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In this edition of Back 2 Health Tips we will discuss headaches. Chronic headaches are a major detriment in the lives of many Americans. Have you ever had to call out of work or school, miss a day out with friends or family, or ever just felt like not leaving the house due to a headache or migraine? A bad headaches can ruin a good day, or make a bad day even worse.

Migraines and headaches can be attributed to many different causes such as head injury, stress, or over stimulation from the environment. With these types of headaches, it is important to find the “trigger”. Dehydration is an all-too-common culprit. So, drinking more water on a consistent basis may help. Identifying foods that might be causing your headache can be difficult. Start a food journal and see if certain foods or drinks might be triggering headaches and work on eliminating them from your diet. Some common triggers are red wine, chocolate or processed meats. But those are certainly not all possible triggers.

If drinking more water and eliminating dietary triggers fail to reduce the severity or frequency of the headaches medical intervention may be necessary. The medical professionals at Back 2 Health have non-prescription alternatives to effectively treat headaches. It beats taking pain pills and going to sleep every time a headache creeps up.

Many patients are surprised to hear, however, that headaches can also have musculoskeletal origins. That means your headaches could be coming from tight or injured muscles in the neck and upper shoulder region. We call this a cervicogenic headache. Tiny muscles in the neck and shoulders can cause major pain in the neck, severe headaches and even trigger migraines. Has a neck massage ever made a headache feel better? This is a temporary way to relax and relieve injured muscle tissue. The Back 2 Health provider team will target the root cause of cervicogenic headaches, and can offer a more permanent solutions to chronic headaches and migraines.

You can usually get an evaluation by a one of our dedicated healthcare professionals in less than 48 hours. If you or a loved one suffer from frequent headaches, schedule an appointment to discuss the ways the Back 2 Health team can help you!

Knee pain is a common issue that affects people of all ages. The knee is a hinge-like structure providing our body with flexibility, support, and a wide range of motion for our legs.¹ This weight-bearing joint bears significant stress as we perform our usual routines, and it serves a powerful role in gait (walking patterns) and locomotion (the ability to walk forward).

The knee is the largest joint in the body and comprises a series of bones, ligaments, cartilage, and tendons. The knee is a team player who works with the other parts of the leg to function!  The knee’s proper movement allows us to go for a jog, climb stairs, sit for long periods, and even allows our favorite basketball player to pivot on the court as they line up for that perfect shot at the basketball hoop.

But how does the knee work? What does it do in the body, and is it susceptible to injury? What does it mean if someone has knee pain? Is knee pain treatable? To answer these questions, it is important to understand the structures inside the knee and how they move and protect the joint!

Understanding the anatomy

Your knee joint is a junction of several bones: the kneecap (patella), the shin bone (tibia), and the thigh bone (femur).

Between the bones is a rubbery, C-shaped cartilage called the meniscus that cushions and protect the bones.² The meniscus absorbs internal and external forces on the joint. This function lets us jump on trampolines, walk downstairs, and apply our body weight onto the knee without pain. Athletes are prone to injuring the meniscus when too much force is applied to the joint; you may have watched your favorite football player roll into a tackle and injure their meniscus during a game, resulting in several weeks being missed as the player heals.

Another type of cartilage lines the bones of the knee where they connect. This slippery cartilage, called articular cartilage,^2, allows for smooth movements of the bones around the knee joint. Articular cartilage protects bone surfaces from rubbing and grating on each other. This soft tissue structure prevents wearing down or degeneration of bony surfaces. You may have heard the phrase “bone on bone” to describe joints; articular cartilage helps prevent this!

Within and surrounding the knee are several important, rope-like ligaments connecting the bones. Several muscles from the pelvis, butt, and hip regions also connect to the knee.  Several small-but-powerful muscles are specific to the knee, too. Lastly, tough, rubbery cords of tissue called tendons connect the muscles to the bones.

Is the knee prone to injury?

The knee is prone to pain due to wear and stress on the joint. Normal aging, repetitive activity, traumas, and sudden movement can create a knee injury. This is due to the knee’s role in lower extremity (leg) movements and the combination of bone surfaces together.

Not all knee injuries or knee conditions feel the same, either.  Some types of knee pain are described as dull and achy, sharp, burning, pulling, tight, or sore. Knee pain can also feel like a deep aching in the joint or right on top of the skin.

Some injuries that occur to the knee are:

• Arthritis
• Fracture
• Tendinitis
• Bursitis
• Torn knee cartilage
• Dislocated kneecap
• Sprained ligaments
• Muscle tears
• Patellofemoral pain syndrome
• And more

Problems in the knee can result from trauma or a medical condition.³ A knee injury can also exist without pain!  When the knee is not working properly, inflammation and other symptoms can occur.  You may have symptoms of a knee condition such as clicking, popping, and locking up or giving out of the knee.  You may notice your knee has decreased overall movement, or specific movements cause discomfort.

