Author Archives Mark Croucher

Chiropractor / Manual Therapy

Posted by Mark Croucher
on February 10, 2016
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Information from the text book Biomechanics of Back Pain addressed Manual therapy.

The term manual therapy is used to describe the primary treatments that chiropractors use.  The authors describe that manual therapies appear to have a neurological effect on pain and improve healing of damaged muscles, tendons and ligaments by stimulating blood supply and preventing adhesions.  Manual therapy may also be helpful in treating painful intervertebral discs (or sciatica due to disc herniation) and this type of problem is receiving more formal scientific attention.

The Biomechanics of Back Pain (considered as a comprehensive, evidence-based approach to the management and treatment of back pain).  By Michael Adams, Nikolai Bogduk, Kim Burton, Patricia Dolan

Another study from the British Medical Journal points to the superior effectiveness of manual therapy over other interventions.

“Manual therapy is more effective and less costly than physiotherapy or care by a general practitioner for treating neck pain. Patients undergoing manual therapy recovered more quickly than those undergoing the other interventions.”

Cost effectiveness of physiotherapy, manual therapy, and general practitioner care for neck pain: economic evaluation alongside a randomized controlled trial.  British Medical Journal 2003

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Peyton Manning Declares He Has At Least One More Surgery In Him

Posted by Mark Croucher
on February 8, 2016
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Satire from The Onion

SANTA CLARA, CA—Following his team’s 24-10 win in Super Bowl 50, Denver Broncos quarterback Peyton Manning ended weeks of speculation surrounding his future by announcing Sunday that he has at least one more surgery in him. “I’ve had a long run and been a part of a lot of pretty big surgeries, but I still think I’ve got one more major operation left in the tank,” said Manning, adding that he had deliberated for the past six months with friends, family, and medical specialists before deciding that he wasn’t ready to hang up his hospital gown for good. “Ultimately, I have to listen to my body, but I’ll keep going as long as I can still handle the anesthesia. I just can’t imagine myself never being under those bright lights in the operating room again. I’ll get on the gurney one more time and then ride off into the sunset.” Manning refused to comment, however, when asked whether he would undergo his next surgery in Denver or potentially at a medical center in Los Angeles.

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I’m scared for Peyton Manning

Posted by Mark Croucher
on February 8, 2016
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I really hope Peyton Manning retires.

He’s had 4 cervical spine (neck) surgeries including fusion of the vertebra after the discs were cut out. He has been left with some neurological damage including numbness and weakness in his arm and hand.  But that’s not the part that I am scared about.  In fact there is a chance that the numbness and weakness will improve.  He was quoted about this issue.

“I can’t feel anything in my fingertips,” Manning said Thursday. “It’s crazy. I’ve talked to a doctor recently who said, Don’t count on the feeling coming back. It was hard for me for about two years, because one doctor told me I could wake up any morning and it might come back. So you wake up every day thinking, Today’s the day! Then it’s not.”

I’m scared for him because of the current lack of natural flexibility in his neck due to the the fusion surgeries.  The middle and lower part of his neck is now RIGID with screws and plates holding the vertebra together.  From a mechanical standpoint this makes his neck more suceptible to what is called adjacent level disease (where the spinal levels above or below the fusion breakdown).  I have not been able to find any literature on “IF” fusion surgery makes the spine easier to break.  It makes one worry a bit though doesn’t it?

What happens to his neck if one of these massive men slam him to the ground on his head and rigid neck. Or if they happen to ram heads with him during an aggressive tackle.  Sure, anyone who plays professional football is accepting and inherent risk to life and limb but I believe his chance for neck fracture, in this particularly violent game, is elevated as a result of the altered rigid biomechanics of his neck.

Peyton, your legacy in sports is complete.  Spare your family from the fear that they must have each time you step on a football field.  I feel it so they must feel it ten fold.


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Do I have spinal degeneration?

Posted by Mark Croucher
on February 6, 2016
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considering  surgeryStudies have shown that patients without any pain have various evidence of spinal damage, degenerative changes and spinal joint arthritis.  Other studies have indicated that future spinal pain may be much more probable due to these types of spinal break down.



