Question
QUESTION: OK so as I under stand C1 and C3 scissor and cause me major migrain headaches that can last for days. But I am at a crisis  point where I must work out and get my body in better shape. My abs are very weak because I have been nursing this injury for years. Any siggestions on how to modify excersises so I don't hurt myself?

ANSWER: Dear Brennan,

First of all who told you that C1 and C3 scissor causing migraines?  That is completely incorrect.  Are you seeking any form of treatment at this time?  By whom, and what is it?

C1, the top vertebra in the spine, does not connect to C3.  The motion in the vertebral segments, Although very small, can irritate nerves and cause headache, but these are not migraine headaches.  They are called vertebrogenic/cervicogenic, tension, suboccipital, or frontal.  Migraine headaches have been signified as a vascular, hormone generated, or precipitated by certain chemicals in food or drink, they are not considered to be  mechanical in nature.

The first thing you need to do is make sure that you have a proper diagnostic opinion of what type of headaches you experience, and what the generators of those headaches are.

Tell me about your headache.  When do they happen?  How long do they last?  How do they feel?  What part of your head is involved; right, left, front, back, the whole head, face, etc...?  What do they feel like...describe them?  When do you notice them the most?  Do you get sick/nausea?  Have any visual problems associated with then such as black dots, blind spots or light sensitivity?  Do your ears ring?  Are you a smoker?  Height/weight/age?  

Give me some more background on your problem so that I can get a better synopsis, and then I would be more than happy to give you some advise on work out issues as well as areas to look for treatment to improve your condition.

Respectfully,
Dr. J. Shawn Leatherman
www.suncoasthealthcare.net




---------- FOLLOW-UP ----------

QUESTION: Hmm lets see I am 5' 2'' tall and 155 pounds my ideal weight is about 125 as I am very stocky. I am 34 I do smoke. My neck injury happened when I was about twenty and was the end of my obsession with gymnastics. I saw a chiroprater regularly for about 5 years ending about two years ago. I racked up quite a bill running in for an adjustment everytime my neck went out. The headaches are definately mechanical in nature for one I can feel my top vertebra slide to either the left or right and the third actualy sticks out enough to where you can see it. The headaches start at the front of my head above an eye usualy and the spread to the whole thing. It is an intense throbbing sensation that is very painful and is agrivated by movement. I do see small black spots and will occasionaly vomit. I know from exsperiance that squinting, fitting my head (even a little bump), stopping fast in a car, lifting or holding my head off the floor or anything that will cause tension in my neck and shoulders will trigger them. They can be quite debilitating. But for the most part they are fairly infrequent about once a month. they can last anywhere from a couple of hours to a couple of days. I treat them with muscle relaxent annti inflamitories like Ibuprofen about 800 milgrams and heat lots of heat. then I try to place my pillow so its pushing on the right spot in hopes that when I relax it will correct its self. I've been pregnant 5 time so my adominals are shot and I need to do somthing. SO I think I've answered all of your questions. Thanks Bren

Answer
Dear Brennen,

Sorry about the delay on this follow-up, my apologies.

Ok, this is a bit off the subject, but...you are a former gymnast and you smoke!?  You know I an gonna get on you for that...not only is that a horrible habit which is doing nothing for your overall health, it also promotes inflammation in the body and several studies have shown it to increase pain levels, therefore it could be contributory to your ongoing headaches as well.  

Your assertion that you can feel the vertebra moving in your neck (sliding) sounds like you have instability issues...which means that getting adjustments may not be the best thing.  This possible sliding of the vertebra should be quantified by flexion and extension view x-rays of the neck, as well as lateral bending views to visualize and measure any instability.  If a significant instability exists, then you should be referred out for a neurosurgical consult.  This may seem like overkill, but a good assessment of the anatomical function is paramount for a proper diagnostic opinion, logical treatment options, and the best outcome.  If no significant instability is found than a logical course of continuing chiropractic care to help with stabilization and proper biomechanical movement is appropriate.  The bottom line is that the offending tissue needs to be isolated to determine the best treatment application.

In relation to the abdominal musculature, the best way to train your abs without inducing a lot of movement in the upper spine is to do hanging leg raises.  I am sure you have seen the arm slings that hand from the horizontal pull-up bars at the gym.  Place your elbows through them for support and hang freely in the air, use your abs to raise the legs up to a horizontal position and hold for 2 seconds, then repeat.  these are vigorous exercises and require strength and stamina...they will work well to focus on the abs.  Induce minor body rotation to hit the obliques in either direction to be more thorough.

Additionally, the transverse abdominus is the most important muscle for movement patterns and stability.  You should be practicing on contraction of this muscle.  It is accomplished by simply sucking in your belly button...inward and upward.  This can be done while walking, sitting, or lying flat on your back.  The transverse abdominus muscle is supposed to contract before every muscular movement in the body for core stabilization.  It is likely that yours is not, and needs to be trained for improved motor patterns.

Now, with the amount of pregnancies, you likely have underlying issues than just the abs such as a loose round ligament of the uterus which will allow it to hand down inside the abdomen.  Also your pelvic floor musculature is probably weak as well.  The best way to strengthen these areas is with pelvic tilt exercise while lying flat on your back, and to do Kegel exercises to strengthen the lower abdominal attachments and the pelvic floor muscles.  Kegels are performed by tightening the muscle that control the flow or urine...so the next time you have to urinate, start and stop the flow of urine repeatedly and that is exactly how a Kegel exercise is performed.  Work up to doing 100 a day, and then start by doing elevator Kegels in which you contract 25% and hold, 50% and hold, 75% and hold, then 100% and hold then release (that would be one repetition).  Do 20 and then gradually work up to 50 a day.

Respectfully,
Dr. J. Shawn Leatherman
www.suncoasthealthcare.net