Dr. Dalfino's Non-Surgical Treatment Blog

"Low Back Pain: Could Your Feet Or Hips Be At Fault?"

The body is an interconnected whole and needs to be looked at as such in order to get at the root of a spinal problem. We are all familiar with low back trauma, bending and stooping in awkward positions to lift something from a trunk, or the slip and fall on ice. In these examples, it's easy to see how the trauma preceded the low back pain.

But sometimes pains in the low back are not so easy to figure out. One area of the spine could be compensating in posture for another, inhibiting a vertebral joint's ability to fully recover. Or maybe you're suffering from the cumulative affects of microtrauma over time.

Such is the short leg; about 1/10 people will have an anatomic difference in leg length of up to one centimeter. This short leg causes the pelvis to incline to one side providing an uneven support for the base of your spine. It's a little like walking with one foot in a small ditch. The uneven pelvis then causes a lumbar scoliosis, which must be further compensated from above.

But a short leg can also be functional, due perhaps to a small or collapsed arch of the foot. This can account for up to 5 mm of leg length difference. Do you have a history of having flat feet or have you ever sprained one of your ankles? The sprained ankle can damage ligaments to such a degree that the normal arch of the foot can no longer be maintained.

Depending on the degree of the problem we may be able to help your low back pain by correcting a problem in the foot. Many in-shoe orthotics are available to correct a fallen arch. If the problem is very severe, you may also need a visit to a podiatrist.

In any case, it's important to consider the foundation of a spinal problem, and it can be as simple a problem as bad foot posture that is affecting how your low back functions. Also, problems in the sacroiliac joint or hips can affect how the lower spine moves.

So pay attention to where the pain is located, but also consider that other joints nearby may be affecting your recovery as well.

As a doctor of chiropractic, my office is fully equipped to handle problematic low back conditions that don’t seem to clear up in response to what you've tried in the past. Have your feet been checked? Has someone looked at your posture carefully?

If you would like to discuss any health concerns, our office can assist you in taking the next step to better health with a complimentary consultation. Just call 203-922-9277 to schedule an appointment.

"Fibromyalgia and Cord Compression?"

Fibromyalgia is a difficult problem to diagnose or determine its cause. Since exercises, diet, and weight loss can be so helpful to fibromyalgia patients, we may think they can completely solve the problem.

Chiropractors recognize the importance of good spinal posture in affecting a variety of health problems, including fibromyalgia. It's important to not think of the disease as having a single solution, but rather as a more complex entity, needing a comprehensive approach. But is there any research on the spine being involved in patients with fibromyalgia?

Recent research (Holman AJ. Positional cervical spinal cord compression and fibromyalgia: a novel comorbidity with important diagnostic and treatment implications. J Pain 2008; May 20 epub.) has looked into a specific  problem seen in fibromyalgia patients: spinal cord compression. The scientist took MRIs of fibromyalgia patients with the neck in different positions such as max forward and backward bend. These positions can show the spinal cord is compressed/pinched where a neutrally positioned MRI or CT scan may not. In the study, 71% of patients with fibromyalgia had positional cervical spinal cord compression.

So what does this mean? It means if you have fibromyalgia there may be an undetected cervical compression problem that may also be affecting you.

Good neck posture and mobility are keys to good health. We can diagnose your condition and see if there is a spinal component to your problem that may have been overlooked. Sometimes it's the low back pain that keeps us from exercising and ultimately getting rid of the fibromyalgia-inactivity-pain cycle. And, as the research above suggests, maybe the problem is in the neck and this needs to be addressed in a specific and comprehensive manner. Sometimes immobility in one area of the spine is compensated for in another, which can make your ability to heal somewhat lessened. Maybe the neck has been a concern of yours for a long time since the fibromyalgia symptoms came on following a neck trauma such as a whiplash. If you also suffer from headaches and have spinal pain, these are important clues that some of your symptoms may be spinally related.

It's important to view your fibromyalgia symptoms from a global perspective, and not just think of one isolated issue as the root cause, and the only place where treatment needs to be directed. If you would like a complimentary consultation to begin to address your health concerns, just give us a call at 203-922-9277 to make an appointment.

