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Carpal Tunnel Syndrome – OVERVIEW (Part 1)

5 Feb

Carpal tunnel syndrome (CTS) represents a collection of signs and symptoms resulting from the compression or pinching of the median nerve as it passes through the carpal tunnel at the wrist. In this overview, you will see why CTS can be a challenging ailment to diagnose and treat.

SYMPTOMS: Numbness, tingling, and pain. Less commonly, burning and/or sharp pain in the index to the thumb-side half of the fourth finger, palm-side only. Loss of grip strength (such as unscrewing a jar) may occur but usually later in the course of the condition.

PATHOPHYSIOLOGY: Compression of the median nerve inside the bony carpal tunnel occurs when the pressure inside the tunnel increases, often due to overuse with subsequent swelling. There are multiple epidemiologic factors including genetic, medical, social, vocational, avocational, and demographic with a complex interplay between some or all these factors. However, definitive causative factors remain obscure and unclear in many cases.

EPIDEMIOLOGY: About one to three people per every 1,000 will develop CTS in a given year, and estimates show about 50 people per 1,000 currently live with CTS in the general population. However, the incidence may rise as high as 150 cases per 1,000 subjects per year, with prevalence rates greater than 500 cases per 1,000 subjects in certain high-risk groups. The incidence and prevalence is similar in developed countries like the United States, the United Kingdom, and the Netherlands, but CTS is almost unheard of in some developing countries. The female-to-male ratio for CTS is three-to-ten females to one male. Carpal tunnel syndrome seems to peak at age 45-60 years old with only 10% of CTS patients under the age of 31. The condition is not fatal, but if left untreated, severe cases can lead to complete, irreversible median nerve damage and a loss of much hand function.

CLINICAL PRESENTATION: A patient’s history is often more valuable than the physical examination when it comes to CTS. Patients may report the above-listed symptoms, which may worsen at night and interrupt sleep. Symptoms may also increase in intensity during activities like driving, crocheting, and painting. Frequently, CTS affects both hands, but it’s usually worse in the dominant hand. Patients may have difficulty “mapping” their symptoms well and may feel numbness, tingling, pain, and/or weakness in the whole arm and/or forearm. It’s often prudent to look for additional compression elsewhere in the course of the median nerve in the neck, shoulder, and/or elbow. Less commonly, the patient may experience whole hand hot/cold sensitivity with color changes and/or sweating, which may indicate autonomic nervous system involvement. The use of CTS questionnaires can help diagnose and track progress during care. This discussion will continue next month – stay tuned!

The Elderly & Back Pain – Is Chiropractic Effective?

1 Feb

Around the world, low back pain (LBP) is a leading cause of disability and ranks sixth in terms of “overall disease burden.” Chronic low back pain (cLBP) has a profound socioeconomic impact on individuals, families, and communities—so much so that the World Health Organization has identified LBP as a major disabling condition.

Older people tend to have greater physical disability caused by LBP compared with younger individuals, and old age is often associated with non-recovery and poor outcomes. One study found that more than a quarter of older people in the United States had cLBP upon entering retirement and that baby-boomers (those born between 1946 and 1964) account for 51% of all costs (over $10 billion) associated with cLBP.

So the question of the month is: how safe and effective is chiropractic care for older patients with cLBP? To help answer this question, researchers searched multiple sources for studies that included patients over 55 years of age with cLBP (more than three months of LBP), that utilized some form of manual therapy, that included tools that measured pain and disability, and that utilized a randomized control trial design. Researchers excluded data from experiments in which subjects had prior back surgeries, had pelvis-only pain (e.g. tail bone pain), or had received only a single treatment without follow-up.

Though only four studies met these stringent criteria, the authors did conclude that manual therapies, which include spinal manipulation delivered by doctors of chiropractic, can improve pain and function in older patients with chronic low back pain with very few adverse side effects.

