If you have a headache, you’re not alone. Nine out of ten Americans suffer from headaches. Some are occasional, some frequent, some are dull and throbbing, and some cause debilitating pain and nausea. The origin of headaches can vary greatly. Depending on what types of headaches you have, you do not have to keep popping Advils, hoping that the pain goes away. There is a better alternative. Research shows that spinal manipulation – the primary form of care provided by doctors of chiropractic – may be an effective treatment option for tension headaches and headaches that originate in the neck. (cervicogenic headaches) A report released in 2001 by researchers at the Duke University Evidence-Based Practice Center in Durham, N.C., found that spinal manipulation resulted in almost immediate improvement for headaches that originate in the neck, and had significantly fewer side effects and longer-lasting relief of tension-type headache than a commonly prescribed medication.

Origins of headaches can vary from muscle spasm, stress, lack of sleep, tumor, and dehydration. It is very important you find the CAUSE of the headache rather than relying on over the counter pain medication to treat the SYMPTOMS.

If you are experiencing headaches, earaches, stuffiness or ringing in the ears, or discomfort in the jaw, throat or mouth area, it may be a condition known as Orofacial Pain.

In the past, symptoms such as these were associated with and referred to as TMD, or Temporomandibular Disorder. Today, we use the broader term Orofacial Pain to describe pain that is not confined to your jaw, but also refers to pain or discomfort in your head, neck or shoulder areas as well as the systemic conditions that may cause these symptoms. Orofacial Pain can have many causes. Depending on the diagnosis, a variety of treatments are available.

The treatment of Orofacial Pain begins with a comprehensive evaluation of the patient. A complete patient history, thorough physical exam, laboratory tests and imaging studies will be conducted to properly diagnose the condition. Once the disorder has been identified, our expert staff will employ a multidisciplinary approach to easing the symptoms and treating the root cause of the problem. Treatments may include physical therapy, prescription medication, oral appliance therapy, and acupuncture. At MSR we also use biofeedback as treatment. This includes relaxation therapy, psychological, and behavioral approaches to pain management and lifestyle modification.

Your neck is very vulnerable to injury. Located at the top of the spinal column, the cervical bones in the neck support the head and are capable of a wide range of motion. While this large range of motion is highly useful, it often leads to stress being placed on the neck while it is in an awkward position, resulting in pain and stiffness. Sources of this stress can be as simple as falling asleep with your neck at a bad angle or it can be something more severe such as a herniated disc or spinal nerve root inflammation. Other common causes include bad posture while using a computer, watching TV or even reading a book. You may also experience neck pain as a result of car accidents, chronic degenerative conditions, and aging. Chiropractic treatment combined with physiotherapy in particular is very effective for common neck pain.
A common injury to the neck is a whiplash injury that can occur during rear-end automobile collisions, when your head suddenly moves backward and then forward — similar to the motion of someone cracking a whip. These extreme sudden jerky motions push your neck muscles and ligaments beyond their normal range of motion therefore creating micro tearing of the muscles and ligament in the neck and sometime herniation of the spinal discs can occur. Whiplash injuries can be mild or severe and sometimes symptoms do not manifest until days after the injury occurred. Treatment typically begins with over-the-counter pain relievers and ice applied to the painful neck muscles. Physical therapy, and spinal manipulation is very helpful in the acute and sub-acute stages of the injury to reduce inflammation and restore proper range of motion. Most people recover from whiplash in just a few weeks, but some people may develop chronic pain after a whiplash injury due to severe soft tissue injuries.

Medical researches have shown that muscular strain is the major cause of middle back pain among desk/computer workers. The back muscles and tendons provide support to the thoracic spine and the ribs of your back.  They are the muscles that take the stress that may arise from activities like sitting, lifting of heavy objects, running, exercising, etc…. Sitting in wrong postures for long periods of time can also weaken and fatigue mid back muscles. As a result, strains or spasms may occur.  In addition, your thoracic spine is articulated with you rib cage. Is the event of wrong exercise or over exercising it can lead to misalignment of the ribs and result in sharp pain of the mid back complex while taking a deep breath. Spinal and rib manipulation in particular is very effective to treat this type of condition in conjunction with physiotherapy to strengthen the mid back complex.

A common disorder seen in our office is Upper-Crossed Syndrome (UCS) (Janda 1988). In UCS, tightness of the upper trapezius and levator scapula on the posterior side crosses with anterior tightness of the pectoralis major and minor. Weakness of the deep cervical flexors muscles crosses with weakness of the middle and lower trapezius. This pattern of imbalance creates joint dysfunction, particularly at the Co-C1, C4-C5 segment, cervicothoracic joint, glenohumeral joint, and T4-T5 segment.  Specific postural changes are seen in UCS, including forward head posture, increased cervical lordosis and thoracic kyphosis, elevated and protracted shoulders, and rotation or abduction and winging of the scapulae. These postural changes decrease glenohumeral stability as the glenoid fossa becomes more vertical due to serratus anterior weakness leading to abduction, rotation, and winging of the scapulae. This loss of stability requires the levator scapula and upper trapezius to increase activation to maintain glenohumeral centration (Janda 1988).

