Is It My Neck or Thoracic Outlet Syndrome?

29 Jan

Neck pain can arise from many different sources, and the patient’s clinical presentation can be quite similar making it a challenge to diagnose. One of those related, and sometimes co-existing conditions, is called thoracic outlet syndrome, or TOS. Let’s first discuss the anatomy of the neck and the thoracic outlet so we all have a good “picture” in mind of what we’re talking about.

TOS can arise from either blood vessel compression, nerve compression or both, making the ease of diagnosis difficult. Adding to the challenge, the “pinch” of the structure can occur at more than one place! The nerves and blood vessels can get pinched at the exiting holes in the spine (“neuroforamen”), by tight “scalene” muscles, under the collar bone (clavicle) and/or by a tight pectoralis minor muscle near the arm pit. Hence, the symptoms usually include pain and numbness in the shoulder, arm and hand (usually affecting the 4th & 5th fingers). It’s our job to run different tests to figure out where the primary pinch or pinches are located so we can treat the right area.

The causes of TOS can be many, with one of the obvious being a fractured collar bone or clavicle. Another is from having an extra rib. As there is not a lot of room for an extra structure, this can be a point of compression for some (but doesn’t create TOS in everyone). An overly tight scalene muscle, scar tissue, an extra large muscle and so on can also result in pinching of the nerves and/or blood vessels.

Purses, backpacks, carrying golf clubs, a mailbag and the like can also cause a pinch. A seat belt injury in a car accident is yet another cause, either from the direct trauma, or later when scar tissue forms in the area.

Our posture alone (without trauma), such as a slouchy, slumped posture where the shoulders roll forwards can cause TOS and, large breasts and obesity also add to the list of risk factors. Women are affected 3x more than men. Certain jobs where reaching overhead or outwards such as waitresses, carpenters, electricians, increase TOS risk.

You can depend on us to identify, locate and treat the areas that need attending as chiropractic includes many effective TOS treatment methods. The surgical outcomes are less than impressive so do EVERYTHING else first (a good surgeon will tell you that).

We realize that you have a choice in where you choose your healthcare services.  If you, a friend or family member requires care for neck pain, we sincerely appreciate the trust and confidence shown by choosing our services and look forward in serving you and your family presently and, in the future.

 

How Does Chiropractic Help Headaches?

15 Jan

Headaches are one of the most common reasons people seek chiropractic care. Many patients with headaches benefit significantly from adjustments made to the upper cervical region. So, the question is, how does adjusting the neck help headaches? To help answer this question, let’s look at a study that was recently published that examined this exact issue…

It’s been said that if one understands anatomy, determining WHERE the problem is located becomes easy. So, let’s take a look at the anatomy in the upper most part of the neck. In the study previously mentioned (http://www.ncbi.nlm.nih.gov/pubmed/21278628), the authors found an intimate relationship between the muscles that connect the upper 2 cervical vertebra (C1 and 2) together and their anatomical connection to the dura mater (the covering of the spinal cord). They identified this anatomical connection between the muscles that span between the back aspect of C1/2 and the dural connection as having a significant role in the development of headaches usually referred to as cervicogenic headaches.

There are several reasons why chiropractors adjust or manipulate the upper cervical vertebrae in patients with headaches. The obvious reason is simply because it helps to reduce the intensity, frequency and duration of headaches. The reason it works is this: If one or both of the upper 2 vertebrae (C1 and C2, also referred to as the atlas and axis, respectively) are either blocked or fixed and cannot properly move independently, then there is an abnormal change in the biomechanics in that region. Similarly, if one of the two vertebrae is rotated or shifted in reference to the other, a similar biomechanical “lesion” or problem occurs (often referred to as a “subluxation”). You can take all the ibuprofen, Aleve, Tylenol or other perhaps stronger, prescription medication for the headache, but it is not logical that the biomechanical problem at C1 and/or C2 is going to change by inducing a chemical change (i.e., taking a pill). All you’re doing is masking the symptoms for a while, at best.

