Archive for January, 2012

Scoliosis is a curvature of the spine that is shaped like a “C” or an “S” when looking at the person from behind. I’m sure you’ve noticed when you’re at a beach, at a swimming pool, or walking in an airport, some people have a high shoulder, walk with a bit of a limp if one leg is short, and may have a shoulder blade that sticks out more than the other. Scoliosis often develops for unknown reasons (hence the term, “idiopathic”) during the adolescent age range between 10 or 11 years old and can progress, not change or less often, improve up to age 16 to 18. During these 4-6 years, the time when the adolescent is growing quickly, the curve often worsens without any intervention but few studies have looked at what types of treatment or combinations of treatment work the best, especially non-surgical methods.

A recent study was conducted that looked at the response to non-surgical treatment using conventional medical treatment (MT) vs. conventional MT plus chiropractic, as well as conventional MT and “sham” (fake) chiropractic treatment. This is a pilot study using a small population of patients in order to determine if a larger scale study would be important to run (which was determined to be the case).

The conventional medical treatment approach included two groups – observation (a “wait and watch” approach) in a braced group verses a non-braced group. The chiropractic treatment group received spinal manipulation using “diversified technique” which is widely used where the patient is treated while lying on their stomach, sides, and back and the type of manipulation used was the thrust type where the “cracking” sound occurs (which is caused by the release of gas from the joint capsules and is technically called cavitation). This was applied to the regions determined by the chiropractor as requiring the treatment by using palpation (touch) methods, postural examination, range of motion, and x-ray and all chiropractors involved had 6-hours of training to assure consistent and similar approaches were used. Treatments were administered (determined by a survey of many chiropractors) at 3x/week for a month, 2x/week for a month, 1x/week for a month, and 2x/month for 3 months or as needed for a total of 6 months. The “sham” or fake chiropractic treatment used the same treatment frequency and similar positioning of the patient but purposely did not obtain a joint cavitation or “crack” but still seemed “real” to the patient.

The primary outcome used to determine “success” was a reduction of the scoliosis curve measured on x-ray at a 6-month point. Using the standard medical model, those with curves of 20-25 degrees require careful observation, curves 26-40 degrees are potential candidates for bracing, those greater than 40 degrees are potential candidates for surgery and, an increase in curve by more than 5 degrees measured twice a year or every 6-months is considered failure.

The results are interesting. Of those receiving only conventional medical treatment, none improved and one failed. The same occurred in the conventional MT plus sham/fake chiropractic. NO ONE failed and one improved in the chiropractic treatment plus MT group making it the only successful non-surgical treatment approach in the study. The preliminary findings from this study are huge! Chiropractic treatment in this group of adolescent children was determined to be THE ONLY non-surgical approach that had the ability to maintain (not allow the curve to progress) or even better, improve the curve!

We realize you have a choice in who you choose to provide your 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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Have you ever woken up in the middle of the night and noticed your hand sleeping to the point where you had to get out of bed and shake or flick your fingers to alleviate the numbness? If the numbness was primarily on the thumb-side half of your hand, it may have been carpal tunnel syndrome that woke you up. So, the question is, why is it such an issue at night?

To properly answer this question, let’s get familiar with the anatomy of the wrist. There are 2 bones that make up the forearm – the ulna (on the pinky side) and the radius (on the thumb side). Just beyond that, there are two rows of four bones each called the carpal bones for a total of 8 small bones that make up the wrist joint. These carpal bones are arranged in a horseshoe or tunnel shape. When you look down at your wrist and wiggle your fingers quickly, you can see all the movement that occurs on the palm side of the wrist. That’s a lot of movement! You can also see the muscles on the upper half of the forearm moving rapidly as the fingers wiggle.

There are 9 muscle tendons that travel through the carpal tunnel, as well as some blood vessels and most important, the median nerve sits on top of all those moving tendons. Just beneath the floor of the tunnel is a ligament called the transverse carpal ligament. The tendons inside the tunnel are surrounded by lubricating sheaths that make it easier for the tendons to slide back and forth as we wiggle our fingers, grip to open a jar, type on a computer, play a musical instrument, or so on. Without the tendon sheaths, the friction between the rubbing tendons would quickly build up heat, resulting in swelling, pain and numbness. However, in spite of the lubricating function of the sheaths, when we work our fingers and hands too much, swelling and inflammation does occur.

