Do you frequently wake up at night because your hands and lower arms have gone numb or “asleep”? You may find that it happens when you are sitting at a desk or even when driving long distances. This is commonly caused by compression of the nerves and blood vessels that enter the arm. The technical term is referred to as “thoracic outlet syndrome”.
The neck portion of your spine, the cervical spine, has seven vertebrae. Passing inside of vertebrae is the spinal cord. Originating from the spinal cord, there are eight nerves. These nerves exit the spine between each of the vertebrae and combine together into a large bundle of nerves. The bundle of nerves then pass under the chest muscles, through the shoulder and down the arm. The primary function for most of these nerves is to control pain or touch sensations and the contraction of the muscles of the arm.
When someone sleeps with their arm under their pillow or over their head, the bundle of nerves can become mildly stretched. When this happens, the nerves cannot perform their job as well. For example, if a water droplet hits your hand, a message from the hand is sent through the nerves to the spinal cord and then to the brain. Your brain then consciously tells you that your hand is being touched. So, if the nerves become stretched, they cannot communicate their message to the spine properly. This will eventually make your hand and arm feel numb and weak. This can also happen to those of you that prefer to sleep curled up into the fetal position. Your arms are likely curled up tight in front of your chest. This position causes compression of the nerves as they pass through the shoulder and into the arm area. The resulting numbness in the arm and hand will occur again for the same reason. Also, if you spend too much time at the computer or drive for long distances, the muscles in the chest and shoulder can become very tight. This can also compress the nerves as they pass through the shoulder and give the same result of numbness. If these muscles are only mildly tight but not enough to cause numbness, the overall space that the nerves have to pass through is still less. If you combine this scenario with your arm in the previously mentioned sleeping positions, you are even more vulnerable to experience the numbness.
So how stop the numbness? First of all, avoid sleeping with your arms over your head or curled up in front of you. To alleviate the potentially tight muscles in the chest and shoulder, a simple stretch has been shown. Avoid a slouching posture, as the shoulders will roll forward and further decrease the available space for the nerves to pass through the shoulder and into the arm. If you are experiencing numbness into the arm or hand, you should also have your neck properly examined by a Chiropractor because all of these nerves pass through this area. Problems in the neck can cause symptoms very similar to Thoracic Outlet Syndrome.
Next week I will discuss proper sleeping positions. If you have any questions about neck pain or a topic for my next blog, email me at firstname.lastname@example.org or visit my website, http://www.landrumdc.com
Natural Bridge Apex, KY
Get your rakes out! It’s time again to get your rakes and blowers out of your sheds and spend your weekends picking up those colorful extracts from your trees
It is very surprising how many people end up calling the office early Monday mornings because of the acute low back pain they have earned while raking. This is usually due to raking in the incorrect posture for too long at one time. The weight of the leaves or needles is not usually the culprit. The most common cause of the low back pain is the repetitive twisting motion that many people do as they pull the rake towards themselves. Our backs are not designed to handle repetitive twisting motions, especially if lifting is involved.
Commonly, you don’t even notice the pain while raking. It often builds up during the night when your back is no longer moving. During this time, the inflammation or swelling accumulates and the joints become stiffened. You then jump out of bed thinking your raked your whole yard and got off pain free when the acute muscle spasm and pain hits you. You might even have a sharp pain that may or may not travel down to the leg or buttocks.
The best treatment for this condition is to restore normal joint movement of the area and keep it that way long enough for it to heal. Chiropractors receive good results in my office by doing adjustments of the effected joints to restore their mobility. By having good mobility in the swollen and sore joints, the swelling can be flushed out, the circulation inside the joint is improved, and the joints heal much faster with less pain. It is important that people understand that only your body will heal the injury and that the chiropractor is just making that system work more efficiently and at a faster rate. Applying ice packs or even frozen peas for ten to fifteen minutes at a time, two to three times per day, will help decrease the swelling around the nerves and joints. In the unfortunate event that something more serious has occurred, such as a herniated disk, the chiropractor is trained to identify and conservatively treat it. If conservative therapy will not work, the appropriate referral to a specialist can be made. This is usually done in conjunction with your medical doctor.
