Conditions We’ve Helped
Often, patients or potential patients are unaware of what their condition truly means. We have designed this page to help you educate yourself about conditions you or a loved one are experiencing. You may also visit the testimonial section of this website to see what our patients are saying about us.
Injuries from Motor Vehicle Collisions
According to the National Highway Traffic Safety Administration each year there are more than 6 million car accidents in the United States which claim over 40,000 lives. Vehicular crashes are the leading cause of death for people between the ages of 2 and 34. In some of these automobile crashes the injuries are only minor and the patient returns to normal after a short period of time. However, many individuals continue to suffer neck pain, lower back pain, restriction of daily activities, numbness and tingling in the arms and legs and cognitive issues months or even years after the accident. They may have been treated by their medical physicians, orthopedic and neurosurgical specialist, pain management specialist and even may have seen a chiropractor but continue to suffer. Our doctors at The Paulk Clinic are trained and equipped to evaluate these injuries successfully and treat these potentially life-changing injuries. By employing the latest in diagnostic testing and treatment protocols we can help in some cases were others failed. Look at the auto accident tab on this website to learn more about how we handled these potentially devastating injuries.
Lower Back Pain
About 85% of the population experienced disabling low back at least once during their lives! That almost all of us. At any time, 6.8% of the US population is suffering from an episode of back pain lasting more than 2 weeks. That’s a lot of bad backs. Estimated cost of back pain in the US is over 50 billion dollars a year. There is a standard medical treatment for back pain relief depending upon the severity of the condition. Muscle relaxers, pain killers, rest, hot packs and physical therapy are sometimes used for back pain therapy. However, research has determined that this approach is not very helpful.
If the problem doesn’t improve or worsens, then surgery may be performed. The medical approach is sometimes necessary–even back surgery has its place. In 40 years of practice, I have referred patients to orthopedic surgeons or neurosurgeons for possible back surgery when all other options have failed. Thankfully, there have not been many. But, according to some studies, most spinal surgery for acute lower back problems should be rarely performed. Many people who have had back surgery report a recurrence of their symptoms within a year or two and may return to the operating table. In some cases, the surgery makes no difference whatsoever, and other cases it does bring long-term relief.
We take a different approach to the treatment of acute and chronic lower back pain. Recent research indicates that chiropractic should be the first choice for treatment of lower back pain. Following an extensive evaluation including chiropractic/neurological/orthopedic evaluations, a treatment plan will be formulated to meet the patient’s specific needs. If the evaluation deems that further evaluation and/or treatment should be performed by a medical specialist, we have a close working relationship with multiple, top medical specialist in the Atlanta area.
Migraines and Chronic Headache
Each year over 10 million people go to the doctor or emergency room suffering from headaches. Headache is one of the top 10 reasons people see the doctor. Headache is the most common bodily pain reported, according to recent surveys. The pain in a headache originates in a network of nerves and spread over the scalp, in the face, mouth and throat and neck. Headaches can also come from pain in his muscles are blood vessels in the brain. There are many types of headaches that include, cluster headaches, pregnancy headaches, rebound headaches, sinus headaches, tension headaches, spinal headaches, caffeine headaches, menstrual headaches, cough headaches, exertion headaches, hypertension headaches, tumor headaches, meningitis and encephalitis headaches, posttraumatic headaches and migraine headaches
The migraine headache is perhaps the best known special type of headache. It is really called The Migraine Syndrome. By syndrome, we mean a lot of things accompany the headache–all of them bad. Symptoms can include dizziness, visual problems, spots before the eyes, redness, swelling, tearing in the eyes, muscle contraction, irritability, nausea, vomiting, constipation or diarrhea. These symptoms often arise before the headache appears. Typical medical treatment for these conditions include medications such as Triptans, DHE45, beta blockers, calcium channel blockers, Ergotamine and antidepressants. These medications sometimes help however did not necessarily get to the root cause of the problem. Recent research published by the Journal of Manipulative and Physiological Therapeutics (JMPT) states that chiropractic interventions that improve spinal function can relieve headache symptoms. Another study by JMPT in 2011 stated that chiropractic interventions can improve migraines as well as headaches that originate from the neck. (Cervicogenic headache).
Our doctors have had great success in locating the underlying cause of headaches and formulating the proper treatment. Headaches sufferers should have a chiropractic evaluation to determine if this treatment is appropriate. This decision could change your life.
