Dr. Dalfino's Non-Surgical Treatment Blog

" Whiplash and Your Ligaments "

Most people who get a whiplash-like injury think it is caused by a problem in their muscles. It's easy to see this why this may be the case since muscle pain following car accidents is so common. Deep pain and even spasm can occur after severe trauma resulting in daily pain and even headaches. Since our 10-12 pound head is attached to our necks, by muscles that go into the shoulder region, whiplash can feel like a muscle pull and taking muscle relaxants seems a reasonable approach. Although tears of muscles fibers do occur in whiplash, these can heal rather quickly due to the rich blood supply. The ligaments such as disks hold the joints of the neck together keeping the nerves from being pressed upon and stretched. These are the structures that are critically injured during whiplash. The muscles that contract to protect the joints from moving too much are generally less of a problem than when the ligaments are injured. A recent study (BMC Musculoskelet Disord 2006;21:103) showed that after whiplash, the strength of the neck ligaments is further reduced. This means that you are more susceptible to getting injured if you previously suffered a trauma. To detect ligament injuries you can look at MRIs immediately after the trauma. In many cases they can show small tears or the inflammation and swelling that goes with tears of these important structures. You can also have stress x-rays taken in the positions of forward and backward bending. These types of x-rays can show which ligaments have been traumatized and are allowing the bones of the neck to move too much. When this increased motion is severe, this is called instability. Some newer MRI machines can scan in different positions so that the tears and their motion effects are seen with one test. Some people may find the MRI scanner to be a bit restrictive or claustrophobic. X-rays are usually the most practical and least costly choice. A thorough examination is needed following whiplash, including these stress x-rays. Neurological tests are also required to see if your nerves have been injured. Our office is always available to consult with you about your health concerns. Just call Dr. Dalfino’s Office at 203-922-9277 to schedule an appointment. A proper care plan begins with an accurate diagnosis. It's important to know about the condition of your ligaments after a whiplash, it's not just a pulled muscle.

" Low Back Pain: Fix the Problem First and You Won ' t Need to Worry about the Pain "

It's gotten a bit confusing how we sometimes look at our health. When pain strikes the low back we usually think we just got a new problem or injury. But why then was coughing, shaving, or doing the laundry, so different this time? These are things we do everyday. Rarely is a new episode of low back pain brought on by a well-defined injury or trauma. Trauma in most cases is usually quite trivial. We confuse pain as a signal for something that is physically changing each time. So what is the problem? The problem is joint sprain or subluxation. This is a ligament problem and occurs with small micro traumas over many years, or sometimes with acute events such as car accidents or falls. Over time the ligaments stretch, causing the joints and vertebrae to displace, irritating the delicate nerve fibers. But over a few days or weeks, the pain that accompanies this injury gradually lessens, and in many cases goes away all on its own. But has the problem also gone away? Likely not, because when ligaments are traumatized, the repair mechanism involves scar tissue, which is less elastic than the original, and makes the joint vulnerable to re-injury and sometimes impairs the free and symmetrical motion of the spine. The doctor of chiropractic examines for this type of joint sprain using palpation for tenderness and edema, and x-rays to see the directions the vertebrae have moved towards. These specific analyses can tell us the vulnerable directions and how the vertebrae need to be repositioned to promote good alignment and good posture. The adjustment is designed to reduce this misalignment, and induce more symmetric motion. When movements are asymmetrical in the spine, they can lead to premature degeneration of the spine and arthritis. This may be why a simple task such as lifting a laundry basket can flare up the back so easily. You may be lifting with good form and posture but with an asymmetrical spine, the loading is very off balance. Sometimes the disks are so damaged that a simple sneeze is enough to cause excruciating pain. So when these trivial events seem to trip you up, it means there is an underlying problem that is not getting corrected.

