LITTLEFIELD, T., SABA, N., & KELLY, K. (2004). On the current incidence of deformational plagiocephaly: An estimation based on prospective registration at a single center Seminars in Pediatric Neurology, 11 (4), 301-304 DOI: 10.1016/j.spen.2004.10.003

 
Speltz, M., Collett, B., Stott-Miller, M., Starr, J., Heike, C., Wolfram-Aduan, A., King, D., & Cunningham, M. (2010). Case-Control Study of Neurodevelopment in Deformational Plagiocephaly PEDIATRICS, 125 (3) DOI: 10.1542/peds.2009-0052

Yoga for chronic low back pain

I often recommend Yoga to my patients as an excellent way to strengthen and relax the body and mind.   I fully believe it is an excellent practice but as a health professional I must ensure the safety and well being of my patients so I have the research to back up my recommendation.

Research into yoga for back pain 

A literature review done in 2007 found three published randomized controlled studies evaluating the effectiveness of yoga for low back pain (LBP) and one feasibility study.   All 3 studies found yoga to be beneficial for low back pain.  

Galantino et al., in 2004 studied the effects of a modified yoga protocol on patients with CLBP (chronic low back pain).  22 subjects were randomized into 2 groups including 11 in the yoga group and 11 in the control group.  The yoga group received 1 hour session twice weekly for 6 weeks and asked to practice as often as possible throughout the week.  Results were not powered for statistical significance (small group sizes) but the potentially important trend appeared of decreased depression and improved flexibility and balance in patients with CLBP undergoing a yoga intervention.

 In 2005 Williams et al., evaluated a lyengar yoga intervention where the yoga group received a 90 min class weekly for 29 weeks and patients were encouraged to practice yoga at home for 30min, 5 days per week.   The control group received periodic educational material as well as two 1-hr lectures. The authors of this study concluded yoga therapy could significantly reduce disability and pain and decrease use of medications in patients with CLBP.

 Sherman et al., conducted an RCT in 2005 to compare yoga classes to conventional exercise and self care books in patients with LBP.  101 Participants were randomly assigned to one of the three interventions including 36 participants to the yoga class, 35 to the conventional exercise class, and 30 to the self-care book.  The authors concluded that yoga was more effective than a self-care book in reducing pain and improving functional status in patients with CLBP. Furthermore, they stated these benefits appeared to persist for at least several months after intervention. On the other hand, while the yoga group consistently reported superior outcomes compared to the exercise group, none of these differences was statistically significant. Finally, the authors noted the yoga intervention was safe and had moderately good adherence. In conclusion, the authors suggested that the Viniyoga style of yoga was an effective and safe treatment for patients with nonspecific CLBP.

 Take home points:

• Yoga can be an effective management tool for people suffering with low back pain
• Yoga can decrease pain, disability, and medication use as well as increase flexibility
• Patients and practionner should understand that differently styles of yoga exist and some may be better suited for low back pain than others.
• Patients should be directed to seek out experienced instructors who have worked with low back pain patients in the past.

 

 

 Sources: 

Sorosky, S., Stilp, S., & Akuthota, V. (2007). Yoga and pilates in the management of low back pain Current Reviews in Musculoskeletal Medicine, 1 (1), 39-47 DOI: 10.1007/s12178-007-9004-1

What’s Holding You Back?

Approximately 80 per cent of Canadians will experience back pain at some point in their lives. Add this to our stressful schedules and work-related back injuries, and we have a virtual back pain epidemic.   

Back Pain 101

Our inactive lifestyle is damaging our backs. Many of us spend our days driving or  hunched in front of computers, often without any postural support. Studies show that sitting places significantly more pressure on the joints and discs of the spine than either standing or walking. After all, our bodies were built to move!   

We spend upwards of $21 billion annually on back pain products, including over-the-counter pain medication. Yet, amazingly, most people wait up to six months to seek treatment, while 30% do nothing at all in the hope that the back pain will eventually go away.   Nearly a third of back pain cases last longer than a month and a significant portion become chronic and persist for months to years.    

