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Difficultly in Carpal Tunnel Syndrome Management

20 Mar

Carpal tunnel syndrome (CTS) can be a complex condition that can be a challenge to manage for several reasons.

  • There can be multiple contributing causes. Seldom is CTS the result of one traumatic event, like a broken wrist that produces instant symptoms that requires emergency surgical treatment. Rather, the condition tends to develop over time as the result of an accumulation of microtraumas that affect the tissues in the carpal tunnel and place pressure on the median nerve and hamper its mobility. To complicate matters even more, conditions like hypothyroidism, pregnancy, obesity, and the use of birth control pills can also affect the function of the median nerve, either directly or indirectly through swelling/inflammation.
  • Median nerve entrapment elsewhere. The median nerve originates in the cervical spine and travels from the neck to the shoulder and down the arm. Compression anywhere along the path of the nerve can stimulate CTS-like symptoms. Additionally, entrapment of the median nerve elsewhere on its course can often co-occur with entrapment at the wrist.
  • It might not be carpal tunnel syndrome. While we commonly associate symptoms in the hand and fingers with CTS, there are two additional nerves—the radial and ulnar—that innervate other parts of the hand and fingers. Radial and ulnar nerve entrapment can also co-occur with CTS.
  • Work can be the cause. Occupational exposure to vibration, repetitive movements, infrequent breaks, and awkward wrist postures can each increase the risk for CTS. It may not be possible for the patient to change how they perform their work, which can make recovery difficult. 
  • Some factors can’t be controlled. Women are three times more likely to develop CTS than men, which is believed to be due to females having a narrower carpal tunnel and possibly hormonal differences compared with males. The risk for CTS also increases with age. 
  • Patients often wait too long. Because CTS symptoms come on gradually, it’s easy to ignore them, and a patient may not seek care until their symptoms become so bothersome or severe that they simply can’t maintain their usual activities. Unfortunately, the longer a patient waits, the longer it may take to achieve a satisfactory resolution. In some cases, a full resolution may not be possible or surgery may be the only viable option. 

The good news is that chiropractic care can be an effective intervention for managing CTS, especially if you seek care sooner rather than later. If necessary, your doctor of chiropractic will co-manage the case with an allied healthcare provider to give you the best possible chance at recovery.

Pain Relief Chiropractic

4909 Louise Dr

Mecanicsburg, PA 17055

 (717) 697-1888

Member of Chiro-Trust.org 

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Exercises to Prevent Sports-Related Back Pain

16 Mar

According to a systematic review that included 201 studies, low back pain may affect between 10-67% of athletes at any given moment, with anywhere from 17-94% experiencing sports-related back pain each year. This broad range is due to the age, level of competition, and the specific sports included in each study. For example, the data show the risk for low back pain is higher in gymnastics, diving, weightlifting, golfing, football, and rowing. That said, what can be done to lower the risk for sports-related back pain?

In 2022, researchers recruited 70 high school volleyball players—another sport with a high prevalence of low back pain—and assigned them to one of two groups: a control group that continued their normal activities and an intervention group that performed their usual activities in addition to four weeks of stretching and exercises focused on dynamic thoracic mobility and trunk stabilization. This program, which took about ten minutes to complete, included the jack-knife stretch (to loosen the hamstrings to improve forward bending), gastrocnemius stretch (to loosen the calf muscles to enhance ankle dorsiflexion), iliopsoas stretch (to loosen the hip flexors and reduce lumbar lordosis), and trunk stabilization (front plank to strengthen the low back and gluteal muscles).

During the study, 33% of the players in the control group reported low back pain, compared with just 8.8% in the intervention group. This means the participants who worked on improving strength and flexibility were nearly four times less likely to experience low back pain. Additionally, the players in the intervention group demonstrated improved physical function with respect to back endurance; spine/back flexibility; shoulder and trunk range of motion; ankle mobility; and iliopsoas, quadriceps, and hamstring flexibility. 

The study highlights the importance of a strong and flexible core for reducing the incidence of low back pain, something that also applies to non-athletes. Doctors of chiropractic often observe deficiencies in core strength and flexibility in patients with low back pain and advise such patients to perform at-home exercises to not only aid in the rehabilitation process but also reduce the risk for a future episode of low back pain.

Pain Relief Chiropractic

4909 Louise Dr

Mechanicsburg, PA 17055

 (717)697-1888

Member of Chiro-Trust.org 

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Does Lowering Cholesterol Reduce Cardiovascular Disease Risk?

29 Jul

For decades, the public has been told that elevated cholesterol levels are a major cause of heart disease and stroke. However, in recent years, researchers have begun to question this notion.

