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Powell Chiropractic Center, 7311 Clinton Highway, Powell, TN (2025)

10/30/2025

If you consider a vertebral segment as consisting of three legs like a tripod, the front of the vertebrae is the large vertebral body and the two legs in the back are the articular facets. The spinal cord passes between these three legs as it travels its course from the brainstem down to the tail bone, with spinal nerve roots exiting each vertebral level to innervate various parts of the body. Spondylolisthesis is a term used to describe when one vertebra shifts forward with respect to an adjacent vertebra, typically in the lower back. In some instances, the patient may not experience symptoms, but in other cases, they may experience localized pain or pain that radiates along the course of the nerve that exits the spine at that level. Spondylolisthesis is generally classified by its suspected cause: degenerative, isthmic, traumatic, dysplastic, or pathologic.

Degenerative spondylolisthesis develops gradually over time due to degenerative disk disease and other age-related changes and is NOT due to fracture. Hence, the entire vertebrae slides forward over the other and can distort the path of the spinal cord. This is more common in adults over 50 years of age, more often in females than males.
Isthmic spondylolisthesis results from defects in a small bony area between the front and back of the vertebra called the pars interarticularis, which is often caused from repeated microtrauma into hyperextension of the spine. This is more common in young athletes.
Traumatic spondylolisthesis results from a singular traumatic event, such as when the lumbar spine is struck by a heavy object. Fortunately, this type rarely occurs, but when it does, it’s more often found in working-age males.
Dysplastic spondylolisthesis is congenital and secondary to variations in facet joint orientation or abnormal alignment. There is also research that suggests a genetic component exists in that spondylolisthesis is more common if a first-degree relative has the condition.
Pathological spondylolisthesis is caused by a systemic disease such as infection, osteoporosis, or neoplasm. It may also manifest as a complication from spine surgery.
The good news is that more than three quarters of spondylolisthesis patients may experience a full recovery with chiropractic treatment. Doctors of chiropractic will often employ a multimodal treatment approach that includes patient education, at-home care with heat/ice, manual therapies; specific exercises; supplement recommendations; and physiotherapy modalities such as electrical stimulation, ultrasound, cold laser, and pulsed magnetic field. When necessary, your chiropractor will team up with an allied healthcare provider to manage more complicated cases.

10/30/2025

After low back pain, neck pain is the most common reason for a visit to a chiropractic office. There are many risk factors for neck pain including postural faults in the neck and upper torso. Let’s look at how common poor posture is among youths and what can be done to reduce the risk for neck pain in children and teens both inside and outside of the doctor’s office.

Upper crossed syndrome (UCS) is a postural fault characterized by a weakness of the deep neck flexors and interscapular (middle and lower trapezius) muscles and over-tightness/shortness of the upper back and neck and pectoralis (chest) musculature forming an “X” when looking at the body from the side and connecting the weak muscles and tight muscles with imaginary lines. This can cause the head and shoulders to rest forward of their normal position, straining the soft tissues of the neck and upper back, which can manifest as neck pain.

In a January 2023 study, researchers examined secondary school students and observed that 37.8% exhibited UCS, 38.9% had forward head posture, and 80% had forward shoulder posture. Further analysis revealed that students who were overweight, physically inactive, wore a heavy backpack, and spent too much time on electronic devices were at greater risk for poor posture. Additionally, the data show that UCS is associated with worse academic performance!

The good news is that a randomized controlled study that included adolescents from two schools found that those who participated in a 16-week resistance and stretching program incorporated into their standard gym class led to measurable improvements in neck and shoulder posture. The program in the study included chin and scapular retractions; stretching of the pectoralis, levator scapulae, and anterior scalenes muscles; and strengthening of the shoulder external rotator muscles. Replacing screen time and other sedentary behaviors with physical activity (such as after school sports), as well as proper backpack use (using both straps, keeping the weight of the back higher on the back, and restricting the bag’s weight to less than 10-20% of the child’s bodyweight) are also strategies for avoiding poor posture.

If a teenager with neck pain and faulty posture presents for chiropractic care, treatment will include hands-on care in the office, which can include manual therapies and physiotherapy modalities. Between visits, the patient may be asked to perform exercises to restore muscle balance in the neck and upper torso to help correct their posture. Not only can this approach help relieve their neck pain, but it can also lower their risk for neck pain in the future!

