Archive for March, 2013

Carpal Tunnel Syndrome (CTS) results in numbness, tingling, and sometimes weak grip strength due pinching of the median nerve as it travels through the carpal tunnel at the wrist. There are many conditions that are similar to CTS, many of which we have discussed in the past. The following is a list of “13 fun facts” aimed at helping to properly identify CTS, knowing what to do about it, and at helping to make an informed decision as to whom to seek help for it.

1. CTS is most common in women, age >50, who work in a repetitive, rapid moving manually demanding occupation (typing/computer work, line assembly work, waiting tables, and more).
2. CTS is complicated by the presence of obesity, diabetes, hypothyroid, pregnancy, taking birth control pills, and other conditions that cause inflammation (rheumatoid arthritis and others).
3. CTS may develop on the dominant side, the non-dominant side or both– each case is individual.
4. CTS symptoms may FIRST present as morning or night time numbness that can wake the sufferer up once or many times during the night.
5. CTS sufferers USUALLY wait for weeks, months or even years before seeking help for it, which is a risk factor for a delayed recovery – GET HELP ASAP!!!
6. CTS can often be managed without surgery– especially IF you have it treated sooner rather than later.
7. CTS surgery may be necessary if non-surgical care fails. This may be due to the nerve being damaged beyond a certain point (an EMG/NCV or, electromyography/nerve conduction velocity helps determine this along with an accurate history and examination).
8. CTS non-surgical care includes: chiropractic manipulation of the wrist, elbow, shoulder and/or neck– depending on the case. All health care providers usually include a night wrist splint, anti-inflammatory measures, ergonomic modifications of work stations, and stretching exercises.
9. CTS non-surgical success favors chiropractic because of the inclusion of the manual therapies. When only exercise, night splinting, and NSAIDS are used, the success rate drops off dramatically.
10. Reduced thyroid function makes CTS worse because of the unique type of swelling associated with hypothyroidism called “myxedema.” Because of the confined space available in the carpal tunnel, a small amount of swelling can result in nerve compression and the classic numbness/tingling symptoms in the middle three fingers on the palm-side of the hand.
11. CTS is worse at night because it is impossible to control the position of the wrist while we sleep. As a result, we tend to curl the wrist and hand under our chin, and when the wrist bends forwards or backwards, the pressure inside the carpal tunnel increases significantly due to the change in tunnel size. This is why wearing a wrist splint at night REALLY HELPS as it keeps the wrist from bending, keeping the tunnel as wide as possible, thus lowering the pressure within it.
12. CTS patients respond well in some cases to vitamin B6. This is due to the healing effects of B6 (peridoxine) on neuropathy and/or it’s anti-inflammatory qualities. Other anti-inflammatory nutrients include ginger, turmeric, boswellia, bioflavinoids, white willow bark, quercetin, and others.
13. CTS patients do not always improve after surgery. This can be due to the fact that the median nerve is frequently “pinched” in more than one area such as the neck, thoracic outlet (shoulder), pronator tunnel (elbow) as well as at the wrist. When more than one compression is present, this is referred to as “double” or “multiple crush syndrome.”

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Low back pain (LBP) and its relationship to balance has been the topic for the past two Health Updates, and an initial discussion regarding specific balance exercises was introduced last month. This month’s Health Update will complete the discussion about what you can do to preserve your current balance skills, or better yet, improve them! Remember, wear your foot orthotics and don’t forget to move them between your different shoes. Similarly, if you have leg length imbalance, move your heel lift to other shoes or simply purchase additional lifts and keep the heel lift in several pairs of shoes. Also, test your balance skills now before starting a balance exercise program and re-test every 2-4 weeks to measure improvement (see the January 2013 Health Update for the testing protocol).

The initial exercise we discussed was standing with your feet together and holding that position for progressively longer times (eyes open and closed). Once you can hold this position with your eyes closed for ≥ 30 seconds, start increasing the balance challenge by:

1. Move your heel of the left foot next to the big toe of the right foot and repeat the exercise with the eyes open and closed. Repeat on the other side! When successful for ≥30 sec., do it with eyes closed…..
2. Place your left foot in front of the right foot/toes (like standing on a balance beam) and repeat the exercise with the eyes open and closed. Repeat on the other side! When successful for ≥30 sec., do it with eyes closed…..
3. Repeat #1 and #2 standing on a thin pillow and/or a wobble cushion or rocker board, making sure you are “safe” by standing in the corner of a room or in an entrance to a room where you can grab the door frame when needed. DO NOT RISK falling!
4. Rocker board exercise options:
a. Rock forwards/backwards (FW/BW) looking straight ahead (don’t look down at your feet). Make sure the board you are using is “safe” (where you can safely step off forwards and backwards). Don’t use a board that is too high off the ground (about 3” is maximum). Repeat the FW/BW rocking slowly for 10 minutes periodically opening and closing your eyes.
b. Repeat “A” but stand at a 45° angle to the front/back direction so you are rocking at an angle using the same methods and time frame.
c. Repeat “A” but stand at a 90° angle to the front/back direction so you are rocking at an angle using a similar method and time frame.