" Fibromyalgia and Exercise: The Jury is In! "

As heath care evidence accumulates, hopefully this translates into better treatments for patients. Fibromyalgia in particular, has been a frustrating disease for many patients and physicians since drug treatments seem to provide little benefit. One treatment that has been studied extensively is supervised aerobic exercise and strength training. The prestigious scientific review group called Cochrane (Cochrane Database Syst Rev 2007;4:CD003786) recently reviewed the exercise evidence in fibromyaglia. The conclude that: "there is 'gold' level evidence (www.cochranemsk.org) that supervised aerobic exercise training has beneficial effects on physical capacity and FMS [fibromyalgia] symptoms. But have you started yet? Is aerobic exercise and strength or resistance training part of your daily routine? If not, then I have to ask, why not? For many patients they may need a personal trainer or a skilled doctor of chiropractic, who will help you to work around and instead of your injuries and help to keep you motivated, on tract, and accountable. If you've sprained your low back in the past this can severely limit your ability to exercise pain-free. The spine IS the core of the body so it needs to be flexible and healthy for you to exercise effectively over the long-term. Taking drugs to cover up the pain while you train can lead to further injury. You need to listen to your body to know when to slow down and take it easy. Muscle pain is inevitable with exercise. Joint pain is another story and needs to be avoided. I have found that adding chiropractic care to your active lifestyle can help keep you going as embark on this new and hopefully long journey. For others, long-term inactivity has led to weight gain that needs to come down first before hitting the gym. And when weight-loss is occurring it is hard to repair muscle strain, so it is very easy to over-train which usually results in the patient quitting their new program Exercising while you are excessively overweight will often lead to failure and injury to your knees or spine. So it is important to proceed with caution. Don't enter a marathon tomorrow. I want you to start right to ensure the best chances for success.

" Headache and High Blood Pressure: A New Link? "

Headaches are one of the common pains we get. High blood pressure is also very common, affecting about 50 million Americans. Could they be linked? Yes, but not in the way you may think. Some doctors question whether taking pain pills actually corrects the cause of the headache. But there are also other, perhaps more seemingly silent concerns. Is simply cutting the fire alarm when the house is on fire ever a good idea? If your headache is coming from a problem such as a sprained and subluxated neck, is taking a pill going to do anything to help the joint injury? We all see the TV commercials and the long pill aisles at the supermarket. We must be consuming quite a bit and that is true. But could are excessive use of these drugs be causing another problem, one that may not be explained on the pill bottle label? Researchers have looked at over-the-counter medications such as acetaminophen (e.g. Tylenol) and ibuprofen (e.g. Advil), to see if taking them over the long-term elevates the risk for developing high blood pressure (Hypertension 2005;46:500. Women's Health Study I and II) The study investigated 5,123 women between the ages of 34 and 77 and followed them over many years. Compared with women who did not use acetaminophen, the relative risk for those who took >500 mg per day was 1.93 (1.30 to 2.88) among older women. and 1.99 (1.39 to 2.85) among younger women.  A relative risk of 1.93 is a 93% increase in risk. The range was a 30% increase to a 185% increase. For nonsteroidal anti-inflammatory drugs (e.g. ibuprofen), the risk of developing high blood pressure in older women also increased, ranging from a 78% to a 161% elevation. For younger women, the increased risks ranged from a 10% increase to a 132% increase. Aspirin use was not associated with developing high blood pressure. The authors concluded that because acetaminophen and nonsteroidal anti-inflammatory drugs are commonly used, they might contribute to the high prevalence (percent of the population with this disease) of high blood pressure in the United States.

" Carpal Tunnel and the Magic Bullet "

Patients with severe carpal tunnel symptoms often become desperate in their search for a cure. Most patients with chronic diseases fall prey to this, looking for the one answer, the one magic pill or magic bullet that will rid them of all their troubles now and forever. In carpal tunnel care, you may have looked for the magic splint, the best surgeon, the one exercise, the one vitamin or herb or magnet, to find relief of your pain. As carpal tunnel symptoms worsen, affecting not only our daily lives and even our jobs, the urgency to find the one thing becomes greater and greater. It's no wonder there's no shortage of promises and potions out there to deliver you the magic bullet. Perhaps you could look at this problem in another way? Not the one thing that has thus far eluded you, but rather the many things you've found difficult to face and take care of, the things that may prevent problems but only if you faithfully adhere to them. What I'm getting at is this: there are many pieces to the carpal tunnel puzzle and you can think of hand pain more of as a signal that the final straw that is finally breaking the camel's back. Yes it is true that those with vitamin deficiencies get more nerve symptoms and taking B6 can help some people with their symptoms. But B6 is part of the B-complex that we should be getting everyday in our diets. Whether you have symptoms or not, you should be eating right, and that means lots of vegetables. Most of us will benefit from correcting our lack of vitamin intake by taking different vitamins in supplement form. Or maybe we are overweight; it's true of 60% of Americans. We need to maintain an ideal weight whether or not our hands hurt. Or perhaps we have a neck problem that we are not addressing. Sometimes neck problems cause hand pain and sometimes they do not. Whether or not the neck itself is causing your hand to hurt, you should get your neck fixed so that movements are free and symmetrical. Lastly, exercise and stretching should be party of everyone's daily routine, not just those with hand symptoms. If you need help with implementing these different approaches to your health, give Dr. Dalfino a call at 203-922-9277 to schedule a consultation.