10/29/2025

Neck pain is a very common condition that is the second most common reason patients seek chiropractic care (after low back pain). The term “mechanical neck pain” is a common classification defined as pain located in the cervical spine or cervicothoracic junction that is elicited and/or exacerbated by cervical motion and/or palpation of cervical musculature. While it’s understandable that neck pain should be traced back to dysfunction in the neck itself, it’s suggested that the thoracic spine or mid-back may contribute to or even be the cause of neck pain in some patients.

These days, as we spend more and more time looking at screens, it’s becoming more and more common for individuals to develop postural abnormalities like forward head posture. When the head rests forward of the shoulders, the upper trapezius muscles that connect the rear of the neck and the upper back must work harder to keep the head upright. This prolonged muscle strain can lead to inflammation, which can be felt as neck pain. In fact, an April 2023 study that examined 148 adults, half with neck pain, identified an association between abnormal mid-back posture and neck pain. Similarly, a December 2022 study found that individuals with neck pain are more likely to exhibit hypermobility in the upper thoracic region.

To identify if treatment aimed at improving function in the thoracic spine can benefit neck pain sufferers, researchers performed a systematic review and meta-analysis of eight randomized controlled trials published between 2010 and 2020 that included a total of 457 patients. Their analysis revealed that thoracic thrust manipulation—a form of treatment performed by doctors of chiropractic—led to a significant reduction in neck pain and disability, more so than other treatment options including non-thrust manipulation, mobilization, strengthening exercises, infrared therapy, placebo, or no treatment. The authors point out that this study provides evidence that thoracic spine manipulation is an effective intervention for patients with mechanical neck pain and should be considered as part of a multimodal approach for managing the condition.

Other studies have found that dysfunction in the mid back may also contribute to shoulder impingement syndrome and low back pain. This highlights the importance of examining the whole patient when they present for care and not just their area of chief complaint—something doctors of chiropractic are trained to do. If you suffer from neck pain and visit a doctor of chiropractic, don’t be surprised if treatment also includes a mid-back adjustment. It may be just what’s needed to alleviate your neck pain and return you to your normal activities.

10/29/2025

Though whiplash associated disorders (WAD) is a term used to encompass the myriad of symptoms associated with whiplash injury, research has largely focused on the neck, and more recently, brain. However, there is another area of the body that often experiences injury during trauma involving the sudden back and forth movement of the head and neck: the thoracic spine, or mid back.

In a large-scale study that looked at the medical records of more than 6,000 whiplash patients, researchers found that two-thirds complained of post-injury thoracic or midback pain and 23% still experienced these symptoms a year later. This can be explained by the mechanism of a whiplash injury that involves forceful stretch loading to the upper back muscles, which affects both the cervical and thoracic spine. More recently, researchers observed microscopic injury to the mid and lower fibers of the trapezius muscle located in the mid back and thoracolumbar region in WAD patients.

Interestingly, the thoracic spine contributes up to 33% and 21% of the movement occurring during cervical flexion and rotation, respectively. Thus, injury that restricts the range of motion of the soft tissues of the neck can place added strain on the mid-back. Likewise, injury to the midback can force the tissues of the neck to work harder to accommodate cervical range of motion. This could worsen existing injuries or even result in a secondary injury to the neck or midback.

A systematic review that included 38 studies and more than 50,000 WAD patients in total revealed the more than 60% had thoracic pain, and about the same percentage had myofascial pain and trigger points in the trapezius muscles. It was also common for WAD patients to have injuries that affect the muscles that attach to the base of the neck/upper back, which could affect the activity of tissues in the adjacent regions, including the thoracic spine. Due to these findings, the authors of the review recommend healthcare providers perform a more extensive clinical evaluation of the thoracic spine when patients present with WAD to prevent chronic pain and to restore function as quickly as possible so that patients can resume their normal activities.