Many people find that after a several chiropractic adjustments, their headaches are significantly improved. This is because restoring proper biomechanics to the C1/2 region reduces the abnormal forces on the vertebrae as well as any abnormal pull or traction of the posterior cervical muscles on the dural attachment. It has been reported that the function of this muscle/dura connection is to resist excessive movement of the dura towards the spinal cord when we look upwards and forwards. During neurosurgery, observation of mechanical stress on the dura was found to be associated in patients with headaches. In chronic headache sufferers, adjustments applied to this area results in significant improvement. There is no other treatment approach that matches the ability that adjustments or manipulation have in restoring the C1/2 biomechanical relationship thus, helping the headache sufferer. Another treatment option that has been shown to benefit the headache patient is injections to this same area. However, given the side effects of cortisone, botox, and other injectable chemicals, it’s clear that chiropractic should be utilized first. It’s the safest, most effective, and fastest way to restore function in the C1/2 area, thus relieving headaches.

We realize that you have a choice in where you choose your healthcare services.  If you, a friend or family member requires care for headaches, we sincerely appreciate the trust and confidence shown by choosing our services and look forward in serving you and your family presently and, in the future.

Common Whiplash Myths – Part 2.

15 Jan

Last time, we began discussing common myths about whiplash injuries, and this month, we will continue on that course. Remember, the amount of injury that occurs in an acceleration/deceleration injury is dependant on many factors, some of which include gender (females>males), body type (tall slender = worse), the amount of vehicular damage (less is sometimes worse as the energy of the strike was not absorbed by crushing metal), head position at the time of impact (rotation is worse than looking straight ahead), and more. Therefore, each case MUST be looked at on its own merits, not just analyzed based on a formula or accident reconstruction.

MYTH #5: THERE MUST BE DIRECT CONTACT WITH THE NECK FOR INJURY TO OCCUR. Injury to the neck most commonly occurs due to the rapid, uncontrolled whipping action of the head, forcing the neck to move well beyond its normal range of motion in a forwards/backwards direction (if it’s a front or rear-end collision) or, at an angle if the head is rotated or when the strike occurs at an angle. When this occurs, the strong ligaments that hold the bones together stretch and tear in a mild, moderate, or severe degree, depending on the amount of force. Once stretched, increased motion between the affected vertebra results as ligaments, when stretched, don’t repair back to their original length and, just like a severe ankle sprain, future problems can result. This excess motion between vertebra can result in an accelerated type of arthritis and is often seen within five years following a cervical sprain or whiplash injury.

MYTH #6:  SEAT BELTS PREVENT WHIPLASH INJURIES. It’s safe to say that wearing seat belts saves lives and, it’s the law! So, WEAR YOUR SEAT BELTS! They protect us from hitting the windshield or worse, being ejected from the vehicle. But, as far as preventing whiplash, in some cases (low speed impacts where most of the force is transferred to the car’s occupants), the opposite may actually be true. (This is not an excuse to not wear a seatbelt!) The reason seat belts can add to the injury mechanism is because when the chest or trunk is held tightly against the car seat, the head moves through a greater arc of motion than it would if the trunk were not pinned against the seat, forcing the chin further to the chest and/or the back of the head further back. The best way to minimize the whiplash injury is to have a well-designed seat belt system where the height of the chest harness can be adjusted to the height of the driver so that the chest restraint doesn’t come across the upper chest or neck. Move the side adjustment so the chest belt crosses between the breasts (this also reduces injury risk to the breasts) and attaches at or near the height of the shoulder (not too high). Another preventer of whiplash is positioning the head restraint high enough (above the ears typically) and close to the head (no more than ½ to 1 inch) so the head rest stops the backwards whipping action. Also, keep the seat back more vertical than reclined so the body doesn’t “ramp” up the seat back forcing the head over the top of the head restraint.

We realize you have a choice in where you choose your healthcare services.  If you, a friend or family member requires care for whiplash, we sincerely appreciate the trust and confidence shown by choosing our services and look forward in serving you and your family presently and, in the future.

 

Common Whiplash Myths.

