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When to Seek Surgical Care for Carpal Tunnel Syndrome

6 Aug

Carpal tunnel syndrome (CTS) is a condition that occurs when the median nerve is compressed as it passes through the wrist. One treatment option available to patients is carpal tunnel release surgery, which severs the carpal tunnel ligament to reduce pressure on the affected nerve to resolve the numbness, pain, tingling, and weakness symptoms associated with CTS. When is surgical treatment for CTS necessary and when should a non-surgical option be pursued?

The short answer is that surgery should only be considered as a first option in an emergency situation, such as a serious wrist fracture that pinches the median nerve. Beyond that, treatment guidelines generally advise patients to exhaust non-surgical, conservative approaches before consulting with a surgeon. Aside from potentially higher healthcare costs and a prolonged recovery, surgery also carries the risk for serious complications. Another thing to consider is that the current research suggests that jumping straight to surgery may not necessarily produce better long-term outcomes than non-surgical treatment options.

In one randomized clinical trial, researchers recruited 120 female CTS patients to receive either surgery or a conservative treatment approach that involved manual therapies. The research team evaluated each patient after one month, three months, six months, and one year. In the short term—one month and three months—the results favored the conservative approach. However, both groups reported similar outcomes after six months and one year.

The same research team repeated the study with another group of female CTS patients and reported similar results. In the short term, conservative care achieved greater results while both approaches had similar outcomes over the long term.

A systemic review that looked at results from ten studies involving patients with confirmed CTS in one or both hands came to a similar conclusion. The review found that non-surgical care provided more satisfying results in the short term with both approaches achieving similar results over time.

While these studies show that conservative treatment to reduce pressure in the carpal tunnel is an effective option for the CTS patient, doctors of chiropractic will also examine the full course of the median nerve to identify other places the it may be compressed, such as the neck, shoulder, and elbow. Median nerve compression in these areas can often co-occur with CTS and will need to be addressed to achieve a satisfactory result.

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.

Spinal Stability and Low Back Pain

3 Aug

When it comes to managing a low back condition, the goal of chiropractic treatment is for the patient return to their normal daily activities as soon as possible. This not only means addressing low back pain but also low back disability, including impaired postural control and reduced spinal stability, which can manifest in reduce position sense, increased postural sway, and impaired balance.

Movement control and spinal stability are controlled the deep muscles, the superficial muscles, and the nervous system that sends information to and from the brain. Dysfunction in ANY of these can result in lumbar spine instability.

To complicate matters, when an injury is present, the body will alter its neuromotor patterns as a protective mechanism. However, this can lead to some muscles becoming overworked while others may become deconditioned. If unaddressed, additional musculoskeletal conditions may result in nearby parts of the body, which explains why patients will often present with multiple seemingly unrelated complaints.

In addition to manual therapies like manipulation and mobilization to restore proper joint movement, treatment for low back pain may also include core stabilization/strengthening exercises and balance exercises.

For abdominal strengthening, one exercise that works well is a spine-sparing sit-up. Place the hands behind the lower back to prevent flattening of the lumbar curve and lift the head and chest as a unit a few inches off the floor, hold for ten seconds, and repeat to tolerance (five to ten reps to start out with).

To strengthen your sides, try a side-bridge or side-plank (from feet or knees), holding for ten seconds and repeating as tolerated.

To strengthen the back, try the front plank. Rest on your forearms in a push-up position for ten seconds and repeat as tolerated. The bird dog is another good exercise. Kneel on your hands and knees and raise the opposite arm and leg without twisting the trunk and hold for ten seconds, repeat with the other arm/leg.

For improved balance, stand on one leg with your eyes open or closed (if able) as long as you can. This stimulates the neuromotor system.  Be safe, and do these in a corner to prevent falling!

Make these exercises a habit. Consistency will help improve low back function and you’ll reduce your risk for a future episode of low back pain!

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.

Lowering the Risk for Chronic Disease

30 Jul

It’s common for the elderly to have multiple chronic conditions, all of which can impact their ability to live a vibrant, independent lifestyle. While it may not be possible to avoid adverse health conditions in our later years, it appears there are steps we can take now to give ourselves the best possible chance to maintain good health for as long as possible.

In an April 2020 study published in the Journal of the American Medical Association, 32 researchers from around the world collaborated to investigate the association of a healthy lifestyle with years lived free of major chronic diseases like type 2 diabetes, coronary heart disease (CHD), stroke, cancer, asthma, and chronic obstructive pulmonary disease (COPD). The data set for the study included 116,043 adults (average age 43.7 year) whom researchers followed for an average of 12.5 years.

At baseline, the investigators looked at four lifestyle factors (smoking, body mass index, physical activity, and alcohol consumption) and assigned a scoring system for each factor (0=poor; 1=intermediate; 2=optimal) for a total score of 8.

During the course of the study, 15% of participants developed at least one chronic disease. The research team’s analysis showed that every one-point increase in an individual’s healthy lifestyle score translated to an increase of .96 chronic disease-free years in men and .89 chronic disease-free years in women.

Compared to individuals with a score of 0, those with a score of 16 benefited from an average of 9.4-9.9 additional chronic disease-free years!

The findings showed that maintaining a healthy weight (BMI or body mass index of ~25), not smoking, avoiding excessive alcohol consumption, and getting regular exercise dramatically increased the odds of reaching age 70 without chronic disease.

Doctors of chiropractic frequently encourage patients to live a healthy lifestyle because not only can it add years to your life, as this study suggests, it can add life to your years.

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.

Reducing the Risk for Chronic Whiplash-Related Pain

27 Jul

A study published in 2019 found that nearly half of whiplash associated disorders (WAD) sufferers are still symptomatic one year after their injury. Why is that, and what can one do to reduce their risk for chronic WAD symptoms?