When examining a patient with suspected WAD, doctors of chiropractic will focus on the whole patient as dysfunctional elsewhere in the body can often contribute to the patient’s presenting complaint, including the thoracic region. Once these potential causes are identified, the chiropractor can put together a treatment recommendation to address each to help alleviate pain and disability. This will often involve a multimodal approach that includes manual therapies, specific exercises, nutrition recommendations, and physiotherapy modalities. In more severe cases, the patient may be referred to an allied healthcare provider for treatment that falls beyond the chiropractor’s scope of practice.

10/28/2025

Carpal tunnel syndrome (CTS) is a condition that results from pressure applied to the median nerve on the palm side of the wrist. The disorder is associated with both motor and sensory signs and symptoms such as numbness, pain, and paresthesia that radiates from the wrist first to the first three digits and can include muscle weakness, including grip weakness and hand dexterity loss. For mild-to-moderate CTS, treatment guidelines recommend pursuing non-surgical approaches before consulting with a surgeon, with chiropractic care offering patients an excellent option. Among the tools at a doctor of chiropractic’s disposal are neurodynamic techniques.

Neurodynamic techniques encompass a group of hands-on manual therapies that promote the lengthening and mobility of nerves. In the case of CTS, neurodynamic techniques are focused on the median nerve both at the wrist and elsewhere along the course of the nerve from its origin in the neck and through the shoulder, elbow, and forearm. This is especially important as restriction of the median nerve before the wrist can both stimulate similar symptoms as CTS and increase the risk for entrapment at the wrist. Regardless, failure to examine the full course of the median nerve can lead to a suboptimal outcome for the patient.

In a July 2023 systematic review and meta-analysis of twelve randomized controlled trials that included 1,000 patients with mild-to-moderate CTS, researchers found evidence that neurodynamic techniques are effective for improving CTS-related symptoms and wrist/hand function. Their findings also showed that such techniques improve function of the median nerve itself, by way of nerve conduction diagnostic testing. This echoes findings from a systematic review published in 2022 that included six randomized controlled trials and 401 CTS patients that found that neurodynamic techniques led to immediate improvements in pain, function, and nerve conduction.

Emphasizing the importance of looking at the whole patient versus just focusing on the wrist, a 2022 randomized controlled trial divided 62 CTS patients into two groups, one with treatment on just the wrist alone and the other received treatment at the wrist and elsewhere on the course of the median nerve. While both groups reported improvements in pain, grip strength, and functional status, the patients in the more comprehensive treatment group experienced greater benefits.

In addition to neurodynamic techniques, conservative chiropractic care for managing CTS may include other manual therapies, nocturnal splinting, exercise training, nutritional consulting, and physiotherapy modalities like electrical stimulation, ultrasound, laser, and pulsed magnetic field. If necessary, the patient’s chiropractor will co-manage the case with an allied healthcare professional for treatments beyond their scope of care.

10/28/2025

Migraine is a neurovascular brain disorder that affects about 15% of the population and is the number one cause of disability in adults under the age of 50. Neck pain has been estimated to be twelve times more likely to occur in migraine patients than in healthy subjects. Similarly, migraineurs with neck pain report more frequent and disabling headaches, as well as increased sensitization in the trigeminocervical complex where sensory input from the face and neck converge. However, there is debate on the nature of the relationship between neck pain and migraines.

On one hand, some experts feel migraines cause increased brain or central sensitization, which causes neck pain. On the other hand, there are experts who suspect sensitization mechanisms resulting from neck pain contribute to migraine. To address this “chicken or the egg” debate, an August 2023 study compared migraine patients with and without neck pain to observe the differences in clinical characteristics.

In the study, 44 migraine patients without neck pain, 64 migraine patients with neck pain, and 54 pain-free control subjects underwent physical examinations and completed multiple questionnaires to identify characteristics about their headache symptoms, neck pain/disability, and the effect of these conditions on their mental health and quality of life. As expected, both treatment groups had more positive findings than the control group. However, those in the migraine-with-neck-pain group had worse headache characteristics, more pronounced cervical musculoskeletal impairments, enhanced signs and symptoms related to sensitization, and worse psychological burden than the migraineurs without neck pain. In another 2023 study, researchers found that migraine patients with impaired balance—which may be due to altered proprioception caused by dysfunction in the cervical spine—had weaker neck muscles, more frequent migraine episodes, and more intense neck pain.