15 Jan

Whiplash is most commonly associated with the rapid, uncontrolled movement of the head as it whips back and forth during a motor vehicle collision. Though different types of injuries are associated with rear vs. front vs. side collisions, the net result is similar: the neck hurts! This month, we will look at several “myths” or untruths associated with the cause of whiplash or WAD, whiplash associated disorders.

MYTH #1: MEN ARE MORE VULNERABLE TO INJURY BECAUSE OF THEIR GREATER NECK MUSCLE MASS: FACT: This is exactly the opposite! Women are more vulnerable because they have LESS muscle mass, and hence, less tissue stopping the neck from going through a greater range of motion during the “crack the whip” process. Woman with long, slender necks are especially more vulnerable. They also take longer to recover and are more likely to suffer permanent residual problems long after their case settles.

MYTH #2: YOU CAN’T HAVE A CONCUSSION UNLESS YOU HIT YOUR HEAD: This seems logical as most concussions occur from direct head trauma. However, during the whiplash process the brain, which is suspended by ligament-like structures inside the skull, bathed in a liquid, can literally smash into the inside wall of the skull resulting in concussion just from the whipping action, without hitting anything. Permanent residuals such as memory problems, articulating thoughts, staying on task, and more can result. This is often called “post-concussive syndrome” or “mild traumatic brain injury.”

MYTH #3: NEGATIVE X-RAYS MEANS NO INJURY: Often, in the ER after a motor vehicle collision, x-rays are taken and read by the radiologist as “…essentially normal.” This can be confused as meaning, “…then there was no injury.” X-rays only show the bones in the neck and head region, not the muscles, tendons, ligaments or nerves. MRI (magnetic resonant imaging) shows more of these “soft tissues,” not just bone. But, due to the high costs of MRI, x-rays are performed first, and only later, if symptoms warrant it, is an MRI ordered. Soft tissue injury to the ligaments (the tissues that strongly hold bone to bone) can be assessed when we take flexion / extension (or bending forwards & backwards) x-rays, but many times these are not ordered in the ER.

MYTH #4: REST AND TIME ALONE WILL HEAL WHIPLASH: Though time for healing plays a role in recovery following all injuries, many patients find this approach fails and their pain persists. In fact, studies suggest that mobilization and manipulation performed as soon as possible after a whiplash injury yields significantly better outcomes than wearing a cervical collar and not moving the neck. Whiplash injuries, when not properly treated, often results in permanent loss of motion, pain, headache, and more. The days of rest and time only should be replaced by the sports medicine model of hot/cold packs, modalities such as interferential, pulsed magnetic stimulation, light or laser therapy, manipulation, massage, traction and guided exercise. Not, “…wait and watch.”

Tune in next month for addition myths about whiplash as there are MANY! Rest assured that prompt chiropractic care is the best approach for treatment of the whiplash injured patient.

We realize you have a choice in where you choose your healthcare services.  If you, a friend or family member requires care for whiplash, we sincerely appreciate the trust and confidence shown by choosing our services and look forward in serving you and your family presently and, in the future.

 

The Healing Secrets of Ethnic Cuisine.

15 Jan

Dr. Michael F. Roizen

Co-Author of 4 #1 NY Times Bestsellers including: YOU Staying Young.

The Owner’s Manual For Extending Your Warranty (Free Press)

Our basic premise is that your body is amazing.  You get a do over. It doesn’t take that long, and it isn’t that hard if you know what to do.  In these notes, we give you a short course in what to do so it becomes easy for you, and for you to teach others. We want you to know how much control you have over your quality and length of life.

This month, I wanted to reemphasize something that tastes really good—ethnic foods. What do spicy Indian curry, zesty Italian pesto, refreshing Spanish gazpacho, and Mexican chocolate-rich mole sauce have in common? They’ll all get your taste buds dancing, and bring you more gold than Michael Phelps. Tasty ethnic cuisine all-stars like these deliver a heap of phytonutrients that make you younger by avoiding cancer, heart disease, high blood sugar, dementia, and more. Benefits like these are just another great reasons to visit your city’s summertime street fairs and make liberal and creative use of the herbs and spices hiding in your kitchen cabinet.