Knee pain may not involve the entire knee, either. Some individuals report having knee pain on one side of the knee. Knee pain can occur in the front, on the back, on the inner or outer sides, or deep within the knee joint. Sometimes pain can prevent proper movement and functioning, such as weight-bearing, on the knee.⁴ The location of the pain is an important characteristic regarding knee pain treatment.^4,5,6

Who is at risk for developing knee pain? Several risk factors increase the likelihood of developing a knee injury. These include increasing age,^4,5 being overweight, certain diseases like gout or autoimmune conditions, previous history of injury, lack of exercise, and more.³

Additionally, if the lower back or pelvis is misaligned or off balance, this can cause you to put more of your body weight on one side versus the other. Over time the added weight and stress placed on that knee joint can lead to increased risk of injury, sprains and strains and cause the cartilage to wear down faster than normal.

When do I see a doctor?

You should make an appointment with a musculoskeletal specialist if you have:

• Difficulty or loss of ability to walk comfortably on the affected side
• Knee pain that occurs while resting or at night
• Injury that causes knee deformity
• Swelling of the joint or the calf area
• Knee pain that persists longer than several days
• Difficulty or loss of ability to bend the knee
• Signs of infection or inflammation including fever, warmth, swelling, or erythema (redness)
• Any other unusual symptoms prompting immediate medical attention

How is knee pain treated?

Knee pain and knee injuries are best diagnosed with a proper evaluation and assessment. A doctor of chiropractic is a musculoskeletal specialist and the right person to assess the most common knee conditions.  If the doctor needs more information, he or she may include imaging such as x-rays to visualize bones and joint spaces or an MRI to visualize soft tissues like ligaments and muscles for possible injury.  Many knee diagnoses are based on medical history and physical examination alone!

Treatment options will depend on the severity, duration, and frequency of the pain and the cause of the condition. Some people seek treatment for knee conditions even without dysfunction to improve movement and quality of life.^7,8<

Conservative care can be very effective in treating different forms of knee pain. Thankfully, there are many options available to a person.  Conservative care may include specific stretches for muscles and tendons of the knee, injection of a steroid or lubrication into the knee, joint mobilization, specific exercises to strengthen the surrounding muscles and tendons, hands-on soft tissue work into the muscles and fascia, changes in exercise routine or modifications at work or home, home exercise, and stretching programs, and more. <

Suppose your knee pain is due to an injury. In that case, your condition may be co-managed by your doctor with another healthcare professional such as a primary care doctor, orthopedist, or physical therapist.<

If you’re experiencing knee pain, it may go away on its own in a few days.  However, if the pain does not go away or it keeps returning, then it’s time to call Back 2 Health Physical Medicine and make an appointment for a proper evaluation. <

References<

1. Zeller, J.M., Lynm, C., and Glass, R.M. (2007). Knee Pain. JAMA. 2007;297(15):1740.

2. Netter, Frank H. Atlas of Human Anatomy. 1906-1991. Philadelphia, PA: Saunders/Elsevier, 2014.

3. “Causes and tips for coping with chronic knee pain.” (2018). Medical News Today. Retrieved March 2021 from https://www.medicalnewstoday.com/articles/311308.

4. Farrokhi, S., Chen, Y. F., Piva, S. R., Fitzgerald, G. K., Jeong, J. H., & Kwoh, C. K. (2016). The Influence of Knee Pain Location on Symptoms, Functional Status, and Knee-related Quality of Life in Older Adults With Chronic Knee Pain: Data From the Osteoarthritis Initiative. The Clinical Journal of Pain, 32(6), 463–470.

5. Foroughi, N., Smith, R.M., Lange, A.K., Baker, M.K., Fiatarone Singh, M.A., Vanwanseele, B. (2010). Dynamic alignment and its association with knee adduction moment in medial knee osteoarthritis. Knee. Jun;17(3):210-6.

6. Farrokhi, S., Piva, S.R., Gil, A.B., Oddis, C.V., Brooks, M.M., Fitzgerald, G.K. (2013). Association of severity of coexisting patellofemoral disease with increased impairments and functional limitations in patients with knee osteoarthritis. Arthritis Care Res (Hoboken). Apr;65(4):544-51.

7. Rubin, B.R. (2005). Management of Osteoarthritic Knee Pain. J Am Osteopath Assoc;105:S23–S28.

8. Frese, T., et al. (2013). Knee Pain as the Reason for Encounter in General Practice. International Scholarly Research Notices Hindawi. Retrieved March 2021 from https://www.hindawi.com/journals/isrn/2013/930825.<

Back 2 Health is proud to support our brave military by providing comprehensive care for veterans and their families through the VA Community Care Network (CCN). We’ve been a part of the CCN since the beginning and have provided high quality chiropractic, medical and physical therapy care for many veterans and their families.

