What We Treat

The approach a Doctor of Chiropractic will take to manage low back pain will differ depending if the injury is new (acute), recent (subacute), or has persisted for three months or longer (chronic).

Though some management tools overlap between each group, each stage of injury includes unique challenges that require specific interventions.

ACUTE LOW BACK PAIN: In this stage, it’s important to address inflammation and to avoid aggravating the injury, which can hinder recovery. Chiropractic pain management strategies include a multi-modal care approach that can include manual therapies (spinal manipulation, mobilization, stretching, massage, and more), tools to reduce inflammation (ice, topical agents, electrical stimulation), at-home exercise, and nutrition/diet recommendations (anti-inflammatory diet, turmeric, Boswellia, omega-3 fatty acids, vitamin D3, etc.). Importantly, the patient must be assured that they can get better.

SUBACUTE LOW BACK PAIN: The management strategy and treatment goals at this stage are like the acute stage, but the intensity of care may be increased. The patient may also receive instruction on muscle strengthening exercises specific to their case, and they should maintain normal activities as much as possible so that the condition does not become chronic and more challenging.

CHRONIC LOW BACK PAIN:  In the chronic phase, the patient may have changed their movement patterns to avoid pain, which may place adjacent tissues and other areas of the body at risk for injury. They may also be hesitant to return to their previous lifestyle out of fear of making their pain worse, causing them to give up a hobby or even change careers. This can lead to depression and anxiety, which may need to be co-managed with an allied healthcare provider.

At this stage, the key is to restore normal joint motion, address faulty mechanics, strengthen muscles that have atrophied, and encourage the patient to resume their normal lifestyle and activities.

Following the conclusion of care, the patient may also find that routine visits to their chiropractor can help them reduce their risk for a future episode.

See our blog for an interesting perspective on back pain – https://torontoneckandbackpain.com/this-could-be-your-back-pain/

The thoracic portion of the spine is the longest part of the spine and is made up of twelve vertebrae (T1-T12), which lies between the cervical spine (C1-C7) or neck, and the lumbar spine (L1-L5) or lower back. The thoracic spine protects the very important spinal cord that begins in the brain and runs down to approximately T12 where the cord turns into what looks like a horse’s tail (the cauda equina).

The spinal nerves then travel into the lumbar spine and sacrum (tailbone) and innervate the low back, pelvis, legs, and feet. Nerve roots exit at each vertebral level of the spine innervating the upper (cervical), middle (thoracic) and lower (lumbar) portions of the body.

Looking closer at the T1-T12 nerves, T1-T2 nerves innervate (motor/muscle and sensory/feeling) the top of the chest and the inner arms and hands (providing strength to the deep, intrinsic hand muscles). Nerves T3-T5 innervate the chest wall and help control the rib cage, lungs, and diaphragm (the breathing muscle that separates the chest cavity from the abdominal cavity). The T6-T12 nerves innervates the abdominal and back muscles that work with the lumbar nerves to help stabilize our core, balance, posture, and the coughing process.

The thoracic spine also supports the rib cage, which protects our lungs, heart, and its great vessels that supply our body with fresh, oxygenated (arterial) blood and trades off carbon dioxide (venous blood) for oxygen in the lungs each time we take a breath. All of this is done automatically, without effort or thinking, thanks to our autonomic nervous system (ANS— made up of sympathetic and parasympathetic nerves) of which many of the sympathetic nerves arise in the thoracic region.

Unlike the cervical and lumbar portions of the spine, which allow for a great deal of movement, the thoracic spine is much more rigid and stable, which leads to a lower risk for injury. Potential causes of mid-back pain include poor posture; prolonged sitting; or conditions like scoliosis (curvature) or hyper-kyphosis (increased “humping” of the TS); sprain of the ligaments that hold bones firmly together (usually by a sudden, unexpected movements or trauma); bruising, cracking, or fracturing of the ribs or thoracic vertebrae; compression fracturing due to osteoporosis; and overuse injuries from repetitive lifting, bending, and twisting.

Doctors of Chiropractic are trained to evaluate and treat patients with middle back pain utilizing various forms of manual therapies (including spinal manipulation, mobilization, and massage), exercise training, posture retraining, and more.

For a good overall review of options and benefits to different types of back pain in general, check out this article on our website blog – https://torontoneckandbackpain.com/back-pain-clinic-in-toronto-exploring-treatment-options-and-the-benefits-of-chiropractic-care/

There are many types of headaches, and each has an underlying cause that must be addressed to achieve a satisfactory outcome. A 2020 review of research from the previous two decades suggests that the best conservative, non-pharmaceutical approach for headaches may involve either a top-down or bottom-up approach.

When the primary cause of a headache is musculoskeletal in nature, the review found that a bottom-up approach is more likely to benefit the patient. For example, cervicogenic headaches are headaches caused by dysfunction in the cervical spine. A headache in this category will likely respond well to cervical spinal manipulation and other forms of manual therapy provided by Doctors of Chiropractic. Tension-type headaches can have several underlying causes, but tight muscles in the back of the neck tend to be common, and treatment to relax the affected muscles can help reduce headache frequency and intensity.

