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The Neck Cervical Spine Anatomy.

The cervical spine begins at the base of the skull. Seven vertebrae make up the cervical spine with eight pairs of cervical nerves. The individual cervical vertebrae are abbreviated C1, C2, C3, C4, C5, C6 and C7. The cervical nerves are also abbreviated; C1 through C8.

Cervical Vertebrae and Supporting Structures

The cervical bones, the vertebrae are smaller in size when compared to other spinal vertebrae. The purpose of the cervical spine is to contain and protect the spinal cord, support the skull, and enable diverse head movement ( rotate side to side, bend forward and backward).

A complex system of ligaments, tendons, and muscles help to support and stabilize the cervical spine. Ligaments work to prevent excessive movement that could result in serious injury. Muscles also help to provide spinal balance and stability, and enable movement. Muscles contract and relax in response to nerve impulses originating in the brain. Some muscles work in pairs or as antagonists. This means when a muscle contracts, the opposing muscle relaxes. There are different types of muscle: forward flexors, lateral flexors, rotators, and extensors.

Spinal Cord and Cervical Nerve Roots

Nerve impulses travel to and from the brain through the spinal cord to a specific location by way of the peripheral nervous system (PNS). The PNS is the complex system of nerves that branch off from the spinal nerve roots. These nerves travel outside of the spinal canal or spinal cord into the organs, arms, legs, fingers – throughout the entire body.

Injury or mild trauma to the cervical spine can cause a serious or life-threatening medical emergency (spinal cord injury or SCI, fracture). Pain, numbness, weakness, and tingling are symptoms that may develop when one or more spinal nerves are injured, irritated, or stretched. The cervical nerves control many bodily functions and sensory activities.

C1: Head and neck
C2: Head and neck
C3: Diaphragm
C4: Upper body muscles ( Deltoids, Biceps)
C5: Wrist extensors
C6: Wrist extensors
C7: Triceps
C8: Hands

Neck Pain.

The neck (cervical spine) is composed of vertebrae that begin at the base of the skull and end in the upper torso. The vertebrae along with the ligaments provide stability to the spine. The muscles allow for support and movement of the neck. The neck supports the weight of the head which is 5 kg amounting to a significant load for the neck to cope with during motion thus increasing stress onto the neck (cervical spine). Compare to the rest of the spine, the neck is less protected and is more susceptible to injury and various disorders that can result in pain and restricted motion. Sometimes neck pain is a temporary condition going away on its own accord. Other cases require medical diagnosis and treatment to relieve the symptoms.

Causes

Neck pain may result from injury to the soft tissues including muscles, ligaments, nerves, bones and joints of the spine. Soft tissue injuries or prolonged wear and tear are amongst the most common causes of neck pain. Infection or tumors may cause neck pain in rare instances. Sometimes neck problems may be the source of pain in the upper back, shoulders or arms.

Neck pain may result from abnormalities in the soft tissues, muscles, ligaments, and nerves as well as in bones and joints of the spine. The most common causes of neck pain are soft-tissue abnormalities due to injury or prolonged wear and tear. In rare instances, infection or tumors may cause neck pain. In some people, neck problems may be the source of pain in the upper back, shoulders, or arms. Cold Laser Therapy section this therapy has a five star rating for treating neck injuries and conditions.

Neck Injury

Due to its flexibility and the weight of the head it supports the neck is extremely vulnerable to injury. Road traffic or diving accidents, contact sports, and falls are the main causes of neck injury. A “rear end” shunt during a car accident may result in hyper-extension, a backward motion of the neck beyond normal limits, or hyper- flexion a forward motion of the neck beyond normal limits. The use of seat belts and head restrains in cars can help to prevent or minimize neck injury. The soft tissues such as muscles and ligaments are most commonly involved. Severe injuries including fracture or dislocation of the neck may lead to the damage the spinal cord and cause paralysis.

Arthritis of the Neck

The neck is a common site for arthritis to develop.

The most common type of arthritis that affects the neck is osteoarthritis. This condition is also known as cervical spondylosis, cervical osteoarthritis, or degenerative joint disease of the neck.

Other forms of arthritis that can affect the neck are rheumatoid arthritis, psoriatic, ankylosing spondylitis, Reiter’s disease, gout, pseudogout, and diffuse idiopathic skeletal hyperostosis (DISH).

Rheumatoid arthritis can destroy joints in the neck and cause severe stiffness and pain. Rheumatoid arthritis typically affects upper neck area. View our Cold Laser Therapy section this therapy has a five star rating for treating  this condition

Cervical spondylosis is a condition that mainly affects older people, usually over the age of 45. Men are affected more often than women. This condition results from degenerative changes that occur in the cervical spine (the spine of the neck). Changes in cartilage metabolism lead to slow wear and tear of discs and joints in the neck. Over time, the degenerative changes can lead to a bulging or herniated disc, calcium build-up within the disc, or bony growths on the spine. The end result is nerve compression or inflammation.

Also, depending on which way the disc herniates or the direction of the bony growths, there is a possibility that the spinal cord or nerve roots leading from the spinal cord could be compressed.

There is also the possibility that the blood flow to certain nerves may be affected.

Symptoms depend on the location of the nerve compression, but can include pain, numbness, weakness, headaches, urinary problems, etc.

Initially the person may not have any symptoms.

Others will have neck or shoulder pain, headaches in the back of the head, or stiffness of the neck. They may have difficulty turning or bending the neck from side-to-side.

Some will have pain that shoots down a certain part of the arm. They may also notice numbness, weakness, or pain in the arm. One or both sides may be affected. Often it causes the hands to become clumsy.

Some individuals will have numbness or weakness in their legs. This indicates that there may be pressure on the spinal cord. This is considered a surgical emergency. Many with this condition will have decreased vibration-sense in their legs. They may be unsteady while walking. In fact, spondylosis with myelopathy is a fairly common cause of unsteadiness in the elderly.

Others will have a specific level on the chest or abdomen where there is a noticeable change in sensation.

Problems with urination may occur. Some will have to urinate more often, while others will have to urinate urgently. A few will develop urinary incontinence.

The symptoms may get worse with turning, extending, or bending the neck. In others, coughing or straining may temporarily cause shooting pain in the arms or shoulders or it may worsen weakness in the legs.

Physical exam may reveal numbness or pain along a certain nerve distribution. Certain muscles may be weak and the reflexes not as brisk as normal. The affected individual may have difficulty with turning the neck or bending it from side to side. The arms or legs may be stiff. The hands may be weak and the muscles of the hands atrophied.

X-rays can be helpful in making the diagnosis. However, though X-ray findings of degenerative changes are often found in many older people, only a few will truly evidence the neurological changes caused by this condition. Alone, finding degenerative changes on X-rays is not conclusive but part of an overall determination of this condition that must take into consideration other factors. X-rays done with flexion and extension may show instability.

CT scan can be used to look at the spinal column and see if there is any narrowing or other abnormality.

MRI can also be used to look at the spinal column and see if there is any narrowing or other abnormality.

Nerve conduction studies and electromyography can be done to test the nerves and muscles.

The primary treatment for this condition is first to determine what type of arthritis is causing the problem. The second is making sure the neck is not unstable. Then, it is important to restrict neck movements. This is usually done with a cervical collar.

Medical treatment is usually with anti-inflammatory medicines, analgesics, and muscle relaxants. However, if this fails, then surgery may be necessary.

Physical therapy modalities such as Cold/Low level laser therapy, including stretching and strengthening exercises.

Patients may respond to steroid injections placed in the epidural space.

If that does not work, then surgery to decompress the nerve and stabilize the neck may be necessary.

Surgery is usually done if:

Conservative measures such as a cervical collar do not work.
There is severe pain.
There are significant neurological deficits, such as difficulty walking, severe hand weakness, or bladder problems.
There is compression of the spinal cord.

With any nerve condition, if it is not treated early, there is a danger that the loss of nerve function may be permanent. Nerves are very delicate. Once they are injured beyond a certain point, they do not recover. Therefore, the symptoms that can be caused by this condition could become permanent if not treated appropriately (i.e., numbness, weakness, and urinary problems).

There is no specific way to prevent this condition. However, good posture should be maintained.

Also, avoid repetitive injuries to the neck and cervical spine.

Neck Disc Injury, “Slipped Disc”, also known as Prolapsed, Bulging, Herniated or Extruded Disc

Disc Problems

What Causes Disc Problems?

Discs are the soft but strong cushions that separate the bones (vertebrae) in your spine and absorb shock as you move. Repeated strain over time, an injury, or sudden, forceful movements can damage discs and irritate nerves, causing pain, numbness, or tingling in your back and legs, neck,Shoulders and arms.

Common Slipped Disc, Neck Disc Injury

A Slipped Disc or (Disc Prolapsed) in the neck is a common cause of neck pain. Slipped disc treatment during the early stages involves limited mobilisation. Later, more active physical therapy rehabilitation is useful. During the later stages neck pain treatment can be enhanced if a pillow is used to support the neck.

Other Causes

Less common causes of neck pain include tumors, infections, or congenital abnormalities of the vertebrae.

Whiplash Associated Disorder (WAD) and Cervical Spine Injury

What is whiplash? 

An acute “whiplash” injury follows sudden or excessive hyper-extension, hyper-flexion, or rotation of the neck and causes neck pain and other symptoms. “Whiplash” injury is common in road traffic accidents, and may also be caused by sports injuries, falls or assaults. Most cases of “whiplash” injury occur as the result of rear-end vehicle collisions at speeds of less than 10 miles per hour. Patients present with neck pain and stiffness, occipital headache, thoracic back pain and/or lumber back pain, and upper-limb pain and paraesthesia.

There are two types of injury:

• Typical cervical hyper-extension injuries occur in passengers an drivers of a stationary or slow-moving vehicle that is struck from behind. Body is thrown forward but the head lags, resulting in hyper-extension of the neck. When the head and neck have reached maximum extension, the neck then snaps into flexion.
• A rapid deceleration injury throws the head forwards and flexes the neck. When the chin hits the chest it limits forward flexion but the forward movement may be sufficient to cause longitudinal distraction and neurological damage. Hyper-extension may occur in the subsequent recoil.

“Whiplash” injuries may occur at relatively low vehicle velocity impacts. One study showed the cervical muscle injury threshold to be about 10 km/hour. Whiplash-associated disorders (WAD) can be classified by the severity of signs and symptoms:

• Grade 1: no complaints or physical signs.
• Grade 2: indicates neck complaints but no physical signs.
• Grade 3: indicates neck complaints and musculoskeletal signs.
• Grade 4: neck complaints and neurological signs.
• Grade 5: neck complaints dislocation and fracture. Most cervical spine fractures occur predominantly at two levels:

1. One third of injuries occur at the level of C2, and one half of injuries occur at the level of C6 or C7.

2. Most fatal cervical spine injuries occur in upper cervical levels, either at cranio-cervical junction C1, or at C2

 Uncomplicated cases of Whiplash Associated Disorder (WAD)

“Whiplash”(WAD) cases that are uncomplicated are the result of sprained ligaments in the neck. The muscles of the neck spasm naturally, as a protective reaction. The “Whiplash”(WAD) injury may cause stiff neck and pain that may be present down one or both arms if the nerves of neck part of spinal cord get compressed. Pain Relief for “Whiplash”(WAD) can be found with Chiropractic  or Physiotherapy including pain medication and Cold/ low level laser therapy,

Patient’s with chronic whiplash benefited from Chiropractic  or Physiotherapy

Severe cases

In severe cases of “whiplash” may last for a month or more with persistent and in some cases constant pain. This may indicate that the “whiplash” injury has extensive damage and resulting in discs rupturing and trapped nerves in the neck. This may also predispose to a “slipped”disc, also known as a prolapsed, bulging, ruptured or herniated disc in the back. (View our Cold/low level laser therapy Section, a five star rating has been given to cold/low level laser therapy for soft tissue neck injuries)

Cold/Low level Laser Therapy (LILT). treatment research  for Neck Pain

Neck pain  is common, often persistent, and responds poorly to medication. So it is encouraging to read that a relatively novel, non-invasive treatment shows evidence of effectiveness. A systematic review and meta-analysis of 16 randomised controlled trials of low-level laser therapy (LLLT)’ yielded 820 patients, for whom data was pooled. LLLT was found to reduce pain immediately after treatment in acute neck pain and up to 22 weeks after completion of treatment in patients with chronic neck pain. Low-level laser – or cold laser – is yet to be established as a medical treatment but, according to Wikipedia, papers are appearing at the rate of around 25 per month, mainly investigating treatment of musculoskeletal disorders. (View our Cold/Low Level Laser Therapy section)

1. Chow RT, Johnson Ml, Lopes-Martins RA, Bjordal JM. Efficacy of low-level laser therapy in the management of neck pain: a systematic review and meta-analysis of randomised placebo or active-treatment controlled trials. Lancet 2009 Dec 5;374(9705):1897-908.

Cold or Low Laser Therapy(LLLT) has been tested in over 200 clinical trials (RCTs) and published in the world’s top medical journals including a review by The Lancet, a clinical study in the journal PAIN and is acknowledged by the World Health Organisation Bone and Joint Task Force (published in the journal Spine).

(View our Cold/Low Level Laser Therapy section)

Whiplash Associated Disorder (WAD Research)

“Whiplash”(WAD). FROM: Journal of Orthopaedic Medicine 1999; 21 (1): 22–25 university Department of Orthopaedic Surgery, Bristol, UK Khan S, Cook J, Gargan M, Bannister G

Objective:To determine which patients with chronic “whiplash” (WAD) will benefit from chiropractic treatment.

Design: Retrospective review by structured telephone interviews of 93 consecutive patients seen in chiropractic clinic. Setting: Independent chiropractic clinic in a large city. Subjects: 93 patients, 68 female. Main outcome measure: Gargan and Bannister grading pre and post treatment.

Results:

Three groups of patients were recognised.

Group 1 consisted of patients with isolated neck pain associated with a restricted range of neck movement.

Group 2 consisted of patients with neurological symptoms or signs associated with a restricted range of movement.

Group 3 comprised patients who described severe neck pain but all of whom had a full range of neck movement. Patients in this group often described an unusual group of symptoms, with a bizarre, non-dermatomal pain distribution. There was a significant difference in outcome between the three groups (p<0.001) with only groups 1 and 2 improving following chiropractic manipulation.

Conclusion:

“Whiplash”(WAD) and neck injuries are common. Chiropractic is the only proven effective treatment in chronic cases. Our study enables patients to be classified at initial assessment in order to target those patients who will benefit from such treatment.

When Should You Seek Medical Care?

Cases of severe neck pain occur following an injury such as motor vehicle accident, blow to the head or fall related accident. Only a trained professional, such as a paramedic, should immobilize the patient to avoid the risk of further injury and possible paralysis. Medical care should be sought immediately.

Immediate medical care should also be sought when an injury causes pain in the neck that radiates down the arms and legs. Radiating pain or numbness in your arms or legs causing weakness in the arms or legs without significant neck pain should also be evaluated. If there has not been an injury, you should seek medical care when neck pain is:

• continuous and persistent
• severe
• accompanied by pain that radiates down the arms or legs
• accompanied by headaches, numbness, tingling, or weakness

Diagnosis

Determining the source of the pain is essential to recommend the appropriate treatment and rehabilitation. Therefore, a comprehensive examination is required to determine the cause of neck pain.

Your Chiropractor will take a complete history of the symptoms you are having with your neck. The Chiropractor may ask you about other illnesses, any injury that occurred to your neck, and any complaints you have associated with neck pain. Previous treatment for your neck condition will also be noted.

Chiropractor will also perform a physical examination. This examination may include evaluation of neck motion, tenderness of the neck and the function of the nerves and muscles in your arms and legs.

X-rays often will be obtained to allow your Chiropractor to look at the bones in your neck. This entails simple diagnostic imaging study (radiography) and aids your Chiropractor to determine the cause of neck pain and to prescribe effective treatment.

Further evaluation may involve the following:

• MRI (magnetic resonance imaging). This non x-ray study allows an evaluation of the spinal cord and nerve roots.
• CT (computed tomography). This specialized x-ray study allows careful evaluation of the bone and spinal canal.
• EMG (electromyography). This test evaluates nerve and muscle function.

Treatment

The treatment of neck pain depends on the diagnosis. Most patients are treated successfully with Chiropractic care or Physiotherapy. Also rest, medication, immobilization, exercise, activity modifications, or a combination of these methods can be very useful.

Inflammation is a result of stretching muscles and ligaments beyond their limits, this therapy is extremely affective in the treatment of inflammation. Cold/Low level laser therapy a five star rating for soft tissue neck injuries (“Whiplash”). Surgery is required in very few cases to relieve neck pain. For most patients, a combination of Chiropractic care, rest, medication, and Physiotherapy will relieve neck pain. Surgery may be necessary to reduce pressure on the spinal cord or a nerve root when pain is caused by a herniated disc or bony narrowing of the spinal canal. Surgery may also be required following an injury to stabilize the neck and minimize the possibility of paralysis, such as when a fracture results in instability of the neck.

Cervical Disc Injury.

Causes and Risk Factors of Cervical disc injuries

Most cervical disc syndromes are caused by injuries that involve hyperextension, which results in compression of the anatomic structures.

Flexion injuries in the cervical area do not result in nerve compression.

Symptoms of Cervical disc injuries

Pain, loss of sensation or new sensations, and weakness are the main symptoms and signs of cervical disc injury. The most common symptom is pain and it is usually the only one. Rarely, cervical disc injury is complicated by compression of either a cervical nerve root or even more rarely by a compression of the spinal cord. When compression of the nervous tissue occurs, patients will report abnormal sensations other than pain and will report loosing strength in one arm (nerve root compression) or in both arms and legs (spinal cord compression).

1. Pain is the most common complaint and can be felt in the neck or arm.

a. Pain is usually limited to the neck and upper back between the shoulder blades. It occurs because of low-grade inflammation of the disc and the cervical vertebra joints. While the disease is chronic, inflammation can flare up after a minor added injury or for other reasons that are not yet well understood. Less commonly, neck and shoulder pain occur because the disc bulges acutely (herniates) and stretches the posterior longitudinal ligament. With conservative treatment, this pain usually goes away in a few weeks, but it is likely to happen again, especially if the affected individual does not change his/her lifestyle.

b. Rarely, the pain will be felt down the arm. This pain can be lightning, caused or aggravated by movements of the neck, or can be dull and persistent. Pre-existing neck pain is also present in many individuals. After the arm pain starts, some people report feeling less pain in their neck. When arm pain is present, it is usual.

Cervicogenic headaches.

Cervicogenic headaches are defined as headaches originating from the neck. The location is typically at the back of the head, sides and top of the head as well as around the forehead and eyes affecting one or more of the above regions at once. These headaches can be located on one or both sides of the head.

Cervicogenic headaches are usually associated with dysfunction of the upper neck which can present itself as neck pain or local tenderness, reduced neck range of motion and exacerbation of the headaches by neck movement. The past history of neck trauma is typical for this type of headaches. The cervicogenic headaches are caused by irritation of nerve endings of injured joints, ligaments, muscles and discs of the neck. The nerve endings in the injured areas send pain signals up the upper nerves of the neck to the brain causing “cross wiring” with the fibers of the trigeminal nerve (one of the nerves in the head) which is responsible for perception of the head pain thus causing the headaches.

Neck pain as well as “whiplash” (WAD) injuries and both conditions can result in headaches and all three are commonly treated by Chiropractors. The treatment is focused on the small joints in the back of the neck called facet joints that are responsible for neck pain. When these joints dysfunction but injury to the muscles he nerve fibres that innervate / act as sensors for these facet joints also serve to act as sensors to parts of the head. When these facet joints dysfunction these sensors become active, the brain cannot clearly differentiate between the facet joints and the mapping of the head and create the sensation of pain in a broader area- Headache.

Temporomandibular Jaw Disorders (TMD, TMJ Syndrome)

“TMD” temporomandibular (jaw) disorders, also called “TMJ syndrome.” If you felt pain sometimes in your jaw area, or maybe your dentist or Chiropractor has told you that you have TMD.

If you have questions about TMD, you are not alone. Researchers, too, are looking for answers to what causes TMD, what are the best treatments, and how can we prevent these disorders. The National Institute of Dental and Craniofacial Research has written this pamphlet to share with you what we have learned about TMD.

TMD is not just one disorder, but a group of conditions, often painful, that affect the jaw joint (temporomandibular joint, or TMJ) and the muscles that control chewing. Although we don’t know how many people actually have TMD, the disorders appear to affect about twice as many women as men.

The good news is that for most people, pain in the area of the jaw joint or a muscle is not a signal that a serious problem is developing. Generally, discomfort from TMD is occasional and temporary, often occurring in cycles. The pain eventually goes away with little or no treatment. Only a small percentage of people with TMD pain develop significant, long-term symptoms.

What is the Temporomandibular Joint?

The temporomandibular joint connects the lower jaw, called the mandible, to the temporal bone at the side of the head or neck. If you place your fingers just in front of your ears and open your mouth, you can feel the joint on each side of your head. Because these joints are flexible, the jaw can move smoothly up and down and side to side, enabling us to talk, chew and yawn. Muscles attached to and surrounding the jaw joint controls its position and movement.

When we open our mouths, the rounded ends of the lower jaw, called condyles, glide along the joint socket of the temporal bone. The condyles slide back to their original position when we close our mouths. To keep this motion smooth, a soft disc lies between the condyle and the temporal bone. This disc absorbs shocks to the TMJ from chewing and other movements.

What Are Temporomandibular Disorders?

Researchers generally agree that temporomandibular disorders fall into three main categories:

• Myofascial pain, the most common form of TMD, which is discomfort or pain in the muscles that control jaw function and the neck and shoulder muscles;
• Neck Pain/Ache.
• Internal derangement of the joint, meaning a dislocated jaw or displaced disc, or injury to the condyle;
• Degenerative joint disease, such as osteoarthritis or rheumatoid arthritis in the jaw joint.

A person may have one or more of these conditions at the same time.

T M J Treatment

If you place your fingers in front of each ear and open your jaw, you’ll feel lots of clicking, or a grinding movement. This is the temporomandibular joint (TMJ), a place where your skull’s temporal bone attaches to your mandible (Jaw).

Because this joint comprises of a large number of ligaments, cartilage, fascia, discs, muscles, nerves and blood vessels that run around and through it, you can have all kinds of problems: trouble opening the mouth wide; a locked jaw; headache; clicking or popping sounds, tinnitus (ringing in the ears); throat fullness; shoulder, cheek or jaw pain; neck ache; facial nerve pain; ear or eye pain; dental pain; nausea; blurred vision and dizziness when the TMJ joint is misaligned.

An unhealthy skull/jaw alignment can put great stress upon the spinal column. By relieving pressure on the upper neck and bones of the skull, chiropractic treatment may relieve or correct TMJ problems. There are also documented cases of dental problems that, once corrected, help patients to hold their spinal adjustments for longer periods between chiropractic treatments.

All TMJ sufferers need chiropractic treatment; anyone who has been to the dentist should follow up with a check up from their chiropractor.

Trapped Nerve or “Pinched” Nerve.

Having a Trapped nerve hurts often feeling like severe, sharp, excruciating and intense pain. Trapped nerves could happen nearly anywhere affecting nerves that go to the arms, fingers, wrists, neck, head, back, shoulders, legs, muscles and internal organs. “Pinched” or trapped nerves can affect your health, posture, vitality, resistance to disease, even your emotional health. “Pinched”/trapped nerves can make life a misery.

Trapped?

Do nerves really  get  trapped? Actually directly trapping the nerve is quite rare. Much more common is what chiropractors call the vertebral subluxation complex or subluxations. Other terms for this are: nerve impingement, nerve irritation, nerve lesion, spinal stress and meningeal tension.

Even though there may be no actual trapping, people like the word because it’s so descriptive. It can really feel like something is being trapped in there. Some health professionals even use it. People at times seeing a chiropractor’s saying their GP, osteopath, massage therapist referred them because they had a trapped nerve and should visit a chiropractor to get the trapped nerve freed.

What Can Cause Subluxations?

Nearly any kind of stress can cause a subluxation: a fall or an accident, even a very small one that happened years ago; a poor sleeping position; poor posture; fatigue; emotional stress; poor nutrition or a combination of stresses. A subluxation need not happen all at once. It could set in the body over time. 

 Trapped Nerves Don’t Normally Hurt

Chiropractors sometimes say that people with painful Trapped nerves might be considered lucky they know they have a problem and they (hopefully) will go to a chiropractor.

 If You Don’t Experience The Pain From a Trapped Nerve?  What Would Be The Outcome?

Some patients may watch their body suffer and their health deteriorate for years without the faintest idea that the problem may be coming from their spine. These people desperately need to see a chiropractor but because they don’t have spine or nerve pain they may never receive the care they need. This is the big job facing chiropractors today educating people about vertebral subluxations and the need for periodic spinal checkups.

Treatment of Trapped Nerves

Trapped nerves do not get untrapped by themselves. No amount of painkillers or muscle relaxants can fix them. Only doctors of chiropractic are able to analyze your spinal column for trapped nerves or vertebral subluxations and use spinal adjustment techniques to gently realign the spine, release the internal stress and free the body from the trapped nerves.

Chiropractors are health care practitioners who are most experienced in freeing body of vertebral subluxations.

Nerves Travel Through the Body?

Individual nerve fibers are tiny. Although they may be many inches long they are so thin you need a powerful microscope to see them. Nerve fibers are also found in large bundles called nerves. Billions of nerve fibers are bundled inside your spinal cord – an extension of your brain, which passes through the spinal column. Nerves branch off from spinal cord and exit spine through openings between the vertebrae to connect to every cell in the body.

Life without Nerves

Without nerves you couldn’t see, hear, touch, taste or smell or feel hot, cold, pleasure or pain, and no messages could come in and no messages could go out; without nerves no muscles could move.

Nerves Keep the Body Alive and Healthy

Nerve messages also help regulate the body’s activities such as breathing, heartbeat, digestion, excretion, blood pressure and immune system so that the body can respond to germs, changes in temperature and all kinds of stress. In addition to nerve impulses, nutrients flow over your nerves to nourish the muscles and tissues. If this flow is blocked it may cause your muscles to waste away.

If the nerves are trapped, “impinged” or otherwise interfered with, the flow of messages and nutrients over them can be disrupted and the body can become “diseased” or weakened. When you are diseased you have less energy and vitality and are less able to deal with physical and emotional stress.

Lowered resistance to disease, infection, colds, flu, allergies, ulcers, constipation, diarrhoea, asthma, fevers, headaches, seizures, bedwetting, hearing, balance or visual disturbances and many other health problems have been related to an unhealthy nervous system.

How Do Nerves Get Impinged or Trapped

The skeletal system, especially the spinal column, protects the spinal cord and other nerves. If the spinal bones (vertebrae) are misaligned even slightly they may “pinch,” impinge, irritate, compress or stretch the nerves they are supposed to protect.

This in turn can affect other structures in the area including blood vessels, discs, ligaments, joints, muscles, fascia, tendons and meninges. As mentioned earlier, this is referred to as a subluxation.

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The Neck Cervical Spine Anatomy.

The cervical spine begins at the base of the skull. Seven vertebrae make up the cervical spine with eight pairs of cervical nerves. The individual cervical vertebrae are abbreviated C1, C2, C3, C4, C5, C6 and C7. The cervical nerves are also abbreviated; C1 through C8.

Cervical Vertebrae and Supporting Structures

The cervical bones, the vertebrae are smaller in size when compared to other spinal vertebrae. The purpose of the cervical spine is to contain and protect the spinal cord, support the skull, and enable diverse head movement ( rotate side to side, bend forward and backward).

A complex system of ligaments, tendons, and muscles help to support and stabilize the cervical spine. Ligaments work to prevent excessive movement that could result in serious injury. Muscles also help to provide spinal balance and stability, and enable movement. Muscles contract and relax in response to nerve impulses originating in the brain. Some muscles work in pairs or as antagonists. This means when a muscle contracts, the opposing muscle relaxes. There are different types of muscle: forward flexors, lateral flexors, rotators, and extensors.

Spinal Cord and Cervical Nerve Roots

Nerve impulses travel to and from the brain through the spinal cord to a specific location by way of the peripheral nervous system (PNS). The PNS is the complex system of nerves that branch off from the spinal nerve roots. These nerves travel outside of the spinal canal or spinal cord into the organs, arms, legs, fingers – throughout the entire body.

Injury or mild trauma to the cervical spine can cause a serious or life-threatening medical emergency (spinal cord injury or SCI, fracture). Pain, numbness, weakness, and tingling are symptoms that may develop when one or more spinal nerves are injured, irritated, or stretched. The cervical nerves control many bodily functions and sensory activities.

C1: Head and neck
C2: Head and neck
C3: Diaphragm
C4: Upper body muscles ( Deltoids, Biceps)
C5: Wrist extensors
C6: Wrist extensors
C7: Triceps
C8: Hands

Neck Pain.

The neck (cervical spine) is composed of vertebrae that begin at the base of the skull and end in the upper torso. The vertebrae along with the ligaments provide stability to the spine. The muscles allow for support and movement of the neck. The neck supports the weight of the head which is 5 kg amounting to a significant load for the neck to cope with during motion thus increasing stress onto the neck (cervical spine). Compare to the rest of the spine, the neck is less protected and is more susceptible to injury and various disorders that can result in pain and restricted motion. Sometimes neck pain is a temporary condition going away on its own accord. Other cases require medical diagnosis and treatment to relieve the symptoms.

Causes

Neck pain may result from injury to the soft tissues including muscles, ligaments, nerves, bones and joints of the spine. Soft tissue injuries or prolonged wear and tear are amongst the most common causes of neck pain. Infection or tumors may cause neck pain in rare instances. Sometimes neck problems may be the source of pain in the upper back, shoulders or arms.

Neck pain may result from abnormalities in the soft tissues, muscles, ligaments, and nerves as well as in bones and joints of the spine. The most common causes of neck pain are soft-tissue abnormalities due to injury or prolonged wear and tear. In rare instances, infection or tumors may cause neck pain. In some people, neck problems may be the source of pain in the upper back, shoulders, or arms. Cold Laser Therapy section this therapy has a five star rating for treating neck injuries and conditions.

Neck Injury

Due to its flexibility and the weight of the head it supports the neck is extremely vulnerable to injury. Road traffic or diving accidents, contact sports, and falls are the main causes of neck injury. A “rear end” shunt during a car accident may result in hyper-extension, a backward motion of the neck beyond normal limits, or hyper- flexion a forward motion of the neck beyond normal limits. The use of seat belts and head restrains in cars can help to prevent or minimize neck injury. The soft tissues such as muscles and ligaments are most commonly involved. Severe injuries including fracture or dislocation of the neck may lead to the damage the spinal cord and cause paralysis.

Arthritis of the Neck

The neck is a common site for arthritis to develop.

The most common type of arthritis that affects the neck is osteoarthritis. This condition is also known as cervical spondylosis, cervical osteoarthritis, or degenerative joint disease of the neck.

Other forms of arthritis that can affect the neck are rheumatoid arthritis, psoriatic, ankylosing spondylitis, Reiter’s disease, gout, pseudogout, and diffuse idiopathic skeletal hyperostosis (DISH).

Rheumatoid arthritis can destroy joints in the neck and cause severe stiffness and pain. Rheumatoid arthritis typically affects upper neck area. View our Cold Laser Therapy section this therapy has a five star rating for treating  this condition

Cervical spondylosis is a condition that mainly affects older people, usually over the age of 45. Men are affected more often than women. This condition results from degenerative changes that occur in the cervical spine (the spine of the neck). Changes in cartilage metabolism lead to slow wear and tear of discs and joints in the neck. Over time, the degenerative changes can lead to a bulging or herniated disc, calcium build-up within the disc, or bony growths on the spine. The end result is nerve compression or inflammation.

Also, depending on which way the disc herniates or the direction of the bony growths, there is a possibility that the spinal cord or nerve roots leading from the spinal cord could be compressed.

There is also the possibility that the blood flow to certain nerves may be affected.

Symptoms depend on the location of the nerve compression, but can include pain, numbness, weakness, headaches, urinary problems, etc.

Initially the person may not have any symptoms.

Others will have neck or shoulder pain, headaches in the back of the head, or stiffness of the neck. They may have difficulty turning or bending the neck from side-to-side.

Some will have pain that shoots down a certain part of the arm. They may also notice numbness, weakness, or pain in the arm. One or both sides may be affected. Often it causes the hands to become clumsy.

Some individuals will have numbness or weakness in their legs. This indicates that there may be pressure on the spinal cord. This is considered a surgical emergency. Many with this condition will have decreased vibration-sense in their legs. They may be unsteady while walking. In fact, spondylosis with myelopathy is a fairly common cause of unsteadiness in the elderly.

Others will have a specific level on the chest or abdomen where there is a noticeable change in sensation.

Problems with urination may occur. Some will have to urinate more often, while others will have to urinate urgently. A few will develop urinary incontinence.

The symptoms may get worse with turning, extending, or bending the neck. In others, coughing or straining may temporarily cause shooting pain in the arms or shoulders or it may worsen weakness in the legs.

Physical exam may reveal numbness or pain along a certain nerve distribution. Certain muscles may be weak and the reflexes not as brisk as normal. The affected individual may have difficulty with turning the neck or bending it from side to side. The arms or legs may be stiff. The hands may be weak and the muscles of the hands atrophied.

X-rays can be helpful in making the diagnosis. However, though X-ray findings of degenerative changes are often found in many older people, only a few will truly evidence the neurological changes caused by this condition. Alone, finding degenerative changes on X-rays is not conclusive but part of an overall determination of this condition that must take into consideration other factors. X-rays done with flexion and extension may show instability.

CT scan can be used to look at the spinal column and see if there is any narrowing or other abnormality.

MRI can also be used to look at the spinal column and see if there is any narrowing or other abnormality.

Nerve conduction studies and electromyography can be done to test the nerves and muscles.

The primary treatment for this condition is first to determine what type of arthritis is causing the problem. The second is making sure the neck is not unstable. Then, it is important to restrict neck movements. This is usually done with a cervical collar.

Medical treatment is usually with anti-inflammatory medicines, analgesics, and muscle relaxants. However, if this fails, then surgery may be necessary.

Physical therapy modalities such as Cold/Low level laser therapy, including stretching and strengthening exercises.

Patients may respond to steroid injections placed in the epidural space.

If that does not work, then surgery to decompress the nerve and stabilize the neck may be necessary.

Surgery is usually done if:

Conservative measures such as a cervical collar do not work.
There is severe pain.
There are significant neurological deficits, such as difficulty walking, severe hand weakness, or bladder problems.
There is compression of the spinal cord.

With any nerve condition, if it is not treated early, there is a danger that the loss of nerve function may be permanent. Nerves are very delicate. Once they are injured beyond a certain point, they do not recover. Therefore, the symptoms that can be caused by this condition could become permanent if not treated appropriately (i.e., numbness, weakness, and urinary problems).

There is no specific way to prevent this condition. However, good posture should be maintained.

Also, avoid repetitive injuries to the neck and cervical spine.

Neck Disc Injury, “Slipped Disc”, also known as Prolapsed, Bulging, Herniated or Extruded Disc

Disc Problems

What Causes Disc Problems?

Discs are the soft but strong cushions that separate the bones (vertebrae) in your spine and absorb shock as you move. Repeated strain over time, an injury, or sudden, forceful movements can damage discs and irritate nerves, causing pain, numbness, or tingling in your back and legs, neck,Shoulders and arms.

Common Slipped Disc, Neck Disc Injury

A Slipped Disc or (Disc Prolapsed) in the neck is a common cause of neck pain. Slipped disc treatment during the early stages involves limited mobilisation. Later, more active physical therapy rehabilitation is useful. During the later stages neck pain treatment can be enhanced if a pillow is used to support the neck.

Other Causes

Less common causes of neck pain include tumors, infections, or congenital abnormalities of the vertebrae.

Whiplash Associated Disorder (WAD) and Cervical Spine Injury

What is whiplash? 

An acute “whiplash” injury follows sudden or excessive hyper-extension, hyper-flexion, or rotation of the neck and causes neck pain and other symptoms. “Whiplash” injury is common in road traffic accidents, and may also be caused by sports injuries, falls or assaults. Most cases of “whiplash” injury occur as the result of rear-end vehicle collisions at speeds of less than 10 miles per hour. Patients present with neck pain and stiffness, occipital headache, thoracic back pain and/or lumber back pain, and upper-limb pain and paraesthesia.

There are two types of injury:

• Typical cervical hyper-extension injuries occur in passengers an drivers of a stationary or slow-moving vehicle that is struck from behind. Body is thrown forward but the head lags, resulting in hyper-extension of the neck. When the head and neck have reached maximum extension, the neck then snaps into flexion.
• A rapid deceleration injury throws the head forwards and flexes the neck. When the chin hits the chest it limits forward flexion but the forward movement may be sufficient to cause longitudinal distraction and neurological damage. Hyper-extension may occur in the subsequent recoil.

“Whiplash” injuries may occur at relatively low vehicle velocity impacts. One study showed the cervical muscle injury threshold to be about 10 km/hour. Whiplash-associated disorders (WAD) can be classified by the severity of signs and symptoms:

• Grade 1: no complaints or physical signs.
• Grade 2: indicates neck complaints but no physical signs.
• Grade 3: indicates neck complaints and musculoskeletal signs.
• Grade 4: neck complaints and neurological signs.
• Grade 5: neck complaints dislocation and fracture. Most cervical spine fractures occur predominantly at two levels:

1. One third of injuries occur at the level of C2, and one half of injuries occur at the level of C6 or C7.

2. Most fatal cervical spine injuries occur in upper cervical levels, either at cranio-cervical junction C1, or at C2

 Uncomplicated cases of Whiplash Associated Disorder (WAD)

“Whiplash”(WAD) cases that are uncomplicated are the result of sprained ligaments in the neck. The muscles of the neck spasm naturally, as a protective reaction. The “Whiplash”(WAD) injury may cause stiff neck and pain that may be present down one or both arms if the nerves of neck part of spinal cord get compressed. Pain Relief for “Whiplash”(WAD) can be found with Chiropractic  or Physiotherapy including pain medication and Cold/ low level laser therapy,

Patient’s with chronic whiplash benefited from Chiropractic  or Physiotherapy

Severe cases

In severe cases of “whiplash” may last for a month or more with persistent and in some cases constant pain. This may indicate that the “whiplash” injury has extensive damage and resulting in discs rupturing and trapped nerves in the neck. This may also predispose to a “slipped”disc, also known as a prolapsed, bulging, ruptured or herniated disc in the back. (View our Cold/low level laser therapy Section, a five star rating has been given to cold/low level laser therapy for soft tissue neck injuries)

Cold/Low level Laser Therapy (LLLT). treatment research  for Neck Pain

Neck pain  is common, often persistent, and responds poorly to medication. So it is encouraging to read that a relatively novel, non-invasive treatment shows evidence of effectiveness. A systematic review and meta-analysis of 16 randomised controlled trials of low-level laser therapy (LLLT)’ yielded 820 patients, for whom data was pooled. LLLT was found to reduce pain immediately after treatment in acute neck pain and up to 22 weeks after completion of treatment in patients with chronic neck pain. Low-level laser – or cold laser – is yet to be established as a medical treatment but, according to Wikipedia, papers are appearing at the rate of around 25 per month, mainly investigating treatment of musculoskeletal disorders. (View our Cold/Low Level Laser Therapy section)

1. Chow RT, Johnson Ml, Lopes-Martins RA, Bjordal JM. Efficacy of low-level laser therapy in the management of neck pain: a systematic review and meta-analysis of randomised placebo or active-treatment controlled trials. Lancet 2009 Dec 5;374(9705):1897-908.

Cold/Low Laser Therapy(LLLT) has been tested in over 200 clinical trials (RCTs) and published in the world’s top medical journals including a review by The Lancet, a clinical study in the journal PAIN and is acknowledged by the World Health Organisation Bone and Joint Task Force (published in the journal Spine).

