Archive for February, 2011

Low Back Pain and Balance Exercises

Posted: February 17, 2011 in Back Pain

You may recall last month, we talked about the relationship between low back pain and balance, particularly our unfortunate increased tendency to fall as we “mature.”  This month, we’re going to look at ways to improve our balance by learning specific exercises that utilize the parts of our nervous system that regulate balance or, proprioception.  Particularly, our cerebellum (back of the brain that regulates coordination), the vestibular system (the inner ear where the semi-circular canals are located), the ascending tracts in our spinal cord (the “highways” that bring information to the brain from our feet and the rest of our body), and the small “mechano-receptors” located in our joints that pick up our movements as we walk and run and sends that information through our nerves, up the spinal cord tracts to the brain.  Here are some very practical exercises to do, “…for the rest of our lives.” Start with the easy ones!

1.         Easy (Level 1): Standing eyes open/closed – Start with the feet shoulder width apart, look straight ahead to get your balance and then close the eyes and try not to sway counting to 30 by, “…one thousand one, one thousand two, one thousand three, etc.” Repeat this with your feet closer together until they touch each other.  You can make this harder by standing on a pillow or cushion — but don’t start that way!

2.         Medium (Level 2): Lunges – from a similar starting position as #1, step forwards with one leg and squat slightly before returning back to the start position. Repeat this 5x with each foot/leg.  As you progress, you can take a longer stride and/or squat down further with each repetition. You can even hold onto light dumbbells and/or close your eyes to make it more challenging.

3.         Hard (Level 3): Rocker or wobble board exercises – use a platform that rocks back & forth or, wobbles in multiple directions.  Rock back and forth, eyes open and then closed, once you get comfortable on the board.  You can rotate your body on the board, standing straight ahead (12 o’clock) followed by 45 degree angles as you work your way around in a circle at 45 degree increments (12, 1:30, 3, 4:30, 6, 7:30, 9, 10:30 and back to noon). Repeat these eyes open and closed.  The Wii Balance board is a fun way to exercise – check that out as well.

You can “improvise” and mix up different exercises and create your own routine.  Just remember, stay safe, work slowly until you build up your confidence and keep challenging yourself.

We realize you have a choice in whom you choose for healthcare services.  If you, a friend or family member requires care for low back pain, we sincerely appreciate the trust and confidence shown by choosing our services and look forward in serving you and your family presently and, in the future.

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There are many different exercises that can be done for carpal tunnel syndrome (CTS) and we’ve discussed some of these in the past.

To understand “why” gliding exercises are helpful, let’s review the anatomy.  There are 9 tendons that move through the narrow carpal tunnel at the wrist. This confined space is literally jammed full and when we move our hands and fingers in a fast, repetitive manner, we produce friction and therefore heat between the tendons that attach the muscles in the forearm to the fingers in the hand. These tendons are in “sheaths” that wrap around the tendon and provide lubrication for the sliding tendon.  If the friction/heat builds up too quickly, swelling occurs, which increases the pressure inside the confined space of the carpal tunnel.  The median nerve sits on top of all these sheathed tendons and when they expand or swell, the nerve gets pushed up into the roof of the tunnel (the transverse carpal ligament).  An analogy would be a river or lake rising to a point where a bridge that goes over the river is eventually engulfed by the rising water. Any object under the bridge would get pushed into the bottom of the bridge (which would represent the median nerve being pinched up against the bridge, or transverse carpal ligament. When nerves are pinched, depending on how hard the pinch, there is numbness, weakness, pain and tingling. If the nerve is damaged, the symptoms are more severe.  Therefore, in treating CTS, a combination of ice massage over the carpal tunnel (for about 5 minutes or until numb), chiropractic joint manipulation, a splint at night to prevent wrist bending (which increases CT pressure) and EXERCISE are very important.  Follow our recommendations as the when to start the exercises – too soon may actually irritate CTS more!

The concepts behind gliding exercises include: 1. Break up adhesions that form between the sliding tendons and their sheaths; 2. Move blood and other fluids OUT of the tunnel; 3. Improve the range of movement of the wrist and fingers joints.  So here they are:

1.      FINGER EXTENSIONS: a. Hold the arm out straight at shoulder height (near a wall); b. Rotate your arm so the palm faces downwards; c. Bend the wrist backwards as hard as possible by pressing the palm of the hand against the wall. d. Reach over with the opposite hand, grab the thumb and pull back so that a firm “good hurt” stretch is felt in the forearm and HOLD for 5-10 seconds.  Repeat this 3 times, pulling the thumb a little harder each time.  Repeat this on both sides (so you can see what the difference is in terms of flexibility) 3x/day or as directed.