Sciatica–Pinched Nerve (Leg Pain, Weakness, Numbness, Tingling)
The term sciatica describes the symptoms of leg pain with possibly tingling, numbness and/or weakness that starts in the lower back and travels through the buttock and travels down the large sciatic nerve in the back of the leg. Patients have told me the pain feels like a hot poker or electric wire running down the back of the leg to the foot.
Sciatic pain is often characterized by one or a combination of symptoms including constant pain only on one side of the buttock or leg, sometimes extending all the way to the toes (sometimes both legs), pain that is worse when sitting, leg pain that is often described as burning, tingling or searing (versus a dull ache) and may have sharp pain that makes it difficult to stand up or walk. The sciatic pain can vary from frequent and irritating to being constant and incapacitating. It depends on what is causing the sciatic nerve to be inflamed.
Typical medical treatment consisted of anti-inflammatory medication, heat/cold, narcotic pain medications, bed rest and if the condition does not improve, epidural spinal steroid injections.
Causes of sciatica can vary from lumbar disc herniations (damage to the disc and separate the vertebra in the lower back), lumbar degenerative disc disease (wear and tear on the lumbar disc), lumbar spinal stenosis (a narrowing of the center of the vertebra in the low back), or possibly a piriformis syndrome. The piriformis syndrome is a condition where muscles within the hip tighten, impinging the large sciatic nerve in the hip and mimicking a lumbar disc problem.
Very specific diagnostic procedures need to be performed to determine the underlying cause of sciatic problem.
Unfortunately, standard medical treatment usually does not address the underlying cause of pain and only works to temporarily control the symptoms.
We employ a treatment system referred to as Nonsurgical Spinal Decompression. This is a state-of-the-art computer controlled traction system that has proven effective in decompressing damaged disc and relieving the pressure on the sciatic nerve. When spinal decompression therapy is successful, we can correct the underlying cause of the pain, not just temporarily cover the symptoms. To learn more about this effective treatment, go to the Our Services tab on the home page to learn more.
Shoulder pain can be a very complex problem. It can be acute (recent) or chronic (long-standing). It can be from acute injury to the internal ligaments or tendons in shoulder. It can be due to acute injury to the muscles that support the shoulder.
Chronic shoulder pain can develop from long-standing postural problems that result in wear and tear on the joint structures in the shoulder. Mechanical misalignments of the shoulder joint, neck or upper back can also result in continued wear and tear and eventually a painful condition.
Medical treatment of long-standing shoulder pain normally consisted of anti-inflammatory medications, pain medications, steroid injections that can be effective for short-term pain relief however does not address the possible underlying structural issues that caused the problem.
Proper assessment of the mechanical and postural issues should be performed before more invasive procedures are done.
Arm and Hand Problems
Arm and hand problems are very common. Many of these issues can be linked to nerves. The nerves that controls the arm and hand start in the neck, pass through the openings between the neck bones and pass through the upper shoulder, down through the arm and hand and allow the shoulder arm and hand to move and to feel. Any nerve damage or pressure in these areas or pinched nerves in the neck can cause pain, loss of mobility, loss of sensation, tingling and numbness in the arm and hands. Pressure on the nerves in the neck can also lead to or make worse symptoms of carpal tunnel syndrome.
The pressure on the nerves can be caused by many things: Damage to the disc in the neck (disc herniations, bulging), wear and tear to the disc in the neck (osteoarthritis, spinal stenosis), abnormal alignment of one or more of the bones of the neck (cervical subluxation), abnormal curves in the neck (cervical kyphosis and forward head posture), misalignment of the shoulder structures, thoracic outlet syndrome( compression of the nerves, arteries, or veins in the passageway from the lower neck to the armpit) and entrapment syndromes (pressure on the nerves around joints of the shoulder, elbow or wrist.)
Symptoms can include numbness in the shoulder, arm and/or hand, shoulder pain, tingling, burning or abnormal sensation and weakness in the shoulder, arm, wrist and/or hand and fingers.
The standard medical approach is to prescribe prescriptive medications such as painkillers or steroids to deal with the pain but it is critical to be aware that this only is masking the problem and may put you at risk for other health issues as result of the medication.