"Could Neck Problems Be Affected By Your Posture?"

While most of us have a look in the mirror at least once a day, few of us look at our appearance from a different angle, such as from the side. But, the view from the side can be quite revealing if you suffer from chronic neck pain.

First, note the position of your head in relation to you shoulders. Is it right above the shoulders or does it lean forward from your chest? If it does, this would be called forward head posture, and can come from a problem in your neck. Lower areas of your spine can also cause this problem. Some of us have increased our weight over the years with much of it added to our abdominal region. Because of this increased core weight, the body must counter-balance the weight gain by causing the lumbar spine to "sway- back."

While this “sway-back” problem can create pain this the lumbar spine, it can also have far reaching effects in the posture of the neck. Usually someone with a protruding stomach and sway back will have somewhat rounded shoulders and a forward head posture. If treatment is only directed at the neck without considering how other areas may affect the stability of the neck, then the results may be less than optimum.

In an accident, many areas of the body can potentially be injured.

As a chiropractor, I not only look at your primary injuries but also how mechanically one area of the spine can affect a distant area. These more distant areas can cause neck pain by referral or they can impede complete recovery because the body is compensating for abnormal posture or movement elsewhere.

X-rays of the full spine can show this abnormal posture as can a detailed postural analysis from our office.

So do you like what you see when you view your posture from the side? If your posture leaves something to be desired, or you're wondering whether your neck problem could be improved by changing another part of your spine, then it is important to be thoroughly checked. Just examining the neck after a whiplash may leave some injuries undiscovered. Are there tender spots in other areas of the spine? Does your overall upright posture seem lacking?

Our office always offers complimentary consultations to address any health concerns you may have. Just call 203-922-9277 to schedule an appointment.

"Acupuncture for Migraine Headaches?"

Many patients with migraine headaches seek out alternative therapies for their condition if daily medications do not seem to help. Some choose to look East and may consider acupuncture for their care. But what is the evidence for this treatment? Does it work?

Two studies in recent years (Alecrim-Andrade J, et. al. Acupuncture in migraine prophylaxis: a randomized sham-controlled trial. Cephalgia 2006;26:520 and Linde K, et. al. Acupuncture for patients with migraine: a randomized controlled trial. JAMA 2005;293:2118.) compared the results from a  sham acupuncture procedure to the real deal. Unfortunately, the sham procedure had the same results as the bonafide treatment, meaning the acupuncture treatment was ineffective for persons with migraine headache.

In contrast, there are several studies (Tuchin PJ. A twelve month clinical trial of chiropractic spinal manipulative therapy for migraine. Australas Chiropr Osteopathy 1999;8:61 and  Tuchin PJ, et. al. A randomized controlled trial of chiropractic spinal manipulative therapy for migraine. J Manipulative Physiol Ther 2000;23:91 and Nelson CF, et. al. The efficacy of spinal manipulation, amitriptyline and the combination of both therapies for the prophylaxis of migraine headache. J Manipulative Physiol Ther 1998;21:511.) that suggest chiropractic care may be an effective treatment for patients with this severe problem.

Although it may seem difficult to understand just how a spinal adjustment might help a patient with migraine, it is what the research does, in fact, show. It is something that doctors of chiropractic and their patients have known anecdotally for decades. Having scientific proof for something can provide to you added confidence in your health care choices.

It could be that sprains of the delicate joints of the neck region interfere with the neural connection to the blood supply of the brain. Or perhaps it is imbalanced neuromuscular reflexes that are the culprit. Ultimately, how something works is less important to a patient than IF something works.

Another factor to consider in a health care decision is the safety profile of chiropractic vs. long-term medication use, as well as potential side effects. The safety of chiropractic care is well proven, with few people experiencing untoward side effects or severe complications.

Chiropractic is a natural, non-drug, and proven alternative and efficacious treatment for migraine.

If you would like to discuss how chiropractic care may be able to help your migraine pain, we are always available for complimentary consultations. Just call 203-922-9277  to schedule an appointment.

