Archive for December, 2012

Low Back Pain and Sleep – Part 3

Posted: December 18, 2012 in Back Pain

For the last 2 months, we’ve discussed the importance of sleep and its effect on low back pain (LBP). Last month, we offered 9 ways to improve sleep quality, and this month we will conclude this topic with 11 more. Sleep deprivation has been called, “…an epidemic” by the Centers for Disease Control and Prevention. To achieve and maintain good health, we must ensure restorative sleep! Here are additional ways to do that (continued from last month):

10. Avoid snacks at bedtime …especially grains and sugars as these will raise your blood sugar and delay sleep. Later, when blood sugar drops too low (hypoglycemia), you not only wake up but falling back to sleep becomes problematic. Dairy foods can also interrupt sleep.
11. Take a hot bath, shower or sauna before bed. This will raise your body temperature and cooling off facilitates sleep. The temperature drop from getting out of the bath signals to your body that “it’s time for bed.”
12. Keep your feet warm! Consider wearing socks to bed as our feet often feel cold before the rest of the body because they have the poorest circulation. Cold feet make falling asleep difficult!
13. Rest your mind! Stop “brain work” at least 1 hour before bed to give your mind a rest so you can calm down. Don’t think about tomorrow’s schedule or deadlines.
14. Avoid TV right before bed. TV can be too stimulating to the brain, preventing you from falling asleep quickly as it disrupts your pineal gland function.
15. Consider a “sound machine.” Listen to the sound of white noise or nature sounds, such as the ocean or forest, to drown out upsetting background noise and soothe you to sleep.
16. Relaxation reading. Don’t read anything stimulating, such as a mystery or suspense novels, as it makes sleeping a challenge.
17. Avoid PM caffeine. Studies show that caffeine can stay active in your system long after consumption.
18. Avoid alcohol. Though drowsiness can occur, many will often wake up several hours later, unable to fall back asleep. This can prohibit deep sleep, the most restoring sleep (~4th hour).
19. Exercise regularly! Exercising for at least 30 minutes per day can improve your sleep.
20. Increase your melatonin. If you can’t increase levels naturally with exposure to bright sunlight in the daytime and absolute complete darkness at night, consider supplementation.

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Carpal Tunnel Syndrome (CTS) is the most investigated, researched, and talked about disorder when it comes to work related injuries to the upper extremity because it is often the cause of so much lost work time, disability costs, and the source of financial hardship for many of its sufferers. So, the questions are: Is there a way to detect it early? What can be done to prevent CTS? And, what can you do to facilitate in the treatment process of CTS?

1. EARLY DETECTION: Because CTS symptoms usually start out mildly, maybe a little numbness or tingling in the hand or fingers that can be easily “shaken off,” people usually do not identify these early symptoms as, “…a big deal” and consequently, do nothing about it. After a while, and the time depends on how severely the median nerve is pinched, you may start waking up at night needing to shake out your hands in order to return to sleep. Similarly, when driving, you may need to change your hand position on the steering wheel due to the same symptoms. If you are really stubborn (and many people are) and you STILL don’t give in and come to us for treatment, then buttoning shirts, writing, crocheting, knitting, playing piano, typing, etc., may all soon become affected. The KEY in early detection is to NOT ignore the early symptoms. Come in right away!

2. PREVENTION: There are many highly effective preventative tactics. For example, recognize that certain conditions predispose us to CTS and anything to avoid and/or properly manage these conditions will help. Some of these conditions include diabetes mellitus, pregnancy, the use of birth control pills, inflammatory arthritis (such as rheumatoid or lupus), hypothyroidism, and obesity. From an ergonomic approach, make sure your work station is set up properly including (but not limited to) the position of the monitor, the keyboard, the mouse, and your chair. Set up the area so the extremes of wrist bending can be avoided. If a wrist brace doesn’t get in the way, it may help, especially when there is a high incidence rate of CTS with your co-workers. Most importantly, small mini-breaks and stretching can be highly effective during the day. If you develop any symptoms, come in and see us RIGHT AWAY (see #1 above).