The most common source of pain from WAD injuries arises from joint capsules and ligaments, which are tough, tight bands of tissue that hold joints together and help stabilize the cervical spine. When these soft tissues are damaged, the body will take measures to restrict movement so that the injury doesn’t become more severe. This is one reason why cervical range of motion is reduced when the neck is injured.

You may recall that a patient with whiplash used to be fitted with a cervical collar to protect the neck and limit movement. However, researchers have since discovered that, in many cases, restricting all cervical movement for a prolonged period of time can lead to a weakening of the deep neck muscles—which are important for maintaining cervical posture—and the buildup of potentially troublesome scar tissue. These days, patients are encouraged to remain active provided their movements do not generate acute pain. Not only does staying active reduce the risk of deep neck muscle atrophy, but movement is necessary to produce the compressive forces that help maintain the flow of nutrients to the cartilaginous tissues in the neck.

The back-and-forth whiplash process can also result in trauma to the brain, also known as a concussion. The brain is suspended in the skull by ligaments and is cushioned by fluid. In a rear-end collision, the oblique angle of the chest restraint results in a twisting of the torso upon impact as the body accelerates forward. The brain slams into the front inside of the skull and then rebounds and hits the back inside of the skull as the trunk is forced backward during the deceleration phase of the injury. Depending on the degree of force, concussion can involve the front, back, or both parts of the brain resulting in memory problems, confusion, fatigue/drowsiness, dizziness, vision problems, headache, nausea/vomiting, light/noise sensitivity, and more. The good news is that chiropractic care applied to the cervical spine has been demonstrated to benefit patients with these post-concussive symptoms that often accompany WAD, which may reduce the chances that such symptoms become chronic in nature. The current research suggests that patients who seek treatment soon after a whiplash event— like a car accident, slip and fall, or sports collision—are not only more likely to experience a faster recovery but they are also less likely to develop a chronic condition. Chiropractic care offers a safe and conservative form of treatment for WAD that is often recommend by treatment guidelines.

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.

Neck Pain Among Office Workers

23 Jul

Neck pain is the second most common reason patients seek chiropractic care, and it’s particularly a problem with office workers. One study estimated that neck pain affects 42-69% of those who work in office environments. Many such individuals will experience recurring episodes of neck pain, and at least one in six may develop chronic, ongoing neck pain. While chiropractic offers a safe and effective way to manage neck pain, are there any steps an office worker can take to reduce the risk for neck pain in the first place?

According to one study, taking a daily walk may be an effective neck pain prevention strategy. In the study, which included 387 office workers without spinal symptoms in the previous three months, researchers asked participants to wear a pedometer and note any spinal pain symptoms over the next year.

Of the 367 participants who completed the study, 16% reported the onset of neck pain. The results showed that for every 1,000 steps a participant averaged each day, their risk for neck pain fell by 14%. The authors concluded that increasing daily walking steps is protective for the onset of neck pain in those who work sedentary jobs, and managers should formulate and test strategies to encourage walking to reduce the incidence of neck pain among employees.

What about other forms of exercise? A meta-analysis of data from two randomized control trials that included over 500 participants showed moderate-quality evidence that participating in a workplace exercise program can reduce the risk for developing a new episode of neck pain by up to 68%. In the first trial, participants performed stretching and endurance training twice a day at work and twice a day at home. The second trial involved a combination of strength, stabilization, aerobic, and body awareness exercises that included health information, ergonomic training, and stress management training three times a week for one hour over a nine-month time frame.

While it’s not possible to completely avoid a condition like neck pain, the evidence suggests that regularly engaging in physical activity may substantially lower the risk. For those who do develop neck pain, it’s important to seek chiropractic care as soon as possible, which may lead to a faster resolution of symptoms and reduce the risk for both neck pain recurrence and chronic neck pain.

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.

Footwear Changes for the Knee Osteoarthritis Patient

20 Jul

Osteoarthritis (OA) is the leading cause of knee pain and disability in the elderly population. While treatment to address knee OA will often focus on the knee itself, a patient may also need to change their footwear. Why is that?

During normal walking, joint loading is NOT evenly distributed, and the distribution most often greatest on the medial (inner) side of the knee. This greater load can cause  wear and tear over time and lead to thinning of the smooth, slippery cartilage surfaces on the medial side of the joint, which eventually leads to bone-on-bone contact, the end-stage of OA. By changing where joint loading occurs on the knee, it’s possible to slow this process and potentially delay or even prevent the need for a knee joint replacement.

This can be accomplished through either a change in footwear or adding an insole or orthotic to an existing shoe. On the footwear front, an OA patient may need to avoid clogs, barefoot shoes, high heels, and extra-rigid/stiff shoes. Rather, walking or running shoes or, for more formal occasions, a shoe with a shock-absorbing sole and padded collars that’s not too rigid may be a better choice. A well-trained employee at a specialty shoe store can help identify which shoes will work best for your situation.

One study investigated the use of lateral wedges both with and without custom arch supports for people with medial knee osteoarthritis (OA) and pronation (rolled in feet). Each of the 26 participants wore one or the other for two months and switched to the other option after a two-month “washout” or rest period. The researchers concluded that the lateral heel wedge WITH foot orthotic/arch supports provided the best benefit to the participants with respect to performance on a timed stair climb test. Another study found that adding a mobility shoe reduced medial joint loading to an even greater degree.

For the knee OA patient, chiropractic treatment may also include specific exercise training, weight management/nutrition, manual therapies, modality use (electrical stim, magnetic field, laser, ultrasound, and more), and the use of a knee brace—all in the effort to reduce pain and improve mobility.

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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