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Hip Pain and Total Hip Replacement

18 Mar

According to medical historians, the first artificial total hip arthroplasty (THA) was performed in Germany in the early 1890s. Since then, there have been many advancements in the design of the artificial hip and how the procedure is performed, even to the point of the introduction of the minimally invasive total hip arthroplasty, or miTHA, which offers similar long-term outcomes but involves only a small incision size results in less pain and disability in the surgical recovery period. An individual with pain or mobility issues associated with hip dysfunction may wonder if a hip replacement is in their future, but how would they know?

It’s estimated that more than half of hip fractures occur at the femoral neck or the angled bony stem that connects the thigh bone to the “ball” of the hip. Several studies have shown that when a femoral neck fracture does not initially lead to a hip replacement, there is a high risk for osteonecrosis, or the death of the bone due to reduced blood supply, which would need to be addressed with THA. Hence, individuals with a history of hip fracture and progressively worsening pain may be a THA candidate.

But what about those without a history of hip fracture? At the end of the 20th century, most THA patients were over 60 years old, and the advice from clinicians was to wait as long as possible before undergoing the procedure. In recent decades, that advice has shifted with some patients opting for THA in middle age.

However, one reality about surgery is that it can’t be undone if it doesn’t resolve the problem, and there is always the risk of complications. That’s why treatment guidelines often recommend exhausting non-surgical options before consulting with a surgeon. For the patient with hip pain and disability, chiropractic care may be a non-surgical approach worth considering.

Depending on examination findings, treatment may involve the application of manual therapies, modalities, and specific exercise recommendations to restore normal motion to the hip joint. Additionally, a doctor of chiropractic will look for potential issues elsewhere that may be placing added stress on the hip, such as the knees, ankles, and lower back. In many patients, there may be several contributing causes to the patient’s chief complaint, and each will need to be managed to achieve an optimal outcome.

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 Carpal Tunnel Syndrome

16 Mar

While many people may consider carpal tunnel syndrome (CTS) to be the default cause of any pain, numbness, tingling, or weakness in the hand and/or wrist, the condition is more complex. In some cases, a patient with such symptoms may not have CTS at all. So when a patient comes into the office to be evaluated for CTS, how does their doctor of chiropractic determine if CTS is the culprit and how is the condition managed?

To begin, CTS occurs when the median nerve is compressed as it travels through the wrist, which can result in pain, numbness, tingling, and weakness in the thumb, index, middle, and the thumb side of the ring finger. Traditionally, investigators believed the compression of the median nerve itself was responsible for generating these symptoms, but recent studies suggest it may be reduced mobility of the median nerve that’s to blame or it may be a combination of both compression and loss of nerve mobility.

If the patient’s symptoms are localized to the thumb and the first three fingers, as described above, then the median nerve may be affected. However, if symptoms occur on the other side of the ring finger and the pinky, then a different nerve, the ulnar, may be entrapped.

The median nerve itself doesn’t just appear at the wrist. It arises from the neck, passes through the shoulder, and runs down the arm. Compression of the median nerve at any of these locations can result in CTS-like hand and wrist symptoms, even in the absence of symptoms further up the course of the nerve. Additionally, compression can occur in multiple locations, which is described as double- or multi-crush syndrome. This was first reported in 1973 by Upton and McComas, and since then, multiple studies have reported that when a nerve is compressed in more than one location, it becomes hypersensitized and is more susceptible to damage or injury.

When median nerve entrapment is suspected, a doctor of chiropractic will examine the entire length of the nerve to identify all possible issues that should be addressed. If the contributing factors are musculoskeletal in nature, then treatment may include manipulation, mobilization, soft tissue work, modalities, nocturnal splinting, workstation modifications, stretches, and at-home exercises to reduce pressure on and increase the mobility of the median nerve. Changes in hormone levels can also lead to swelling of tissues that surround the median nerve. In which case, co-management with the patient’s physician may be required to achieve an optimal outcome.

The good news is that the non-surgical, multi-modal approach used by doctors of chiropractic is highly effective in patients with CTS, especially if the patient seeks care early in the course of the disease when the symptoms are milder.

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.

