The Challenges of Carpal Tunnel Syndrome

25 May

Carpal Tunnel Syndrome (CTS) is one of the most common “peripheral neuropathies” patients have when they visit a chiropractor for the first time. Peripheral neuropathy (PN) is defined as “…damage or disease affecting nerves, which may impair sensation, movement, gland or organ function, or other aspects of health, depending on the type of nerve affected.” Let’s take a closer look!

Common causes of PN include systemic conditions such as diabetes, vitamin deficiency, medication side effects (such as chemotherapy meds), traumatic injury, after radiation therapy, excessive alcohol intake, an autoimmune disease such as rheumatoid arthritis, and/or viral infection. PN can be linked to an individual’s genetics that are present from birth. For others, it can be unknown which is then referred to as “idiopathic.”

PN can affect one nerve (mononeuropathy) or multiple nerves (polyneuropathy) and can be acute (which means it comes on quickly) or chronic (which means it comes on gradually over time and progresses slowly). PN symptoms can include cramp/charley horse-like pain, muscle twitching, muscle atrophy or shrinkage, numbness, tingling, pins and needles, burning or cold feeling, and can also affect other tissues such as bone causing degeneration, skin changes, and hair and nail changes. PN can also affect a patient’s balance and coordination which can increase an individual’s chances of falling. If organs or glands are also impacted, PN can lead to poor bladder control, heart rate or blood pressure changes, and/or affect the sweat glands.

Getting back to CTS specifically, one of the challenges of this condition is determining the cause/s. Here’s what we know about CTS: 1) it is more common in women than men; 2) it is more common in those who are overweight; 3) it is more common in those who work in highly repetitive environments; 4) it is more common over age 50; 5) it is often accompanied by other upper extremity “over-use” conditions like tendonitis in the hand, wrist, elbow, and/or shoulder and can also involve the neck (as CTS cases improve faster when treatment is also applied to the cervical spine); and 6) it commonly includes one or more of the conditions previously mentioned that can cause neuropathy such as diabetes and rheumatoid arthritis. Other conditions such as hypothyroid can also cause or worsen an existing case of CTS, in part due to “myxedema,” a type of swelling that occurs with this condition. Here, the additional swelling can add to the compression or pressure pushing on the median nerve in the carpal tunnel and either cause CTS or worsen an existing case.

Because CTS can have more than one underlying cause, it’s important that your doctor determine as many as possible in order to achieve the best treatment results. We’ve all heard of the cases that fail to respond to surgical intervention, which in many cases is because there were MULTIPLE CAUSES and only one was addressed with the surgical approach. Surgery has always been described as “the last resort” and indeed it’s appropriate in some cases. However, MANY CTS patients respond well to chiropractic management, which often includes (but is not limited to): 1) joint manipulation and mobilization of the hand, wrist, forearm, elbow, shoulder, and neck; 2) use of a night-time splint; 3) home/work exercises; 4) physical therapy modalities; 5) nutritional considerations; and 6) ergonomic modifications (work station assessment). If these approaches fail to achieve satisfying results, your doctor will refer you to a hand surgeon to determine which procedure might be best for you.

We realize you have a choice in whom you consider for your health care provision and we sincerely appreciate your trust in choosing our service for those needs.  If you, a friend, or family member requires care for Carpal Tunnel Syndrome, we would be honored to render our services.

Low Back Pain? Should You Take an NSAID?

21 May

Statistics suggest that low back pain (LBP) will plague most of us at some point in our lives, if it hasn’t already. Most healthcare professions that manage patients with low back pain focus on pain management. In fact, studies have reported that 67% of patient satisfaction is driven by pain elimination. One of the most common strategies for reducing pain is managing inflammation. The “easiest” way to do this (according to the many TV commercials and magazine advertisements) is to take one of the many non-steroidal anti-inflammatory drugs (NSAIDs) such as Ibuprofen (Advil, Nuprin), Piroxicam Flurbiprofen, and Indomethacin. Let’s take a closer look to see if this is a good or bad idea!

In a recent March 2015 article, researchers investigated the use of NSAIDs between 1993 and 2012 in patients who had fractures that failed to heal, technically called “non-union fractures.” They found that non-union fractures increased during years when NSAID use was increasingly recommended for patients with fractures and dropped in years when NSAID use declined. This isn’t the first study to report poor fracture healing results from NSAIDs when they’re used as the primary form of pain relief and in fact, studies on this subject date back to the early 1990s. So how does this equate to LBP? Most directly, fractures are one of the many causes of LBP, so for that population, the answer is clear. However, LBP is much more commonly caused by sprains (ligament injuries) and strains (muscle/tendon injuries), as well as cartilage injury. Here too, studies show that the healing rate of sprains, strains, and cartilage is also delayed when NSAIDs are used as the primary pain relief approach. This healing delay is reportedly due to NSAIDs’ inhibition of “proteoglycan synthesis,” a component of ligament and cartilage tissue regeneration and repair. NSAIDs also inhibit release of prostaglandins (especially prostaglandin E2), which is needed for tissue repair. These effects are ESPECIALLY observed with long-term use, but recent studies show injured athletes are best off NOT taking NSAIDs AT ALL as these drugs delay the healing process and thus the athlete’s ability to return to their sport.