The chiropractic approach is to determine the area of interference or compression to the nerve and to apply appropriate treatment to relieve the pressure on the nerve and therefore eradicate the symptoms.
Everyone gets neck pain from time to time. Right? It may occur after waking first thing in the morning if she slept wrong. Or it might be at the end of a long workday he finished a stressful project.
You turn your head from side to side, and your neck really hurts.
There’s a big difference between the stiff neck and one hurts so bad that it makes her head spin, but how do you know when it’s “bad enough”, that it is time to see a doctor about the pain.
How to Manage Her Neck Pain at Home
Use Ice: Cold can reduce swelling to an area that is inflamed. Hold a cold pack or a frozen bag of vegetables wrapped in a towel on your neck. A good rule of thumb is 20 minutes off, 40 minutes on and then repeat.
Check Your Pillow
Make sure you use a firm or extra firm pillow and sleep on your back or side. If your pillow is too flat, it forces her neck to bend in an unnatural position. After a long (or even short) night’s sleep, the muscles in your neck may be so stretched you are guaranteed to have a rough morning.
Avoid Driving If You’re Unable to Turn Her Neck past Her Shoulder
Driving in traffic, especially in heavy traffic or when your backing up, requires you to look over your shoulder to see behind you. If your neck is stiff, restricting your ability to look over your shoulder, it could impair your ability to drive safely. Driving may also require you to turn her neck quickly from side to side. If you have neck pain, this may overstretch her neck can cause severe pain. It is best to avoid driving until your next normal movement is restored.
When Should You See a Doctor for Neck Pain?
While there are several things you can do at home to help relieve your neck pain, its importance to know when it’s time to see a doctor for you neck pain.
- Your neck pain and stiffness does not improve after a few days.
- You cannot look to the right or left without severe neck pain.
- You feel like you must use over-the-counter pain medications just to make it through the day and are using it regularly to treat your neck pain.
- You are worried that your neck pain may have a serious cause.
- Your neck pain started in the neck but has moved to numbness or tingling in her hands or wrists.
- Your neck pain started within a few days of a car accident or has been persisting for quite some time after the car accident.
- Your neck pain is worse when he first wakes up in the morning but then begins to feel better as the day progresses.
Typically, when you see your medical doctor for these chronic neck pain issues they will prescribed prescriptive anti-inflammatories, prescriptive pain medications and if the pain does not improve they may order steroid injections. In many cases, this does afford some temporary relief however it does not address the underlying cause of the neck pain.
Neck Pain Causes
- Sports injuries: A sports player could have a collision or fall. A common sports collision injury is a stinger, which happens when nerves in the neck/shoulder are impacted and pain, numbness and weakness can radiate down the shoulder, arm and hand.
- Poor posture: Whether it’s at work or at home and/or commuting, poor posture can lead to neck problems. If a person’s head is often tilted forward for long periods of time, then the next muscles, tendons and ligaments need to work harder. Activities such as sitting and watching television, sitting long hours in front of a computer, long periods of time looking at your cell phone, reading a book, gardening and unusual positions at work can correct postural problems that restrict range of motion in the neck and upper back creating abnormal movement between the vertebra resulting in what is called a subluxation.
- Chronic whiplash injuries: If an individual has had a whiplash type injury in an automobile collision research shows that over 50% of these victims remained with chronic neck pain. The force of the impact can result in damage to the ligaments, disc creating chronic pressure on the nerves and if not properly addressed will worsen with time.
- Cervical degenerative disc disease: We all experience wear and tear on the cervical spine over time. It is natural for these tests to gradually lose hydration and the ability to cushion the spines vertebra resulting in abnormal pressure on the desk and nerves. If the disc degenerates enough, it can lead to painful irritation of the cervical nerves in various ways, such as a herniated disc, pinched nerve or changes in the small joints a cause arthritis.
- Cervical herniated disc: A cervical disc is herniated minutes jelly like inter-layer, the nucleus pulposus, leaks out through a tear in the disc protective outer layer. This could result from injury, aging or is very common following a whiplash type of injury in an automobile collision.
- Cervical spinal stenosis with myelopathy: Spinal stenosis occurs when the spines degeneration leads to a narrowing of the spinal canal, such as from a herniated disc that pushes into the spinal canal or bone spurs at grow into the canal. When the spinal canal narrows enough to compress the spinal cord–a large bundle of nerves that runs inside the spinal canal–myelopathy can result. Myelopathy is when compression of the spinal cord starts causing symptoms such as weakness or problems with coordination in the arms, legs, hands or feet.
