Sleepy Monday Is Upon Us

Sleepy Monday Is Upon Us

Spring is right around the corner and we finally got a break from the frigid cold temperatures that have been plaguing us all winter long. Combine warmer weather with daylight savings time and it seems like long sunny days are right around the corner. So what could be so bad about that?

Believe it or not the effects of daylight can dramatically impact our sleep patterns. Most people take a few more days to accommodate to the new sunrise and sun set schedule. Sometimes this manifests as a few later nights and earlier mornings than we would like. This may lead to general sluggishness in the morning. Scientists have developed a term for this condition referred to as “Sleepy Monday.” Most of us will be waking up what feels like one hour earlier (assuming we fall asleep at the time our body usually tells us to). The results of this relative hour shift of awake time can actually cause injury during our morning commute. By some accounts there is expected to be a 6-10% increase in auto accidents across the country on the first Monday following daylight savings time.

Unfortunately, folks, that’s this Monday. With a 6-10% increase in auto accidents, there should be an increase in Baltimore auto accidents, neck pain, back pain, and whiplash. While that is not necessarily a bad thing for me and my practice, I do not wish harm on anyone and want you to take any necessary precautions that you can to avoid becoming a patient.

Generally speaking this is a short term adjustment that we all must make and generally takes most people only 1-2 days to adjust back to a normal circadian rhythm. Besides drinking an extra cup of coffee in the morning on Monday, make sure to go to bed a little bit earlier the night before. Turn off the television as you drift off to sleep to make sure that you are rested the fully recommended 8 hours of sleep the night before.

So that’s it for now- enjoy your warmer weekend and have as much fun as you can with the one hour less of weekend that we have. Remember- there will be a lot of sleepy drivers on the road on Monday, so make sure you are extra rested to avoid being involved in a Baltimore auto accident and getting baltimore whiplash.

If you are unlucky enough to be involved in a Baltimore auto accident and require Baltimore auto accident treatment please contact Mid-Atlantic Spinal Rehab & Chiropractic at (443) 842-5500. We would be glad to help!

Dr. Gulitz

X-rays in a Chiropractic Office?

As a Chiropractor with a busy practice in Baltimore I see a lot of patients. Mainly they have headaches, neck pain, and back pain or some combination of the above. Most are referred to me by friends, family, doctors, previous patients, etc. Regardless of how patients find me one of the most common questions I get asked is “do I need an x-ray?”. Like most questions in clinical practice, there is no simple yes or no, but rather a series of guidelines that can be followed which, when combined with clinical intuition, can lead to an answer.

The first thing you should think about is why a patient might need an x-ray. Simply put, x-rays look at bones. They give me a picture at a moment in time as to the underlying spinal structures so that I can determine if it is safe to perform physical therapy with or without chiropractic manipulation. Essentially, I am looking to rule out contraindications to chiropractic care and physical therapy. If there is any indication of fracture, dislocation, cancer, infection, or instability found on x-ray then I know how best to proceed with care. I will not take an x-ray simply because you “want to see what you look like.” That is irresponsible care.

The good news is that generally speaking, most new patients do not require x-rays. If a patient has an acute case of non-radiating, reproduceable spinal pain then chances are a short course of conservative chiropractic therapy and physical therapy modalities will help and the patient will respond quickly. I tell most patients that if the therapy I am going to provide will help they should expect to see some form of improvement (be it better range of motion, decreased pain frequency and/or severity, less radiation of pain, etc) within 2-4 weeks. If at that point they are not improving or if they are getting worse, we can either take an x-ray at that point or consider referral for other advanced imaging (MRI, CT, ultrasound, etc) at that time. By some accounts 80-90 percent of new chiropractic patients with neck and back pain fall into that category and do not require an x-ray on their first visit.

The last 10-20 percent of patients typically do require x-rays on their first visit. These are patients who have a history of metabolic diseases (think decreased bone density), history of spinal fractures, history of spinal surgery, new onset of radiation of pain past the elbows (upper extremity) or past the knees (lower extremity), pain that wakes you up at night, new onset of pain over age 50, and acute trauma (think motor vehicle collisions, whiplash injuries, auto accidents, slip and fall injuries, worker’s compensation injury, etc).

Fortunately for me and my patients I purchased and installed a new digital x-ray developer. This allows me to take any necessary x-rays and have them developed and read in about 60 seconds. Patients that require x-rays do not need to reschedule or be referred off-site prior to getting the care that they need. I will always give patients a copy of their x-rays on a CD so that they can archive them for their records and/or bring them to any other medical provider should they need to do so. I transmit all of my x-rays digitally to a teleradiology group to make sure that board certified radiologists confirm my findings and protect the health of any new patient. A second set of eyes is always better than just one.

If you are not sure that you require an x-ray on your first visit we can discuss the pros and cons given your specific circumstance and make an appropriate choice at that time. If you, or anyone you know requires chiropractic care that may include the need for an x-ray, please contact Mid-Atlantic Spinal Rehab & Chiropractic at (443) 842-5500. We would be glad to help!

Dr. Gulitz

What is Sciatica?

As many of my blog followers can attest, I spend a fair amount of time talking about injuries sustained in Baltimore auto accidents. Today I will talk about a different condition that is generally not traumatically induced, although it can be.  Many people have heard of the term sciatica, but what exactly is it?

Sciatica refers to a set of symptoms associated with compression of one of the five spinal nerves that combine to form the sciatic nerve.

Symptoms of sciatica include lower back pain along with radiation of the back pain typically down a leg or into the buttock. Sciatica may cause numbness and/or tingling and/or weakness down an extremity. Or, it may just be back pain with some dull pain down a leg.