Treating Low Back-Related Leg Pain

12 Mar

Low back-related leg pain (LBRLP) is a common condition that drives patients into primary care clinics, including chiropractic offices, but these cases are often complex, and determining the underlying cause can be clinically challenging. Let’s take a look at the current treatment strategies for LBRLP.

To begin with, the patient’s doctor will need to determine if the leg pain is radicular or referred in nature as this will help indicate which structures or soft tissues in the lower back will need to be addressed. The term “radicular” is reserved for the presence of nerve root compression or a pinched nerve root, most commonly caused by a herniated low back disk. Referred leg pain arises from a ligament, joint, or a tear in the outer layer of the disk (which can precede herniation).

Some clinical signs and symptom that support radicular leg pain include a more specific geographic tracing of leg pain that often exceeds the level of the knee affecting the outer foot (S1 nerve), the top of the foot (L5 nerve), or the inside of the foot (L4 nerve). In radicular LBRLP, there may also be neurological loss such as sensory impairment and/or muscle weakness in a specific area or in certain muscles that can help determine the specific nerve(s) involved. Patients often describe referred leg pain as a generalized deep ache or numbness that often stays above the knee. It’s also possible for the patient to have multiple contributing causes for their LBRLP, which can make the diagnostic process more complex.

From a treatment standpoint, studies show a lack of long-term benefits for managing LBRLP with prescription medication, epidural corticosteroid injections, and surgery. However, there is evidence that spinal manipulation—a treatment provided by doctors of chiropractic—is more effective than no treatment, passive modalities, and exercise in managing LBRLP. In fact, a 2019 survey of 1,907 chiropractors revealed that 81% often treat patients with LBRLP.

More recent research suggests combining spinal manipulative therapy with exercise, and patient education may provide even better results for patients with LBRLP.  This makes sense as there have been several studies showing that a multimodal management approach for low back conditions such as degenerative joint and/or disk disease, spinal stenosis, and disk herniations is often superior to a single treatment strategy.

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.

Combating the Obesity Epidemic

18 Feb

Obesity is defined as having a body mass index (kg/m²) of 30 or higher. The Centers for Disease Control and Prevention reports that approximately 42.4% of adults in the United States are obese, up from 30.5% just two decades ago. The current scientific literature notes that obesity is associated with an increased risk for heart disease, diabetes, hypertension, and some cancers.

Being severely overweight can also elevate one’s risk for musculoskeletal pain conditions. In the past, researchers hypothesized that excess weight places added strain on the joints and soft tissues in the body, increasing the risk for injury. This may be a contributing factor, but a 2020 study suggests that inflammation in the body associated with obesity may be a more important risk factor for developing conditions like back and neck pain. Whatever the mechanisms, obesity can cause both long-term health concerns and can make carrying out everyday activities more difficult due to musculoskeletal pain and disability.

The good news is that even if there is a family history of obesity, it may not be due to genetics but rather shared lifestyle habits among family members. Even if an individual has a genetic predisposition for obesity, it’s not necessarily irreversible, and the research shows that engaging in healthy lifestyle behaviors can change how those genes are expressed. So while it may be more difficult for some to achieve a healthier weight, it’s certainly possible in almost every case.

Fat accumulates in the body when excess calories are stored as fat. Diet and exercise are considered the cornerstones of weight management because you can control how many calories are consumed and can take steps to affect how many are burned.

While there’s no one-size-fits-all diet, the current research supports a meal plan that includes plenty of fruits and vegetables, lean meats, healthy fats, and a lower intake of red/cured meat, added sugar, and highly processed food products. The time of day that calories are consumed may also be important. Some experts suggest eating smaller meals throughout the day while others advise intermittent fasting strategies. It may take trial and error to see what dietary strategies are best for you.

Current federal guidelines recommend 150 minutes per week of moderate intensity exercise (or 75 minutes of high-intensity exercise) as well as two resistance training sessions that target the major muscle groups. There’s no consensus on which form of exercise is the best, so you’ll want to experiment to find an exercise strategy that you enjoy and can incorporate into your lifestyle. Of course, consult with your doctor before beginning any diet or exercise program, and don’t be afraid to ask questions or seek advice. Your healthcare provider may have insights that can accelerate the weight loss process or even recommend experts such as a dietician or personal trainer to help you. If back pain, neck pain, or any other musculoskeletal conditions are getting in the way of achieving your goals, your chiropractor can treat you in the office and provide home care recommendations to help keep such issues from flaring up in the future.