While research to understand migraines is ongoing, the cause of this form of headache is believed to rest in chemical interactions in the brain. As such, the investigators reported that a top-down approach involving cognitive behavioral therapy, biofeedback, and neuroscience education may offer the most benefit to the patient. However, other sources related migraines to the electrical function of the brain and may, therefore, also have a cervicogenic or neck component as well.

Because each case is unique, and headaches can have multiple underlying or contributing causes (they can also co-occur), the authors note that the ideal bottom-up/top-down treatments will depend on the doctor’s clinical reasoning and experience. That is, there is no one size fits all. For example, there are several studies showing that migraine headache patients may experience reduced headache frequency and intensity after receiving manual therapies to address trigger points in their cervical muscles (a bottom-up approach).

The authors conclude that a multi-modal approach may be the most effective way to manage migraine, tension-type, cervicogenic, and other types of headaches. Such an approach may include spinal manipulation, spinal mobilization (non-thrust), soft-tissue therapies (massage, trigger point therapy, stretching, myofascial release), needling (wet & amp; dry needling of trigger points and/or acupuncture), general exercise, targeted exercise, and cognitive interventions.

Most chiropractors embrace and utilize all or at least many of these non-drug treatment strategies when managing patients with headaches, though they may co-manage with other healthcare providers if necessary.

An interesting blog article regarding headaches can be found on our website at – https://torontoneckandbackpain.com/chiropractor-for-headaches-in-toronto/

Carpal tunnel syndrome (CTS) is a condition characterized by the slow onset of pain, tingling, or numbness (paresthesia) in the thumb, index, and middle and thumb-half of the ring finger. Over time, symptoms can increase in both frequency and severity to the point that the individual cannot comfortably carry out their regular work or leisure activities. Initially, a sufferer may manage the condition by shaking their hand or flicking their fingers, but as the symptoms worsen, they may try home and over-the-counter remedies to find temporary relief, at best. It’s at this point when they may seek treatment with a Doctor of Chiropractic.

But why would a chiropractor be useful for managing CTS? It starts by understanding the anatomy of the carpal tunnel itself. This structure is made up of eight small bones that form the arch of the tunnel with the transverse carpal ligament serving as the floor. Several tendons as well as the median nerve pass through this tunnel. The median nerve emerges from the neck and travels through the shoulder, elbow, and forearm before entering the carpal tunnel. It then supplies motor instructions to part of the hand and relays sensory information back to the brain.

Anything within the carpal tunnel that reduces the available space—tendon inflammation, water retention, or compression of the shape of the tunnel—will apply force on the median nerve that can affect its normal movement and function. When this occurs, symptoms will begin to manifest.

The goal of treatment is to reduce pressure on the median nerve and improve its mobility as it passes through the carpal tunnel. Primarily, Doctors of Chiropractic accomplish this with the use of manual therapies—manual and instrumental soft tissue mobilizations, massage therapy, bone and joint mobilizations or manipulations, and neurodynamic techniques—to restore normal movement to the affected joints and associated soft tissues. A 2022 systematic review and meta-analysis (considered the most respected form of research) concluded that manual therapies provide statistically significant improvement in symptom severity, physical function, and sensory and motor nerve conduction in mild-to-moderate CTS cases.

To achieve a satisfactory outcome for the patient, chiropractic care may also include addressing musculoskeletal issues along the course of the median nerve as dysfunction in the neck, shoulder/arm, and forearm/elbow often co-occur with carpal tunnel syndrome and can produce CTS-like symptoms. If non-musculoskeletal conditions are present, the case may need to be co-managed with the patient’s medical physician or a specialist.

For more carpal tunnel syndrome information, see this article on our website blog – https://torontoneckandbackpain.com/carpal-tunnel-syndrome/

Whiplash associated disorders (WAD) encompass a cluster of symptoms—dizziness, mental fog, fatigue, difficulty concentrating and/or comprehending, light/noise sensitivity, memory loss, nervousness/irritability, sleep disturbance, anxiety/depression, and more—that result from a sudden acceleration and deceleration that injures the soft tissues of the head and neck. While each case is unique and can require a tailored treatment plan to give the patient the best chance at a positive outcome, there is research to support that two choices are among the worst and one choice may be the best for WAD treatment.

Worst Choice #1 – Doing nothing, especially in the presence of immediate symptoms (including concussive symptoms). Not only can delaying treatment lead to needless suffering, but it may prolong the recovery process and even increase the risk for chronic WAD.