(View our Cold/Low Level Laser Therapy section)

Whiplash Associated Disorder (WAD Research)

“Whiplash”(WAD). FROM: Journal of Orthopaedic Medicine 1999; 21 (1): 22–25 university Department of Orthopaedic Surgery, Bristol, UK Khan S, Cook J, Gargan M, Bannister G

Objective:To determine which patients with chronic “whiplash” (WAD) will benefit from chiropractic treatment.

Design: Retrospective review by structured telephone interviews of 93 consecutive patients seen in chiropractic clinic. Setting: Independent chiropractic clinic in a large city. Subjects: 93 patients, 68 female. Main outcome measure: Gargan and Bannister grading pre and post treatment.

Results:

Three groups of patients were recognised.

Group 1 consisted of patients with isolated neck pain associated with a restricted range of neck movement.

Group 2 consisted of patients with neurological symptoms or signs associated with a restricted range of movement.

Group 3 comprised patients who described severe neck pain but all of whom had a full range of neck movement. Patients in this group often described an unusual group of symptoms, with a bizarre, non-dermatomal pain distribution. There was a significant difference in outcome between the three groups (p<0.001) with only groups 1 and 2 improving following chiropractic manipulation.

Conclusion:

“Whiplash”(WAD) and neck injuries are common. Chiropractic is the only proven effective treatment in chronic cases. Our study enables patients to be classified at initial assessment in order to target those patients who will benefit from such treatment.

When Should You Seek Medical Care?

Cases of severe neck pain occur following an injury such as motor vehicle accident, blow to the head or fall related accident. Only a trained professional, such as a paramedic, should immobilize the patient to avoid the risk of further injury and possible paralysis. Medical care should be sought immediately.

Immediate medical care should also be sought when an injury causes pain in the neck that radiates down the arms and legs. Radiating pain or numbness in your arms or legs causing weakness in the arms or legs without significant neck pain should also be evaluated. If there has not been an injury, you should seek medical care when neck pain is:

• continuous and persistent
• severe
• accompanied by pain that radiates down the arms or legs
• accompanied by headaches, numbness, tingling, or weakness

Diagnosis

Determining the source of the pain is essential to recommend the appropriate treatment and rehabilitation. Therefore, a comprehensive examination is required to determine the cause of neck pain.

Your Chiropractor will take a complete history of the symptoms you are having with your neck. The Chiropractor may ask you about other illnesses, any injury that occurred to your neck, and any complaints you have associated with neck pain. Previous treatment for your neck condition will also be noted.

Chiropractor will also perform a physical examination. This examination may include evaluation of neck motion, tenderness of the neck and the function of the nerves and muscles in your arms and legs.

X-rays often will be obtained to allow your Chiropractor to look at the bones in your neck. This entails simple diagnostic imaging study (radiography) and aids your Chiropractor to determine the cause of neck pain and to prescribe effective treatment.

Further evaluation may involve the following:

• MRI (magnetic resonance imaging). This non x-ray study allows an evaluation of the spinal cord and nerve roots.
• CT (computed tomography). This specialized x-ray study allows careful evaluation of the bone and spinal canal.
• EMG (electromyography). This test evaluates nerve and muscle function.

Treatment

The treatment of neck pain depends on the diagnosis. Most patients are treated successfully with Chiropractic care or Physiotherapy. Also rest, medication, immobilization, exercise, activity modifications, or a combination of these methods can be very useful.

Inflammation is a result of stretching muscles and ligaments beyond their limits, this therapy is extremely affective in the treatment of inflammation. Cold/Low level laser therapy a five star rating for soft tissue neck injuries (“Whiplash”). Surgery is required in very few cases to relieve neck pain. For most patients, a combination of Chiropractic care, rest, medication, and Physiotherapy will relieve neck pain. Surgery may be necessary to reduce pressure on the spinal cord or a nerve root when pain is caused by a herniated disc or bony narrowing of the spinal canal. Surgery may also be required following an injury to stabilize the neck and minimize the possibility of paralysis, such as when a fracture results in instability of the neck.

Cervical Disc Injury.

Causes and Risk Factors of Cervical disc injuries

Most cervical disc syndromes are caused by injuries that involve hyperextension, which results in compression of the anatomic structures.

Flexion injuries in the cervical area do not result in nerve compression.

Symptoms of Cervical disc injuries

Pain, loss of sensation or new sensations, and weakness are the main symptoms and signs of cervical disc injury. The most common symptom is pain and it is usually the only one. Rarely, cervical disc injury is complicated by compression of either a cervical nerve root or even more rarely by a compression of the spinal cord. When compression of the nervous tissue occurs, patients will report abnormal sensations other than pain and will report loosing strength in one arm (nerve root compression) or in both arms and legs (spinal cord compression).

1. Pain is the most common complaint and can be felt in the neck or arm.

a. Pain is usually limited to the neck and upper back between the shoulder blades. It occurs because of low-grade inflammation of the disc and the cervical vertebra joints. While the disease is chronic, inflammation can flare up after a minor added injury or for other reasons that are not yet well understood. Less commonly, neck and shoulder pain occur because the disc bulges acutely (herniates) and stretches the posterior longitudinal ligament. With conservative treatment, this pain usually goes away in a few weeks, but it is likely to happen again, especially if the affected individual does not change his/her lifestyle.

b. Rarely, the pain will be felt down the arm. This pain can be lightning, caused or aggravated by movements of the neck, or can be dull and persistent. Pre-existing neck pain is also present in many individuals. After the arm pain starts, some people report feeling less pain in their neck. When arm pain is present, it is usual.

Cervicogenic headaches.

Cervicogenic headaches are defined as headaches originating from the neck. The location is typically at the back of the head, sides and top of the head as well as around the forehead and eyes affecting one or more of the above regions at once. These headaches can be located on one or both sides of the head.

Cervicogenic headaches are usually associated with dysfunction of the upper neck which can present itself as neck pain or local tenderness, reduced neck range of motion and exacerbation of the headaches by neck movement. The past history of neck trauma is typical for this type of headaches. The cervicogenic headaches are caused by irritation of nerve endings of injured joints, ligaments, muscles and discs of the neck. The nerve endings in the injured areas send pain signals up the upper nerves of the neck to the brain causing “cross wiring” with the fibers of the trigeminal nerve (one of the nerves in the head) which is responsible for perception of the head pain thus causing the headaches.

Neck pain as well as “whiplash” (WAD) injuries and both conditions can result in headaches and all three are commonly treated by Chiropractors. The treatment is focused on the small joints in the back of the neck called facet joints that are responsible for neck pain. When these joints dysfunction but injury to the muscles he nerve fibres that innervate / act as sensors for these facet joints also serve to act as sensors to parts of the head. When these facet joints dysfunction these sensors become active, the brain cannot clearly differentiate between the facet joints and the mapping of the head and create the sensation of pain in a broader area- Headache.

Temporomandibular Jaw Disorders (TMD, TMJ Syndrome)

“TMD” temporomandibular (jaw) disorders, also called “TMJ syndrome.” If you felt pain sometimes in your jaw area, or maybe your dentist or Chiropractor has told you that you have TMD.

If you have questions about TMD, you are not alone. Researchers, too, are looking for answers to what causes TMD, what are the best treatments, and how can we prevent these disorders. The National Institute of Dental and Craniofacial Research has written this pamphlet to share with you what we have learned about TMD.

TMD is not just one disorder, but a group of conditions, often painful, that affect the jaw joint (temporomandibular joint, or TMJ) and the muscles that control chewing. Although we don’t know how many people actually have TMD, the disorders appear to affect about twice as many women as men.

The good news is that for most people, pain in the area of the jaw joint or a muscle is not a signal that a serious problem is developing. Generally, discomfort from TMD is occasional and temporary, often occurring in cycles. The pain eventually goes away with little or no treatment. Only a small percentage of people with TMD pain develop significant, long-term symptoms.

What is the Temporomandibular Joint?

The temporomandibular joint connects the lower jaw, called the mandible, to the temporal bone at the side of the head or neck. If you place your fingers just in front of your ears and open your mouth, you can feel the joint on each side of your head. Because these joints are flexible, the jaw can move smoothly up and down and side to side, enabling us to talk, chew and yawn. Muscles attached to and surrounding the jaw joint controls its position and movement.

When we open our mouths, the rounded ends of the lower jaw, called condyles, glide along the joint socket of the temporal bone. The condyles slide back to their original position when we close our mouths. To keep this motion smooth, a soft disc lies between the  condyle and the temporal bone. This disc absorbs shocks to the TMJ from chewing and other movements.

What Are Temporomandibular Disorders?

Researchers generally agree that temporomandibular disorders fall into three main categories:

• Myofascial pain, the most common form of TMD, which is discomfort or pain in the muscles that control jaw function and the neck and shoulder muscles;
• Neck Pain/Ache.
• Internal derangement of the joint, meaning a dislocated jaw or displaced disc, or injury to the condyle;
• Degenerative joint disease, such as osteoarthritis or rheumatoid arthritis in the jaw joint.

A person may have one or more of these conditions at the same time.

T M J Treatment

If you place your fingers in front of each ear and open your jaw, you’ll feel lots of clicking, or a grinding movement. This is the temporomandibular joint (TMJ), a place where your skull’s temporal bone attaches to your mandible (Jaw).

Because this joint comprises of a large number of ligaments, cartilage, fascia, discs, muscles, nerves and blood vessels that run around and through it, you can have all kinds of problems: trouble opening the mouth wide; a locked jaw; headache; clicking or popping sounds, tinnitus (ringing in the ears); throat fullness; shoulder, cheek or jaw pain; neck ache; facial nerve pain; ear or eye pain; dental pain; nausea; blurred vision and dizziness when the TMJ joint is misaligned.

An unhealthy skull/jaw alignment can put great stress upon the spinal column. By relieving pressure on the upper neck and bones of the skull, chiropractic treatment may relieve or correct TMJ problems. There are also documented cases of dental problems that, once corrected, help patients to hold their spinal adjustments for longer periods between chiropractic treatments.

All TMJ sufferers need chiropractic treatment; anyone who has been to the dentist should follow up with a check up from their chiropractor.

Trapped Nerve or “Pinched” Nerve.

Having a Trapped nerve hurts often feeling like  severe, sharp, excruciating and intense pain. Trapped nerves could happen nearly anywhere affecting nerves that go to the arms, fingers, wrists, neck, head, back, shoulders, legs, muscles and internal organs. “Pinched” or Trapped nerves can affect your health, posture, vitality, resistance to disease, even your emotional health. “Pinched”/trapped nerves can make life a misery.

Trapped ?

Do nerves really get trapped? Actually directly trapping the nerve  is quite rare. Much more common is what chiropractors call the vertebral subluxation complex or subluxations. Other terms for this are: nerve impingement, nerve irritation, nerve lesion, spinal stress and meningeal tension.

Even though there may be no actual trapping, people like the word because it’s so descriptive. It can really feel like something is being trapped in there. Some health professionals even use it. People at times seeing a chiropractor’s  saying their GP, osteopath, massage therapist referred them because they had a trapped nerve and should visit a chiropractor to get  the trapped nerve freed.

What Can Cause Subluxations?

Nearly any kind of stress can cause a subluxation: a fall or an accident, even a very small one that happened years ago; a poor sleeping position; poor posture; fatigue; emotional stress; poor nutrition or a combination of stresses. A subluxation need not happen all at once. It could  set in the body over time. 

 Trapped Nerves Don’t Normally Hurt

Chiropractors sometimes say that people with painful  Trapped nerves might be considered lucky-they know they have a problem and they (hopefully) will  go to a chiropractor.

 If  You  don’t Experience The pain From a  Trapped Nerve?  What Would Be The Outcome?

Some patients  may watch their body suffer and their health deteriorate for years without the faintest idea that the problem may be coming from their spine. These people desperately need to see a chiropractor but because they don’t have spine or nerve pain they may never receive the care they need. This is the big job facing chiropractors today – educating people about vertebral subluxations and the need for periodic spinal checkups.

Treatment Of Trapped Nerves

Trapped nerves do not get untrapped by themselves. No amount of painkillers or muscle relaxants can fix them. Only doctors of chiropractic are able to analyze your spinal column for trapped nerves or vertebral subluxations and use spinal adjustment techniques to gently realign the spine, release the internal stress and free the body from the trapped nerves.

Chiropractors are heakth care practitioners who are most experienced in freeing body of vertebral subluxations.

Nerves  Travel Through the Body?

Individual nerve fibers are tiny. Although they may be many inches long they are so thin you need a powerful microscope to see them. Nerve fibers are also found in large bundles called nerves. Billions of nerve fibers are bundled inside your spinal cord – an extension of your brain, which passes through the spinal column. Nerves branch off from spinal cord and exit spine through openings between the vertebrae to connect to every cell in the body.

Life without Nerves

Without nerves you couldn’t see, hear, touch, taste or smell or feel hot, cold, pleasure or pain,and no messages could come in and no messages could go out; without nerves no muscles could move.

Nerves Keep the Body Alive and Healthy

Nerve messages also help regulate the body’s activities such as breathing, heartbeat, digestion, excretion,  blood pressure and immune system so that the body can respond to germs, changes in temperature and all kinds of stress. In addition to nerve impulses, nutrients flow over your nerves to nourish the muscles and tissues. If this flow is blocked it may cause your muscles to waste away.

If the nerves are trapped, “impinged” or otherwise interfered with, the flow of messages and nutrients over them can be disrupted and the body can become “diseased” or weakened. When you are diseased you have less energy and vitality and are less able to deal with physical and emotional stress.

Lowered resistance to disease, infection, colds, flu, allergies, ulcers, constipation, diarrhea, asthma, fevers, headaches, seizures, bedwetting, hearing, balance or visual disturbances and many other health problems have been related to an unhealthy nervous system.

How Do Nerves Get Impinged or Trapped

The skeletal system, especially the spinal column, protects the spinal cord and other nerves. If  the spinal bones (vertebrae) are misaligned even slightly they may “pinch,” impinge, irritate, compress or stretch the nerves they are supposed to protect.

This in turn can affect other structures in the area including blood vessels, discs, ligaments, joints, muscles, fascia, tendons and meninges. As mentioned earlier, this is referred to as a subluxation.

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Cold/Low level Laser Therapy (LILT). Treatment and Research  for Neck Pain

Neck pain  is common, often persistent, and responds poorly to medication. So it is encouraging to read that a relatively novel, non-invasive treatment shows evidence of effectiveness. A systematic review and meta-analysis of 16 randomised controlled trials of low-level laser therapy (LLLT)’ yielded 820 patients, for whom data was pooled. LLLT was found to reduce pain immediately after treatment in acute neck pain and up to 22 weeks after completion of treatment in patients with chronic neck pain. Low-level laser – or cold laser – is yet to be established as a medical treatment but, according to Wikipedia, papers are appearing at the rate of around 25 per month, mainly investigating treatment of musculoskeletal disorders. (View our Cold/Low Level Laser Therapy section)

1. Chow RT, Johnson Ml, Lopes-Martins RA, Bjordal JM. Efficacy of low-level laser therapy in the management of neck pain: a systematic review and meta-analysis of randomised placebo or active-treatment controlled trials. Lancet 2009 Dec 5;374(9705):1897-908.

A Review on research published by The Lancet, for the treatment of neck pain with Cold/Low Laser Therapy (LLLT)

Low level Laser treatment for neck pain.

Cold/Low level laser, a review on research published by The Lancet shows that Low Level Laser Therapy (LLLT) also so known as Cold Laser Therapy has been tested in over 200 clinical trials (RCTs) and published in the world’s top medical journals including a review by The Lancet, a clinical study in the journal PAIN and is acknowledged by the World Health Organisation Bone and Joint Task Force, and published in the journal Spine. There are 26 research papers on low level laser therapy, for Musculoskeletal pain and syndromes, both chronic and acute, Rheumatoid Arthritis, Cervical Spine Osteoarthritis, lateral and medial epicondylitis,(Tennis, Golfers Elbow).Achilles Tendonitis, Carpal Tunnel, TMJ, Tendonitis, Bursitis, soft tissue injuries, fractures, neck, shoulder, back, lower back pain, disc injuries, hip, joints knee, ankle injuries, conditions and disorders, and research on low level laser therapy are included on this page, scroll down.

(View our Cold/Low Level Laser Therapy section)

Pain Relief  for Rheumatoid Arthritis, Cervical Spine Osteoarthritis, Injuries and inflammatory Conditions. Low Level Laser Therapy (LLLT) also known as Cold Laser therapy,   Research on the Clinical application of GaAIAs 830 NM diode laser in treatment of Rheumatoid Arthritis,Cervical Spine Osteoarthritis,  including  LLLT Research  on Pain Relief  for other Inflammatory  Conditions, and  Injuries.

Cold/Low Level Laser Therapy (LLLT) Clinical application of GaAIAs 830 NM diode laser in treatment of Rheumatoid Arthritis. Department of Orthopaedic Surgery, Osaka City University Medical School, Japan

The authors have been involved in the treatment of rheumatoid arthritis (RA), in particular chronic poly-arthritis and the associated pain complaints. The biggest problem facing such patients is joint contracture, leading to bony ankylosis. This in turn severely restricts the range of motion (ROM) of the RA-affected joints, thereby seriously restricting the patient’s quality of life (QOL). The authors have determined that in these cases, daily rehabilitation practice is necessary to maintain the patient’s QOL at a reasonable level.

The greatest problem in the rehabilitation practice is the severe pain associated with RA-affected joints, which inhibits restoration of mobility and improved ROM. LLLT or low reactive level laser therapy has been recognized in the literature as having been effective in pain removal and attenuation. The authors accordingly designed a clinical trial to assess the effectiveness of LLLT in RA related pain (subjective self-assessment) and ROM improvement (objective documented data).

From July 1988 to June 1990, 170 patients with a total of 411 affected joints were treated using a GaAlAs diode laser system (830 nm, 60 mW C/W). Patients mean age was 61 years, with a ratio of males: females of 1: 5.25 (16%: 84%). Effectiveness was graded under three categories: excellent (remarkable improvement), good (clearly apparent improvement), and unchanged (little or no improvement).

For pain attenuation, scores were: excellent – 59.6%; good – 30.4%; unchanged – 10%.

For ROM improvement the scores were: excellent – 12.6%; good – 43.7%; unchanged – 43.7%. This gave a total effective rating for pain attenuation of 90%, and for ROM improvement of 56.3%.

Kanji Asada, Yasutaka Yutani, Akira Sakawa and Akira Shimazu

0898-5901/91/020077-06 $05.00  © 1991 by John Wiley & Sons, Ltd.

Low Level Laser Therapy for Osteoarthritis and Rheumatoid Arthritis: A Metaanalysis

ABSTRACT.Osteoarthritis (OA) and rheumatoid arthritis (RA) affect a large proportion of the population. Low level laser therapy (LLLT) was introduced as an alternative non-invasive treatment for RA and OA about 10 years ago, but its effectiveness is still controversial. We assessed the effectiveness of LLLT in the treatment of RA and OA.

Objective.

Methods.A systematic review was conducted, following an a priori protocol, according to the methods recommended by the Cochrane Collaboration. Trials were identified by a literature search of Medline, Embase, and the Cochrane Controlled Trials Register. Only randomized controlled trials of LLLT for the treatment of patients with a clinical diagnosis of RA or OA were eligible. Thirteen trials were included, with 212 patients randomized to laser and 174 patients to placebo laser, and 68 patients received active laser on one hand and placebo on the opposite hand. Treatment duration ranged from 4 to 10 weeks. Follow-up was reported by only 2 trials for up to 3 months.

Results. In patients with RA, relative to a separate control group, LLLT reduced pain by 70% relative to placebo and reduced morning stiffness by 27.5 min (95% CI –52.0 to –2.9), and increased tip to palm flexibility by 1.3 cm (95% CI –1.7 to –0.8). Other outcomes such as functional assessment, range of motion, and local swelling were not different between groups. There were no significant differences between subgroups based on LLLT dosage, wavelength, site of application, or treatment length. In RA, relative to a control group using the opposite hand, there was no difference between control and treatment hand, but all hands were improved in terms of pain relief and disease activity. For OA, a total of 197 patients were randomized. Pain was assessed by 3 trials. The pooled estimate (random effects) showed no effect on pain (standardized mean difference –0.2, 95% CI –1.0 to +0.6), but there was statistically significant heterogeneity (p > 0.05). Other outcomes of joint tenderness, joint mobility, and strength were not significant.

Conclusion.LLLT should be considered for Pain relief and morning stiffness in RA, particularly since it has few side effects. For OA, the results are conflicting in different studies and may depend on the method of application and other features of the LLLT. Clinicians and researchers should consistently report the characteristics of the LLLT device and the application techniques. New trials on LLLT should make use of standardized, validated outcomes. Despite some positive findings, this metaanalysis lacked data on how effectiveness of LLLT is affected by 4 factors: wavelength, treatment duration of LLLT, dosage, and site of application over nerves instead of joints. There is a need to investigate the effects of these factors on effectiveness of LLLT for RA and OA in randomized controlled clinical trials. (J Rheumatol 2000;27:1961–9)

LUCIE BROSSEAU, VIVIAN WELCH, GEORGE WELLS, PETER TUGWELL, ROBERT de BIE, ARNE GAM, KATHERINE HARMAN, BEVERLEY SHEA, and MICHELLE MORIN

Key Indexing Terms:

Leaders of International laser organizations met during the third Congress of the World Association for Laser Therapy held in  Athens, Greece, to explore ways of advancing research, education and practice world-wide. Photo was taken immediately after the special session in May, 2000

Cold /Low Level Laser (LLLT)

Low Level laser Therapy (LLLT) also known as Cold Laser Therapy/Treatment

The lasers used  are certified as  low level laser therapy  (LLLT).  For the past 30 years the technology of low level laser therapy (also known as Cold Laser Therapy has been formally accepted in North America and in many other parts of the world such as Europe, Russia and Japan.  In all this time there have been no recorded long-term adverse effects from low level laser therapy.  It is considered to be non-invasive, painless and safe.

Low Level Laser Therapy (LLLT) uses laser light energy to stimulate cells to function optimally.  In the body, light sensitive chromophores and other elements within the cell absorb energy, initiating a series of important photochemical changes such as increased production of ATP. The mitochondria and Kreb’s Cycle stimulation initiates the production of ATP, providing the cell with the extra energy needed to accelerate the healing process and positively influence pain.  These activities can occur in all types of cells and includes ligament, nerves, cartilage and muscle.

Low Level Laser Therapy (LLLT) is a treatment where by a low level laser is utilized to treat chronic and acute pain.  Low level laser therapy may be used for patients suffering from Sciatica, back and neck, hip, knee, ankle, foot pain and conditions a, musculoskeletal pain, joint pain associated with arthritis, fibromyalgia, tendonitis, bursitis, neuropathy, Achilles tendonitis, migraine headaches, sprains and strains, trapped nerves, carpal tunnel syndrome , back, neck, shoulder pain and other associated pains. Low Level laser therapy also treats conditions such as TMJ, reflex sympathetic dystrophy (RSD) and other inflammatory and scarring conditions. By increasing serotonin levels, low level laser therapy contributes to the body’s own healing process. Non-thermal and non-invasive, low level laser therapy involves a combination of low level laser and electric stimulation and is one of the most effective healing therapies. Completed in ten to twelve sessions, low level laser therapy(LLLT) can significantly reduce treatment time and costs.

A Review on research published by The Lancet, for the treatment of neck pain with Cold/Low Laser Therapy (LLLT)

Low level Laser treatment for neck pain.

Neck pain is common, often persistent, and responds poorly to medication. So it is encouraging to read that a relatively novel, non-invasive treatment shows evidence of effectiveness. A systematic review and meta-analysis of 16 randomised controlled trials of low-level laser therapy (LLLT)’ yielded 820 patients, for whom data was pooled. LLLT was found to reduce pain immediately after treatment in acute neck pain and up to 22 weeks after completion of treatment in patients with chronic neck pain. Low-level laser – or cold laser is yet to be established as a medical treatment but, according to Wikipedia, papers are appearing at the rate of around 25 per month, mainly investigating treatment of musculoskeletal disorders.

1. Chow RT, Johnson Ml, Lopes-Martins RA, Bjordal JM. Efficacy of low-level laser therapy in the management of neck pain: a systematic review and meta-analysis of randomised placebo or active-treatment controlled trials. Lancet 2009 Dec 5;374(9705):1897-908.

Lower Back Pain, Low Level Laser Therapy (LLLT) Research.

Abstract

Objective:

The aim of this study was to investigate the clinical effects of low-level laser therapy (LLLT) in patients with acute low back pain (LBP) with radiculopathy.

Background Data:

Acute LBP with radiculopathy is associated with pain and disability and the important pathogenic role of inflammation. LLLT has shown significant anti-inflammatory effects in many studies.

Materials and Methods:

A randomized, double-blind, placebo-controlled trial was performed on 546 patients. Group A (182 patients) was treated with nimesulide 200 mg/day and additionally with active LLLT; group B (182 patients) was treated only with nimesulide; and group C (182 patients) was treated with nimesulide and placebo LLLT. LLLT was applied behind the involved spine segment using a stationary skin-contact method. Patients were treated 5 times weekly, for a total of 15 treatments, with the following parameters: wavelength 904 nm; frequency 5000 Hz; 100-mW average diode power; power density of 20 mW/cm² and dose of 3 J/cm²; treatment time 150 sec at whole doses of 12 J/cm². The outcomes were pain intensity measured with a visual analog scale (VAS); lumbar movement, with a modified Schober test; pain disability, with Oswestry disability score; and quality of life, with a 12-item short-form health survey questionnaire (SF-12). Subjects were evaluated before and after treatment. Statistical analyses were done with SPSS 11.5.

 Results:

Statistically significant differences were found in all outcomes measured (p < 0.001), but were larger in group A than in B (p < 0.0005) and C (p < 0.0005). The results in group C were better than in group B (p < 0.0005).

Conclusions: The results of this study show significant improvement in acute LBP treated with LLLT used as additional therapy.

Ljubica M. Konstantinovic, Ph.D.,¹Zeljko M. Kanjuh, M.S.,¹Andjela N. Milovanovic, M.S.,²Milisav R. Cutovic, Ph.D.,¹Aleksandar G. Djurovic, Ph.D.,³Viktorija G. Savic, M.S.,⁴Aleksandra S. Dragin, M.S.,¹and Nesa D. Milovanovic, M.S.¹

¹Clinic for Rehabilitation, Medical School, Belgrade, Serbia ²Center for Physical Medicine, Clinical Center of Serbia, Belgrade, Serbia.³Clinic for Rehabilitation, Military Medical Academy, Belgrade, Serbia.⁴Department for Physical Medicine, Institute for Rheumatology, Belgrade, Serbia.

Address correspondence to: Ljubica Konstantinovic, Ph.D. Clinic for Rehabilitation dr Miroslav ZotovicMedical School, University of Belgrade Sokobanjska 13, Belgrade

Low Level Laser Therapy (LLLT)

Low Level  Laser Therapy (LLLT) has a 5 star rating for soft tissue injuries,conditions and inflammation.  Low Level Laser Therapy is a handheld, non-invasive, light-emitting medical device which is used over different areas of the body. It provides an unmatched advantage in the treatment of conditions such as;

Athletic and sports Injuries, Soft tissue injuries including Sprains and Strains, Tendonitis and Haematomas

Lower leg (calf pain) inflammation, Shin splints, Hamstring, Achilles tendonitis, Bursitis, conditions and disorders

Ankle sprains, injury, and fractures, inflammation conditions and disorders

Heel and foot injury, pain, Bursitis, Achilles Tendonitis, Plantar fasciitis, conditions and disorders

Knee pain, injuries, tears, ligament, Tendon injury, ruptures, Runners Knee, inflammation, Bursitis, conditions and disorders

Shoulder injury, pain, Shoulder tears, fractures inflammation, Tenosynovitis ,Tendonitis, Bursitis, conditions such as frozen shoulder, and disorders

Neck injury, Neck Pain, Neck sprain, Whiplash injury.

Back Injury,   Lower back pain, Sciatica, slipped discs, prolapsed disc, herniated / bulging discs, Trapped nerves and inflammation.

Elbow, Wrist and Hand injury, Tendonitis, inflammation, fractures, conditions and disorders, such as Tennis Elbow,(Golfers Elbow) Carpal Tunnel Syndrome,

Hip injury and pain, Sacroiliac Joint inflammation, groin and thigh strain (pull), sports hernia, Hip Bursitis/Tendonitis, Trochanteric Bursitis, conditions and disorders

Muscle sprain and spasms, Cramps, Joint Pain and stiff Joints.

Pain Relief, including Arthritic pain relief.

Wound Management including Skin Ulcers, Pressure Sores and Burns, Skin infections

Chronic pain such as Trigeminal Neuralgia and Chronic Neck and Back pain.

Safety

Low level laser therapy(LLLT) is not harmful. Lasers used for tissue stimulation have insufficient strength to damage cells. 30 years of clinical studies and clinical use have shown no adverse effects whatsoever.

The Advantages of Low Intensity Laser Therapy

• Non-invasive
• Non-toxic
• Easily applied
• Highly effective
• Cure rate > 95%
• No known negative side effects

Mechanism of Action

Therapeutic lasers work by supplying energy to the body in the form of photons of light. The tissues and cells then absorb this energy, where it is used to accelerate the normal rate of tissue healing.

Therapeutic Benefits of Laser Therapy:

• Anti-inflammatory Action: Laser light reduces swelling, leading to decreased pain, less stiffness, and a faster return to normal joint and muscle function.
• Rapid Cell Growth: Laser light accelerates cellular reproduction and growth.
• Faster Wound Healing: Laser light stimulates fibroblast development and accelerates collagen synthesis in damaged tissue.
• Reduced Fibrous Tissue Formation: Laser light reduces formation of scar tissue, leading to more complete healing, with less chance of weakness and re-injury later.
• Increased Vascular Activity: Laser light increases blood flow to the injured area.
• Stimulated Nerve Function: Laser light speeds nerve cell processes which may decrease pain and numbness associated with nerve-related conditions.

Frequency of Treatments

While some patients get immediate results, others require 6-12 treatments before seeing a lasting effect. Less severe or acute injuries will require fewer treatments than chronic or severe conditions.

Low Level Laser Therapy (LLLT) Applications, Case Studies and Low Level Laser Research with 26 Worldwide Clinical Studies is presented below:

Musculoskeletal pain syndromes, both chronic and acute.Cold/Low level laser therapy (LLLT)has been shown to be effective in a variety of musculoskeletal conditions and associated pain presentations.In Rheumatoid Arthritis, LLLT can benefit not only the pain of acute small joint inflammation but also the chronic pain.In a review article on rheumatology (3), some 18 papers were considered. All studies involved double-blind trials with LLLT in chronic rheumatoid, and reported significant improvement in pain (80% success rate in relieving pain). Upon comparing LLLT to a similar rate of pain attenuation using anti-inflammatory drugs (NSAIDs), the LLLT was free of any side-effects while 20% of patients treated with NSAIDs suffered unacceptable side-effects of medication . In another study of 170 patients with rheumatoid arthritis using LLLT (4), pain attenuation of up to 90% was noted.Trellis et al (6) used LLLT for osteoarthritis of the knee in 40 patients. He reported a significant reduction of 82% of the patients with improved joint mobility. Among 36 randomized patients, with pain caused by cervical osteoarthritis, those who received Infra-Red and Low Level Laser treatment improved 75% compared with the group receiving mock treatment (31%) . Similarly, a study of 60 patients with Cervical Osteoarthritis, Low Pulsed Laser was successful in relieving pain and in improving function.
The results of a study show that cervical myofascial pain is significantly improved at 3-month with Diode laser . A similar successful LLLT treatment has been described for whiplash injuries.In a randomized study with 30 patients with supraspinatus or bicipital tendonitis, the results demonstrated the effectiveness of laser therapy in tendonitis of the shoulder . Another study with a patient population (n = 324), with either medial epicondylitis (Golfer’s elbow; n = 50) or lateral epicondylitis (Tennis elbow; n = 274), and randomly allocated, provides further evidence of the efficacy of LLLT in the management of lateral and medial epicondylitis .

Treatment with low-level laser therapy (LLLT) was shown effective in treating Carpal Tunnel Syndrome pain. Another study, significant decreases in McGill Pain Questionnaire scores, median nerve sensory latency, and Phalen and Tinel signs were observed after treatment series with Low Level Laser Therapy. Patients could perform their previous work  .

In acute trauma there is a soft tissue injury comprising swelling, haematoma, pain and reduced mobility. Sporting injuries and domestic accidents usually involve damage to muscles, joint ligaments and tenclass. In the absence of bone fracture or other injury demanding priority treatment, LLLT should be instituted at the earliest opportunity. Kumar reported a comparative study in 50 patients with inversion injuries of the ankle. He found that compared to conventional physiotherapy, the LLLT treated patients showed a more rapid resolution of symptoms and an earlier return to full weight-bearing .

Fibromyaliga (FM) is characterized by widespread pain in the body, associated with particular tender points. It is often accompanied by disturbed sleep patterns, fatigue, headaches, irritable bowel and bladder syndrome, morning stiffness, anxiety and depression. FM can cause a high level of functional disability and have a significantly negative effect on quality of life. One study suggests that “Laser Therapy is effective on pain, muscle spasm, morning stiffness, fatigue, depression and total tender point number in Fibromyalgia”.

A randomized controlled study with 63 with non-radiating low back pain showed that LLLT significantly improved pain and function.

In summary, the bulk of published work to date supports the use of LLLT for treatment of a variety of musculoskeletal conditions and associated pain. Moreover, the LLLT proved to be not only more effective than conventional methods, but more economical as well. The added advantage of absence of side effects, non-invasive nature of therapy and the ease of application, ensures good patient acceptance of the treatment modality.

Low Intensity Laser Therapy(LILT) for Head, Neck and Facial Pain.

Prof P.F. Bradley

The clinical application of low incident power density laser radiation for the treatment of acute and chronic pain is now a well established procedure. This paper reviews the currently available English speaking literature and summarises a selection of serious scientific papers which report a beneficial effect following the treatment of a wide variety of acute and chronic syndromes whose main presenting symptom is pain.

Head and Neck Clinical Applications of LILT

LILT is proving useful in a wide variety of painful conditions in the Head and Neck but the following are particular applications:

  1. TM Joint Pain Dysfunction

  2. Post Herpetic Neuralgia

  3. Trigeminal Neuralgia

  4. Painful Ulcerative Conditions

  5. Pain of Advanced Oro Facial Cancer

 The above information has been suppled by Quantum Healing Lasers .Com

  The Ability of Low Level Laser Therapy (LLLT) to Mitigate Fibromyalgic Pain.

  The CFIDS Chronicle Physicians’ Forum Fall 1993

  Douglas Ashendorf, MD, FAAPMR Newark, New Jersey

Physiotherapist Shows Lasers Relieve Pain.

A physiotherapist at Royal Brisbane Hospital (Australia) recently received a PhD from the University of Queensland for demonstrating that laser treatment prompts the release of endorphins into the bloodstream. Endorphins are a type of natural morphine that dulls pain. Physiotherapist Liisa Laakso studied the effects of lasers on 56 people who suffered myofascial pain syndrome, a chronic hypersensitivity often secondary to a person’s primary painful affliction, such as arthritis. Previous experiments linking endorphin release and lasers have only been done on rats.

In the study, Laakso applied different doses and wavelengths of a laser diode to “trigger points” on the body and took blood samples measuring endorphin levels in these subjects and a control group. The control group reported some pain relief – most likely a placebo effect – but endorphins were present. Those patients that underwent laser treatment reported pain reduction of up to 78%, and endorphins were present in their blood.

THERMOGRAPHIC STUDY OF LOW LEVEL LASER      THERAPY FOR ACUTE-PHASE INJURY.

 Yoshimi Asagai, M.D.1, Atsuhiro Imakiire, M.D.2, Toshio Ohshiro, M.D.3,  1. Shinano Handicapped Children`s Hospital Shimosuwa, Nagano, Japan    2. Department of Orthopaedic Surgery, Tokyo Medical University Shinjuku, Tokyo, Japan     3. Japan Medical Laser Laboratory, Shinanomachi, Tokyo, Japan. 

Acute-phase injury is generally treated by localized cooling of the region, and rarely by theactive use of low level laser therapy (LLLT) in Japan. Thermographic studies of acutephase injury revealed that circulatory disturbances at the site of trauma occurred due to swelling and edema on the day following the injury, and that skin temperature was high at the site of the trauma and low at the periphery. Following LLLT, circulatory disturbances rapidly improved, while temperature in the high temperature zone around the site of trauma fell by 3 degrees on the average, but at the periphery the low temperature rose by 3 degrees on the average to nearly normal skin temperature. Clinically, swelling and edema improved. LLLT was also useful in treating necrosis of the skin in the wound area and in accelerating healing of surgical wounds of paralytic feet, which are prone to delayed, wound healing and also wounds due to spoke injury. LLLT is useful in treating swelling and edema in acutephase injury and in accelerating healing of surgical wounds. 

Key words: Laser therapy, acute-phase injury, thermography, ankle joint sprain

Introduction

It has not been clearly defined to date if LLLT is indicated for acute-phase injury with swelling and calor. Yet it is frequently considered to be contraindicated in acute-phase injury. We have previously reported that, in patients with cerebral palsy with reduced peripheral skin temperature, the skin surface temperature was elevated to normal after LLLT

(1). in this study, we used thermography to examine changes in skin temperature following LLLT chie fly inacute-phase injury. 

Patients and Methods

Subjects were 7 patients with sprains of the ankle joint, two patients with fractures of the tibial shaft, and one patient with dislocation of the elbow joint. LLLT was also used in orthopedic surgery for disorders of the distal lower extremity such as talipes varus, which is frequently followed by postoperative necrosis of the skin in the wound area as well as delayed wound healing, and pre- and postoperative treatment of paralytic feet with circulatory disturbances. The procedure was as follows. Room temperature was maintained at 25oC. After acclimatization for 20 minutes, continuous irradiation with a GaAlAr semiconductor laser (JQ305, Minato Medical Science Co., Ltd., Japan) with the wavelength adjusted to 810 nm and the output to 100mW was applied using the contact method.

The spot size on the tissue was 0.56cm2 with a power density of 17.86W/cm2 at 100mW, the energy density per point being 107.5J/cm2. The area surrounding the site of trauma was irradiated for 3 to 5 minutes in total, one minute per spot, and changes in the skin surface temperature were followed using Thermotracer TH1106. The test was performed from immediately after injury till 5 days post-trauma, an average of two days after injury. 

Results 

Immediately after injury, the skin surface temperature was elevated to about 34 degrees at and around the site of trauma (Fig. 1). On the day following the injury, skin temperature remained elevated around the site of trauma to the same degree as immediately after injury, but was markedly reduced to about 29 degrees at its periphery (Fig. 2). Skin temperature began to fall in the high temperature zone and began to rise in the peripheral low temperature zone immediately following LLLT, and the peripheral skin temperature reached a peak or became almost normal at about 40 minutes after the initiation of irradiation (Fig. 3). Changes in post-LLLT skin temperature in all patients 

a b c

 1. Sprain of the right ankle joint immediately after injury: 

a) Before irradiation, a high temperature zone extends over the trauma site  and a wide area around it.

 b) At 10 minutes after LLLT,skin temperature fell at the trauma site, and rose in the toes at the periphery.

 c) At 20 minutes after LLLT,skin temperature was re-elevated at the trauma site.

31 Laser Therapy Vol. 12 Official Journal of the World Association for Laser Therapy (WALT) showed that skin temperature fell by an average of 3degrees in the high temperature zone around the site of trauma, and rose by an average of 3 degrees in the peripheral low temperature zone, both to approximately normal skin temperature. Clinically, swelling and edema were diminished and repeated irradiation suppressed exacerbation of swelling and edema.Patients receiving pre- and post-operative

application of LLLT for such conditions as talipes varus, in which postoperative necrosis of skin in the wound area and delayed wound healing are frequent, spoke injury produced when the foot is caught in a bicycle’s spokes (Fig. 4), and paralytic feet with distal circulatory failure due to spin bifida or cerebral palsy, we have not seen any necrosis of the skin in the wound area or delayed wound healing.