So, why do we have numbness at night when we aren’t working, gripping and moving our fingers repetitively? The answer lies in how we sleep. Since we are asleep, we cannot control where we position our hands and wrists. Most of us curl up in a ball and tuck our hands under our chin or someplace cozy. Normally, when we bend our wrists, the pressure inside the carpal tunnel doubles. However, a carpal tunnel patient already has a higher level of pressure in their wrist. So, when a carpal tunnel patient bends their wrist in the exact same way, the pressure goes up even more – that is, 3, 4, 5, or more times than a normal person without their wrist bent. That is why a wrist “cock-up” splint works so well at night! It keeps the wrist straight so we can’t bend it. Often, this allows the CTS patient to sleep through the night instead of waking up 2, 3, or more times with numbness, tingling, and/or pain on the thumb half of the hand.

We realize you have a choice in who you 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 (FM) is a chronic condition that does not limit itself to just one area but rather, it manifests as a generalized, whole body condition where basically, everything hurts. The diagnosis is typically made by exclusion or, by eliminating all other possible conditions as there is no single blood test for FM and unless other conditions that are test sensitive are present at the same time, most tests come back negative. Of course, this leaves the FM patient upset because, “….no one can figure out what’s wrong with me.” We all seem to want a test to prove what we have is “real.”

Unfortunately, in the real world, no blood test, x-ray, or exam procedure is 100% accurate (sensitive and specific), so even when tests return positive, there can be “false positives” that are caused by many things such as drug induced test alterations and/or other conditions that alter the same test. On the other hand, there are “false negatives,” so even though the test came back negative, it’s still possible that the problem one is present but the test may just not be sensitive (accurate) enough to detect it. FM is one of those conditions where only after a myriad of tests have been run and come back negative, can the diagnosis of FM be made with some degree of confidence.

Essentially, we have to prove that you don’t have something else causing similar symptoms before we can confidently (or at lease more confidently) diagnose you with fibromyalgia. To complicate this further, in “secondary FM,” the cause of FM is known and is due to an underlying condition such as rheumatoid arthritis, lupus, hypothyroid, HIV, cancer, as well as physical trauma such as after a car accident or a work injury. When an accident is involved, the symptoms may be more confined to one area (then called “regional FM”) making the diagnosis even more challenging as the classic 11 of 18 tender points may not hold up in these cases.

Finally, there are doctors out there that simply don’t “believe in” the condition and may say to the FM patient, “…there is no such thing, it’s all in your head, you simply have learn how to live with it. There’s nothing that can be done.” Well, they actually may be partially right – that is, the “…it’s all in your head” part (don’t get mad… just wait!). Another finding that is well-published in peer review literature is the concept called central and peripheral “sensitization.” This occurs when increased incoming sensory information from injured skin, muscles, and/or organs, in a sense bombard areas in the central nervous system (spinal cord and brain) leaving it “sensitized” or, more sensitive to “normal” incoming information. This is because the threshold or tolerance to normal incoming sensory stimuli is reduced and results in increased muscle pain commonly described by patients with FM.

To better illustrate this, hypersensitivity or central sensitization was found in people after a whiplash injury. They recruited 14 whiplash patients and 14 “normals” to compare their responses when stimulating the leg (the non-injured area) as well as the neck (injured area). Theoretically, if central sensitization didn’t exist, the responses to the exact same stimulus on the healthy leg of both the whiplash patients and the normal subjects would be equal. Instead, what was found was that the whiplash patients had significantly lower pain thresholds for 2 of 3 tests (a single electrical stimulus in the muscle, repeated electrical stimulation in the muscle and on the skin, but not from heat when applied to the skin). Each pain threshold was measured at the neck and leg before and after local anesthesia was applied to the painful, sore neck muscles. In the whiplash cases, the lower pain threshold was found when stimulating both skin and muscles at the healthy leg and at the injured anesthetized neck equally. That proves that the central nervous system (brain and spinal cord) has a “pain memory” which lowers the threshold so the whiplash patients feel pain more intensely and quicker than the non-injured people. This can help patients understand the answer to the question, “…why won’t this pain go away?” This pain memory or hypersensitization is similarly found in FM patients.

If you, a friend or family member requires care for FM, we sincerely appreciate the trust and confidence shown by choosing our services!

Headaches, Neck Pain and Concussion

Posted: January 13, 2012 in Headache

Have you ever “banged” your head from falling? For those playing backyard football, soccer, hockey, or baseball as kids or adults, it’s really quite common. So, how can we tell when the “bang” is dangerous vs. not? And, how does a concussion occur?

What is a concussion? A concussion is “traumatic brain injury” (TBI) where the brain is “jarred” and literally bruises as a result of some sort of trauma (a “bang”).

What causes a concussion? Causation is usually from some sort of trauma either by being hit by a moving object (like a ball), from hitting the head during a fall, and even without a direct strike if the head is violently moved back and forth (such as in a “whiplash” injury resulting from a car accident). When there is no direct strike of the head and in the absence of being “knocked out,” the person may not be aware that they have a concussion.