3. SELF-MANAGEMENT: Certainly consider and implement the “prevention” approaches described above in #2. Specific exercises for stretching, strengthening, and dexterity REALLY HELP! We will teach you these, as it is important that you perform the correct exercises accurately. Improper exercising will only add to the problems that lead to CTS or, worsen it. Control your diet to avoid obesity, to control diabetes and the other sometimes preventable conditions described above. Wearing a wrist splint, especially at night can also really help. There are many types from Velcro wrist wraps with or without thumb loops to cock-up splints, carpal lock splints, and many more. The key as to whether to use a wrist splint or not during work is largely dependent on the comfort of the splint during the work day. Many occupations simply require too much wrist bending or movement for the splint to be comfortably worn during the work day which ends up bruising the forearm and/or hand due to the repetitive motion into the edges of the splint. If or when daytime use of the splint isn’t tolerated, use it only at night to prevent extreme wrist bending while sleeping. This usually REALLY helps. Bottom line, remember the saying, “…an ounce of prevention is worth a pound of cure!”

Fibromyalgia (FM) and sleep dysfunction seem to go hand in hand. In fact, most people who have FM complain of problems associated with sleeping. Sleep problems can include difficulty falling asleep with or without waking up one to multiple times a night. Also, the inability to reach “deep sleep” results in waking up un-restored. People with fibromyalgia frequently state, “… I feel exhausted when I wake up; I have no energy.” They often feel more tired in the morning, and many go back to sleep during the day to ease their fatigue. Another common FM complaint is having great difficulty concentrating during the day, often referred to as, “…fibro fog.” Other sleep disorders such as sleep apnea and restless leg syndrome are also often associated with FM.

Restless legs syndrome (RLS) is a neurologic disorder that is characterized by an overwhelming urge to move the legs at rest, thus interfering with sleep. Restless legs syndrome is more common among those who have fibromyalgia. Patients with RLS describe this as an unpleasant sensation in their legs and sometimes their arms or other parts of the body accompanied by the irresistible urge to move the legs in attempt to relieve the sensation. The terms, “itchy” or “pins and needles” or “creepy crawly” are frequently used when describing the sensations and can range from mild to intolerable. Symptoms are typically worse at rest, especially when lying or sitting and frequently results in sleep deprivation and stress. The intensity of the symptoms can vary, frequently worse in the nighttime, better in the morning. RLS may affect up to 10% of the population in the United States, especially women, and can affect both young and old, even young children. The severe cases usually affect the middle-aged or older and account for about 2-3% of the 10% incident rate. The diagnosis is often delayed, sometimes for 10-20 years. Although the cause is not clearly described, genetics seems to play a role given about 50% of those affected have a family member with the condition.

Other conditions often associated with RLS include iron deficiency, Parkinson’s disease, kidney failure, iron deficiency, diabetes and peripheral neuropathy. Treatment applied to these conditions often indirectly helps RLS resulting in sleep quality improvement. Medications such as anti-nausea drugs, antipsychotic drugs, some anti-depressants, and cold/allergy medications that contain antihistamines can worsen symptoms. Pregnancy can also trigger RLS, especially in the last trimester. It commonly takes about 3-4 weeks for the symptoms to quiet down after delivery. Other factors that affect RLS include alcohol intake and sleep deprivation itself. Improving sleep and/or eliminating alcohol can be quite effective treatment strategies. There are no medical tests that confirm the diagnosis of RLS, but blood tests can at least rule out other conditions, and when all the tests are negative, the diagnosis is made based on a patient’s symptoms, family history, medication use, the presence of an interrupted sleep pattern with daytime fatigue, and knowledge about the condition.

Treatment utilizing chiropractic management has been reported to be effective in managing RLS associated symptoms including the use of spinal manipulation, muscle release techniques, exercise training, and at times, physical therapy modalities. Nutritional approaches that emphasize muscle relaxation have also been reportedly helpful.

What Are Cervicogenic Headaches?

Posted: December 18, 2012 in Headache

Headaches are a very common problem that can have multiple causes ranging from stress to trauma. To make matters worse, there are MANY different types of headaches. One such type is the “cervicogenic headache” (others include migraines, cluster headaches, etc.).

