Scapular Dyskinesis

20 May

The shoulder joint is really four joints—glenohumeral, scapulothoracic, acromioclavicular, and sternoclavicular—that all work in a coordinated manner to maneuver the upper arm. The shoulder blade, or the scapula, is an important player in normal shoulder movement because important muscles and related tissues are anchored in this bone. However, an issue with the scapula is easy to miss when diagnosing a patient seeking care for shoulder pain.

The main reason the scapula is overlooked is that when its position or motion is affected—a condition referred to as scapular dyskinesis—the patient may not initially experience pain or discomfort. However, though the condition may start in an asymptomatic manner, abnormal scapular movement can affect the motion of the rest of the shoulder, which can lead to the type of painful condition that drives a patient to their medical doctor or chiropractor’s office.

Indeed, the available research shows that patients with rotator cuff tears, glenohumeral instability, impingement syndrome, and labral tears often have scapular dyskinesis as well. One review found that between 67% and 100% of athletes with shoulder injuries have scapular dyskinesis. The same review noted that 54% of athletes in sports that require overhead motions had scapular dyskinesis.

Researchers have also observed abnormal scapular kinematics in sedentary, non-athletic individuals due to poor posture that places excessive strain on the upper back and neck to keep the head upright.

What can be done if a patient with shoulder pain exhibits scapular dyskinesis? First, treatment in a chiropractic setting might focus on manual therapies to restore normal motion to the affected joints. A doctor of chiropractic may also provide recommendations with heat and ice or nutrients to reduce inflammation. The patient will also be encouraged to perform at-home exercises as part of the recovery process.

A good starter exercise is to sit up tall by holding the head in line with the thorax (retract the chin), and “kiss” the scapula together followed by rolling the shoulders forward to separate the scapula WITHOUT shrugging the shoulders upward. Repeat this slowly, initially in front of a mirror, and concentrate on moving both sides rhythmically and equally. Eventually, do the same while on all fours or from a push-up position for something more difficult. Exercises that address forward head posture may also be recommended to reduce the load on the scapula caused by slouching.

As with many musculoskeletal conditions, the sooner a patient seeks care, the more likely they will achieve a successful treatment outcome—often in fewer visits—using conservative treatment approaches like chiropractic care.

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.

Reducing Carpal Tunnel Syndrome in the Office

13 May

Carpal tunnel syndrome (CTS) is a condition that occurs when the median nerve is compressed or restricted as it passes through the wrist. Because repetitive wrist and hand motions can inflame the tissues in the wrist and place pressure on the median nerve, workers in jobs that require such movements—such as those seated at a computer workstation all day—tend to have an elevated risk for the condition. That said, what can be done to minimize the risk?

A January 2021 study looked specifically at 1,000 office workers under age 50 from 30 workplaces in China. Participants completed a questionnaire that included information on demographics, work type, related physical and psychosocial factors, and wrist and hand symptoms using a body chart and a rating of the intensity of symptoms, nocturnal symptoms, and aggravating activities. Then, participants were clinically evaluated, and CTS was confirmed using standard testing protocols.

The authors reported that 22% of participants had wrist symptoms and 15% had hand symptoms, with 9.6% meeting the clinical criteria for CTS. Further analysis identified the following risk factors for CTS among office computer users: smoking, working with hand/wrist pain, prolonged computer use time, and working without breaks.

Mandatory breaks spread throughout the workday may be an effective strategy for reducing the risk for CTS among office workers. There is also strong research supporting the health benefits of integrating exercise with meditation during such breaks.

Meditation has been found to reduce stress and anxiety, as well as reduce chronic neck pain—another common complaint in the office environment. Incorporating physical activity during a short break will not only help lower the risk for CTS, but it may also reduce the risk for chronic ailments like cardiovascular disease and diabetes that are associated with high levels of sedentary behavior.

While it may not be possible to eliminate one’s risk for CTS, if hand and wrist symptoms are present, it’s important to seek care sooner rather than later because earlier intervention improves the odds for a satisfactory result. Doctors of chiropractic are trained to examine the whole person and look for all contributing factors in a patient’s chief complaint. With suspected CTS, it’s not uncommon to find additional areas along the course of the median nerve (the neck, shoulder, elbow, forearm) that need to be addressed to resolve the patient’s pain, numbness, tingling, and weakness symptoms.

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.

A Look at Resveratrol

11 May

Polyphenols are a group of over 500 phytochemicals, which are naturally occurring organic compounds produced in plants, that can reduce oxidative stress and inflammation in the body. Consumption of polyphenols has been reported to improve and help manage digestive disorders, obesity, diabetes, neurodegenerative conditions, and cardiovascular diseases.