" Fibromyalgia and Your Care: How ' s That Working for You? "

Dr. Phil often talks to viewers about their concerns this way. I think something can be learned from this approach when it comes to our bodily health. Perhaps you've been through the health care maze known as "fibrocare." Many patients start off with one little problem, such as fatigue or a headache, which just seems to grow and grow, much like the entourage of doctors we collect to get answers. How many physicians did you see before being properly diagnosed? Unfortunately, most fibro sufferers endure years of misdiagnoses, years of visits to various specialists, and of course constant and widespread pain. So is it working well? Are you getting healthy? Getting back to your old healthy self? Is so, then great. If not, then read on. Were alternatives and perhaps more natural/non-drug approaches brought to your attention? Unfortunately the maze can be quite daunting...hard to really get a sense of any direction or what lies around the next corner. Chiropractic care is one such alternative that remains a practical secret for many. You've seen signs for chiropractic doctors, but what do they do? How would they approach the fibromyalgia problem? As with any health issue it's impossible to tell what is going on and what is the best remedy without a thorough examination. I cannot speculate on your personal health. Everyone is an individual and deserves very specific attention. What I do know is that chiropractic care does seem to improve many types of aches and pain, including those associated with fibromyalgia. Spinal pain is one of the most common symptoms. Although I have few doubts about the importance of regular chiropractic in my own and my family's life, most patients rarely see how they could potentially benefit from such care. Since I cannot afford to run television advertisements at prime time each night (in contrast to big drug companies), to start to change the public's perception, I send these Health Updates. My hope is that you will be interested enough to call and discuss how my chiropractic care could be a potential solution to your fibromyalgia pains. No promises other than I will do my level best to try and help.

" Whiplash-are you covered? "

Americans are addicted to their automobiles. Nowhere else in the world do privately owned cars enjoy such an integrated connection to our everyday lives. Many hours spent driving and in traffic do increase the possibility that one day an unfortunate accident will occur. Even if you are the best and most safe driver, this does little to keep someone else from hitting you. Most states require insurance as a condition for the privilege of using the public roads and highways. But how much insurance should one carry? What does it cost to repair a car today, and perhaps more importantly, what does it cost to get you back to work and healthy again after a whiplash-type of trauma? It may surprise you how much a ride in the ambulance, or a short stay in the hospital will set you back. Although chiropractic care expenses are generally less than care provided at hospitals or by surgeons, the costs can add up quickly, especially if you've suffered significant injury to your ligaments, disks and nerves. That's why it's important that you have adequate coverage should the unexpected occur. Periodically review your insurance coverage and make sure it is keeping up with the times. You don't want to be caught in a bind where your coverage does not meet your needs. In areas of insurance, med-pay and underinsured/not insured policies, help to protect you when others are not adequately covered and help to offset the costs of your treatment. Your insurance agent can help you navigate the various policy options that will best protect you and your family. Most agents will consult with you at no charge, so take advantage of their expertise. And if you have suffered an injury, a doctor of chiropractic can properly assess the extent of spinal trauma and provide non-drug and non-surgical care for your pain. Most injuries from whiplash result in tears and sprain of the delicate ligaments that support the bones of the neck. Chiropractic doctors often specialize in the care of patients with spine and neck trauma.

" Is Carpal Tunnel Surgery the Only Potential Solution? "