Research suggests that back pain treatments are most effective in the acute and early stage, and that the longer the problem is allowed to linger, the more difficult and lengthy the healing process may be.   

 Doctors of chiropractic are specialists, who provide drug-free, hands-on treatment that targets the source of pain. Studies show that chiropractic treatment is increasingly recognized as one of the safest and most effective solutions for most back pain sufferers.     

Are you holding back from taking charge of your back pain?   Click HERE to take an online quiz from the Canadian Chiropractic Association to find out!   

  You can also visit the Ontario Chiropractic Association Web site ator the Canadian Chiropractic Association for lots of patient information, hand-outs and more regarding chiropractic care.

Does your neck crack by itself? Advice for the hypermobile neck

A chiropractic adjustment is a specific and precise release of a joint that is limited in its normal range of motion.  This is very different from someone who can “crack” their own neck or back.  “Self-cracking” is a common practice for some people.  They claim it feels good or loosens their neck.  If fact self “cracking” can create excessive movement, or hypermobility in the area, loosening muscles and ligaments, which furthers the hypermobility in the area leading to easier and more frequent “cracks”.   Below is my advice on how to stop this bad practice.

 How to stop the cracking

1. Stop the self-cracking.  It is not helping you. 
2. Get treatment. If you feel stiffness in the morning, while driving or anytime throughout the day, your body may very well be saying “I need an adjustment!” but make sure it is a real chiropractic adjustment, delivered at the correct joint by a trained chiropractor. 
3. Strengthen the area.   If your neck or back is constantly cracking, it is a good sign that the surrounding muscles are weak and/or ligaments may be loose, leading to hypermobility in the joints.

General Neck Exercises 

Here are some good general neck strengthening exercises for the muscles of the neck and upper back.  If you are experiencing pain or discomfort it is best to seek specific advice from a health professional about your exact condition.

1. Chin tuck:  

 this exercise strengthens the muscles in the front of the neck, called the deep neck flexors (longus colli and longus capitus).  As well it provides a stretch for the suboccipitals at the back of the neck.  This exercise can easily be done anywhere at any time.  While driving in the car, on a bus, sitting at your desk or even lying in bed at night.  Do this as often as you remember throughout the day.

2.  isometric range of motion.  

This activity will strengthen the global muscles of the night.  It is performed by resisting neck movements in all planes.  Put you hand on your forehand and try to bend your head down while resisting with your hand.  Hold for 10 seconds.  Then repeat trying to turn you head to the left and resisting it, turning to the right and resisting, looking upwards and resisting, and finally ear to each shoulder while resisting.

3.  middle trapezius. 

 

The trapezius muscle attaches to the lower part of the neck, to the shoulder blades and down to the mid back.  The middle fibers are this muscle are often neglected and weakened leading to neck pain and dysfunction.   To target this muscle use hold a resistance band with two hands at chest level and pull hand apart and back while pinching the shoulder blades together.  

Research into Neck Exercise

These exercises will strengthen the muscles of the neck.  In fact a study in JAMA 2003 showed that both isometric strength training exercises and dynamic endurance training exercises (ie. chin tucks and lifts) effectively decreased neck pain and disability in women with chronic neck pain during the 1 year follow up period.  And it was observed the benefits could be obtained by training as infrequently as twice per week.  Aerobic and stretching exercises were much less effective than controlled endurance and strength training of the neck muscles.  Stronger muscles mean better support and alignment of the neck, which means less pain and less cracking. 

Source:   Active neck muscle training in the treatment of chronic neck pain in women: A randomized controlled trial.   JAMA, May 21, 2003 – Vol 298 No. 19

What is the best exercise for VMO?

Lately, I have had few patients come in with chronic knee pain.  Whether the diagnosis is patellafemoral  pain syndrome, chrondomalcia patella, patellar tendonosis, or arthritis rehab exercises for the knee focus on the quadriceps.  The VMO is a small and often ignored muscle of the quadricep complex.  There are certain exercises that are given to target the VMO, but how good are they at really activating and isolating the muscle?  I decided to look into the research to make sure I am giving my patients the best advice I possibly can.    The source of this blog was based on a systematic review of 14 quality research papers looking into the activation of VMO during knee exercises. 