Worst Choice #2 – Indiscriminate soft cervical collar use. While the concept of immobilizing the neck for a prolonged time frame to allow the soft tissues to heal makes sense, studies have shown that this practice can be detrimental to the patient. For example, cervical collar overuse can decondition the deep neck muscles that stabilize the cervical spine. When the collar is no longer in use, the deep neck muscles can no longer fulfill their duty and the body will recruit the superficial neck muscles to help maintain cervical posture, causing them to fatigue and increasing the risk for additional problems. One study found that WAD patients sent home from the emergency room (ER) with a cervical collar were about 3.5 times more likely to be back in the ER within three months.

Best Choice #1 – Multimodal, conservative care. A systematic review of 1,616 previously

published studies looked to find out which interventions or treatments were most cost-effective for managing WAD. The researchers found the favorable approach WAD management includes a combination of manual therapies (such as spinal manipulative therapy and other forms of hands-on treatment provided by Doctors of Chiropractic), neck-specific exercises, and patient education.

If you experience a sports collision, slip and fall, or auto accident that doesn’t result in immediate issues that require emergency care, try to maintain your usual activities as best you can, and if you experience pain or other WAD-related symptoms, contact your Doctor of Chiropractic of family Medical Doctor for an evaluation.

Fibromyalgia (FM) is a complicated disorder that’s difficult to diagnose because it involves multiple body systems. As a result, there are a myriad of factors in the body that can play a role in a patient’s symptoms. That said, it’s best to take a whole-body approach when it comes to treating a complex condition like FM, starting with the nervous system.

When a patient presents to a chiropractor, the initial examination will look at the body as a whole and will not be limited to the main area of complaint. This includes a postural examination in regards to individual leg length (to see if one is shorter); the height of the pelvis, shoulder, and occiput (head); and a gait assessment to evaluate the function of the foot, ankle, knee, hip/pelvis, spine, and head.

Because the nervous system is housed in the spine and cranium, chiropractors specifically look at how the spine compensates for abnormal function elsewhere in the body. When spinal segmental dysfunction is present, altered neurological function often coincides, which results in the symptoms that drive people to the office.

The benefits of spinal manipulative therapy (SMT)—the primary form of treatment delivered by Doctors of Chiropractic—have been recognized by all other healthcare professions including medical doctors, physical therapists, and osteopathic physicians. In fact, referring patients to chiropractors for SMT has become very commonplace in the healthcare environment. Research has proven SMT to be a FIRST course of care and highly recommended for MANY complaints, especially low back, mid-back, and neck pain, headaches, and many more.

Because fibromyalgia (FM) involves the WHOLE BODY—hence its definition of “wide spread pain,” chiropractic offers a unique approach because it too benefits the whole body by restoring function to the nervous system. For example, when balance is off due to a short leg (this affects 90% of the population to some degree), it can tilt the pelvis, which then places stress on the spine so that it must curve (scoliosis) to keep the head level. Correcting the short leg with a heel lift can restore balance to the pelvis, take pressure off the spine, and relieve some of a patient’s pain symptoms.

In prior articles, we have looked at the many benefits chiropractic offers the FM patient in addition to SMT and other manual therapies. Some of these include tips for improving sleep, exercise training (very important in managing FM), diet—specifically an anti-inflammatory diet (rich in antioxidants)—and supplementation (such as magnesium, malic acid, omega-3 fatty acids, vitamin D3, Co-enzyme Q10, and more).

Most importantly, studies show that the FM patient is BEST served when a “team” of healthcare professionals work together on behalf of the FM patient. Depending on a patient’s needs, the team can include a Doctor of Chiropractic, a primary care doctor, a massage therapist, a clinical psychologist, and others.

While chiropractic care is often best known for helping with lower back pain, and perhaps neck or back pain in general, many other conditions can also benefit from the chiropractic approach.

Conditions affecting the arms and legs, shoulders and hips, and hands or feet can all have improvement from chiropractic treatments.

For further information, visit our sister blog site for articles on conditions like tennis elbow, rotator cuff tears, hip arthritis, knee pain, ankle sprains, and more:

https://www.dkchiroblog.com/category/joint-pain//

Doctors of Chiropractic received extensive training not only in manual therapies, but also healthcare advice in general. A patient’s daily health choices can impact not only neck and back pain, but also their overall ability to stay well.

As part of a treatment strategy for an existing condition, or as a separate and valuable approach to quality of life and longevity, a Chiropractic Doctor can support a patient in their own healthcare and self-care choices.

For further information, visit our sister blog site for articles on health and lifestyle advice like nutrition, fitness, sleep, and more:

https://www.dkchiroblog.com/category/whole-body-health/

 

Occasionally we meet patients that have a very strong interest in either health and wellness, or science and academics. To help provide a more in-depth view of chiropractic’s role in treating various conditions, we offer a series of articles that are more advanced in nature.

These same articles we share with various medical and other practitioners in the Greater Toronto Area to help increase access and awareness of chiropractic’s benefits to patients looking to improve their health status.

For further information, visit our sister blog site for referenced articles that delve deeply into many aspects of health and wellness:

https://www.dkchiroblog.com/category/advanced/