Findings such as these have led researchers to opine that migraine patients should be sub-grouped into those with or without co-occurring neck pain for the purpose of both research and formulating treatment guidelines. For those with neck pain and migraines, treatment addressing musculoskeletal impairments in the neck may be the most beneficial approach. Doctors of chiropractic are well-equipped to evaluate patients with migraines and neck pain and to provide care to address musculoskeletal conditions that may be contributing to or possibly causing the patient’s condition.

10/27/2025

The median nerve originates from nerve roots (specifically C5-T1) that exit the cervical spine and then merge together in the brachial plexus in the neck and shoulder region traveling down the arm, through the wrist, and into the hand. Compression or restriction of the mobility of the median nerve anywhere along its course can result in the symptoms commonly associated with carpal tunnel syndrome (CTS), including numbness, tingling, pain, and weakness in the thumb and index, middle, and the thumb-side of the ring finger. So how do doctors of chiropractic differentiate between CTS where the median nerve is compressed at the wrist and another peripheral neuropathy like pronator tunnel syndrome (PTS) in which compression occurs as the nerve passes through the forearm, just below the elbow?

When a patient seeks care for suspected CTS, they’ll first complete a history. This information will direct the course of their chiropractor’s examination to best identify what is generating the patient’s symptoms. Classically, PTS will also include symptoms that start near the elbow (aching, numbness) due to activities that require repetitive elbow flexion and forearm/hand rotations (called supination and pronation) with firm gripping. However, there are presentations of CTS in which pain can be referred into the forearm and even above the elbow. One way your doctor of chiropractic can differentiate PTS from CTS is to apply compression over the pronator teres muscle for 30 seconds. If PTS is present, then this activity can reproduce paresthesia (numb/tingling) into the forearm, hand, and fingers, whereas this may not have the same result in cases of CTS.

Of note, CTS and PTS can co-occur together or along with compression of the median nerve at the neck or shoulder, which may only be identified following a thorough examination. To highlight the importance of properly identifying PTS and CTS, two separate studies have found that PTS is misdiagnosed between 32% and 49% of the time. Failure to address PTS can result in inappropriate treatment at the wrist, including unsuccessful surgical decompression.

Conservative chiropractic treatment for CTS and PTS will typically involve a multimodal approach using manual therapies, physiotherapy modalities, nutrition recommendations, nocturnal splinting, activity modification, and at-home exercises to reduce inflammation and restore the mobility of the median nerve as it travels from the neck to the hand. Because issues like hypothyroidism, diabetes, obesity, autoimmune diseases, and other systemic/chronic conditions can contribute to CTS and PTS, co-management with an allied healthcare provider may be required to achieve a satisfactory result. As with other musculoskeletal conditions, both CTS and PTS are easier to manage with conservative, non-surgical treatment approaches—including chiropractic care—earlier in the course of the disorder, so don’t delay treatment until either (or both) conditions become severe. In the most advanced cases, surgical intervention may be the only option available to a patient.

10/27/2025

Low back pain (LBP) is a global health problem that will affect most adults at least once in their lifetime. For many, LBP may become a chronic issue that can significantly affect their ability to work and carry out normal activities of daily living. While we often discuss how chiropractic care serves as an excellent front-line treatment for LBP, it’s seldom discussed how seeing a doctor of chiropractic first can save a patient and their insurer from future healthcare expenditures involving medications, advanced imaging, surgery, and adverse effects that can result from these services.

Advanced imaging such as MRI are often used to confirm a diagnosis, and in many cases, the findings can save lives. However, when it comes to low back pain, unnecessary imaging can lead to immediate costs and treatment that may not resolve the patient’s LBP and may place them at risk for harm. In 2018, researchers conducted a chart review of 313 patients referred for MRI and found that 130 imaging requests were unnecessary, which corresponded to a previous 2014 study that found 46.7% of MRI for LBP are inappropriate. A 2012 study that looked at data from the Washington State Worker’s Compensation system found that about 1 in 5 workers with LBP underwent an MRI within six weeks of their injury. Those who first went to a chiropractor were half as likely to be referred to MRI while those who first visited a surgeon were 78% more likely to receive advanced imaging.