What are the symptoms associated with concussion? Immediate symptoms usually include a headache and a reduced level of alertness or consciousness. A concussion temporarily interferes with the way the brain works and as a result (depending on the specific location and degree of the “brain bruise”) it can affect memory (short term the greatest), levels of awareness, judgment, feeling “spacey,” reflexes, speech, balance, coordination and sleep patterns. Other symptoms may include nausea and/or vomiting. Most people describe the experience as an abrupt injury where a bright flash of light occurs in the visual field that blocks the vision temporarily. Many do not actually become unconscious but may say they “blacked out” for a second or two. When unconsciousness does occur, the length of time they are “out” may be a way of determining severity. Symptoms can vary from mild to severe and the following are EMERGENCY symptoms where immediate health care provision is necessary: significant changes in alertness and consciousness, convulsions or seizures, muscle weakness on one or both sides, persistent confusion, persistent unconsciousness (coma), repeated vomiting, unequal pupils, unusual eye movements and walking problems. Neck injury is often associated with a head injury, which is why the injured person is stabilized on a board before being transported. Symptoms during recovery include being withdrawn, easily upset, confused, having a hard time with tasks that require memory and/or concentrating, having mild headaches and sensitivity to noise.

What tests are commonly performed on the post-concussive patient and, what is the treatment? A physical exam can include a careful evaluation of the cranial nerves such as pupil size and eye movement, as well as assessment of one’s thinking ability, coordination and reflexes. Special tests may include an EEG (brain wave test), especially when seizures are involved. A head CT scan or head MRI. Treatment may require a hospital stay if severe signs are present. A “wait & watch” approach is often practiced but prompt gentle chiropractic approaches often facilitates healing and should strongly be considered. Refraining from rigorous sports is strongly advised.

The Whiplash Syndrome

Posted: January 13, 2012 in Whiplash

The term “whiplash” was coined by Dr. Harold Crowe in 1928 during an interview on car collision related neck injuries but he reportedly “…regretted it later.” The term “whiplash” quickly became a household word and relates to a sudden movement of the head producing a neck sprain. It is now accepted that not only forward/backward movements during motor vehicle collisions (MCV) result in neck injury but also side to side and angular movements at the time of impact. In the past, we’ve discussed the number of milliseconds that takes place during the whiplash process after impact (~500 msec.) and the fact that voluntary muscle contraction takes longer (~800 msec.) making it next to impossible to adequately “brace” prior to impact, even when the collision is anticipated. Today, we’re going to look at the symptoms and complaints that are commonly described by whiplash patients.

“Early whiplash syndrome” is defined as the condition where immediate or very close to immediate symptoms are noted. One study reported symptoms commonly described after a MVC include the following: neck pain (93%), headache (72%), shoulder pain (49%) and back pain (38%) and, 87% of patients had multiple symptoms. Others reported nausea (48%) and dizziness (38%) as initial symptoms. For some, many of these symptoms resolve within days, weeks or months leaving a smaller percentage with symptoms that last beyond 6 months, which is then referred to as “late whiplash syndrome.” In one study of 52 patients, symptoms improved over a 2 week to 12 month time frame but then remained static or unchanged for the following year. Another study of 117 patients at the 2-year point, reported the following symptoms (the frequency of occurrence is in parentheses): Neck pain (17%), headache (15%), fatigue (13%), shoulder pain (13%), insomnia (12%), anxiety (11%), concentration loss (10%), and forgetfulness (10%).

Reasons for the continuation into a late syndrome are supported by two possible causes. 1. It is due to a high level initial symptom, including severe neck pain and headache often with radiating arm pain (radiculopathy). 2. It is caused by the stressful events that are present either at the time of the motor vehicle collision or soon thereafter. These stressors could include work loss, marital stress, financial stress, and/or depression or anxiety issues associated with being injured. It was also reported that the specific type of headache suffered in the late whiplash syndrome in a 47 patient study, 74% had tension-type headache, 15% had migraine and 11% had cervicogenic headache. Some authors have reported that the type of headaches that occur as a result of an MVC are similar to almost identical to those seen after head trauma from other causes including sports injuries such as football, hockey, and boxing.

Because “whiplash” results in a mechanical type of injury to the small joints of the neck, muscles and ligaments, the only logical choice for management and treatment is chiropractic. This is because chiropractic addresses the mechanical injury with a manual, hands-on approach specifically aimed at restoring function in the injured area. Studies are clear that whiplash patients make a faster, less painful recovery, return to work and desired activities faster and are the most satisfied when utilizing chiropractic when compared to covering up the symptoms with medications that have negative side effects that interfere with being able to think and ultimately, reduce productivity.

We realize you have a choice in where you choose your healthcare services. If you, a friend or family member requires care for whiplash, 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.