In an article published in the BMJ (formerly the British Medical Journal) in 2020, an international group of authors discussed the controversy surrounding the use of current recommended cholesterol targets to determine who should be prescribed a statin medication (a primary tool for lowering cholesterol levels). They state the current important targets include: 1) patients who have sustained a cardiovascular event; 2) adult diabetic patients; 3) individuals with low density lipoprotein cholesterol (LDL-C) levels over 190 mg/dl; and 4) individuals with an estimated ten-year risk greater than 7.5%.

However, the authors note that a systematic review of 35 randomized control trials concluded that achieving these cholesterol target levels DOES NOT confer any additional benefit and that using these targets failed to identify many high-risk patients resulting in unnecessary treatment of low-risk individuals and vice versa. Researchers concluded that using LDL-C is questionable as an appropriate target for preventing cardiovascular disease. Further, they describe the significant discordance between well-accepted clinical guidelines and the empirical evidence gleaned from dozens of clinical trials that cholesterol lowering does not reduce cardiovascular disease (CVD) risk or mortality.

Similarly, an April 2018 Journal of the American Medical Association study called SPRINT (Systolic Blood Pressure Intervention Trial) concluded that participants over the age of 65 years old without diagnosed CVD who were taking statins at baseline had no significant differences in primary outcomes when compared to those not taking statins, with or without adjustment for nonrandom statin use and regardless of the ten-year cardiovascular event risk level based on survival/mortality.

So, what DOES increase the risk of heart disease and premature death? An important answer to this question was found in a 2019 study that looked at lifestyle factors and high-risk factors for developing atherosclerosis cardiovascular disease (ASCVD). The study concluded that high-risk lifestyle factors such as poor diet quality, sedentarism, ambient air pollution and noise, sleep deprivation, poor gut health, and psychosocial stress ALL affect numerous direct and indirect pathways that lead to ASCVD.

These are all factors linked to elevated inflammation in the body, suggesting that systemic inflammation may be a primary driver of ASCVD and strategies to reduce inflammation may be the key to reducing one’s risk for cardiovascular disease. These strategies include eating a heart-healthy diet, limiting sedentary behaviors, getting regular exercise, maintaining a healthy weight, not smoking, avoiding excessive alcohol intake, getting plenty of quality sleep each night, reducing exposure to pollutants, and managing stress. If aches and pains are affecting your ability to live a healthier lifestyle, schedule an appointment with your doctor of chiropractic.

This information should not be substituted for medical or chiropractic advice. Any and all healthcare concerns, decisions, and actions must be done through the advice and counsel of a healthcare professional who is familiar with your updated medical history.

The Chiropractic Treatment Approach for Whiplash

22 Jul

Whiplash associated disorders (WAD) describes a constellation of symptoms (neck pain, headache, mental fog, radiating arm pain, mid- and/or lower-back pain, neck and upper back stiffness, muscle spasms, fatigue, anxiety, memory loss, etc.) that can result from the sudden forward and backward whipping motion of the head and neck. While motor vehicle collisions are most often associated with WAD, such an injury can also stem from a sports collision, fall, and physical abuse/trauma. Since the condition is a common reason individuals are referred for chiropractic care, let’s take a look at how WAD is diagnosed and managed.

Your doctor of chiropractic will ask you to complete initial paperwork that includes the usual biographical data as well as questionnaires specific to the event that caused the WAD injury. The physical examination will include various movement tests to help them determine the pain generator(s) and whether or not there is neurological injury. X-rays taken from the front, side, and at the end range of motion may be used to assess ligament integrity. If necessary, advanced imaging—a CT scan or MRI, for example—may be ordered to provide a clearer picture about damage to the soft tissues (such as the disks).

The current treatment guidelines for WAD recommend therapies that promote restoration of motion and for patients to continue activity as much as “normal” since immobilizing the neck (by wearing a cervical collar, for example) can actually delay recovery and prolong a return to normal activity. Doctors of chiropractic are trained to employ a number of manual therapy options for reducing pain and disability to facilitate the healing process. In-office treatment may also include massage and physical therapy modalities like electric stim, ultrasound, laser, magnetic field, and more.

A chiropractor may also prescribe specific exercises for the patient to perform at home to strengthen the deep cervical muscles and to improve the patient’s range of motion. To manage pain and inflammation, the patient may also receive instruction on the application of heat and/or ice, as well as recommendations for natural anti-inflammatory agents like ginger, turmeric, bioflavonoids, or to reduce their intake of processed foods, which can promote inflammation in the body. If brain injury is present, chiropractors frequently partner with other healthcare professionals who specialize in such matters. Often, a team approach will offer the best outcomes in more complicated cases.

Since studies have demonstrated that WAD patients who delay care are more likely to develop chronic symptoms, it’s important to receive a thorough examination of the neck and associated soft tissues sooner rather than later.