Why is the VMO important?

Patellofemoral pain is often the cause of a muscle imbalance or timing problem between the muscles of the quadriceps; vastus medialis oblique (VMO) and vastus lateralis (VL).  This imbalance can lead to patellar maltracking problems and improper biomechanics of the knee-joint leading to pain and dysfunction.  In individuals with normal patellar tracking the vastus medialis oblique (VMO) fires first. When the VL fires before the VMO, the patella is more likely to track laterally. To correct the patellar tracking problem and strengthen the VMO, the patient should perform exercises that recruit more muscle fibers of the area.  That is to say, an exercise that targets the weakened VMO over the predominant VL muscle.

What does the research say? 

 Several studies focus on exercises to recruit more VMO muscle fibers. Exercises described in the literature to activate the VMO are knee extensions, straight leg raises, wall squats, mini-squats, step-ups, lunges, leg press, balance and reach, open and closed kinetic chain exercises, and isometric muscle actions.  There is still controversy in the literature as to which exercises recruit more muscle fibers of the VMO.  Six studies found no difference in the VMO/VL ratio during various exercises.  Yet another study concluded that medial hip rotation with knee extension recruited more muscle fibres of the VMO than the VL.  Where as another similar study found hip position did not affect VMO fibres during knee extension.  Two more studies concluded that squats recruit muscle fibers of the VMO, but hip position does not have an affect.   Another study looked further into the squat exercise, comparing wide and narrow stance, and that agreed that it does recruit VMO muscle fibers regardless of the hip position.  No studies have concluded one exercise or a group of exercises that isolates the VMO. Several exercises recruit muscle fibers of the VMO, but do not necessarily isolate the muscle in comparison to the other knee extensors.

 

 

So which exercise is the best?

There is still controversy in the literature as to which exercises recruit more muscle fibers of the VMO. There is no one best exercise.  The use of biofeedback with exercise will increase the muscle activity of the VMO sooner, but a rehabilitation program without biofeedback will still increase the muscle activity of the VMO. Medial rotation of the hip during knee extension has shown to be more effective than lateral rotation, but during a wall slide or step-up hip placement did not affect the muscle fibers recruited of the VMO.  The more difficult the activity, the more muscle fibers of the VMO are recruited (for example more muscle fibers are recruited while cutting than walking or when doing lateral step-up while holding weight than not holding weight).

Take home point

 With patellafemoral pain the best way to rehab your knee is to strengthen the VMO is through general quadriceps exercises.  Research has shown rehabilitation exercise to be effective.  Trust the guidance of your health professional and challenge your body in a safe way to get the best results.

Source:  VMO Exercises: A Systematic Review, Cassandra Offenberger.   School of Physical Education at West Virginia University.  2008.

What is tennis elbow?

“But I don’t play tennis!”

You can have tennis elbow even if you have ever picked up a racquet in your life?  The medical term for this condition where pain is present on the outside (or lateral part) of the elbow caused by repetitive wrist motion is lateral epicondylosis.  It is a repetitive strain injury (or RSI) that causes pain and suffering to athletes and workers alike.  Typical duration of this compliant can range  from 3 weeks to 3.5 years, the average being 6 to 12 weeks.

Where is the pain coming from?

The culprit in most cases is the extensor carpi radialis brevis tendonious insertion.  This area on the outside of the elbow is where several smaller muscles all attach near the same bony part of the elbow, called the lateral epicondyle. Repetitive microtraumatic injury at the extensor origin leads to a microtear, which repairs itself.   With a repetitive injury, the common extensor tendon can’t keep up with the need for constant repair and it experiences degeneration and leads to a failure of tendon  over time.   The pain is coming from this degenerative process of continual tendon damage and tissue death. 

