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Non-Surgical Care for Rotator Cuff Tears

17 Feb

While the anatomy of the shoulder allows for a wide range of motion and movement, it comes at the cost of a less stable joint, especially for those who routinely perform activities that require lifting the arms. This is likely why shoulder pain is one of the leading reasons patients seek chiropractic care, trailing behind low back and neck pain. The most common cause of shoulder pain is from tearing of the rotator cuff muscles (RCMs), particularly muscles that rotate the shoulder outward.

The “typical” rotator cuff tear patient is typically over 50 years of age with shoulder pain that has slowly worsened over time. A 2018 study found that as many as 96% of people over age 50 have RCM abnormalities, of which MANY are asymptomatic or non-painful. The study also reported that 24% of a random sample of 46 young people with an average age of 23 years old with no symptoms and no history of past injury, had degenerative changes in the RCMs. This finding supports the notion that rotator cuff injuries may occur early in adulthood and progress slowly until the symptoms drive a patient to seek care.

In a study involving 167 patients with rotator cuff tears, researchers observed no difference in outcomes one year after participants received either conservative care or surgery. This led the authors to recommend that non-surgical care, such as chiropractic care, should be considered as the PRIMARY method of treatment for rotator cuff tears of non-traumatic origin.

One study looked at impingement syndrome in a case series of four patients who received multimodal chiropractic care that included shoulder manipulation, shoulder girdle exercises, and ultrasound. In all four cases, the patients reported complete resolution of their shoulder pain and disability with five treatments. When researchers followed up with the patients four to eight weeks later, the participant’s symptoms had not returned.

A systematic review of data from 200 articles found evidence for the following non-surgical treatment options—which are commonly provided in chiropractic clinics—for shoulder pain: exercise training (specific favored over general), manual therapy, laser, extracorporeal shockwave, pulsed electromagnetic field (PEMF), transcutaneous electrical nerve stimulation (TENS), myofascial trigger point therapy, acupuncture, and microwave and light therapy. For a patient with a rotator cuff tear, conservative chiropractic care is an excellent option for reducing pain and improving function in the affected shoulder!

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 vs. Surgery for Carpal Tunnel Syndrome

13 Feb

When people suspect they have carpal tunnel syndrome (CTS), it’s typical that their first thought is that their condition will require surgery and a lengthy recovery. While surgery may be warranted in emergency situations, treatment guidelines encourage patients to seek non-surgical options first. So how do non-surgical approaches like manual therapy interventions —provided in a chiropractic setting—compare with surgery to treat CTS?

In 2018, a team of European researchers reviewed data from ten studies that compared the effectiveness of surgery vs. non-surgical care for the treatment of CTS. While the results favored non-surgical approaches at three months and surgery at six months, the available data show no difference in outcome one year later. Thus, the research team concluded that conservative treatment should be preferred unless otherwise indicated.

If both surgery and non-surgical options produce similar outcomes at the one-year mark, can CTS improve on its own?

In one study that involved 22 patients (19 of whom had CTS in both hand), researchers incorporated a twelve-week waiting period into the experiment to see if symptoms worsened, stayed the same, or improved. Questionnaires completed by the participants who abstained from manual therapy interventions showed that their symptoms worsened during the twelve-week non-treatment period.

The treatment phase of the study involved six sessions twice a week for three weeks and incorporated manual therapies to address the soft tissues of the hand and wrist and the carpal bones. The patients reported that treatment resulted in improvements with respect to both pain and function. This led the researchers to recommend manual therapy interventions as a valid non-surgical treatment approach for CTS. Doctors of chiropractic specialize in manual therapy techniques and employ these regularly for many neuromusculoskeletal conditions, including CTS and related conditions that may contribute to a patient’s hand and wrist symptoms—something that a carpal tunnel release procedure cannot address. To achieve optimal results, it’s important to seek PROMPT assessment and non-surgical treatment for CTS.

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.