- Cervical vertebral subluxation: As the cervical spine goes through life, it is subjected to multiple traumas big and small. The cervical spine supports the head which can weigh anywhere from 10-12 pounds and the cervical spine allows the head to turn in all directions freely. Because of the spines ability to move in many directions it is the weakest part of the spine itself. Over time, due to the stresses and strains of life, these vertebra can lose their ability to move properly and become fixated in an abnormal position. Over time, due to this abnormal position abnormal pressure is exerted onto the joints, ligaments, muscles and even the nerves resulting in restriction in motion and pain.
- Cervical foraminal stenosis: This condition occurs one foramina–the holes in the vertebral through which nerve roots that branch off from the spinal cord can exit the spinal canal–become narrowed. This narrowing of the whole can cause irritation for the nerve root that runs through it. Foraminal stenosis is associated with radiating pain in a pattern that is specific to the nerve that is pinched by the narrowing. In some situations, there is a combination of cervical stenosis causing myelopathy, as well as specific nerve root pattern associated with a cervical foraminal being narrowed.
- Myofascial pain: This chronic condition has trigger points, which results from aching muscles and surrounding connective tissues, typically in the upper back or neck. Trigger points can be chronically painful or only painful to touch. The pain might stay in 1one spot or it can be referred pain that spreads into/from another area of the body.
- Spondylolisthesis: This condition occurs when one vertebra slips over the one below it. It can be due to a tiny fracture in the vertebra or possibly from advanced disc degeneration or ligament laxity. This is a serious condition and can only be evaluated with specific diagnostic procedures.
- Ankylosing spondylitis: This progressive arthritis of the spine and pelvis can cause widespread inflammation, pain and stiffness throughout the spine, including the neck.
- Spinal cord tumor: A tumor, such as from cancer, could develop in the cervical spine and press against the nerve. These types of tumors more commonly occur as cancer that has started in another part of the body metastasizes.
- Infection: If part of the cervical spine becomes infected, then inflammation could cause neck pain. One example would be meningitis.
Chiropractors are uniquely qualified to evaluate chronic neck pain and to formulate treatment options. This condition should not be taken lightly and proper evaluation should be performed.
Middle Back Pain
There are many sources of problems in the upper back (thoracic spine) especially when you consider the numerous joints and muscles that make up the middle back and rib cage. If one joint or one muscle is injured or inflamed, this can create a cascade of pain and dysfunction that can be difficult to treat. The mid and upper back is known as the thoracic spine. It is the largest portion of the spine consisting of 12 of the 24-spinal vertebra with attachments along the ribs. All thoracic vertebra connect to the ribs and together they protect the thorax. That’s why it is called the thoracic spine.
It is quite common for problems in the neck to refer pain into the middle back region. Pain can be referred from a pinched nerve in the lower neck and into the shoulder blade area, particularly between the shoulder blade and the spine creating a hard, hot pain in the shoulder blade region without creating pain in the neck. In these cases, treatment of the pain in middle back only, will not resolve the problem. I have been told by patients that the pain feels like someone has a knife stuck in the middle back.
Proper evaluation to determine the root cause of the middle back pain is imperative to proper and effective treatment.
Degenerative disorders such as osteoarthritis, spinal stenosis, and degenerative disc disease directly affect the spine.
- Osteoarthritis, is a common joint disorder, that causes progressive deterioration of cartilage. The body reacts by forming bone spurs that affect joint motion and is more susceptible to injury and pain.
- Spinal stenosis causes the small nerve passageways in the vertebra to narrow, compressing entrapping nerve roots. Stenosis may cause neck, shoulder, and arm pain, as well as numbness, when these nerves are unable to function normally.
- Degenerative disc disease can cause reduction in the elasticity and height of intervertebral disc. Overtime, disc bulge or herniate, causing tingling, numbness and pain that runs into the arm or legs.
The majority of people over 40 have different degrees of osteoarthritis or spinal stenosis. Allow this condition to go its normal course, it only gets worse unless proper intervention is done. Don’t let anyone telling there is nothing that can be done about it.