You can then “make up” exercises standing on the rocker board or cushion like simulating a golf swing, tennis stroke, or other favorite sport, yoga move, etc. Be creative and make it fun!!!

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.

Fibromyalgia and “SHINE”

Posted: March 1, 2013 in Fibromyalgia

Fibromyalgia (FM) management can be as difficult as making a definitive diagnosis. FM is characterized by generalized body aches and feeling exhausted, and yet, in spite of the exhaustion, the inability to sleep is a “classic” FM complaint. Some have referred to FM as “blowing a fuse” or as an “energy crisis,” as more energy is expended than what’s being made. FM sufferers, as well as the caregivers, know how physically and mentally difficult it is to manage this controversial condition. Many management strategies that have been published; SHINE is one approach. SHINE stands for Sleep, Hormones, Infections, Nutritional supplements, and Exercise. By focusing treatment strategies on these 5 areas, significant benefits can be achieved.

SLEEP: Some feel this is the most important problem to manage in order to gain control of FM. If we cannot reach “deep sleep,” (which is the sleep stage that is usually reached after about the 4th hour into sleep) then the body cannot fully rest. When discussing sleep problems with the FM patient, it is common to hear them say, “…I wake up every 1-2 hours and can’t get back to sleep for at least 15-30 minutes.” This results in NEVER getting to the deep sleep stage and eventually, because the body hasn’t fully relaxed often for years, everything starts hurting. This is the hallmark of FM. Some “tips” to help us get to sleep and stay sleeping include: keeping the bedroom cool (such as 65°), taking a hot bath before sleep to relax your tight muscles, spraying the pillow with lavender oil (helps promote sleep), taking 75-150mg of magnesium, avoiding caffeine (especially later in the day), the use of Valarian Root (a muscle relaxing herb) and/or melatonin (an amino acid that promotes sleep) can also help. The goal is to try to get 8-9 hours of sleep a night. Establish a routine in the evenings and go to bed at the same time or close to it.

HORMONES: These chemicals are produced by our endocrine glands (pituitary, thyroid, parathyroid, adrenals, ovaries/testes, and part of our pancreas. They are in balance with each other, and somehow, in FM they often fall out of balance. Have your health care provider perform tests (usually blood and/or urine) to determine your hormone levels and get them balanced!

INFECTION: The lack of sleep lowers our immune function, and infections can occur more readily. In addition to treatments, there are nutritionally based approaches to improve immune function, and if recurrent illnesses are part of your FM profile PLEASE consult with us regarding ways to boost your immune system!

NUTRITIONAL SUPPLEMENTS: This topic is related to the last as there are MANY supplement recommendations that have been found to boost immune function, increase energy, enhance sleep quality, and more. This is an area of FM management that is largely overlooked by traditional medical management approaches. Remember, a “team” of providers offers the FM sufferer the best way to manage this challenging to treat condition. Look for health care providers who are willing to work together as a team on your behalf.

EXERCISE: This is a MUST! For example, in a 2010 Oregon Health & Sciences University study, women with FM who practiced yoga for 8 weeks had a 24% pain reduction, 30% fatigue reduction, and 42% depression reduction.

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

Last month, we looked at the published evidence that overwhelmingly supports the use of cervical traction. As promised, this month’s focus is the proper methods of applying it. The type of traction that this discussion will address will be limited to the kind that can be purchased and then used in the home, usually multiple times a day, giving it a clear advantage over in-office traction treatments which can only be applied a few times a week during office visits. In some cases however, it may be appropriate to use the in-office type for a few sessions to determine dosage and/or tolerance prior to administering a home unit, but this varies from case to case, and each type of traction unit is different. In the neck or cervical spine, there are many varieties including: sitting over-the-door types, cervical collar types, as well as supine (lying on the back) types. Each variety has its pros and cons and prices vary considerably from $10 to $600.

CONDITIONS: Probably the most common condition treated with cervical traction is “cervical radiculopathy,” or a pinched nerve. When a nerve root in the neck is pinched, pain, numbness, tingling, and/or muscle weakness occurs in the area the particular nerve innervates. For example, if a patient presents with pain and numbness radiating down the arm to the thumb and index finger and/or have weakness in bending their elbow and extending their wrist, then we know that the C6 nerve is pinched. When pulling or stretching the neck relieves the arm pain, traction is usually helpful. If pain worsens, the person is probably not ready for traction yet.