This study supports the benefits of chiropractic care for the aging population and emphasizes the need for effective treatment options for cLBP with a low risk for serious adverse effects. With the size of the senior population expected to double over the next several decades, Chiropractic care will surely continue to play an important role in improving the quality of life of the elderly.

Do Coffee Drinkers Live Longer?

29 Jan

There has been great debate over the years about the pros and cons of drinking coffee.  The confusion is justified, as one study will report on the negative affects while the next will highlight its beneficial attributes. So here we go again, but this time, the focus is on whether or not the compounds found in coffee can help you live longer.

In a 2017 study published by the International Agency for Research on Cancer and the Imperial College London, researchers surveyed 520,000 people from ten European countries and concluded that drinking coffee does appear to promote a longer lifespan. According to the study, other significant health benefits associated with coffee consumption include lower mortality rates from liver and digestive disease in both men and women; decreased mortality from cancer, circulatory disease, and cerebrovascular disease (stroke) in women; and a reduced suicide rate for men. Coffee consumption also lowers inflammatory markers and other negative biomarkers in the blood, giving us some insight on how the compounds in coffee may promote longevity.

The other study, this one funded by the National Cancer Institute, included a diverse set of subjects, as the survey included more than 185,000 adults from various ethnic backgrounds. The authors of this study also concluded a link between coffee consumption and living longer.

Regarding the dosage of coffee required to achieve the most benefits, the European study found the more coffee consumed, the better. They observed that participants who consumed three cups a day had better protection against all-cause death than those consuming less, especially when compared with the non-coffee drinkers. Also, because the researchers surveyed people from many different parts of Europe, it didn’t appear to matter what brand of coffee the particpants consumed, how it was prepared, or the serving style.

The United States-based study echoed many of the same findings as it reported that individuals consuming two to four cups a day had an 18% lower risk of early death in comparison with the non-coffee drinkers, regardless of the ethnicity, coffee type, or preparation style.

Not to burst your bubble about the health benefits of coffee, but moderation is still recommended regarding your daily indulgence. Nutritionists also warn that adding heavy cream and sugar may nullify many of the health benefits of black coffee plus add unnecessary calories to your diet.

Look for future research to focus on determining which compounds found in coffee provide the most benefit and if they can be consumed as a supplement for people who are not coffee drinkers.

What You NEED to Know About Whiplash

22 Jan

Whiplash injuries are very common and are primarily associated with car and rear-end collisions in particular. This is what happens when you’re rear ended…

  1. At 0-50 milliseconds (ms): As the car is initially propelled forward, the seatback pushes the torso forward while the head remains in its original position, which straightens or flattens out the cervical curve.
  2. At 50–75 ms: As the torso accelerates forward, the head/neck moves backwards forming an S-shaped curve with flexion of the upper cervical region and extension of the lower cervical region, stressing the ligaments in back (upper) and front (lower) cervical spine regions.
  3. At 150-175 ms: The torso is at its maximum forward position in reference to the neck and the head/neck is forced into peak extension (backward bending). The head may contact the head restraint or ride over it if of the torso slides up the back a reclined seat. This can further damage the ligaments in the front of the cervical spine.
  4. At 200-600 ms: The head and torso are then thrown forward by the rebound off the seatback, hyperflexing the neck (and mid- and/or low-back) and potentially causing further injury to the ligaments in the back of the spine. Depending on whether or not a seatbelt is in use, the head may strike the steering wheel and/or windshield causing further injury.

It may seem logical to think that if we can anticipate an impending MVC, then less injury will occur. Unfortunately, this doesn’t hold true because the total length of time it takes for the sequence described above to occur is about 600 ms and we cannot voluntarily contract our muscles in less than 800-1000 ms. Therefore, you simply won’t have time to brace yourself for impact.