Of course, the best cure for low back pain is prevention. When you are raking, keep your back straight and pull the rake directly towards your body. Do not pull the rake to your side, as this will automatically encourage your back to twist. It is also important to not try to rake the entire yard in one day. Spread the job out over a few days. Some may laugh at this, but it is recommended that you actually warm up and stretch before starting to rake. Go for a light ten-minute walk and do a few repetitions of stretching for the low back before starting. Lastly, an emerging trend in the leaf extraction business is with leaf blowers. Leaf blowers help decrease the amount of bending over and twisting that you would normally have to perform and even speed up the process. Regardless of which method you take, it’s time to get started! Leaf removal starts November 1 (Hopkinsville, KY)!
If you have any questions about back pain or a topic for my next blog, email me at email@example.com or visit my website, http://www.landrumdc.com
Natural Bridge Apex, KY
Whiplash can be defined as any Injury to the neck caused by a sudden movement of the head, backwards, forwards, or sideways. Whether from a car accident, sports, or an accident at work, whiplash or other neck injuries warrant a thorough chiropractic check-up. The biggest danger with whiplash injuries is that the symptoms can take from months to years to develop. Too often people don't seek treatment until more serious complications develop. Even after whiplash victims settle their insurance claims, some 45% report they still suffer with symptoms two years later.
In the past a typical whiplash injury, where no bones were broken, were hard to document. Soft tissue injury didn't show up on normal x-rays/radiographs and insurance companies would deny coverage. Literally adding insult to injury, the patient's real pain was sometimes considered to be a fraud, a liar, or at best a hypochondriac. Today’s imaging devices (CAT Scans, MRI and Ultra Sound) now show soft tissue injuries with much greater detail.
Whenever someone has a whiplash injury, there are typical symptoms that one may experience.
When there are no bones broken and the head doesn't strike the windshield, the following symtoms are the most common:
62% to 98% complain of neck pain, which typically starts two hours up to two days after the accident. This is often the result of tightened muscles that react to either muscle tears or joint sprains.
66% to 70% of those suffering from whiplash complain of headache. The pain may be on one side or both, on again off again or constant, in one spot or more general. These headaches, like the neck pain, are often the result of strained, tense muscles trying to keep the sprained cervical joints of the neck stable. They pain of these headaches are often felt at the back of the head, forehead, temples, and behind the eyes.
Shoulder pain often described as pain radiating down the back of the neck into the shoulder blade area, may also be the result of tensed muscles.
Muscle tears are often described as burning pain, prickling or tingling.
A more severe injury, such as disc damage or herniation, may cause sharp pain with certain movements, with or without radiation into the arms, hand and fingers, which are relieved by holding your hand over your head.
The following is a list of other symptoms that one may feel after a whiplash injury:
Pain between the shoulder blades
Low back pain and/or stiffness
Ringing in the ears
Numbness and tingling
Pain in the jaw or face
If you experience any of these symptoms, play it safe and get a chiropractic check up. To see a chiropractor in regards to any type of related injury, you do not need a referral from your medical doctor. Once a proper examination is performed and an accurate diagnosis is made, safe and conservative chiropractic treatment can commence.
If you have any questions about your back pain give me an email at firstname.lastname@example.org or visit my website http://www.landrumdc.com/
As the white stuff begins to accumulate on our sidewalks and streets, we will have the wonderful task of getting out there and shoveling it. As with every year when we receive a good dump of snow, I will be anticipating the rush of patients into the office suffering with acute low back pain.
Most people are not use to a long stint of physical work that requires a lot
of low back movement and strength. So, when they challenge themselves too much, problems often arise. The most common scenario involves an average person just like you that may not even have arthritis or an old injury that would predispose you to having problems. However, you may have mildly stiff joints and muscles in your back but not enough to cause pain or restrict any regular daily activities. This means that your lower back may have only 80% of its potential mobility and strength and you do not even know it. This would not interfere with your work or day-to-day activities and you would not even
be consciously aware of it. However, when you go out and shovel that heavy wet snow for an hour and demand the full 100% of your back’s potential….it cannot handle it.
At first your back may just feel a little stiff and perhaps weak. Then, after sitting down or relaxing for a while, the ache begins as the inflammation in the joints accumulates. If you are unlucky enough to have the inflammation around or near a nerve, the pain will become worse. Once the nerves are irritated, they begin to fire at a greater become “over stimulated”. Then, whatever the nerve is responsible for controlling, such as the muscles, will also function at a higher level of intensity and become “over stimulated”. This is where the muscle spasms originate. They feel like waves of sharp pain that can hit you even during the smallest of movements. You may also experience pain or tingling down one leg, commonly termed “sciatica”. At this point, it may even hurt to cough, laugh, sneeze, or to do just about anything. If you are stubborn, you will stall a day or so “waiting for it to go away”. It is then that most people slowly walk into my office. The joints in your low back would now be extremely stiff and sore.