The statistics above are taken from:

Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Populations

American Journal of Neuroradiology


The mission of AJNR is to further knowledge in all aspects of neuroimaging, head and neck imaging, and spine imaging for neuroradiologists, radiologists, trainees, scientists, and associated professionals through print and/or electronic publication of quality peer-reviewed articles that lead to the highest standards in patient care, research, and education and to promote discussion of these and other issues through its electronic activities.


AJNR will continue to be internationally recognized as the primary source of information regarding all aspects of neuroimaging, including head and neck and spine imaging, for all professionals engaged in these and related fields. Continued optimization of delivery will enable it to and enhance patient care, research, therapy, training, and life-long learning.

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Spinal Stenosis Signs

Posted by Mark Croucher
on February 5, 2016
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spine-center-postureA recent study published in the prestigious medical journal Spine has outlined 6 specific signs to help diagnose Lumbar Spine Stenosis.  The study was based on polls of 279 physicians from 29 different countries with an average of 19 years in practice.  The study suggests that clinicians can be 80% certain of the diagnosis by answering 6 basic questions.

The six top items were “leg or buttock pain while walking”, “flex forward to relieve symptoms”, “feel relief when using a shopping cart or bicycle”, “motor or sensory disturbance while walking”, “normal and symmetric foot pulses”, “lower extremity weakness” and “low back pain”.

Conclusions. This is the first study to reach an international consensus on the clinical diagnosis of LSS, and suggests that within six questions clinicians are 80% certain of diagnosis. We propose a consensus-based set of “7 history items” that can act as a pragmatic criterion for defining LSS in both clinical and research settings, which in the long-term may lead to more cost-effective treatment, improved health-care utilization and enhanced patient outcomes.

Level of Evidence: 2

Consensus on the Clinical Diagnosis of Lumbar Spinal Stenosis: Results of an International Delphi Study.
Tomkins-Lane, Christy PhD; Melloh, Markus MD, PhD; Lurie, Jon MD; Smuck, Matt MD; Freeman, Brian MD; Samartzis, Dino MD, PhD; Hu, Richard MD; Barz, Thomas MD; Stuber, Kent DC; Schneider, Michael DC, PhD; Haig, Andrew MD; Schizas, Constantin MD; Cheung, Jason MD; Mannion, Anne F. PhD; Staub, Lukas MD, PhD; Comer, Christine PhD; Macedo, Luciana PhD; Ahn, Sang-ho; Takahashi, Kazuhisa MD, PhD; Sandella, Danielle MS
Spine:  Post Acceptance: February 1, 2016
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Here’s a crazy study

Posted by Mark Croucher
on February 5, 2016
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My favorite research review of the week!

Swearing as a Response to Pain—Effect of Daily Swearing Frequency

charlotte faceThis article presents further evidence that, for many people, swearing (cursing) provides readily available and effective relief from pain. However, overuse of swearing in everyday situations lessens its effectiveness as a short-term intervention to reduce pain.

Previously we showed that swearing produces a pain lessening (hypoalgesic) effect for many people.20 This paper assesses whether habituation to swearing occurs such that people who swear more frequently in daily life show a lesser pain tolerance effect of swearing, compared with people who swear less frequently. Pain outcomes were assessed in participants asked to repeat a swear word versus a nonswear word. Additionally, sex differences and the roles of pain catastrophizing, fear of pain, and daily swearing frequency were explored. Swearing increased pain tolerance and heart rate compared with not swearing. Moreover, the higher the daily swearing frequency, the less was the benefit for pain tolerance when swearing, compared with when not swearing. This paper shows apparent habituation related to daily swearing frequency, consistent with our theory that the underlying mechanism by which swearing increases pain tolerance is the provocation of an emotional response.

pain journal

December 2011Volume 12, Issue 12, Pages 1274–1281

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Posted by Mark Croucher
on February 4, 2016
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golf swing

Many of our patients are “fond” of golf to put it lightly.  The little ol’ white ball beckons them in the wee hours of the morning.  I myself enjoy the game but I have some things to say about our little addiction.

It’s not that great for your back or your neck for that matter.

Think about the force generated on my lower back as I coil back and then dynamically swing through the ball. Notice that my head position is in the middle, staying still.  My left shoulder is pinned to my neck at my full backswing.  Nice technique but the rotational (torsion) forces on my neck from my shoulder rotation are huge.  The same type of rotational strain on my lower back is tremendous.  No matter how good your technique.