For many patients with carpal tunnel syndrome (CTS), surgical release is too often the only discussed option for treatment. Why is this? How medical doctors are taught as well as what is read, drives many to their decisions. So what does the medical literature actually say in 2007? A recent article published in a scientific journal (Adv Tech Stand Neurosurg 2007;32:175-249) may provide some perspective. The paper is titled, "Carpal Tunnel Syndrome-a comprehensive review." Unfortunately the "comprehensive" review pretty much only discusses the surgical approach to this most difficult problem. The conclusion states, " Surgery for carpal tunnel syndrome requires meticulous attention to history-taking, investigation, counseling, training and surgical technique if unsatisfactory results and complications are to be avoided." The authors are to be commended for providing a sober perspective on the potential outcome and pitfalls of surgery for CTS. The part that makes me feel this review is very incomplete, is that chiropractic care is not discussed. That is too often '"to be expected." But patients deserve to be told their many options for care, including alternatives to surgery such as chiropractic care. When all you have is a hammer, everything starts to look like a nail. So that is what this Health Update is all about, a chance for you to consider surgical alternatives. No one doctor has all the answers but it's important to hear the various perspectives so you can make an informed decision. Our office always offers complementary consultations. You can come by for a visit, tour our facility and ask any questions you may have. I want to explain the various types of techniques we use to address carpal tunnel symptoms. Sometimes the neck is involved, affecting the nerves that go to the hand and wrist. This is called the double-crush syndrome, and is often overlooked by providers who only examine the wrist for the cause of the wrist and hand symptoms. If your neck was injured in a whiplash or sports trauma, this may be one aspect of your health that has not yet been addressed. By adjusting the problem in the neck region, the nerves to the wrist may function more normally.

" Headaches are letting you know..... "

.....that there is a problem. Our bodies often let us know there is something not quite right, but are we listening? Too often in life, with hectic day to day schedules, getting the kids to school and so on, we cannot be troubled by these little warning signs. So we often just take a pill to mask the pain and get on with our lives. But is this the best way to react to a warning, a signal? If the smoke alarm shrilled in your home, what would you do? I hope you would get out as quickly as possible and call 911. Would you say to yourself, "maybe it will go away?" I hope not. And if there were a fire, would stopping the alarm help a raging inferno? Most likely this will help things very little. What if the alarm started to give little beeps (letting you know to change the battery). Would you change it with a fresh one or just remove it from the device? I think most homeowners know the answers to these simple questions. And you would think that we would give the same correct concern when are bodies give us warning signals. Unfortunately we often pay more attention to warning signs from our homes and automobiles (like that little clicking sound), than the most important house of all-our bodies. When your neck muscles ache, this is a signal. When you turn your head and hear clicking sounds, this is another signal. And when a headache occurs, the signal is getting louder and louder. But are we listening? It's better to think of these signals as just that, signals- not the actual problem. So when you take a drug to stop the signal, rarely is the actual problem being addressed. So how are your signals and alarms? Do you seem to take medications on a weekly or daily basis? A headache pill here and there is rarely an issue. But incorporating pain pills as part of your daily diet may be a health concern. They are not considered one of the five basic food groups. Side effects from these types of medications are rare, but the risks do increase with long-term use. Do you go through a small bottle each month?

" Low Back Problems and Their Cause "

Low back pain for many of us is somewhat of a middle age problem. Lots of sufferers begin to seek chiropractic care in their 30's and 40's and wonder how it all happened. Perhaps it was a sneeze, a long drive, or gardening in the yard that set the pain off. But you were always able to do these things before without so much as a chirp from your low back. And now things are different. Even job stress can add to back pain. So how come your back seems so weak, when it was so strong before? What changed? Not much in fact. The reality is that back problems begin during our youth. With advances in MRI technology we can study changes in the disks of the back to see when these injuries first occur. Spinal degeneration begins to occur at age 10, provided some trauma has occurred, such as from competitive sports or simply goofing off as a child. Rarely is significant pain involved and the child seems to shake off the injury with little future consequence. But having back pain is not the same as a having a back problem, such as a sprain of the disk. When the pain subsides, it does not always mean that symmetrical motion of the joint is restored and the vertebrae are now back in their normal position...but the pain may be much less. Our bodies have a tremendous capacity to heal on their own without any type of doctor helping out. Mother Nature and innate intelligence is the best doctor. But sometimes recovery and return to full and optimum health is incomplete. Over time the effects of gravity and daily stresses, cause the joint to become more injured until something as simple as making the bed causes excruciating pain. But was it really the bed making? Probably not because this is something you've done every day of your life. A thorough examination by a doctor of chiropractic prior to the onset of pain could have perhaps discovered one of these "silent" injuries. But most people wait until the pain happens before seeking help. It's important to be checked after a trauma, even in young children. Properly diagnosing the extent of injury is the first step to getting you the care you may need. The pain often goes away quickly and we often think the problem has also completely healed. Getting regular check ups to make sure the motions of your spine are fluid and symmetrical is one potential way to avoid bigger problems down the road. Your doctor of chiropractic can also advise you on preventive strategies to minimize the risk of injury, such as proper lifting techniques.