For any joint in our body to heal properly once it is injured, it must be able to move properly. When it comes to restoring the proper range of motion of stiff, sore, and inflamed joints, no health care practitioner is better trained to do it than a chiropractor. Only when the mobility of the joints is fully restored and maintained will they heal naturally, completely, and at a much faster rate. By restoring the normal functioning of your spine, it is able to heal faster and more efficiently. An even better treatment for low back pain from shoveling snow is prevention ofthe injury in the first place.
The technique you use to shovel the snow is very important. Push the snow shovel in front of you. Don’t push the snow at the side of your body in a sweeping motion. This will make your low back twist repetitively and you will be forced to lean to one side. If you use this improper motion, you are just asking for a sore back. If the snowfall is deep and heavy and you have a large area to do, don’t try to shovel the entire driveway at once. The remaining snow will still be there the next day still waiting for you.
If you have any questions about your back pain give me an email at email@example.com or visit my website http://www.landrumdc.com/
Whether you are “Cyber Monday” shopping at home, watching Youtube at work or sitting at your computer desk naked looking for a new car it is important to have your computer station set up properly. As you may have noticed, occupations in today’s workforce that require physical labor are decreasing in number. In turn, they are being replaced by faster and more efficient computer based equipment. Due to this, the average employee is spending much more time sitting in front of a computer screen. Also, as the number of households that have computers increases in leaps and bounds every year, people are spending even more time at home in front of the computer. Many repetitive strain injuries such as shoulder/arm tendonitis, carpal tunnel syndrome, neck pain, headaches and upper back pain are directly related to an improperly set-up computer workstation.
To start with, make these quick changes to get the ball rolling:
1) In regards to the monitor, the height of the screen is important. The top level of the written text should be at eye level. If it is too low, stack something like old books under it to raise it to eye level. If the monitor is too low, it will cause stiffness in the neck and possibly headaches.
2) The distance between your eyes and the screen should be about an arm’s
length 18-24 inches. Being too close or far away will cause eye strain.
3) If your keyboard is at the proper height, you should be able to type without bending the wrists backwards (dorsiflexion). If your wrists are bent backwards, put a spongy support under the wrists to help keep your wrist neutral. These can be purchased at any office supply store. You can also fold in the little legs that are under the keyboard. This will level out the keyboard and maintain the wrists in a neutral position. If the wrists are kept in an improper position, tendonitis of the forearm or carpel tunnel will likely arise.
4) When using a mouse, be sure your wrist is not angled left or right. This will cause tendonitis or carpal tunnel if done incorrectly.
5) If you are typing while reading from a piece of paper or book that is lying on your desk, do not have it placed too far to the left or right. It should be in an upright position and relatively close to you. When you have your head turned too far one way for a prolonged period of time, the neck will inevitably get sore.
6) Be sure you are using a quality chair. The backrest should give good lumbar
support and be angled 95 to 110 degrees. If the chair has armrests, they should support the elbows lightly. The elbows should be bent at 90 to 110 degrees. The shoulders should be in a comfortable position and hanging loosely, not in a shrug position. Do not let the shoulders roll forward, as this will allow the back to slouch. A good lumbar supports should help correct many of these issues.
7) Never sit for periods longer than 45 minutes. Get up from your seat and go get some water or act like your doing something important. It’s not a good idea to keep the ligaments and tendons it a stretched position for long periods of time.
Try to make these changes to your computer workstation. You will notice a difference immediately and it will help prevent the chronic problems such as tendonitis or carpal tunnel syndrome. Chiropractors are treating many patients with neck, wrist, forearm, shoulder, and upper back problems that are mostly related to how their computer workstations are set up. As I have mentioned before, the best cure for these problems is prevention.
There are many different instigators of pain in the lower back. Two of the most common ones are the joints of the spine (facet joints) and a degenerated/herniated disk. Both of these can cause irritation of the nerves such as numbness, tingling and produce a referred pain further down the leg (sciatica). However, another very common one that is often misdiagnosed by some practitioners is the sacroiliac joint. It is actually the joint between the “sacrum” and “ileum” bones located at each side of the pelvis and not in the spine at all.
