Back and Neck Pain, Causes and Solutions

What is Causing that Back or Neck Pain

Learn more: Watch the video or read the article below

There really are two types of pain that we will experience when we feel back or neck pain. The first is mechanical pain, and the second is non-mechanical pain. You can see a breakdown of the causes of each in the following lists:

Potential Causes of Non-Mechanical Back or Neck Pain:

  • Infection

  • Tumor

  • Cancer

  • Other Diseases

Potential Causes of Mechanical Back or Neck Pain:

  • Joints

Dr. Phelan describes jointsA joint is the point of contact between elements of an animal skeleton whether movable or rigidly fixed together with the surrounding and supporting parts (as membranes, tendons, or ligaments).

  • Ligaments

Dr. Phelan describes ligamentsLigaments are a tough band of tissue that serves to connect the articular extremities of bones or to support or retain an organ in place

  • Nerves

Dr. Phelan describes nerves

Nerves are any of the filamentous bands of nervous tissue that connect parts of the nervous system with the other organs.

  • Discs

Dr. Phelan describes discs in thespine

A disc is any of the tough elastic discs that are interposed adjoining vertebrae and that consist of an outer fibrous ring enclosing an inner pulpy nucleus.

  • Muscle

Dr. Phelan describes muscles
A muscle is a body tissue consisting of long cells that contract when stimulated and produce motion.

  • Tendon

Dr. Phelan describes tendonsA tendon is a tough cord or band of dense white fibrous connective tissue that unites a muscle with some other part (as a bone) and transmits the force which the muscle exerts.

  • Bursa

Dr. Phelan describes what a bursa is

The bursa is a small, thin, watery sac between a tendon and a bone.

When going to see a provider of any kind, whether it’s a medical doctor or a chiropractor, the first thing that we have to do is determine what type of pain you are experiencing. Once we’ve safely eliminated the non-mechanical pain category as a source of your pain, we can start to focus on the origin of the pain itself. We will check the potential sources for your pain, which may be caused by one or more of these sources. All of these sources are capable of producing pain, either by themselves or in concert with any of the others.

Your top priority should be to receive an accurate diagnosis. Dr. Phelan is an outstanding diagnostician, and he will provide you with the most conservative plan possible to help you to heal as quickly as possible. When treatment plans require services outside of spinal manipulation, physiotherapy, exercise, ergonomic lifestyle changes, or massage, then Dr. Phelan will provide you with a referral to another highly qualified physician.

If you’re interested in speaking with us about back or neck pain, please go to our website,  If you would like to make an appointment, please get in contact with us by calling 919-562-0302. We would be happy to help you. Thank you.

Wake Forest Chiropractic
851 Wake Forest Business Park, Suite E
Wake Forest, NC 27587

November 14, 2009
© copyright 2009-2010 Wake Forest Chiropractic. All rights reserved.
Images are courtesy of the US Library of Medicine and the US National Institutes of Health

Temporomandibular Joint Disorders – TMJ

The Importance of Obtaining the Correct Diagnosis for Jaw Pain

Learn more: watch the video or read the transcript below

Transcript of Video:

Let’s look at TMJ or TMJ dysfunction (TMJD or TMD). Temporomandibular joint disorder is a condition that can cause popping, clicking, or pain in the jaw. Other symptoms associated with TMJD are headache, ear pain, ringing in the ears, neck pain, shoulder pain, dizziness and nausea.

There is a significant level of confusion regarding this condition, and the person suffering from jaw pain often wonders whether they have a muscle problem, joint problem, or problems with their teeth.  Many TMJ patients will visit multiple healthcare providers in their search for an accurate diagnosis and the proper treatment. Unfortunately, this is very common, and the process may take years. In turn, the symptoms may become more severe, money and time are unnecessarily wasted, and the patient may become confused and frustrated.

It is crucial to find a healthcare provider who has strong diagnostic skills and an open mind to that can see issues beyond their own specialty.  Once you have a correct diagnosis, your healthcare provider can recommend that you see the proper specialist such as a dentist, an orthodontist, a chiropractor or an oral surgeon.

Image of the tempormandibular joint anatomy

TMJ Anatomy

This image shows the anatomy of the temporomandibular joint. The lower jaw is called the mandible.  Above the joint is the part of the skull referred to as the temporal bone. The joint where the temporal bone connects to the mandible make up the T and the M of the TMJ. The J is simply the joint. Everyone really has two TMJs, one on each side in front of your ears.

What we’re really talking about here is temporomandibular joint (TMJ) dysfunction. What can become dysfunctional in the temporomandibular joint? There are several conditions that can cause TMJD and its symptoms.  Let’s look at them one by one.

