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Chiropractic Care for Chronic Carpal Tunnel Syndrome

11 Jan

Because the early symptoms of carpal tunnel syndrome (CTS) can be mild and tolerable, many patients put off seeing a doctor until the pain, numbness, tingling, and weakness in their wrist and hand is no longer bearable. The current research supports chiropractic care as an excellent non-surgical option for new-onset CTS, but what about patients with chronic CTS?

In a case series study of 18 women with chronic CTS (defined as CTS lasting more than six months), researchers looked at the potential benefits of soft tissue mobilization combined with nerve slider neurodynamic technique on pain and pressure sensitivity at various points along the course of the median nerve from the cervical spine into the hand before, immediately after, and one week following just a single treatment.

The treatment session consisted of a 30-minutes of soft tissue techniques (including soft tissue mobilization, nerve slider neuromobilization, myofascial release, stretching, and cross-fiber friction over the muscular interfaces through which the median nerve travels) at four locations: the front/side of the neck (anterior scalene muscles), the distal to middle anterior upper arm (biceps brachii), the proximal palm-side forearm (pronator teres), and stretching the transverse carpal ligament and soft tissues on the palm-side of the hand. The patients reported a reduction in pain following treatment that persisted for up to one week following just one treatment.

Another study looked at the long-term effects from manual therapies on patients with chronic CTS. In this study, patients received two treatments a week for three weeks. Not only did the patients report improvement in their CTS symptoms following the conclusion of care, but these benefits persisted when researchers followed-up with participants six months later.

Manual therapies are a primary treatment approach utilized by chiropractors for both acute and chronic CTS, along with many standard management strategies such as night splints, physical modalities, and specific home-based exercise recommendations. This multi-modal approach places chiropractic at the top of the list as the ideal choice for the CTS patient!

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.

Cauda Equina Syndrome

7 Jan

The cauda equina (Latin for “horse’s tail”) is made up of many nerves that travel down and exit out the sides of the lumbar spine and sacrum (tail bone) and transfer information (motor and sensory) to and from our legs and brain.

If the cauda equina becomes compressed, the resulting cauda equina syndrome (CES) is characterized by symptoms such as severe low back pain (LBP); numbness and weakness in the legs, buttocks, and perineum (pelvic floor region); weakness of bowel and/or bladder control causing incontinence; and sexual dysfunction.

Potential causes for CES include a severe herniated disk in the lumbar spine (most common cause); narrowing of the spinal canal (called spinal stenosis); a lesion or tumor that applies pressure on the cauda equina; an infection, fracture, or trauma (such as a car crash); or a birth defect.

Cauda equina syndrome is typically diagnosed in the following ways: 1) the patient’s history—often of acute LBP with radiating leg symptoms; 2) a neurological exam to assess sensation, strength, gait, and reflexes; and 3) advanced imaging, such as an MRI or CT scan, of the lower back.

If CES has a fast onset, the patient should seek emergency care. Surgery may be required to avoid permanent sexual dysfunction, loss of bowel and/or bladder control, and in some cases, paralysis of the legs.

If the onset of CES is gradual, then a non-surgical approach such as chiropractic care may be appropriate. Doctors of chiropractic are trained to identify and diagnose CES, but chiropractors usually see these patients long after the initial symptoms since most patients go directly to the ER due to their severity. However, a team of healthcare providers comprising of chiropractors, primary care physicians, physical therapists, occupational therapists, social workers, and/or mental health counselors can manage LBP and other residual problems associated with CES. As with all conditions that result in permanent impairment, those afflicted often need to manage symptoms to obtain an optimum quality of life that chiropractic care can greatly facilitate.

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.

Benign Paroxysmal Positional Vertigo Management Strategies

21 Dec

Benign paroxysmal positional vertigo (BPPV) is a common cause of vertigo, or dizziness, that is associated with movement of the head (though some motions may be more problematic than others) that goes away when movement ceases. Essentially, BPPV is caused by crystals becoming displaced within the semicircular canals (inner ear), which causes eddy currents in the fluid that circulates in the canals. Instead of the normal flow that bends small hair-like nerves in the same direction telling the brain that you’re standing, laying, running, etc., the brain is essentially given mixed messages of what position you’re in, resulting in a “sea-sickness” type of sensation.