"Hand Pain and Its Causes"

When hand pain strikes, it can be a difficult problem to deal with since we use our hands for so much; our work, our play. It can also be distressing psychologically to have a part of your body not working as it should.

Hand pain can be a difficult thing to diagnose since there are many causes of hand pain. One familiar cause is a carpal tunnel syndrome. This is where the bony tunnel in the wrist is narrowed, entrapping the nerves that pass through and go into the hand.

Another cause for hand pain is a thoracic outlet syndrome. The thoracic outlet can be compressed in the shoulder girdle region causing hand pain, often at night.

The last thing to consider with hand pain is a neck problem such as a disk lesion compressing the nerves in the neck causing referred or radicular (nerve root) pain into the hand.

These three problems can independently cause hand pain or they can all co-exist to varying degrees. You are entitled to more than one cause, correct? Getting a proper diagnosis is the first key to a full correction of a problem. If your hand pain is being treated with analgesics (pain killers), there may be a reduction in pain sensations but pain medications cannot release an entrapped nerve. You might also want to consider that pain is a signal. The problem that is causing the pain should be a patient's focus. When the fire alarm goes off at home do we think to put out the fire alarm, or put out the fire? Pain is the fire alarm, not the fire.

Recent research (Nord KM, et. al. False positive rate of thoracic outlet syndrome diagnostic maneuvers. Electromyogr Clin Neurophysiol 2008;48:67.) has shown that differentiating between these three unique disorders with clinical tests can be problematic, since false positive tests are more a rule, rather than an exception. Patients with carpal tunnel syndrome were one of the most frequently misdiagnosed groups of patients.

You may also need x-rays of your spine to fully get at the cause of your hand pain and determine the best course of action; pills, surgery or specific chiropractic care. Chiropractic is an often-overlooked conservative form of care. It carries very low risks, and should be a considered option for anyone who is considering bracing, medications or wrist surgery

If you would like to discuss your health concerns, we are always available for complimentary consultations. Just call 203-922-9277 to schedule an appointment today.

"Stress and Headaches"

How does stress affect your wellbeing? And how is stress related to getting headaches? There are many paths to this and I will discuss the most common ways stress can make you more headache prone.

Stress  can affect our sleep. Americans just do not get enough sound, restful and restorative sleep. Studies suggest that few of us get the necessary eight hours each night. Tossing and turning, and simply not recovering from the previous day, adds tension to your morning. Sleep deprivation itself can lead to headaches. Sometimes we compensate for this by taking in a lot of caffeine each day, which can then create a vicious cycle, making us jittery and affecting our ability to fall asleep later that night.

How we react to it stress also affects us. Some of us literally "take it out' on our bodies, channeling the stress into our neck and shoulders. This can cause tension-type headaches where the back muscles of your neck are tight and ropey. "Knots" in the muscles can develop, sending shooting pains into your head, as if it’s trapped in a vise, being squeezed by the muscle tension.

Stress can affect us by disrupting our normal healthy routine. Instead of eating right and exercising, we resort to eating junk foods and avoiding the gym. Over-eating and not maintaining a healthy weight can add to the stress on our body, the spine, and our heart.

A lot of us think we handle stress well and just need a two-week vacation to get back on track. But really, two weeks off does little to change your life for the other fifty weeks during the year. The key is to learn how to handle and deal with stressors on a "day to day" basis. Sometimes, it's a spinal injury that is not corrected that adds to a stressful feeling. Sometimes, it's conflict at work or at home, that is simply not getting resolved. Are we ourselves taking time out to smell the roses?

Each day, try to do something positive for yourself, and resist the temptation to worry about the future and fret about the past. Take each day as it comes and try to have positive thoughts. These practices can help improve your outlook and perspective. There's a lot to be said for the person who wears "rose-colored glasses," or the person who can just let the water "run off of the duck's back."

Try a different attitude in approaching the stressful things in your life. Sometimes just getting things into perspective and not stressing the small stuff are important to leading a more stress-free life, and enjoying the hidden pleasures that life brings to us each and every day.

