Do Kids Get Structural Problems?

“My kids are way too young for spinal problems…”

During my years in practice, people have often asked why we check so many kids in the office. Most people are under the impression that children are way too young to have a structural problem in the spine. For the most part, you would be absolutely correct. About 60% of the kids we check in the office have no structural problems at all, and thank goodness for that.

However, statistics from the Center for Disease Control show some alarming numbers. Each year, over 1 million children between the ages of 0-5 will be hospitalized due to a fall. Another 700,000 will be hospitalized from an accidental trauma. That’s not even including the number of kids who will suffer a trauma to the spine, but are never taken to the ER!

Now think about this, most people will never even know or think about taking their kids to a chiropractor following a fall or trauma. The great news is that kids are extraordinarily resilient to injury. They bounce back up, and their ability to heal is just much better than that of an average adult. However, structural problems in the spine don’t necessarily cause neck pain and back pain, especially in children. What they can do is create other secondary conditions. Whenever there is pressure in the nerves at the base of the brain from a structural misalignment at the top of the neck, many kids can show conditions like: 

• Asthma
• Allergies
• Immune problems
• Ear infections
• ADHD
• Torticollis

These are just some of the common conditions that parents bring their kids to chiropractors for. While it’s not a chiropractor’s job to treat these symptoms, they are signs that the nerve supply from a child’s spine is compromised. On many kids, this can be tied to a difficult or traumatic birth process.

The best part of all is how much kids love getting gentle adjustments. It’s often times a parent’s worst nightmare to take their kids to a doctor. The screaming and tantrums on display at a pediatrician or a dentist can unnerve even the strongest parent. A child and infant adjustment is very different than adults, and you’ll usually see kids jumping on to my tables excited to be checked!

But the most important reason that kids should be checked early is just because it makes sense. When most of us adults develop some bad secondary conditions, x-rays usually show that a problem has been growing in the spine for 15+ years. Why let kids develop the same problems that us adults have had. Just like we take our kids for a dental check-up to ensure that they are free of cavities, our kids deserve a structural check-up to prevent the damage of a developing spine.

TMJ and the Neck – What’s the Connection?

One of the most common and troublesome problems is a condition known as Temporomandibular joint dysfuction, or TMD for short. In fact, many of you may have heard someone talk about their TMJ or having TMD, but didn’t quite know what it was.

TMD involves the joint that connects your jaw to your head. Proper movement of this joint is critical to proper function. It has a profound affect on people because dysfunction of that joint can cause a variety of problems including:

• Sharp/stabbing jaw pain
• Inability to open the jaw properly
• Headaches
• Neck pain
• Painful clicking
• Teeth grinding
• Clenching
• and much more...

It has rapidly become one of the more common reasons for visits to a neurologist and pain clinics, because of the dramatic impact that this sensitive piece of anatomy has on a person’s quality of life. Many times, this condition is treated with medications. In some cases, muscle relaxers or injections to the joint.

What does this have to do with the neck?

A search of PubMed will show numerous references for increased incidence of TMD in conjunction with a whiplash injury, or head/neck trauma. A systematic review of these papers show that people with whiplash/head injury actually have more severe pain and more pronounced dysfunction of the joint.

Another review showed that just treating the TMJ in these whiplash related cases poor outcomes suggesting that the cause of the problem may be outside the joint itself. The whiplash associated cases showed just a 48% improvement compared to the non-whiplash cases which improved 75% of the time. That leaves a huge amount of people who are still in pain and suffering because the primary insult to the body was not addressed properly.

TMD usually comes in 2 varieties:

1. Muscular dysfunction – the muscles of the jaw (pterygoids, masseter, temporalis) become hypertonic and dysfunctional creating painful musculature and sloppy movement.

2. Articular dysfunction – the joint itself can have problems. Dislodging of the disc, arthritic degeneration, and inflammation can irritate the very sensitive nerve endings that cover the joint.

Not much can be done about arthritic breakdown of a joint. However, this is a less common cause of TMD. The most common causes of TMJ problems stem from muscular imbalance and dislodging of the articular disc. In a way, these two problems are intimately related. When you have bad jaw muscles moving the jaw abnormally, then it leaves more room for the articular disc to shift out of place.

So what can make these jaw muscles dysfunctional? To know that, we have to know what controls the muscle. Every muscle in your body is controlled by a nerve. Whether it be a big bulky bicep, an achy sore back muscle, the blood pumping heart muscle, and the food digesting stomach.

For the jaw muscles, a special nerve called the Trigeminal Nerve emanates from the skull and provides innervation for the face, jaw muscles, teeth, brain, and other important structures. (as seen in the above image)

The trigeminal nerve is one of twelve specialized nerves called Cranial Nerves. The unique thing about Cranial Nerves is that they do not exit out of the spine. They actually begin come out of the brain and the brainstem, and exit out of the skull. Therefore, a problem with one of the cranial nerves is usually indicative of a problem at the brain stem.

