Archive for January, 2013

Carpal Tunnel Syndrome (CTS) is a very common problem affecting a large population (1 out of 20 in the general population) including typists, assembly line workers, postal employees, secretaries, servers/waiters, musicians, carpenters, and many others. CTS drives a high level of cost to the health care system between time lost from work, treatment costs, and short and long term disability payments (on average $30,000 per claim, and this is an old stat!). Continued CTS signs and symptoms can persist long after surgical treatment and the question that typically arises when this happens is “…why?” Let’s take a look at reasons for failed treatment of CTS…

The classic non-surgical medical management model for treating CTS includes non-steroidal, anti-inflammatory medication (like ibuprofen), rest, and the use of nocturnal (night time) wrist splints. This approach works in some cases, but in the majority, it is unsuccessful and leads to the next medical management step: surgery.

The classic chiropractic management model for treating CTS includes similar initial treatment approaches including anti-inflammatory measures, rest, and night wrist splints. One anti-inflammatory measure is ice massage or cupping, where the ice is rubbed directly on the skin until numbness is achieved (this usually takes about 4 minutes). Prior to numbness, there will be a burning and aching often described as intense, “…like a brain-freeze when I drink a slushy too fast.” The ice cup approach can be repeated several times a day. Other anti-inflammatory measures may include the use of herbal anti-inflammatory nutrients such as ginger, tumeric, boswellia, bioflavinoids, and/or the use of digestive enzymes taken between meals to help reduce the inflammation. The “rest” component is also shared by both models as is the use of the night wrist splint. So, what makes the chiropractic model different?

The nerve affected in CTS is called the median nerve. It arises initially from the nerves in the neck, specifically, C6-8 and T1 nerve roots which are part of the brachial plexus. These form into one nerve (the median nerve) which travels through small openings, first at the neck followed by the shoulder (called the thoracic outlet), then into the arm through a muscle at the elbow (pronator tunnel), and finally through the carpal tunnel at the wrist to innervate the hand including the palm and the 2nd, 3rd digits and thumb side of the 4th finger. The median nerve can get “crushed” in more than one tunnel and treatment must address the WHOLE nerve, not just at the carpal tunnel / wrist. This chiropractic management of CTS helps many patients because the nerve along its entire course including the neck, shoulder, and elbow is treated, not just the wrist!

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.

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Fibromyalgia and Sleep

Posted: January 5, 2013 in Fibromyalgia

Last month, we focused on how important sleep is in the management of the fibromyalgia (FM) and the relationship between sleep dysfunction and Restless Leg Syndrome. Now that it’s clear that the sleep and FM pairing is so important, how can we improve sleep quality? As stated last month, FM and sleep dysfunction go hand in hand and is a consistent complaint of the FM patient. The need to establish better “sleep hygiene” has been found to be one of the most important treatment strategies for those suffering from FM. This can help decrease pain, fatigue, and the “fibro fog” that is often described that impairs the ability to concentrate and work efficiently. Listed below are some sleep strategies that work very well, all you have to do is try them!

1. SLEEP QUANTITY: The advice is to only sleep as much as is needed to feel refreshed and alert the following day. Getting too much sleep does not equate to good quality sleep. In fact, reducing the time in bed seems to improve the quality of sleep, as excessively long periods of time in bed result in fragmented, superficial or shallow sleep and doesn’t allow one to enter the deeper, restoring stages of sleep.
2. KEEP A SLEEP LOG: Document the amount you sleep each night and pay attention to things that may have interfered with that night’s sleep. You will find that reviewing these notes over several weeks will give you strong clues as to the triggers that interfere with your ability to sleep so you can develop strategies to deal effectively with these sleep barriers.
3. BE CONSISTENT: Establishing a regular time to wake up each morning as a consistent routine will help establish and strengthen your circadian rhythms, and a regular arousal time puts you on a consistent sleep cycle and leads to a regular time of sleep onset at night.
4. USE RELAXATION TECHNIQUES: The use of relaxation therapies such as visualization, deep breathing, a gentle massage, and southing background music or sounds are all great ways to boost restful sleep.
5. EXERCISE REGULARLY: This sounds counterintuitive but REALLY WORKS well! The KEY to exercise is to do this at least 3 hours prior to going to bed. Exercise not only “clears your head” but it provides a great way to reduce the accumulation of stress and exerts beneficial effects by promoting better, deeper sleep. Start slowly and gradually increase the duration and intensity of a form of exercise that you enjoy and look forward to doing. Pilates, Yoga, Ti Chi, Qui Gong, water aerobics, walking in the woods, or working out at your favorite gym or health club with some pals are some options.
6. BACKGROUND NOISE: Some FM sufferers really benefit from background “white” noise. Sound machines offer a variety of sounds that can help immensely! Avoiding sudden loud noises like low flying air craft or the slamming of a door or cupboard can disturb sleep quality even if we cannot remember the event the next morning.
7. NO NAPS PLEASE: Avoid a daytime nap; however, if you have to “recharge,” keep the time short (no more than a 15-30 min. “power nap”). Long naps interfere with nighttime sleep.
8. TEMPERATURE: Keep your bedroom cool; warm temperatures interfere with sleep.
9. APPETITE: Consider a light snack rich in carbohydrates if hunger interferes with sleep.
10. NO CAFFEINE: Avoid caffeine or alcohol in the evenings as they both can interfere with sleep quality and the ability to get to sleep.