 

It might be the joint

Degenerative changes in the radiocapitellar joint can occasionally be the source of pain in the lateral elbow and can be misdiagnosed as lateral epicondylitis.  To differentiate lateral epicondylosis from degenerative changes in the radiocapitellar joint, axial load combined with passive supination, pronation of the elbow is applied.  This test compresses the radiocapitellar joint and causes pain in case of bony articular degeneration, but does not increase pain in lateral epicondylosis.  Also x-rays of the elbow can be taken when lateral epicondylitis is suspected. 

How to treat lateral epicondylosis?

There is no medication for chronic lateral epicondylosis because it is not an inflammatory process, it is a degenerative one.  Therefore the best way to manage the condition and relieve pain is by addressing the cause, ie. the extensor carpi radialis brevis and its associated muscles/tendons.   Your chiropractor is expertly trained to diagnosis and treat tennis elbow.  To begin with you must rest the elbow and avoid activities that cause or increase your discomfort.   Your chiropractor will have modalities to help with the pain and promote tissue healing, like laser, microcurrent or IFC.  Stretching and strengthening the elbow/forearm and wrist muscles is essential and you will need to do daily rehab exercises as prescribed by your health provider.  Examples of such exercises are shown below.   

Furthermore, your chiropractor will assess the radiocapitellar joint for any signs or bony degeneration and proper alignment.  Commonly with injuries around joints, the bone of the joint can become misaligned and only a chiropractor is trained to fix the alignment problems.   If the pain is enough to interfere with your daily activities, including work, an orthopedic brace may be recommended.   Only if the condition has progressed to a chronic state and months of rehab treatment haven’t work, surgery is an option where the tendon(s) will be surgically removed and reattached to an area where it is under less tension in a hope to relieve painful symptoms.

 

 

References:

Regan W, Wold LE, Conrad R and Morrey BF.  Microscopic histopathology of chronic refractory lateral epicondylitis.  The American Journal of Sports Medicine 1992; 20 (6): 746-49

 Gellman H.  Tennis Elbow (lateral epicondylitis).  Orthopedic Clinics of North America 1992; 23 (1): 75-82

Foley AE.  Tennis Elbow.  American Family Physician 1993; 48 (2) 281-88.

Field LD, Savoie FH.  Common elbow injuries in sport.  Sports Medicine  1998; 26 (3)

Chiropractic care for the unhappy baby

Chiropractic care is for more than just backs and necks.  There are many reports of chiropractors helping patients with digestive problems, asthma and sleeping.  And now there is a surge in the scientific research articles of chiropractic care helping infants and children with colic, sleep disorders, acid reflux, ear infections, etc.    It is my hope to educate the public on the benefits of chiropractic care for the young.  Below is a brief abstract from a scientific paper published in The Journal of the Canadian Chiropractic Association.  Click here to the view the article in full. 

Abstract

The mother of a 3-month old girl presented her daughter for chiropractic care with a medical diagnosis of gastroesophageal reflux disease. Her complaints included frequently interrupted sleep, excessive intestinal gas, frequent vomiting, excessive crying, difficulty breastfeeding, plagiocephaly and torticollis. Previous medical care consisted of Prilosec prescription medication. Notable improvement in the patient’s symptoms was observed within four visits and total resolution of symptoms within three months of care. This case study suggests that patients with complaints associated with both musculoskeletal and non-musculoskeletal origin may benefit from chiropractic care.

Keywords: GERD, chiropractic, pediatric

Treatment

With the parent’s consent, the patient was cared for with high velocity low amplitude (HVLA) thrust type spinal manipulative therapy (SMT) characterized as Diversified Technique⁹ with technique modification appropriate for the patient’s age and size. Chiropractic SMT was applied to the atlas in the following manner. With the patient in the seated position, the clinician’s index finger contacted the right transverse process of the patient’s atlas. An HVLA thrust with a lateral to medial vector and a slight posterior to anterior component was applied (see Figure 1). The patient also received pediatric SMT to correct the posterior malposition of the T4 VB using an index finger contact over the spinous process of the patient’s T4 VB. A posterior to anterior HVLA vector was applied (See Figure 2). With respect to the patient’s cranial distortions; the patient’s parietal, temporal bones and mandible were corrected using Craniosacral Therapy⁸ (see Figure 3 and ​4).