Cervical Displacement, Whiplash, and the Brain Stem

One of the reasons that our office gets referrals is because of how Cervical Displacement impacts the health and function of the brain stem. While the top of the neck doesn’t apply direct pressure to the brain stem, the movement and function of the neck has large implications for this important piece of anatomy.

When someone has an episode of whiplash, there can be substantial damage and injury to the neck, but the more concerning portion is what happens to the nervous system. A phenomenon known as Central Sensitization occurs. This problem happens when the brain stem fires inappropriately to the limbic system (controls the basic emotions (fear, pleasure, anger) and drives (hunger, sex, dominance, care of offspring)) and reticular activating system (the places where pain is interpreted in the brain). When this happens, even the slightest touch or movement can trigger a pain sensation in the brain.

This is why many doctors can find no physical damage to the body, but people will suffer with chronic pain issues like fibromyalgia. People recognize this quickly when the pain is stemming from the neck, shoulders or back, but the reality is that this same thing is happening in the jaw muscles.

To get to the root of someone’s problems, we have to evaluate this critical, but under studied part of the nervous system. 

How does Structural Chiropractic address this?

1. Restore healthy biomechanics to the spine – create a state of Normal Structure in the neck so that the proper signals get to the brain.

2. Increase circulation through the brain – proper alignment ensures that blood to and from the brain stem properly. Proper blood flow means better nerve firing.

3. Restore health biomechanics to the jaw – Once the neck alignment is restored, most of the time the jaw will reset on it’s own. However, sometimes gentle jaw adjustments may be necessary. 

Neck Protecting Tips for Sleeping Positions...

“Doc, I know that you can help me get better, but what can I do on my own to keep this problem from coming back again?”

Almost everyone who comes to my office want to know what they can do to protect their neck from shifting into a bad position again, and one of the most important things someone can do to protect their neck is to create an optimal position for sleep.

Why is sleep important? Aside from the obvious benefits it has on mood, energy, healing, and overall longevity, the way we sleep also impacts the structural integrity of the spine. Just think about it, most of us spend almost 1/3 of our lives sleeping, and that time is often spent in one of a few postures.

In fact, I’ve seen numerous patients tell me that their problem began upon waking, or that they think that their problem began because they slept funny. The fact is that a prolonged period in a structurally poor position can affect the neck and affect the neurovascular tissues that travel through the neck. This can lead to Secondary Conditions like torticollis, neck pain, headaches, and back problems.

So how do we protect our neck and the nerves that pass through it? These  tips should get you off on the right foot.

Positioning Matters

There are 3 primary positions, and sub variations around that.

Stomach Sleeping – Avoid it:

If you haven’t been told already, stomach sleeping without a specialized pillow can put your neck in too much twist in your neck.

Just try this. Turn your head to your right. Now keep it there for an hour.

I bet that sounds pretty terrible. Now think about how that must feel to have your neck sitting like that for 6-8 hours by the time you wake up.

Stomach sleeping also puts the spine in a hyper-extended position which can also lead to back pain on rising.

Side Sleeping

Side sleeping is a position where almost anyone can get their spine into a neutral position. It allows the
lumbar, thoracic, and cervical spine to line up in one plane when the correct pillows are used.

 A pillow between bent knees helps keep the pelvis neutral, while a head pillow should be high enough to support the neck, but not be so high that it pushes the neck upwards like you see on the right. 

Side sleeping can cause shoulder pain on the side of the low shoulder. This can be corrected by laying on the shoulder blade rather than the arm itself.

Back Sleeping

Sleeping on your back is probably the easiest way to protect your neck. However, it is associated with higher incidences of snoring and sleep apnea. Back sleeping can also be excruciating for someone suffering from acute low back pain. If this is the case for you, then a side sleeper may be your best resort.

What Pillow Do I use?

EVERYONE wants to know about pillows. It’s almost like they’re looking to justify buying $100 pillow as long as it’s approved by their doctor.

What’s the best brand? Does it need to have contours? What should it be made of? Water? Foam? Feathers?

While I do make specific recommendations for my patients in the office, the truth is that the brand and material matter far less than what the pillow is looking to accomplish.

Pillows should comfortably support the structure of your spine. If your head feels jammed or you feel too extended, then you are not getting the necessary support.

Any conversation about investing in a pillow should involve measurements of your head and neck so that your pillow fits your specific anatomy (it keeps your spine inline when lying down). The material should be hypoallergenic and supportive for long term use. That will usually leave feather based pillows out of the conversation, which they are shown to increase discomfort in pain patients.

Side sleepers – Side sleeping puts your shoulder distance between the head and the bed. Alarger pillow with firmer material is best to support the head and reduce cervical strain.

Back sleepers – Sleeping on your back puts a small distance between the head and the bed. A thinner pillow is usually helpful here. However, if you have severe Anterior Head Syndrome, than a flat pillow may be very uncomfortable and force too much hyperextension. Measurement is key to address your pillow concerns here, but correcting the anterior head syndrome will require a chiropractic approach.

While this may not solve all of your sleep dilemmas. It’s a fast and easy way to start getting better sleep today.