In recent decades, a great deal of research has focused on a polyphenol called resveratrol that is found in over 70 plant species (most notably in the skins of red grapes) and of varying amounts in tea, pomegranates, nuts, dark chocolate, and many berries. However, because the body quickly metabolizes resveratrol, it’s generally taken in supplement form in order to achieve a dose high enough to provide a therapeutic effect.

A 2017 study reported that resveratrol can increase insulin sensitivity and improve blood glucose control, which may reduce the risk for diabetes and help type 2 diabetics manage their disease. It also improves blood vessel flexibility, which can help control hypertension or high blood pressure. A 2020 study reported that elderly women who took resveratrol experienced improved blood flow in the brain, which improved cognitive function.

Is resveratrol something that every adult should take as part of a healthier lifestyle? Unfortunately, no. As more studies are conducted on resveratrol, some adverse effects and interactions have come to light.  A 2020 study reported that like many antioxidants, resveratrol can have a pro-oxidant effect in some situations, which could in theory have negative consequences, although human volunteers in resveratrol studies have not reported serious issues or side effects. Taking resveratrol prior to exercise may counteract some of the health benefits associated with physical activity. Other reported side effects can include diarrhea, nausea, itchy bottom, and allergic reactions.  There have been some anecdotal reports of tendonitis such as ankle pain, swelling, and tennis elbow, although this side-effect is difficult to find in scientific literature.

Importantly, resveratrol has been observed to interact with the anti-blood clotting medication warfarin, which can result in unexpected anticoagulation and potential bleeding. Hence, it’s important that anyone taking resveratrol supplements should consult with a pharmacist to check for potential drug interactions.

As with any vitamin or supplement, inform yourself on the potential risks and benefits before deciding on adding them to your health regimen. With resveratrol, there are clearly a lot of health benefits to be obtained, but there are some individuals who should avoid its use. Your doctor of chiropractic can assist you when making decisions about a healthy diet and natural anti-inflammatory approaches for maintaining health and reducing the risk for chronic diseases that can interfere with your quality of 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.

A Vascular Cause of Low Back Pain

6 May

For the older adult, pain that radiates into the leg is a common complaint. This process, called neurogenic claudication, occurs when the spinal cord and/or nerve roots are pinched as they exit the arthritic spine (a condition called spinal stenosis). However, there is another degenerative condition that can cause pain in the legs called peripheral vascular disease, and it can be quite challenging to differentiate between vascular and neurogenic claudication.

Peripheral vascular disease (PVD) is a slow, progressive narrowing, blockage, or spasm in a blood vessel that can affect any blood vessel outside of the heart including arteries, veins, or lymphatic vessels. This hardening of the arteries most often affects the legs and feet, although it can affect any organ, including the brain. The most common cause is atherosclerosis, which is the buildup of plaque inside the vessel wall that narrows the blood vessels in one or both legs. This depletes blood flow, and as a result, oxygen and nutrients can’t easily reach their intended destination. Other causes can include injury to the affected part, irregular anatomy of the muscles and ligaments, and infection.

The first symptom of PVD is typically painful leg cramping during exercise that is relieved with rest. This usually occurs after a certain length of walking time, which gets shorter as the disease progresses. This experience is similar to symptoms reported by patients with spinal stenosis, and as such, individuals with PVD may find themselves consulting with a doctor of chiropractic about what they suspect is a musculoskeletal condition. So how does a doctor of chiropractic differentiate leg pain from PVD from leg pain from spinal stenosis associated with dysfunction in the lumbar spine?

One study that administered questions to patients with either neurogenic claudication (NC) or vascular claudication (VC) found that specific symptoms could help in the diagnostic process. For example, if standing still does not trigger pain, NC could be ruled out. On the other hand, NC is likely if standing triggers or increases pain, bending or leaning forward relieves pain when symptoms are above the knees, and sitting provides relief. Patients with VC are more likely to experience leg pain down to the calf that is relieved by standing still. For a definitive diagnosis, a referral for more advanced diagnostics may be required.

Doctors of chiropractic frequently treat patients with spinal stenosis with neurogenic claudication and will refer a patient to a vascular specialist or their medical physician if PVD is suspected so the patient can be provided with appropriate care.  

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.

Dietary Management of Joint Pain

23 Apr

It’s generally accepted that the normal aging process includes stiff joints and sore muscles. While exercise, stretching, hot/cold packs, and chiropractic care are commonly used tools for the non-pharmaceutical management of joint pain, there’s a growing body of research suggesting that dietary approaches to reduce inflammation may be just as important.