Discussion 

There have been many reports on wound healing (2, 3).Currently, the site of trauma is cooled to reduce swelling in acute-phase injury. An important problem in the healing

of wounds and associated fractures is how to suppress swelling and edema, and improvement of local swelling and edema is also crucial for the healing of ligament injury in sprained ankles. However, the use of LLLT for sprained ankles is controversial (4). Thermography has been used for evaluating the effect of LLLT (5). In the present thermographic evaluation, the surface temperature was high around the trauma site and low in the periphery, which indicated that local blood and lymph flow were impaired by swelling and edema, thus raising temperature. When LLLT was applied to these areas, it was found that skin temperature fell in the high temperature zone but

rose in the low temperature zone to approximately the normal temperature in both zones, suggesting improved  blood and lymphatic circulation. Clinically, reduction of local swelling and edema was considered to have led to the improvement of blood and lymph flow. 

Conclusions 

1: In acute-phase injury, skin temperature was elevated around the site of trauma, and reduced in the periphery on the day following the injury. 

2: Immediately after irradiation, skin temperature fell by 3oC on the average in the high temperature zone around the trauma site, and rose by 3oC on the average reaching normal temperature in the low temperature zone at the periphery of the injury.

3: LLLT rapidly improved blood and lymphatic flow, which had been impaired by injury, and alleviated swelling and edema. LLLT was also useful in accelerating healing

of the surgical wound.

Address for Correspondence:  Yoshimi Asagai MD, Director, Shinano Handicapped  Children`s Hospital, 6525-1 Shimosuwa, Suwagun, Nagano, Japan 393 

a b c

2. Contusion of the right tibial shaft 1 day after injury: a) before irradiation,

a) Skin temperature is high at the trauma site, and low at the periphery.

b) At 10 minutes after LLLT:skin temperature fell at the trauma site, and rose slightly at the periphery. c) At 40 minutes after LLLT: skin temperature at the periphery reached a peak and nearly normal skin temperature

a b c

 3. Fracture of the right tibia 2 days after removal of nailing: a) Before irradiation, skin temperature was high in the surgical wound, and low at the periphery. b) Immediately after LLLT, skin temperature was reduced in the high temperature zone, and elevated in the low temperature zone. c) At 40 minutes after LLLT, skin temperature at the periphery reached a peak.

a b

4. Spoke injury:

a) At 6 days after injury the left foot had been caught in the rear wheel of a bicycle, and this left a large skin defect on the back of the foot and a contusion, with marked swelling and edema.

 b) After daily LLLT, epithelialization was observed and the wound healed at 23 days after injury.

http://www.walt.nu Laser Therapy Vol. 12 32 

References

1. Asagai,Y.,Ueno,R.,Miura,Y.,Ohshiro,T.(1995):Application of low reactive-level laser therapy(LLLT) in patients with cerebral palsy of the adult tension athetosis type. Laser Therapy,7:113-118. 

2. asaki, K., Ohshiro, T. (1997): Assessment in the rat model of the effects of 830nm diode laser irradiation in a diachronic wound hearing study. Laser Therapy,

9:25-32.

3. ubota, J., Ohshiro, T. (1996): The effects of diode laser LLLT on flap survival: Measurement of flap microcirculation with laser speckle flowmetry. Laser Therapy, 8:241-246.

4. Robert A. Henrica C.W., Ton F, Lenssen, Frans, A.J.M., Gauke, K., Paul G.(1998): Low-level laser therapy in ankle sprains: A randomized clinical trial.

Arch. Phys. Med. Rehabil, 79:1415-1420.

5. Ohshiro, T. (1988): Thermographic analysis and evaluationof pain attenuation with the GaAlAs LLLT laser system. In Ohshiro T and Calderhead RG: ‘Low Lever Laser Therapy: A Practical Introduction’. John Wiley & Sons, Chichester, UK. pp.56-62. 33 Laser Therapy Vol. 12 Official Journal of the World Association for Laser Therapy (WALT)

Results have suggested that the pain relieving properties of LLLT have been the most consistent benefit. The duration of benefit has varied from one hour to one week, and seems to increase as treatment progresses.

Other areas of improvement were not as clear. Improvement in sleep was observed with some regularity although this was undoubtedly due in part to decreased pain. The “non-restorative” sleep complaints were less regularly improved. Improvement with regard to abnormal sensations in the limbs (paresthesia and subjective swelling) appears to be fairly consistent. Improvements in fatigue, mood and headache.

Although the pilot study is incomplete, I believe that these early findings warrant the further investigation of laser therapy for patients with fibromyalgia. This is further supported by the relatively few and harmless side effects of this therapy, the fact that equipment and operating costs are reasonable, and the reality that there are few effective alternative treatments for fibromyalgia patients.

Carpal Tunnel Study Results Released

Laser Focus World

A physician at UMDNJ-Robert Wood Johnson Medical School is evaluating a “cold” laser to treat patients with carpal tunnel syndrome, a debilitating nerve condition that causes severe pain and numbness in the hand.

Clinical results of a double-blind study of 11 patients afflicted with carpal tunnel syndrome who were treated with a diode-laser device manufactured by Lasermedics (Missouri City, TX) showed that after six to 15 treatments, nine of the 11 patients experienced relief of pain and other associated symptoms as well as normalization of abnormal latencies.

The study was conducted by Michael L. Weintraub, a neurologist from Briarcliff, NY, and reported in the February 1996 issue of Neurology.

The patients all used a 30mW 830nm, a hand-held, battery-operated, nonsurgical laser device that employs the process of photo-biostimulation.

Dr. Weintraub concluded that the results of his study support the efficacy and safety of laser-light treatment in carpal tunnel syndrome.

Physiotherapist Shows Lasers Relieve Pain.

A physiotherapist at Royal Brisbane Hospital (Australia) recently received a PhD from the University of Queensland for demonstrating that laser treatment prompts the release of endorphins into the bloodstream. Endorphins are a type of natural morphine that dulls pain. Physiotherapist Liisa Laakso studied the effects of lasers on 56 people who suffered myofascial pain syndrome, a chronic hypersensitivity often secondary to a person’s primary painful affliction, such as arthritis. Previous experiments linking endorphin release and lasers have only been done on rats.

In the study, Laakso applied different doses and wavelengths of a laser diode to “trigger points” on the body and took blood samples measuring endorphin levels in these subjects and a control group. The control group reported some pain relief – most likely a placebo effect – but endorphins were present. Those patients that underwent laser treatment reported pain reduction of up to 78%, and endorphins were present in their blood.

The effect of infra-red laser irradiation on the duration and severity of postoperative pain: a double blind trial.

Kevin C. Moore, Naru Hira, Ian J. Broome* and John A. Cruikshank, Departments of Anaesthesia and General Surgery, The Royal Oldham Hospital, Oldham, U.K *Department of Anaesthesia, The Royal Hallamshire Hospital, Sheffield, U.K.,General Practitioner, Pennymeadow Clinic, Ashton-under-Lyne, U.K.

This trial was designed to test the hypothesis that LLLT reduces the extent and duration of post-operative pain. Twenty consecutive patients for elective cholecystectomy were randomly allocated for either LLLT or as controls. The trial was double blind. Patients for LLLT received 6-8-min treatment (GaAlAs: 830 nm: 60 mW CW: CM) to the wound area immediately following skin closure prior to emergence from GA. All patients were prescribed on demand post-operative analgesia (IM or oral according to pain severity). Recordings of pain scores (0-10) and analgesic requirements were noted by an independent assessor. There was a significant difference in the number of doses of narcotic analgesic (IM) required between the two groups.

Controls n = 5.5: LLLT n = 2.5.

No patient in the LLLT group required IM analgesia after 24 h. Similarly the requirement for oral analgesia was reduced in the LLLT group.

 Controls n = 9: LLLT n = 4.

 Control patients assessed their overall pain as moderate to severe compared with mild to moderate in the LLLT group.

 The results justify further evaluation on a larger trial population.

 Address for correspondence:

 Dr K. C. Moore, Department of Anaesthesia, The Royal Oldham Hospital, Rochdale Road, Oldham OL1 2JH, U.K.

 0898-5901/92/040145-05 $07.50   ©1992 by John Wiley & Sons, Ltd.

Efficacy of laser irradiation on the area near the stellate ganglion is dose-dependent:    A double-blind crossover placebo-controlled study.

Toshikazu Hashimoto, Osamu Kemmotsu, Hiroshi Otsuka, Rie Numazawa, and Yoshihiro Ohta, Department of Anaesthesia, Hokkaido University Hospital, Sapporo, Japan

In the present study we evaluate the effects of laser irradiation on the area near the stellate ganglion on regional skin temperature and pain intensity in patients with postherpetic neuralgia. A double blind, crossover and placebo-controlled study was designed to deny the placebo effect of laser irradiation.

 Eight inpatients (male 6, female 2) receiving laser therapy for pain attenuation were enrolled in the study after institutional approval and informed consent. Each patient received three sessions of treatment on a separate day in a randomised fashion. Three minutes irradiation with a 150 mW laser (session 1), 3 minutes irradiation with a 60 mW laser (session 2), and 3 minutes placebo treatment without laser irradiation. Neither the patient nor the therapist was aware which session type was being applied until the end of the study. Regional skin temperature was evaluated by thermography of the forehead, and pain intensity was recorded using a visual analogue scale (VAS). Measurements were performed before treatment, immediately after (0 minutes) then 5, 10, 15, and 30 min after treatment. Regional skin temperature increased following both 150 mW and 60mW laser irradiation, whereas no changes were obtained by placebo treatment. VAS decreased following both 150 mW and 60 mW laser treatments, but no changes in

VAS were obtained by placebo treatment. These changes in the temperature and VAS were further dependent on the energy density, i.e. the dose.

Results demonstrate that laser irradiation near the stellate ganglion produces effects similar to stellate ganglion block. Our results clearly indicate that they are not placebo effects but true effects of laser irradiation.

Address for Correspondence:   Toshikazu Hashimoto MD, Department of Anaesthesia, I Hokkaido University I Hospital N15, W7, Kita-ku Sapporo, Japan 060.

LASER THERAPY 1997:9:7-12  ©1997 by LT Publishers l.K., Ltd.

Successful management of female office workers with “repetitive stress injury” or”carpal tunnel syndrome” by a new treatment modality- application of low level lasers for pain

E. Wong G LEE J. Zu CHERMAN and D. P. MASON

Western Heart Institute and St. Mary’s Spine Center St. Mary’s Medical Center. San Francisco. CA. USA and Head and Neck Pain Center, Honolulu HL. USA

Abstract

Female office workers with desk jobs who are incapacitated by pain and tingling in the hands and fingers are often diagnosed by physicians as “repetitive stress injury” (RSI) or “carpal tunnel syndrome” (CTS). These patients usually have poor posture with their head and neck stooped forward and shoulders rounded; upon palpation. they have pain and tenderness at the spinous processes C5 – T1 and the medial angle of the scapula. In 35 such patients we focused the treatment primarily at the posterior neck area and not the wrists and hands. A low level laser (100 mW) was used and directed at the tips of the spinous processes C5 – Tl.

The laser rapidly alleviated the pain and tingling in the arms, hands and fingers, and diminished tenderness at the involved spinous processes. Thereby, it has become apparent that many patients labelled as having RSI or CTS have predominantly cervical radicular dysfunction resulting in pain to the upper extremities which can be managed by low level laser.

Successful long-term management involves treating the soft tissue lesions in the neck combined with correcting the abnormal head, neck and shoulder posture by taping. Cervical collars, and clavicle harnesses as well as improved work ergonomics.

LASER THERAPY, 1997:9: 131- 136 09/97 © 1997 by LT Publishers, U.K., Ltd  Physiological responses in chronic pain patients. LLLT protocol.  Scott D. Fender and David Diffee

Pain Research Group, Arvada, Colorado, U.S.A.

Use of Low Reactive Level Laser Therapy (LLLT) utilising helium-neon lasers has increased lately especially in pain control. New protocols are being developed aimed at a complex of primary and secondary symptomologies. One of these protocols Stellate Ganglion Stimulation has shown in our research a unique set of developments. Targeting the area of the stellate ganglion is showing great promise in the rehabilitation of patients with a history of chronic musculoskeletal pain syndromes, but several patients with pre-existing psychological symptomology have exacerbated during the initial stages of utilization of this protocol.

Patients with a history of psychological diagnosis for dysthymia, anxiety, post traumatic stress disorder or minor diffuse brain injury have shown an exacerbation of these symptomologies during the initial phases of stimulation treatment. Overall, response to this form of therapy seems to be positive but some patients require dermatomal and/or site-specific therapy to maximize outcome. With specific psychological treatment combined with a more conservative amount of stimulation initially the increase in these symptoms shows a tendency to remit with the pain response. Our continued research is currently focusing on the mechanisms for this type of response as well as protocol refinement to maximize its effectiveness.

 Address for correspondence:

Scott D. Fender DDS DAPM, 5275 Marshall Street, Suite 203, Arvada, CO 80002, U.S.A. 0898-5901/92/040169-05$07.50nn© 1992 by John Wiley & Sons, Ltd.

Mechanisms of the analgesic effects of therapeutic lasers in vivo.

L Navratil (1)and I Dylevsky(2)

  1: Outpatient Department of Radiobiology, Institute of Biophysics, First Medical Faculty, and

  2: Department of Functional Anatomy, Second Medical Faculty and Faculty of Physical Education Charles University, Prague, Czech Republic

The analgesic effects in the course of application of therapeutic lasers to affected tissue have been described in a number of works in the literature. Although a few scientific-based reports have appeared, those on laser-induced analgesia are mainly clinical works describing the effect of the therapy which, however, do not study the mechanism of the laser action. There are several different possible responses induced by non-invasive low level laser therapy (LLLT).

The purpose of the present communication is to review the arrangement and characterisation of these responses. By being aware of these effects, the laser therapist can acquire a physiological and morphological scheme making possible the appropriate choice of the site of application of LLLT, choice of the irradiation technique, and selection of appropriate doses.

Address for Correspondence:

Leos Navratil MD PhD, Department of Clinical Radiahiology, Institute of Biophysics, First Medical Faculty, Charles University Saln1ovska 3, CZ 120 00, Prague 2, Czech Republic. 03/97 Rep. US 5 10 12 14 © 1997 by LT Publishers U.K, Ltd.   LASER THERAPY 1997:9:33-40   Experimental Physiology (1994) 79. 227-234 Printed in Great Britain

Can low reactive-level laser therapy be used in the treatment of neurogenic facial pain?   A double-blind, placebo controlled investigation of patients with trigeminal neuralgia.

ArneEckerdal and Lehmann Bastian. Department of Oral and Maxillofacial Surgery and Oral Medicine, Odense University Hospital, Denmark

Neurogenic facial pain has been one of the more difficult conditions to treat, but the introduction of laser therapy now permits a residual group of patients hitherto untreatable to achieve a life free from or with less pain. The present investigation was designed as a double-blind, placebo controlled study to determine whether low reactive-level laser therapy (LLLT) is effective for the treatment of trigeminal neuralgia. Two groups of patients (14 and 16) were treated with two probes. Neither the patients nor the dental surgeon were aware of which was the laser probe until the investigation had been completed. Each patient was treated weekly for five weeks.

The results demonstrate that of 16 patients treated with the laser probe, 10 were free from pain after completing treatment and 2 had noticeably less pain, while in 4 there was little or no change. After a one year follow-up, 6 patients were still entirely free from pain. In the group treated with the placebo system, i.e. the non-laser probe, one was free from pain, 4 had less pain, and the remaining 9 patients had little or no recovery. After one year only one patient was still completely free from pain. The use of analgesics was recorded and the figures confirmed the fact that LLLT is effective in the treatment of trigeminal neuralgia. It is concluded that the present study clearly shows that LLLT treatment, given as described, is an effective method and an excellent supplement to conventional therapies used in the treatment of trigeminal neuralgia.

Address for Correspondence:

Arne Eckerdal DDS DOS Consultant, Department of Oral and Maxillofacial Surgery & Oral Medicine, Odense University Hospital, DK-5000 Odense, Denmark.  12/96 Rep. US X 8-10-12  LASER THERAPY, 1996: 8: 247-252

Double-blind crossover trial of low level laser therapy in the treatment of post-herpetic neuralgia.

Kevin C Moore, Naru Hira. Parswanath S. Kramer, Copparam S. Jayakumar and Toshio Ohshiro

Post herpetic neuralgia can he an extremely painful condition which in many cases proves resistant to all the accepted forms of treatment. It is frequently most severe in the elderly and may persist for years with no predictable course.

This trial was designed as a double blind assessment of the efficacy of low level laser therapy in the relief of the pain of post herpetic neuralgia with patients acting as their own controls. Admission to the trial was limited to patients with established post herpetic neuralgia of at least six months duration and who had shown little or no response to conventional methods of treatment. Measurements of pain intensity and distribution were noted over a period of eight treatments in two groups of patients each of which received four consecutive laser treatments.

The results demonstrate a significant reduction in both pain intensity and distribution following a course of low level laser therapy.    John Wiley & Sons. Ltd.

Efficacy of low-level laser therapy for pain attenuation of post-herpetic neuralgia.

Osamu Kemmotsu, Kenichi Sato,Hitoshi Furumido, Koji Harada, Chizuko Takigawa, Shigeo Kaseno, Sho Yokota, Yukari Hanaoka and Takeyasu Yamamura

Department of Anaesthesiology, Hokkaido University School of Medicine, N-15. W-7, Kita-ku. Sapporo 060, Japan.

The efficacy of low reactive-level laser therapy (LLLT) for pain attenuation in patients with postherpetic neuralgia (PHN) was evaluated in 63 patients (25 males. 38 females with an average age of 69 years) managed at our pain clinic over the past four years. A double blind assessment of LLLT was also performed in 12 PHN patients. The LLLT system is a gallium aluminium arsenide (GaAlAs) diode laser (830 nm, 60 mW continuous wave). Pain scores (PS) were obtained using a linear analogue scale (1 to 10) before and after LLLT.

The immediate effect after the initial LLLT was very good (PS: <3) in 26, and good (PS: 7-4) in 30 patients. The long-term effect at the end of LLLT (the average number of treatments 36 + 12) resulted in no pain (PS: 0) in 12 patients and slight pain (PS: 1-4) in 46 patients. No complications attributable to LLLT occurred. Although a placebo effect was observed, decreases in pain scores and increases of the body surface temperature by LLLT were significantly greater than those that occurred with the placebo treatment. Our results indicate that LLLT is a useful modality for pain attenuation in PHN patients and because LLLT is a non-invasive, painless and safe method of therapy, it is well acceptable by patients.

Address for correspondence: Osamu Kemmotsu, Department of Anaesthesiology, Hokkaido University School of Medicine, N-15, W-7, Kita-ku, Sapporo 060, Japan. 0898-5901/91/020071-05 $05.00  © 1991 by John Wiley & Sons, Ltd.

Mechanistic approach to GaAIAs diode laser effects on production of reactive oxygen species  from human neutrophils as a model for therapeutic modality at cellular level.

Makoto Yamaya*, Chiyuki Shiroto’, Hiroki Kobayashi*, Shinji Naganuma*, Jyuichi Sakamoto*, Koh-Jun Suzuki*, Shigeyuki Nakaji*, Kazuo Sugawara* and Takashi Kumae *Department of’ Hygiene, Hirosaki University School of Medicine. Hirosaki; .-Shiroto Clinic Coshogawara, Aomori: Department of Industrial Health. The Institute of Public Health, Tokyo. Japan

There have been many reports on the applications of low reactive level laser (LLL) therapy for pain attenuation or pain removal. Our group has reported previously on the effects of in vitro irradiation of LLLT particularly on the phagocytic activity of human Neutrophils, using luminol-dependent chemiluminescence (LmCL) for measurement of reactive oxygen species (ROS) production from human Neutrophils. However, the mechanisms of the attenuation of phagocytic activity of NEUTROPHILS by LLL irradiation is not yet fully understood.

In this study. we used luminol-dependent and lucigenin-dependent chemiluminescence (LgCL) for detection of affected ROS producing process of human Neutrophils by LLL irradiation. Two soluble action stimuli, N-formyl-Met-Leu-Phc (fMLP) and phorbol myristate acetate (PMA) were used to avoid the possible influence of lag-time from recognition to uptake of particles at the ROS production.

In case of using fMLP as a stimulus, the maximum luminescence intensity of LULL was increased hut LgCL luminescence was decreased by LLL irradiation. When PMA was used as a stimulus, the times to reach the maximum luminescence intensity of LmCL and LgCL were shortened by LLL irradiation, but there was no effect on the maximum luminescence intensity of both.

These results suggest that LLL irradiation enhances the ROS production activity of human Neutrophils by the activation of the superoxide converting system, the active clement in which is mainly myeloperoxidase. LLL irradiation enabled a more rapid activation of the superoxide production system, NADPH -oxidase.

0898-5901/93/03011 1-06 $08.00   © 1993 by John Wiley & Sons. Ltd  LASER THERAPY 1993: 5: 111-116

Laser therapy takes pain, discomfort out of post-cancer condition

LOW-LEVEL laser therapy promises to be a valuable weapon in the fight against  lymphoedema, the painful and permanent swelling of an arm which frequently follows breast cancer operations. Doctors at Adelaide’s Flinders University (FU) have conducted trials which have produced the first clinical evidence that infra-red laser can improve tissue conditions rapidly in the affected area.

Associate professor Neil Piller told the university magazine, Flinders Journal that loosening the tissue encouraged the regrowth of lymph vessels. The results are very exciting,” Dr Piller said. “This is the first time anyone specifically has set out to trial lasers in this way. Previously, information about the possible efficacy of lasers has come as a by-product of research into such areas as wound treatment and arthritic conditions, and even then there has been very little work done.”

Lymphoedema results from deliberate or accidental removal of lymph nodes or vessels. It affects about 15 per cent of women sometime after a breast cancer operation. In the FU trials, 15 women with prolonged or severe lymphoedema were given 16 half-hour laser treatments over 10 weeks. “All had arms swollen to between 140 and 180 per cent of normal volume. A scanning laser, focusing 2-4 joules of power to each square centimetre, was applied to the entire arm.

In all cases, the treatment reduced the amount of oedema, the volume of fluid and the circumference of the arm above the elbow. Tissues in the upper and lower arm were softened and patients reported less pain, tightness and heaviness, and far greater mobility. “Giving them 16 treatments actually was overkill,” Dr Piller said. “Since the trial ended, we have achieved significant results from just three or four treatments, or in some cases one or two.”

Diode Laser in Cervical Myofascial Pain: A Double-Blind Study versus Placebo

* F. Ceccherelli, * L. Altafini, * G. Lo Castro, * A. Avila, *F. Ambrosio, and * G. P. Giron

*Institute of Anesthesiology and Intensive Care, University of Padua, and the Associazione Italiana per la Ricerca e, l’Aggiornamento Scientif co, Padua, Italy

Summary

We present a double-blind trial in which a pulsed infrared beam was compared with a placebo in the treatment of myofascial pain in the cervical region. The patients were submitted to 12 sessions on alternate days to a total energy dose of 5 J each. At each session, the four most painful muscular trigger points and five bilateral homometameric acupuncture points were irradiated. Those in the placebo group submitted to the same number of sessions following an identical procedure, the only difference being that the laser apparatus was nonoperational. Pain was monitored using the Italian version of the McGill pain questionnaire and the Scott Huskisson visual analogue scale.

The results show a pain attenuation in the treated group and a statistically significant difference between the two groups of patients, both at the end of therapy and at the 3-month follow-up examination.

Address correspondence and repent requests to:  Dr. F. Ceccherelli at the Istituto di Anestesiologiae Rianimazione, via C. Battisti 267, 35121 Padova, Italia.

 The Clinical journal of Pain 5:301-304

copyright 1989 Raven Press, Ltd., New York   Wave- length Power Energy Density Power Density Energy per point Pulses 904nm 5mW av (25Wpeak) (not given) (not given) 1 J 1KHz x 200nS

Pain scores and side effects in response to low level laser therapy (LLLT) for physical trigger points.

E Liisa Laakso Carolyn Richardson, and Tess Cramond

1: Physiotherapy Department, Royal Brisbane Hospital, Brisbane; 2: Physiotherapy Department, University of Queensland, Brisbane; and 3: Pain Clinic, Royal Brisbane Hospital, Brisbane, Queensland, Australia.

Clinically, Low Level Laser Therapy – LLLT has been used successfully in the treatment of chronic pain but many have questioned the scientific basis for its use. Many studies have been poorly designed or poorly controlled.

A double-blind, placebo-controlled, random allocation study was designed to analyse the effect of second daily infrared (JR) laser (820 nm, 25 mW) and visible red laser (670 nm, 10 mW) at 1 J/cm2 and 5 J/cm2 on chronic pain. Forty-one consenting subjects with chronic pain conditions exhibiting myofascial trigger points in the neck and upper trunk region underwent five treatment sessions over a two week period. To assess progress, pain scores were measured using visual analogue scales before and after each treatment. The incidence of side effects was recorded.

All groups demonstrated significant reductions in pain over the duration of the study with those groups which received infrared (820 nm) laser at I J/cm2 and 5 J/cm2. Demonstrating   the most significant effects (p < 0.001). Only those subjects who had active laser treatment experienced side effects.

Results indicated that responses to LLLT at the parameters used in this study are subject to placebo and may be dependent on power output, dose and/or wavelength.

Addressee for Correspondence: E Liisa Laakso BPhty PhD, Physiotherapy Department, Royal Brisbane Hospital, Herston, (Queensland, Australia, 4029.   6/97 Rep. US $8-10-12 Copyright 1997 by LT Publishers, U.K. Ltd. LASER THERAPY. 9: 67-72 67

Two wavelengths studied.

Best results with the higher powered infrared laser compared with the lower powered red laser   Wave- length   Average Power Energy Density Power Density Energy Pulses Time Beam Spot size 820 25mW 5 J/Cm2 0.89 W/Cm2 0.14 J 5,000Hz 5.62 secs 0.89Cm2

Low level laser therapy (LLLT) of tendinitis and myofacial pains a randomized, double-blind, controlled study.Mimmi Logdberg-Anderssont (1), Sture Mutzell (2), and Ake Hazel (3) 1: Akersberga Health Care Centre, 2: Danderyd University Hospital, Danderyd, and   3: Vaxholm Health Care Centre, Stockholm, Sweden.

The purpose of this randomised, double-blind study was to examine the effect of GaAs laser therapy for tendonitis and myofascial pain in a sample from the general population of Akersberga in the northern part of Greater Stockholm.

176 patients (of an original group of 200) completed the scheduled course of treatment. The patients were assigned randomly to either a laser group (92 patients, of whom 74 had tendonitis, completed the study) or a placebo group (84 patients, of whom 68 had tendonitis, completed the study). All 176 patients received six treatments during a period of 3-4 weeks. Their pain was estimated objectively using a pain threshold meter, and subjectively with a visual analogue scale before, at the end of, and four weeks after the end of treatment.

  Laser therapy had a significant, positive effect compared with placebo measured from the first assessment to the third assessment, four weeks after the end of treatment. Laser treatment was most effective on acute tendonitis.

 Address for Correspondence   Sture Mutzell, Danderyd University Hospital 5-182 87 Danderyd, Sweden.  03/07 Rep US 10-12-14, 1997 By LT Publishers, U.K., Ltd.

 LASER THERAPY, 1997:9: 79-86   Wave- length Power Energy Density Power Density Energy per point Pulses 904nm 8mW av (10Wpeak) 0.5-1.0 J/Cm2 (not given) 1J 4KHz x 180nS

The efficady of laser therapy for musculoskeletal and skin disorders: a criteria-based meta-analysis of randomized clinical trials.

Beckerman H, de Bie RA, Bouter LM, et al.

The efficacy of laser therapy for musculoskeletal and skin disorders has been assessed on the basis of the results of 36 randomized clinical trials (RCTs) involving 1,704 patients. For this purpose, a criteria-based meta-analysis that took into account the methodological quality of the individual trials was used. The studies with a positive outcome were generally of a better quality than the studies with a negative outcome. No clear relationship could be demonstrated between the laser dosage applied and the efficacy of laser therapy, or between the dosage and the methodological score.

In general, the methodological quality of these studies appeared to be rather low. Consequently, no definite conclusions can be drawn about the efficacy of laser therapy for skin disorders. The efficacy of laser therapy for musculoskeletal disorders seems, on average, to be larger than the efficacy of a placebo treatment. More specifically, for rheumatoid arthritis, post-traumatic joint disorders, and myofascial pain, laser therapy seems to have a substantial specific therapeutic effect.

Further RCTs, avoiding the most prevalent methodological errors, are needed in order to enable the benefits of laser therapy to be more precisely and validly evaluated.

Physical Therapy. 72(7):483-91, 1992 Jul. (60 ref)

LLLT using a diode laser in successful treatment of a herniated lumbar/sacral disc, with magnetic resonance imaging (MRI) assessment: a case report.

Tatsuhide Abe

Abe Orthopaedic Clinic Futuoka City Fukuoka Prefecture Japan X12′ A 40-year-old woman presented at the Abe Orthopedic Clinic with a 2-year history of lower hack pain and pain in the left hip and leg diagnosed as a ruptured disc between the 5th lumbar/lst sacral vertebrae. The condition had failed to respond to conventional treatment methods including pelvic traction, nonsteroid anti-inflammatory drugs and aural block anesthetic injections.

MRI scans were made of the affected disc, showing it protruding on the left side through the aural membrane. The gallium aluminum arsenide (GaAlAs) diode laser (830 nm, 60 mW) was used in outpatient therapy and after 7 months, the patient’s condition had dramatically improved demonstrated by motility exercises. This improvement was confirmed by further MRI scans, which showed clearly the normal condition of the previously herniated L5/SI disc.

O898-5901/89/020093-03 $05.00   © 1989 by John Wiley & Sons. Ltd.

Physiological responses in chronic pain patients LLLT protocol.

Scott D. Fender and David Diffee, Pain Research Group, Arvada, Colorado, U.S.A.

Use of Low Reactive Level Laser Therapy (LLLT) utilising helium-neon lasers has increased lately especially in pain control. New protocols are being developed aimed at a complex of primary and secondary symptomologies. One of these protocols, Stellate Ganglion Stimulation, has shown in our research a unique set of developments.

Targeting the area of the stellate ganglion is showing great promise in the rehabilitation of patients with a history of chronic musculoskeletal pain syndromes, but several patients with preexisting psychological symptomology have exacerbated during the initial stages of utilization of this protocol. Patients with a history of psychological diagnosis for dysthymia, anxiety, post traumatic stress disorder or minor diffuse brain injury have shown an exacerbation of these symptomologies during the initial phases of stimulation treatment.

Overall, response to this form of therapy seems to be positive but some patients require dermatomal and/or site-specific therapy to maximize outcome. With specific psychological treatment combined with a more conservative amount of stimulation initially the increase in these symptoms shows a tendency to remit with the pain response. Our continued research is currently focusing on the mechanisms for this type of response as well as protocol refinement to maximize its effectiveness.

Address for correspondence:  Scott D. Fender DDS DAPM, 5275 Marshall Street, Suite 203, Arvada, CO 80002, U.S.A.  0898-5901/92/040169-05 $07.50  © 1992 by John Wiley & Sons, Ltd.

Clinical application of GaAIAs 830 NM diode, low level laser therapy  in treatment of Rheumatoid Arthritis.

Kanji Asada, Yasutaka Yutani, Akira Sakawa and Akira Shimazu

Department of Orthopaedic Surgery, Osaka City University Medical School, Japan

The authors have been involved in the treatment of rheumatoid arthritis (RA), in particular chronic poly-arthritis and the associated pain complaints. The biggest problem facing such patients is joint contracture, leading to bony ankylosis. This in turn severely restricts the range of motion (ROM) of the RA-affected joints, thereby seriously restricting the patient’s quality of life (QOL). The authors have determined that in these cases, daily rehabilitation practice is necessary to maintain the patient’s QOL at a reasonable level.

The greatest problem in the rehabilitation practice is the severe pain associated with RA-affected joints, which inhibits restoration of mobility and improved ROM. LLLT or low reactive level laser therapy has been recognized in the literature as having been effective in pain removal and attenuation. The authors accordingly designed a clinical trial to assess the effectiveness of LLLT in RA related pain (subjective self-assessment) and ROM improvement (objective documented data).

From July 1988 to June 1990, 170 patients with a total of 411 affected joints were treated using a GaAlAs diode laser system (830 nm, 60 mW C/W). Patients mean age was 61 years, with a ratio of males: females of 1: 5.25 (16%: 84%). Effectiveness was graded under three categories: excellent (remarkable improvement), good (clearly apparent improvement), and unchanged (little or no improvement).

For pain attenuation, scores were: excellent – 59.6%; good – 30.4%; unchanged – 10%.

For ROM improvement the scores were: excellent – 12.6%; good – 43.7%; unchanged – 43.7%. This gave a total effective rating for pain attenuation of 90%, and for ROM improvement of 56.3%.

0898-5901/91/020077-06 $05.00  

© 1991 by John Wiley & Sons, Ltd.

Mechanisms of the analgesic effect of therapeutic lasers in vivo.

  L Navratil (1) and I Dylevsky (2)

1: Outpatient Department of Radiobiology, Institute of Biophysics, First Medical Faculty, and 2: Department of Functional Anatomy, Second Medical Faculty and Faculty of Physical Education Charles University, Prague, Czech Republic

The analgesic effects in the course of application of therapeutic lasers to affected tissue have been described in a number of works in the literature. Although a few scientific-based reports have appeared, those on laser-induced analgesia are mainly clinical works describing the effect of the therapy which, however, do not study the mechanism of the laser action.

There are several different possible responses induced by non-invasive low level laser therapy (LLLT). The purpose of the present communication is to review the arrangement and characterisation of these responses. By being aware of these effects, the laser therapist can acquire a physiological and morphological scheme making possible the appropriate choice of the site of application of LLLT, choice of the irradiation technique, and selection of appropriate doses.

Address for Correspondence: Leos Navratil MD PhD, Department of Clinical Radiahiology, Institute of Biophysics, First Medical Faculty, Charles University Saln1ovska 3, CZ 120 00, Prague 2, Czech Republic.

© 1997 by LT Publishers U.K, Ltd.

LASER THERAPY 1997:9 : 33-40

Experimental Physiology (1994) 79. 227-234 Printed in Great Britain

Laser’s Effect on Bone and Cartilage Change Induced by Joint Immobilization An Experiment with Animal Model.

Masami Akai, MD,1* Mariko Usuba, RPT,1 Toru Maeshima, Yoshio Shirasaki,2 and Shozo Yasuaka, MD3 ‘Department of Physical Therapy Tsukuba College of Technology, Tsukuba, Ibaraki, Japan Mechanical Engineering Laboratory, Agency of Industrial Science and Technology, TsuPuba, Ibaraki Japan. Yasuoka Orthopaedic Clinic, Mitaka, Tokyo, Japan

Objective:

Influence of low-level (810nm, Ga-Al-As semiconductor) laser on bone and cartilage during joint immobilization was examined with rats’ knee model.

Materials and Methods:

The hind limbs of 42 young Wistar rats were operated on in order to immobilise the knee joint. One week after operation they were assigned to three groups; irradiance 3.9W/cm2, 5.8W/cm2, and sham treatment. After 6 times of treatment for another 2 weeks both hind legs were prepared for 1) indentation of the articular surface of the knee (stiffness and loss tangent), and for 2) dual energy X-ray absorptiometry (bone mineral density) of the focused regions.

Results and Conclusions:

The indentation test revealed preservation of articular cartilage stiffness with 3.9 and 5.8W/cm2 therapy. Soft laser treatment has a possibility for prevention of biomechanical changes by immobilisation.

Correspondence to:  Masami Akai, M.D., Department of Central Rehabilitation Service University Hospital, Faculty of Medicine, University of Tokyo 7-3-1 Hongo, Bunkyo-ku, Tokyo 113, Japan.

Lasers Surg. Med. 21:480-484, 1997.   © 1997 Wiley-Liss, Inc.

Histological and Clinical Responses of Articular Cartilage to Low-level Laser Therapy: Experimental Study.

I. RUIZ CALATRAVA, J.M.SANTISTEBAN VALENZUELA, R.J.G0MEZ-VILLAMANDOS J.I.REDONDO, J.C.G0MEZ-VILLAMANDOS, l.AVIGA JURADO

Department of Veterinary Clinical Pathology-Surgery, Faculty of Veterinary Medicine, University of Cordoba, Spain. Correspondence to 1. Ruiz Calatrava, Department of Veterinary Clinical Pathology-Surgery, Faculty of Veterinary Medicine, University of Cordoba, Avda. Medina Azahara, 9, 14005 Cordoba, Spain

Abstract

This study was carried out to evaluate the effects of low-level laser irradiation on experimental lesions of articular cartilage.

A standard lesion was practiced on the femoral trochlea of both hind limbs of 20 clinically normal Californian rabbits. These animals were divided into two groups of 10 individuals each, depending on the laser equipment used for treatment. One group was treated with HeNe laser (8 J cm – 2, 632.8 nm wavelength) and the other with infra-red (JR) laser (8 J cm – 2, 904 nm wavelength). In both groups, five points of irradiation to the right limb alone were irradiated per session for a total of 13 sessions, applied with an interval of 24 h between sessions. These points were the following: left and right femoral epicondyles, left and right tibial condyles and the centre of articulation. The distance between these points was approximately 1 cm. The untreated left limb was left as a control. During treatment, extension angle and periarticular thickness were considered. At the end of the treatment, samples were collected for histopathological study and stained with: Haematoxylin-Eosin, PAS and Done.

The results show a statistically higher anti-inflammatory capacity of the IR laser (p<0.0001). The functional recovery was statistically similar for both treatments (p<0.176). Histological study showed, at the end of the treatment, hyaline cartilage in the IR group, fibrocartilage in the HeNe group and granulation tissue in the control limbs. Clinical and histological results indicated that this laser treatment had a clear anti-inflammatory effect that provided a fast recuperation and regeneration of the articular cartilage.

Lasers in Medical Science 1997, 12:117-121

© 1997 W.B. Saunders Company Ltd

THERMOGRAPHIC STUDY OF LOW LEVEL LASER THERAPY FOR ACUTE-PHASE INJURY.

Yoshimi Asagai, M.D.1, Atsuhiro Imakiire, M.D.2, Toshio Ohshiro, M.D.3,    1. Shinano Handicapped Children`s Hospital Shimosuwa, Nagano, Japan  2. Department of Orthopaedic Surgery, Tokyo Medical University Shinjuku, Tokyo, Japan 3. Japan Medical Laser Laboratory, Shinanomachi, Tokyo, Japan.

Acute-phase injury is generally treated by localized cooling of the region, and rarely by theactive use of low level laser therapy (LLLT) in Japan. Thermographic studies of acutephase injury revealed that circulatory disturbances at the site of trauma occurred due to swelling and edema on the day following the injury, and that skin temperature was high at the site of the trauma and low at the periphery. Following LLLT, circulatory disturbances rapidly improved, while temperature in the high temperature zone around the site of trauma fell by 3 degrees on the average, but at the periphery the low temperature rose by 3 degrees on the average to nearly normal skin temperature. Clinically, swelling and edema improved. LLLT was also useful in treating necrosis of the skin in the wound area and in accelerating healing of surgical wounds of paralytic feet, which are prone to delayed, wound healing and also wounds due to spoke injury. LLLT is useful in treating swelling and edema in acutephase injury and in accelerating healing of surgical wounds.

Key words: Laser therapy, acute-phase injury, thermography, ankle joint sprain

Introduction

It has not been clearly defined to date if LLLT is indicated for acute-phase injury with swelling and calor. Yet it is frequently considered to be contraindicated in acute-phase injury. We have previously reported that, in patients with cerebral palsy with reduced peripheral skin temperature, the skin surface temperature was elevated to normal after LLLT

(1). in this study, we used thermography to examine changes in skin temperature following LLLT chie fly inacute-phase injury. 