In a January 2015 study, researchers criticized the common use of NSAIDs in elderly patients for the treatment of non-cancerous pain. They found 75% of the elderly population studied was prescribed NSAIDs which, in retrospect, the researchers determined to be inappropriate!  Because NSAIDs interfere with healing, the net effect is an ACCELERATION of osteoarthritis and joint deterioration! In 1995, a North Carolina School of Medicine study compared four groups of patients with soft tissue injuries (tendon strains): Group 1 received NO treatment (control group); Group 2 received exercise only; Group 3 received exercise AND Indomethacin; and Group 4 received Indomethacin only. At 72 hours post-injury, ONLY the exercise group had an INCREASE in prostaglandins (E2 particularly – necessary for healing). This effect was even more profound at 108 hours after injury. The research team also found DNA synthesis in the fibroblasts (an important part of the repair mechanism) was greatest in the exercise group and was completely lacking in the NSAID-only group.

We realize you have a choice in whom you consider for your health care provision and we sincerely appreciate your trust in choosing our service for those needs.  If you, a friend, or family member requires care for back pain, we would be honored to render our services.

How to Prevent Whiplash! (Part 2)

20 May

Last month, we covered the importance of your car seat’s head restraint for preventing whiplash. This month, let’s discuss additional measures one can take…

AIRBAGS: In addition to a correctly positioned head restraint, having a vehicle that is equipped with airbags has been described as “essential in the prevention of injuries and/or death,” especially in frontal or head-on collisions. Airbags are inflatable devices that fill up in a fraction of a second during a serious motor vehicle collision (MVC). Depending on the year, make, and model of your vehicle, airbags are located in the front of the steering column, by the glove compartment on the passenger side, and possibly in the doors and/or in the column between the doors. These offer additional protection that seatbelts alone cannot provide and can prevent the head and chest from striking the steering wheel, dashboard, or the door in the case of side-impact airbags. The front airbags typically do not deploy in rear or side impact collisions whereas the side airbags will deploy in side impacts and rollovers, thus providing protection between the occupants and doors, side windows, and roof. In order to maximize your protection from injury in a front-end collision, make sure you do the following each time you get into your vehicle: 1) always wear both your lap and shoulder seat belts as airbags are designed to work WITH the lap/shoulder belt system; 2) maintain a safe distance between you and the driver’s side airbag of at least 10 inches / 25 centimeters (if you’re too close, you risk making contact with the airbag as it inflates which can cause abrasions and bruising); 3) position the steering wheel towards your chest (not your head or neck); 4) move the passenger seat back as far as possible because of the greater distance/larger airbag that exists between the passenger and dashboard; 5) make sure passengers avoid putting their feet up on the dash or placing any objects between their body and the dashboard.

SEAT BELTS: It has been estimated that in Canada alone, if all drivers and passengers wore their seat belts, 300 road fatalities could be avoided each year! Seat belts have always been considered the BEST way to protect against injury or death in a car crash. These typically cross the lap and chest and prevent the occupant from being ejected or thrown about inside the vehicle in an accident. Here are some important points to remember: 1) wear a lap/shoulder belt system whenever possible; 2) sit up straight, positioning the lap belt low over the pelvic bones/hips, NOT over the stomach; 3) place the shoulder harness over the shoulder, across the chest, and NEVER place the belt under the arm or behind the back; 4) all occupants must wear a seat belt regardless if the vehicle is moving or not; and 5) a pregnant occupant should place the lap belt over the pelvic bones below the baby, not over or above the stomach/baby.

 ANTI-LOCK BRAKE SYSTEMS (ABS): Here, electronic controls stop your wheels from locking up when the brake pedal is forcibly pressed to help the driver maintain control on rough, wet, and slippery surfaces. This helps prevent skidding and can result in a shorter stopping distance.  An ABS can also help drivers more safely steer around what they’re heading towards while allowing for maximum braking pressure. Tips include: 1) HOLD / DON’T PUMP the brake pedal firmly; 2) keep steering around objects while fully braking; 3) DO NOT expect the braking distance to be shorter; 4) have the ABS inspected at the recommended number of miles noted in your vehicle’s manual; and 5) MOST IMPORTANT, stay a safe distance behind the vehicle ahead of you – NO TAILGAITING!

We realize you have a choice in whom you consider for your health care provision and we sincerely appreciate your trust in choosing our service for those needs.  If you, a friend, or family member requires care for Whiplash, we would be honored to render our services.

New Research Shows Eating at Certain Times May Decrease Heart Disease Risk

19 May

Everyone knows what they eat has a huge impact on both their energy levels and their overall wellbeing.  Because countless studies have demonstrated the effect nutrition has on many aspects of health, some experts even say that the majority of health problems can be avoided through proper diet (in addition to regular exercise).