Poor posture, obesity, and weak abdominal muscles often disrupt spinal balance, causing the neck to bend forward to compensate. Stress and emotional tension cause muscles to tighten in contract, resulting in pain and stiffness. Abnormal postural positions contribute chronic neck pain with symptoms extending into the upper back and the arms as well as the lower back and the legs. Proper assessment of abnormal postural positions need to be made to formulate a treatment regimen to improve postural abnormalities and slow down or stop these degenerative conditions.
Our doctors have been trained in Chiropractic Bio-Physics, a specialized treatment protocol that is effective in improving postural problems. This involves specialized in office treatment as well as extensive home exercise protocols.
Don’t accept that spinal deterioration is inevitable.
Back Pain Caused by Scoliosis
Everyone’s spine has subtle natural curves. But some people have different curves, side-to-side spinal curves that also twist the spine. This condition is called “Scoliosis”. On x-ray, with a front or rearview of the body, the spine of a person with scoliosis looks more like to” S “or a “C” than a straight line. These curves can make a person shoulders or waist appear uneven.
These curves cannot be corrected simply by learning to stand up straight. You can’t cause scoliosis; it does not come from carrying heavy backpacks are participating vigorously in sports, or poor posture. These activities, however can exacerbate the pain from scoliosis.
Adult scoliosis is a continuation of scoliosis that began as a teenager. That may progress during the adult life. These abnormal curvatures occur in the middle back and lower back with forward concept with abnormalities such as uneven shoulder height, a rib hot, or a prominence of the lower back on the side of the curvature. Curves can worsen in the older patient due to disc degeneration and/or significant spinal imbalance. Additionally, arthritis, effects joints of the spine and leads to the formation of bone spurs.
Many patients with scoliosis suffer from spinal pain due to the abnormal stresses on the joints, bones of the spine and the extremities due to the abnormal weightbearing. The abnormal curvatures creates abnormal motion within the joints which creates abnormal pressure that creates pain.
Symptoms can consist of:
- Lower back pain and stiffness are two of the most common symptoms.
- Numbness, cramping and shooting pain in the legs due to pinched nerves in the low back
- Fatigue results from strain on the muscles of the lower back, legs, mid back and neck.
- Shoulder pain results from imbalance of the shoulder and stresses and strains on the ligaments tendons and muscles.
- Mid back pain and stiffness due to imbalance of the muscles, ligaments and tendons.
- Foot and knee pain due to abnormal weightbearing of the knees and feet.
- Headaches due to abnormal stresses in the neck.
- Loss of range of motion (generalized spinal stiffness) of the spine resulting from abnormal position of the spine.
- Development of osteoarthritis of the spine
Medical treatment for this pain usually consist of prescriptive anti-inflammatory medications, over-the-counter pain medications, steroid injections, physical therapy and even narcotic medications. If these treatments fail in the pain continues to worsen the final option is surgery.
A study published in the Journal of Chiropractic Medicine in 2011 reported that chiropractic treatment afforded significant relief for patient suffering from back pain caused by scoliosis. Chiropractic adjustments help to restore normal motion the bones in the neck and back which can afford significant relief. Our doctors have treated many patients with scoliosis with good results. Go to the How It Works tab on the home page to learn more.
Ligament Injury (ligamentous laxity)
The bones of the spine are held together with an intricate system of strong ligaments that attach one vertebra to the next vertebra. These ligaments are cartilage type tissue that is very strong and has very little stretch. Ligaments limit the motion of each individual bone in the spine to allow normal motion and normal alignment.
There are two prominent ligaments in the spine. The anterior longitudinal ligament which runs from the top of the spine to the bottom of the spine and is attached to the front part of the vertebra. The posterior longitudinal ligament which runs from the top of the spine to the bottom of the spine and attaches to the back of the vertebra. There are also individual smaller ligaments that attach one vertebra to the next vertebra above and below. There are many other ligaments in the spine that assist in holding the vertebra together such as ligamentum nuchae, ligamentum flavum, intertransverse, supraspinous and several others. There are other specialized ligaments that hold the bones in the top of the neck to the skull. These ligaments are very susceptible to injury due to their location. These ligaments literally hold her head to the neck and are very susceptible to injury particularly if the impact was from the side or the individual’s head was turned at the point of impact. An injury to these ligaments can be devastating.