There are several “canalith reposition maneuvers” available, and the choice of which maneuver to use depends on which canal(s) is affected. According to the Mayo Clinic, these maneuvers consist of several simple head movements, which can provide release in up to 80% of BPPV patients within a few treatment sessions, though the problem can recur.  

In an August 2020 study, researchers set out to determine whether vitamin D and calcium supplementation could prevent the recurrence of BPPV. A group of 518 BPPV patients from eight participating hospitals were provided with a twice daily 400 IU vitamin D and 500mg calcium carbonate supplement for a year. Another 532 BPPV patients served as a control group that did not receive a supplement.

The data show that patients in the supplement group were less likely to experience a recurrence in the following year (37.8% vs. 46.7%), especially those with low vitamin D levels at the start of the study. The researchers concluded that vitamin D and calcium can be considered in patients with frequent attacks of BPPV, especially when their blood level of vitamin D is low.

            Interestingly, another study published in August 2020 found that vitamin D deficiency may be associated with up to a 3.29 times increased risk for BPPV recurrence, giving individuals yet another reason to spend time in the sun, take a vitamin D supplement, and eat vitamin D-rich foods to improve their vitamin D status.

            A review of your health history and an examination can reveal if your vertigo/dizziness symptoms are indicative of BPPV. If so, your doctor of chiropractic can train you in the various canalith reposition maneuvers to relieve those frequently debilitating symptoms. He or she will also counsel you on nutritional supplementation and diet. As noted in the recent study, the recurrence rate of BPPV is high and the intake of vitamin D and calcium can significantly reduce that rate.

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.

Car Crash Characteristics and Whiplash Recovery

17 Dec

While many cases of whiplash that result from a motor vehicle collision (MVC) have a successful outcome, some experts estimate that up to 25% of whiplash patients will experience chronic pain and disability. Several studies have sought to identify characteristics that differentiate these individuals from those who recover so that additional treatment can be offered to reduce the risk for chronicity. Let’s see if the characteristics of a MVC can shed any light on this…

In a 2019 study, researchers assessed 37 acutely injured patients within a week of their MVC, two weeks later, and three months later in order to determine any association between pain and disability with both specific crash measurements (head turned at time of impact, seatbelt use, whether or not airbags deployed, if the vehicle was struck while stopped or while turning, the principle direction of force, damage cost estimates, speed of impact, etc.) and patient characteristics (sex, body mass index, signs of post-traumatic distress, negative affect, etc.).

The research team identified a positive association between the percentage of self-reported neck disability at three months post-MVC and post-traumatic distress, negative affect (such as anger or sadness), and uncontrolled pain. There was no direct effect with crash characteristics such as vehicle damage, principle direction of force, or speed change. Though they recommended a larger study to confirm their findings, researchers were unable to establish a link between chronic whiplash pain and disability and specific crash characteristics. That is, there was no apparent connection between a person’s risk for ongoing whiplash issues and the severity of the collision. This study points out that recovering from a whiplash associated disorder requires a biopsychosocial care approach, not just focusing on the biology or tissue damage/diagnosis, but also the patient’s attitude about the injury and getting better.

This echoes a similar study that linked post-traumatic stress disorder (PTSD) with prolonged whiplash associated disorders recovery. In the study, researchers found that hyperarousal/numbing PTSD symptoms were predictive of long-term neck pain-related disability.

In addition to managing musculoskeletal disorders with manual therapies, nutritional recommendations, modalities, and specific exercise recommendations, doctors of chiropractic may utilize more whole body, health-oriented approaches to help patients learn how to relax and reduce stress and anxiety with techniques such as deep-breathing, visualization, contract-relax or tensing exercises, and more. When needed, your chiropractor can coordinate with primary care and specialty care providers, such as mental health counselors and clinical psychologists.