As shown, the jaw itself articulates with the temporal bone, and this demonstrates the location of the temporal bone. In between the mandible and the temporal bone is a small fibrocartilaginous disc called the articular disc, which is bonded to the jaw by some ligaments. Popping and clicking can occur if we have a situation where the disc itself becomes disrupted and dislodged from the condyle, or rounded part, of the jaw itself.

Now, you have a situation where the disc can become free floating. Attached to the posterior elements, or the back, of the disc is a material called retrodiscal tissue that produces the synovial fluid which lubricates the joint. This tissue will work to hold the disc in place, but what can happen over time that is the disc can migrate forward and become adhered to the anterior portion, or front, of the temporal bone.

Close-up of TM joint including disc, ligaments, condyle, and muscles

Close-up of a Healthy Tempormandibular Joint (TMJ)

When this occurs, we have a situation where the mandible rotates and translates forward as you open and close it. As it translates forward, it has to climb up and over the disc instead of the disc riding with it. When this happens you will notice that when you initially open your jaw there is no pop but as you open wider, the pop occurs as the jaw slides up and over that disc. Now you understand the first diagnosis, which is disc disruption in the jaw.

A second diagnosis involves the capsule. In the image above, the capsule is illustrated by the thin, light blue area that begins at the back of the TMJ, goes under the condyle, and in front of the muscle.  The capsule is the ligamentous envelope that wraps around the joint itself, and the capsule itself can become inflamed. The person can have perfectly normal open and closing of the jaw and they may or may not experience popping or clicking. The problem is not the disc, even if the disc is dislodged, but the capsule itself is inflamed.  This tissue is the same ligamentous material that holds our ankle together. When you sprain your ankle, it swells, becomes inflamed and uncomfortable. The same thing can happen in that capsule in the jaw. So, if the person has jaw pain, they may automatically assume they have TMJ or TMJD when they really do not. What they have is ligamentous inflammation of the capsule itself.

The third possibility may involve the retrodiscal tissue which we mentioned previously. The retrodiscal tissue is the structure in the posterior elements of the jaw that connects to the disc. The retrodiscal tissue itself can become inflamed.  That will typically happen with people that frequently clench or grind their teeth (called bruxism) while they are sleeping. This contracts the jaw, driving the mandible back up into the temporal bone and squeezing the retrodiscal tissue in between. When the retrodiscal tissue is inflamed, the result is jaw pain.

If the inflammation of the retrodiscal tissue lasts long enough, you will actually start to get adhesions that form in the jaw inside the joint itself. You may have vascularization, or the development of blood vessels, of the adhesions.  The trauma that results from these adhesions and scar tissue can also become a source of pain.

The fourth issue we will discuss is problems with occlusion or with the teeth as the teeth are fitting together. When a person opens and closes their jaw, they may notice that some of the teeth are not lining up properly. What they will notice is that when they close their jaw some of the teeth will land early on one side, and the jaw will then have to settle into a normal closure.

Another problem with occlusion can be an under bite. We have heard of people who close their lower jaw and their lower teeth are actually too far forward, and they have to move their jaw backward in order to close fully. That can cause problems with the TM joint as well.

The last problem that we can see with the temporomandibular joint is really somewhat external. This involves the musculature that runs the joint and the muscles that open and close our jaw, move it from side to side, and forward and back. These are very big powerful muscles which are inserting on the jaw itself. These muscles can become short and tight, and like anywhere else in our body with short, tight contracted muscles, they are going to cause pain sooner or later whether it’s in our necks or in our backs or in our jaw.

To summarize, there are five possibilities when we have temporomandibular joint dysfunction:

  1. Issues with the disc
  2. Inflammation of the capsule
  3. Inflammation of the retrodiscal tissue
  4. Alignment of your bite, or occlusion
  5. Tightening of the musculature of the jaw

When we see you in our office, we will typically begin an examination that allows us to arrive at an accurate diagnosis. We can treat some of these conditions in our office in Wake Forest, NC. There are some that we do not treat, and for those we will refer you to an experienced specialist for the proper treatment.

If there is a problem involving retrodiscal tissue inflammation, capsulitis or musculature that’s hypertonic, short and tight, that is probably something that we can help with here in the office. Approximately 70 percent of the people that I see with a diagnosis of TMJ dysfunction fall into this category, and we have the ability to treat them.