Low Back Pain and Directional Preference for Exercises

10 Feb

Several studies have found that a treatment approach that combines specific exercises with spinal manipulation, mobilization, and nutrition is often ideal for reducing pain and improving function in patients with low back pain. But how does your doctor of chiropractic know which low back exercises to recommend and which to avoid? The answer: it depends.

Because each patient is unique (age, health status, fitness), it’s clear that exercise prescriptions need to be individually tailored to be safe and to avoid injury. Perhaps one of the most important tools your doctor will take into consideration is the concept of directional preference. That is, which position helps your back feel good or bad? From a sitting position, first slump and slouch and then ask yourself, “Does this feel good, bad, or no different?”

Next, sit up straight and arch your lower back and ask the same question. Do you prefer one over the other? If so, the position in which you feel BEST is YOUR directional preference.

Using that concept, let’s say you feel best slumped and slouched, which is quite common. What are the “BEST” exercises for this flexion directional preference (FDP)?

  • While laying down and facing upward, pull one knee to the chest followed by the other, repeating five to ten times each (staying within reasonable pain boundaries).
  • While laying down and facing upward, flatten and “push” the arch of your lower back into the floor by rocking your pelvis forward and hold three to five seconds, repeating five to ten times.
  • While sitting, bend forward and try to touch your toes. Repeat multiple times a day as needed.

If you feel best in the arched sitting posture, then the ideal exercises for you may be those that utilize the extension directional preference (EDP):

  • While sitting or standing, place your hands behind your back, and arch your back over your hands (as far as comfortably allowed). Hold for three to five seconds, repeat five to ten times.
  • Sit up as arched as your can and try to hold that position as long as possible when doing sitting tasks (computing, driving, etc.).
  • Do a “saggy push-up” (also called a “Cobra,” or prone press-up) by keeping your hips on the floor while doing a push-up, arching the low back.

You can improvise and make up your own exercises using this concept, but while some discomfort is to be expected, avoid sharp lancinating pain. If you don’t have a directional preference and feel good in both positions, do ALL of the above! Your doctor of chiropractic can help monitor and train you in these and many more exercises as part of your treatment plan to reduce back pain and improve back function.

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.

Reasons to Eat More Blueberries

27 Jan

Not only are blueberries delicious and easily attainable at the supermarket but they are also incredibly good for you. But don’t take our word for it, let’s look at what researchers say…

A 2019 review looked at findings from eleven studies that involved blueberry interventions. The researchers found that blueberries benefit memory and executive function in both children and adults, and blueberries can improve psychomotor function in seniors, including those with mild-cognitive impairment. The authors also reported that blueberry intake reduces risks for developing metabolic syndrome (heart disease, stroke, and type-2 diabetes), cancer, cardiovascular disease, and cognitive decline.

In a 2018 study involving 215 older adults, researchers observed that those with the greatest cognitive impairments who consumed a daily 600mg polyphenol-rich grape and blueberry extract for six months experienced significant improvements with respect to episodic memory.

Not only are blueberries low in calories (only 84 calories per cup) but just one cup of blueberries contains four grams of fiber, 24% of the recommended daily allowance (RDI) of vitamin C, 36% of the RDI of vitamin K, and 25% of the RDI of manganese.

Blueberries are antioxidant rich, which can protect the body from the free radicals that are known to damage cells and contribute to aging and diseases, like cancer. These antioxidants can also reduce oxidization of LDL (“bad”) cholesterol, which is a risk factor for heart disease.

There is research that suggests regular blueberry intake is associated with lower blood pressure and a reduced risk for heart attack.

Blueberries can improve insulin sensitivity and glucose metabolism—both of which can reduce the risk for diabetes and may even benefit diabetics.

Much like cranberries, blueberries contain anti-adhesive substances that can help keep bacteria from sticking around in the bladder and causing a urinary tract infection.

If you regularly exercise (you do, don’t you?), then the good news is that blueberries may reduce soreness and aid in muscle recovery following a strenuous workout.