Don’t just eat ethnic sometimes — sprinkle more of this good stuff on the foods you munch every day.  How? Think outside the box, like Dr. Mike does (me). I dust steamed broccoli with cinnamon and spreads yellow mustard (a great source of the super-healthy spice turmeric) on everything from celery to grilled salmon, and whole-grain pasta!

Giving your spice rack a work-out is just as brilliant as eating fruit and veggies. Take oregano.  Prized in Italian and Greek cuisine, these tasty little leaves boast 30 times more polyphenols than potatoes, 12 times more than oranges, and 4 times more than blueberries. You’d never munch a bunch of oregano that’s as big as a potato, but even a pinch packs a wallop. A tablespoon of fresh oregano’s got as much antioxidant power as a medium-sized apple!

Here’s the lowdown on other herbs and spices that punch up the flavor of popular ethnic cuisine, along with ways you can use them to get healthier as you spice up whatever you’re cooking tonight.

Turmeric:  The compound curcumin, found in yellow mustard (not so much in brown mustard, as that has real mustard seed.. but there’s true value in its less expensive yellow imitation).  Turmeric and curry powder have anti-inflammatory, antiviral, antibacterial, and antifungal properties, and may offer protection from cancer, diabetes, arthritis and Alzheimer’s disease. It is a premiere flavor in Indian cuisine and you can use it on veggies, sautéed chicken, or salad dressing.

Cinnamon: A compound in this tasty spice called hydroxychalcone makes receptors on cells work better, so your body absorbs blood sugar more easily. Getting ½ to 1 teaspoon a day, sprinkled on food, could lower blood sugar 10 points.It’s a favorite in German baked goods and Greek main dishes like hearty moussaka. Cinnamon is also delicious on oatmeal, in hot cocoa, and sprinkled on fresh fruit, like apples and bananas.

Ginger: This popular flavor in Thai cuisine may also cut your odds for inflammatory diseases like arthritis, as well as cancer and migraine headaches. You can also eat some if you’re prone to motion sickness or are nauseous, too. Try grated fresh ginger in salad dressings and shake powdered ginger into whole-grain muffins.

Garlic: Munching a clove a day could help lower your cholesterol by as much as 9%. Garlic contains tons of tangy compounds that may help protect against cancers of the breast, stomach, colon, esophagus, and pancreas — and soothe high blood pressure a bit, too. Garlic’s a favorite from Scandinavia to Spain and China. Use it to spice up veggies, fish, and your next pan of brown rice. It seems to make everything taste better (you could even try it on fruit and all veggies).

Rosemary: A top seasoning in Mediterranean cooking (the French roast it with almonds, the Italians add it to herb mixes), rosemary’s antioxidant capabilities make it a must for 21st-century grill masters. Adding this herb to meat, fish, and veggie marinades before grilling reduces cancer-causing compounds, called heterocyclic amines, by up to 80%.

So, use spices to keep your body and brain younger and watch the Dr Oz show for more spicy tips.

Thanks for reading.

Young Dr Mike

NOTE: You should NOT take this as medical advice. 

This article is of the opinion of its author.

Before you do anything, please consult with your doctor.

You can follow Dr Roizen  (and get updates on the latest and most important medical stories  of the week) on twitter @YoungDrMike. 

Feel free to continue to send questions to youdocs@gmail.com. You can follow Dr Roizen on twitter @YoungDrMike (and get updates on the latest and most important medical stories of the week).  The YOU docs have a new web site: YOUBeauty.com  and its companion BeautySage.com the only site we know of where you can find skin products proven to meet the claims (opened for business on June 1st, 2012), and a new book: YOU: The Owner’s Manual for Teens.