If cervical rotation occurs at the time of impact, such as looking into the rearview mirror, then the risk for injury may increase. There is recent evidence suggesting that it is difficult to avoid rotation of the cervical region during a collision because the diagonal path of the chest restraint promotes trunk rotation in the later stage of whiplash as the torso rebounds forward.  Nonetheless, looking straight ahead at the time of impact may reduce the degree of injury in some collisions.

To achieve the best long-term outcome, treatment should emphasize movement and exercise as soon as possible. In addition to treatments performed in the clinic, doctors of chiropractic commonly recommend whiplash patients to perform home exercises, home cervical traction, and other self-help methods with the objective of returning to a normal lifestyle as quickly as possible.

Migraine Headaches and Nutrition?

18 Jan

According to a World Health Report, migraines are the nineteenth most common patient complaint worldwide with an 18% of women and 6% of men in the United States experiencing at least one migraine headache episode each year.

There is evidence that patients with migraines have an energy deficit disorder associated with their glucose intake. As such, adopting a strict ketogenic diet (in which ketones are the primary source of energy for the body in place of glucose) does appear to benefit patients with migraines.

A 2017 study set out to determine if it was the absence of glucose or the increase in ketone bodies that made the difference for patients. In the study, researchers provided four female migraine patients with a specially designed ten-gram beverage containing a specific type of ketone  called B-hydroxybutyrate or bHB twice a day for four weeks.

After one month, their migraine frequency rate dropped 50% to eight days/month on average without any serious side effects.  The patients also lost weight, presumably due to consuming less glucose in their diet. An additional benefit of higher levels of ketones in the body is that they have an anti-inflammatory effect.

A larger double-blind, randomized, placebo-controlled trial is now underway with a group of 90 patients that will last three months The goal of the study is to determine if this nutritional supplement is capable of reducing migraine headaches without the significant side effects and associated disabilities that are currently associated with many migraine medications.

Chiropractic care often includes nutritional counseling as an important part of caring for the whole person. In fact, there is research supported evidence that spinal manipulation alone has a very positive benefit for migraine headache patients as noted in the 2010 and 2014 UK studies regarding the effectiveness of manual therapies. Based on the outcome of this large-scale study, the use of ketone-based supplementation for migraines may become a new standard.

Knee Pain and Jumping Injuries

15 Jan

The term “jumper’s knee” was first coined in 1973 to describe an injury to the tendon that attaches the lower (most common) to the prominence (tibial tuberosity) on the proximal shin bone (tibia) or the upper pole of the knee cap or “patella” to the quadriceps femoris muscle.

Jumper’s knee is one of the more common tendinopathies that affect up to 20% of all adult athletes in sports with frequent jumping, typically among adolescent basketball and volleyball players. Individuals who are obese or who are bow-legged or knock-kneed or whose lower limbs are unequal in length have a higher risk for jumper’s knee. Poor jumping technique can also increase the risk for this condition as can cause overtraining, especially on hard surfaces.

The disease process for jumper’s knee can be divided into four stages: 1) pain only after activity without disability; 2) pain during and after without disability; 3) prolonged pain during and after which affects function; 4) complete tendon tear that requires surgical repair.

Treatment for jumper’s knee can include: 1) reducing jumping activity;  2) icing the knee for 15-30 minutes, four to six times a day, especially after the activity; 3) a thorough exam of the hip, knee, ankle, and foot to assess joint function; 4) stretching the hamstrings, calf, quadriceps, hip flexors, gluteal (buttocks), iliotibial band, and tissues around the knee cap; 5) strengthening exercises focused on specific parts of the quadriceps (vastus medialis oblique especially) and other leg muscles; 6) ultrasound and other therapies that may help speed recovery; and 7) taping to help patellar tracking.

Doctors of chiropractic are trained to evaluate and treat the whole person and frequently treat athletic injuries. A successful treatment outcome for jumper’s knee requires both local knee care and the management of the entire lower “kinetic chain” which includes the foot, ankle, knee, hip, and pelvis.

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