Patients and Methods

Subjects were 7 patients with sprains of the ankle joint, two patients with fractures of the tibial shaft, and one patient with dislocation of the elbow joint. LLLT was also used in orthopedic surgery for disorders of the distal lower extremity such as talipes varus, which is frequently followed by postoperative necrosis of the skin in the wound area as well as delayed wound healing, and pre- and postoperative treatment of paralytic feet with circulatory disturbances. The procedure was as follows. Room temperature was maintained at 25oC. After acclimatization for 20 minutes, continuous irradiation with a GaAlAr semiconductor laser (JQ305, Minato Medical Science Co., Ltd., Japan) with the wavelength adjusted to 810 nm and the output to 100mW was applied using the contact method.

The spot size on the tissue was 0.56cm2 with a power density of 17.86W/cm2 at 100mW, the energy density per point being 107.5J/cm2. The area surrounding the site of trauma was irradiated for 3 to 5 minutes in total, one minute per spot, and changes in the skin surface temperature were followed using Thermotracer TH1106. The test was performed from immediately after injury till 5 days post-trauma, an average of two days after injury. 

Results

Immediately after injury, the skin surface temperature was elevated to about 34 degrees at and around the site of trauma (Fig. 1). On the day following the injury, skin temperature remained elevated around the site of trauma to the same degree as immediately after injury, but was markedly reduced to about 29 degrees at its periphery (Fig. 2). Skin temperature began to fall in the high temperature zone and began to rise in the peripheral low temperature zone immediately following LLLT, and the peripheral skin temperature reached a peak or became almost normal at about 40 minutes after the initiation of irradiation (Fig. 3). Changes in post-LLLT skin temperature in all patients 

a b c

Fig. 1. Sprain of the right ankle joint immediately after injury: 

a) Before irradiation, a high temperature zone extends over the trauma site    and a wide area around it.

 b) At 10 minutes after LLLT,skin temperature fell at the trauma site, and rose in the toes at the periphery.

 c) At 20 minutes after LLLT,skin temperature was re-elevated at the trauma site.

31 Laser Therapy Vol. 12 Official Journal of the World Association for Laser Therapy (WALT) showed that skin temperature fell by an average of 3degrees in the high temperature zone around the site of trauma, and rose by an average of 3 degrees in the peripheral low temperature zone, both to approximately normal skin temperature. Clinically, swelling and edema were diminished and repeated irradiation suppressed exacerbation of swelling and edema.Patients receiving pre- and post-operative   application of LLLT for such conditions as talipes varus, in which postoperative necrosis of skin in the wound area and delayed wound healing are frequent, spoke injury produced when the foot is caught in a bicycle’s spokes (Fig. 4), and paralytic feet with distal circulatory failure due to spin bifida or cerebral palsy, we have not seen any necrosis of the skin in the wound area or delayed wound healing. 

Discussion

There have been many reports on wound healing (2, 3).Currently, the site of trauma is cooled to reduce swelling in acute-phase injury. An important problem in the healing

of wounds and associated fractures is how to suppress swelling and edema, and improvement of local swelling and edema is also crucial for the healing of ligament injury in sprained ankles. However, the use of LLLT for sprained ankles is controversial (4). Thermography has been used for evaluating the effect of LLLT (5). In the present thermographic evaluation, the surface temperature was high around the trauma site and low in the periphery, which indicated that local blood and lymph flow were impaired by swelling and edema, thus raising temperature. When LLLT was applied to these areas, it was found that skin temperature fell in the high temperature zone but

rose in the low temperature zone to approximately the normal temperature in both zones, suggesting improved  blood and lymphatic circulation. Clinically, reduction of local swelling and edema was considered to have led to the improvement of blood and lymph flow.

Conclusions

1: In acute-phase injury, skin temperature was elevated around the site of trauma, and reduced in the periphery on the day following the injury. 

2: Immediately after irradiation, skin temperature fell by 3oC on the average in the high temperature zone around the trauma site, and rose by 3oC on the average reaching normal temperature in the low temperature zone at the periphery of the injury.

3: LLLT rapidly improved blood and lymphatic flow, which had been impaired by injury, and alleviated swelling and edema. LLLT was also useful in accelerating healing  of the surgical wound. 

Address for Correspondence:  Yoshimi Asagai MD, Director, Shinano Handicapped Children`s Hospital, 6525-1 Shimosuwa, Suwagun,Nagano, Japan 393

a b c

Fig. 2. Contusion of the right tibial shaft 1 day after injury: a) before irradiation,

Skin temperature is high at the trauma site, and low at the periphery.

b) At 10 minutes after LLLT:skin temperature fell at the trauma site, and rose slightly at the periphery. c) At 40 minutes after LLLT: skin temperature at the periphery reached a peak and nearly normal skin temperature

a b c

3. Fracture of the right tibia 2 days after removal of nailing:

 a) Before irradiation, skin temperature was high in the surgical wound and low at the periphery.

 b) Immediately after LLLT, skin temperature was reduced in the high temperature zone, and elevated in the low temperature zone.

c) At 40 minutes after LLLT, skin temperature at the periphery reached a peak.

a b

 4. Spoke injury:

 a) At 6 days after injury the left foot had been caught in the rear wheel of a bicycle, and this left a large skin defect on the back of the foot and a contusion, with marked swelling and edema.

b) After daily LLLT, epithelialization was observed and the wound healed at 23 days after injury.

http://www.walt.nu Laser Therapy Vol. 12 32

References

1. Asagai,Y.,Ueno,R.,Miura,Y.,Ohshiro,T.(1995):Application of low reactive-level laser therapy(LLLT) in patients with cerebral palsy of the adult tension athetosis type. Laser Therapy,7:113-118.

2. asaki, K., Ohshiro, T. (1997): Assessment in the rat model of the effects of 830nm diode laser irradiation in a diachronic wound hearing study. Laser Therapy,

9:25-32.

3. ubota, J., Ohshiro, T. (1996): The effects of diode laser LLLT on flap survival: Measurement of flap microcirculation with laser speckle flowmetry. Laser Therapy, 8:241-246.

4. Robert A. Henrica C.W., Ton F, Lenssen, Frans, A.J.M., Gauke, K., Paul G.(1998): Low-level laser therapy in ankle sprains: A randomized clinical trial.

Arch. Phys. Med. Rehabil, 79:1415-1420.

5. Ohshiro, T. (1988): Thermographic analysis and evaluationof pain attenuation with the GaAlAs LLLT laser system. In Ohshiro T and Calderhead RG: ‘Low Lever Laser Therapy: A Practical Introduction’. John Wiley & Sons, Chichester, UK. pp.56-62. 33 Laser Therapy Vol. 12 Official Journal of the World Association for Laser Therapy (WALT)

Lower Back Pain, Low Level Laser Therapy (LLLT) Research.

Abstract

Objective:The aim of this study was to investigate the clinical effects of low-level laser therapy (LLLT) in patients with acute low back pain (LBP) with radiculopathy.

Background Data : Acute LBP with radiculopathy is associated with pain and disability and the important pathogenic role of inflammation. LLLT has shown significant anti-inflammatory effects in many studies.

 Materials and Methods: A randomized, double-blind, placebo-controlled trial was performed on 546 patients. Group A (182 patients) was treated with nimesulide 200 mg/day and additionally with active LLLT; group B (182 patients) was treated only with nimesulide; and group C (182 patients) was treated with nimesulide and placebo LLLT. LLLT was applied behind the involved spine segment using a stationary skin-contact method. Patients were treated 5 times weekly, for a total of 15 treatments, with the following parameters: wavelength 904 nm; frequency 5000 Hz; 100-mW average diode power; power density of 20 mW/cm² and dose of 3 J/cm²; treatment time 150 sec at whole doses of 12 J/cm². The outcomes were pain intensity measured with a visual analog scale (VAS); lumbar movement, with a modified Schober test; pain disability, with Oswestry disability score; and quality of life, with a 12-item short-form health survey questionnaire (SF-12). Subjects were evaluated before and after treatment. Statistical analyses were done with SPSS 11.5.

 Results: Statistically significant differences were found in all outcomes measured (p < 0.001), but were larger in group A than in B (p < 0.0005) and C (p < 0.0005). The results in group C were better than in group B (p < 0.0005). Conclusions: The results of this study show significant improvement in acute LBP treated with LLLT used as additional therapy.

Ljubica M. Konstantinovic, Ph.D.,¹Zeljko M. Kanjuh, M.S.,¹Andjela N. Milovanovic, M.S.,²Milisav R. Cutovic, Ph.D.,¹Aleksandar G. Djurovic, Ph.D.,³Viktorija G. Savic, M.S.,⁴Aleksandra S. Dragin, M.S.,¹and Nesa D. Milovanovic, M.S.¹

¹Clinic for Rehabilitation, Medical School, Belgrade, Serbia ²Center for Physical Medicine, Clinical Center of Serbia, Belgrade, Serbia.³Clinic for Rehabilitation, Military Medical Academy, Belgrade, Serbia.⁴Department for Physical Medicine, Institute for Rheumatology, Belgrade, Serbia.

Address correspondence to: Ljubica Konstantinovic, Ph.D. Clinic for Rehabilitation dr Miroslav ZotovicMedical School, University of Belgrade

Sokobanjska 13, Belgrade

 Chiropractic Treatment

Chiropractic addresses the function of central nervous system which is the “master system” of the body controlling ad regulating function of all other subsystems including musculoskeletal system. Properly aligned skeletal system would improve performance, reduce the risk of injury and improve healing of existing injuries.

Chiropractors specialize in the non-drug treatment of musculoskeletal problems, including joint sprains and disc injuries. To some extent, the chiropractic approach to sports injuries is similar to that of traditional medical care.

Usually chiropractor’s initial examination would include standard orthopaedic and neurological tests to diagnose whether a particular pain is due to a strain, sprain, or disc problem. X-ray examination is also performed to screen for fractures and other bone disorders, such as osteoporosis.  

Chiropractic management of sports injuries often includes widely used physical therapies such as ice, Low Level laser therapy (LLLT) to reduce swelling and inflammation, or electronic muscle stimulation for muscle strains and spasms. 

Importance of Restoring Structural Body Balance.

Chiropractic management of sport injuries has an emphasis on adjustment and improving function of spinal and other joints through manipulation as well as restoring overall structural balance of the body. Chiropractor assess the effect of the muscle injury on the rest of the body as it would cause tightening of other muscle and joints in order to maintain general balance. Chiropractic adjustments help to restore the natural balance that was present before the injury.

Cold/Low level Laser Therapy (LILT). Treatment and Research  for Neck Pain

Neck pain  is common, often persistent, and responds poorly to medication. So it is encouraging to read that a relatively novel, non-invasive treatment shows evidence of effectiveness. A systematic review and meta-analysis of 16 randomised controlled trials of low-level laser therapy (LLLT)’ yielded 820 patients, for whom data was pooled. LLLT was found to reduce pain immediately after treatment in acute neck pain and up to 22 weeks after completion of treatment in patients with chronic neck pain. Low-level laser – or cold laser – is yet to be established as a medical treatment but, according to Wikipedia, papers are appearing at the rate of around 25 per month, mainly investigating treatment of musculoskeletal disorders. (View our Cold/Low Level Laser Therapy section)

1. Chow RT, Johnson Ml, Lopes-Martins RA, Bjordal JM. Efficacy of low-level laser therapy in the management of neck pain: a systematic review and meta-analysis of randomised placebo or active-treatment controlled trials. Lancet 2009 Dec 5;374(9705):1897-908.

A Review on research published by The Lancet, for the treatment of neck pain with Cold/Low Laser Therapy (LLLT)

Low level Laser treatment for neck pain.

Cold/Low level laser, a review on research published by The Lancet shows that Low Level Laser Therapy (LLLT) also so known as Cold Laser Therapy has been tested in over 200 clinical trials (RCTs) and published in the world’s top medical journals including a review by The Lancet, a clinical study in the journal PAIN and is acknowledged by the World Health Organisation Bone and Joint Task Force, and published in the journal Spine. There are 26 research papers on low level laser therapy, for Musculoskeletal pain and syndromes, both chronic and acute, Rheumatoid Arthritis, Cervical Spine Osteoarthritis, lateral and medial epicondylitis,(Tennis, Golfers Elbow).Achilles Tendonitis, Carpal Tunnel, TMJ, Tendonitis, Bursitis, soft tissue injuries, fractures, neck, shoulder, back, lower back pain, disc injuries, hip, joints knee, ankle injuries, conditions and disorders, and research on low level laser therapy are included on this page, scroll down.

(View our Cold/Low Level Laser Therapy section)

Pain Relief  for Rheumatoid Arthritis, Cervical Spine Osteoarthritis, Injuries and inflammatory Conditions. Low Level Laser Therapy (LLLT) also known as Cold Laser therapy,   Research on the Clinical application of GaAIAs 830 NM diode laser in treatment of Rheumatoid Arthritis,Cervical Spine Osteoarthritis,  including  LLLT Research  on Pain Relief  for other Inflammatory  Conditions, and  Injuries.

Cold/Low Level Laser Therapy (LLLT) Clinical application of GaAIAs 830 NM diode laser in treatment of Rheumatoid Arthritis. Department of Orthopaedic Surgery, Osaka City University Medical School, Japan

The authors have been involved in the treatment of rheumatoid arthritis (RA), in particular chronic poly-arthritis and the associated pain complaints. The biggest problem facing such patients is joint contracture, leading to bony ankylosis. This in turn severely restricts the range of motion (ROM) of the RA-affected joints, thereby seriously restricting the patient’s quality of life (QOL). The authors have determined that in these cases, daily rehabilitation practice is necessary to maintain the patient’s QOL at a reasonable level.

The greatest problem in the rehabilitation practice is the severe pain associated with RA-affected joints, which inhibits restoration of mobility and improved ROM. LLLT or low reactive level laser therapy has been recognized in the literature as having been effective in pain removal and attenuation. The authors accordingly designed a clinical trial to assess the effectiveness of LLLT in RA related pain (subjective self-assessment) and ROM improvement (objective documented data).

From July 1988 to June 1990, 170 patients with a total of 411 affected joints were treated using a GaAlAs diode laser system (830 nm, 60 mW C/W). Patients mean age was 61 years, with a ratio of males: females of 1: 5.25 (16%: 84%). Effectiveness was graded under three categories: excellent (remarkable improvement), good (clearly apparent improvement), and unchanged (little or no improvement).

For pain attenuation, scores were: excellent – 59.6%; good – 30.4%; unchanged – 10%.

For ROM improvement the scores were: excellent – 12.6%; good – 43.7%; unchanged – 43.7%. This gave a total effective rating for pain attenuation of 90%, and for ROM improvement of 56.3%.

Kanji Asada, Yasutaka Yutani, Akira Sakawa and Akira Shimazu

0898-5901/91/020077-06 $05.00  © 1991 by John Wiley & Sons, Ltd.

Low Level Laser Therapy for Osteoarthritis and Rheumatoid Arthritis: A Metaanalysis

ABSTRACT.Osteoarthritis (OA) and rheumatoid arthritis (RA) affect a large proportion of the population. Low level laser therapy (LLLT) was introduced as an alternative non-invasive treatment for RA and OA about 10 years ago, but its effectiveness is still controversial. We assessed the effectiveness of LLLT in the treatment of RA and OA.

Objective.

Methods.A systematic review was conducted, following an a priori protocol, according to the methods recommended by the Cochrane Collaboration. Trials were identified by a literature search of Medline, Embase, and the Cochrane Controlled Trials Register. Only randomized controlled trials of LLLT for the treatment of patients with a clinical diagnosis of RA or OA were eligible. Thirteen trials were included, with 212 patients randomized to laser and 174 patients to placebo laser, and 68 patients received active laser on one hand and placebo on the opposite hand. Treatment duration ranged from 4 to 10 weeks. Follow-up was reported by only 2 trials for up to 3 months.

Results. In patients with RA, relative to a separate control group, LLLT reduced pain by 70% relative to placebo and reduced morning stiffness by 27.5 min (95% CI –52.0 to –2.9), and increased tip to palm flexibility by 1.3 cm (95% CI –1.7 to –0.8). Other outcomes such as functional assessment, range of motion, and local swelling were not different between groups. There were no significant differences between subgroups based on LLLT dosage, wavelength, site of application, or treatment length. In RA, relative to a control group using the opposite hand, there was no difference between control and treatment hand, but all hands were improved in terms of pain relief and disease activity. For OA, a total of 197 patients were randomized. Pain was assessed by 3 trials. The pooled estimate (random effects) showed no effect on pain (standardized mean difference –0.2, 95% CI –1.0 to +0.6), but there was statistically significant heterogeneity (p > 0.05). Other outcomes of joint tenderness, joint mobility, and strength were not significant.

Conclusion.LLLT should be considered for Pain relief and morning stiffness in RA, particularly since it has few side effects. For OA, the results are conflicting in different studies and may depend on the method of application and other features of the LLLT. Clinicians and researchers should consistently report the characteristics of the LLLT device and the application techniques. New trials on LLLT should make use of standardized, validated outcomes. Despite some positive findings, this metaanalysis lacked data on how effectiveness of LLLT is affected by 4 factors: wavelength, treatment duration of LLLT, dosage, and site of application over nerves instead of joints. There is a need to investigate the effects of these factors on effectiveness of LLLT for RA and OA in randomized controlled clinical trials. (J Rheumatol 2000;27:1961–9)

LUCIE BROSSEAU, VIVIAN WELCH, GEORGE WELLS, PETER TUGWELL, ROBERT de BIE, ARNE GAM, KATHERINE HARMAN, BEVERLEY SHEA, and MICHELLE MORIN

Key Indexing Terms:

Leaders of International laser organizations met during the third Congress of the World Association for Laser Therapy held in  Athens, Greece, to explore ways of advancing research, education and practice world-wide. Photo was taken immediately after the special session in May, 2000

Cold /Low Level Laser (LLLT)

Low Level laser Therapy (LLLT) also known as Cold Laser Therapy/Treatment

The lasers used  are certified as  low level laser therapy  (LLLT).  For the past 30 years the technology of low level laser therapy (also known as Cold Laser Therapy has been formally accepted in North America and in many other parts of the world such as Europe, Russia and Japan.  In all this time there have been no recorded long-term adverse effects from low level laser therapy.  It is considered to be non-invasive, painless and safe.

Low Level Laser Therapy (LLLT) uses laser light energy to stimulate cells to function optimally.  In the body, light sensitive chromophores and other elements within the cell absorb energy, initiating a series of important photochemical changes such as increased production of ATP. The mitochondria and Kreb’s Cycle stimulation initiates the production of ATP, providing the cell with the extra energy needed to accelerate the healing process and positively influence pain.  These activities can occur in all types of cells and includes ligament, nerves, cartilage and muscle.

Low Level Laser Therapy (LLLT) is a treatment where by a low level laser is utilized to treat chronic and acute pain.  Low level laser therapy may be used for patients suffering from Sciatica, back and neck, hip, knee, ankle, foot pain and conditions a, musculoskeletal pain, joint pain associated with arthritis, fibromyalgia, tendonitis, bursitis, neuropathy, Achilles tendonitis, migraine headaches, sprains and strains, trapped nerves, carpal tunnel syndrome , back, neck, shoulder pain and other associated pains. Low Level laser therapy also treats conditions such as TMJ, reflex sympathetic dystrophy (RSD) and other inflammatory and scarring conditions. By increasing serotonin levels, low level laser therapy contributes to the body’s own healing process. Non-thermal and non-invasive, low level laser therapy involves a combination of low level laser and electric stimulation and is one of the most effective healing therapies. Completed in ten to twelve sessions, low level laser therapy(LLLT) can significantly reduce treatment time and costs.

A Review on research published by The Lancet, for the treatment of neck pain with Cold/Low Laser Therapy (LLLT)

Low level Laser treatment for neck pain.

Neck pain is common, often persistent, and responds poorly to medication. So it is encouraging to read that a relatively novel, non-invasive treatment shows evidence of effectiveness. A systematic review and meta-analysis of 16 randomised controlled trials of low-level laser therapy (LLLT)’ yielded 820 patients, for whom data was pooled. LLLT was found to reduce pain immediately after treatment in acute neck pain and up to 22 weeks after completion of treatment in patients with chronic neck pain. Low-level laser – or cold laser is yet to be established as a medical treatment but, according to Wikipedia, papers are appearing at the rate of around 25 per month, mainly investigating treatment of musculoskeletal disorders.

1. Chow RT, Johnson Ml, Lopes-Martins RA, Bjordal JM. Efficacy of low-level laser therapy in the management of neck pain: a systematic review and meta-analysis of randomised placebo or active-treatment controlled trials. Lancet 2009 Dec 5;374(9705):1897-908.

Lower Back Pain, Low Level Laser Therapy (LLLT) Research.

Abstract

Objective:

The aim of this study was to investigate the clinical effects of low-level laser therapy (LLLT) in patients with acute low back pain (LBP) with radiculopathy.

Background Data:

Acute LBP with radiculopathy is associated with pain and disability and the important pathogenic role of inflammation. LLLT has shown significant anti-inflammatory effects in many studies.

Materials and Methods:

A randomized, double-blind, placebo-controlled trial was performed on 546 patients. Group A (182 patients) was treated with nimesulide 200 mg/day and additionally with active LLLT; group B (182 patients) was treated only with nimesulide; and group C (182 patients) was treated with nimesulide and placebo LLLT. LLLT was applied behind the involved spine segment using a stationary skin-contact method. Patients were treated 5 times weekly, for a total of 15 treatments, with the following parameters: wavelength 904 nm; frequency 5000 Hz; 100-mW average diode power; power density of 20 mW/cm² and dose of 3 J/cm²; treatment time 150 sec at whole doses of 12 J/cm². The outcomes were pain intensity measured with a visual analog scale (VAS); lumbar movement, with a modified Schober test; pain disability, with Oswestry disability score; and quality of life, with a 12-item short-form health survey questionnaire (SF-12). Subjects were evaluated before and after treatment. Statistical analyses were done with SPSS 11.5.

 Results:

Statistically significant differences were found in all outcomes measured (p < 0.001), but were larger in group A than in B (p < 0.0005) and C (p < 0.0005). The results in group C were better than in group B (p < 0.0005).

Conclusions: The results of this study show significant improvement in acute LBP treated with LLLT used as additional therapy.

Ljubica M. Konstantinovic, Ph.D.,¹Zeljko M. Kanjuh, M.S.,¹Andjela N. Milovanovic, M.S.,²Milisav R. Cutovic, Ph.D.,¹Aleksandar G. Djurovic, Ph.D.,³Viktorija G. Savic, M.S.,⁴Aleksandra S. Dragin, M.S.,¹and Nesa D. Milovanovic, M.S.¹

¹Clinic for Rehabilitation, Medical School, Belgrade, Serbia ²Center for Physical Medicine, Clinical Center of Serbia, Belgrade, Serbia.³Clinic for Rehabilitation, Military Medical Academy, Belgrade, Serbia.⁴Department for Physical Medicine, Institute for Rheumatology, Belgrade, Serbia.

Address correspondence to: Ljubica Konstantinovic, Ph.D. Clinic for Rehabilitation dr Miroslav ZotovicMedical School, University of Belgrade Sokobanjska 13, Belgrade

Low Level Laser Therapy (LLLT)

Low Level  Laser Therapy (LLLT) has a 5 star rating for soft tissue injuries,conditions and inflammation.  Low Level Laser Therapy is a handheld, non-invasive, light-emitting medical device which is used over different areas of the body. It provides an unmatched advantage in the treatment of conditions such as;

Athletic and sports Injuries, Soft tissue injuries including Sprains and Strains, Tendonitis and Haematomas

Lower leg (calf pain) inflammation, Shin splints, Hamstring, Achilles tendonitis, Bursitis, conditions and disorders

Ankle sprains, injury, and fractures, inflammation conditions and disorders

Heel and foot injury, pain, Bursitis, Achilles Tendonitis, Plantar fasciitis, conditions and disorders

Knee pain, injuries, tears, ligament, Tendon injury, ruptures, Runners Knee, inflammation, Bursitis, conditions and disorders

Shoulder injury, pain, Shoulder tears, fractures inflammation, Tenosynovitis ,Tendonitis, Bursitis, conditions such as frozen shoulder, and disorders

Neck injury, Neck Pain, Neck sprain, Whiplash injury.

Back Injury,   Lower back pain, Sciatica, slipped discs, prolapsed disc, herniated / bulging discs, Trapped nerves and inflammation.

Elbow, Wrist and Hand injury, Tendonitis, inflammation, fractures, conditions and disorders, such as Tennis Elbow,(Golfers Elbow) Carpal Tunnel Syndrome,

Hip injury and pain, Sacroiliac Joint inflammation, groin and thigh strain (pull), sports hernia, Hip Bursitis/Tendonitis, Trochanteric Bursitis, conditions and disorders

Muscle sprain and spasms, Cramps, Joint Pain and stiff Joints.

Pain Relief, including Arthritic pain relief.

Wound Management including Skin Ulcers, Pressure Sores and Burns, Skin infections

Chronic pain such as Trigeminal Neuralgia and Chronic Neck and Back pain.

Safety

Low level laser therapy(LLLT) is not harmful. Lasers used for tissue stimulation have insufficient strength to damage cells. 30 years of clinical studies and clinical use have shown no adverse effects whatsoever.

The Advantages of Low Intensity Laser Therapy

• Non-invasive
• Non-toxic
• Easily applied
• Highly effective
• Cure rate > 95%
• No known negative side effects

Mechanism of Action

Therapeutic lasers work by supplying energy to the body in the form of photons of light. The tissues and cells then absorb this energy, where it is used to accelerate the normal rate of tissue healing.

Therapeutic Benefits of Laser Therapy:

• Anti-inflammatory Action: Laser light reduces swelling, leading to decreased pain, less stiffness, and a faster return to normal joint and muscle function.
• Rapid Cell Growth: Laser light accelerates cellular reproduction and growth.
• Faster Wound Healing: Laser light stimulates fibroblast development and accelerates collagen synthesis in damaged tissue.
• Reduced Fibrous Tissue Formation: Laser light reduces formation of scar tissue, leading to more complete healing, with less chance of weakness and re-injury later.
• Increased Vascular Activity: Laser light increases blood flow to the injured area.
• Stimulated Nerve Function: Laser light speeds nerve cell processes which may decrease pain and numbness associated with nerve-related conditions.

Frequency of Treatments

While some patients get immediate results, others require 6-12 treatments before seeing a lasting effect. Less severe or acute injuries will require fewer treatments than chronic or severe conditions.

Low Level Laser Therapy (LLLT) Applications, Case Studies and Low Level Laser Research with 26 Worldwide Clinical Studies is presented below:

Musculoskeletal pain syndromes, both chronic and acute.Cold/Low level laser therapy (LLLT)has been shown to be effective in a variety of musculoskeletal conditions and associated pain presentations.In Rheumatoid Arthritis, LLLT can benefit not only the pain of acute small joint inflammation but also the chronic pain.In a review article on rheumatology (3), some 18 papers were considered. All studies involved double-blind trials with LLLT in chronic rheumatoid, and reported significant improvement in pain (80% success rate in relieving pain). Upon comparing LLLT to a similar rate of pain attenuation using anti-inflammatory drugs (NSAIDs), the LLLT was free of any side-effects while 20% of patients treated with NSAIDs suffered unacceptable side-effects of medication . In another study of 170 patients with rheumatoid arthritis using LLLT (4), pain attenuation of up to 90% was noted.Trellis et al (6) used LLLT for osteoarthritis of the knee in 40 patients. He reported a significant reduction of 82% of the patients with improved joint mobility. Among 36 randomized patients, with pain caused by cervical osteoarthritis, those who received Infra-Red and Low Level Laser treatment improved 75% compared with the group receiving mock treatment (31%) . Similarly, a study of 60 patients with Cervical Osteoarthritis, Low Pulsed Laser was successful in relieving pain and in improving function.
The results of a study show that cervical myofascial pain is significantly improved at 3-month with Diode laser . A similar successful LLLT treatment has been described for whiplash injuries.In a randomized study with 30 patients with supraspinatus or bicipital tendonitis, the results demonstrated the effectiveness of laser therapy in tendonitis of the shoulder . Another study with a patient population (n = 324), with either medial epicondylitis (Golfer’s elbow; n = 50) or lateral epicondylitis (Tennis elbow; n = 274), and randomly allocated, provides further evidence of the efficacy of LLLT in the management of lateral and medial epicondylitis .

Treatment with low-level laser therapy (LLLT) was shown effective in treating Carpal Tunnel Syndrome pain. Another study, significant decreases in McGill Pain Questionnaire scores, median nerve sensory latency, and Phalen and Tinel signs were observed after treatment series with Low Level Laser Therapy. Patients could perform their previous work  .

In acute trauma there is a soft tissue injury comprising swelling, haematoma, pain and reduced mobility. Sporting injuries and domestic accidents usually involve damage to muscles, joint ligaments and tenclass. In the absence of bone fracture or other injury demanding priority treatment, LLLT should be instituted at the earliest opportunity. Kumar reported a comparative study in 50 patients with inversion injuries of the ankle. He found that compared to conventional physiotherapy, the LLLT treated patients showed a more rapid resolution of symptoms and an earlier return to full weight-bearing .

Fibromyaliga (FM) is characterized by widespread pain in the body, associated with particular tender points. It is often accompanied by disturbed sleep patterns, fatigue, headaches, irritable bowel and bladder syndrome, morning stiffness, anxiety and depression. FM can cause a high level of functional disability and have a significantly negative effect on quality of life. One study suggests that “Laser Therapy is effective on pain, muscle spasm, morning stiffness, fatigue, depression and total tender point number in Fibromyalgia”.

A randomized controlled study with 63 with non-radiating low back pain showed that LLLT significantly improved pain and function.

In summary, the bulk of published work to date supports the use of LLLT for treatment of a variety of musculoskeletal conditions and associated pain. Moreover, the LLLT proved to be not only more effective than conventional methods, but more economical as well. The added advantage of absence of side effects, non-invasive nature of therapy and the ease of application, ensures good patient acceptance of the treatment modality.

Low Intensity Laser Therapy(LILT) for Head, Neck and Facial Pain.

Prof P.F. Bradley

The clinical application of low incident power density laser radiation for the treatment of acute and chronic pain is now a well established procedure. This paper reviews the currently available English speaking literature and summarises a selection of serious scientific papers which report a beneficial effect following the treatment of a wide variety of acute and chronic syndromes whose main presenting symptom is pain.

Head and Neck Clinical Applications of LILT

LILT is proving useful in a wide variety of painful conditions in the Head and Neck but the following are particular applications:

  1. TM Joint Pain Dysfunction

  2. Post Herpetic Neuralgia

  3. Trigeminal Neuralgia

  4. Painful Ulcerative Conditions

  5. Pain of Advanced Oro Facial Cancer

 The above information has been suppled by Quantum Healing Lasers .Com

  The Ability of Low Level Laser Therapy (LLLT) to Mitigate Fibromyalgic Pain.

  The CFIDS Chronicle Physicians’ Forum Fall 1993

  Douglas Ashendorf, MD, FAAPMR Newark, New Jersey

Physiotherapist Shows Lasers Relieve Pain.

A physiotherapist at Royal Brisbane Hospital (Australia) recently received a PhD from the University of Queensland for demonstrating that laser treatment prompts the release of endorphins into the bloodstream. Endorphins are a type of natural morphine that dulls pain. Physiotherapist Liisa Laakso studied the effects of lasers on 56 people who suffered myofascial pain syndrome, a chronic hypersensitivity often secondary to a person’s primary painful affliction, such as arthritis. Previous experiments linking endorphin release and lasers have only been done on rats.

In the study, Laakso applied different doses and wavelengths of a laser diode to “trigger points” on the body and took blood samples measuring endorphin levels in these subjects and a control group. The control group reported some pain relief – most likely a placebo effect – but endorphins were present. Those patients that underwent laser treatment reported pain reduction of up to 78%, and endorphins were present in their blood.

THERMOGRAPHIC STUDY OF LOW LEVEL LASER      THERAPY FOR ACUTE-PHASE INJURY.

 Yoshimi Asagai, M.D.1, Atsuhiro Imakiire, M.D.2, Toshio Ohshiro, M.D.3,  1. Shinano Handicapped Children`s Hospital Shimosuwa, Nagano, Japan    2. Department of Orthopaedic Surgery, Tokyo Medical University Shinjuku, Tokyo, Japan     3. Japan Medical Laser Laboratory, Shinanomachi, Tokyo, Japan. 

Acute-phase injury is generally treated by localized cooling of the region, and rarely by theactive use of low level laser therapy (LLLT) in Japan. Thermographic studies of acutephase injury revealed that circulatory disturbances at the site of trauma occurred due to swelling and edema on the day following the injury, and that skin temperature was high at the site of the trauma and low at the periphery. Following LLLT, circulatory disturbances rapidly improved, while temperature in the high temperature zone around the site of trauma fell by 3 degrees on the average, but at the periphery the low temperature rose by 3 degrees on the average to nearly normal skin temperature. Clinically, swelling and edema improved. LLLT was also useful in treating necrosis of the skin in the wound area and in accelerating healing of surgical wounds of paralytic feet, which are prone to delayed, wound healing and also wounds due to spoke injury. LLLT is useful in treating swelling and edema in acutephase injury and in accelerating healing of surgical wounds. 

Key words: Laser therapy, acute-phase injury, thermography, ankle joint sprain

Introduction

It has not been clearly defined to date if LLLT is indicated for acute-phase injury with swelling and calor. Yet it is frequently considered to be contraindicated in acute-phase injury. We have previously reported that, in patients with cerebral palsy with reduced peripheral skin temperature, the skin surface temperature was elevated to normal after LLLT

(1). in this study, we used thermography to examine changes in skin temperature following LLLT chie fly inacute-phase injury. 

Patients and Methods

Subjects were 7 patients with sprains of the ankle joint, two patients with fractures of the tibial shaft, and one patient with dislocation of the elbow joint. LLLT was also used in orthopedic surgery for disorders of the distal lower extremity such as talipes varus, which is frequently followed by postoperative necrosis of the skin in the wound area as well as delayed wound healing, and pre- and postoperative treatment of paralytic feet with circulatory disturbances. The procedure was as follows. Room temperature was maintained at 25oC. After acclimatization for 20 minutes, continuous irradiation with a GaAlAr semiconductor laser (JQ305, Minato Medical Science Co., Ltd., Japan) with the wavelength adjusted to 810 nm and the output to 100mW was applied using the contact method.

The spot size on the tissue was 0.56cm2 with a power density of 17.86W/cm2 at 100mW, the energy density per point being 107.5J/cm2. The area surrounding the site of trauma was irradiated for 3 to 5 minutes in total, one minute per spot, and changes in the skin surface temperature were followed using Thermotracer TH1106. The test was performed from immediately after injury till 5 days post-trauma, an average of two days after injury. 

Results 

Immediately after injury, the skin surface temperature was elevated to about 34 degrees at and around the site of trauma (Fig. 1). On the day following the injury, skin temperature remained elevated around the site of trauma to the same degree as immediately after injury, but was markedly reduced to about 29 degrees at its periphery (Fig. 2). Skin temperature began to fall in the high temperature zone and began to rise in the peripheral low temperature zone immediately following LLLT, and the peripheral skin temperature reached a peak or became almost normal at about 40 minutes after the initiation of irradiation (Fig. 3). Changes in post-LLLT skin temperature in all patients 

a b c

 1. Sprain of the right ankle joint immediately after injury: 

a) Before irradiation, a high temperature zone extends over the trauma site  and a wide area around it.

 b) At 10 minutes after LLLT,skin temperature fell at the trauma site, and rose in the toes at the periphery.

 c) At 20 minutes after LLLT,skin temperature was re-elevated at the trauma site.

31 Laser Therapy Vol. 12 Official Journal of the World Association for Laser Therapy (WALT) showed that skin temperature fell by an average of 3degrees in the high temperature zone around the site of trauma, and rose by an average of 3 degrees in the peripheral low temperature zone, both to approximately normal skin temperature. Clinically, swelling and edema were diminished and repeated irradiation suppressed exacerbation of swelling and edema.Patients receiving pre- and post-operative

application of LLLT for such conditions as talipes varus, in which postoperative necrosis of skin in the wound area and delayed wound healing are frequent, spoke injury produced when the foot is caught in a bicycle’s spokes (Fig. 4), and paralytic feet with distal circulatory failure due to spin bifida or cerebral palsy, we have not seen any necrosis of the skin in the wound area or delayed wound healing.

Discussion 

There have been many reports on wound healing (2, 3).Currently, the site of trauma is cooled to reduce swelling in acute-phase injury. An important problem in the healing

of wounds and associated fractures is how to suppress swelling and edema, and improvement of local swelling and edema is also crucial for the healing of ligament injury in sprained ankles. However, the use of LLLT for sprained ankles is controversial (4). Thermography has been used for evaluating the effect of LLLT (5). In the present thermographic evaluation, the surface temperature was high around the trauma site and low in the periphery, which indicated that local blood and lymph flow were impaired by swelling and edema, thus raising temperature. When LLLT was applied to these areas, it was found that skin temperature fell in the high temperature zone but

rose in the low temperature zone to approximately the normal temperature in both zones, suggesting improved  blood and lymphatic circulation. Clinically, reduction of local swelling and edema was considered to have led to the improvement of blood and lymph flow. 

Conclusions 

1: In acute-phase injury, skin temperature was elevated around the site of trauma, and reduced in the periphery on the day following the injury. 

2: Immediately after irradiation, skin temperature fell by 3oC on the average in the high temperature zone around the trauma site, and rose by 3oC on the average reaching normal temperature in the low temperature zone at the periphery of the injury.

3: LLLT rapidly improved blood and lymphatic flow, which had been impaired by injury, and alleviated swelling and edema. LLLT was also useful in accelerating healing

of the surgical wound.

Address for Correspondence:  Yoshimi Asagai MD, Director, Shinano Handicapped  Children`s Hospital, 6525-1 Shimosuwa, Suwagun, Nagano, Japan 393 

a b c

2. Contusion of the right tibial shaft 1 day after injury: a) before irradiation,

a) Skin temperature is high at the trauma site, and low at the periphery.

b) At 10 minutes after LLLT:skin temperature fell at the trauma site, and rose slightly at the periphery. c) At 40 minutes after LLLT: skin temperature at the periphery reached a peak and nearly normal skin temperature

a b c

 3. Fracture of the right tibia 2 days after removal of nailing: a) Before irradiation, skin temperature was high in the surgical wound, and low at the periphery. b) Immediately after LLLT, skin temperature was reduced in the high temperature zone, and elevated in the low temperature zone. c) At 40 minutes after LLLT, skin temperature at the periphery reached a peak.

a b

4. Spoke injury:

a) At 6 days after injury the left foot had been caught in the rear wheel of a bicycle, and this left a large skin defect on the back of the foot and a contusion, with marked swelling and edema.

 b) After daily LLLT, epithelialization was observed and the wound healed at 23 days after injury.

http://www.walt.nu Laser Therapy Vol. 12 32 

References

1. Asagai,Y.,Ueno,R.,Miura,Y.,Ohshiro,T.(1995):Application of low reactive-level laser therapy(LLLT) in patients with cerebral palsy of the adult tension athetosis type. Laser Therapy,7:113-118. 

2. asaki, K., Ohshiro, T. (1997): Assessment in the rat model of the effects of 830nm diode laser irradiation in a diachronic wound hearing study. Laser Therapy,

9:25-32.

3. ubota, J., Ohshiro, T. (1996): The effects of diode laser LLLT on flap survival: Measurement of flap microcirculation with laser speckle flowmetry. Laser Therapy, 8:241-246.

4. Robert A. Henrica C.W., Ton F, Lenssen, Frans, A.J.M., Gauke, K., Paul G.(1998): Low-level laser therapy in ankle sprains: A randomized clinical trial.

Arch. Phys. Med. Rehabil, 79:1415-1420.