BOTTOM LINE: Eat blueberries!

 

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.

Management Strategies for Whiplash and Dizziness

20 Jan

Of all the symptoms associated with whiplash associated disorders (WAD), dizziness may be one of the most concerning to patients because of how it can limit their ability to get up and move around. What can be done to treat dizziness following a WAD injury?

Two studies published in 2019 suggest that manual therapies and therapeutic exercises may be an effective option for such patients.

The first study included 40 WAD patients randomly assigned to either a treatment group or control group. The treatment group engaged in twelve 50-minute exercises sessions spread out over a six-week time frame. The exercises included standing on a foam surface and turning the head side-to-side; walking on an inclined plane and turning the head side-to-side; standing on a trampoline and moving the eyes side-to-side; heel-to-toe walking on a line for up to 5 meters (16.4 feet), and standing on one leg. If able, the treatment group repeated the same exercises with their eyes closed. Assessments completed at the end of the experiment revealed substantial improvements in both dizziness and quality of life among participants in the exercise group that were not experienced by those in the control group.

In the other study, researchers assigned 86 patients with chronic cervicogenic dizziness to one of three groups: SNAG (Sustained Natural Apophyseal Glide) exercise for six weeks; passive joint mobilization with range of motion (ROM) exercises for six weeks; or a control group that received no treatment. The SNAG exercises involved two movements (repeated ten times each): 1) Sit/Stand. Place a towel across the upper neck; as you pull forward with the towel, chin-tuck while pushing back into the towel. 2) Hold one end of the towel against the chest; rotate the head/neck toward the same side as far as possible; with the towel wrapped across the top of the neck, gently push the head further into rotation.

The research team reported that participants in both treatment groups experienced improvements with respect to dizziness, balance, cervical range of motion, and head repositioning accuracy. The authors of the study concluded that both treatment approaches are effective for cervicogenic dizziness (dizziness caused by cervical dysfunction).

The good news is that both spinal mobilization and active exercise are utilized by doctors 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.

Headaches May Suggest a More Severe Concussion

13 Jan

Cervical dysfunction is often a cause or contributing factor of headaches, especially those that occur following a sports injury, slip and fall, or motor vehicle collision. The results of a 2019 study suggest that headaches may also indicate when a patient has a severe traumatic brain injury (TBI).

In the study, researchers asked 121 children with a history of TBI to fill out a questionnaire called the Sports Concussion Assessment Tool (SCAT). A higher score on the SCAT is indicative of a more severe TBI. Among the participants, the SCAT revealed that a third (40) reported headaches following their injury. When the researchers compared the SCAT scores of the kids with post-TBI headaches and those without headaches, they found that the participants who experienced headaches scored five times higher (median score 45.5 vs. 9). These children also performed worse on cognitive assessments involving color naming, matrix reasoning, letter sequencing, and letter switching.

The authors concluded that when headaches are associated with TBI, higher symptom scores (i.e. more severe symptoms) for ALL other symptom categories (sleep, mood, sensory, and cognitive domains) can be expected. In addition, those with headaches also tested worse on neurocognitive examinations.

Interestingly, a study that included a wider age range reported that headache “is consistently the most common symptom following concussion and occurs in over 90% of athletes with sport-related concussion,” which is much higher than the 33% found in the above- mentioned study.

Another study that analyzed information from two large databases found that patients who are hospitalized for headache symptoms associated with TBI are two times more likely to experience more frequent or worse headache symptoms over the following decade. Thus, the worse the initial TBI, the more likely headaches will persist or worsen.

These studies suggest that when an individual suffers a TBI from a sports injury, slip and fall, or car accident AND they have headaches, their condition may be more severe and may require more specialized care or intensive treatment to achieve a successful outcome. These injuries can also affect the cervical region, which may explain why patients with TBI benefit from many of the same treatment approaches doctors of chiropractic use to treat whiplash associated disorder patients.

 

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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