The other condition that would not respond as well to conservative care would be a disc problem where the disc is dislodged. Often, if you can treat the inflammation in the retrodiscal tissue and the capsule, and balance the musculature, the person can go on and live normally with a disc that’s displaced.  There should be no pain, but there may be a little popping once in awhile. These people are not necessarily surgical candidates. This is a non-surgical or a “leave alone” condition unless the jaw is locking and not allowed to open or close.

Once you have an accurate diagnosis and you know exactly which one of these structures is the problem, then you are in a situation where it can be treated. A good diagnosis and directed care, either in our office or at the appropriate orthodontist, dentist or surgeon is the pathway out of chronic temporomandibular joint dysfunction.

If you would like further information on TMJD, jaw pain or jaw problems, please go to our website,  To make an appointment to be examined at our office, please get in contact with us by calling 919-562-0302. We would be happy to help you. Thank you.

Wake Forest Chiropractic
851 Wake Forest Business Park, Suite E
Wake Forest, NC 27587

March 09, 2009
© copyright 2009-2010 Wake Forest Chiropractic. All rights reserved.

Migraine Headache or Cervicogenic Pain?

How do you know if it’s really a migraine?

Learn more: watch the video or read the transcript below

Transcript of Video:
Migraine Headache or Cervicogenic Pain?

Hello, I’m Dr. Shawn Phelan. I’m here to speak to you about head pain, primarily migraines, and another condition called cervicogenic headaches. In the general population, there is often some confusion about head pain. We often assume, or are being told, that we are suffering from a migraine, because we have a severe headache that is causing us nausea, sensitivity to light, ringing in our ears, a funny taste in our mouth, or funny things happening in our visual field. That is not always the case.

Migraine headaches are considered to be something that is either of vascular origin, something that’s caused by a chemistry issue in the brain, usually in the serotonin pathway, neurologic issue, or sometimes a combination of some of all of these issues. Migraine headaches caused by a serotonin imbalance, vascular, or neurologic issues are really rather rare. A true migraine sufferer should only have about seven migraines per year. If you are having more than seven migraines per year, there’s a pretty good chance that there’s an overlay of some sort.

Greater and Lesser Occipital Nerves

Figure 1

Different conditions can cause overlays. The one am speaking about today is called the cervicogenic headache. So the question is, if we are suffering from migraines, is it truly a migraine that we’re suffering from, or is it possibly a cervicogenic headache?

So, let’s take a brief look at the anatomy. Figure 1 (left) shows the skull and two nerves that are coming out of the upper cervical spine. The first is the greater occipital nerve, and the second is the lesser occipital nerve. They exit the spine at the level of the upper cervical spine, and then they transit up into the head. Irritation of those nerves will cause head pain.

Cervicogenic pain radiating to the head

Figure 2

Figure 2 (right) shows us the skull with nerves traveling up into the face. That is another area that we often see pain generated from. Consider the fact that cervicogenic headache can cause all of the same symptoms that a migraine will cause. It will cause visual field disturbances, a funny taste in mouth, ringing in the ears, nausea, and sensitivity to light, called photophobia, but it is not really a migraine headache. It is a problem with the upper cervical spine.

So, if the upper cervical spine and the joints are irritated, inflamed or causing irritation to the nerves then it can cause all of the symptoms that a migraine sufferer will be familiar with. Yet, it is not a not a serotonin imbalance, vascular or neurological issue. It is simply a mechanical compression or mechanical irritation of the nerves in the upper cervical spine that is causing the headache.

The Facet Joints

Figure 3

Figure 3 (left) shows you the upper cervical spine and the facet joints that can become symptomatic and cause cervicogenic headaches. If you are a migraine sufferer, you should be examined by a professional to determine if there is a situation that is driving the cervical spine problem for you. Cervicogenic headaches can be fairly easily treated, and can help you get control of your symptoms, so that you are not at the whim of the migraines.

If you would like further information on cervicogenic headaches or migraines, please go to our website, If you would like to make an appointment to be examined at our office so that we can determine whether or not you are not you are suffering from cervicogenic head pain versus migraines, then please get in contact with us by calling 919-562-0302. We would be happy to help you. Thank you.

Wake Forest Chiropractic
851 Wake Forest Business Park, Suite E
Wake Forest, NC 27587

March 04, 2009
© copyright 2009-2010 Wake Forest Chiropractic. All rights reserved.

So, let’s take a brief look at the anatomy. Figure 1 shows the skull and two nerves that are coming out of the upper cervical spine. The first is the greater occipital nerve, and the second is the lesser occipital nerve. They exit the spine at the level of the upper cervical spine, and then they transit up into the head. Irritation of those nerves will cause head pain.