5. Ohshiro, T. (1988): Thermographic analysis and evaluationof pain attenuation with the GaAlAs LLLT laser system. In Ohshiro T and Calderhead RG: ‘Low Lever Laser Therapy: A Practical Introduction’. John Wiley & Sons, Chichester, UK. pp.56-62. 33 Laser Therapy Vol. 12 Official Journal of the World Association for Laser Therapy (WALT)

Results have suggested that the pain relieving properties of LLLT have been the most consistent benefit. The duration of benefit has varied from one hour to one week, and seems to increase as treatment progresses.

Other areas of improvement were not as clear. Improvement in sleep was observed with some regularity although this was undoubtedly due in part to decreased pain. The “non-restorative” sleep complaints were less regularly improved. Improvement with regard to abnormal sensations in the limbs (paresthesia and subjective swelling) appears to be fairly consistent. Improvements in fatigue, mood and headache.

Although the pilot study is incomplete, I believe that these early findings warrant the further investigation of laser therapy for patients with fibromyalgia. This is further supported by the relatively few and harmless side effects of this therapy, the fact that equipment and operating costs are reasonable, and the reality that there are few effective alternative treatments for fibromyalgia patients.

Carpal Tunnel Study Results Released

Laser Focus World

A physician at UMDNJ-Robert Wood Johnson Medical School is evaluating a “cold” laser to treat patients with carpal tunnel syndrome, a debilitating nerve condition that causes severe pain and numbness in the hand.

Clinical results of a double-blind study of 11 patients afflicted with carpal tunnel syndrome who were treated with a diode-laser device manufactured by Lasermedics (Missouri City, TX) showed that after six to 15 treatments, nine of the 11 patients experienced relief of pain and other associated symptoms as well as normalization of abnormal latencies.

The study was conducted by Michael L. Weintraub, a neurologist from Briarcliff, NY, and reported in the February 1996 issue of Neurology.

The patients all used a 30mW 830nm, a hand-held, battery-operated, nonsurgical laser device that employs the process of photo-biostimulation.

Dr. Weintraub concluded that the results of his study support the efficacy and safety of laser-light treatment in carpal tunnel syndrome.

Physiotherapist Shows Lasers Relieve Pain.

A physiotherapist at Royal Brisbane Hospital (Australia) recently received a PhD from the University of Queensland for demonstrating that laser treatment prompts the release of endorphins into the bloodstream. Endorphins are a type of natural morphine that dulls pain. Physiotherapist Liisa Laakso studied the effects of lasers on 56 people who suffered myofascial pain syndrome, a chronic hypersensitivity often secondary to a person’s primary painful affliction, such as arthritis. Previous experiments linking endorphin release and lasers have only been done on rats.

In the study, Laakso applied different doses and wavelengths of a laser diode to “trigger points” on the body and took blood samples measuring endorphin levels in these subjects and a control group. The control group reported some pain relief – most likely a placebo effect – but endorphins were present. Those patients that underwent laser treatment reported pain reduction of up to 78%, and endorphins were present in their blood.

The effect of infra-red laser irradiation on the duration and severity of postoperative pain: a double blind trial.

Kevin C. Moore, Naru Hira, Ian J. Broome* and John A. Cruikshank, Departments of Anaesthesia and General Surgery, The Royal Oldham Hospital, Oldham, U.K *Department of Anaesthesia, The Royal Hallamshire Hospital, Sheffield, U.K.,General Practitioner, Pennymeadow Clinic, Ashton-under-Lyne, U.K.

This trial was designed to test the hypothesis that LLLT reduces the extent and duration of post-operative pain. Twenty consecutive patients for elective cholecystectomy were randomly allocated for either LLLT or as controls. The trial was double blind. Patients for LLLT received 6-8-min treatment (GaAlAs: 830 nm: 60 mW CW: CM) to the wound area immediately following skin closure prior to emergence from GA. All patients were prescribed on demand post-operative analgesia (IM or oral according to pain severity). Recordings of pain scores (0-10) and analgesic requirements were noted by an independent assessor. There was a significant difference in the number of doses of narcotic analgesic (IM) required between the two groups.

Controls n = 5.5: LLLT n = 2.5.

No patient in the LLLT group required IM analgesia after 24 h. Similarly the requirement for oral analgesia was reduced in the LLLT group.

 Controls n = 9: LLLT n = 4.

 Control patients assessed their overall pain as moderate to severe compared with mild to moderate in the LLLT group.

 The results justify further evaluation on a larger trial population.

 Address for correspondence:

 Dr K. C. Moore, Department of Anaesthesia, The Royal Oldham Hospital, Rochdale Road, Oldham OL1 2JH, U.K.

 0898-5901/92/040145-05 $07.50   ©1992 by John Wiley & Sons, Ltd.

Efficacy of laser irradiation on the area near the stellate ganglion is dose-dependent:    A double-blind crossover placebo-controlled study.

Toshikazu Hashimoto, Osamu Kemmotsu, Hiroshi Otsuka, Rie Numazawa, and Yoshihiro Ohta, Department of Anaesthesia, Hokkaido University Hospital, Sapporo, Japan

In the present study we evaluate the effects of laser irradiation on the area near the stellate ganglion on regional skin temperature and pain intensity in patients with postherpetic neuralgia. A double blind, crossover and placebo-controlled study was designed to deny the placebo effect of laser irradiation.

 Eight inpatients (male 6, female 2) receiving laser therapy for pain attenuation were enrolled in the study after institutional approval and informed consent. Each patient received three sessions of treatment on a separate day in a randomised fashion. Three minutes irradiation with a 150 mW laser (session 1), 3 minutes irradiation with a 60 mW laser (session 2), and 3 minutes placebo treatment without laser irradiation. Neither the patient nor the therapist was aware which session type was being applied until the end of the study. Regional skin temperature was evaluated by thermography of the forehead, and pain intensity was recorded using a visual analogue scale (VAS). Measurements were performed before treatment, immediately after (0 minutes) then 5, 10, 15, and 30 min after treatment. Regional skin temperature increased following both 150 mW and 60mW laser irradiation, whereas no changes were obtained by placebo treatment. VAS decreased following both 150 mW and 60 mW laser treatments, but no changes in

VAS were obtained by placebo treatment. These changes in the temperature and VAS were further dependent on the energy density, i.e. the dose.

Results demonstrate that laser irradiation near the stellate ganglion produces effects similar to stellate ganglion block. Our results clearly indicate that they are not placebo effects but true effects of laser irradiation.

Address for Correspondence:   Toshikazu Hashimoto MD, Department of Anaesthesia, I Hokkaido University I Hospital N15, W7, Kita-ku Sapporo, Japan 060.

LASER THERAPY 1997:9:7-12  ©1997 by LT Publishers l.K., Ltd.

Successful management of female office workers with “repetitive stress injury” or”carpal tunnel syndrome” by a new treatment modality- application of low level lasers for pain

E. Wong G LEE J. Zu CHERMAN and D. P. MASON

Western Heart Institute and St. Mary’s Spine Center St. Mary’s Medical Center. San Francisco. CA. USA and Head and Neck Pain Center, Honolulu HL. USA

Abstract

Female office workers with desk jobs who are incapacitated by pain and tingling in the hands and fingers are often diagnosed by physicians as “repetitive stress injury” (RSI) or “carpal tunnel syndrome” (CTS). These patients usually have poor posture with their head and neck stooped forward and shoulders rounded; upon palpation. they have pain and tenderness at the spinous processes C5 – T1 and the medial angle of the scapula. In 35 such patients we focused the treatment primarily at the posterior neck area and not the wrists and hands. A low level laser (100 mW) was used and directed at the tips of the spinous processes C5 – Tl.

The laser rapidly alleviated the pain and tingling in the arms, hands and fingers, and diminished tenderness at the involved spinous processes. Thereby, it has become apparent that many patients labelled as having RSI or CTS have predominantly cervical radicular dysfunction resulting in pain to the upper extremities which can be managed by low level laser.

Successful long-term management involves treating the soft tissue lesions in the neck combined with correcting the abnormal head, neck and shoulder posture by taping. Cervical collars, and clavicle harnesses as well as improved work ergonomics.

LASER THERAPY, 1997:9: 131- 136 09/97 © 1997 by LT Publishers, U.K., Ltd  Physiological responses in chronic pain patients. LLLT protocol.  Scott D. Fender and David Diffee

Pain Research Group, Arvada, Colorado, U.S.A.

Use of Low Reactive Level Laser Therapy (LLLT) utilising helium-neon lasers has increased lately especially in pain control. New protocols are being developed aimed at a complex of primary and secondary symptomologies. One of these protocols Stellate Ganglion Stimulation has shown in our research a unique set of developments. Targeting the area of the stellate ganglion is showing great promise in the rehabilitation of patients with a history of chronic musculoskeletal pain syndromes, but several patients with pre-existing psychological symptomology have exacerbated during the initial stages of utilization of this protocol.

Patients with a history of psychological diagnosis for dysthymia, anxiety, post traumatic stress disorder or minor diffuse brain injury have shown an exacerbation of these symptomologies during the initial phases of stimulation treatment. Overall, response to this form of therapy seems to be positive but some patients require dermatomal and/or site-specific therapy to maximize outcome. With specific psychological treatment combined with a more conservative amount of stimulation initially the increase in these symptoms shows a tendency to remit with the pain response. Our continued research is currently focusing on the mechanisms for this type of response as well as protocol refinement to maximize its effectiveness.

 Address for correspondence:

Scott D. Fender DDS DAPM, 5275 Marshall Street, Suite 203, Arvada, CO 80002, U.S.A. 0898-5901/92/040169-05$07.50nn© 1992 by John Wiley & Sons, Ltd.

Mechanisms of the analgesic effects of therapeutic lasers in vivo.

L Navratil (1)and I Dylevsky(2)

  1: Outpatient Department of Radiobiology, Institute of Biophysics, First Medical Faculty, and

  2: Department of Functional Anatomy, Second Medical Faculty and Faculty of Physical Education Charles University, Prague, Czech Republic

The analgesic effects in the course of application of therapeutic lasers to affected tissue have been described in a number of works in the literature. Although a few scientific-based reports have appeared, those on laser-induced analgesia are mainly clinical works describing the effect of the therapy which, however, do not study the mechanism of the laser action. There are several different possible responses induced by non-invasive low level laser therapy (LLLT).

The purpose of the present communication is to review the arrangement and characterisation of these responses. By being aware of these effects, the laser therapist can acquire a physiological and morphological scheme making possible the appropriate choice of the site of application of LLLT, choice of the irradiation technique, and selection of appropriate doses.

Address for Correspondence:

Leos Navratil MD PhD, Department of Clinical Radiahiology, Institute of Biophysics, First Medical Faculty, Charles University Saln1ovska 3, CZ 120 00, Prague 2, Czech Republic. 03/97 Rep. US 5 10 12 14 © 1997 by LT Publishers U.K, Ltd.   LASER THERAPY 1997:9:33-40   Experimental Physiology (1994) 79. 227-234 Printed in Great Britain

Can low reactive-level laser therapy be used in the treatment of neurogenic facial pain?   A double-blind, placebo controlled investigation of patients with trigeminal neuralgia.

ArneEckerdal and Lehmann Bastian. Department of Oral and Maxillofacial Surgery and Oral Medicine, Odense University Hospital, Denmark

Neurogenic facial pain has been one of the more difficult conditions to treat, but the introduction of laser therapy now permits a residual group of patients hitherto untreatable to achieve a life free from or with less pain. The present investigation was designed as a double-blind, placebo controlled study to determine whether low reactive-level laser therapy (LLLT) is effective for the treatment of trigeminal neuralgia. Two groups of patients (14 and 16) were treated with two probes. Neither the patients nor the dental surgeon were aware of which was the laser probe until the investigation had been completed. Each patient was treated weekly for five weeks.

The results demonstrate that of 16 patients treated with the laser probe, 10 were free from pain after completing treatment and 2 had noticeably less pain, while in 4 there was little or no change. After a one year follow-up, 6 patients were still entirely free from pain. In the group treated with the placebo system, i.e. the non-laser probe, one was free from pain, 4 had less pain, and the remaining 9 patients had little or no recovery. After one year only one patient was still completely free from pain. The use of analgesics was recorded and the figures confirmed the fact that LLLT is effective in the treatment of trigeminal neuralgia. It is concluded that the present study clearly shows that LLLT treatment, given as described, is an effective method and an excellent supplement to conventional therapies used in the treatment of trigeminal neuralgia.

Address for Correspondence:

Arne Eckerdal DDS DOS Consultant, Department of Oral and Maxillofacial Surgery & Oral Medicine, Odense University Hospital, DK-5000 Odense, Denmark.  12/96 Rep. US X 8-10-12  LASER THERAPY, 1996: 8: 247-252

Double-blind crossover trial of low level laser therapy in the treatment of post-herpetic neuralgia.

Kevin C Moore, Naru Hira. Parswanath S. Kramer, Copparam S. Jayakumar and Toshio Ohshiro

Post herpetic neuralgia can he an extremely painful condition which in many cases proves resistant to all the accepted forms of treatment. It is frequently most severe in the elderly and may persist for years with no predictable course.

This trial was designed as a double blind assessment of the efficacy of low level laser therapy in the relief of the pain of post herpetic neuralgia with patients acting as their own controls. Admission to the trial was limited to patients with established post herpetic neuralgia of at least six months duration and who had shown little or no response to conventional methods of treatment. Measurements of pain intensity and distribution were noted over a period of eight treatments in two groups of patients each of which received four consecutive laser treatments.

The results demonstrate a significant reduction in both pain intensity and distribution following a course of low level laser therapy.    John Wiley & Sons. Ltd.

Efficacy of low-level laser therapy for pain attenuation of post-herpetic neuralgia.

Osamu Kemmotsu, Kenichi Sato,Hitoshi Furumido, Koji Harada, Chizuko Takigawa, Shigeo Kaseno, Sho Yokota, Yukari Hanaoka and Takeyasu Yamamura

Department of Anaesthesiology, Hokkaido University School of Medicine, N-15. W-7, Kita-ku. Sapporo 060, Japan.

The efficacy of low reactive-level laser therapy (LLLT) for pain attenuation in patients with postherpetic neuralgia (PHN) was evaluated in 63 patients (25 males. 38 females with an average age of 69 years) managed at our pain clinic over the past four years. A double blind assessment of LLLT was also performed in 12 PHN patients. The LLLT system is a gallium aluminium arsenide (GaAlAs) diode laser (830 nm, 60 mW continuous wave). Pain scores (PS) were obtained using a linear analogue scale (1 to 10) before and after LLLT.

The immediate effect after the initial LLLT was very good (PS: <3) in 26, and good (PS: 7-4) in 30 patients. The long-term effect at the end of LLLT (the average number of treatments 36 + 12) resulted in no pain (PS: 0) in 12 patients and slight pain (PS: 1-4) in 46 patients. No complications attributable to LLLT occurred. Although a placebo effect was observed, decreases in pain scores and increases of the body surface temperature by LLLT were significantly greater than those that occurred with the placebo treatment. Our results indicate that LLLT is a useful modality for pain attenuation in PHN patients and because LLLT is a non-invasive, painless and safe method of therapy, it is well acceptable by patients.

Address for correspondence: Osamu Kemmotsu, Department of Anaesthesiology, Hokkaido University School of Medicine, N-15, W-7, Kita-ku, Sapporo 060, Japan. 0898-5901/91/020071-05 $05.00  © 1991 by John Wiley & Sons, Ltd.

Mechanistic approach to GaAIAs diode laser effects on production of reactive oxygen species  from human neutrophils as a model for therapeutic modality at cellular level.

Makoto Yamaya*, Chiyuki Shiroto’, Hiroki Kobayashi*, Shinji Naganuma*, Jyuichi Sakamoto*, Koh-Jun Suzuki*, Shigeyuki Nakaji*, Kazuo Sugawara* and Takashi Kumae *Department of’ Hygiene, Hirosaki University School of Medicine. Hirosaki; .-Shiroto Clinic Coshogawara, Aomori: Department of Industrial Health. The Institute of Public Health, Tokyo. Japan

There have been many reports on the applications of low reactive level laser (LLL) therapy for pain attenuation or pain removal. Our group has reported previously on the effects of in vitro irradiation of LLLT particularly on the phagocytic activity of human Neutrophils, using luminol-dependent chemiluminescence (LmCL) for measurement of reactive oxygen species (ROS) production from human Neutrophils. However, the mechanisms of the attenuation of phagocytic activity of NEUTROPHILS by LLL irradiation is not yet fully understood.

In this study. we used luminol-dependent and lucigenin-dependent chemiluminescence (LgCL) for detection of affected ROS producing process of human Neutrophils by LLL irradiation. Two soluble action stimuli, N-formyl-Met-Leu-Phc (fMLP) and phorbol myristate acetate (PMA) were used to avoid the possible influence of lag-time from recognition to uptake of particles at the ROS production.

In case of using fMLP as a stimulus, the maximum luminescence intensity of LULL was increased hut LgCL luminescence was decreased by LLL irradiation. When PMA was used as a stimulus, the times to reach the maximum luminescence intensity of LmCL and LgCL were shortened by LLL irradiation, but there was no effect on the maximum luminescence intensity of both.

These results suggest that LLL irradiation enhances the ROS production activity of human Neutrophils by the activation of the superoxide converting system, the active clement in which is mainly myeloperoxidase. LLL irradiation enabled a more rapid activation of the superoxide production system, NADPH -oxidase.

0898-5901/93/03011 1-06 $08.00   © 1993 by John Wiley & Sons. Ltd  LASER THERAPY 1993: 5: 111-116

Laser therapy takes pain, discomfort out of post-cancer condition

LOW-LEVEL laser therapy promises to be a valuable weapon in the fight against  lymphoedema, the painful and permanent swelling of an arm which frequently follows breast cancer operations. Doctors at Adelaide’s Flinders University (FU) have conducted trials which have produced the first clinical evidence that infra-red laser can improve tissue conditions rapidly in the affected area.

Associate professor Neil Piller told the university magazine, Flinders Journal that loosening the tissue encouraged the regrowth of lymph vessels. The results are very exciting,” Dr Piller said. “This is the first time anyone specifically has set out to trial lasers in this way. Previously, information about the possible efficacy of lasers has come as a by-product of research into such areas as wound treatment and arthritic conditions, and even then there has been very little work done.”

Lymphoedema results from deliberate or accidental removal of lymph nodes or vessels. It affects about 15 per cent of women sometime after a breast cancer operation. In the FU trials, 15 women with prolonged or severe lymphoedema were given 16 half-hour laser treatments over 10 weeks. “All had arms swollen to between 140 and 180 per cent of normal volume. A scanning laser, focusing 2-4 joules of power to each square centimetre, was applied to the entire arm.

In all cases, the treatment reduced the amount of oedema, the volume of fluid and the circumference of the arm above the elbow. Tissues in the upper and lower arm were softened and patients reported less pain, tightness and heaviness, and far greater mobility. “Giving them 16 treatments actually was overkill,” Dr Piller said. “Since the trial ended, we have achieved significant results from just three or four treatments, or in some cases one or two.”

Diode Laser in Cervical Myofascial Pain: A Double-Blind Study versus Placebo

* F. Ceccherelli, * L. Altafini, * G. Lo Castro, * A. Avila, *F. Ambrosio, and * G. P. Giron

*Institute of Anesthesiology and Intensive Care, University of Padua, and the Associazione Italiana per la Ricerca e, l’Aggiornamento Scientif co, Padua, Italy

Summary

We present a double-blind trial in which a pulsed infrared beam was compared with a placebo in the treatment of myofascial pain in the cervical region. The patients were submitted to 12 sessions on alternate days to a total energy dose of 5 J each. At each session, the four most painful muscular trigger points and five bilateral homometameric acupuncture points were irradiated. Those in the placebo group submitted to the same number of sessions following an identical procedure, the only difference being that the laser apparatus was nonoperational. Pain was monitored using the Italian version of the McGill pain questionnaire and the Scott Huskisson visual analogue scale.

The results show a pain attenuation in the treated group and a statistically significant difference between the two groups of patients, both at the end of therapy and at the 3-month follow-up examination.

Address correspondence and repent requests to:  Dr. F. Ceccherelli at the Istituto di Anestesiologiae Rianimazione, via C. Battisti 267, 35121 Padova, Italia.

 The Clinical journal of Pain 5:301-304

copyright 1989 Raven Press, Ltd., New York   Wave- length Power Energy Density Power Density Energy per point Pulses 904nm 5mW av (25Wpeak) (not given) (not given) 1 J 1KHz x 200nS

Pain scores and side effects in response to low level laser therapy (LLLT) for physical trigger points.

E Liisa Laakso Carolyn Richardson, and Tess Cramond

1: Physiotherapy Department, Royal Brisbane Hospital, Brisbane; 2: Physiotherapy Department, University of Queensland, Brisbane; and 3: Pain Clinic, Royal Brisbane Hospital, Brisbane, Queensland, Australia.

Clinically, Low Level Laser Therapy – LLLT has been used successfully in the treatment of chronic pain but many have questioned the scientific basis for its use. Many studies have been poorly designed or poorly controlled.

A double-blind, placebo-controlled, random allocation study was designed to analyse the effect of second daily infrared (JR) laser (820 nm, 25 mW) and visible red laser (670 nm, 10 mW) at 1 J/cm2 and 5 J/cm2 on chronic pain. Forty-one consenting subjects with chronic pain conditions exhibiting myofascial trigger points in the neck and upper trunk region underwent five treatment sessions over a two week period. To assess progress, pain scores were measured using visual analogue scales before and after each treatment. The incidence of side effects was recorded.

All groups demonstrated significant reductions in pain over the duration of the study with those groups which received infrared (820 nm) laser at I J/cm2 and 5 J/cm2. Demonstrating   the most significant effects (p < 0.001). Only those subjects who had active laser treatment experienced side effects.

Results indicated that responses to LLLT at the parameters used in this study are subject to placebo and may be dependent on power output, dose and/or wavelength.

Addressee for Correspondence: E Liisa Laakso BPhty PhD, Physiotherapy Department, Royal Brisbane Hospital, Herston, (Queensland, Australia, 4029.   6/97 Rep. US $8-10-12 Copyright 1997 by LT Publishers, U.K. Ltd. LASER THERAPY. 9: 67-72 67

Two wavelengths studied.

Best results with the higher powered infrared laser compared with the lower powered red laser   Wave- length   Average Power Energy Density Power Density Energy Pulses Time Beam Spot size 820 25mW 5 J/Cm2 0.89 W/Cm2 0.14 J 5,000Hz 5.62 secs 0.89Cm2

Low level laser therapy (LLLT) of tendinitis and myofacial pains a randomized, double-blind, controlled study.Mimmi Logdberg-Anderssont (1), Sture Mutzell (2), and Ake Hazel (3) 1: Akersberga Health Care Centre, 2: Danderyd University Hospital, Danderyd, and   3: Vaxholm Health Care Centre, Stockholm, Sweden.

The purpose of this randomised, double-blind study was to examine the effect of GaAs laser therapy for tendonitis and myofascial pain in a sample from the general population of Akersberga in the northern part of Greater Stockholm.

176 patients (of an original group of 200) completed the scheduled course of treatment. The patients were assigned randomly to either a laser group (92 patients, of whom 74 had tendonitis, completed the study) or a placebo group (84 patients, of whom 68 had tendonitis, completed the study). All 176 patients received six treatments during a period of 3-4 weeks. Their pain was estimated objectively using a pain threshold meter, and subjectively with a visual analogue scale before, at the end of, and four weeks after the end of treatment.

  Laser therapy had a significant, positive effect compared with placebo measured from the first assessment to the third assessment, four weeks after the end of treatment. Laser treatment was most effective on acute tendonitis.

 Address for Correspondence   Sture Mutzell, Danderyd University Hospital 5-182 87 Danderyd, Sweden.  03/07 Rep US 10-12-14, 1997 By LT Publishers, U.K., Ltd.

 LASER THERAPY, 1997:9: 79-86   Wave- length Power Energy Density Power Density Energy per point Pulses 904nm 8mW av (10Wpeak) 0.5-1.0 J/Cm2 (not given) 1J 4KHz x 180nS

The efficady of laser therapy for musculoskeletal and skin disorders: a criteria-based meta-analysis of randomized clinical trials.

Beckerman H, de Bie RA, Bouter LM, et al.

The efficacy of laser therapy for musculoskeletal and skin disorders has been assessed on the basis of the results of 36 randomized clinical trials (RCTs) involving 1,704 patients. For this purpose, a criteria-based meta-analysis that took into account the methodological quality of the individual trials was used. The studies with a positive outcome were generally of a better quality than the studies with a negative outcome. No clear relationship could be demonstrated between the laser dosage applied and the efficacy of laser therapy, or between the dosage and the methodological score.

In general, the methodological quality of these studies appeared to be rather low. Consequently, no definite conclusions can be drawn about the efficacy of laser therapy for skin disorders. The efficacy of laser therapy for musculoskeletal disorders seems, on average, to be larger than the efficacy of a placebo treatment. More specifically, for rheumatoid arthritis, post-traumatic joint disorders, and myofascial pain, laser therapy seems to have a substantial specific therapeutic effect.

Further RCTs, avoiding the most prevalent methodological errors, are needed in order to enable the benefits of laser therapy to be more precisely and validly evaluated.

Physical Therapy. 72(7):483-91, 1992 Jul. (60 ref)

LLLT using a diode laser in successful treatment of a herniated lumbar/sacral disc, with magnetic resonance imaging (MRI) assessment: a case report.

Tatsuhide Abe

Abe Orthopaedic Clinic Futuoka City Fukuoka Prefecture Japan X12′ A 40-year-old woman presented at the Abe Orthopedic Clinic with a 2-year history of lower hack pain and pain in the left hip and leg diagnosed as a ruptured disc between the 5th lumbar/lst sacral vertebrae. The condition had failed to respond to conventional treatment methods including pelvic traction, nonsteroid anti-inflammatory drugs and aural block anesthetic injections.

MRI scans were made of the affected disc, showing it protruding on the left side through the aural membrane. The gallium aluminum arsenide (GaAlAs) diode laser (830 nm, 60 mW) was used in outpatient therapy and after 7 months, the patient’s condition had dramatically improved demonstrated by motility exercises. This improvement was confirmed by further MRI scans, which showed clearly the normal condition of the previously herniated L5/SI disc.

O898-5901/89/020093-03 $05.00   © 1989 by John Wiley & Sons. Ltd.

Physiological responses in chronic pain patients LLLT protocol.

Scott D. Fender and David Diffee, Pain Research Group, Arvada, Colorado, U.S.A.

Use of Low Reactive Level Laser Therapy (LLLT) utilising helium-neon lasers has increased lately especially in pain control. New protocols are being developed aimed at a complex of primary and secondary symptomologies. One of these protocols, Stellate Ganglion Stimulation, has shown in our research a unique set of developments.

Targeting the area of the stellate ganglion is showing great promise in the rehabilitation of patients with a history of chronic musculoskeletal pain syndromes, but several patients with preexisting psychological symptomology have exacerbated during the initial stages of utilization of this protocol. Patients with a history of psychological diagnosis for dysthymia, anxiety, post traumatic stress disorder or minor diffuse brain injury have shown an exacerbation of these symptomologies during the initial phases of stimulation treatment.

Overall, response to this form of therapy seems to be positive but some patients require dermatomal and/or site-specific therapy to maximize outcome. With specific psychological treatment combined with a more conservative amount of stimulation initially the increase in these symptoms shows a tendency to remit with the pain response. Our continued research is currently focusing on the mechanisms for this type of response as well as protocol refinement to maximize its effectiveness.

Address for correspondence:  Scott D. Fender DDS DAPM, 5275 Marshall Street, Suite 203, Arvada, CO 80002, U.S.A.  0898-5901/92/040169-05 $07.50  © 1992 by John Wiley & Sons, Ltd.

Clinical application of GaAIAs 830 NM diode, low level laser therapy  in treatment of Rheumatoid Arthritis.

Kanji Asada, Yasutaka Yutani, Akira Sakawa and Akira Shimazu

Department of Orthopaedic Surgery, Osaka City University Medical School, Japan

The authors have been involved in the treatment of rheumatoid arthritis (RA), in particular chronic poly-arthritis and the associated pain complaints. The biggest problem facing such patients is joint contracture, leading to bony ankylosis. This in turn severely restricts the range of motion (ROM) of the RA-affected joints, thereby seriously restricting the patient’s quality of life (QOL). The authors have determined that in these cases, daily rehabilitation practice is necessary to maintain the patient’s QOL at a reasonable level.

The greatest problem in the rehabilitation practice is the severe pain associated with RA-affected joints, which inhibits restoration of mobility and improved ROM. LLLT or low reactive level laser therapy has been recognized in the literature as having been effective in pain removal and attenuation. The authors accordingly designed a clinical trial to assess the effectiveness of LLLT in RA related pain (subjective self-assessment) and ROM improvement (objective documented data).

From July 1988 to June 1990, 170 patients with a total of 411 affected joints were treated using a GaAlAs diode laser system (830 nm, 60 mW C/W). Patients mean age was 61 years, with a ratio of males: females of 1: 5.25 (16%: 84%). Effectiveness was graded under three categories: excellent (remarkable improvement), good (clearly apparent improvement), and unchanged (little or no improvement).

For pain attenuation, scores were: excellent – 59.6%; good – 30.4%; unchanged – 10%.

For ROM improvement the scores were: excellent – 12.6%; good – 43.7%; unchanged – 43.7%. This gave a total effective rating for pain attenuation of 90%, and for ROM improvement of 56.3%.

0898-5901/91/020077-06 $05.00  

© 1991 by John Wiley & Sons, Ltd.

Mechanisms of the analgesic effect of therapeutic lasers in vivo.

  L Navratil (1) and I Dylevsky (2)

1: Outpatient Department of Radiobiology, Institute of Biophysics, First Medical Faculty, and 2: Department of Functional Anatomy, Second Medical Faculty and Faculty of Physical Education Charles University, Prague, Czech Republic

The analgesic effects in the course of application of therapeutic lasers to affected tissue have been described in a number of works in the literature. Although a few scientific-based reports have appeared, those on laser-induced analgesia are mainly clinical works describing the effect of the therapy which, however, do not study the mechanism of the laser action.

There are several different possible responses induced by non-invasive low level laser therapy (LLLT). The purpose of the present communication is to review the arrangement and characterisation of these responses. By being aware of these effects, the laser therapist can acquire a physiological and morphological scheme making possible the appropriate choice of the site of application of LLLT, choice of the irradiation technique, and selection of appropriate doses.

Address for Correspondence: Leos Navratil MD PhD, Department of Clinical Radiahiology, Institute of Biophysics, First Medical Faculty, Charles University Saln1ovska 3, CZ 120 00, Prague 2, Czech Republic.

© 1997 by LT Publishers U.K, Ltd.

LASER THERAPY 1997:9 : 33-40

Experimental Physiology (1994) 79. 227-234 Printed in Great Britain

Laser’s Effect on Bone and Cartilage Change Induced by Joint Immobilization An Experiment with Animal Model.

Masami Akai, MD,1* Mariko Usuba, RPT,1 Toru Maeshima, Yoshio Shirasaki,2 and Shozo Yasuaka, MD3 ‘Department of Physical Therapy Tsukuba College of Technology, Tsukuba, Ibaraki, Japan Mechanical Engineering Laboratory, Agency of Industrial Science and Technology, TsuPuba, Ibaraki Japan. Yasuoka Orthopaedic Clinic, Mitaka, Tokyo, Japan

Objective:

Influence of low-level (810nm, Ga-Al-As semiconductor) laser on bone and cartilage during joint immobilization was examined with rats’ knee model.

Materials and Methods:

The hind limbs of 42 young Wistar rats were operated on in order to immobilise the knee joint. One week after operation they were assigned to three groups; irradiance 3.9W/cm2, 5.8W/cm2, and sham treatment. After 6 times of treatment for another 2 weeks both hind legs were prepared for 1) indentation of the articular surface of the knee (stiffness and loss tangent), and for 2) dual energy X-ray absorptiometry (bone mineral density) of the focused regions.

Results and Conclusions:

The indentation test revealed preservation of articular cartilage stiffness with 3.9 and 5.8W/cm2 therapy. Soft laser treatment has a possibility for prevention of biomechanical changes by immobilisation.

Correspondence to:  Masami Akai, M.D., Department of Central Rehabilitation Service University Hospital, Faculty of Medicine, University of Tokyo 7-3-1 Hongo, Bunkyo-ku, Tokyo 113, Japan.

Lasers Surg. Med. 21:480-484, 1997.   © 1997 Wiley-Liss, Inc.

Histological and Clinical Responses of Articular Cartilage to Low-level Laser Therapy: Experimental Study.

I. RUIZ CALATRAVA, J.M.SANTISTEBAN VALENZUELA, R.J.G0MEZ-VILLAMANDOS J.I.REDONDO, J.C.G0MEZ-VILLAMANDOS, l.AVIGA JURADO

Department of Veterinary Clinical Pathology-Surgery, Faculty of Veterinary Medicine, University of Cordoba, Spain. Correspondence to 1. Ruiz Calatrava, Department of Veterinary Clinical Pathology-Surgery, Faculty of Veterinary Medicine, University of Cordoba, Avda. Medina Azahara, 9, 14005 Cordoba, Spain

Abstract

This study was carried out to evaluate the effects of low-level laser irradiation on experimental lesions of articular cartilage.

A standard lesion was practiced on the femoral trochlea of both hind limbs of 20 clinically normal Californian rabbits. These animals were divided into two groups of 10 individuals each, depending on the laser equipment used for treatment. One group was treated with HeNe laser (8 J cm – 2, 632.8 nm wavelength) and the other with infra-red (JR) laser (8 J cm – 2, 904 nm wavelength). In both groups, five points of irradiation to the right limb alone were irradiated per session for a total of 13 sessions, applied with an interval of 24 h between sessions. These points were the following: left and right femoral epicondyles, left and right tibial condyles and the centre of articulation. The distance between these points was approximately 1 cm. The untreated left limb was left as a control. During treatment, extension angle and periarticular thickness were considered. At the end of the treatment, samples were collected for histopathological study and stained with: Haematoxylin-Eosin, PAS and Done.

The results show a statistically higher anti-inflammatory capacity of the IR laser (p<0.0001). The functional recovery was statistically similar for both treatments (p<0.176). Histological study showed, at the end of the treatment, hyaline cartilage in the IR group, fibrocartilage in the HeNe group and granulation tissue in the control limbs. Clinical and histological results indicated that this laser treatment had a clear anti-inflammatory effect that provided a fast recuperation and regeneration of the articular cartilage.

Lasers in Medical Science 1997, 12:117-121

© 1997 W.B. Saunders Company Ltd

THERMOGRAPHIC STUDY OF LOW LEVEL LASER THERAPY FOR ACUTE-PHASE INJURY.

Yoshimi Asagai, M.D.1, Atsuhiro Imakiire, M.D.2, Toshio Ohshiro, M.D.3,    1. Shinano Handicapped Children`s Hospital Shimosuwa, Nagano, Japan  2. Department of Orthopaedic Surgery, Tokyo Medical University Shinjuku, Tokyo, Japan 3. Japan Medical Laser Laboratory, Shinanomachi, Tokyo, Japan.

Acute-phase injury is generally treated by localized cooling of the region, and rarely by theactive use of low level laser therapy (LLLT) in Japan. Thermographic studies of acutephase injury revealed that circulatory disturbances at the site of trauma occurred due to swelling and edema on the day following the injury, and that skin temperature was high at the site of the trauma and low at the periphery. Following LLLT, circulatory disturbances rapidly improved, while temperature in the high temperature zone around the site of trauma fell by 3 degrees on the average, but at the periphery the low temperature rose by 3 degrees on the average to nearly normal skin temperature. Clinically, swelling and edema improved. LLLT was also useful in treating necrosis of the skin in the wound area and in accelerating healing of surgical wounds of paralytic feet, which are prone to delayed, wound healing and also wounds due to spoke injury. LLLT is useful in treating swelling and edema in acutephase injury and in accelerating healing of surgical wounds.

Key words: Laser therapy, acute-phase injury, thermography, ankle joint sprain

Introduction

It has not been clearly defined to date if LLLT is indicated for acute-phase injury with swelling and calor. Yet it is frequently considered to be contraindicated in acute-phase injury. We have previously reported that, in patients with cerebral palsy with reduced peripheral skin temperature, the skin surface temperature was elevated to normal after LLLT

(1). in this study, we used thermography to examine changes in skin temperature following LLLT chie fly inacute-phase injury. 

Patients and Methods

Subjects were 7 patients with sprains of the ankle joint, two patients with fractures of the tibial shaft, and one patient with dislocation of the elbow joint. LLLT was also used in orthopedic surgery for disorders of the distal lower extremity such as talipes varus, which is frequently followed by postoperative necrosis of the skin in the wound area as well as delayed wound healing, and pre- and postoperative treatment of paralytic feet with circulatory disturbances. The procedure was as follows. Room temperature was maintained at 25oC. After acclimatization for 20 minutes, continuous irradiation with a GaAlAr semiconductor laser (JQ305, Minato Medical Science Co., Ltd., Japan) with the wavelength adjusted to 810 nm and the output to 100mW was applied using the contact method.

The spot size on the tissue was 0.56cm2 with a power density of 17.86W/cm2 at 100mW, the energy density per point being 107.5J/cm2. The area surrounding the site of trauma was irradiated for 3 to 5 minutes in total, one minute per spot, and changes in the skin surface temperature were followed using Thermotracer TH1106. The test was performed from immediately after injury till 5 days post-trauma, an average of two days after injury. 

Results

Immediately after injury, the skin surface temperature was elevated to about 34 degrees at and around the site of trauma (Fig. 1). On the day following the injury, skin temperature remained elevated around the site of trauma to the same degree as immediately after injury, but was markedly reduced to about 29 degrees at its periphery (Fig. 2). Skin temperature began to fall in the high temperature zone and began to rise in the peripheral low temperature zone immediately following LLLT, and the peripheral skin temperature reached a peak or became almost normal at about 40 minutes after the initiation of irradiation (Fig. 3). Changes in post-LLLT skin temperature in all patients 

a b c

Fig. 1. Sprain of the right ankle joint immediately after injury: 

a) Before irradiation, a high temperature zone extends over the trauma site    and a wide area around it.

 b) At 10 minutes after LLLT,skin temperature fell at the trauma site, and rose in the toes at the periphery.

 c) At 20 minutes after LLLT,skin temperature was re-elevated at the trauma site.

31 Laser Therapy Vol. 12 Official Journal of the World Association for Laser Therapy (WALT) showed that skin temperature fell by an average of 3degrees in the high temperature zone around the site of trauma, and rose by an average of 3 degrees in the peripheral low temperature zone, both to approximately normal skin temperature. Clinically, swelling and edema were diminished and repeated irradiation suppressed exacerbation of swelling and edema.Patients receiving pre- and post-operative   application of LLLT for such conditions as talipes varus, in which postoperative necrosis of skin in the wound area and delayed wound healing are frequent, spoke injury produced when the foot is caught in a bicycle’s spokes (Fig. 4), and paralytic feet with distal circulatory failure due to spin bifida or cerebral palsy, we have not seen any necrosis of the skin in the wound area or delayed wound healing. 

Discussion

There have been many reports on wound healing (2, 3).Currently, the site of trauma is cooled to reduce swelling in acute-phase injury. An important problem in the healing

of wounds and associated fractures is how to suppress swelling and edema, and improvement of local swelling and edema is also crucial for the healing of ligament injury in sprained ankles. However, the use of LLLT for sprained ankles is controversial (4). Thermography has been used for evaluating the effect of LLLT (5). In the present thermographic evaluation, the surface temperature was high around the trauma site and low in the periphery, which indicated that local blood and lymph flow were impaired by swelling and edema, thus raising temperature. When LLLT was applied to these areas, it was found that skin temperature fell in the high temperature zone but

rose in the low temperature zone to approximately the normal temperature in both zones, suggesting improved  blood and lymphatic circulation. Clinically, reduction of local swelling and edema was considered to have led to the improvement of blood and lymph flow.