Now imagine how many swings you take before, during and after a round. Then think about the estimate that nearly 100% of people over 60 years old have degenerated (dried, hardened, broken down) spinal discs.  

Just a little food for thought.


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Disc injury and chronic pain

Posted by Mark Croucher
on February 4, 2016
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discArthritis Research & Therapy 2015

A recent study from Arthritis Research & Therapy helps to shed light on a topic that has been of great discussion for many years.  It has been thought to be a general rule that the discs or pads in between the vertebra do NOT have a good blood supply in the inside of the disc.

Also, in healthy discs, the nerves in the area grow AROUND the disc but not INTO the disc.

Why are those points important?  Well…here’s why.


  1. The lack of blood supply is one of the reasons why discs don’t heal well when they are injured or placed under repetitive loads like sitting all day or bending over and over again. These problems lead to damage or degeneration in the discs (hardening, breakdown, tearing, bulging).
  2. The nerves that grow AROUND the disc can then invade INTO the disc after injury.  This is called nerve ingrowth.  The consensus is that these ingrown nerves are VERY sensitive to pressure and give you MORE PAIN than they would in healthy discs.

When these researches speak about the NP they mean the Nucleus Pulposes which is the center gelatin portion of the disc.  When they use the term IVDs they mean the disc (intervertebral discs).

“Our findings demonstrate that nerves are present within a large proportion of NP samples from degenerate IVDs. This study shows a possible link between nerve ingrowth and degeneration of the IVD and suggests that nerves can migrate in the absence of blood vessels.”

So how does this apply to spinal pain management?  We believe that degenerated discs become more painful due in part to the way the problem affects the nerves.  Research has also helped us to understand that spinal manipulation/mobilization can stimulate the nervous system in ways that help alleviate pain. We also believe that many other manual therapies and targeted exercises also stimulate the nervous system and may be why these other interventions reduce spinal pain.

STUDY:  Nerves are more abundant than blood vessels in the degenerate human intervertebral disc – Arthritis Research & Therapy 2015

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Spinal surgery/Chiropractic care

Posted by Mark Croucher
on February 3, 2016
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  • spine-center-lower-back-painsmAre you dealing with chronic back pain?
  • Do you have pain or numbness in your arms or legs?
  • Have you already had spinal surgery?
  • Have you been considering spinal surgery for back pain?
  • Have you tried PT, spinal injections and medication?

If you answered yes, you may be interested in this.  Our patient base is made up of patients suffering with severe and chronic spinal pain (back and neck) and in may cases radiating pain, numbness or tingling in their arms or legs.  The majority of our patients had already been through physical therapy, spinal injections, medications and subsequent spinal surgery prior to coming to our office.  Many of our patients have been referred to our office from local pain management specialists, surgeons and other medical physicians.

Many of these issues start from damage to the discs that reside in between the spinal bones or vertebra.  The discs can tear, bulge or even rupture creating pressure and inflammation that irritates the spinal nerves.  These nerves that exit from your spine control your arms and legs.  That’s where the leg and arm symptoms come from.

I think its important for people to know that chiropractic treatments have been shown to provide relief to patients with this type of chronic back and neck pain.  Our goals are to improve spinal function (ability for bending, transitions from sitting, walking, standing) and reduce the pain associated with those activities.

There are a number of techniques that can be helpful in reducing the symptoms of numbness, pain and tingling into the arms or legs.  Manual therapies and forms of manual and automated spinal traction can provide relief from this type of debilitating condition.

If you’re suffering from these conditions, consider calling our office.



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Lifelong Learning

Posted by Mark Croucher
on February 2, 2016
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dan carlsonDr. Carlson is teaching a class at Christopher Wren Association through The College of William and Mary here in Williamsburg entitled SPINAL INJURY AVOIDANCE CONCEPTS AND. POSTURAL IMPROVEMENT TUTORIAL. January 26th, Feb 2, 9, 16, 23 and March 1st.  Unfortunately the main class has reached maximum capacity but the Lecture Format is still open on March 31st. Contact Christopher Wren Association at 757-221-1506 

The same class will follow at James City County REC center April 5, 12 and 19.  There are some openings still available at the James City County class so call ahead to register!!  Contact Kristen Tolj – Health and Wellness Coordinator at 757-259-4176.

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