by Erik Reis, DC, DACNB, CBIS
For a majority of the population, daily headaches, neck pain, and migraines are merely a theoretical event that comes up in conversations with family and friends. But for the nearly 21.2% of the US population who currently suffer from these debilitating conditions, life can consist of multiple nights of lost sleep, repeated visits to the doctor, and an endless pursuit of solutions to these life-altering problems.
The last six years of clinical practice have significantly shaped and changed the way I assess, diagnose, and treat these crippling conditions, which are individually unique to the patient who experiences them. As any provider will tell you, patients rarely (if ever) walk into our offices and willingly tell us exactly what symptoms they are experiencing, which is why it is up to the provider to be highly educated, but more importantly, possess the ability to critically think through their patient’s situation. Regardless of the medical designation and/or philosophy, doctors must possess the ability to challenge their own biases to critically think through each case, as if starting from scratch with each patient who walks into their treatment room.
As recent neuroscience has shown, chronic pain can be multifaceted and affected by a magnitude of variables such as trauma (physical, emotional, mental), diet/nutrition, sleep, psychological (BPS) factors, family history, and various environmental influences. As students, we were taught that pain is usually a poor indicator of function, due to the fact that people may move well and still be in pain, with the opposite being just as true.
Since pain is a significant driver of functionality and quality of life, it makes sense for us to dig into various reasons why a patient may experience different types of pain, specifically in those cases that occur in the offices of doctors who primarily treat structural and neurologically based conditions such as whiplash and post-concussion syndrome. Regardless of the profession, we all carry inherent biases toward therapies and treatments for treating chronic head and neck pain, so it is imperative that providers continue to challenge their beliefs and thought processes surrounding various forms of therapies and modalities used to treat these conditions.
For this reason, it is important to start with a thorough history during a new patient examination, along with performing an array of metabolic, structural, and neurological testing to truly determine the origin of a patient’s symptoms in order to eventually create an individualized treatment program designed specifically for the patient. These steps are crucial for proper diagnosis and treatment, as they allow us to truly dig deep enough to find solutions to individual problems while also respecting the fact that the patient seated in front of us is a complete human being with an amazing nervous system that controls nearly every part of their physiology.
For centuries, doctors have understood the importance of the spine and its surrounding structures, which is why we have so many therapies and treatments based on the neck. But as we have seen in the past, structure doesn’t always dictate function, and a majority of the time patients who come in with a clean MRI/CT still have some sort of resultant structural issue that needs to be properly assessed and treated. An even bigger issue is the fact that there are far more similarities than differences between whiplash and post-concussion symptoms, creating a dialogue that should alarm providers to realize the minimal differences between a concussion and a whiplash, which is why we should treat every patient as if they have both conditions and give them the treatment they deserve.
The common denominator is the fact that no matter how the spine is affected, the brain is also being affected in a similar way inside the skull, creating the classic coup-countrecoup movement that can cause damage to both structural and neurological tissues. We now realize an individual doesn’t need to hit their head or lose consciousness in order to acquire a concussion or whiplash, and a majority of the time, they both occur simultaneously.
First and foremost, an in-depth bedside neurological and orthopedic examination must be performed to properly assess the cervical spine and it’s structure. We need to rule out any specific issues that may be alleviated with manual therapy, soft tissue modalities, and/or referrals to other providers for specific services. This is where most people stop. They assume that since they’ve cleared the neck, everything is fine and as good as it can get. But what about those who still have symptoms?
The rest of the story lies in how the spine and neck muscles are influenced by both the eyes and the environment around them.
To give you a clearer picture, let’s do a quick exercise: Place both of your hands on the back of your head, right at the base of the skull. Keeping your head perfectly still, try moving your eyes around in all directions as fast as you can for 15-20 seconds. Did you feel your neck muscles contract/relax? I know it sounds crazy, but your eyes can have a significant impact on the tone of your neck muscles, specifically your suboccipital muscles where most people report having tension-style headaches.
I see providers have missed these simple signs and symptoms all the time when their patients make their way into our office for treatment. Your eyes are a huge window into your brain function and have become so important to neurological rehabilitation that nearly every neurological examination involves some sort of eye movement assessment.
Another significant component involves an individualized assessment and treatment of the inner ear system, which is the first system in your body to completely mature, even before you are out of the womb. The inner ear system helps us orient ourselves in space in relation to gravity and is primarily the reason why you feel motion and movement in an elevator or during takeoff or landing in a plane. The inner ear system, paired with the eyes and neck, can have profound effects on your ability to balance, perform coordinated head-neck movements, and can even affect cognitive processing due to its connections with the hippocampus and frontal lobes.
These systems are highly important for proper brain function, as they are the bedrock for higher processes in the brain that allow us to perform amazing tasks throughout our lifetime.
If you are someone who currently struggles with chronic neck pain, headaches, and/or migraines, reach out to our office for a consultation so we can get to the bottom of your symptoms!
Dr. Erik Reis is a Chiropractic Physician and board-certified Chiropractic Neurologist at The Neural Connection in Bloomington, Minnesota. He holds a diplomate in neurology from the American Chiropractic Neurology Board and is a certified brain injury specialist (CBIS) with the Brain Injury Association of America. https://facebook.com/DrErikReis
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