For a complimentary evaluation with Dr. Dalfino, contact the office at 203-922-9277

"New Research on the "Double Crush" link to Carpal Tunnel Syndrome"

Carpal tunnel syndrome patients often complain of neck pain. The same nerves that go through the wrist tunnel, emerge from the neck and can be compressed or irritated at the neck joints. If the nerve is pinched in these two areas, it has been referred to as a "double crush."  Because of this irritation at the neck, focusing only on the wrist for treatment may not be a comprehensive solution to this often debilitating problem.

Recent research (Russel BS. Chiro & Osteo 2008,162doi:10.1186/1746-1340-16-2) has reviewed the evidence for and against this linkage of two problems. Dr. Russel  concludes if the wrist symptoms only involve sensation, rather than weakness, then the double crush link may be more tenuous. However, if you have a "motor" problem with a nerve, and experience weakness or loss of grip strength, then the implication of a problem also at the neck appears to be more relevant.

However, since many patients with carpal tunnel will also have neck pain, a trial of chiropractic care at both the wrist and neck is a conservative strategy that seems prudent and should be considered.

If your carpal tunnel symptoms developed after a neck injury or you also have pain into the upper arm or shoulder, these may be clues that your nerve is irritated in more than one location.

Getting to the cause of a problem, rather than just treating the symptoms, is a hallmark of specific chiropractic care. We can assist you with doing corrective wrist strengthening exercises and stretches, which may relieve pressure at the wrist tunnel. Some patients can benefit from nutritional counseling and even weight-loss strategies, since excessive weight is a risk factor for developing carpal tunnel syndrome. Other patients may need simple ergonomic instruction such as modifying your posture at a workstation, to take pressure off of both the neck and wrist.

The important thing is get properly diagnosed, with x-rays if needed, to get a full and comprehensive picture of the actual problem. Simply limiting wrist motion with a splint may not be enough to make the wrist and hand both pain-free and functional. Many people only consider surgery or daily medications as their only alternatives and fail to consider natural and drug-free chiropractic care.

Call the office at 203-922-9277 for a free consultation with me to discuss your condition.

"Five Exercises to Help Your Neck Stay Pain-Free"

The neck is the most flexible part of your spine and just like any other area of the body, movement exercises and good posture are important to maintain its health. Neck pains can be brought on or aggravated by how you treat this vital structure. We often neglect our neck when it comes to exercises, focusing instead on our legs or heart. So try these helpful hints and incorporate them into your daily routine.

Moving your neck slowly through all its ranges is key. It is important to do pure movements rather than combinations, rolling the neck around like a ball and socket joint (such as the hip or shoulder) is to be avoided. Instead, flex the neck forward until your chin touches the top of your chest. Then, slowly bend your neck backwards, chin to the sky These movements should not cause pain if they are done slowly and you have no pre-existing injury.

The next movement is side bending and is accomplished by trying to bend either ear towards the shoulder. Do this in front of a mirror so that you keep your head straight looking forward. Note whether you can do this the same amount to each side.

The last movement is rotation. Simply rotate your chin slowly so that you are looking over one shoulder. None of these movements should cause pain or make you dizzy. If they do, then it's a sign you have a neck injury.

An important aspect of neck function is how the shoulder girdle influences neck posture and motion. Try rolling your shoulders forwards and backwards, stretching slowly, to help ease tension at the neck. General exercises such as fast paced walking or hiking are important for your neck too. Remember, your spine is the core of your body and walking is one of the least "injury-producers," something you can keep up well into your later years.

Lastly, make sure your neck posture is kept upright when you are talking on the phone, driving, reading, doing other tasks, or sleeping.  A very small pillow is usually best for sleeping and neck support pillows are available to help maintain the normal forward arch of the neck. A small pillow will allow your head to ease back, relaxing the muscles at the back of the neck.

If you would like a complimentary consultation at our office to address any health concerns, then just call 203-922-9277 to schedule an appointment.

"Depressed with Fibromyalgia?"