This information should not be substituted for medical or chiropractic advice. Any and all healthcare concerns, decisions, and actions must be done through the advice and counsel of a healthcare professional who is familiar with your updated medical history.

Chiropractic Care for Older Headache and Neck Pain Patients

20 Jul

Neck pain and headaches are a leading cause of pain and suffering that affects hundreds of millions of seniors worldwide. Until recently, the use of chiropractic care for elderly adults with headaches and/or neck pain has been poorly understood. Let’s investigate the effectiveness of chiropractic care for the elderly who are affected with these conditions.

Questionnaires completed by 288 doctors of chiropractic revealed that close to a third (28.5%) of their caseload are patients over the age of 65, of which 45.5% presented with neck pain and 31.3% had co-morbid headache. For these patients, treatment typically consisted of a combination of physical (exercise training, traction, e-stim and/or ultrasound) and manual therapy treatments (spinal manipulation, mobilization, soft tissue therapies, and/or massage) applied to the thoracic and cervical spinal regions. On average, patients required nine visits to achieve a satisfactory outcome; however, migraine patients usually required two additional visits, on average.

The authors concluded that the chiropractors surveyed used well-established conservative techniques to effectively manage neck pain the elderly population. Additionally, the researchers note that 82% of the patients in the study utilized at least one additional health service to help manage their condition.

A 2017 collaborative study between the World Health Organization (WHO) and the “Lifting the Burden” campaign emphasized the importance of interdisciplinary collaboration in the management of patients with headaches. Indeed, the study cited that patients have a “clear preference” for the use of complementary and alternative treatments for headaches, of which spinal manipulation is listed as a highly effective treatment strategy. Other studies have noted that chiropractors are one of the most common provider types for patients with migraines, and nearly a third of such patients seek out chiropractic care.

While this article mainly focuses on chiropractic care for the management of neck pain and headache in older adults, patients of all ages can benefit from a multimodal approach that includes manual therapies, specific exercises, nutrition recommendations, etc. to restore normal motion to the neck, shoulders, and upper back to reduce pain and disability.

This information should not be substituted for medical or chiropractic advice. Any and all healthcare concerns, decisions, and actions must be done through the advice and counsel of a healthcare professional who is familiar with your updated medical history.

Manual Therapy for Knee Pain

15 Jul

Knee pain is a common complaint, and patients often wonder if manual therapies provided by a doctor of chiropractic can help manage their knee pain. In many cases, the answer is yes. Let’s take a look at what the research has to say about using manual therapy to address two frequent causes of knee pain and disability: knee osteoarthritis (KOA) and patellofemoral (PF) pain.

A recent systematic review and meta-analysis (the highest regarded level of research) studied the effectiveness of manual therapy for relieving pain, stiffness, and dysfunction in patients with KOA. The review uncovered 14 studies that showed that manual therapy offered “statistically significant” benefits in relieving pain, stiffness, and improving function, with the best results obtained when treatment extended for four or more weeks. The authors concluded that manual therapy is effective and safe and offers a complementary and alternative treatment option for KOA.

In a 2021 study, researchers found that KOA patients who received treatments that included manual therapy and supervised exercise experienced more significant improvements in pain and functions than participants in a supervised exercise-only group.

In 2018, an international panel of 41 specialists released a consensus statement following their review of the available literature with respect to the treatment of PF or kneecap pain and made strong recommendations in support of the use of exercise therapy (especially when combined with hip- and knee-focused exercise) and foot orthoses to improve PF pain and/or function. Researchers also found support for manual therapy applied to the soft tissues, dry needling, and gait retraining; however, they required additional evidence prior to issuing a strong recommendation for these treatment options.

A 2020 study reported that mobilization is an effective treatment in both weight bearing and non-weight bearing positions. Another study published in the same year recommended addressing alignment, muscle imbalance, and patellar maltracking in runners with PF pain.

A literature review published in 2021 highlighted the importance of patient education (PE) with and without targeted, knee-specific exercise intervention as important components of care in decreasing pain and improving function in patients with PF knee pain. The review recommended including individualized PE to each patient that focuses on the latest effective treatments, self-management strategies (specific exercise training), and an explanation of risk factors and movement patterns that may lead to and/or exacerbate PF pain.

For both PF and KOA, doctors of chiropractic utilize a multimodal approach that may include patient education, focused exercises, manual therapies, posture correction, gait retraining, nutrition recommendations, and prescription foot orthotic fitting, if necessary.

This information should not be substituted for medical or chiropractic advice. Any and all healthcare concerns, decisions, and actions must be done through the advice and counsel of a healthcare professional who is familiar with your updated medical history.

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