The main distinction between the symptoms associated with cervicogenic headaches and those associated with migraine headaches are a lack of nausea, vomiting, aura (pre-headache warning that a headache is about to strike), light and noise sensitivity, increased tearing with red eyes, one sided head, neck, shoulder and/or arm pain, and dizziness. The items listed above are primarily found in migraine headache sufferers.

The following is a list of clinical characteristics common in those struggling with cervicogenic headaches:
1. Unilateral (one-sided) head or face pain (rarely is it on both sides).
2. Pain is localized or stays in one spot, usually the back of the head, frontal, temporal (side) or orbital (eye) regions.
3. Moderate to severe pain intensity.
4. Intermittent attacks of pain that last hours to days.
5. Pain is usually deep, non-throbbing, unless migraines occur at the same time.
6. Head pain is triggered by neck movement, sustained awkward head postures, applying deep pressure to the base of the skull or upper neck region, and/or taking a deep breath, cough or sneeze can trigger head pain.
7. Limited neck motion with stiffness.

Infrequently, the cervicogenic headache sufferer can present with migraines at the same time and have both presentations making it more challenging to diagnose.

The cause of cervicogenic headaches can be obvious such as trauma (sports injury, whiplash, slip and fall), or not so obvious, like posture. A forward head posture can increase the relative weight applied to the back of the neck and upper back as much as 2x-4x normal. Last month, we discussed the intimate relationship between the upper 2 cervical vertebra (C1 & C2) and an anatomical connection to the covering of the spinal cord (the dura) as giving rise to cervicogenic headaches. In summary, the upper 3 nerves innervate the head and any pressure on those upper 3 nerves can result in a cervicogenic headache. As chiropractors, we are trained to examine, identify, and treat these types of potentially debilitating headaches.

Whiplash and Chiropractic Management

Posted: December 18, 2012 in Whiplash

Whiplash injuries occur as the result of a sudden acceleration followed by deceleration, and the degree of injury is dependent on many factors. Some of these include: the size of the vehicle, the conditions of the road, the angle of the seat back, the “springiness” of the seat back, the position of the head rest, the size of the patient’s neck, the position of the patient’s head and neck at the time of impact, the awareness of the impending collision, etc. Hence, each case must be evaluated and managed using a unique, individualized approach.

The chiropractic encounter begins with the history and examination. Here we will ask many questions and perform tests that will give us clues to understand the mechanism of injury, identify the primary tissues injured, and determine the best treatment approaches to utilize.

There are many different chiropractic treatment approaches available for patients with whiplash injuries. For example, manual therapies include spinal manipulation, mobilization, manual traction, muscle relaxation and/or stimulation methods, the assessment of the patient’s physical capacities with issuing specific exercises and, considerations of modifying work station issues and/or lifestyle changes. Chiropractic manipulation is a very common approach utilized in the treatment of joint dysfunction. That is, restoring normal movement to the joints affected negatively by the whiplash injury. Terms such as, “stuck,” “fixed,” “subluxation,” and the like are often used to describe altered joint position or function. Typically, the manipulation (also called “adjustment”) is applied well within the normal range of motion of the joint using a “high velocity” (or fast) movement through a short distance in the direction that attempts to correct the joint dysfunction. Because the procedure is quick and of short distance, patients frequently state, “…that felt great!” In fact, if the pre-adjustment position of the patient hurts or is uncomfortable, we will instead use a slow, mobilizing movement.

Exercise strategies are important and typically employed as soon as possible. The type of exercise is (again) case specific, but in general, exercises are initially prescribed in a manner that restores movement with as little discomfort as possible. Following the goal of increasing range of motion, strengthening the injured region with stabilization exercises, and restoring sensory-motor activity to the muscles becomes the primary focus in the management of the whiplash patient. When the intervertebral disks are “deranged” or altered, directions that minimize radiating pain are emphasized in the exercises. After careful in-office training, the patient is instructed to perform exercises at home, often multiple times a day, for stability of the spine and to re-establish motor control and movement. Ergonomic and daily lifestyle modifications are frequently addressed to avoid the possibility of the condition being irritated on a regular basis, thus interfering with the healing process. If a patient is stressing the injured area at work, job modifications can make or break the success of the management program.

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.