Many patients with fibromyalgia have long standing depression, which is more substantial than just having the occasional morning blues. The muscle pain can be either a cause for the depression or even the effect of a prolonged, depressed state of mind. Or, the two may not be linked at all and simply co-exist at the same time. In some patients, the depression may lead to inactivity, an unhealthy diet or weight gain, or even substance abuse. These habits will generally aggravate fibromyalgia pains.

Recent research (Rheumatology[Oxford] 2008 Apr 29) has discovered fibromyalgia patients with physical pain can decrease their pain symptoms when they take anti-depressant medications. I bring this up, not so that more people or directed towards taking additional medications (especially not with being thoroughly diagnosed), but instead to show the mind-body link.

In addition to using chiropractic care to deal with spinal function and posture, there are other important aspects to be considered when thinking about the complexity of fibromyalgia. If the depression seems to predate the muscle pains, then a through work-up and perhaps counseling with a clinical psychologist can be of help.

Other patients can benefit from increasing their activity and starting a rigorous exercise program. Both strength training and aerobic activities, such as fast-paced walking have been shown in studies to help patients. Since you have muscle pain, it may not seem correct to work the muscles more, but research has shown that increasing muscle strength can decrease pain in the long run.

Some people find exercise causes joint pain in their spine and/or hips. Exercising in pain is no fun at all and cannot be sustained. This is where chiropractic can be an important adjunct to keeping you moving.

Exercise is also key to maintaining a healthy weight. Vigorous exercise can also raise endorphin levels, blocking pain and elevating your mood.

A comprehensive approach is the solution to treating fibromyalgia and not simply focusing only on medications for all of our ills. For some patients, drugs will be the answer and can be life-savors. In others, the side effects will eclipse any benefits. Natural approaches should at least be considered if your drug regimen is currently not working for you. Nutrition, exercise, and chiropractic care are the main hallmarks of care at our clinic.

If you would like a complimentary consultation to address your health concerns, then just call 203-922-9277 to schedule an appointment

"Preventing Low Back Pain"

While 80% of us will suffer a severe back pain episode at some point in our lives, most of us at any given time should be more concerned about preventing or aggravating back pain, rather than resolving a set-back. As they say, an ounce of prevention is worth a pound of cure. There are two aspects to prevention of back pain: keeping strong and flexible, and avoiding mistakes during movements.

As far as exercise is concerned, nothing is more beneficial to the spine than walking. Remember that your spine is your "core," and the core is activated with fast-paced walking. Most of us don't think of how the spine is affected with walking, instead focusing on the legs. Make walking part of your daily routine. Walk a few blocks or across town to run an errand, rather than getting into a car for these short trips. Park a few blocks away when you have to use the car, so that you can get in a few minutes of walking. Some of us spend five minutes circling in a parking lot just to get a space close to the front door or we get frustrated when we can't find a space close to the gym! In contrast to sitting, which increases pressure on our disks, walking strengthens muscles and dissipates the pressure on our lower disks.

Keep the back flexible through slow stretching in all of the different ranges. Tight muscles at the back of the thighs-the hamstrings are an often neglected area that affects the lower spine tremendously. To stretch these muscles, stand upright and put on foot on the back of a chair or sofa. Slowly bend forward and hold this position for 30-40 seconds. It should cause a tight burning pain at the back of the leg. It should not cause a shooting pain down your leg, or increase pain in the lower spine. If it does, then see a health care provider immediately. When the hamstrings are flexible, this allows the pelvis to rotate forward when you bend over. If the hamstrings are not flexible, then the lower spine will bend too much to accomplish any lifting task.

The second aspect to preventing back pain is avoiding mistakes, such as lifting with your back, instead of your legs. This is especially true if an object is very heavy. Sometimes the object is light, but we lift in an awkward position, standing with most of our weight on one leg, then bending and twisting, such as getting grocery bags from a back seat, or moving and positioning a child safety seat. Especially avoid twisting motions of the lower spine while bending over. Also, use one of your hands to help brace your spine, which will decrease the pressure on your disks.

If you would like a complimentary consultation to address your health concerns, just call 203-922-9277 to schedule an appointment.