PROTOCOL (DOSAGE): The key to a successful outcome using cervical traction is finding the right dosage. If you start with too much weight, it may leave you feeling sore, or worse, making you reluctant to try it a second time. Therefore, rather than relying on using a certain percentage of body weight, it’s safest to start with less weight and then gradually increase it, such as 5# (# = pounds or .45 kg) for 15-20 minutes. If that dose feels fine, try 7#/15-20 min., then 9#, 11#, 13#, etc., until you find it just isn’t quite as comfortable at the last weight. You have now found your current threshold and should drop down to the last most comfortable weight and use that for a few days and then MAYBE try increasing it again. Studies show a maximum stretch is usually achieved within 15-20 minutes, so extending the time longer may be less productive. Facing the over-the-door unit may be better tolerated than facing away. Try it both ways and you decide which feels best. The next most important issue is frequency.

How often to repeat the traction sessions depends on: 1. The condition’s severity and your response; 2. Your time availability. If there is a severe nerve pinch with muscle twitching, weakness and dense numbness/tingling, then the traction be repeated MANY times a day, gradually increasing the weight to find the optimum amount. We’ve had people repeat the traction 10x/day! With the option of wearing a cervical collar traction unit, you can actually travel and/or do certain activities during traction. We’ve had people travel to and from work while performing traction! Since each case is unique, we’ll discuss that individually. The bottom line, IT WORKS GREAT with proper chiropractic management and in many cases, surgery CAN be avoided!

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

Whiplash Facts

Posted: March 1, 2013 in Whiplash

“Whiplash” is considered a non-medical term that encompasses a range of injuries. These injuries typically affect the neck and are caused by a sudden movement of the neck associated with extension or forceful backward bending. The medical term “cervical acceleration-deceleration” (CAD) is considered to be a more accurate description of what happens during a car accident, and the term “whiplash associated disorders” (WAD) describes the injury’s residual signs and symptoms.

WAD or CAD is most commonly associated with motor vehicle collisions (MVCs), when a vehicle is struck from behind. Other less common causes include: dancing (especially “headbanging”), falls from stools or ladders, bicycle injuries, horse related injuries, and many others. In the UK in 2007, 430,000 people made an insurance claim for WAD, accounting for 14% of every driver’s premium. In the US, over 1 million WAD injuries occur annually due to car accidents alone with an estimated 3.8 cases per 1000 people per year. An estimated 6.2% of the US population has “late whiplash syndrome” or long-term problems associated with WAD.

Prior to the advent of the automobile, WAD was referred to as “railroad spine” (as it resulted from a train crash), first documented in 1919. WAD also occurred frequently in pilots landing on aircraft carriers due to the rapid deceleration that occurred as the planes landed and suddenly braked. When one thinks of “whiplash,” the visual of a high speed crash comes to mind. However, WAD can occur at speeds less than 15 mph due to less crash energy absorption by crushing metal. Since there is less car damage at lower speeds, that energy is transferred to the contents (the people) inside the car.

The neck consists of 7 vertebrae, the 6 disks, the 8 pairs of nerves, and the muscles, ligaments and other “soft-tissues.” There are 4 phases of injury (initial, retraction, extension and rebound), which all occur within 300 msec. Whereas, it takes about 800msec to voluntarily contract a muscle. Therefore, you can’t really “prepare” or fully brace for the impact. Most injuries occur at C5 and C6 in the lower part of the neck between 150 and 300 msec. of the cycle. Factors that influence injury include: the seat back angle, the seat back rebound, the headrest position, the direction the head is positioned at impact (worse if rotated), the occupants gender (females are at greater risk due to a more thin, less muscular neck), the size of each vehicle involved, and more. All these factors make it extremely challenging to accurately reconstruct a MVC on paper.

The most common symptoms associated with WAD include neck and upper back pain and headache, referred pain into the mid-back or down an arm and sometimes legs. The onset of symptoms can be immediate or delayed for days. Risk factors that worsen the prognosis of a case include: the presence of radiating pain from the neck to the arm and hand that follows a specific nerve, failure to respond to initial treatment, a delay in getting treated, and being placed in a cervical collar (especially if not allowing to be mobilized and exercised — i.e. chiropractic care). The key to the success of WAD treatment is to get treated immediately, don’t restrict yourself to a cervical collar, unless you have an unstable fracture, and do your exercises!

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.