Low back pain (LBP) can result from many causes, and sometimes it just occurs for reasons that are not clear, such as the accumulation of stresses that occur over time. Many causes of low back pain have been described such as bending over “wrong,” combined bending and twisting, lifting, over reaching, climbing, sitting too long, repetitious activities at home or work, sports injuries, being out of shape, and so on. But what about balance? Because poor balance leads to falling, which is the #1 cause of injuries in the elderly, ANYTHING that we can do to improve our balance should help prevent falls and hence low back injuries. Let’s look at strategies to improve our balance…

First, let’s measure our ability to balance by using a simple test you can do yourself. Stand on one leg in the corner of a room or in a doorway where you can easily grab onto something if you feel like you’re going to fall. Try to do this without holding on to anything, first with your eyes open and a second time with your eyes closed. If you have a stopwatch, click it when you start and stop (when you put your foot down). Otherwise, count, “…1001, 1002, 1003, etc.” Studies have shown that for those under 60 years old, you’re “normal” if you can balance on one leg with your eyes open for 30 seconds and 25 seconds with your eyes closed. Between ages 60-69, normal is 23 sec. (eyes open) and 10 sec. (eyes closed) is normal. If you’re 70-79 years old, normal is 14 seconds (eyes open) and 4 seconds (eyes closed). Give it a try! Notice how “normal” drops as we age. From 25 sec. to 4 sec. between age 59 and 70 is pretty dramatic! No wonder falling is so common among the elderly!

So, now that you’ve tested yourself, I’m guessing you aren’t too impressed with your balance skills. The question now is, how can we improve our balance? Performing balance exercises with a rocker, wobble board or cushion is VERY EFFECTIVE! You’ll be surprised that if you use this for 10 minutes a day, the improvement in balance is significant in just 2 weeks. Another method takes no effort at all on your part, and that is the use of custom made foot orthotics. Simply known as arch supports, foot orthotics (the good “prescription” kind) correct the rolling in or out of the heel bone, referred to as pronation (rolling in = most common) or supination (rolling out) by wedging the heel of the orthotic/arch support. This stabilizes the ankle joint, reduces the inward or outward shift at the knee and hip joints, and as a result, improves our balance.

Results of a recent study proved this to be the case. Researchers studied 13 subjects over 65 years of age who reported at least 1 unexpected fall in the past 12 months and measured their balance skills using a similar test as the one you just tried as well as 3 other tests (tandem stance, tandem gait, and alternating step tests) twice before and twice after starting use of custom foot orthotic intervention (immediately after and 2 weeks later). In each of the 4 balance tests, improvement was statistically significant in the post-tests and 2-week later follow-up tests PROVING that balance is effectively improved when wearing custom made foot orthotics. We recommend doing BOTH the exercises and the use of custom foot orthotics to obtain even better results. Since falling is such a common occurrence at any age, especially in those over 60-65 years old, these simple strategies seem like a “no-brainer” to implement into a treatment program, especially for people with poor bone density at high risk for fractures.

This seems like an easy question to answer, doesn’t it? The answer of course being, YES!!! However, there are many people who suffer with headaches who have never been to a chiropractor or have not even ever considered it as a “good option.”