In Other Words, You Are What You Eat. But what if there was a way you could be healthier without changing what you eat, even if you are already eating perfectly?  If that sounds interesting, then you are really going to like this… A new study conducted by scientists at San Diego State University found you are not only WHAT you eat but WHEN you eat.  The research, published in the prestigious journal Science, found that, “by limiting the time span during which fruit flies could eat, they could prevent aging – and diet-related heart problems.  The researchers also discovered that genes responsible for the body’s circadian rhythm are integral to this process, but they’re not yet sure how. “Previous research has found that people who tend to eat later in the day and into the night have a higher chance of developing heart disease than people who cut off their food consumption earlier.”

But this study was done on fruit flies, what does that have to do with humans?  Well, fruit flies have been long been used as a starting point to help identify the genetic basis of many ailments, including heart disease.

Some interesting details about the experiment:  The fruit flies were split into two groups.  One group was allowed to eat unrestricted all day and the other was only allowed to eat during a twelve-hour period.  Researches kept track of the sleep patterns and amount of food eaten by each group.

Results:  “Flies on the 12-hour time-restricted feeding schedule slept better, didn’t gain as much weight, and had far healthier hearts than their ‘eat anytime’ counterparts, even though they ate similar amounts of food.”   The researchers observed the same results after five weeks. According to researcher Dr. Shubhroz Gill, “In very early experiments, when we compared 5-week-old flies that were fed for either 24 hours or 12 hours, the hearts of the latter were in such good shape that we thought perhaps we had mistaken some young 3-week-old fruit flies [from a different part of the experiment]… We had to repeat the experiments several times to become convinced that this improvement was truly due to the time-restricted feeding.”

More Good News:  The benefits of time-restricted diets were not restricted to young flies.  When the researchers introduced the time restrictions to older flies, their hearts became healthier too.

What Is the “Take Home Message?”  Of course, more research must be done before the results can be extrapolated to real people, like you and me.  There are several factors to take into consideration with humans, like the fact that humans do not eat the same thing every day and lifestyle often affects when someone can or cannot eat.  Dr. Girish Melkani, a Biologist at San Diego State University writes, “Time-restricted feeding would not require people to drastically change their lifestyles, just the times of day they eat.  The take-home message then would be to cut down on the late-night snacks.”

Why Would Dietitians Recommend Mini-Cans of Soda as a Good Choice for a Snack?

18 May

First, what is a Registered Dietician?  The Academy of Nutrition and Dietetics’ website says they are, “The world’s largest organization of food and nutrition professionals.  The Academy is committed to improving the nation’s health and advancing the profession of dietetics through research, education, and advocacy.” 

According to their website, “Registered dietitian nutritionists – RDNs – are the food and nutrition experts who can translate the science of nutrition into practical solutions for healthy living.  RDNs use their nutrition expertise to help individuals make unique, positive lifestyle changes.  They work throughout the community in hospitals, schools, public health clinics, nursing homes, fitness centers, food management, food industry, universities, research and private practice.  RDNs are advocates for advancing the nutritional status of Americans and people around the world.” 

In other words, Registered Dietitians are serious nutrition experts.  So, why would some registered dietitians suggest a mini-can of cola as a snack?  In fact, according to an article in the Star Tribune, “In February, several… experts wrote online posts for American Heart Month, with each including a mini-can of Coke or soda as a snack idea.  The pieces – which appeared on nutrition blogs and other sites including those of major newspapers – offer a window into the many ways food companies work behind the scenes to cast their products in a positive light, often with the help of third parties who are seen as trusted authorities.” 

The answer to this puzzling question can be found in a statement given to the Star Tribune by a Coca-Cola spokesperson, “We have a network of dietitians we work with… Every big brand works with bloggers or has paid talent.” 

The article also states, “Other companies including Kellogg and General Mills have used strategies like providing continuing education classes for dietitians, funding studies that burnish the nutritional images of their products, and offering newsletters for health experts.  PepsiCo Inc. has also worked with dietitians who mention its Frito-Lay and Tostito chips in local TV segments on healthy eating.  Others use nutrition experts in sponsored content; the American Pistachio Growers has quoted a dietitian for the New England Patriots in a piece on healthy snacks and recipes, and Nestle has quoted its own executive in a post about infant nutrition.”

In other words, it seems like these dietitians are getting paid to endorse a product that may not necessarily benefit the health of the people in their audience.  Everyone knows celebrities and athletes get paid a tremendous amount of money to endorse all kinds of things, including junk food.  Many times top athletes are paid more in endorsement deals than they make playing their sport, but is it really appropriate for certified nutrition experts to get paid to write about nutritional advice that may benefit their sponsors more than their readers?

Here’s How to Get More Health Benefits Out of Your Work Day!

14 May

Prolonged sitting can significantly impact both your cardiovascular and metabolic function.  Ideally, limit your sitting to three hours a day or less, and make it a point to walk 7,000-10,000 steps each day.

Taking a walk during your lunch hour can improve your mood and help reduce the effect of work-related stress. You can get even more out of your walk by simply switching up your pace at regular intervals (3 minutes fast pace and then 3 minutes casual pace, for example).

Tracking your steps can also show you how simple and seemingly minor changes to the way you move around at work can add up.  For example, you can walk across the hall to talk to a co-worker instead of sending an email; take the stairs instead of the elevator; park your car further away from the entrance; or take a longer, roundabout way to your desk.

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