To sum it up, a patient generally presents a posture of forward head, shoulder anteriorly rounded, and shoulder blade winging. You may notice you have a hard time sitting up straight at your desk and are more comfortable slouching. This is due to mid back weakness and tight anterior neck and chest muscles such as SCM, scalens and pectoral muscles.

Besides looking like a hunchback or little old lady, UCS can lead to many musculoskeletal disorders such as rotator cuff instability leading to impartial tear or labrum tear, headaches, numbness and tingling in the arms, and/or early onset osteoarthritis in the neck and mid back.

What is the most common reason why people miss work in United States? Seasonal cold? The flu? No! It’s generalized Low Back Pain! Your back is an intricate structure composed of bones, muscles, ligaments, tendons and disks. Disks are the cartilage-like pads that act as cushions between the segments of your spine. Its acts like the shocks in your car to absorb impact from sitting, standing, and jumping.  Back pain can arise from problems with any of these component parts. In some cases, no specific cause for their back pain can be found. Most of the time, the cause of acute LBP is due to strained muscles and ligaments from improper or heavy lifting and/or after a sudden awkward movement. However, LBP can arise from structural issues, such as:

Bulging or ruptured disks. Disks act as cushions between the vertebrae in your spine. Sometimes, the soft gel-like material inside a disk may bulge out of place or rupture and press on a nerve. But even so, many people who have bulging or herniated disks experience no pain at all . If a bulging or herniated disk presses on the main nerve that travels down your leg, it can cause sciatica — sharp, shooting pain or numbness and tingling or pins and needles through the buttock and back of the thigh, leg or foot.
Arthritis. The joints most commonly affected by osteoarthritis (OA) are the hips, hands, knees and lower back. In some cases arthritis in the spine can lead to a narrowing of the space around the spinal cord, a condition called spinal stenosis. OA can also form calcium deposits and bone spurs that may pinch or irritate soft tissue structure in and around the spine.
Congenital Skeletal irregularities. Scoliosis is a condition in which your spine curves to the side, and may lead to back pain.  If the natural curves in your spine become exaggerated, your upper back may look abnormally rounded or your lower back may arch excessively and cause a biomechanical compensation and lead to problem in your hips and knees.
In rare cases, cancer or a tumor on the spine can press on a nerve, causing back pain. In cases of an infection, fever, and a tender, warm to the touch area accompanying back pain will need emergency care. There are many options of treatment for low back pain. From a conservative approach such as massage, physical therapy, chiropractic, or acupuncture to invasive methods, such as surgery (ie. Fusion, partially remove disc and vertebrae) and somewhere in between such as injections, oral medication and Manipulation Under Anesthesia  All these treatments have their benefits as well as risks. However, it is MSR’s practice standard to always exhaust conservative methods of treatment first before we recommend any invasive procedures.

A common disorder seen in our office is Lower-Crossed Syndrome (LCS) (Janda 1988) is also referred to as distal or pelvic crossed syndrome. In LCS, tightness of the thoracolumbar extensors on the posterior side crosses with tightness of the iliopsoas and rectus femoris (hip flexors) on the anterior side. Weakness of the deep abdominal muscles crosses with weakness of the gluteus maximus and medius. This pattern of imbalance creates joint dysfunction, particularly at the L4-L5 and L5-S1 segments, SI joint, and hip joint. Specific postural changes seen in LCS include anterior pelvic tilt, increased lumbar lordosis, lateral lumbar shift, lateral leg rotation, and knee hyperextension. If the lordosis is deep and short, then imbalance is predominantly in the pelvic muscles; if the lordosis is shallow and extends into the thoracic area, then imbalance predominates in the trunk muscles. (Janda 1987)

In other words, your belly will stick out and your buttocks will point upwards. Most likely it will be hard to bend over and touch your toes.  LCS can lead to early degenerative osteoarthritis of the lumbar spine, hip instability/weakness leading impingement and/or labrum tear, tight hamstrings and hyperextension of the knee leading to patellofemoral disorders.

Elbow pain may also be due to injuries arising from the elbow joints’ network of nerves, blood vessels and ligaments. On occasion, problems in your neck, shoulder, upper arm, forearm or wrist can also result in elbow pain. Most elbow pain is a direct result from overuse injuries like golf, gardening, jobs, and hobbies require repetitive movements. The source of pain is commonly from tendonitis, bursitis, and/or muscle inflammation. It severe case, the pain may be due to a nerve entrapment syndrome in the elbow or the neck. In cases like these may require a nerve conduction test study (NCV/EMG) to find out the origin or pain.

Rest and Ice is generally the best course of self treatment. However, if your elbow pain is recurring, a course of physical therapy may be necessary to strengthen the elbow, forearm and wrist muscle complex.

