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Scapular Stabilization for Shoulder Pain

14 Nov

The shoulder is one of the largest and most complex joints in the body. It’s actually three joints—the AC or acromioclavicular joint (the collar bone/acromion of the shoulder blade joint), the glenohumeral joint (the ball-and-socket joint), and the scapulothoracic joint (the shoulder blade/rib cage “joint”)—all of which involve the scapula to some degree.

The rotator cuff is made up of four muscles, three of which sit on the back side of the scapula and rotate the arm outward (external rotation) and one in front that rotates it inward (internal rotation). The trapezius muscle is made up of three parts: the upper part pulls the shoulder blade up and in, the middle portion pulls the shoulder inward, and the lower section of the muscle pulls the scapula down and inward. The chest muscles rotate the arms inward. There is also a “bursa” or a fluid-filled sac that cushions, lubricates, and protects the rotator cuff tendon attachments. The “labrum” attaches to the rim of the “socket” or cup, to give it more depth and stability for the ball to sit in.

While this arrangement gives the shoulder a wide range of motion, it also makes it less stable and more vulnerable to injury. There are many injuries that can affect the shoulder, with one of the most common being tearing of the rotator cuff tendons (called “tendinitis” or “tendinopathies”), which often lead to a bursitis, or swelling of the bursa sac, resulting in shoulder impingement (pain raising the arm). In fact, over half of people in their 80s have tearing of the rotator cuff.

There are many exercises that help return function to the shoulder in both non-surgical and post-surgical cases. Exercises are aimed at restoring motion, strengthening weak muscles, and stabilizing the shoulder. However, studies show that the best results are achieved when scapula stabilization exercises are included in the treatment process.

One GREAT exercise for stabilizing the scapulae is called the Push-Up Plus (PUP). This is performed by positioning yourself into a push-up position (either toes or knees—you choose based on strength) with your hands shoulder width apart, elbows locked straight, and the fingers pointed outward (thumbs at 12 o’clock). Instead of dropping the chest to the floor, PUSH the middle of the back upward toward the ceiling. Hold the position for three seconds and SLOWLY return to the start position. Repeat five to ten times and gradually increase reps as you’re able.

There are several variations of this. For example, rotating your fingers inward increases activity in the rotator cuff muscles (the most important muscle group for shoulder stabilization) and reduces activity in the chest muscles (pectoralis major) and scapula elevators (levator scapula). You can also alter this by raising your feet to different heights, as the higher the feet, the greater the serratus anterior muscle activity! Your doctor of chiropractic can advise you on which shoulder stabilization exercises may provide the most benefit for your unique case.

 

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.

Carpal Tunnel Syndrome 101

11 Nov

Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy, or pinched nerve, in the extremities. The condition is estimated to affect 3-6% of the population, often in both hands. Let’s discuss what causes CTS, its symptoms, how it’s diagnosed, and how it’s treated…

Causation: Carpal tunnel syndrome occurs when pressure is placed on the median nerve as it travels through the wrist. This can be due to inflammation caused by obesity, repetitive movements, pregnancy, arthritis, hypothyroidism, diabetes mellitus, trauma, mass lesions, amyloidosis, sarcoidosis, multiple myeloma, leukemia, and more. Women are at a greater risk for CTS than men, due to having a smaller wrist and possibly hormonal reasons.

Symptoms: Pain, numbness, and tingling are common CTS symptoms that affect the thumb, index finger, middle finger, and the thumb-side of the ring finger. Symptoms can radiate up into the forearm and even into the shoulder and neck. Weakness in grip strength and nighttime/sleep interruptions are also common symptoms.

Diagnosis: The patient history is very important for diagnosing CTS, as it provides the doctor information to help determine if CTS is likely or if another condition is causing the patient’s symptoms, such as ulnar tunnel syndrome or dysfunction elsewhere along the course of the median nerve. The “flick sign” (flicking the fingers to “wake them up”) predicts electrodiagnostic abnormalities 93% of the time with a false-positive rate of <5%. Other in-office tests include provocative tests (reproducing symptoms), neurological tests for sensation (sharp vs. dull), and strength-muscle tests. More advanced electrodiagnostic tests (EMG/NCV or electromyogram/nerve conduction velocity) can quantify the severity of CTS and verify the diagnosis.