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.

At-Home Exercise for Whiplash Associated Disorders

15 Feb

There is plenty of research supporting chiropractic care as an excellent approach for managing whiplash associated disorders (WAD). While the in-office treatment aspect of care—spinal manipulation, mobilization, soft tissue therapy, massage, modalities, etc.—is important for restoring motion and reducing pain in the neck and surrounding areas, it’s the at-home exercises that not only maintain those improvements but reduce the risk for developing chronic pain or experiencing re-injury in the future.

When the neck is injured in a whiplash event—like a car accident—the superficial muscles in the neck will spasm to protect the nearby tissues from further injury. In the short term, this is a good thing, but if movement remains restricted, the deep neck muscles that are important for maintaining posture can become deconditioned.

As the deep neck muscles weaken, the superficial muscles that normally control voluntary movements will take on the added work, resulting in further weakening of the deep neck muscles—setting up a vicious cycle that can prolong or even prevent WAD recovery. In fact, a 2018 study followed 141 WAD patients for one year and found that those who were unable to return to their pre-injury work activities had an average of 50% reduction in neck muscle strength.

That’s why it’s important to engage in at-home exercises to strengthen the deep neck flexor muscles and put them back to work (so you can get back to your life).

One exercise can be performed by retracting your chin inward followed by nodding your head (as if you’re agreeing with what someone said). You can apply resistance by placing your fist under your chin and slowly working against both the upward and downward movements. Start at 10% maximum resistance. As you improve and as tolerance allows, add additional resistance (up to 50-75% max) and reps to your sets, enough to feel fatigue. If you apply 100% resistance, no motion will occur, which is called an isometric contraction, which works too but not as well as isotonic strengthening (resistance with movement).

There are several ways to strengthen and recondition the deep neck muscles, and your doctor of chiropractic will show you the ideal exercises for your unique case and provide additional self-care recommendations to optimize the healing process, which can include exercise advice, dietary recommendations, and nutrition supplement guidance.

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.

Causes of Neck Pain Outside of the Cervical Spine

11 Feb

When neck pain strikes, it’s often assumed the cause is also in the neck. It’s only logical, right? In many cases, focusing on the neck for diagnosis and treatment may lead to a satisfying result but not all the time. For some patients, neck pain may be related to a condition elsewhere in the body, which would need to be addressed for the patient to find lasting relief.

One such area of the body is the shoulder. Past research has shown the conditions can co-occur, and there are also cases in which managing a cervical condition led to improved pain and function in the shoulder joint. A review of findings from four published studies found the opposite can also be the case. The review revealed that patients with chronic neck pain experienced improvements in pain and disability following a three-week course of treatment featuring scapular stabilization exercises. 

A review of findings from 14 studies showed that manipulative therapy applied to the mid-back resulted in improvements in cervical pain and disability among patients with chronic neck pain.

While it makes sense that areas adjacent to the neck like the shoulder and mid-back can contribute to neck pain, the research suggests that even issues farther down in the body can play a role. A 2019 study revealed that individuals with chronic neck pain exhibited differences in walking symmetry, a known risk factor for problems in the knee and hip joints. Another 2019 study showed that patients with chronic neck pain walked with a stiffer spine. It has also been demonstrated that leg length inequality can lead to dysfunction in the knees, hips, and lower back.

The neck plays an important role in keeping the head upright and keeping the eyes level. If the neck needs to overcompensate for deficiencies in movement in the back or lower extremities, it can lead to a painful cervical condition. Doctors of chiropractic are trained to evaluate the whole patient and identify factors contributing to the patient’s chief complaint. In many cases, a combination of manual therapies (manipulation/mobilization), specific exercises, ergonomic modifications, nutritional counseling, and physical therapy modalities can result in a satisfying treatment outcome.

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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