While typically not advised in treatment guidelines, patients with chronic low back pain are often prescribed opioids. In a 2022 study that looked at long-term outcomes for Medicare beneficiaries with new-onset low back pain, researchers observed that those who visited a chiropractor first were 2.2 times less likely to be prescribed opioids within the following four years. Prolonged opioid use is associated with an elevated risk for misuse, as well as abuse of more serious and illicit drugs.

Treatment guidelines generally frown upon surgical intervention as a first step outside of emergency circumstances; however, a 2022 study found that 41.7% of patients who underwent back surgery in a sample of 2.5 million low back pain patients had minimal non-pharmaceutical, non-operative treatment in the six months before their operation. In fact, another study that used the Washington State Workers Compensation dataset found that low back pain patients were 29 times less likely to end up in the operating room if they first consult with a chiropractor. Not only is surgery costly and comes with a risk for complications and prolonged recovery, but in a July 2022 study, the authors noted that the failure rate of spinal surgeries may be as high as 40% with the majority of failures linked to misdiagnosis!

A June 2023 study that looked at data from a large insurer regarding more than 30,000 patients with new-onset LBP found that seeing a chiropractor first led to an immediate and long-term reduction in healthcare costs and the data “…provides a compelling case for the influence of the first provider on an acute episode of LBP.” Not only is chiropractic care a great conservative treatment option for individuals with low back pain but encouraging chiropractic as a first choice for care can not only provide immediate and long-term savings in healthcare expenditures, but it can also free up those resources for patients with healthcare conditions that may better benefit from their availability.

10/26/2025

Type 2 diabetes is a gradual, progressive chronic disease that is recognized as being one of the most common metabolic disorders as it currently affects 537 million adults worldwide and is predicted to rise to 783 million by 2045. Because increased blood sugar thickens the circulating blood, people with type 2 diabetes are at greater risk of microvascular as well as larger blood vessel complications and disease, as well as reduced life expectancy.

Along with eating a healthy diet, getting regular exercise is important for reducing one’s risk for developing type 2 diabetes, particularly taking regular walks. In fact, past research suggests that taking daily walks can lower one’s risk for type 2 diabetes by 15%, but it turns out that walking speed is also important. A 2023 systematic review and meta-analysis of ten cohort studies revealed that the risk of developing type 2 diabetes did not significantly change until walking speed exceeded 4 km/hour (~2.5 mph) or 87 steps/minute for men and 100 steps/minute for women. The review also found the risk continues to decline with faster walking speeds, at least until 8 km/hour (or about 5 mph).

But what if someone can’t maintain a brisk pace for prolonged periods of time? In another systematic review, also published in 2023, researchers found that adopting a high-intensity interval training (HIIT) approach is a viable option for improving glycemic control, aerobic resistance, and body composition. In HIIT, exercisers workout at high intensity for short burst of time separated by longer intervals at a lower intensity. For a walker, this may be achieved by walking at a brisk pace for a limited period of time, such as one minute, and then slowing down to a moderate pace for two minutes and repeating the process for several cycles. Unfortunately, there’s no one agreed-upon format for an HIIT walking intervention so further research is needed in this area.

Best of all, walking is simple and inexpensive and offers several social, mental, and physical health benefits. Several studies have shown that regular walking is associated with a lower risk of both cardiovascular events and early death. Researchers note that a greater number of steps per day may be associated with a lower risk of premature death.

10/26/2025

The rapid flexion/extension, compression, and rotation of the cervical spine that commonly occurs in motor vehicle collisions can result in trauma that includes facet derangement, disk injury, and ligament sprain or rupture, frequently occurring in the upper cervical region. When the upper cervical spine exhibits excessive motion in combination with pain and other neurological symptoms, the patient may receive a diagnosis of upper cervical instability (UCIS).

Upper cervical instability can be seen on x-ray as anterior translation of the first cervical vertebrae (C1) over the second cervical vertebra (C2) exceeding 3.5 mm on a flexion (forward bending) stress x-ray. It can also be observed as lateral translation of C1 on C2 of more than 2.0 mm of lateral overhang of the lateral mass of C1 over C2 as noted on frontal view x-ray with an open mouth during side bending end-range loading. This is also measured by asymmetry of the periodontal space or the gap between the dens (a protrusion at the front of the vertebrae) of C2 and lateral mass (thicker boney areas on the sides of the vertebrae) of C1. Patients with UCIS often have a loss of normal cervical curve (lordosis), which can place increased force on the intervertebral disks and facet joints.