Conclusions

1: In acute-phase injury, skin temperature was elevated around the site of trauma, and reduced in the periphery on the day following the injury. 

2: Immediately after irradiation, skin temperature fell by 3oC on the average in the high temperature zone around the trauma site, and rose by 3oC on the average reaching normal temperature in the low temperature zone at the periphery of the injury.

3: LLLT rapidly improved blood and lymphatic flow, which had been impaired by injury, and alleviated swelling and edema. LLLT was also useful in accelerating healing  of the surgical wound. 

Address for Correspondence:  Yoshimi Asagai MD, Director, Shinano Handicapped Children`s Hospital, 6525-1 Shimosuwa, Suwagun,Nagano, Japan 393

a b c

Fig. 2. Contusion of the right tibial shaft 1 day after injury: a) before irradiation,

Skin temperature is high at the trauma site, and low at the periphery.

b) At 10 minutes after LLLT:skin temperature fell at the trauma site, and rose slightly at the periphery. c) At 40 minutes after LLLT: skin temperature at the periphery reached a peak and nearly normal skin temperature

a b c

3. Fracture of the right tibia 2 days after removal of nailing:

 a) Before irradiation, skin temperature was high in the surgical wound and low at the periphery.

 b) Immediately after LLLT, skin temperature was reduced in the high temperature zone, and elevated in the low temperature zone.

c) At 40 minutes after LLLT, skin temperature at the periphery reached a peak.

a b

 4. Spoke injury:

 a) At 6 days after injury the left foot had been caught in the rear wheel of a bicycle, and this left a large skin defect on the back of the foot and a contusion, with marked swelling and edema.

b) After daily LLLT, epithelialization was observed and the wound healed at 23 days after injury.

http://www.walt.nu Laser Therapy Vol. 12 32

References

1. Asagai,Y.,Ueno,R.,Miura,Y.,Ohshiro,T.(1995):Application of low reactive-level laser therapy(LLLT) in patients with cerebral palsy of the adult tension athetosis type. Laser Therapy,7:113-118.

2. asaki, K., Ohshiro, T. (1997): Assessment in the rat model of the effects of 830nm diode laser irradiation in a diachronic wound hearing study. Laser Therapy,

9:25-32.

3. ubota, J., Ohshiro, T. (1996): The effects of diode laser LLLT on flap survival: Measurement of flap microcirculation with laser speckle flowmetry. Laser Therapy, 8:241-246.

4. Robert A. Henrica C.W., Ton F, Lenssen, Frans, A.J.M., Gauke, K., Paul G.(1998): Low-level laser therapy in ankle sprains: A randomized clinical trial.

Arch. Phys. Med. Rehabil, 79:1415-1420.

5. Ohshiro, T. (1988): Thermographic analysis and evaluationof pain attenuation with the GaAlAs LLLT laser system. In Ohshiro T and Calderhead RG: ‘Low Lever Laser Therapy: A Practical Introduction’. John Wiley & Sons, Chichester, UK. pp.56-62. 33 Laser Therapy Vol. 12 Official Journal of the World Association for Laser Therapy (WALT)

Lower Back Pain, Low Level Laser Therapy (LLLT) Research.

Abstract

Objective:The aim of this study was to investigate the clinical effects of low-level laser therapy (LLLT) in patients with acute low back pain (LBP) with radiculopathy.

Background Data : Acute LBP with radiculopathy is associated with pain and disability and the important pathogenic role of inflammation. LLLT has shown significant anti-inflammatory effects in many studies.

 Materials and Methods: A randomized, double-blind, placebo-controlled trial was performed on 546 patients. Group A (182 patients) was treated with nimesulide 200 mg/day and additionally with active LLLT; group B (182 patients) was treated only with nimesulide; and group C (182 patients) was treated with nimesulide and placebo LLLT. LLLT was applied behind the involved spine segment using a stationary skin-contact method. Patients were treated 5 times weekly, for a total of 15 treatments, with the following parameters: wavelength 904 nm; frequency 5000 Hz; 100-mW average diode power; power density of 20 mW/cm² and dose of 3 J/cm²; treatment time 150 sec at whole doses of 12 J/cm². The outcomes were pain intensity measured with a visual analog scale (VAS); lumbar movement, with a modified Schober test; pain disability, with Oswestry disability score; and quality of life, with a 12-item short-form health survey questionnaire (SF-12). Subjects were evaluated before and after treatment. Statistical analyses were done with SPSS 11.5.

 Results: Statistically significant differences were found in all outcomes measured (p < 0.001), but were larger in group A than in B (p < 0.0005) and C (p < 0.0005). The results in group C were better than in group B (p < 0.0005). Conclusions: The results of this study show significant improvement in acute LBP treated with LLLT used as additional therapy.

Ljubica M. Konstantinovic, Ph.D.,¹Zeljko M. Kanjuh, M.S.,¹Andjela N. Milovanovic, M.S.,²Milisav R. Cutovic, Ph.D.,¹Aleksandar G. Djurovic, Ph.D.,³Viktorija G. Savic, M.S.,⁴Aleksandra S. Dragin, M.S.,¹and Nesa D. Milovanovic, M.S.¹

¹Clinic for Rehabilitation, Medical School, Belgrade, Serbia ²Center for Physical Medicine, Clinical Center of Serbia, Belgrade, Serbia.³Clinic for Rehabilitation, Military Medical Academy, Belgrade, Serbia.⁴Department for Physical Medicine, Institute for Rheumatology, Belgrade, Serbia.

Address correspondence to: Ljubica Konstantinovic, Ph.D. Clinic for Rehabilitation dr Miroslav ZotovicMedical School, University of Belgrade

Sokobanjska 13, Belgrade

 Chiropractic Treatment

Chiropractic addresses the function of central nervous system which is the “master system” of the body controlling ad regulating function of all other subsystems including musculoskeletal system. Properly aligned skeletal system would improve performance, reduce the risk of injury and improve healing of existing injuries.

Chiropractors specialize in the non-drug treatment of musculoskeletal problems, including joint sprains and disc injuries. To some extent, the chiropractic approach to sports injuries is similar to that of traditional medical care.

Usually chiropractor’s initial examination would include standard orthopaedic and neurological tests to diagnose whether a particular pain is due to a strain, sprain, or disc problem. X-ray examination is also performed to screen for fractures and other bone disorders, such as osteoporosis.  

Chiropractic management of sports injuries often includes widely used physical therapies such as ice, Low Level laser therapy (LLLT) to reduce swelling and inflammation, or electronic muscle stimulation for muscle strains and spasms. 

Importance of Restoring Structural Body Balance.

Chiropractic management of sport injuries has an emphasis on adjustment and improving function of spinal and other joints through manipulation as well as restoring overall structural balance of the body. Chiropractor assess the effect of the muscle injury on the rest of the body as it would cause tightening of other muscle and joints in order to maintain general balance. Chiropractic adjustments help to restore the natural balance that was present before the injury.

Call 02476 222002.Registered with BUPA, AXA  PPP,  AVIVA, Simplyhealth, HSA, Standard Life, Mercia health, BHSF, Pru health,Cigna, Police health care scheme, Medicare,  Medisure, Medicash, Groupma, Allianz, and all other healthcare insurers .

The Neck Cervical Spine Anatomy.

The cervical spine begins at the base of the skull. Seven vertebrae make up the cervical spine with eight pairs of cervical nerves. The individual cervical vertebrae are abbreviated C1, C2, C3, C4, C5, C6 and C7. The cervical nerves are also abbreviated; C1 through C8.

Cervical Vertebrae and Supporting Structures

The cervical bones, the vertebrae are smaller in size when compared to other spinal vertebrae. The purpose of the cervical spine is to contain and protect the spinal cord, support the skull, and enable diverse head movement ( rotate side to side, bend forward and backward).

A complex system of ligaments, tendons, and muscles help to support and stabilize the cervical spine. Ligaments work to prevent excessive movement that could result in serious injury. Muscles also help to provide spinal balance and stability, and enable movement. Muscles contract and relax in response to nerve impulses originating in the brain. Some muscles work in pairs or as antagonists. This means when a muscle contracts, the opposing muscle relaxes. There are different types of muscle: forward flexors, lateral flexors, rotators, and extensors.

Spinal Cord and Cervical Nerve Roots

Nerve impulses travel to and from the brain through the spinal cord to a specific location by way of the peripheral nervous system (PNS). The PNS is the complex system of nerves that branch off from the spinal nerve roots. These nerves travel outside of the spinal canal or spinal cord into the organs, arms, legs, fingers – throughout the entire body.

Injury or mild trauma to the cervical spine can cause a serious or life-threatening medical emergency (spinal cord injury or SCI, fracture). Pain, numbness, weakness, and tingling are symptoms that may develop when one or more spinal nerves are injured, irritated, or stretched. The cervical nerves control many bodily functions and sensory activities.

C1: Head and neck
C2: Head and neck
C3: Diaphragm
C4: Upper body muscles ( Deltoids, Biceps)
C5: Wrist extensors
C6: Wrist extensors
C7: Triceps
C8: Hands

Neck Pain.

The neck (cervical spine) is composed of vertebrae that begin at the base of the skull and end in the upper torso. The vertebrae along with the ligaments provide stability to the spine. The muscles allow for support and movement of the neck. The neck supports the weight of the head which is 5 kg amounting to a significant load for the neck to cope with during motion thus increasing stress onto the neck (cervical spine). Compare to the rest of the spine, the neck is less protected and is more susceptible to injury and various disorders that can result in pain and restricted motion. Sometimes neck pain is a temporary condition going away on its own accord. Other cases require medical diagnosis and treatment to relieve the symptoms.

Causes

Neck pain may result from injury to the soft tissues including muscles, ligaments, nerves, bones and joints of the spine. Soft tissue injuries or prolonged wear and tear are amongst the most common causes of neck pain. Infection or tumors may cause neck pain in rare instances. Sometimes neck problems may be the source of pain in the upper back, shoulders or arms.

Neck pain may result from abnormalities in the soft tissues, muscles, ligaments, and nerves as well as in bones and joints of the spine. The most common causes of neck pain are soft-tissue abnormalities due to injury or prolonged wear and tear. In rare instances, infection or tumors may cause neck pain. In some people, neck problems may be the source of pain in the upper back, shoulders, or arms. Cold Laser Therapy section this therapy has a five star rating for treating neck injuries and conditions.

Neck Injury

Due to its flexibility and the weight of the head it supports the neck is extremely vulnerable to injury. Road traffic or diving accidents, contact sports, and falls are the main causes of neck injury. A “rear end” shunt during a car accident may result in hyper-extension, a backward motion of the neck beyond normal limits, or hyper- flexion a forward motion of the neck beyond normal limits. The use of seat belts and head restrains in cars can help to prevent or minimize neck injury. The soft tissues such as muscles and ligaments are most commonly involved. Severe injuries including fracture or dislocation of the neck may lead to the damage the spinal cord and cause paralysis.

Arthritis of the Neck

The neck is a common site for arthritis to develop.

The most common type of arthritis that affects the neck is osteoarthritis. This condition is also known as cervical spondylosis, cervical osteoarthritis, or degenerative joint disease of the neck.

Other forms of arthritis that can affect the neck are rheumatoid arthritis, psoriatic, ankylosing spondylitis, Reiter’s disease, gout, pseudogout, and diffuse idiopathic skeletal hyperostosis (DISH).

Rheumatoid arthritis can destroy joints in the neck and cause severe stiffness and pain. Rheumatoid arthritis typically affects upper neck area. View our Cold Laser Therapy section this therapy has a five star rating for treating  this condition

Cervical spondylosis is a condition that mainly affects older people, usually over the age of 45. Men are affected more often than women. This condition results from degenerative changes that occur in the cervical spine (the spine of the neck). Changes in cartilage metabolism lead to slow wear and tear of discs and joints in the neck. Over time, the degenerative changes can lead to a bulging or herniated disc, calcium build-up within the disc, or bony growths on the spine. The end result is nerve compression or inflammation.

Also, depending on which way the disc herniates or the direction of the bony growths, there is a possibility that the spinal cord or nerve roots leading from the spinal cord could be compressed.

There is also the possibility that the blood flow to certain nerves may be affected.

Symptoms depend on the location of the nerve compression, but can include pain, numbness, weakness, headaches, urinary problems, etc.

Initially the person may not have any symptoms.

Others will have neck or shoulder pain, headaches in the back of the head, or stiffness of the neck. They may have difficulty turning or bending the neck from side-to-side.

Some will have pain that shoots down a certain part of the arm. They may also notice numbness, weakness, or pain in the arm. One or both sides may be affected. Often it causes the hands to become clumsy.

Some individuals will have numbness or weakness in their legs. This indicates that there may be pressure on the spinal cord. This is considered a surgical emergency. Many with this condition will have decreased vibration-sense in their legs. They may be unsteady while walking. In fact, spondylosis with myelopathy is a fairly common cause of unsteadiness in the elderly.

Others will have a specific level on the chest or abdomen where there is a noticeable change in sensation.

Problems with urination may occur. Some will have to urinate more often, while others will have to urinate urgently. A few will develop urinary incontinence.

The symptoms may get worse with turning, extending, or bending the neck. In others, coughing or straining may temporarily cause shooting pain in the arms or shoulders or it may worsen weakness in the legs.

Physical exam may reveal numbness or pain along a certain nerve distribution. Certain muscles may be weak and the reflexes not as brisk as normal. The affected individual may have difficulty with turning the neck or bending it from side to side. The arms or legs may be stiff. The hands may be weak and the muscles of the hands atrophied.

X-rays can be helpful in making the diagnosis. However, though X-ray findings of degenerative changes are often found in many older people, only a few will truly evidence the neurological changes caused by this condition. Alone, finding degenerative changes on X-rays is not conclusive but part of an overall determination of this condition that must take into consideration other factors. X-rays done with flexion and extension may show instability.

CT scan can be used to look at the spinal column and see if there is any narrowing or other abnormality.

MRI can also be used to look at the spinal column and see if there is any narrowing or other abnormality.

Nerve conduction studies and electromyography can be done to test the nerves and muscles.

The primary treatment for this condition is first to determine what type of arthritis is causing the problem. The second is making sure the neck is not unstable. Then, it is important to restrict neck movements. This is usually done with a cervical collar.

Medical treatment is usually with anti-inflammatory medicines, analgesics, and muscle relaxants. However, if this fails, then surgery may be necessary.

Physical therapy modalities such as Cold/Low level laser therapy, including stretching and strengthening exercises.

Patients may respond to steroid injections placed in the epidural space.

If that does not work, then surgery to decompress the nerve and stabilize the neck may be necessary.

Surgery is usually done if:

Conservative measures such as a cervical collar do not work.
There is severe pain.
There are significant neurological deficits, such as difficulty walking, severe hand weakness, or bladder problems.
There is compression of the spinal cord.

With any nerve condition, if it is not treated early, there is a danger that the loss of nerve function may be permanent. Nerves are very delicate. Once they are injured beyond a certain point, they do not recover. Therefore, the symptoms that can be caused by this condition could become permanent if not treated appropriately (i.e., numbness, weakness, and urinary problems).

There is no specific way to prevent this condition. However, good posture should be maintained.

Also, avoid repetitive injuries to the neck and cervical spine.

Neck Disc Injury, “Slipped Disc”, also known as Prolapsed, Bulging, Herniated or Extruded Disc

Disc Problems

What Causes Disc Problems?

Discs are the soft but strong cushions that separate the bones (vertebrae) in your spine and absorb shock as you move. Repeated strain over time, an injury, or sudden, forceful movements can damage discs and irritate nerves, causing pain, numbness, or tingling in your back and legs, neck,Shoulders and arms.

Common Slipped Disc, Neck Disc Injury

A Slipped Disc or (Disc Prolapsed) in the neck is a common cause of neck pain. Slipped disc treatment during the early stages involves limited mobilisation. Later, more active physical therapy rehabilitation is useful. During the later stages neck pain treatment can be enhanced if a pillow is used to support the neck.

Other Causes

Less common causes of neck pain include tumors, infections, or congenital abnormalities of the vertebrae.

Whiplash Associated Disorder (WAD) and Cervical Spine Injury

What is whiplash? 

An acute “whiplash” injury follows sudden or excessive hyper-extension, hyper-flexion, or rotation of the neck and causes neck pain and other symptoms. “Whiplash” injury is common in road traffic accidents, and may also be caused by sports injuries, falls or assaults. Most cases of “whiplash” injury occur as the result of rear-end vehicle collisions at speeds of less than 10 miles per hour. Patients present with neck pain and stiffness, occipital headache, thoracic back pain and/or lumber back pain, and upper-limb pain and paraesthesia.

There are two types of injury:

• Typical cervical hyper-extension injuries occur in passengers an drivers of a stationary or slow-moving vehicle that is struck from behind. Body is thrown forward but the head lags, resulting in hyper-extension of the neck. When the head and neck have reached maximum extension, the neck then snaps into flexion.
• A rapid deceleration injury throws the head forwards and flexes the neck. When the chin hits the chest it limits forward flexion but the forward movement may be sufficient to cause longitudinal distraction and neurological damage. Hyper-extension may occur in the subsequent recoil.

“Whiplash” injuries may occur at relatively low vehicle velocity impacts. One study showed the cervical muscle injury threshold to be about 10 km/hour. Whiplash-associated disorders (WAD) can be classified by the severity of signs and symptoms:

• Grade 1: no complaints or physical signs.
• Grade 2: indicates neck complaints but no physical signs.
• Grade 3: indicates neck complaints and musculoskeletal signs.
• Grade 4: neck complaints and neurological signs.
• Grade 5: neck complaints dislocation and fracture. Most cervical spine fractures occur predominantly at two levels:

1. One third of injuries occur at the level of C2, and one half of injuries occur at the level of C6 or C7.

2. Most fatal cervical spine injuries occur in upper cervical levels, either at cranio-cervical junction C1, or at C2

 Uncomplicated cases of Whiplash Associated Disorder (WAD)

“Whiplash”(WAD) cases that are uncomplicated are the result of sprained ligaments in the neck. The muscles of the neck spasm naturally, as a protective reaction. The “Whiplash”(WAD) injury may cause stiff neck and pain that may be present down one or both arms if the nerves of neck part of spinal cord get compressed. Pain Relief for “Whiplash”(WAD) can be found with Chiropractic  or Physiotherapy including pain medication and Cold/ low level laser therapy,

Patient’s with chronic whiplash benefited from Chiropractic  or Physiotherapy

Severe cases

In severe cases of “whiplash” may last for a month or more with persistent and in some cases constant pain. This may indicate that the “whiplash” injury has extensive damage and resulting in discs rupturing and trapped nerves in the neck. This may also predispose to a “slipped”disc, also known as a prolapsed, bulging, ruptured or herniated disc in the back. (View our Cold/low level laser therapy Section, a five star rating has been given to cold/low level laser therapy for soft tissue neck injuries)

Cold/Low level Laser Therapy (LLLT). treatment research  for Neck Pain

Neck pain  is common, often persistent, and responds poorly to medication. So it is encouraging to read that a relatively novel, non-invasive treatment shows evidence of effectiveness. A systematic review and meta-analysis of 16 randomised controlled trials of low-level laser therapy (LLLT)’ yielded 820 patients, for whom data was pooled. LLLT was found to reduce pain immediately after treatment in acute neck pain and up to 22 weeks after completion of treatment in patients with chronic neck pain. Low-level laser – or cold laser – is yet to be established as a medical treatment but, according to Wikipedia, papers are appearing at the rate of around 25 per month, mainly investigating treatment of musculoskeletal disorders. (View our Cold/Low Level Laser Therapy section)

1. Chow RT, Johnson Ml, Lopes-Martins RA, Bjordal JM. Efficacy of low-level laser therapy in the management of neck pain: a systematic review and meta-analysis of randomised placebo or active-treatment controlled trials. Lancet 2009 Dec 5;374(9705):1897-908.

Cold/Low Laser Therapy(LLLT) has been tested in over 200 clinical trials (RCTs) and published in the world’s top medical journals including a review by The Lancet, a clinical study in the journal PAIN and is acknowledged by the World Health Organisation Bone and Joint Task Force (published in the journal Spine).

(View our Cold/Low Level Laser Therapy section)

Whiplash Associated Disorder (WAD Research)

“Whiplash”(WAD). FROM: Journal of Orthopaedic Medicine 1999; 21 (1): 22–25 university Department of Orthopaedic Surgery, Bristol, UK Khan S, Cook J, Gargan M, Bannister G

Objective:To determine which patients with chronic “whiplash” (WAD) will benefit from chiropractic treatment.

Design: Retrospective review by structured telephone interviews of 93 consecutive patients seen in chiropractic clinic. Setting: Independent chiropractic clinic in a large city. Subjects: 93 patients, 68 female. Main outcome measure: Gargan and Bannister grading pre and post treatment.

Results:

Three groups of patients were recognised.

Group 1 consisted of patients with isolated neck pain associated with a restricted range of neck movement.

Group 2 consisted of patients with neurological symptoms or signs associated with a restricted range of movement.

Group 3 comprised patients who described severe neck pain but all of whom had a full range of neck movement. Patients in this group often described an unusual group of symptoms, with a bizarre, non-dermatomal pain distribution. There was a significant difference in outcome between the three groups (p<0.001) with only groups 1 and 2 improving following chiropractic manipulation.

Conclusion:

“Whiplash”(WAD) and neck injuries are common. Chiropractic is the only proven effective treatment in chronic cases. Our study enables patients to be classified at initial assessment in order to target those patients who will benefit from such treatment.

When Should You Seek Medical Care?

Cases of severe neck pain occur following an injury such as motor vehicle accident, blow to the head or fall related accident. Only a trained professional, such as a paramedic, should immobilize the patient to avoid the risk of further injury and possible paralysis. Medical care should be sought immediately.

Immediate medical care should also be sought when an injury causes pain in the neck that radiates down the arms and legs. Radiating pain or numbness in your arms or legs causing weakness in the arms or legs without significant neck pain should also be evaluated. If there has not been an injury, you should seek medical care when neck pain is:

• continuous and persistent
• severe
• accompanied by pain that radiates down the arms or legs
• accompanied by headaches, numbness, tingling, or weakness

Diagnosis

Determining the source of the pain is essential to recommend the appropriate treatment and rehabilitation. Therefore, a comprehensive examination is required to determine the cause of neck pain.

Your Chiropractor will take a complete history of the symptoms you are having with your neck. The Chiropractor may ask you about other illnesses, any injury that occurred to your neck, and any complaints you have associated with neck pain. Previous treatment for your neck condition will also be noted.

Chiropractor will also perform a physical examination. This examination may include evaluation of neck motion, tenderness of the neck and the function of the nerves and muscles in your arms and legs.

X-rays often will be obtained to allow your Chiropractor to look at the bones in your neck. This entails simple diagnostic imaging study (radiography) and aids your Chiropractor to determine the cause of neck pain and to prescribe effective treatment.

Further evaluation may involve the following:

• MRI (magnetic resonance imaging). This non x-ray study allows an evaluation of the spinal cord and nerve roots.
• CT (computed tomography). This specialized x-ray study allows careful evaluation of the bone and spinal canal.
• EMG (electromyography). This test evaluates nerve and muscle function.

Treatment

The treatment of neck pain depends on the diagnosis. Most patients are treated successfully with Chiropractic care or Physiotherapy. Also rest, medication, immobilization, exercise, activity modifications, or a combination of these methods can be very useful.

Inflammation is a result of stretching muscles and ligaments beyond their limits, this therapy is extremely affective in the treatment of inflammation. Cold/Low level laser therapy a five star rating for soft tissue neck injuries (“Whiplash”). Surgery is required in very few cases to relieve neck pain. For most patients, a combination of Chiropractic care, rest, medication, and Physiotherapy will relieve neck pain. Surgery may be necessary to reduce pressure on the spinal cord or a nerve root when pain is caused by a herniated disc or bony narrowing of the spinal canal. Surgery may also be required following an injury to stabilize the neck and minimize the possibility of paralysis, such as when a fracture results in instability of the neck.

Cervical Disc Injury.

Causes and Risk Factors of Cervical disc injuries

Most cervical disc syndromes are caused by injuries that involve hyperextension, which results in compression of the anatomic structures.

Flexion injuries in the cervical area do not result in nerve compression.

Symptoms of Cervical disc injuries

Pain, loss of sensation or new sensations, and weakness are the main symptoms and signs of cervical disc injury. The most common symptom is pain and it is usually the only one. Rarely, cervical disc injury is complicated by compression of either a cervical nerve root or even more rarely by a compression of the spinal cord. When compression of the nervous tissue occurs, patients will report abnormal sensations other than pain and will report loosing strength in one arm (nerve root compression) or in both arms and legs (spinal cord compression).

1. Pain is the most common complaint and can be felt in the neck or arm.

a. Pain is usually limited to the neck and upper back between the shoulder blades. It occurs because of low-grade inflammation of the disc and the cervical vertebra joints. While the disease is chronic, inflammation can flare up after a minor added injury or for other reasons that are not yet well understood. Less commonly, neck and shoulder pain occur because the disc bulges acutely (herniates) and stretches the posterior longitudinal ligament. With conservative treatment, this pain usually goes away in a few weeks, but it is likely to happen again, especially if the affected individual does not change his/her lifestyle.

b. Rarely, the pain will be felt down the arm. This pain can be lightning, caused or aggravated by movements of the neck, or can be dull and persistent. Pre-existing neck pain is also present in many individuals. After the arm pain starts, some people report feeling less pain in their neck. When arm pain is present, it is usual.

Cervicogenic headaches.

Cervicogenic headaches are defined as headaches originating from the neck. The location is typically at the back of the head, sides and top of the head as well as around the forehead and eyes affecting one or more of the above regions at once. These headaches can be located on one or both sides of the head.

Cervicogenic headaches are usually associated with dysfunction of the upper neck which can present itself as neck pain or local tenderness, reduced neck range of motion and exacerbation of the headaches by neck movement. The past history of neck trauma is typical for this type of headaches. The cervicogenic headaches are caused by irritation of nerve endings of injured joints, ligaments, muscles and discs of the neck. The nerve endings in the injured areas send pain signals up the upper nerves of the neck to the brain causing “cross wiring” with the fibers of the trigeminal nerve (one of the nerves in the head) which is responsible for perception of the head pain thus causing the headaches.

Neck pain as well as “whiplash” (WAD) injuries and both conditions can result in headaches and all three are commonly treated by Chiropractors. The treatment is focused on the small joints in the back of the neck called facet joints that are responsible for neck pain. When these joints dysfunction but injury to the muscles he nerve fibres that innervate / act as sensors for these facet joints also serve to act as sensors to parts of the head. When these facet joints dysfunction these sensors become active, the brain cannot clearly differentiate between the facet joints and the mapping of the head and create the sensation of pain in a broader area- Headache.

Temporomandibular Jaw Disorders (TMD, TMJ Syndrome)

“TMD” temporomandibular (jaw) disorders, also called “TMJ syndrome.” If you felt pain sometimes in your jaw area, or maybe your dentist or Chiropractor has told you that you have TMD.

If you have questions about TMD, you are not alone. Researchers, too, are looking for answers to what causes TMD, what are the best treatments, and how can we prevent these disorders. The National Institute of Dental and Craniofacial Research has written this pamphlet to share with you what we have learned about TMD.

TMD is not just one disorder, but a group of conditions, often painful, that affect the jaw joint (temporomandibular joint, or TMJ) and the muscles that control chewing. Although we don’t know how many people actually have TMD, the disorders appear to affect about twice as many women as men.

The good news is that for most people, pain in the area of the jaw joint or a muscle is not a signal that a serious problem is developing. Generally, discomfort from TMD is occasional and temporary, often occurring in cycles. The pain eventually goes away with little or no treatment. Only a small percentage of people with TMD pain develop significant, long-term symptoms.

What is the Temporomandibular Joint?

The temporomandibular joint connects the lower jaw, called the mandible, to the temporal bone at the side of the head or neck. If you place your fingers just in front of your ears and open your mouth, you can feel the joint on each side of your head. Because these joints are flexible, the jaw can move smoothly up and down and side to side, enabling us to talk, chew and yawn. Muscles attached to and surrounding the jaw joint controls its position and movement.

When we open our mouths, the rounded ends of the lower jaw, called condyles, glide along the joint socket of the temporal bone. The condyles slide back to their original position when we close our mouths. To keep this motion smooth, a soft disc lies between the  condyle and the temporal bone. This disc absorbs shocks to the TMJ from chewing and other movements.

What Are Temporomandibular Disorders?

Researchers generally agree that temporomandibular disorders fall into three main categories:

• Myofascial pain, the most common form of TMD, which is discomfort or pain in the muscles that control jaw function and the neck and shoulder muscles;
• Neck Pain/Ache.
• Internal derangement of the joint, meaning a dislocated jaw or displaced disc, or injury to the condyle;
• Degenerative joint disease, such as osteoarthritis or rheumatoid arthritis in the jaw joint.

A person may have one or more of these conditions at the same time.

T M J Treatment

If you place your fingers in front of each ear and open your jaw, you’ll feel lots of clicking, or a grinding movement. This is the temporomandibular joint (TMJ), a place where your skull’s temporal bone attaches to your mandible (Jaw).

Because this joint comprises of a large number of ligaments, cartilage, fascia, discs, muscles, nerves and blood vessels that run around and through it, you can have all kinds of problems: trouble opening the mouth wide; a locked jaw; headache; clicking or popping sounds, tinnitus (ringing in the ears); throat fullness; shoulder, cheek or jaw pain; neck ache; facial nerve pain; ear or eye pain; dental pain; nausea; blurred vision and dizziness when the TMJ joint is misaligned.

An unhealthy skull/jaw alignment can put great stress upon the spinal column. By relieving pressure on the upper neck and bones of the skull, chiropractic treatment may relieve or correct TMJ problems. There are also documented cases of dental problems that, once corrected, help patients to hold their spinal adjustments for longer periods between chiropractic treatments.

All TMJ sufferers need chiropractic treatment; anyone who has been to the dentist should follow up with a check up from their chiropractor.

Trapped Nerve or “Pinched” Nerve.

Having a Trapped nerve hurts often feeling like  severe, sharp, excruciating and intense pain. Trapped nerves could happen nearly anywhere affecting nerves that go to the arms, fingers, wrists, neck, head, back, shoulders, legs, muscles and internal organs. “Pinched” or Trapped nerves can affect your health, posture, vitality, resistance to disease, even your emotional health. “Pinched”/trapped nerves can make life a misery.

Trapped ?

Do nerves really get trapped? Actually directly trapping the nerve  is quite rare. Much more common is what chiropractors call the vertebral subluxation complex or subluxations. Other terms for this are: nerve impingement, nerve irritation, nerve lesion, spinal stress and meningeal tension.

Even though there may be no actual trapping, people like the word because it’s so descriptive. It can really feel like something is being trapped in there. Some health professionals even use it. People at times seeing a chiropractor’s  saying their GP, osteopath, massage therapist referred them because they had a trapped nerve and should visit a chiropractor to get  the trapped nerve freed.

What Can Cause Subluxations?

Nearly any kind of stress can cause a subluxation: a fall or an accident, even a very small one that happened years ago; a poor sleeping position; poor posture; fatigue; emotional stress; poor nutrition or a combination of stresses. A subluxation need not happen all at once. It could  set in the body over time. 

 Trapped Nerves Don’t Normally Hurt

Chiropractors sometimes say that people with painful  Trapped nerves might be considered lucky-they know they have a problem and they (hopefully) will  go to a chiropractor.

 If  You  don’t Experience The pain From a  Trapped Nerve?  What Would Be The Outcome?

Some patients  may watch their body suffer and their health deteriorate for years without the faintest idea that the problem may be coming from their spine. These people desperately need to see a chiropractor but because they don’t have spine or nerve pain they may never receive the care they need. This is the big job facing chiropractors today – educating people about vertebral subluxations and the need for periodic spinal checkups.

Treatment Of Trapped Nerves

Trapped nerves do not get untrapped by themselves. No amount of painkillers or muscle relaxants can fix them. Only doctors of chiropractic are able to analyze your spinal column for trapped nerves or vertebral subluxations and use spinal adjustment techniques to gently realign the spine, release the internal stress and free the body from the trapped nerves.

Chiropractors are heakth care practitioners who are most experienced in freeing body of vertebral subluxations.

Nerves  Travel Through the Body?

Individual nerve fibers are tiny. Although they may be many inches long they are so thin you need a powerful microscope to see them. Nerve fibers are also found in large bundles called nerves. Billions of nerve fibers are bundled inside your spinal cord – an extension of your brain, which passes through the spinal column. Nerves branch off from spinal cord and exit spine through openings between the vertebrae to connect to every cell in the body.

Life without Nerves

Without nerves you couldn’t see, hear, touch, taste or smell or feel hot, cold, pleasure or pain,and no messages could come in and no messages could go out; without nerves no muscles could move.

Nerves Keep the Body Alive and Healthy

Nerve messages also help regulate the body’s activities such as breathing, heartbeat, digestion, excretion,  blood pressure and immune system so that the body can respond to germs, changes in temperature and all kinds of stress. In addition to nerve impulses, nutrients flow over your nerves to nourish the muscles and tissues. If this flow is blocked it may cause your muscles to waste away.

If the nerves are trapped, “impinged” or otherwise interfered with, the flow of messages and nutrients over them can be disrupted and the body can become “diseased” or weakened. When you are diseased you have less energy and vitality and are less able to deal with physical and emotional stress.

Lowered resistance to disease, infection, colds, flu, allergies, ulcers, constipation, diarrhea, asthma, fevers, headaches, seizures, bedwetting, hearing, balance or visual disturbances and many other health problems have been related to an unhealthy nervous system.

How Do Nerves Get Impinged or Trapped

The skeletal system, especially the spinal column, protects the spinal cord and other nerves. If  the spinal bones (vertebrae) are misaligned even slightly they may “pinch,” impinge, irritate, compress or stretch the nerves they are supposed to protect.

This in turn can affect other structures in the area including blood vessels, discs, ligaments, joints, muscles, fascia, tendons and meninges. As mentioned earlier, this is referred to as a subluxation.

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An acute “whiplash” injury follows sudden or excessive hyper-extension, hyper-flexion, or rotation of the neck and causes neck pain and other symptoms. “Whiplash” injury is common in road traffic accidents, and may also be caused by sports injuries, falls or assaults. Most cases of “whiplash” injury occur as the result of rear-end vehicle collisions at speeds of less than 10 miles per hour. Patients present with neck pain and stiffness, headache at the back of the head, thoracic back pain and/or lower back pain. Some pins and needles and pain can also be present in the arms. 

Call 02476 222002.Registered with BUPA, AXA  PPP, HSA, AVIVA, Simplyhealth, Standard Life, Mercia health, BHSF, Pru health,.Cigna,Groupma, Police health scheme, Medicare,  Medisure, Medicash and all other healthcare insurers .

Whiplash Associated Disorder (WAD) and Cervical Spine Injury

An acute “whiplash” injury follows sudden or excessive hyper-extension, hyper-flexion, or rotation of the neck and causes neck pain and other symptoms. “Whiplash” injury is common in road traffic accidents, and may also be caused by sports injuries, falls or assaults. Most cases of “whiplash” injury occur as the result of rear-end vehicle collisions at speeds of less than 10 miles per hour. Patients present with neck pain and stiffness, headache at the back of the head, thoracic back pain and/or lower back pain. Some pins and needles and pain can also be present in the arms. 

Typical cervical over-extension injuries occur in passengers an drivers of a stationary or slow-moving vehicle that is struck from behind. Body is thrown forward but the head lags, resulting in hyper-extension of the neck. When the head and neck have reached maximum extension, the neck then snaps into flexion.

• A rapid deceleration injury throws the head forwards and flexes the neck. When the chin hits the chest it limits forward flexion but the forward movement may be sufficient to cause longitudinal distraction and neurological damage. Hyperextension may occur in the subsequent recoil.

“Whiplash” injuries may occur at relatively low vehicle velocity impacts. One study showed the cervical muscle injury threshold to be about 10 km/hour. Whiplash-associated disorders (WAD) can be classified by the severity of signs and symptoms:

• Grade 1: no complaints or physical signs.
• Grade 2: indicates neck complaints but no physical signs.
• Grade 3: indicates neck complaints and musculoskeletal signs.
• Grade 4: neck complaints and neurological signs.
• Grade 5: neck complaints dislocation and fracture. Most cervical spine fractures occur predominantly at two levels:

1. One third of injuries occur at the level of C2, and one half of injuries occur at the level of C6 or C7.

2. Most fatal cervical spine injuries occur in upper cervical levels, either at cranio-cervical junction C1, or at C2

 Uncomplicated cases of Whiplash Associated Disorder (WAD)

“Whiplash”(WAD) cases that are uncomplicated are the result of sprained ligaments in the neck. The muscles of the neck spasm naturally, as a protective reaction. The “Whiplash”(WAD) injury may cause stiff neck and pain that may be present down one or both arms if the nerves of neck part of spinal cord get compressed. Pain Relief for “Whiplash”(WAD) can be found with Chiropractic care or Physiotherapy including pain medication.

****** Studies have shown that 35 of 39 patients, or 91%, of patients with chronic Whiplash associated disorder (WAD) “Whiplash” benefited from chiropractic care and Physiotherapy ********

Severe cases of Whiplash Associated Disorder (WAD).

In severe cases of “Whiplash”(WAD) the symptoms may last for a month or more with persistent and in some cases constant pain. This may indicate that the “Whiplash”(WAD) injury has extensive damage and resulting in discs rupturing and trapped nerves in the neck. This may also predispose to a “slipped” disc, also known as a prolapsed, bulging, ruptured or herniated disc in the back.

(View  our Cold Low Level  Laser Therapy section,a five star rating has been given to Cold/Low Level Laser Therapy, for healing & pain relief ).

( Cold/Low Level Laser Therapy Section.)

The symptoms of Whiplash Associated Disorder (WAD)

• pain or stiffness in the neck, jaw, shoulders, back, or arms

• headaches
• dizziness
• blurred vision or ringing in the ears
• tingling or numbness in the arms, hands or shoulders
• memory loss or difficulty concentrating
• nervousness or irritability
• difficulty sleeping
• fatigue
• burning or prickling or tingling, particularly around your neck
• depression
• vertigo

What if I don’t feel anything at first, but start to have symptoms later?

It is common for “Whiplash”(WAD) symptoms to occur right away but often there is a delay for several hours after the incident and then worsen over the next 36 to 72 hours.

How long do the symptoms last?

Most neck and head pain symptoms clear up within a few days or weeks. For others, the recovery can take up to three or four months. About 35 percent of people with “Whiplash”(WAD) report symptoms for up to a year. Around 15 percent of patients report permanent symptoms as a result of their injuries.

Diagnosis of Whiplash Associated Disorder

Determining the source of the pain is essential in establishing the appropriate treatment and rehabilitation. Therefore, a comprehensive examination is required to determine the cause of neck pain.

“Whiplash”(WAD) is difficult to diagnose since most injuries are to soft tissues like muscles and ligaments and will not show up on an x-ray. If an x-ray fails to reveal a problem, Chiropractor or Physiotherapists will sometimes order specialized tests such as magnetic resonance imaging (MRI). But more often they will make a diagnosis based on your symptoms.

Your Chiropractor or Physiotherapist will take a complete medical history. The Chiropractor or Physiotherapists  may ask you about other illnesses, any injuries that occurred to your neck, and any complaints you have associated with neck pain. Previous treatment for your neck condition will also be noted.

X-rays often will be obtained to allow your Chiropractor or Physiotherapy to look at the Vertebrae (bones) in your neck. This entails simple diagnostic imaging study (radiography) and aids your Chiropractor and Physiotherapist to determine the cause of neck pain and to prescribe effective treatment.

Further evaluation may involve the following:

• MRI (magnetic resonance imaging). This non x-ray study allows an evaluation of the spinal cord and nerve roots.
• CT (computed tomography). This specialized x-ray study allows careful evaluation of the bone and spinal canal.
• EMG (electromyography). This test evaluates nerve and muscle function.