So, rather than having me “reassure you” that chiropractic works GREAT for headache management, let’s look at the scientific literature to see if “they” (the scientific community) agree or not.

In a 2011 meta-analysis, researchers reviewed journals published through 2009 and found 21 articles that met their inclusion criteria and used the results to develop treatment recommendations. Researchers discovered there is literature support utilizing Chiropractic care for the treatment of migraine headaches of either episodic or chronic migraine. Similarly, support for the Chiropractic treatment of cervicogenic headaches, or headaches arising from the neck region (see last month’s Health Update), was reported. In addition, joint mobilization (the “non-cracking” type of neck treatment such as figure 8 stretching and manual traction) or strengthening of the deep neck flexor muscles may improve symptoms in those suffering from cervicogenic headaches as well. The literature review also found low load craniocervical mobilization may be helpful for longer term management of patients with episodic or chronic tension-type headaches where manipulation was found to be less effective.

Okay, we realize this is all fairly technical, so sorry about that. But, it is important to “hear” this so when people ask you why are going to a chiropractor for your headaches, you can say that not only that it helps a lot, but there are a lot of scientific studies that support it too!

Bottom line is that it DOES REALLY HELP and maybe, most importantly, it helps WITHOUT drugs and their related side effects. Just ask someone who has taken some of the headache medications what their side-effects were and you’ll soon realize a non-drug approach should at least be tried first since it carries few to no side effects.

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

Whiplash Avoidance

Posted: January 4, 2013 in Whiplash

Whiplash, or more properly stated, Whiplash Associated Disorders (WAD), is usually associated with car accidents, slip and falls and sports injuries. It is a very common injury affecting millions of people around the world, and costing health care systems billions of dollars. The question of the month is, what can we do to AVOID or prevent whiplash?

STEP 1. SHOP FOR A SAFER CAR. There are many resources that you can review such as the “Insurance Institute for Highway Safety” that have published ratings for the safest seats, head restraints, and include many makes and models of cars, SUV’s and trucks. For example, Volvo and Saab have recently designed car seats where the seat back collapses backwards upon impact so as to minimize the rebound response in a rear-end collision, thus minimizing the head and neck from whipping back and forth. Therefore, before YOU purchase your next car, compare the vehicle’s structural design, its size and weight, the restraint systems, the airbags, the head rests, as well as crash avoidance features. Remember, in general, small cars put you at greater risk simply due to the small mass equaling less protection.

STEP 2. POSITION THE HEAD RESTRAINTS PROPERLY. This means put them in their “up” position. The most common problem with head restraints is that they are placed too low and offer little to no protection if and when you are struck from behind. In fact, 80% of cars have the head restraint in the low or “down” position, which (surprisingly) is WORSE than having no head restraint at all! This is because when the head restraint is too low, it acts like a fulcrum, hitting the middle of the neck promoting MORE hyperextension when compared to having no head restraint whatsoever. Remember, head restraints are designed to fit an “average man,” making it challenging for a tall or short person to obtain a good “fit.” A good position for a head restraint is within 1 inch of the back of the head and 1-2 inches above the mid-portion of the head as “ramping” often occurs especially if the seat back is reclined backwards, and the whole body slides up and over the head restraint.

STEP 3. PREPARE FOR THE CRASH. This actually may NOT be possible since the “whipping” action happens within 500 milliseconds and voluntary muscle contraction is about twice as slow, not to mention that the crash can occur at lightning fast speeds leaving you with little time to prepare. However, if you do have time to prepare, do the following: 1. Put your head and neck all the way back into the seat back and a properly adjusted head restraint so that there is firm contact. 2. Extend the elbows and straighten the arms gripping firmly onto the steering wheel in preparation to brace yourself. 3. Place your foot on the brake as firmly as possible (assuming that you are stopped in traffic). 4. Look straight ahead avoiding neck or head rotation. 5. Tilt your head back slightly so that your eyes are pointed toward the top of the windshield. 6. Prior to impact, shrug your shoulders upwards toward the ears and brace yourself firmly.

STEP 4. SEEK IMMEDIATE TREATMENT. It is critical to obtain treatment as quickly as possible as there is a tremendous advantage to start treatment especially with the first 2 weeks post-collision to avoid the likelihood of a chronic potentially disabling condition.

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.