Treatment: All treatment guidelines recommend conservative, non-surgical care prior to surgery unless there is a unique, unusual case like trauma (fracture), or some other unusual situation. THIS IS WHERE CHIROPRACTIC SHINES! Besides “usual” non-surgical care (night splinting, anti-inflammatory measures, exercises, and ergonomic modifications), chiropractic treatment includes manual therapies such as soft tissue release techniques and joint manipulation. A 2018 study reported that following manipulative therapy, patients experienced an increase in the front-to-back diameter and roundness of their carpal tunnel, which reduced pressure on the tunnel’s contents. Chiropractors also perform manual therapy based on neurodynamic techniques, which a 2019 study concluded were highly effective in a group of patients with mild-to-moderate CTS.

It’s important to note that patients are more likely to achieve a successful outcome if they seek treatment earlier in the course of the disease than if they wait months or even years. If you experience the symptoms associated with CTS, seek care 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.

Nerve Flossing and Low Back Pain

7 Nov

The sciatic nerve is made up of five nerve roots that exit the spine in the lower back (L4 to S3) and then merge into one nerve that travels through the buttock and into the leg. At the back of the knee, the nerve divides into two nerves, the tibial and common peroneal, that travel into the inner and outer lower leg and foot.

When the sciatic nerve is compressed or pinched, a patient can feel pain, tingling, numbness, and even weakness in the hip, buttock, and leg. For individuals under the age of 60, the most common cause of sciatica is a herniated disk. For older adults, the most likely causes of sciatica are spinal stenosis (a narrowing of the openings of the spine the nerves travel through) and spondylolisthesis (when one vertebra slides forward on the neighboring vertebra).

Normally, a nerve root moves freely in and out of the spine through holes located between each vertebra called intervertebral foramen (IVF). Movements or exercises such as hamstring stretches or punting a football create tension on the sciatic nerve and pull the nerve roots out of the IVFs. Similarly, when we stand up straight and look down at our feet, this pulls the spinal cord upward and the nerve roots move into the IVFs.

When managing sciatica, chiropractors will utilize a technique called nerve flossing. Like flossing teeth, the back and forth motion of the dental floss is conceptually the same action as the back and forth motion of the five nerve roots that merge into the sciatic nerve. To pull the nerve roots out of the IVF, extend the head/neck upward and then flex the foot/ankle upward as well (toes toward the nose). To pull the nerve back into the IVF, point the foot/ankle downward while the head/neck flexes forward (chin to chest). Repeat multiple times as long as pain or other symptoms do not worsen. The idea behind this is to free up the nerve root by reducing adhesions in the IVF.

Nerve flossing is usually performed first by a doctor of chiropractic to make sure it is well tolerated and safe so that the patient can perform the exercise at home several times a day. Studies show that this method helps reduce tension on the sciatic nerve while also stretching the hamstrings, which are often tight in patients with 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.

The Power of Music on the Mind

28 Oct

Using functional MRI, researchers have observed that music activates the visual, motor, and coordination centers on both sides of the brain. Research also shows that music affects deeper brain areas involving memory and emotion—more than almost any other stimulus. Additionally, music engages less used neural connections in the brain, strengthening them to potentially restore or improve impaired/lost functions.

The American Music Therapy Association (AMTA) notes that music therapists work with older adults to help with dementia, children and adults to reduce asthma episodes, hospitalized patients to reduce pain, children with autism to improve communication skills, premature infants to improve sleep patterns and increase weight, people with Parkinson’s disease to improve motor function, and more.

One of the most publicized music therapy cases involved Congresswoman Gabby Giffords. After a near-fatal head injury, Giffords suffered from aphasia, the inability to speak due to damage of the language pathways located on the left side of the brain. By layering words on top of melody and rhythm and with a lot of practice, new neuropathways were formed, allowing her to regain the ability to speak. Her music therapist, Meaghan Morrow, compared the process to a freeway detour, describing the brain’s ability to form new roads or paths around damaged areas (a process called “neuroplasticity”) so the information can reach the same part of the brain that the damaged freeway once provided.

Dr. Oliver Sacks’ book Musicophilia describes the role of music therapy in managing Parkinson’s disease, which spurred the book and film “Awakenings.” In his book, Dr. Sacks cites an 1871 article by neurologist Dr. John Hughlings Jackson entitled, “Singing by Speechless Children.”

In previous months, we’ve discussed how walking backward can improve memory recall. Other research has found that trying new things or performing activities in a different way can create new pathways in the brain, which may improve brain health. So next time your drive to the store, take a different route. Tomorrow, try holding your toothbrush or your hairbrush with your other hand.

Of course, continue to get regular exercise, eat a healthy diet, get plenty of sleep, avoid smoking, abstain from excessive drinking, and get regular chiropractic care to keep your mind and body in the best shape possible to give yourself the best chance of a long and happy life!