During forceful injury, particularly of the type seen in automobile collisions, these ligaments can be injured. The injury can be minor or more serious. If the forces applied to these ligaments are great enough these ligaments, can tear and become permanently injured. If the ligaments are torn bad enough, they never heal properly and can create instability between the individual vertebra. The instability created between the individual vertebra can result in chronic pain, chronic loss of motion in the affected area of the spine and will result in increased probability of future arthritic changes in the spine.
Unfortunately, these injuries are not normally assessed properly by most physicians. Physical examination, Standard x-rays or even MRIs and CAT scans do not normally show this injury. This explains why some individuals continue to suffer pain and disability following injury sustained in a motor vehicle collision. The patient receives extensive treatment with poor results.
As a matter of fact, these injuries are recognized by the medical profession as being significant enough to be rated as a permanent injury by the AMA Guides to Evaluation of Permanent Impairment, Fifth Edition. The AMA guides are the Gold standard for determining disability and impairment by the medical and legal profession.
Special diagnostic procedures need to be performed to determine if this injury is present following an automobile collision injury, slip and fall are any significant traumatic incident involving injury to the spine.
This special diagnostic procedure is called Digital Radiographic Mensuration Analysis (DRMA). This is a specialized computerized system that measures the amount of movement between the vertebra in the neck and lower back using forward bending and backward bending radiographs (x-rays). The AMA Guides to Evaluation of Permanent Impairment, Fifth and Sixth Edition stipulates specific degrees of movement between the bones in the spine that are considered normal. If the measurements exceed the movement that is considered normal then this is indicative of abnormal motion between one vertebra compared to the next and indicates significant ligament damage in the spine. This condition is called Alteration of Motion Segment Integrity (AOMSI).
Measurement of abnormal motion between the bones in the spine has been accepted as a proper diagnostic procedure since the 1990s. In the past, however these measurements were done using a pencil, straight edge and a protractor to measure the forward bending and backward bending x-rays. This method proved to be cumbersome and inaccurate. With the advent of computerized mensuration analysis these measurements have become more consistent and highly accurate.
Our office considers this technology (DRMA) a critical tool to rule in or rule out in the patient suspected of having a spinal ligament injury that is causing impairment with either a new injury or the continue to experience chronic pain following a spinal injury particularly in motor vehicle collisions. This diagnostic tool also gives objective information to the insurance companies and the attorneys so proper compensation can be determined.
All significant spinal injury patients have this procedure performed in our office to determine the level of injury, to rule in or rule out significant ligament injury (AOMSI) so we can formulate the most effective treatment protocols.
Go to the Auto Accident tab on the home page to learn more.
Vertigo, or dizziness, affects millions of people around the world each year. In a majority of the cases, vertigo is nothing than a temporary inconvenience. In some cases, vertigo is a debilitating condition. Day-to-day activities is kept to a minimum due to the severe dizziness.
In many cases, the area of dysfunction in the nervous system is the cerebellum. The cerebellum is in the posterior aspect (back part) of the brain and controls our coordinated movements.
There are specific neurological tests that the we utilize to determine cerebellar function. Standing with your feet together and eyes closed, the test is positive if the patient sways back and forth. Other tests include, touching the index finger to the nose with the eyes closed, walking heel to toe, moving the fingers rapidly as if playing the piano, or touching all of your fingers to your thumb as fast as possible. These tests and others are used to determine the function of the cerebellum.
Treatment of the cerebellar dysfunction may include:
- Unilateral (one-sided) Adjustments: Extremities (arms and legs), lumbar (low back) and cervical (neck) spine will be manipulated on one side only to fire muscle spindle cells (muscle receptors) and joint mechanoreceptors (joint receptors) into the same cerebellum and opposite cerebra cortex (brain). The thoracic (mid-back) spine will be globally manipulated to fire the dorsal columns (back part of the spinal cord) and reduce rib fixations.
- Caloric: A warm water caloric of 180 milliliters may be administered in the ear to stimulate the ipsilateral (same side) cerebellum.
- Eye Exercises: Eye exercises may be used to increase the frequency of firing to the cerebellum and frontal lobe of the brain.
- Heat Therapy: Heat therapy is used to promote an increased metabolic and healing rate to the involved tissue. Increased heat helps increase activation to the brain. Heat has immediate soothing and palliative effects as decreased joint stiffness, decreased muscle spasms and releases histamine and bradykinin causing vasodilation of the tissues.