Treatment for Whiplash Associated Disorder (WAD).

The treatment of neck pain depends on the diagnosis. Most patients are treated successfully with Chiropractic care. Also rest, medication, immobilization, exercise, activity modifications, or a combination of these methods can be very useful.

Inflammation is a result of stretching muscles and ligaments beyond their limits. Cold/Low Level Laser Therapy is extremely effective in the treatment of inflammation. Surgery is required in very few cases to relieve neck pain. For most patients, a combination of Chiropractic care or Physiotherapy, rest, medication, will relieve neck pain.

Surgery may be necessary to reduce pressure on the spinal cord or a nerve root when pain is caused by a herniated disc or bony narrowing of the spinal canal. Surgery may also be required following an injury to stabilize the neck and minimize the possibility of paralysis, such as when a fracture results in instability of the neck.

If you’ve seen your doctor about your injury and the symptoms persist for more than four weeks, it may be time for you to see a specialist. Such as a neurologist or Chiropractor who can help diagnose your condition.

What is the treatment for Whiplash Associated Disorder (WAD.

Doctors often prescribe anti-inflammatory painkillers or muscle relaxants. You can apply ice to the injured area to reduce pain and swelling for up to 15 minutes every hour. Chiropractic treatment is very effective in the management of “Whiplash”(WAD).

Cold/low level Laser Therapy (LLLT). Research,for neck pain and injuries, published by The Lancet.

Neck pain is a pain in the neck. It is common, often persistent, and responds poorly to medication. So it is encouraging to read that a relatively novel, non-invasive treatment shows evidence of effectiveness. A systematic review and meta-analysis of 16 randomised controlled trials of low-level laser therapy (LLLT)’ yielded 820 patients, for whom data was pooled. LLLT was found to reduce pain immediately after treatment in acute neck pain and up to 22 weeks after completion of treatment in patients with chronic neck pain. Low-level laser – or cold laser – is yet to be established as a medical treatment but, according to Wikipedia, papers are appearing at the rate of around 25 per month, mainly investigating treatment of musculoskeletal disorders.

1. Chow RT, Johnson Ml, Lopes-Martins RA, Bjordal JM. Efficacy of low-level laser therapy in the management of neck pain: a systematic review and meta-analysis of randomised placebo or active-treatment controlled trials. Lancet 2009 Dec 5; 374(9705):1897-908.

Cold/ Low Laser Therapy(LLLT) has been tested in over 200 clinical trials (RCTs) and published in the world’s top medical journals including a review by The Lancet, a clinical study in the journal PAIN and is acknowledged by the World Health Organisation Bone and Joint Task Force (published in the journal Spine).

(View our Cold / Low Level Laser Therapy(LLLT) section. Cold/low level Laser Therapy has a five star rating for  healing & pain relief  for Whiplash  soft tissue injuries ).

What can I do to help prevent Whiplash associated disorder (WAD)

Since the most common cause of the injury is car crashes, experts say safe driving, seatbelts, and properly adjusted headrests are your best protection against “Whiplash” (WAD). Seatbelts help keep you from being thrown forward; a low headrest in your car allows your head to pivot backwards over the top during an accident: Always raise or lower your car’s headrest until the centre of the rest meets the centre of the back of your head.

Causes and Risk Factors of Cervical disc injuries

Most cervical disc syndromes are caused by injuries that involve hyperextension, which results in compression of the anatomic structures.

Flexion injuries in the cervical area do not result in nerve compression.

Symptoms of Cervical disc injuries

Pain, loss of sensation or new sensations, and weakness are the main symptoms and signs of cervical disc injury. The most common symptom is pain and it is usually the only one. Rarely, cervical disc injury is complicated by compression of either a cervical nerve root or even more rarely by a compression of the spinal cord. When compression of the nervous tissue occurs, patients will report abnormal sensations other than pain and will report loosing strength in one arm (nerve root compression) or in both arms and legs (spinal cord compression).

1. Pain is the most common complaint and can be felt in the neck or arm.

a. Pain is usually limited to the neck and upper back between the shoulder blades. It occurs because of low-grade inflammation of the disc and the cervical vertebra joints. While the disease is chronic, inflammation can flare up after a minor added injury or for other reasons that are not yet well understood. Less commonly, neck and shoulder pain occur because the disc bulges acutely (herniates) and stretches the posterior longitudinal ligament. With conservative treatment, this pain usually goes away in a few weeks, but it is likely to happen again, especially if the affected individual does not change his/her lifestyle.

b. Rarely, the pain will be felt down the arm. This pain can be lightning, caused or aggravated by movements of the neck, or can be dull and persistent. Pre-existing neck pain is also present in many individuals. After the arm pain starts, some people report feeling less pain in their neck. When arm pain is present, it is usual.

Back to Top

An acute “whiplash” injury follows sudden or excessive hyper-extension, hyper-flexion, or rotation of the neck and causes neck pain and other symptoms. “Whiplash” injury is common in road traffic accidents, and may also be caused by sports injuries, falls or assaults. Most cases of “whiplash” injury occur as the result of rear-end vehicle collisions at speeds of less than 10 miles per hour. Patients present with neck pain and stiffness, headache at the back of the head, thoracic back pain and/or lower back pain. Some pins and needles and pain can also be present in the arms. 

Call 02476 222002.Registered with BUPA, AXA  PPP, HSA, AVIVA, Simplyhealth, Standard Life, Mercia health, BHSF, Pru health,.Cigna,Groupma, Police health scheme, Medicare,  Medisure, Medicash and all other healthcare insurers .

Whiplash Associated Disorder (WAD) and Cervical Spine Injury

An acute “whiplash” injury follows sudden or excessive hyper-extension, hyper-flexion, or rotation of the neck and causes neck pain and other symptoms. “Whiplash” injury is common in road traffic accidents, and may also be caused by sports injuries, falls or assaults. Most cases of “whiplash” injury occur as the result of rear-end vehicle collisions at speeds of less than 10 miles per hour. Patients present with neck pain and stiffness, headache at the back of the head, thoracic back pain and/or lower back pain. Some pins and needles and pain can also be present in the arms. 

Typical cervical over-extension injuries occur in passengers an drivers of a stationary or slow-moving vehicle that is struck from behind. Body is thrown forward but the head lags, resulting in hyper-extension of the neck. When the head and neck have reached maximum extension, the neck then snaps into flexion.

• A rapid deceleration injury throws the head forwards and flexes the neck. When the chin hits the chest it limits forward flexion but the forward movement may be sufficient to cause longitudinal distraction and neurological damage. Hyperextension may occur in the subsequent recoil.

“Whiplash” injuries may occur at relatively low vehicle velocity impacts. One study showed the cervical muscle injury threshold to be about 10 km/hour. Whiplash-associated disorders (WAD) can be classified by the severity of signs and symptoms:

• Grade 1: no complaints or physical signs.
• Grade 2: indicates neck complaints but no physical signs.
• Grade 3: indicates neck complaints and musculoskeletal signs.
• Grade 4: neck complaints and neurological signs.
• Grade 5: neck complaints dislocation and fracture. Most cervical spine fractures occur predominantly at two levels:

1. One third of injuries occur at the level of C2, and one half of injuries occur at the level of C6 or C7.

2. Most fatal cervical spine injuries occur in upper cervical levels, either at cranio-cervical junction C1, or at C2

 Uncomplicated cases of Whiplash Associated Disorder (WAD)

“Whiplash”(WAD) cases that are uncomplicated are the result of sprained ligaments in the neck. The muscles of the neck spasm naturally, as a protective reaction. The “Whiplash”(WAD) injury may cause stiff neck and pain that may be present down one or both arms if the nerves of neck part of spinal cord get compressed. Pain Relief for “Whiplash”(WAD) can be found with Chiropractic care or Physiotherapy including pain medication.

****** Studies have shown that 35 of 39 patients, or 91%, of patients with chronic Whiplash associated disorder (WAD) “Whiplash” benefited from chiropractic care and Physiotherapy ********

Severe cases of Whiplash Associated Disorder (WAD).

In severe cases of “Whiplash”(WAD) the symptoms may last for a month or more with persistent and in some cases constant pain. This may indicate that the “Whiplash”(WAD) injury has extensive damage and resulting in discs rupturing and trapped nerves in the neck. This may also predispose to a “slipped” disc, also known as a prolapsed, bulging, ruptured or herniated disc in the back.

(View  our Cold Low Level  Laser Therapy section,a five star rating has been given to Cold/Low Level Laser Therapy, for healing & pain relief ).

( Cold/Low Level Laser Therapy Section.)

The symptoms of Whiplash Associated Disorder (WAD)

• pain or stiffness in the neck, jaw, shoulders, back, or arms

• headaches
• dizziness
• blurred vision or ringing in the ears
• tingling or numbness in the arms, hands or shoulders
• memory loss or difficulty concentrating
• nervousness or irritability
• difficulty sleeping
• fatigue
• burning or prickling or tingling, particularly around your neck
• depression
• vertigo

What if I don’t feel anything at first, but start to have symptoms later?

It is common for “Whiplash”(WAD) symptoms to occur right away but often there is a delay for several hours after the incident and then worsen over the next 36 to 72 hours.

How long do the symptoms last?

Most neck and head pain symptoms clear up within a few days or weeks. For others, the recovery can take up to three or four months. About 35 percent of people with “Whiplash”(WAD) report symptoms for up to a year. Around 15 percent of patients report permanent symptoms as a result of their injuries.

Diagnosis of Whiplash Associated Disorder

Determining the source of the pain is essential in establishing the appropriate treatment and rehabilitation. Therefore, a comprehensive examination is required to determine the cause of neck pain.

“Whiplash”(WAD) is difficult to diagnose since most injuries are to soft tissues like muscles and ligaments and will not show up on an x-ray. If an x-ray fails to reveal a problem, Chiropractor or Physiotherapists will sometimes order specialized tests such as magnetic resonance imaging (MRI). But more often they will make a diagnosis based on your symptoms.

Your Chiropractor or Physiotherapist will take a complete medical history. The Chiropractor or Physiotherapists  may ask you about other illnesses, any injuries that occurred to your neck, and any complaints you have associated with neck pain. Previous treatment for your neck condition will also be noted.

X-rays often will be obtained to allow your Chiropractor or Physiotherapy to look at the Vertebrae (bones) in your neck. This entails simple diagnostic imaging study (radiography) and aids your Chiropractor and Physiotherapist to determine the cause of neck pain and to prescribe effective treatment.

Further evaluation may involve the following:

• MRI (magnetic resonance imaging). This non x-ray study allows an evaluation of the spinal cord and nerve roots.
• CT (computed tomography). This specialized x-ray study allows careful evaluation of the bone and spinal canal.
• EMG (electromyography). This test evaluates nerve and muscle function.

Treatment for Whiplash Associated Disorder (WAD).

The treatment of neck pain depends on the diagnosis. Most patients are treated successfully with Chiropractic care. Also rest, medication, immobilization, exercise, activity modifications, or a combination of these methods can be very useful.

Inflammation is a result of stretching muscles and ligaments beyond their limits. Cold/Low Level Laser Therapy is extremely effective in the treatment of inflammation. Surgery is required in very few cases to relieve neck pain. For most patients, a combination of Chiropractic care or Physiotherapy, rest, medication, will relieve neck pain.

Surgery may be necessary to reduce pressure on the spinal cord or a nerve root when pain is caused by a herniated disc or bony narrowing of the spinal canal. Surgery may also be required following an injury to stabilize the neck and minimize the possibility of paralysis, such as when a fracture results in instability of the neck.

If you’ve seen your doctor about your injury and the symptoms persist for more than four weeks, it may be time for you to see a specialist. Such as a neurologist or Chiropractor who can help diagnose your condition.

What is the treatment for Whiplash Associated Disorder (WAD.

Doctors often prescribe anti-inflammatory painkillers or muscle relaxants. You can apply ice to the injured area to reduce pain and swelling for up to 15 minutes every hour. Chiropractic treatment is very effective in the management of “Whiplash”(WAD).

Cold/low level Laser Therapy (LLLT). Research,for neck pain and injuries, published by The Lancet.

Neck pain is a pain in the neck. It is common, often persistent, and responds poorly to medication. So it is encouraging to read that a relatively novel, non-invasive treatment shows evidence of effectiveness. A systematic review and meta-analysis of 16 randomised controlled trials of low-level laser therapy (LLLT)’ yielded 820 patients, for whom data was pooled. LLLT was found to reduce pain immediately after treatment in acute neck pain and up to 22 weeks after completion of treatment in patients with chronic neck pain. Low-level laser – or cold laser – is yet to be established as a medical treatment but, according to Wikipedia, papers are appearing at the rate of around 25 per month, mainly investigating treatment of musculoskeletal disorders.

1. Chow RT, Johnson Ml, Lopes-Martins RA, Bjordal JM. Efficacy of low-level laser therapy in the management of neck pain: a systematic review and meta-analysis of randomised placebo or active-treatment controlled trials. Lancet 2009 Dec 5; 374(9705):1897-908.

Cold/ Low Laser Therapy(LLLT) has been tested in over 200 clinical trials (RCTs) and published in the world’s top medical journals including a review by The Lancet, a clinical study in the journal PAIN and is acknowledged by the World Health Organisation Bone and Joint Task Force (published in the journal Spine).

(View our Cold / Low Level Laser Therapy(LLLT) section. Cold/low level Laser Therapy has a five star rating for  healing & pain relief  for Whiplash  soft tissue injuries ).

What can I do to help prevent Whiplash associated disorder (WAD)

Since the most common cause of the injury is car crashes, experts say safe driving, seatbelts, and properly adjusted headrests are your best protection against “Whiplash” (WAD). Seatbelts help keep you from being thrown forward; a low headrest in your car allows your head to pivot backwards over the top during an accident: Always raise or lower your car’s headrest until the centre of the rest meets the centre of the back of your head.

Causes and Risk Factors of Cervical disc injuries

Most cervical disc syndromes are caused by injuries that involve hyperextension, which results in compression of the anatomic structures.

Flexion injuries in the cervical area do not result in nerve compression.

Symptoms of Cervical disc injuries

Pain, loss of sensation or new sensations, and weakness are the main symptoms and signs of cervical disc injury. The most common symptom is pain and it is usually the only one. Rarely, cervical disc injury is complicated by compression of either a cervical nerve root or even more rarely by a compression of the spinal cord. When compression of the nervous tissue occurs, patients will report abnormal sensations other than pain and will report loosing strength in one arm (nerve root compression) or in both arms and legs (spinal cord compression).

1. Pain is the most common complaint and can be felt in the neck or arm.

a. Pain is usually limited to the neck and upper back between the shoulder blades. It occurs because of low-grade inflammation of the disc and the cervical vertebra joints. While the disease is chronic, inflammation can flare up after a minor added injury or for other reasons that are not yet well understood. Less commonly, neck and shoulder pain occur because the disc bulges acutely (herniates) and stretches the posterior longitudinal ligament. With conservative treatment, this pain usually goes away in a few weeks, but it is likely to happen again, especially if the affected individual does not change his/her lifestyle.

b. Rarely, the pain will be felt down the arm. This pain can be lightning, caused or aggravated by movements of the neck, or can be dull and persistent. Pre-existing neck pain is also present in many individuals. After the arm pain starts, some people report feeling less pain in their neck. When arm pain is present, it is usual.

Back to Top

An acute “whiplash” injury follows sudden or excessive hyper-extension, hyper-flexion, or rotation of the neck and causes neck pain and other symptoms. “Whiplash” injury is common in road traffic accidents, and may also be caused by sports injuries, falls or assaults. Most cases of “whiplash” injury occur as the result of rear-end vehicle collisions at speeds of less than 10 miles per hour. Patients present with neck pain and stiffness, headache at the back of the head, thoracic back pain and/or lower back pain. Some pins and needles and pain can also be present in the arms. 

Call 02476 222002.Registered with BUPA, AXA  PPP, HSA, AVIVA, Simplyhealth, Standard Life, Mercia health, BHSF, Pru health,.Cigna,Groupma, Police health scheme, Medicare,  Medisure, Medicash and all other healthcare insurers .

Whiplash Associated Disorder (WAD) and Cervical Spine Injury

An acute “whiplash” injury follows sudden or excessive hyper-extension, hyper-flexion, or rotation of the neck and causes neck pain and other symptoms. “Whiplash” injury is common in road traffic accidents, and may also be caused by sports injuries, falls or assaults. Most cases of “whiplash” injury occur as the result of rear-end vehicle collisions at speeds of less than 10 miles per hour. Patients present with neck pain and stiffness, headache at the back of the head, thoracic back pain and/or lower back pain. Some pins and needles and pain can also be present in the arms. 

Typical cervical over-extension injuries occur in passengers an drivers of a stationary or slow-moving vehicle that is struck from behind. Body is thrown forward but the head lags, resulting in hyper-extension of the neck. When the head and neck have reached maximum extension, the neck then snaps into flexion.

• A rapid deceleration injury throws the head forwards and flexes the neck. When the chin hits the chest it limits forward flexion but the forward movement may be sufficient to cause longitudinal distraction and neurological damage. Hyperextension may occur in the subsequent recoil.

“Whiplash” injuries may occur at relatively low vehicle velocity impacts. One study showed the cervical muscle injury threshold to be about 10 km/hour. Whiplash-associated disorders (WAD) can be classified by the severity of signs and symptoms:

• Grade 1: no complaints or physical signs.
• Grade 2: indicates neck complaints but no physical signs.
• Grade 3: indicates neck complaints and musculoskeletal signs.
• Grade 4: neck complaints and neurological signs.
• Grade 5: neck complaints dislocation and fracture. Most cervical spine fractures occur predominantly at two levels:

1. One third of injuries occur at the level of C2, and one half of injuries occur at the level of C6 or C7.

2. Most fatal cervical spine injuries occur in upper cervical levels, either at cranio-cervical junction C1, or at C2

 Uncomplicated cases of Whiplash Associated Disorder (WAD)

“Whiplash”(WAD) cases that are uncomplicated are the result of sprained ligaments in the neck. The muscles of the neck spasm naturally, as a protective reaction. The “Whiplash”(WAD) injury may cause stiff neck and pain that may be present down one or both arms if the nerves of neck part of spinal cord get compressed. Pain Relief for “Whiplash”(WAD) can be found with Chiropractic care or Physiotherapy including pain medication.

****** Studies have shown that 35 of 39 patients, or 91%, of patients with chronic Whiplash associated disorder (WAD) “Whiplash” benefited from chiropractic care and Physiotherapy ********

Severe cases of Whiplash Associated Disorder (WAD).

In severe cases of “Whiplash”(WAD) the symptoms may last for a month or more with persistent and in some cases constant pain. This may indicate that the “Whiplash”(WAD) injury has extensive damage and resulting in discs rupturing and trapped nerves in the neck. This may also predispose to a “slipped” disc, also known as a prolapsed, bulging, ruptured or herniated disc in the back.

(View  our Cold Low Level  Laser Therapy section,a five star rating has been given to Cold/Low Level Laser Therapy, for healing & pain relief ).

( Cold/Low Level Laser Therapy Section.)

The symptoms of Whiplash Associated Disorder (WAD)

• pain or stiffness in the neck, jaw, shoulders, back, or arms

• headaches
• dizziness
• blurred vision or ringing in the ears
• tingling or numbness in the arms, hands or shoulders
• memory loss or difficulty concentrating
• nervousness or irritability
• difficulty sleeping
• fatigue
• burning or prickling or tingling, particularly around your neck
• depression
• vertigo

What if I don’t feel anything at first, but start to have symptoms later?

It is common for “Whiplash”(WAD) symptoms to occur right away but often there is a delay for several hours after the incident and then worsen over the next 36 to 72 hours.

How long do the symptoms last?

Most neck and head pain symptoms clear up within a few days or weeks. For others, the recovery can take up to three or four months. About 35 percent of people with “Whiplash”(WAD) report symptoms for up to a year. Around 15 percent of patients report permanent symptoms as a result of their injuries.

Diagnosis of Whiplash Associated Disorder

Determining the source of the pain is essential in establishing the appropriate treatment and rehabilitation. Therefore, a comprehensive examination is required to determine the cause of neck pain.

“Whiplash”(WAD) is difficult to diagnose since most injuries are to soft tissues like muscles and ligaments and will not show up on an x-ray. If an x-ray fails to reveal a problem, Chiropractor or Physiotherapists will sometimes order specialized tests such as magnetic resonance imaging (MRI). But more often they will make a diagnosis based on your symptoms.

Your Chiropractor or Physiotherapist will take a complete medical history. The Chiropractor or Physiotherapists  may ask you about other illnesses, any injuries that occurred to your neck, and any complaints you have associated with neck pain. Previous treatment for your neck condition will also be noted.

X-rays often will be obtained to allow your Chiropractor or Physiotherapy to look at the Vertebrae (bones) in your neck. This entails simple diagnostic imaging study (radiography) and aids your Chiropractor and Physiotherapist to determine the cause of neck pain and to prescribe effective treatment.

Further evaluation may involve the following:

• MRI (magnetic resonance imaging). This non x-ray study allows an evaluation of the spinal cord and nerve roots.
• CT (computed tomography). This specialized x-ray study allows careful evaluation of the bone and spinal canal.
• EMG (electromyography). This test evaluates nerve and muscle function.

Treatment for Whiplash Associated Disorder (WAD).

The treatment of neck pain depends on the diagnosis. Most patients are treated successfully with Chiropractic care. Also rest, medication, immobilization, exercise, activity modifications, or a combination of these methods can be very useful.

Inflammation is a result of stretching muscles and ligaments beyond their limits. Cold/Low Level Laser Therapy is extremely effective in the treatment of inflammation. Surgery is required in very few cases to relieve neck pain. For most patients, a combination of Chiropractic care or Physiotherapy, rest, medication, will relieve neck pain.

Surgery may be necessary to reduce pressure on the spinal cord or a nerve root when pain is caused by a herniated disc or bony narrowing of the spinal canal. Surgery may also be required following an injury to stabilize the neck and minimize the possibility of paralysis, such as when a fracture results in instability of the neck.

If you’ve seen your doctor about your injury and the symptoms persist for more than four weeks, it may be time for you to see a specialist. Such as a neurologist or Chiropractor who can help diagnose your condition.

What is the treatment for Whiplash Associated Disorder (WAD.

Doctors often prescribe anti-inflammatory painkillers or muscle relaxants. You can apply ice to the injured area to reduce pain and swelling for up to 15 minutes every hour. Chiropractic treatment is very effective in the management of “Whiplash”(WAD).

Cold/low level Laser Therapy (LLLT). Research,for neck pain and injuries, published by The Lancet.

Neck pain is a pain in the neck. It is common, often persistent, and responds poorly to medication. So it is encouraging to read that a relatively novel, non-invasive treatment shows evidence of effectiveness. A systematic review and meta-analysis of 16 randomised controlled trials of low-level laser therapy (LLLT)’ yielded 820 patients, for whom data was pooled. LLLT was found to reduce pain immediately after treatment in acute neck pain and up to 22 weeks after completion of treatment in patients with chronic neck pain. Low-level laser – or cold laser – is yet to be established as a medical treatment but, according to Wikipedia, papers are appearing at the rate of around 25 per month, mainly investigating treatment of musculoskeletal disorders.

1. Chow RT, Johnson Ml, Lopes-Martins RA, Bjordal JM. Efficacy of low-level laser therapy in the management of neck pain: a systematic review and meta-analysis of randomised placebo or active-treatment controlled trials. Lancet 2009 Dec 5; 374(9705):1897-908.

Cold/ Low Laser Therapy(LLLT) has been tested in over 200 clinical trials (RCTs) and published in the world’s top medical journals including a review by The Lancet, a clinical study in the journal PAIN and is acknowledged by the World Health Organisation Bone and Joint Task Force (published in the journal Spine).

(View our Cold / Low Level Laser Therapy(LLLT) section. Cold/low level Laser Therapy has a five star rating for  healing & pain relief  for Whiplash  soft tissue injuries ).

What can I do to help prevent Whiplash associated disorder (WAD)

Since the most common cause of the injury is car crashes, experts say safe driving, seatbelts, and properly adjusted headrests are your best protection against “Whiplash” (WAD). Seatbelts help keep you from being thrown forward; a low headrest in your car allows your head to pivot backwards over the top during an accident: Always raise or lower your car’s headrest until the centre of the rest meets the centre of the back of your head.

Causes and Risk Factors of Cervical disc injuries

Most cervical disc syndromes are caused by injuries that involve hyperextension, which results in compression of the anatomic structures.

Flexion injuries in the cervical area do not result in nerve compression.

Symptoms of Cervical disc injuries

Pain, loss of sensation or new sensations, and weakness are the main symptoms and signs of cervical disc injury. The most common symptom is pain and it is usually the only one. Rarely, cervical disc injury is complicated by compression of either a cervical nerve root or even more rarely by a compression of the spinal cord. When compression of the nervous tissue occurs, patients will report abnormal sensations other than pain and will report loosing strength in one arm (nerve root compression) or in both arms and legs (spinal cord compression).

1. Pain is the most common complaint and can be felt in the neck or arm.

a. Pain is usually limited to the neck and upper back between the shoulder blades. It occurs because of low-grade inflammation of the disc and the cervical vertebra joints. While the disease is chronic, inflammation can flare up after a minor added injury or for other reasons that are not yet well understood. Less commonly, neck and shoulder pain occur because the disc bulges acutely (herniates) and stretches the posterior longitudinal ligament. With conservative treatment, this pain usually goes away in a few weeks, but it is likely to happen again, especially if the affected individual does not change his/her lifestyle.

b. Rarely, the pain will be felt down the arm. This pain can be lightning, caused or aggravated by movements of the neck, or can be dull and persistent. Pre-existing neck pain is also present in many individuals. After the arm pain starts, some people report feeling less pain in their neck. When arm pain is present, it is usual.

Back to Top

Call 02476 222002.Registered with BUPA, AXA  PPP,  AVIVA, Simplyhealth, HSA, Standard Life, Mercia health, BHSF, Pru health,Cigna, Police health care scheme, Medicare,  Medisure, Medicash, Groupma, Allianz, and all other healthcare insurers .

The Neck Cervical Spine Anatomy.

The cervical spine begins at the base of the skull. Seven vertebrae make up the cervical spine with eight pairs of cervical nerves. The individual cervical vertebrae are abbreviated C1, C2, C3, C4, C5, C6 and C7. The cervical nerves are also abbreviated; C1 through C8.

Cervical Vertebrae and Supporting Structures

The cervical bones, the vertebrae are smaller in size when compared to other spinal vertebrae. The purpose of the cervical spine is to contain and protect the spinal cord, support the skull, and enable diverse head movement ( rotate side to side, bend forward and backward).

A complex system of ligaments, tendons, and muscles help to support and stabilize the cervical spine. Ligaments work to prevent excessive movement that could result in serious injury. Muscles also help to provide spinal balance and stability, and enable movement. Muscles contract and relax in response to nerve impulses originating in the brain. Some muscles work in pairs or as antagonists. This means when a muscle contracts, the opposing muscle relaxes. There are different types of muscle: forward flexors, lateral flexors, rotators, and extensors.

Spinal Cord and Cervical Nerve Roots

Nerve impulses travel to and from the brain through the spinal cord to a specific location by way of the peripheral nervous system (PNS). The PNS is the complex system of nerves that branch off from the spinal nerve roots. These nerves travel outside of the spinal canal or spinal cord into the organs, arms, legs, fingers – throughout the entire body.

Injury or mild trauma to the cervical spine can cause a serious or life-threatening medical emergency (spinal cord injury or SCI, fracture). Pain, numbness, weakness, and tingling are symptoms that may develop when one or more spinal nerves are injured, irritated, or stretched. The cervical nerves control many bodily functions and sensory activities.

C1: Head and neck
C2: Head and neck
C3: Diaphragm
C4: Upper body muscles ( Deltoids, Biceps)
C5: Wrist extensors
C6: Wrist extensors
C7: Triceps
C8: Hands

Neck Pain.

The neck (cervical spine) is composed of vertebrae that begin at the base of the skull and end in the upper torso. The vertebrae along with the ligaments provide stability to the spine. The muscles allow for support and movement of the neck. The neck supports the weight of the head which is 5 kg amounting to a significant load for the neck to cope with during motion thus increasing stress onto the neck (cervical spine). Compare to the rest of the spine, the neck is less protected and is more susceptible to injury and various disorders that can result in pain and restricted motion. Sometimes neck pain is a temporary condition going away on its own accord. Other cases require medical diagnosis and treatment to relieve the symptoms.

Causes

Neck pain may result from injury to the soft tissues including muscles, ligaments, nerves, bones and joints of the spine. Soft tissue injuries or prolonged wear and tear are amongst the most common causes of neck pain. Infection or tumors may cause neck pain in rare instances. Sometimes neck problems may be the source of pain in the upper back, shoulders or arms.

Neck pain may result from abnormalities in the soft tissues, muscles, ligaments, and nerves as well as in bones and joints of the spine. The most common causes of neck pain are soft-tissue abnormalities due to injury or prolonged wear and tear. In rare instances, infection or tumors may cause neck pain. In some people, neck problems may be the source of pain in the upper back, shoulders, or arms. Cold Laser Therapy section this therapy has a five star rating for treating neck injuries and conditions.

Neck Injury

Due to its flexibility and the weight of the head it supports the neck is extremely vulnerable to injury. Road traffic or diving accidents, contact sports, and falls are the main causes of neck injury. A “rear end” shunt during a car accident may result in hyper-extension, a backward motion of the neck beyond normal limits, or hyper- flexion a forward motion of the neck beyond normal limits. The use of seat belts and head restrains in cars can help to prevent or minimize neck injury. The soft tissues such as muscles and ligaments are most commonly involved. Severe injuries including fracture or dislocation of the neck may lead to the damage the spinal cord and cause paralysis.

Arthritis of the Neck

The neck is a common site for arthritis to develop.

The most common type of arthritis that affects the neck is osteoarthritis. This condition is also known as cervical spondylosis, cervical osteoarthritis, or degenerative joint disease of the neck.

Other forms of arthritis that can affect the neck are rheumatoid arthritis, psoriatic, ankylosing spondylitis, Reiter’s disease, gout, pseudogout, and diffuse idiopathic skeletal hyperostosis (DISH).

Rheumatoid arthritis can destroy joints in the neck and cause severe stiffness and pain. Rheumatoid arthritis typically affects upper neck area. View our Cold Laser Therapy section this therapy has a five star rating for treating  this condition

Cervical spondylosis is a condition that mainly affects older people, usually over the age of 45. Men are affected more often than women. This condition results from degenerative changes that occur in the cervical spine (the spine of the neck). Changes in cartilage metabolism lead to slow wear and tear of discs and joints in the neck. Over time, the degenerative changes can lead to a bulging or herniated disc, calcium build-up within the disc, or bony growths on the spine. The end result is nerve compression or inflammation.

Also, depending on which way the disc herniates or the direction of the bony growths, there is a possibility that the spinal cord or nerve roots leading from the spinal cord could be compressed.

There is also the possibility that the blood flow to certain nerves may be affected.

Symptoms depend on the location of the nerve compression, but can include pain, numbness, weakness, headaches, urinary problems, etc.

Initially the person may not have any symptoms.

Others will have neck or shoulder pain, headaches in the back of the head, or stiffness of the neck. They may have difficulty turning or bending the neck from side-to-side.

Some will have pain that shoots down a certain part of the arm. They may also notice numbness, weakness, or pain in the arm. One or both sides may be affected. Often it causes the hands to become clumsy.

Some individuals will have numbness or weakness in their legs. This indicates that there may be pressure on the spinal cord. This is considered a surgical emergency. Many with this condition will have decreased vibration-sense in their legs. They may be unsteady while walking. In fact, spondylosis with myelopathy is a fairly common cause of unsteadiness in the elderly.

Others will have a specific level on the chest or abdomen where there is a noticeable change in sensation.

Problems with urination may occur. Some will have to urinate more often, while others will have to urinate urgently. A few will develop urinary incontinence.

The symptoms may get worse with turning, extending, or bending the neck. In others, coughing or straining may temporarily cause shooting pain in the arms or shoulders or it may worsen weakness in the legs.

Physical exam may reveal numbness or pain along a certain nerve distribution. Certain muscles may be weak and the reflexes not as brisk as normal. The affected individual may have difficulty with turning the neck or bending it from side to side. The arms or legs may be stiff. The hands may be weak and the muscles of the hands atrophied.

X-rays can be helpful in making the diagnosis. However, though X-ray findings of degenerative changes are often found in many older people, only a few will truly evidence the neurological changes caused by this condition. Alone, finding degenerative changes on X-rays is not conclusive but part of an overall determination of this condition that must take into consideration other factors. X-rays done with flexion and extension may show instability.

CT scan can be used to look at the spinal column and see if there is any narrowing or other abnormality.

MRI can also be used to look at the spinal column and see if there is any narrowing or other abnormality.

Nerve conduction studies and electromyography can be done to test the nerves and muscles.

The primary treatment for this condition is first to determine what type of arthritis is causing the problem. The second is making sure the neck is not unstable. Then, it is important to restrict neck movements. This is usually done with a cervical collar.

Medical treatment is usually with anti-inflammatory medicines, analgesics, and muscle relaxants. However, if this fails, then surgery may be necessary.

Physical therapy modalities such as Cold/Low level laser therapy, including stretching and strengthening exercises.

Patients may respond to steroid injections placed in the epidural space.

If that does not work, then surgery to decompress the nerve and stabilize the neck may be necessary.

Surgery is usually done if:

Conservative measures such as a cervical collar do not work.
There is severe pain.
There are significant neurological deficits, such as difficulty walking, severe hand weakness, or bladder problems.
There is compression of the spinal cord.

With any nerve condition, if it is not treated early, there is a danger that the loss of nerve function may be permanent. Nerves are very delicate. Once they are injured beyond a certain point, they do not recover. Therefore, the symptoms that can be caused by this condition could become permanent if not treated appropriately (i.e., numbness, weakness, and urinary problems).

There is no specific way to prevent this condition. However, good posture should be maintained.

Also, avoid repetitive injuries to the neck and cervical spine.

Neck Disc Injury, “Slipped Disc”, also known as Prolapsed, Bulging, Herniated or Extruded Disc

Disc Problems

What Causes Disc Problems?

Discs are the soft but strong cushions that separate the bones (vertebrae) in your spine and absorb shock as you move. Repeated strain over time, an injury, or sudden, forceful movements can damage discs and irritate nerves, causing pain, numbness, or tingling in your back and legs, neck,Shoulders and arms.

Common Slipped Disc, Neck Disc Injury

A Slipped Disc or (Disc Prolapsed) in the neck is a common cause of neck pain. Slipped disc treatment during the early stages involves limited mobilisation. Later, more active physical therapy rehabilitation is useful. During the later stages neck pain treatment can be enhanced if a pillow is used to support the neck.

Other Causes

Less common causes of neck pain include tumors, infections, or congenital abnormalities of the vertebrae.

Whiplash Associated Disorder (WAD) and Cervical Spine Injury

What is whiplash? 

An acute “whiplash” injury follows sudden or excessive hyper-extension, hyper-flexion, or rotation of the neck and causes neck pain and other symptoms. “Whiplash” injury is common in road traffic accidents, and may also be caused by sports injuries, falls or assaults. Most cases of “whiplash” injury occur as the result of rear-end vehicle collisions at speeds of less than 10 miles per hour. Patients present with neck pain and stiffness, occipital headache, thoracic back pain and/or lumber back pain, and upper-limb pain and paraesthesia.

There are two types of injury:

• Typical cervical hyper-extension injuries occur in passengers an drivers of a stationary or slow-moving vehicle that is struck from behind. Body is thrown forward but the head lags, resulting in hyper-extension of the neck. When the head and neck have reached maximum extension, the neck then snaps into flexion.
• A rapid deceleration injury throws the head forwards and flexes the neck. When the chin hits the chest it limits forward flexion but the forward movement may be sufficient to cause longitudinal distraction and neurological damage. Hyper-extension may occur in the subsequent recoil.

“Whiplash” injuries may occur at relatively low vehicle velocity impacts. One study showed the cervical muscle injury threshold to be about 10 km/hour. Whiplash-associated disorders (WAD) can be classified by the severity of signs and symptoms:

• Grade 1: no complaints or physical signs.
• Grade 2: indicates neck complaints but no physical signs.
• Grade 3: indicates neck complaints and musculoskeletal signs.
• Grade 4: neck complaints and neurological signs.
• Grade 5: neck complaints dislocation and fracture. Most cervical spine fractures occur predominantly at two levels:

1. One third of injuries occur at the level of C2, and one half of injuries occur at the level of C6 or C7.

2. Most fatal cervical spine injuries occur in upper cervical levels, either at cranio-cervical junction C1, or at C2

 Uncomplicated cases of Whiplash Associated Disorder (WAD)

“Whiplash”(WAD) cases that are uncomplicated are the result of sprained ligaments in the neck. The muscles of the neck spasm naturally, as a protective reaction. The “Whiplash”(WAD) injury may cause stiff neck and pain that may be present down one or both arms if the nerves of neck part of spinal cord get compressed. Pain Relief for “Whiplash”(WAD) can be found with Chiropractic  or Physiotherapy including pain medication and Cold/ low level laser therapy,

Patient’s with chronic whiplash benefited from Chiropractic  or Physiotherapy

Severe cases

In severe cases of “whiplash” may last for a month or more with persistent and in some cases constant pain. This may indicate that the “whiplash” injury has extensive damage and resulting in discs rupturing and trapped nerves in the neck. This may also predispose to a “slipped”disc, also known as a prolapsed, bulging, ruptured or herniated disc in the back. (View our Cold/low level laser therapy Section, a five star rating has been given to cold/low level laser therapy for soft tissue neck injuries)

Cold/Low level Laser Therapy (LLLT). treatment research  for Neck Pain

Neck pain  is common, often persistent, and responds poorly to medication. So it is encouraging to read that a relatively novel, non-invasive treatment shows evidence of effectiveness. A systematic review and meta-analysis of 16 randomised controlled trials of low-level laser therapy (LLLT)’ yielded 820 patients, for whom data was pooled. LLLT was found to reduce pain immediately after treatment in acute neck pain and up to 22 weeks after completion of treatment in patients with chronic neck pain. Low-level laser – or cold laser – is yet to be established as a medical treatment but, according to Wikipedia, papers are appearing at the rate of around 25 per month, mainly investigating treatment of musculoskeletal disorders. (View our Cold/Low Level Laser Therapy section)

1. Chow RT, Johnson Ml, Lopes-Martins RA, Bjordal JM. Efficacy of low-level laser therapy in the management of neck pain: a systematic review and meta-analysis of randomised placebo or active-treatment controlled trials. Lancet 2009 Dec 5;374(9705):1897-908.

Cold/Low Laser Therapy(LLLT) has been tested in over 200 clinical trials (RCTs) and published in the world’s top medical journals including a review by The Lancet, a clinical study in the journal PAIN and is acknowledged by the World Health Organisation Bone and Joint Task Force (published in the journal Spine).

(View our Cold/Low Level Laser Therapy section)

Whiplash Associated Disorder (WAD Research)

“Whiplash”(WAD). FROM: Journal of Orthopaedic Medicine 1999; 21 (1): 22–25 university Department of Orthopaedic Surgery, Bristol, UK Khan S, Cook J, Gargan M, Bannister G

Objective:To determine which patients with chronic “whiplash” (WAD) will benefit from chiropractic treatment.

Design: Retrospective review by structured telephone interviews of 93 consecutive patients seen in chiropractic clinic. Setting: Independent chiropractic clinic in a large city. Subjects: 93 patients, 68 female. Main outcome measure: Gargan and Bannister grading pre and post treatment.

Results:

Three groups of patients were recognised.

Group 1 consisted of patients with isolated neck pain associated with a restricted range of neck movement.

Group 2 consisted of patients with neurological symptoms or signs associated with a restricted range of movement.

Group 3 comprised patients who described severe neck pain but all of whom had a full range of neck movement. Patients in this group often described an unusual group of symptoms, with a bizarre, non-dermatomal pain distribution. There was a significant difference in outcome between the three groups (p<0.001) with only groups 1 and 2 improving following chiropractic manipulation.