Although UCIS patients have the option for surgical fusion of C1-2, like all spinal fusion surgeries, there are associated risks and complications, not to mention the invasive approach, the expense, and future ramifications (including reduced range of motion and its negative impact on the adjacent cervical vertebral levels). This can result in the need for further treatment down the line, including additional surgical procedures, which can have a negative effect on quality of life.

Fortunately, there are non-surgical treatment options available to the UCIS patient, including chiropractic care. In a September 2023 case-series study, nine patients with radiographically confirmed UCIS and loss of cervical lordosis underwent a chiropractic treatment regimen directed primarily at restoring normal cervical lordotic curve. Treatment included three specific types of cervical traction and chiropractic spinal manipulation rendered at an average frequency of twice a week. In all nine cases, the patients reported significant symptomatic and functional improvements, with cervical lordosis and UCIS improvements observed on x-rays.

Doctors of chiropractic are well trained in the diagnosis and management of upper cervical instability, as well as pathologies that frequently occur with whiplash. The good news is that many patients experience positive outcomes as a result of a multimodal treatment approach. However, in cases that are more complex or when more invasive treatments are necessary, the patient will be referred to the appropriate healthcare provider.

10/25/2025

Because of the close anatomical relationship between the wrist and elbow, it’s not uncommon for patients to present for care with symptoms that affect both regions. In some cases, they may have two distinct musculoskeletal conditions that need simultaneous treatment. But in other cases, the pain in one area may be referred by a musculoskeletal complaint in the other. Let’s take a look at some of the most common conditions doctors of chiropractic see when a patient comes in for wrist and/or elbow pain.

Perhaps the most well-known conditions affecting the elbow include lateral and medial epicondylitis (golfer’s and bowler’s elbow, respectively). Pain in the lateral aspect of the elbow most often involves a musculotendinous injury, which includes tennis elbow or lateral epicondylitis, most frequently caused from overuse, often resulting from occupation or sport. Although this is often described as a “self-limiting” condition—meaning it’s likely to resolve on its own—there is a high recurrence rate, and it is often associated with an extended sick leave and disability that requires professional management.

On the medial side of the elbow (the side closest to the trunk if you stood with your arms down and palms facing forward), other conditions include ulnar neuritis (cubital tunnel syndrome), ulnar collateral ligament injury (a common baseball pitcher injury), flexor pronator strain (often from overuse of hand tools), and snapping medial triceps.

Like the elbow, the wrist can be divided into various anatomical regions such as the medial and lateral side as well as the anterior (palm side) and posterior wrist. The most common condition associated with the wrist is carpal tunnel syndrome, which is often described as pins and needles or tingling in the fingers excluding the pinky and ring finger caused by restriction of the median nerve at the wrist. Additionally, there is ulnar tunnel syndrome, which manifests as symptoms in the pinky and pinky side of the ring finger. The radial nerve also passes through the wrist, and when this nerve becomes entrapped, the patient may experience symptoms on the back of the hand.

Outside of emergency circumstances, these various conditions can often be managed through a multimodal approach by a doctor of chiropractic that includes manual therapies, specific exercises, orthoses/braces, activity modifications, and physiotherapy modalities. Unfortunately, as these conditions have a tendency to gradually worsen over time, patients often wait until their symptoms become severe enough that carrying out normal work and life activities becomes difficult. While conservative care may still yield satisfactory results for the patient, a longer course of treatment may be necessary. If the condition does not fully respond to this approach, then referral to an allied healthcare provider may be needed for more invasive treatments such as injections or even surgery.

Powell Chiropractic Center

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Monday	7am - 11:45am
	2pm - 5:45pm
Tuesday	8am - 11:45am
	2pm - 4:45pm
Wednesday	7am - 11:45am
	2pm - 5:45pm
Friday	7am - 11:45am
	2pm - 5:45pm