2.      BEAR CLAW to FULL FIST: a. Same start position as “1”; b. bend the wrists back & fingers pointing up, so that the palms face away from you and open up the fingers & thumb (the “high 5” position); c. Flex/bend only the tips of your fingers keeping the base of the finger knuckles straight (“Bear Claw”); hold 5 seconds and then repeat a. & b. but change “c” so that you make a full fist by bending all the hand joints; hold 5 seconds and repeat the entire cycle 3 times (hand open – bear claw – hand open – full fist x3) and repeat multiple times a day or as directed.

We realize you have a choice in who consider for your health care provision and we sincerely appreciate your trust in choosing our service for those needs.  If you, a friend or family member require care for CTS, we would be honored to render our services.

Fibromyalgia Facts

Posted: February 17, 2011 in Fibromyalgia

Fibromyalgia (FM) is a condition that is characterized by widespread, generalized pain “all over” the body that does not follow any specific anatomical pathway like the course of a nerve, muscle, or blood vessel. It is often diagnosed only after all other conditions have been eliminated by using various testing approaches such as blood tests, x-ray, CT or MRI Scans, and others.  Controversy exists between health care providers (HCP’s) as some believe that FM either doesn’t exist at all or if it does, it’s grossly over diagnosed while others feel most patients have some form or degree of FM.  Because of this common split in beliefs, patients may be treated poorly by those non-believing HCP’s, which often alienates them from seeking further care for FM.

Recent literature suggests FM is disorder of “central pain processing” or, a specific situation where the pain threshold (the point where pain is felt) is reached sooner than what is normal.  Fibromyalgia has been classified into 2 separate groups – primary and secondary FM.  Primary FM is diagnosed when no known cause can be identified while secondary FM is related to a specific cause such as a disease or condition.  Conditions that have been reportedly associated with FM include irritable bowel syndrome (IBS), TMJ (jaw disorders), chronic low back pain, and headaches. There are genetic as well as environmental factors associated with FM.  Researchers have found that there is a strong familial component with 1st degree relatives where an 8 fold greater risk of developing FM compared to the general population exists. These people are also more likely to have one of the other associated conditions previously mentioned (IBS, TMJ, headaches). Environmental factors can lead to FM in 5-10% of the cases. Some of these include physical trauma such as car accidents, following infections such as parvovirus, Epstein-Barr virus, and Lyme disease. Psychological stress, hormonal alterations such as hypothyroid, drug side effects, vaccination reactions and certain catastrophic events such as war are included in the “environmental factors” category. Gender differences include woman being 2-3 times more likely to suffer from FM than men.

So, what are the treatment options for FM? Typically, if you go to a medical doctor, you can expect various forms of drug therapy – possibilities include anti-depressants, anti-anxiety meds, and sleep aids but with these, watch out for grogginess, side effects and some habit forming/dependency problems. Pain killers or analgesics – opioides are NOT appropriate but often prescribed and narcotics can also be habit forming. Tylenol is perhaps the safest but is not very effective.  Anti-inflammatory include aspirin, ibuprofen but watch for stomach irritation and blood thinning problems. Dr. Christopher Morris, MD reports that drug treatments for FM have, “…very limited success in providing significant improvement in most patients.”  He recommends behavior modification for sleep improvement, exercise (walking, water exercises, strength training, yoga, tai chi, Qi Gong), as well as cognitive behavioral therapy, massage therapy, chiropractic, acupuncture, biofeedback, hypnosis, and dietary modification.  Examples of dietary changes include avoiding foods with certain additives including MSG (monosodium glutamate) and aspartame where in one study, “complete resolution” of FM symptoms was reported.

Patients with FM NEED a “quarterback” to guide them in their management of FM and chiropractic is the PERFECT choice as many of these holistic approaches are utilized or can be coordinated through our office.

We recognize the importance of including chiropractic in your treatment planning and realize you have a choice of providers. If you, a friend or family member requires care for FM, we sincerely appreciate the trust and confidence shown by choosing our services and look forward in serving you and your family presently and, in the future.

Neck pain is a very common problem affecting up to 70% of the adult population at some point in life.  Though there are specific causes of neck pain such as arising from a sports injury, a car accident or “sleeping crooked,” the vast majority of the time, no direct cause can be identified and thus the term nonspecific is applied. There are many symptoms associated with patients complaining of neck pain and many of these symptoms can be confused with other conditions.  Wouldn’t it be nice to know what neck related symptoms are most likely to respond to chiropractic manipulation before the treatment has started?  This issue has been investigated with very favorable results!