Back not too long ago, it was thought that this joint did not move at all and was not a potential source of pain. A recent study has disproved this theory. The researchers in this study injected “freezing or anesthetic” specifically into this joint in people with low back pain. They used x-rays to be sure the needle was actually inside of the “sacroiliac joint”. Once the anesthetic was given time to take affect, the low back pain was significantly better and then the pain returned when the anesthetic wore off. Although it was not a cure for their back problem, it clearly demonstrated that the sacroiliac joint should be added to the list of possible causes of acute and chronic low back pain.
Problems with the sacroiliac joint are one of the most common causes of acute low back pain that I see in my office. It can occur in the absence of any heavy lifting or accidents. When sore, you will feel the pain two to three inches to one side from the middle of the low back. It can even occur on both sides at the same time. The nerves that control pain in this joint can cause pain to be referred to the hip, groin, and leg. As well, strong and painful muscle spasms can accompany the pain in the joint.
Research has also shown that the fastest way for any joint to heal, particularly in the low back and pelvis, is to restore the movement or mobility of the joint. All the joints in your body are designed to nourish themselves, remove swelling, and heal after injury. But, for this to occur, the joint has to be able to move properly. In cases of low back pain, the joints become very “stiff or jammed”. It is the job of the chiropractor to do “adjustments” to restore and maintain this movement, allowing it to heal.
The next time you go to Wal-mart for your weekly outing, try to notice how other people’s heads are positioned. Sound weird? Probably. But if you know what to look for, you can see which people likely have headaches and neck problems. When someone is standing with their arms at their sides, look at them from the side. Their ear, shoulder, hip, knee, and ankle should be in vertical alignment. In other words if you drop a piece of string from their ear it should pass through all of those points.
Did you know that for every inch a person’s head is positioned "forward", that gravity is pulling their head even further forward, equal to a pull of 10 pounds?! It’s true! As far as the muscles in your upper back and neck are concerned, they have to work even harder than normal in order to keep the head (chin) from dropping forwards onto your chest. This forces the muscles that raise the chin or pull the head back to remain in constant contraction, putting pressure and tension on the joints, muscles, and eventually the nerves of the neck and upper back. As an example, if a person’s head is tipped forward two inches, it would be similar to hanging a 20-pound watermelon from the front of his or her head? It is no wonder that people who do this consistently end up with tension headaches, upper back pain, and neck pain.
When your head is held in a forward position, the mobility of the joints in the upper four vertebrae of the neck will be significantly restricted. All of our joints need to move and be positioned properly to remain healthy. If these joints have abnormal pressure on them due to improper positioning and are not allowed to glide freely, degeneration of the joints and discs in that area will eventually occur.
To prevent forward head posture from happening in the first place, practice good posture and keep the muscles of your neck strong and flexible. If you have had forward head posture for some time, see your chiropractor so that the mobility in the joints and flexibility of the muscles within and around the neck can be restored. He or she can also show you some simple exercises to help strengthen and release the chronic spasm of the muscles involved. Once your treatment protocol is complete, your postural habits are improved, and you either commence or continue to exercise regularly, your persistent neck pain and headaches will be a thing of the past.
Note Homer's excellent head posture
“Piriformis syndrome” is caused by an entrapment (pinching) or irritation of the sciatic nerve as it exits the back of the pelvis, deep within the buttock region. The sciatic nerve usually exits the back of the pelvis immediately below a muscle, called the piriformis muscle. The piriformis muscle is located on both sides of your body, deep within the buttock area. In rare situations (11% of population), the nerve actually passes right through the piriformis muscle. For various reasons, the piriformis muscle can go into spasm and entrap or even pinch the sciatic nerve. This can result in pain along the back of the thigh and knee, with further pain and/or numbness extending as far down as the sole of the foot, called “sciatica”.
Piriformis syndrome can result in “sciatica”. These same sciatica symptoms feel very comparable to that of a herniated disk. A herniated disk usually pinches directly on one of the five nerves that eventually form the sciatic nerve. Because the resulting symptoms of both of these problems are very similar (pain, numbness and tingling below the knee and into the foot), it is not hard to misdiagnose what is actually going on if you don’t look for both potential causes.