 

 

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 Link Between Whiplash and Fibromyalgia

24 Oct

It’s estimated that up to 50% of whiplash associated disorder (WAD) patients will develop chronic symptoms such as neck and upper back pain, headache, dizziness, emotional and cognitive disturbance, referred pain, and physical dysfunctions. Fibromyalgia (FM) is a condition that is also characterized by long-term, persistent symptoms such as chronic widespread musculoskeletal pain, sleep disturbance, cognitive disturbance, fatigue, and physical dysfunctions. Both WAD and FM patients share similar chronic, debilitating signs and symptoms. Why is this so?

In one study, researchers evaluated cognitive loss, central sensitization, and health-related quality of life (QoL) in chronic WAD patients, FM patients, and individuals without any known chronic conditions to serve as a control group. Participants in both the WAD and FM group exhibited significant cognitive impairment, central sensitization, and decreased health-related QoL, suggesting that brain injury plays a significant role in each condition.

In WAD injuries, the mechanism of injury causing cognitive loss (the brain’s inability to process information) appears to arise from the brain slamming into the inside of the skull. In a classic rear-end collision, the brain first hits the back of the brain casing followed by the rebounding into the front of the skull, causing a concussion.

A 2011 study found that among 58 women who had been admitted to the emergency room for a whiplash injury, three met the clinical criteria for FM three years later. Another 2011 study found that among 326 WAD patients with persistent neck pain lasting longer than three months, up to 14% met the criteria for FM. Based on these findings, it’s clear that the whiplash process could be a strong contributing factor for developing FM. Indeed, a 2015 study that looked at the health histories of 939 FM patients identified trauma as a precipitating factor in 27% of cases.

While we typically associated whiplash with motor vehicle collisions, such injuries can also occur in sport collisions, physical assaults, and falling. It’s possible that a greater percentage of FM cases may be due to trauma the participant simply wasn’t able to recall. Emotional trauma and post-traumatic stress disorder have also been associated with an elevated risk for FM. The disease process for FM isn’t entirely understood, and in cases when the cause is not known, it’s possible the condition could be the result of a cumulation of factors, including WAD.

Nonetheless, it’s clear that chronic WAD and FM are potentially debilitating conditions and seeking treatment after a trauma, such as a motor vehicle collision, is important for mitigating the risk for chronic symptoms. The good news is that both FM and WAD patients respond very favorably to chiropractic care!  Doctors of chiropractic are trained to examine, diagnose, and treat those presenting with FM and WAD. Studies have reported that the inclusion of spinal manipulation enhances recovery in acute and chronic WAD, as well as FM.

 

 

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.

Do Cell Phones Cause Horns?

21 Oct

It’s not hard to argue that nearly everyone spends too much time on their electronic devices, especially smartphones. You may be familiar with the terms “text neck” or “forward head posture”, but have you heard that excessive cellphone use may cause your body to grow horns?

If you reach around to the back of your head, just above the top of the neck, you should feel a bump in the midline. This is NORMAL, and it’s called the external occipital protuberance (EOP). The EOP serves as an attachment point for the nuchal ligament and the trapezius muscle, which function to keep the head upright and tilted backward. The size of the EOP normally varies (averaging around 5mm), depending on race, gender, genetics, and occupation.

A 2016 study revealed that an alarming number of young people had spurs (technically called enthesophytes) extending from the EOP, an occurrence associated with the wear-and-tear of osteoarthritis that can develop later in life. In the study, researchers reviewed x-rays of 218 men and women 18 to 30 years old who either had back pain, neck pain, or headaches or no history of such conditions. The research team observed an enlarged EOP (EEOP for short) in 41% of participants, regardless of the presence or absence of musculoskeletal pain. However, the data did show that EEOP was three-times more common in men than women.

The same study authors conducted a larger study in 2018 that included 1,200 adults of all ages and found that the combination of male gender, the degree of forward head protraction (FHP), and age predicted the presence of EEOP. Their results showed that being a young male with a greater amount of FHP lead to the formation of EEOP.

The researchers suspect that the age component of their finding (after all, the frequency and severity of degenerative skeletal spur formation typically worsen with age) may be due to young adults placing a greater mechanical load on their necks due to forward head posture caused by excessive device use.

The good news is that studies have demonstrated forward head posture can be improved with specific resistance and stretching exercises, monitoring your posture while using electronic devices, and reducing electronic device use. Your doctor of chiropractic can show you exercises that you can perform at home to reduce forward head posture.

 

 

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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