Michael F. Roizen, M.D., is chief wellness officer and chair of the Wellness Institute at the Cleveland Clinic. His radio show streams live on http://www.healthradio.net  Saturdays from 5-7 p.m . E-mail him questions at YouDocs@gmail.com.   He is the co-author of 4 #1 NY Times Best Sellers including : YOU Staying Young and YOU: The Owner’s Manual. He is Chief Medical Consultant to the two year running Emmy award winning Dr Oz show– The Dr Oz show is #2 nationally in daytime TV.  See what all the fun is about, and what he, The Enforcer, is up to. Check local listings or log onto DoctorOz.com for channel and time. And for more health info, log onto youbeauty.com anytime.

 

 

 

Carpal Tunnel Syndrome – Natural Treatment Options.

15 Jan

Carpal Tunnel Syndrome (CTS) is a condition characterized by pain, numbness and/or tingling in the hand. This includes the palm and the 2nd, 3rd, and half of the 4th finger, usually sparing the thumb. Another indication of CTS is weakness in grip strength such as difficulty opening a jar to even holding a coffee cup. CTS can occur from many different causes, the most common being repetitive motion injuries such as assembly line or typing/computing work. Here is a PARTIAL list of potential causes of CTS: heredity (a small sized tunnel), aging (>50 years old), rheumatoid arthritis, pregnancy, hypothyroid, birth control pill use, trauma to the wrist (especially colles fractures), diabetes mellitus, acromegaly, the use of corticosteroids, tumors (benign or malignant), obesity (BMI>29 are 2.5 more likely), double crush (pinching of the nerve in more than 1 place such as the neck and the carpal tunnel), heterozygous mutations in a gene (associated with Charcot-Marie-Tooth), Parvovirus b19, and others. Again, repetitive trauma is still the most common cause. It becomes quite clear that a COMPLETE physical examination must be conducted, not just evaluation of the wrist! Once the cause(s) of CTS has been nailed down, then treatment options can be considered.

From a treatment perspective, we’ve previously discussed what chiropractors typically do for CTS (spinal and extremity joint manipulation, muscle/soft tissue mobilization, physical therapy modalities such as laser, the use of a wrist splint – especially at night, work task modifications, wrist/hand/arm/neck exercises, vitamin B6, and more). But, what about using other “alternative” or non-medical approaches, especially those that can be done with chiropractic treatment? Here is a list of four alternative or complementary treatment options:

Anti-inflammatory Goals: Reducing systemic inflammation reduces overall pressure on the median nerve that travels through the limited space within the carpal tunnel at the wrist. An “anti-inflammatory diet” such a Mediterranean diet, gluten-free diet, paleo-diet (also referred to as the caveman diet) can also help. Herbs that can helps include arnica, bromelain, white willow bark, curcumen, ginger, turmeric, boswellia, and vitamins such as bioflavinoids, Vitamin B6 (and other B vitamins such as B1 and B12), vitamin C, and also omega 3 fatty acids.

Acupuncture: Inserting very thin needles into specific acupuncture points both near the wrist and further away can unblock energy channels (called meridians), improve energy flow, release natural pain reducing chemicals (endorphins and enkephlins), promote circulation and balance the nervous system. For CTS, the acupuncture points are located on the wrist, arm, thumb, hand, neck, upper back and leg. The number of sessions varies, dependant on how long the CTS has been present, the person’s overall health, and the severity of CTS.

Laser acupuncture: The use of a low level (or “cold” laser) or a class IV pulsed laser over the same acupuncture points as mentioned above can have very similar beneficial effects (without needles)! One particular study of 36 subjects with CTS for an average of 24 months included 14 patients who had 1-2 prior surgeries for CTS with poor post-surgical results. Even in that group, improvement was reported after 3 laser treatments per week for 4-5 weeks! In total, 33 of the 36 subjects reported 50-100% relief. These benefits were reportedly long-term as follow-up at 1-2 years later showed only 2 out of 23 subjects had pain that returned and subsequent laser treatment was again successful within several weeks.

Acupressure: Acupuncture point stimulation with manual pressure. These points can be self-stimulated by the CTS sufferer multiple times a day via deep rubbing techniques.

We realize you have a choice in who 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 require care for CTS, we would be honored to render our services.

 

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