Specific diagnostic tests performed by your chiropractor are what distinguish a herniated disk from piriformis syndrome. In simple terms, with piriformis syndrome your chiropractor will not find many positive test results that indicate that the lumbar spine is involved. More often, the acute pain or tenderness is localized to the buttock and hip, while the low back appears quite normal and often pain free.
Many weekend athletes and people who spend long hours sitting in cars or at work are prone to this syndrome. The athlete's cause is commonly due to improper stretching and warm-up exercises as well as overuse during activity. In this case it is most likely that the piriformis muscle is irritated and usually in spasm. For the patient who sits for extended periods of time, their primary cause is due to contracture or tightening of the piriformis muscle. In this case the piriformis muscle is shortened and does not allow for the smooth movement of the sciatic nerve during leg motion.
Any treatment plan must include stretching of the gluteal or buttock muscles as well as stretching of the piriformis muscles. Dr. Landrum can help you by instructing you on the proper stretches and the correct way to perform them. A series of spinal and hip joint adjustments may also be required to relieve your symptoms.
If you are currently diagnosed with a disk herniation but are wondering if the symptoms you are experiencing may at least be partially from piriformis syndrome, call my office for an appointment to have it checked thoroughly. It is always a good idea to rule out other possible causes of your sciatica before simply having surgery.
Although doctors of chiropractic treat more than just back pain, a large percentage of chiropractic patients visit their doctor looking for relief from this pervasive condition. In fact, 70 to 85 percent of all people have back pain at some time in their life.
A few interesting facts regarding back pain:
Low back pain is the fifth most common reason for all physician visits in the United States.1,2
Back pain is the most frequent cause of activity limitation in people younger than 45 years old.3
Most cases of back pain are mechanical or non-organic—meaning they are not caused by serious conditions, such as inflammatory arthritis, infection, fracture or cancer.
Approximately one quarter of U.S. adults reported having low back pain lasting at least one whole day in the past three months2, and 7.6 percent reported at least one episode of severe acute low back pain within a one-year period.4
Low back pain is also very costly: approximately 5 percent of people with back pain disability account for 75 percent of the costs associated with low back pain.5
One-half of all working Americans admit to having back pain symptoms each year.6
Approximately 2 percent of the U.S. work force is compensated for back injuries each year.7
Americans spend at least $50 Billion per year on back pain—and that’s just for the more easily identified costs.8
If a person has back pain, what should they do?
If your back pain is not resolving quickly, visit your doctor of chiropractic. Your pain will often
result from mechanical problems that your doctor of chiropractic can address. Many chiropractic
patients with relatively long-lasting or recurring back pain feel improvement shortly after starting chiropractic treatment. The relief is often greater after a month of chiropractic treatment than after seeing a family physician.
The chiropractic approach is to find the cause of the pain and treat it directly. This may involve
realigning the spine or extremities by chiropractic adjustments, physiotherapy for the muscles
and ligaments, rehabilitative exercises, or a combination of these. Sometimes the doctor of
chiropractic will suggest exercises or activities to prevent a reoccurrence of the problem. This
may provide a long term solution to the condition through prevention.
During the first visit, the doctor of chiropractic will complete a thorough examination that
• Patient history
• Physical examination
• Diagnostic studies (when indicated)
• Education about the problem and discussion of a chiropractic treatment plan or – if
warranted – referral to the appropriate health care specialist
Chiropractic spinal manipulation is proven to be a safe, effective, and affordable treatment
option. Chiropractic care reduces pain, restores normal range of motion, and decreases the need
Tips to Prevent Back Pain
Some back pain is caused by non-preventable factors (traumatic accidents, congenital defects,
tumors), but the majority of low back pain is preventable. Suggestions on how you can prevent
back pain include:
• Maintain a healthy diet and weight.
• Remain active.
• Avoid prolonged inactivity or bed rest.
• Warm up or stretch before exercising or other physical activities.
• Maintain proper posture.
• Wear comfortable, low-heeled shoes.
• Sleep on a mattress of medium firmness to minimize any curve in your spine.
• Lift with your knees, keep the object close to your body, and do not twist when lifting.
• Quit smoking. Smoking impairs blood flow, resulting in oxygen and nutrient deprivation
to spinal tissues.
• Work with your doctor of chiropractic to ensure that your workstation is ergonomically
1. Hart LG, Deyo RA, Cherkin DC. Physician office visits for low back pain. Frequency, clinical evaluation, and treatment patterns from a U.S. national survey.