Conclusion:

“Whiplash”(WAD) and neck injuries are common. Chiropractic is the only proven effective treatment in chronic cases. Our study enables patients to be classified at initial assessment in order to target those patients who will benefit from such treatment.

When Should You Seek Medical Care?

Cases of severe neck pain occur following an injury such as motor vehicle accident, blow to the head or fall related accident. Only a trained professional, such as a paramedic, should immobilize the patient to avoid the risk of further injury and possible paralysis. Medical care should be sought immediately.

Immediate medical care should also be sought when an injury causes pain in the neck that radiates down the arms and legs. Radiating pain or numbness in your arms or legs causing weakness in the arms or legs without significant neck pain should also be evaluated. If there has not been an injury, you should seek medical care when neck pain is:

• continuous and persistent
• severe
• accompanied by pain that radiates down the arms or legs
• accompanied by headaches, numbness, tingling, or weakness

Diagnosis

Determining the source of the pain is essential to recommend the appropriate treatment and rehabilitation. Therefore, a comprehensive examination is required to determine the cause of neck pain.

Your Chiropractor will take a complete history of the symptoms you are having with your neck. The Chiropractor may ask you about other illnesses, any injury that occurred to your neck, and any complaints you have associated with neck pain. Previous treatment for your neck condition will also be noted.

Chiropractor will also perform a physical examination. This examination may include evaluation of neck motion, tenderness of the neck and the function of the nerves and muscles in your arms and legs.

X-rays often will be obtained to allow your Chiropractor to look at the bones in your neck. This entails simple diagnostic imaging study (radiography) and aids your Chiropractor to determine the cause of neck pain and to prescribe effective treatment.

Further evaluation may involve the following:

• MRI (magnetic resonance imaging). This non x-ray study allows an evaluation of the spinal cord and nerve roots.
• CT (computed tomography). This specialized x-ray study allows careful evaluation of the bone and spinal canal.
• EMG (electromyography). This test evaluates nerve and muscle function.

Treatment

The treatment of neck pain depends on the diagnosis. Most patients are treated successfully with Chiropractic care or Physiotherapy. Also rest, medication, immobilization, exercise, activity modifications, or a combination of these methods can be very useful.

Inflammation is a result of stretching muscles and ligaments beyond their limits, this therapy is extremely affective in the treatment of inflammation. Cold/Low level laser therapy a five star rating for soft tissue neck injuries (“Whiplash”). Surgery is required in very few cases to relieve neck pain. For most patients, a combination of Chiropractic care, rest, medication, and Physiotherapy will relieve neck pain. Surgery may be necessary to reduce pressure on the spinal cord or a nerve root when pain is caused by a herniated disc or bony narrowing of the spinal canal. Surgery may also be required following an injury to stabilize the neck and minimize the possibility of paralysis, such as when a fracture results in instability of the neck.

Cervical Disc Injury.

Causes and Risk Factors of Cervical disc injuries

Most cervical disc syndromes are caused by injuries that involve hyperextension, which results in compression of the anatomic structures.

Flexion injuries in the cervical area do not result in nerve compression.

Symptoms of Cervical disc injuries

Pain, loss of sensation or new sensations, and weakness are the main symptoms and signs of cervical disc injury. The most common symptom is pain and it is usually the only one. Rarely, cervical disc injury is complicated by compression of either a cervical nerve root or even more rarely by a compression of the spinal cord. When compression of the nervous tissue occurs, patients will report abnormal sensations other than pain and will report loosing strength in one arm (nerve root compression) or in both arms and legs (spinal cord compression).

1. Pain is the most common complaint and can be felt in the neck or arm.

a. Pain is usually limited to the neck and upper back between the shoulder blades. It occurs because of low-grade inflammation of the disc and the cervical vertebra joints. While the disease is chronic, inflammation can flare up after a minor added injury or for other reasons that are not yet well understood. Less commonly, neck and shoulder pain occur because the disc bulges acutely (herniates) and stretches the posterior longitudinal ligament. With conservative treatment, this pain usually goes away in a few weeks, but it is likely to happen again, especially if the affected individual does not change his/her lifestyle.

b. Rarely, the pain will be felt down the arm. This pain can be lightning, caused or aggravated by movements of the neck, or can be dull and persistent. Pre-existing neck pain is also present in many individuals. After the arm pain starts, some people report feeling less pain in their neck. When arm pain is present, it is usual.

Cervicogenic headaches.

Cervicogenic headaches are defined as headaches originating from the neck. The location is typically at the back of the head, sides and top of the head as well as around the forehead and eyes affecting one or more of the above regions at once. These headaches can be located on one or both sides of the head.

Cervicogenic headaches are usually associated with dysfunction of the upper neck which can present itself as neck pain or local tenderness, reduced neck range of motion and exacerbation of the headaches by neck movement. The past history of neck trauma is typical for this type of headaches. The cervicogenic headaches are caused by irritation of nerve endings of injured joints, ligaments, muscles and discs of the neck. The nerve endings in the injured areas send pain signals up the upper nerves of the neck to the brain causing “cross wiring” with the fibers of the trigeminal nerve (one of the nerves in the head) which is responsible for perception of the head pain thus causing the headaches.

Neck pain as well as “whiplash” (WAD) injuries and both conditions can result in headaches and all three are commonly treated by Chiropractors. The treatment is focused on the small joints in the back of the neck called facet joints that are responsible for neck pain. When these joints dysfunction but injury to the muscles he nerve fibres that innervate / act as sensors for these facet joints also serve to act as sensors to parts of the head. When these facet joints dysfunction these sensors become active, the brain cannot clearly differentiate between the facet joints and the mapping of the head and create the sensation of pain in a broader area- Headache.

Temporomandibular Jaw Disorders (TMD, TMJ Syndrome)

“TMD” temporomandibular (jaw) disorders, also called “TMJ syndrome.” If you felt pain sometimes in your jaw area, or maybe your dentist or Chiropractor has told you that you have TMD.

If you have questions about TMD, you are not alone. Researchers, too, are looking for answers to what causes TMD, what are the best treatments, and how can we prevent these disorders. The National Institute of Dental and Craniofacial Research has written this pamphlet to share with you what we have learned about TMD.

TMD is not just one disorder, but a group of conditions, often painful, that affect the jaw joint (temporomandibular joint, or TMJ) and the muscles that control chewing. Although we don’t know how many people actually have TMD, the disorders appear to affect about twice as many women as men.

The good news is that for most people, pain in the area of the jaw joint or a muscle is not a signal that a serious problem is developing. Generally, discomfort from TMD is occasional and temporary, often occurring in cycles. The pain eventually goes away with little or no treatment. Only a small percentage of people with TMD pain develop significant, long-term symptoms.

What is the Temporomandibular Joint?

The temporomandibular joint connects the lower jaw, called the mandible, to the temporal bone at the side of the head or neck. If you place your fingers just in front of your ears and open your mouth, you can feel the joint on each side of your head. Because these joints are flexible, the jaw can move smoothly up and down and side to side, enabling us to talk, chew and yawn. Muscles attached to and surrounding the jaw joint controls its position and movement.

When we open our mouths, the rounded ends of the lower jaw, called condyles, glide along the joint socket of the temporal bone. The condyles slide back to their original position when we close our mouths. To keep this motion smooth, a soft disc lies between the  condyle and the temporal bone. This disc absorbs shocks to the TMJ from chewing and other movements.

What Are Temporomandibular Disorders?

Researchers generally agree that temporomandibular disorders fall into three main categories:

• Myofascial pain, the most common form of TMD, which is discomfort or pain in the muscles that control jaw function and the neck and shoulder muscles;
• Neck Pain/Ache.
• Internal derangement of the joint, meaning a dislocated jaw or displaced disc, or injury to the condyle;
• Degenerative joint disease, such as osteoarthritis or rheumatoid arthritis in the jaw joint.

A person may have one or more of these conditions at the same time.

T M J Treatment

If you place your fingers in front of each ear and open your jaw, you’ll feel lots of clicking, or a grinding movement. This is the temporomandibular joint (TMJ), a place where your skull’s temporal bone attaches to your mandible (Jaw).

Because this joint comprises of a large number of ligaments, cartilage, fascia, discs, muscles, nerves and blood vessels that run around and through it, you can have all kinds of problems: trouble opening the mouth wide; a locked jaw; headache; clicking or popping sounds, tinnitus (ringing in the ears); throat fullness; shoulder, cheek or jaw pain; neck ache; facial nerve pain; ear or eye pain; dental pain; nausea; blurred vision and dizziness when the TMJ joint is misaligned.

An unhealthy skull/jaw alignment can put great stress upon the spinal column. By relieving pressure on the upper neck and bones of the skull, chiropractic treatment may relieve or correct TMJ problems. There are also documented cases of dental problems that, once corrected, help patients to hold their spinal adjustments for longer periods between chiropractic treatments.

All TMJ sufferers need chiropractic treatment; anyone who has been to the dentist should follow up with a check up from their chiropractor.

Trapped Nerve or “Pinched” Nerve.

Having a Trapped nerve hurts often feeling like  severe, sharp, excruciating and intense pain. Trapped nerves could happen nearly anywhere affecting nerves that go to the arms, fingers, wrists, neck, head, back, shoulders, legs, muscles and internal organs. “Pinched” or Trapped nerves can affect your health, posture, vitality, resistance to disease, even your emotional health. “Pinched”/trapped nerves can make life a misery.

Trapped ?

Do nerves really get trapped? Actually directly trapping the nerve  is quite rare. Much more common is what chiropractors call the vertebral subluxation complex or subluxations. Other terms for this are: nerve impingement, nerve irritation, nerve lesion, spinal stress and meningeal tension.

Even though there may be no actual trapping, people like the word because it’s so descriptive. It can really feel like something is being trapped in there. Some health professionals even use it. People at times seeing a chiropractor’s  saying their GP, osteopath, massage therapist referred them because they had a trapped nerve and should visit a chiropractor to get  the trapped nerve freed.

What Can Cause Subluxations?

Nearly any kind of stress can cause a subluxation: a fall or an accident, even a very small one that happened years ago; a poor sleeping position; poor posture; fatigue; emotional stress; poor nutrition or a combination of stresses. A subluxation need not happen all at once. It could  set in the body over time. 

 Trapped Nerves Don’t Normally Hurt

Chiropractors sometimes say that people with painful  Trapped nerves might be considered lucky-they know they have a problem and they (hopefully) will  go to a chiropractor.

 If  You  don’t Experience The pain From a  Trapped Nerve?  What Would Be The Outcome?

Some patients  may watch their body suffer and their health deteriorate for years without the faintest idea that the problem may be coming from their spine. These people desperately need to see a chiropractor but because they don’t have spine or nerve pain they may never receive the care they need. This is the big job facing chiropractors today – educating people about vertebral subluxations and the need for periodic spinal checkups.

Treatment Of Trapped Nerves

Trapped nerves do not get untrapped by themselves. No amount of painkillers or muscle relaxants can fix them. Only doctors of chiropractic are able to analyze your spinal column for trapped nerves or vertebral subluxations and use spinal adjustment techniques to gently realign the spine, release the internal stress and free the body from the trapped nerves.

Chiropractors are heakth care practitioners who are most experienced in freeing body of vertebral subluxations.

Nerves  Travel Through the Body?

Individual nerve fibers are tiny. Although they may be many inches long they are so thin you need a powerful microscope to see them. Nerve fibers are also found in large bundles called nerves. Billions of nerve fibers are bundled inside your spinal cord – an extension of your brain, which passes through the spinal column. Nerves branch off from spinal cord and exit spine through openings between the vertebrae to connect to every cell in the body.

Life without Nerves

Without nerves you couldn’t see, hear, touch, taste or smell or feel hot, cold, pleasure or pain,and no messages could come in and no messages could go out; without nerves no muscles could move.

Nerves Keep the Body Alive and Healthy

Nerve messages also help regulate the body’s activities such as breathing, heartbeat, digestion, excretion,  blood pressure and immune system so that the body can respond to germs, changes in temperature and all kinds of stress. In addition to nerve impulses, nutrients flow over your nerves to nourish the muscles and tissues. If this flow is blocked it may cause your muscles to waste away.

If the nerves are trapped, “impinged” or otherwise interfered with, the flow of messages and nutrients over them can be disrupted and the body can become “diseased” or weakened. When you are diseased you have less energy and vitality and are less able to deal with physical and emotional stress.

Lowered resistance to disease, infection, colds, flu, allergies, ulcers, constipation, diarrhea, asthma, fevers, headaches, seizures, bedwetting, hearing, balance or visual disturbances and many other health problems have been related to an unhealthy nervous system.

How Do Nerves Get Impinged or Trapped

The skeletal system, especially the spinal column, protects the spinal cord and other nerves. If  the spinal bones (vertebrae) are misaligned even slightly they may “pinch,” impinge, irritate, compress or stretch the nerves they are supposed to protect.

This in turn can affect other structures in the area including blood vessels, discs, ligaments, joints, muscles, fascia, tendons and meninges. As mentioned earlier, this is referred to as a subluxation.

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The Neck Cervical Spine Anatomy.

The cervical spine begins at the base of the skull. Seven vertebrae make up the cervical spine with eight pairs of cervical nerves. The individual cervical vertebrae are abbreviated C1, C2, C3, C4, C5, C6 and C7. The cervical nerves are also abbreviated; C1 through C8.

Cervical Vertebrae and Supporting Structures

The cervical bones, the vertebrae are smaller in size when compared to other spinal vertebrae. The purpose of the cervical spine is to contain and protect the spinal cord, support the skull, and enable diverse head movement ( rotate side to side, bend forward and backward).

A complex system of ligaments, tendons, and muscles help to support and stabilize the cervical spine. Ligaments work to prevent excessive movement that could result in serious injury. Muscles also help to provide spinal balance and stability, and enable movement. Muscles contract and relax in response to nerve impulses originating in the brain. Some muscles work in pairs or as antagonists. This means when a muscle contracts, the opposing muscle relaxes. There are different types of muscle: forward flexors, lateral flexors, rotators, and extensors.

Spinal Cord and Cervical Nerve Roots

Nerve impulses travel to and from the brain through the spinal cord to a specific location by way of the peripheral nervous system (PNS). The PNS is the complex system of nerves that branch off from the spinal nerve roots. These nerves travel outside of the spinal canal or spinal cord into the organs, arms, legs, fingers – throughout the entire body.

Injury or mild trauma to the cervical spine can cause a serious or life-threatening medical emergency (spinal cord injury or SCI, fracture). Pain, numbness, weakness, and tingling are symptoms that may develop when one or more spinal nerves are injured, irritated, or stretched. The cervical nerves control many bodily functions and sensory activities.

C1: Head and neck
C2: Head and neck
C3: Diaphragm
C4: Upper body muscles ( Deltoids, Biceps)
C5: Wrist extensors
C6: Wrist extensors
C7: Triceps
C8: Hands

Neck Pain.

The neck (cervical spine) is composed of vertebrae that begin at the base of the skull and end in the upper torso. The vertebrae along with the ligaments provide stability to the spine. The muscles allow for support and movement of the neck. The neck supports the weight of the head which is 5 kg amounting to a significant load for the neck to cope with during motion thus increasing stress onto the neck (cervical spine). Compare to the rest of the spine, the neck is less protected and is more susceptible to injury and various disorders that can result in pain and restricted motion. Sometimes neck pain is a temporary condition going away on its own accord. Other cases require medical diagnosis and treatment to relieve the symptoms.

Causes

Neck pain may result from injury to the soft tissues including muscles, ligaments, nerves, bones and joints of the spine. Soft tissue injuries or prolonged wear and tear are amongst the most common causes of neck pain. Infection or tumors may cause neck pain in rare instances. Sometimes neck problems may be the source of pain in the upper back, shoulders or arms.

Neck pain may result from abnormalities in the soft tissues, muscles, ligaments, and nerves as well as in bones and joints of the spine. The most common causes of neck pain are soft-tissue abnormalities due to injury or prolonged wear and tear. In rare instances, infection or tumors may cause neck pain. In some people, neck problems may be the source of pain in the upper back, shoulders, or arms. Cold Laser Therapy section this therapy has a five star rating for treating neck injuries and conditions.

Neck Injury

Due to its flexibility and the weight of the head it supports the neck is extremely vulnerable to injury. Road traffic or diving accidents, contact sports, and falls are the main causes of neck injury. A “rear end” shunt during a car accident may result in hyper-extension, a backward motion of the neck beyond normal limits, or hyper- flexion a forward motion of the neck beyond normal limits. The use of seat belts and head restrains in cars can help to prevent or minimize neck injury. The soft tissues such as muscles and ligaments are most commonly involved. Severe injuries including fracture or dislocation of the neck may lead to the damage the spinal cord and cause paralysis.

Arthritis of the Neck

The neck is a common site for arthritis to develop.

The most common type of arthritis that affects the neck is osteoarthritis. This condition is also known as cervical spondylosis, cervical osteoarthritis, or degenerative joint disease of the neck.

Other forms of arthritis that can affect the neck are rheumatoid arthritis, psoriatic, ankylosing spondylitis, Reiter’s disease, gout, pseudogout, and diffuse idiopathic skeletal hyperostosis (DISH).

Rheumatoid arthritis can destroy joints in the neck and cause severe stiffness and pain. Rheumatoid arthritis typically affects upper neck area. View our Cold Laser Therapy section this therapy has a five star rating for treating  this condition

Cervical spondylosis is a condition that mainly affects older people, usually over the age of 45. Men are affected more often than women. This condition results from degenerative changes that occur in the cervical spine (the spine of the neck). Changes in cartilage metabolism lead to slow wear and tear of discs and joints in the neck. Over time, the degenerative changes can lead to a bulging or herniated disc, calcium build-up within the disc, or bony growths on the spine. The end result is nerve compression or inflammation.

Also, depending on which way the disc herniates or the direction of the bony growths, there is a possibility that the spinal cord or nerve roots leading from the spinal cord could be compressed.

There is also the possibility that the blood flow to certain nerves may be affected.

Symptoms depend on the location of the nerve compression, but can include pain, numbness, weakness, headaches, urinary problems, etc.

Initially the person may not have any symptoms.

Others will have neck or shoulder pain, headaches in the back of the head, or stiffness of the neck. They may have difficulty turning or bending the neck from side-to-side.

Some will have pain that shoots down a certain part of the arm. They may also notice numbness, weakness, or pain in the arm. One or both sides may be affected. Often it causes the hands to become clumsy.

Some individuals will have numbness or weakness in their legs. This indicates that there may be pressure on the spinal cord. This is considered a surgical emergency. Many with this condition will have decreased vibration-sense in their legs. They may be unsteady while walking. In fact, spondylosis with myelopathy is a fairly common cause of unsteadiness in the elderly.

Others will have a specific level on the chest or abdomen where there is a noticeable change in sensation.

Problems with urination may occur. Some will have to urinate more often, while others will have to urinate urgently. A few will develop urinary incontinence.

The symptoms may get worse with turning, extending, or bending the neck. In others, coughing or straining may temporarily cause shooting pain in the arms or shoulders or it may worsen weakness in the legs.

Physical exam may reveal numbness or pain along a certain nerve distribution. Certain muscles may be weak and the reflexes not as brisk as normal. The affected individual may have difficulty with turning the neck or bending it from side to side. The arms or legs may be stiff. The hands may be weak and the muscles of the hands atrophied.

X-rays can be helpful in making the diagnosis. However, though X-ray findings of degenerative changes are often found in many older people, only a few will truly evidence the neurological changes caused by this condition. Alone, finding degenerative changes on X-rays is not conclusive but part of an overall determination of this condition that must take into consideration other factors. X-rays done with flexion and extension may show instability.

CT scan can be used to look at the spinal column and see if there is any narrowing or other abnormality.

MRI can also be used to look at the spinal column and see if there is any narrowing or other abnormality.

Nerve conduction studies and electromyography can be done to test the nerves and muscles.

The primary treatment for this condition is first to determine what type of arthritis is causing the problem. The second is making sure the neck is not unstable. Then, it is important to restrict neck movements. This is usually done with a cervical collar.

Medical treatment is usually with anti-inflammatory medicines, analgesics, and muscle relaxants. However, if this fails, then surgery may be necessary.

Physical therapy modalities such as Cold/Low level laser therapy, including stretching and strengthening exercises.

Patients may respond to steroid injections placed in the epidural space.

If that does not work, then surgery to decompress the nerve and stabilize the neck may be necessary.

Surgery is usually done if:

Conservative measures such as a cervical collar do not work.
There is severe pain.
There are significant neurological deficits, such as difficulty walking, severe hand weakness, or bladder problems.
There is compression of the spinal cord.

With any nerve condition, if it is not treated early, there is a danger that the loss of nerve function may be permanent. Nerves are very delicate. Once they are injured beyond a certain point, they do not recover. Therefore, the symptoms that can be caused by this condition could become permanent if not treated appropriately (i.e., numbness, weakness, and urinary problems).

There is no specific way to prevent this condition. However, good posture should be maintained.

Also, avoid repetitive injuries to the neck and cervical spine.

Neck Disc Injury, “Slipped Disc”, also known as Prolapsed, Bulging, Herniated or Extruded Disc

Disc Problems

What Causes Disc Problems?

Discs are the soft but strong cushions that separate the bones (vertebrae) in your spine and absorb shock as you move. Repeated strain over time, an injury, or sudden, forceful movements can damage discs and irritate nerves, causing pain, numbness, or tingling in your back and legs, neck,Shoulders and arms.

Common Slipped Disc, Neck Disc Injury

A Slipped Disc or (Disc Prolapsed) in the neck is a common cause of neck pain. Slipped disc treatment during the early stages involves limited mobilisation. Later, more active physical therapy rehabilitation is useful. During the later stages neck pain treatment can be enhanced if a pillow is used to support the neck.

Other Causes

Less common causes of neck pain include tumors, infections, or congenital abnormalities of the vertebrae.

Whiplash Associated Disorder (WAD) and Cervical Spine Injury

What is whiplash? 

An acute “whiplash” injury follows sudden or excessive hyper-extension, hyper-flexion, or rotation of the neck and causes neck pain and other symptoms. “Whiplash” injury is common in road traffic accidents, and may also be caused by sports injuries, falls or assaults. Most cases of “whiplash” injury occur as the result of rear-end vehicle collisions at speeds of less than 10 miles per hour. Patients present with neck pain and stiffness, occipital headache, thoracic back pain and/or lumber back pain, and upper-limb pain and paraesthesia.

There are two types of injury:

• Typical cervical hyper-extension injuries occur in passengers an drivers of a stationary or slow-moving vehicle that is struck from behind. Body is thrown forward but the head lags, resulting in hyper-extension of the neck. When the head and neck have reached maximum extension, the neck then snaps into flexion.
• A rapid deceleration injury throws the head forwards and flexes the neck. When the chin hits the chest it limits forward flexion but the forward movement may be sufficient to cause longitudinal distraction and neurological damage. Hyper-extension may occur in the subsequent recoil.

“Whiplash” injuries may occur at relatively low vehicle velocity impacts. One study showed the cervical muscle injury threshold to be about 10 km/hour. Whiplash-associated disorders (WAD) can be classified by the severity of signs and symptoms:

• Grade 1: no complaints or physical signs.
• Grade 2: indicates neck complaints but no physical signs.
• Grade 3: indicates neck complaints and musculoskeletal signs.
• Grade 4: neck complaints and neurological signs.
• Grade 5: neck complaints dislocation and fracture. Most cervical spine fractures occur predominantly at two levels:

1. One third of injuries occur at the level of C2, and one half of injuries occur at the level of C6 or C7.

2. Most fatal cervical spine injuries occur in upper cervical levels, either at cranio-cervical junction C1, or at C2

 Uncomplicated cases of Whiplash Associated Disorder (WAD)

“Whiplash”(WAD) cases that are uncomplicated are the result of sprained ligaments in the neck. The muscles of the neck spasm naturally, as a protective reaction. The “Whiplash”(WAD) injury may cause stiff neck and pain that may be present down one or both arms if the nerves of neck part of spinal cord get compressed. Pain Relief for “Whiplash”(WAD) can be found with Chiropractic  or Physiotherapy including pain medication and Cold/ low level laser therapy,

Patient’s with chronic whiplash benefited from Chiropractic  or Physiotherapy

Severe cases

In severe cases of “whiplash” may last for a month or more with persistent and in some cases constant pain. This may indicate that the “whiplash” injury has extensive damage and resulting in discs rupturing and trapped nerves in the neck. This may also predispose to a “slipped”disc, also known as a prolapsed, bulging, ruptured or herniated disc in the back. (View our Cold/low level laser therapy Section, a five star rating has been given to cold/low level laser therapy for soft tissue neck injuries)

Cold/Low level Laser Therapy (LLLT). treatment research  for Neck Pain

Neck pain  is common, often persistent, and responds poorly to medication. So it is encouraging to read that a relatively novel, non-invasive treatment shows evidence of effectiveness. A systematic review and meta-analysis of 16 randomised controlled trials of low-level laser therapy (LLLT)’ yielded 820 patients, for whom data was pooled. LLLT was found to reduce pain immediately after treatment in acute neck pain and up to 22 weeks after completion of treatment in patients with chronic neck pain. Low-level laser – or cold laser – is yet to be established as a medical treatment but, according to Wikipedia, papers are appearing at the rate of around 25 per month, mainly investigating treatment of musculoskeletal disorders. (View our Cold/Low Level Laser Therapy section)

1. Chow RT, Johnson Ml, Lopes-Martins RA, Bjordal JM. Efficacy of low-level laser therapy in the management of neck pain: a systematic review and meta-analysis of randomised placebo or active-treatment controlled trials. Lancet 2009 Dec 5;374(9705):1897-908.

Cold/Low Laser Therapy(LLLT) has been tested in over 200 clinical trials (RCTs) and published in the world’s top medical journals including a review by The Lancet, a clinical study in the journal PAIN and is acknowledged by the World Health Organisation Bone and Joint Task Force (published in the journal Spine).

(View our Cold/Low Level Laser Therapy section)

Whiplash Associated Disorder (WAD Research)

“Whiplash”(WAD). FROM: Journal of Orthopaedic Medicine 1999; 21 (1): 22–25 university Department of Orthopaedic Surgery, Bristol, UK Khan S, Cook J, Gargan M, Bannister G

Objective:To determine which patients with chronic “whiplash” (WAD) will benefit from chiropractic treatment.

Design: Retrospective review by structured telephone interviews of 93 consecutive patients seen in chiropractic clinic. Setting: Independent chiropractic clinic in a large city. Subjects: 93 patients, 68 female. Main outcome measure: Gargan and Bannister grading pre and post treatment.

Results:

Three groups of patients were recognised.

Group 1 consisted of patients with isolated neck pain associated with a restricted range of neck movement.

Group 2 consisted of patients with neurological symptoms or signs associated with a restricted range of movement.

Group 3 comprised patients who described severe neck pain but all of whom had a full range of neck movement. Patients in this group often described an unusual group of symptoms, with a bizarre, non-dermatomal pain distribution. There was a significant difference in outcome between the three groups (p<0.001) with only groups 1 and 2 improving following chiropractic manipulation.

Conclusion:

“Whiplash”(WAD) and neck injuries are common. Chiropractic is the only proven effective treatment in chronic cases. Our study enables patients to be classified at initial assessment in order to target those patients who will benefit from such treatment.

When Should You Seek Medical Care?

Cases of severe neck pain occur following an injury such as motor vehicle accident, blow to the head or fall related accident. Only a trained professional, such as a paramedic, should immobilize the patient to avoid the risk of further injury and possible paralysis. Medical care should be sought immediately.

Immediate medical care should also be sought when an injury causes pain in the neck that radiates down the arms and legs. Radiating pain or numbness in your arms or legs causing weakness in the arms or legs without significant neck pain should also be evaluated. If there has not been an injury, you should seek medical care when neck pain is:

• continuous and persistent
• severe
• accompanied by pain that radiates down the arms or legs
• accompanied by headaches, numbness, tingling, or weakness

Diagnosis

Determining the source of the pain is essential to recommend the appropriate treatment and rehabilitation. Therefore, a comprehensive examination is required to determine the cause of neck pain.

Your Chiropractor will take a complete history of the symptoms you are having with your neck. The Chiropractor may ask you about other illnesses, any injury that occurred to your neck, and any complaints you have associated with neck pain. Previous treatment for your neck condition will also be noted.

Chiropractor will also perform a physical examination. This examination may include evaluation of neck motion, tenderness of the neck and the function of the nerves and muscles in your arms and legs.

X-rays often will be obtained to allow your Chiropractor to look at the bones in your neck. This entails simple diagnostic imaging study (radiography) and aids your Chiropractor to determine the cause of neck pain and to prescribe effective treatment.

Further evaluation may involve the following:

• MRI (magnetic resonance imaging). This non x-ray study allows an evaluation of the spinal cord and nerve roots.
• CT (computed tomography). This specialized x-ray study allows careful evaluation of the bone and spinal canal.
• EMG (electromyography). This test evaluates nerve and muscle function.

Treatment

The treatment of neck pain depends on the diagnosis. Most patients are treated successfully with Chiropractic care or Physiotherapy. Also rest, medication, immobilization, exercise, activity modifications, or a combination of these methods can be very useful.

Inflammation is a result of stretching muscles and ligaments beyond their limits, this therapy is extremely affective in the treatment of inflammation. Cold/Low level laser therapy a five star rating for soft tissue neck injuries (“Whiplash”). Surgery is required in very few cases to relieve neck pain. For most patients, a combination of Chiropractic care, rest, medication, and Physiotherapy will relieve neck pain. Surgery may be necessary to reduce pressure on the spinal cord or a nerve root when pain is caused by a herniated disc or bony narrowing of the spinal canal. Surgery may also be required following an injury to stabilize the neck and minimize the possibility of paralysis, such as when a fracture results in instability of the neck.

Cervical Disc Injury.

Causes and Risk Factors of Cervical disc injuries

Most cervical disc syndromes are caused by injuries that involve hyperextension, which results in compression of the anatomic structures.

Flexion injuries in the cervical area do not result in nerve compression.

Symptoms of Cervical disc injuries

Pain, loss of sensation or new sensations, and weakness are the main symptoms and signs of cervical disc injury. The most common symptom is pain and it is usually the only one. Rarely, cervical disc injury is complicated by compression of either a cervical nerve root or even more rarely by a compression of the spinal cord. When compression of the nervous tissue occurs, patients will report abnormal sensations other than pain and will report loosing strength in one arm (nerve root compression) or in both arms and legs (spinal cord compression).

1. Pain is the most common complaint and can be felt in the neck or arm.

a. Pain is usually limited to the neck and upper back between the shoulder blades. It occurs because of low-grade inflammation of the disc and the cervical vertebra joints. While the disease is chronic, inflammation can flare up after a minor added injury or for other reasons that are not yet well understood. Less commonly, neck and shoulder pain occur because the disc bulges acutely (herniates) and stretches the posterior longitudinal ligament. With conservative treatment, this pain usually goes away in a few weeks, but it is likely to happen again, especially if the affected individual does not change his/her lifestyle.

b. Rarely, the pain will be felt down the arm. This pain can be lightning, caused or aggravated by movements of the neck, or can be dull and persistent. Pre-existing neck pain is also present in many individuals. After the arm pain starts, some people report feeling less pain in their neck. When arm pain is present, it is usual.

Cervicogenic headaches.

Cervicogenic headaches are defined as headaches originating from the neck. The location is typically at the back of the head, sides and top of the head as well as around the forehead and eyes affecting one or more of the above regions at once. These headaches can be located on one or both sides of the head.

Cervicogenic headaches are usually associated with dysfunction of the upper neck which can present itself as neck pain or local tenderness, reduced neck range of motion and exacerbation of the headaches by neck movement. The past history of neck trauma is typical for this type of headaches. The cervicogenic headaches are caused by irritation of nerve endings of injured joints, ligaments, muscles and discs of the neck. The nerve endings in the injured areas send pain signals up the upper nerves of the neck to the brain causing “cross wiring” with the fibers of the trigeminal nerve (one of the nerves in the head) which is responsible for perception of the head pain thus causing the headaches.

Neck pain as well as “whiplash” (WAD) injuries and both conditions can result in headaches and all three are commonly treated by Chiropractors. The treatment is focused on the small joints in the back of the neck called facet joints that are responsible for neck pain. When these joints dysfunction but injury to the muscles he nerve fibres that innervate / act as sensors for these facet joints also serve to act as sensors to parts of the head. When these facet joints dysfunction these sensors become active, the brain cannot clearly differentiate between the facet joints and the mapping of the head and create the sensation of pain in a broader area- Headache.

Temporomandibular Jaw Disorders (TMD, TMJ Syndrome)

“TMD” temporomandibular (jaw) disorders, also called “TMJ syndrome.” If you felt pain sometimes in your jaw area, or maybe your dentist or Chiropractor has told you that you have TMD.

If you have questions about TMD, you are not alone. Researchers, too, are looking for answers to what causes TMD, what are the best treatments, and how can we prevent these disorders. The National Institute of Dental and Craniofacial Research has written this pamphlet to share with you what we have learned about TMD.

TMD is not just one disorder, but a group of conditions, often painful, that affect the jaw joint (temporomandibular joint, or TMJ) and the muscles that control chewing. Although we don’t know how many people actually have TMD, the disorders appear to affect about twice as many women as men.

The good news is that for most people, pain in the area of the jaw joint or a muscle is not a signal that a serious problem is developing. Generally, discomfort from TMD is occasional and temporary, often occurring in cycles. The pain eventually goes away with little or no treatment. Only a small percentage of people with TMD pain develop significant, long-term symptoms.

What is the Temporomandibular Joint?

The temporomandibular joint connects the lower jaw, called the mandible, to the temporal bone at the side of the head or neck. If you place your fingers just in front of your ears and open your mouth, you can feel the joint on each side of your head. Because these joints are flexible, the jaw can move smoothly up and down and side to side, enabling us to talk, chew and yawn. Muscles attached to and surrounding the jaw joint controls its position and movement.

When we open our mouths, the rounded ends of the lower jaw, called condyles, glide along the joint socket of the temporal bone. The condyles slide back to their original position when we close our mouths. To keep this motion smooth, a soft disc lies between the  condyle and the temporal bone. This disc absorbs shocks to the TMJ from chewing and other movements.

What Are Temporomandibular Disorders?

Researchers generally agree that temporomandibular disorders fall into three main categories:

• Myofascial pain, the most common form of TMD, which is discomfort or pain in the muscles that control jaw function and the neck and shoulder muscles;
• Neck Pain/Ache.
• Internal derangement of the joint, meaning a dislocated jaw or displaced disc, or injury to the condyle;
• Degenerative joint disease, such as osteoarthritis or rheumatoid arthritis in the jaw joint.

A person may have one or more of these conditions at the same time.

T M J Treatment

If you place your fingers in front of each ear and open your jaw, you’ll feel lots of clicking, or a grinding movement. This is the temporomandibular joint (TMJ), a place where your skull’s temporal bone attaches to your mandible (Jaw).

Because this joint comprises of a large number of ligaments, cartilage, fascia, discs, muscles, nerves and blood vessels that run around and through it, you can have all kinds of problems: trouble opening the mouth wide; a locked jaw; headache; clicking or popping sounds, tinnitus (ringing in the ears); throat fullness; shoulder, cheek or jaw pain; neck ache; facial nerve pain; ear or eye pain; dental pain; nausea; blurred vision and dizziness when the TMJ joint is misaligned.

An unhealthy skull/jaw alignment can put great stress upon the spinal column. By relieving pressure on the upper neck and bones of the skull, chiropractic treatment may relieve or correct TMJ problems. There are also documented cases of dental problems that, once corrected, help patients to hold their spinal adjustments for longer periods between chiropractic treatments.

All TMJ sufferers need chiropractic treatment; anyone who has been to the dentist should follow up with a check up from their chiropractor.

Trapped Nerve or “Pinched” Nerve.

Having a Trapped nerve hurts often feeling like  severe, sharp, excruciating and intense pain. Trapped nerves could happen nearly anywhere affecting nerves that go to the arms, fingers, wrists, neck, head, back, shoulders, legs, muscles and internal organs. “Pinched” or Trapped nerves can affect your health, posture, vitality, resistance to disease, even your emotional health. “Pinched”/trapped nerves can make life a misery.

Trapped ?

Do nerves really get trapped? Actually directly trapping the nerve  is quite rare. Much more common is what chiropractors call the vertebral subluxation complex or subluxations. Other terms for this are: nerve impingement, nerve irritation, nerve lesion, spinal stress and meningeal tension.

Even though there may be no actual trapping, people like the word because it’s so descriptive. It can really feel like something is being trapped in there. Some health professionals even use it. People at times seeing a chiropractor’s  saying their GP, osteopath, massage therapist referred them because they had a trapped nerve and should visit a chiropractor to get  the trapped nerve freed.

What Can Cause Subluxations?

Nearly any kind of stress can cause a subluxation: a fall or an accident, even a very small one that happened years ago; a poor sleeping position; poor posture; fatigue; emotional stress; poor nutrition or a combination of stresses. A subluxation need not happen all at once. It could  set in the body over time. 

 Trapped Nerves Don’t Normally Hurt

Chiropractors sometimes say that people with painful  Trapped nerves might be considered lucky-they know they have a problem and they (hopefully) will  go to a chiropractor.

 If  You  don’t Experience The pain From a  Trapped Nerve?  What Would Be The Outcome?

Some patients  may watch their body suffer and their health deteriorate for years without the faintest idea that the problem may be coming from their spine. These people desperately need to see a chiropractor but because they don’t have spine or nerve pain they may never receive the care they need. This is the big job facing chiropractors today – educating people about vertebral subluxations and the need for periodic spinal checkups.

Treatment Of Trapped Nerves

Trapped nerves do not get untrapped by themselves. No amount of painkillers or muscle relaxants can fix them. Only doctors of chiropractic are able to analyze your spinal column for trapped nerves or vertebral subluxations and use spinal adjustment techniques to gently realign the spine, release the internal stress and free the body from the trapped nerves.

Chiropractors are heakth care practitioners who are most experienced in freeing body of vertebral subluxations.

Nerves  Travel Through the Body?

Individual nerve fibers are tiny. Although they may be many inches long they are so thin you need a powerful microscope to see them. Nerve fibers are also found in large bundles called nerves. Billions of nerve fibers are bundled inside your spinal cord – an extension of your brain, which passes through the spinal column. Nerves branch off from spinal cord and exit spine through openings between the vertebrae to connect to every cell in the body.

Life without Nerves

Without nerves you couldn’t see, hear, touch, taste or smell or feel hot, cold, pleasure or pain,and no messages could come in and no messages could go out; without nerves no muscles could move.

Nerves Keep the Body Alive and Healthy

Nerve messages also help regulate the body’s activities such as breathing, heartbeat, digestion, excretion,  blood pressure and immune system so that the body can respond to germs, changes in temperature and all kinds of stress. In addition to nerve impulses, nutrients flow over your nerves to nourish the muscles and tissues. If this flow is blocked it may cause your muscles to waste away.

If the nerves are trapped, “impinged” or otherwise interfered with, the flow of messages and nutrients over them can be disrupted and the body can become “diseased” or weakened. When you are diseased you have less energy and vitality and are less able to deal with physical and emotional stress.

Lowered resistance to disease, infection, colds, flu, allergies, ulcers, constipation, diarrhea, asthma, fevers, headaches, seizures, bedwetting, hearing, balance or visual disturbances and many other health problems have been related to an unhealthy nervous system.

How Do Nerves Get Impinged or Trapped

The skeletal system, especially the spinal column, protects the spinal cord and other nerves. If  the spinal bones (vertebrae) are misaligned even slightly they may “pinch,” impinge, irritate, compress or stretch the nerves they are supposed to protect.

This in turn can affect other structures in the area including blood vessels, discs, ligaments, joints, muscles, fascia, tendons and meninges. As mentioned earlier, this is referred to as a subluxation.

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