The VA Community Care Network is VA’s direct link with community providers to ensure Veterans receive timely, high-quality care. CCN uses industry-standard approaches and guidelines to administer services, pay for services promptly, and manage the network to its full potential.

All too often we see our proud service members living through pain, assuming that nothing more can be done. Or worse, they have to take powerful pain medications just to get through the day. The VA has teamed with the healthcare providers at Back 2 Health to offer a solution and it’s the CCN. We’ve been able to provide the High Quality care that these veterans and their families deserve through this incredible program. With the proper referral the VACCN will cover 100% of the costs of treatment allowing veterans and their families to get the care they need without waiting in long lines at the VA or having to pay out of pocket. It’s a Win-Win!

If you would like a referral to see one of our providers, contact your local VA medical center and request a referral to Back 2 Health Physical Medicine or to Dr. Adam Hall specifically. Once we get your referral we’ll contact you to set up your appointment.

Driving Posture Tips, Tricks, and Stretches for a Long Drive

Road trips can be sources of endless fun. Long trips through an idyllic countryside are quaint and relaxing. Let’s face it, though, sitting in a car for hours can hurt. Between stiff limbs and aching joints, a long drive isn’t always comfortable.

Often, these aches and pains can be mitigated through simple posture adjustments. A slight seat adjustment or some low-impact stretching can make all the difference. Small changes can lead to beneficial results.

If road trips and long drives cause you pain and discomfort, then these driving posture tips and tricks are for you.

Make Sure Your Seat is Adjusted

Most of your proper driving posture begins with the placement of the seat. A properly aligned driver’s seat will provide ergonomic support to minimize pain and fatigue.

Start by adjusting the seat distance. Make sure you can operate the pedals with your legs somewhat bent. Your arms should comfortably reach the steering wheel while slightly extended. There should be no pain or fatigue in your arms or shoulders.

Next, check the angle of the back. Your entire back must be in contact with the seat for proper support. Keep the angle no more than 110 degrees. You should also be able to see all mirrors from this position.

The seat should be flat, and the back of your knees should be a couple of inches from the seat itself. When adjusting the seat for visibility, make sure you can read your instrument panel and the road without moving your head. If you have existing injuries, such as back pain, then use lumbar supports and supporting pillows to ensure a smooth ride.

Finally, adjust your headrest. When doing so, remember the following tips:

• The headrest should be aligned to meet the center of your head.
• The headrest must always be within four inches of your head to prevent whiplash.
• The top of the headrest should be no higher than the top of your head.

These adjustment settings are designed to be both safe and comfortable. Though there is some room for specific preferences, straying too far can lead to undue pain or fatigue. Start with these tips, and adjust slowly to maintain the best ratio of comfort and safety.

Reassess the Steering Wheel Position

Holding your arms outstretched for long periods isn’t often comfortable. With a poorly positioned steering wheel, the driver may feel neck and shoulder pain. However, adjustments are quick and simple.

After the seat position is set, adjust the steering wheel so that your chest is 10 to 12 inches away. Your arms should have a slight bend. With your arms fully extended and your back flush against the seat, your wrists should rest on the steering wheel.

Hand placement is also important. Though many might have learned the “10 and 2” placement, this is now outdated. The best positions are now “9 and 3 o’clock.” This placement reduces the chance of airbag injuries, and it allows the driver to rest their elbow on the armrest.

When holding the wheel, be sure to:

• Grip lightly with your fingers
• Bend your arms at an angle of 120 degrees
• Keep your shoulders relaxed
• Rest your elbows on the armrests, if possible

This steering wheel posture will minimize stress on your neck, arms, and shoulders. These tips also ensure that you are best positioned for safe and responsible steering wheel control.

Remember Your Stretches

Even with the best posture, you’ll need to take breaks now and then. Pulling off at a rest area and taking some time to stretch will improve blood flow and ease your muscles. A break will also keep your mind clear and focused. And when staring at the road for long periods of time, even your mind can start to ache. Stretching can also help reduce the risk of chronic pain and injuries.

Always do the following stretches when the car is stopped and parked. When you’re in a safe place, these areas will benefit from targeting stretching:

• For drivers, focus on stretching your neck, shoulders, and back. This will increase blood flow and reduce strain and soreness.
• Passengers should keep their backs and arms stretched and limber. Don’t forget your glutes to relieve tightness and tension.
• Remember your legs! Stretch your hips, legs, and ankles to keep blood flowing and muscles loose during a long drive.

You can also take a short walk. This will help clear your mind and increase your circulation. An elevated heart rate will help kickstart your entire system and get you ready to slide back behind the wheel.

Taking trips can be a great way to escape and have fun. Without the proper posture, though, the journey can cause plenty of pain and discomfort. Before your next road trip, ensure your seat and steering wheel are adjusted for comfort and safety. Of course, always wear your seat belt. If you start to feel pain or fatigue, pull over into a safe location. Then, stretch your muscles and joints, and clear your head before you continue.

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