2. Deyo RA, Mirza SK, Martin BI. Back pain prevalence and visit rates: estimates from U.S. national surveys, 2002. Spine. 2006;31:2724-7.
3. National Institutes of Health
4. Carey TS, Evans AT, Hadler NM, Lieberman G, Kalsbeek WD, Jackman
AM, et al. Acute severe low back pain. A population-based study of prevalence
and care-seeking. Spine. 1996;21:339-44.
5. Frymoyer JW, Cats-Baril WL. An overview of the incidences and costs of low
back pain. Orthop Clin North Am. 1991;22:263-71.
6. Vallfors B. Acute, Subacute and Chronic Low Back Pain: Clinical Symptoms, Absenteeism and
Working Environment. Scan J Rehab Med Suppl 1985; 11: 1-98.
7. Andersson GB. Epidemiological features of chronic low-back pain. Lancet.
8. This total represents only the more readily identifiable costs for medical care, workers compensationpayments and time lost from work. It does not include costs associated with lost personal income due to acquired physical limitation resulting from a back problem and lost employer productivity due to employee medical absence. In Project Briefs: Back Pain Patient Outcomes Assessment Team (BOAT). In MEDTEP Update, Vol. 1 Issue 1, Agency for Health Care Policy and Research, Rockville, MD, Summer 1994.
Did you realize that one of the top reasons that individuals visit their doctor is because of headaches? Headaches of even the slightest severity can prevent you from enjoying many of life’s day to day activities. Believe it or not, the number of children, teenagers and adults who are seeking chiropractic care for relief of headaches is right up there in numbers with neck pain or low back pain. Yet, it still surprises me how most of the people do not realize the headaches they are experiencing are primarily tension type headaches, and not migraines.
Tension-type headaches are one of the most common, yet easiest to treat, type of headache. Muscle tension, joint stiffness, and nerve irritation at the back of the neck and head can create a dull, steady pain over the forehead, temples, back of neck and even down the shoulders. Commonly, there is a band-like pressure on both sides of the head. The pain is usually constant, non-throbbing, ranges from mild to moderate in severity, and usually builds in intensity. It is very common for people to even wake up in the morning and feel the headache before even getting out of bed! Tension headaches may last from 30 minutes to even a week and are commonly related to stress, poor posture, and a lack of regular physical exercise. They affect both men and women in equal numbers, and are common in children. They can cause nausea and are not made worse by routine physical activity.
A study done at Ohio University in 1998 showed that more than 70 percent of people who experience this type of headache also had frequent disrupted sleep due to the associated neck stiffness or pain. In addition, these people reported that, over time, this scenario created further fatigue and headache-related anxiety or stress. The same studies also found that 44 percent of the people who experience this type of headache said that it affected their performance at work or school and 72 percent said the pain caused them to miss work or school an average of 3.5 days in the last six months. (1)
Over the past few years, research has shown that spinal manipulation - the primary form of treatment provided by Chiropractors - is an effective treatment option for tension-type headaches and headaches that originate from the neck.(2,3) For example, a report released by researchers at the Duke University Evidence-Based Practice Center in Durham, NC, found that spinal manipulation resulted in almost immediate improvement for those 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. Also, a study in the Journal of Manipulative and Physiological Therapeutics found that spinal manipulative therapy was an effective treatment for tension headaches and that those who ceased chiropractic treatment after four weeks experienced a sustained therapeutic benefit in contrast with those patients who received a commonly prescribed medication.
In addition to chiropractic treatment, anyone who suffers from neck stiffness or headaches should be stretching their neck muscles daily, the ergonomics of their place of work should be reviewed to prevent poor posture, and they should participate in some form of regular physical activity. For more information on headaches, neck pain - feel free to give me an email at firstname.lastname@example.org.
2. Boline PD , Kassak K, Bronfort G, Nelson C, Anderson AV. “Spinal manipulation vs. amitriptyline for the treatment of chronic tension-type headaches: a randomized clinical trial.” Manipulative Physiol Therapy ; 18:148-54.
3. Gert Bronfort, Willem J.J. Assendelft, Roni Evans, Mitchell Haas, Lex Bouter. “Efficacy of spinal manipulation for chronic headache: A systematic review” Journal of Manipulative and Physiological Therapeutics. September 2001 (Vol. 24, Issue 7, ages 457-466).
Probably not a tension headache