The following list of foods and food additives can promote inflammation and should be avoided as much as possible:

  • Sugar: Though it can be a challenge to resist the temptation of desserts, sodas, and some fruit juices, processed sugars trigger the release of inflammatory messengers called cytokines. But beware, the word “sugar” is camouflaged on many food labels, so watch for any word ending with “-ose”, such as glucose, fructose, and sucrose.
  • Saturated Fats: Studies show that saturated fats trigger adipose inflammation, which worsens arthritis and contributes to heart disease. Saturated fats are commonly found in pizza, cheese, red meat, full-dairy products, pasta dishes, and grain-based desserts.
  • Trans Fats: Since the early 1990s, researchers have warned us about trans fats triggering systemic inflammation. Fast foods and other fried products, processed snacks, frozen breakfast foods, cookies, donuts, crackers, and most margarines are popular culprits. Avoid foods containing partially hydrogenated oils listed in the ingredients.
  • Omega-6 Fatty Acids: Even though we do need SOME of these fats in our diet, a balance favoring omega-3 fatty acids is important. Omega-6 fatty acids can be found in certain oils (corn, safflower, sunflower, grapeseed, soy, peanut, and vegetable), in mayonnaise, and many salad dressings.
  • Refined Carbohydrates: This list includes white flour products including breads, rolls, crackers, white rice, white potatoes (instant mashed or French fries); and many cereals. Refined carbs are widely believed to be a major contributor to obesity, which increases inflammation in the body.
  • MSG (mono-sodium glutamate) is commonly found in foods that utilize soy sauce. It can also be added to many fast foods, soups, salad dressings, and deli meats to enhance flavor.
  • Gluten: Gluten sensitivity is a common health problem that causes joint pain and gut trouble. Gluten is found in wheat, barley, and rye. In those with gluten intolerance or Celiac disease, complete avoidance is necessary as gluten sets off an autoimmune response that damages the small intestine over time resulting in malabsorption of nutrients.
  • Aspartame: This artificial sweetener can trigger an autoimmune response in some individuals, resulting in inflammatory joint pain.
  • Alcohol: Excess intake can damage the liver, which interferes with many important metabolic functions resulting in inflammation.

On the other hand, a diet like the Mediterranean diet that focuses on eating fruits, vegetables, nuts, fish, olive oil, and whole grains while avoiding red and processed meats, dairy, saturated fats, and refined sugars, has been shown to reduce inflammation and reduce the risk for many chronic diseases and promote weight loss. If you have any questions on dietary approaches to reduce inflammation and fight joint pain, don’t hesitate to ask your doctor of chiropractic at your next visit.

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.

Whiplash and Dizziness

15 Apr

Whiplash associated disorders (WAD) is a term used to describe the myriad of symptoms that can occur following the sudden acceleration and deceleration of the head and neck. One of these symptoms is dizziness. How does the whiplash process lead to an impaired sense of balance, and are some individuals at greater risk than others?

It’s important to understand that our sense of balance is the result of input from the inner ear, eyes, and nervous system, which is then processed by the cerebellum located in the rear of the brain, just above the spinal cord. Abnormal function in any of these areas can result in the sensation of dizziness, which can dramatically affect one’s quality of life.

In a 2020 study, researchers enrolled 27 older (over 65) adult WAD patients and 32 young adult WAD patients in a battery of tests to determine which, if any, aspects of the balance system were impaired. Researchers concluded that older participants were at increased risk for vertigo and were also more likely to have abnormal proprioception and lesions near the cerebellum. This suggests that the rapid forward and backward motion associated with whiplash resulted in trauma near the area of the brain that may be most important for maintaining balance and affected the ability of the nervous system to efficiently relay sensory information to and from the rest of the body.

One hypothesis is that age-related declines in muscle strength may have reduced the neck’s ability to resist the back-and-forth whiplash motion. This can lead to increased injury to the tissues in the neck and potential injury to the brain, something that is supported by several recent studies linking whiplash and mild-traumatic brain injury.

Cervicogenic dizziness is a term used to describe dizziness caused by dysfunction in the cervical spine. A 2011 systemic review concluded that manual therapies—especially spinal manipulation and joint mobilization—are effective treatment options for this condition. A follow-up systemic review in 2019 affirmed this finding.

Doctors of chiropractic commonly evaluate and treat patients with whiplash associated disorders, including those experiencing dizziness, with a multimodal approach involving manual therapies and specific exercises. If examination findings suggest injury to areas of the body outside the scope of care, chiropractors can co-manage with the patient’s medical doctor or refer to a specialist.

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.