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 Neck Pain

14 Dec

Doctors of chiropractic often approach neck pain with manual therapy as the primary form of treatment. However, there are several types of manual therapy, including high velocity, low amplitude (HVLA) thrust manipulation; mobilization; and/or soft tissue techniques. Is one type of manual therapy superior when it comes to managing neck pain? What does the research show? A 2017 systematic review of 23 randomized controlled trials compared various manual therapy techniques on their own (or combined), with or without the addition of specific exercise recommendations.

For acute (recent onset) to sub-acute neck pain, the review concluded:

  • High-velocity, low-amplitude thrust manipulation combined with exercise resulted in better outcomes when treatment was applied to the cervical vs. the thoracic spine.
  • High-velocity, low-amplitude thrust manipulation combined with soft tissue techniques and exercise applied to both the neck and mid-back led to better outcomes than when soft tissue techniques plus exercise only targeted the neck.

For chronic neck pain, the data show:

  • Both HVLA thrust manipulation and soft tissue techniques in addition to exercise are more effective than either manual therapy or exercise alone for improving pain and function.
  • Thrust manipulation applied to the neck and mid-back was more effective for improving neck mobility than mobilization.
  • Mobilization and soft tissue techniques are both more effective than no treatment for improving pain and disability.

This systematic review favors all types of manual therapies for the management of all stages of neck pain (acute, sub-acute, chronic), especially when combined with exercise. The data also suggests the incorporating treatment of the mid-back may lead to better outcomes.

While manual therapies in general can benefit the neck pain patient, the approach a doctor of chiropractic takes will depend on the patient’s unique case (based on patient history and exam findings) and preferences. For example, a patient may prefer a gentle, low force technique or their chiropractor may use a combination of manual therapy techniques. Additionally, care may also include nutritional/dietary recommendations or physical modalities.

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.

Managing Chronic Hamstring Strains

10 Dec

Chronic hamstring strains are more difficult to diagnose because the pain (in the hip region and deep in the buttocks and upper thigh) comes on gradually and is aggravated by repetitive activities like running, rowing, or biking and worsens with prolonged sitting. Hamstring injuries become chronic when a damaged or torn tendon fails to properly heal, often caused by returning to the sport too quickly and/or from mismanagement. Chronic tendonitis can lead to degenerative changes resulting in a weaker tendon, which can lead to long-term pain and disability.

Non-surgical care for chronic high hamstring tendinopathy is often challenging because the usual treatment approaches for acute hamstring strains are less responsive. It’s not unusual for a prolonged recovery of three to six months, with many only partially recovering with a high recurrence rate. Treatment may include:

  1. Rest (time away from a sport), though cross training of a different body region during this time can combat the psychological stress associated with chronic injuries.
  2. Ice and heat (ice packs, baths, and ice massage is initially recommended to reduce pain and inflammation) applied for ten to twenty minutes, every two to four hours each day. Contrast therapy includes alternating between ice and heat to create a “pump” as heat vasodialates blood vesicles and draws in fluids, which loosens fibrotic scar tissue and relaxes muscles, while ice vasoconstricts and pushes out fluid (inflammation).
  3. Because lack of flexibility is “the norm” for chronic high hamstring tendinopathy, regular stretching will be necessary for recovery. Stretches can include lying on the back, pulling the bent knee toward the chest, and slowly straightening the knee; the popular “hurdler” stretch, or sitting with one leg straight on a bench or ground and slowly trying to lock the knee straight while reaching for the toes; or from standing, placing the heel on a chair seat followed by an anterior pelvic tilt (arch the low back by tilting the buttocks upwards).
  4. A mix of concentric (resistance as the muscle shortens, such as bringing the heel toward the buttocks) and eccentric (resistance during the opposite of concentric or the straightening of the knee during a hamstring curl) strengthening exercises will typically benefit patients with chronic high hamstring tendinopathy.

Your doctor of chiropractic can guide you in the treatment process as well as address musculoskeletal issues, such as low back pain, that may have preceded the hamstring injury. As is typical with musculoskeletal injuries, the sooner a patient seeks care, the more likely they will achieve a satisfactory 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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