Your wrist is a complex joint made up of eight small bones arranged in two rows between the bones in your forearm and the bones in your hand.  They are connected with tough bands of ligament that attach to your forearm bones and hand bones. Injuries to any of the parts of your wrist can cause pain and affect your ability to use your wrist and hand. Most common causes of hand and wrist are repetitive strain injuries. Any activity that involves repetitive wrist motion from swinging a golf club or typing can inflame the soft tissues around joints especially when you perform the movement for a long period of time without rest.

The most common and well known condition is carpal tunnel syndrome. This condition usually arises from increased pressure on the median nerve, which passes through the carpal tunnel, a passageway in the palm side of your wrist. However, hand pain can also be indicative of a pinched nerve in your neck due to a herniated disc. The best way to treat hand/wrist pain is properly diagnosing the origin of pain. From there, carpal manipulation and physical therapy is generally very effective in treating most soft tissue injuries to the wrist and hand.

Our hip joint is a weight bearing joint, therefore hip pain is a common problem, and it can be confusing because there are many causes. Some of the common conditions are, arthritis, bursitis, stress fracture, and referred low back pain.

It is important to make an accurate diagnosis of the cause of your symptoms so that appropriate treatment can be directed at the underlying problem. Hip joint can be the source of pain, but it can be a common site for referred pain from the spine, pelvis, and the groin. Common conditions include tendonitis, bursitis, and vary forms of arthritis. Hip pain can be due to structural issue to the ball and socket joint and the underlying cartilage. However, it is important to rule out congenital hip condition as well as other referred pain source to formulate a proper treatment plan. At MSR, our multidisciplinary team will examine your condition from various aspects and order the correct diagnostic test to formulate an effective treatment plan.

Knee pain can affect people of all ages. The condition ranges from sports related injuries, mechanical problems, and various types of arthritis.  A knee injury can affect any of the ligaments, tendons or fluid-filled sacs (bursae) that surround your knee joint as well as the bones, cartilage and ligaments that form the joint itself.   We often see patient with chronic knee pain that leads to low back pain and vise versa. Some of the more common knee injuries include:

Torn meniscus. The meniscus is made of a tough, rubbery cartilage and acts as a shock absorber between your upper leg and lower leg. It can be torn, or cracked if you suddenly twist your knee while bearing weight on it.
Knee bursitis. Some knee injuries cause inflammation in the bursae, the small sacs of fluid that cushion the outside of your knee joint so that tendons and ligaments glide smoothly over the joint.
Patellar tendinitis. Tendinitis is irritation and inflammation of one or more tendons — the thick, fibrous cords that attach muscles to bones. Runners, skiers and cyclists are prone to develop inflammation in the patellar tendon, which connects the quadriceps muscle on the front of the thigh to the shinbone.
The most common knee condition seen in our office is a condition called chondromalacia patella. Patients will often come in the office and complain of knee pain while using stairs, getting out of a crouch position, or sports related jumping action such as spiking a volleyball.   Depends on the grade (I-IV) of chondromalacia, physical therapy with specific exercises is effective in treating this condition through strengthening the muscles that support your knees, such as your quadriceps, hamstrings and especially the muscles around your lower inner thigh.

Foot pain may be caused by many different conditions or injuries. Acute or repeated trauma, disease, or a combination is the most common causes of foot pain.  Poor biomechanical alignment can also lead to foot pain. Wearing shoes that are too tight or high heels can cause pain around the balls of the feet and the bones in that area. Shoes that are tied too tightly may cause pain and bruising on the top of the foot. Common sports injuries such as a sprain of the foot or ankle can occur when ligaments that hold the bones together are overstretched and their fibers tear. These conditions are generally treated with physical therapy and deep tissue massages. Misdiagnosing foot pain is common because the pain can be a sign of other serious conditions like diabetic neuropathy or numbness and tingling caused by a lumbar spine nerve compression. Proper blood tests and electrical diagnostic studies (EMG/NCV) is necessary to rule out these conditions.

Why Choose Us

At Manhattan Spine Rehabilitation we created a “one stop” shop where there is usually no need for an outside referral for testing. We have a team of medical specialists and a state of the art high tech digital X-Ray system and neuro-diagnostic testing that will allow our team doctors to have the test results immediately. To make things even more convenient and “painless” for you, we are open 6 days a week with TWO locations ONE block from major transit hubs. Our office has extended our hours in order to take late appointments on weekdays and are open on Saturdays because we understand the demand and long hours of your job in this city.

Our Approach

At MSR our board-certified doctors work as a team to ensure we treat the condition from a conservative approach first and, if needed, have more invasive methods available within our offices or wide network of specialists for referrals. Our goal is to provide one on one individualized treatment plans for each patient based on an assessment of occupation, lifestyle and activities of daily living.

Insurance Accepted

Our friendly staff will handle all of your insurance needs starting from verifying your insurance (prior to your arrival in the office) to determining the exact limits of coverage.  The benefit of leaving this to experienced professionals saves you time dealing with your insurance and helps avoid unnecessary out of pocket medical expenses. Our offices accept most major medical, injury, and motor vehicle accident insurances. We also accept non-insured patients and offer flexible payment plans with credit cards.