Technically speaking, true sciatica is compression of the sciatic nerve. In clinical practice most presentations of sciatica are not sciatica, but instead are a combination of other causes of back pain that cause radiating leg pain. In fact, sciatica is NOT a diagnosis, but rather a series of symptoms that describe back pain with radiating leg pain. If a patient tells me they have sciatica what it really means is “I have leg pain associated with back pain and I’m not sure why.”

The typical causes of sciatica include: disc herniation, spinal stenosis, facet joint irritation, piriformis syndrome and in some extremely rare cases other space occupying lesions such as cancer that can mimick the condition. Patients that carry extra abdominal weight such as obese and/or pregnant patients can get sciatica as well.

Most patients that present with sciatica will have an x-ray to rule out nefarious causes of the sciatica. Once cleared for therapy they undergo a series of physical therapy modalities along with chiropractic spinal manipulation to help alleviate the symptoms causing the nerve compression. Most patients respond fairly quickly to therapy and their peripheral (leg) symptoms resolve.

Patients that have no response or negative response to care are often referred for MRIs and/or to a specialist to consider pain management/injections. These approaches, although more invasive, are often effective in alleviating symptoms where chiropractic care has not been able to help.

If you, or anyone you know suffers from sciatica in Baltimore please contact Mid-Atlantic Spinal Rehab & Chiropractic at (443) 842-5500. We would be happy to help!

Important Tips to Avoid Injury While Shoveling Snow

In light of the recent monstrous amounts of snow we have been receiving in Baltimore it occurred to me that I should mention some basic ways to avoid neck pain and back pain while shoveling.

First tip: Make sure you are physically capable of a work out. A recent article by the Baltimore Sun found here details the death of several men in Howard County who died of apparent heart attacks while shoveling. No one really ever plans on having a heart attack, but it speaks to the bigger issue that shoveling is really a work out. With any work out, make sure you are physically fit enough to do it before you begin. Consult your physician if you are not sure.

Second Tip: Warm up. As with any other work out you want to make sure that you are ready for exertion. Make sure to stretch your back before beginning any work out so you do not strain a muscle. Even a few jumping jacks will get you appropriately warmed up quickly.

Third Tip: Use the right tool. For light dustings of snow I prefer a push broom which avoids repetitive bending or lifting. If you need to use a shovel to pick up snow, make sure you have a sturdy but light weight shovel. Often the big, heavy, industrial shovels are way more than is necessary to clear snow, resulting in increased weight to carry and often times increased back pain as a result.

Fourth Tip: Use Proper Biomechanics. As with any dreaded tasks there is a desire to rush through it and “just get it done.” The problem with taking this approach while shoveling is that it is often the cause of increased back pain and visits to my chiropractic office. As with all heavy lifting, make sure to bend your knees and lift with your legs, not your back. If you have to move snow to one location make sure that you turn your entire body (avoid twisting at the waist). Typically, if you throw the snow over your shoulder the increased twisting at your waist while carrying a heavy load will cause an increase in lower back pain.

Fifth Tip: Find a friend with a Snow Blower. In the best case scenario you may have a friend or relative with a snow blower. This will allow a machine to do all the heavy lifting and help save your back. If you are a friend that has a snow blower, please remember to help out the elderly and less fortunate by clearing their sidewalks and driveways.

While most of these tips are straightforward and probably pretty obvious, you might be surprised how often my phone rings with patients who did not take proper precautions and now have acute lower back or neck pain from shoveling.

If you, or anyone you know has suffered from back pain or neck pain while shoveling, please contact Mid-Atlantic Spinal Rehab & Chiropractic at (443) 842-5500. We would be happy to help!

Dr. Gulitz

Undiagnosed Shoulder Pain Following Baltimore Auto Accidents

Some of my faithful blog followers might be asking why I would blog about shoulder pain following a Baltimore auto accident, when I am, in fact, a chiropractor. Traditionally chiropractors focus strictly on the diagnosis and treatment of spinal complaints including headaches, neck pain, and back pain. In many states, including Maryland where I practice, chiropractors can apply for physical therapy privileges, giving them the ability to diagnose and treat non-spinal musculoskeletal complaints.

Due to the successful “click it or ticket” campaigns there are more and more shoulder complaints following Baltimore auto accidents than you might otherwise expect. The shoulder harness can restrain a shoulder and cause an injury to an occupant.

Typically shoulder pain is treated like any other injury that I treat in my office following a Baltimore auto accident. I use a combination of physical therapy modalities (heat/ice, electric muscle stimulation, ultrasound, etc) and then progress to passive stretching and active therapeutic exercises. In the majority of cases the shoulder pain resolves within a few months.

In some cases shoulder pain persists past 6-8 weeks. This makes sense as everyone is different and not everyone responds the same to therapy. For shoulder pain that does not improve quickly, I typically order an MRI to rule out ligament tearing and rotator cuff pathology. Interestingly, MRIs do not catch all shoulder pathology on their own. That is, there are additional testing that I use on occasion to diagnose “tricky” shoulder problems that do not display pathology on traditional MRIs.

For patients that have failed conservative rehab of shoulder pain and have negative MRIs, I usually recommend an arthrogram. An arthrogram is a special application of radiography in which a dye is injected into the shoulder and then the shoulder is imaged in various different positions. It can be combined with MRI or CT scan to give a better understanding of underlying pathology such as partial thickness muscle tears and labral tears.

Once appropriately diagnosed the patient is referred to a shoulder orthopedist for (typically) shoulder surgical intervention. While I do not promote unnecessary surgery and as a chiropractor I personally think that it should be the last resort, I am in favor of surgery when it is the only remedy for an injured patient.

If you, or someone you know has been injured in a Baltimore auto accident and have shoulder pain, please contact Mid-Atlantic Spinal Rehab & Chiropractic at (443) 842-5500. We would be glad to help!

Dr. Gulitz