The ability to predict a favorable response to treatment has been termed, “clinical prediction rules” which in general, are usually made up of combinations of things the patient says and findings from exams. In a large study, data from about 20,000 patients receiving about 29,000 treatments, was collected and analyzed to find out what complaints responded well to chiropractic treatment.  The results showed that the presence of any 4 of these 7 presenting complaints predicted an immediate improvement in 70-95% of the patients: 1. Neck pain; 2. Shoulder, arm pain; 3. Reduced neck, shoulder, arm movement; 4. Stiffness; 5. Headache; 6. Upper, mid back pain, and 7. None or one presenting symptom.  Items not associated with a favorable immediate response included “numbness, tingling upper limbs,” and “fainting, dizziness and light-headedness in 4-12% of the patients.  The “take-home” message here is that was far more common to see a favorable response (70-95%) of the patients compared to an unfavorable response (4-12%), supporting the observation that most patients with neck complaints will respond favorably to chiropractic treatment.

So, what do we do as chiropractors when a patient presents with neck pain?  First, after gathering preliminary information such as name, address and insurance information, a history of the presenting complaint is taken. This consists of information including what started the neck complaint (if you know), when it started, what makes it worse, what makes it better, the quality of pain (aches, stiff, numb, etc.), the location and if there is radiating complaints, the severity (0-10 pain scale), timing (such as worse in the morning, evening, etc.), and if there have been prior episodes. Various questionnaires are included that are scored so improvement down the road can be tracked and a past history that includes a medication list, past injuries or illnesses, family history and a systems review are standard.  The exam includes vital signs (BP, pulse, height, weight, temperature and respiration), palpation, range of motion, orthopedic and neurological examination.  X-ray and/or other “special tests” may also be included, when needed. A review of all the findings are discussed and after permission to treat is granted, a chiropractic adjustment may then be rendered.  A list treatment options may include: 1. Adjustments; 2. Soft tissue therapy (trigger point stimulation, myofascial release); 3. Physical therapy modalities; 3. Posture correction exercises and other exercises/home self-administered therapies; 4. Education about job modifications; 5. Co-management with other health care providers if/when needed.

We realize you have a choice in healthcare providers.  If you, a friend or family member requires care for low back pain, we sincerely appreciate the trust and confidence shown by choosing our services and look forward in serving you and your family presently and, in the future.

When you woke up today, you thought this was like any other Tuesday.  You packed the kid’s lunches and off to school they went.  You’re on your way to work and everything is on schedule- it’s a good day!  You are stopped at a red light when out of nowhere, someone crashes into the back end of your car and you feel your head snap back over the headrest and then bounce forwards, almost hitting the steering with your forehead. Everything goes blank for a second or two. “What just happened?”  Initially, you’re in “shock,” and after checking to make sure you’re not bleeding, you notice that your neck and head are hurting in a way that’s new to you.  When the police arrive and start asking you questions about what had happened, you try to piece together the sequence of events of the collision but you’re not quite sure how it all fits together.  Your memory just isn’t real clear. Within the first few days, significant neck pain and headache overshadow everything else but you begin to notice that you’re ability to “think clearly” is just not quite right.  Your memory seems fuzzy, you lose your train of thought easily, sometimes in the middle of a discussion, and you are tired – really tired! Taking a nap several times a day is needed. The other day, you were discussing a project with a group of co-workers and you had to ask “…now where was I?” several times during the discussion as you lost your place in the middle of a thought.

Mild traumatic brain injury or, MTBI, is exactly what is described above.  Many patients do not even mention these things to their chiropractor when they present after a car crash as it’s hard to describe these symptoms and many feel it’s just because they are tired or upset about the accident.  When directly asked if any of these symptoms exist, the patient is often surprised and say, “…how did you know?” They are even more surprised when they learn there is an actual reason and explanation for feeling this way. Most of the time, the patient has to be asked if these symptoms exist! This is actually “normal” behavior for those suffering from MTBI.

To better understand how this occurs, think of the more catastrophic situation where the person hits their head to the point of creating an internal bleed and is unconscious. In this case, it’s easier to appreciate the presence of a “brain injury.” With severe head trauma, the person usually has significant memory loss, having no memory of the accident and maybe worse, not being able to recognize family or friends.  Losing the memory of days, weeks, months or years of time is common with these severe head injuries.  However, in MTBI, there is less bruising to the brain and consequently, there are less severe symptoms.  Though the symptoms are similar, MTBI is in a way, a mild form of the above.  With MTBI, the person does NOT have to hit their head on anything to bruise the brain. This is because the speed at which the head is propelled forward and back literally slams the brain into the inside walls, creating the bruising.  Because the brain is suspended inside our skull, damage to some of the nerve cells occurs, most commonly the brain stem, the frontal lobe and/or the temporal lobe. Depending on which part of the brain is injured, the physical findings may include problems with walking, balance, coordination, strength/endurance, as well as difficulties with communicating (“cognitive deficits”), processing information, memory, and altered psychological functions. Recognizing these symptoms and managing MTBI in a coordinated approach with a neuropsychologist is sometimes needed.

We realize that you have a choice in where you seek help for your health care needs and we truly appreciate your consideration in allowing us to help you through that potentially difficult process.