The Chiropractic Approach to Carpal Tunnel Syndrome

6 Jan

Carpal tunnel syndrome (CTS) is a condition that occurs when pressure is applied to the median nerve as it passes through the wrist resulting in symptoms such as tingling, numbness, and weakness. Outside of an emergency leading to a sudden onset of such symptoms—like a broken wrist—surgery is rarely advised as a first-line treatment. In general, treatment guidelines recommend exhausting all non-surgical options before consulting a surgeon. So, what happens when a patient consults a doctor of chiropractic for CTS?

First, the patient completes paperwork regarding their current symptoms and their health history. The information provided will inform the doctor about the chronicity, frequency, and intensity of the patient’s symptoms. The history may also reveal conditions that are known to contribute to an elevated risk for CTS such as diabetes, birth control pill usage, pregnancy, hypothyroid, etc.

Next, the doctor of chiropractic will conduct a thorough examination, with added focus on the course of the median nerve. The median nerve arises from the spinal cord in the neck as nerve roots travel down through the shoulder, past the elbow, and through the wrist. If the nerve is compressed anywhere along this route, a patient may experience CTS-like symptoms, so it’s important to locate where the nerve is “pinched” in order to ensure the best chance for a positive outcome. To complicate matters, the median nerve may be compressed at several points, a condition referred to a double crush or multiple crush syndrome. Not only that, but the median nerve isn’t the only nerve that supplies sensation to the hand. When entrapped, the ulnar and radial nerves can also produce symptoms in the hand and these symptoms can be mistaken for CTS by the layperson because it’s the most commonly known peripheral neuropathy.

Once all the potential contributing factors to the patient’s hand and wrist symptoms are identified, the doctor of chiropractic will recommend a course of treatment that may involve manipulation, mobilization, therapeutic exercises, modalities, wrist splinting, and even dietary recommendations, depending on the patient’s unique situation. The goal is to reduce pressure on the median nerve by restoring normal motion in the affected joints, as well as in reducing inflammation that may be present from a variety of causes.

While patients with more severe cases of CTS can benefit from non-surgical approaches, like chiropractic care, it’s important to note that it may take longer for such patients to experience improvements in pain and disability, and it may not be possible to totally reverse the course of the disease if it has progressed too far. As with many conditions, the sooner a patient seeks care, the greater their chance for achieving a successful outcome.

 

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.

Spinal Stenosis and Non-Surgical Care

2 Jan

It’s common to see older adults with a slumped posture, and though there are many possible reasons for this, perhaps the most common cause is a condition called spinal stenosis.

The Mayo Clinic notes that spinal stenosis can result from wear-and-tear that narrows the spinal disks. This narrowing can place pressure on the nerve roots as they exit the spine prior to traveling down into the legs. The symptoms—which can include pain, numbness/tingling, and weakness—typically come on gradually and may worsen over time. The spinal stenosis patient may feel more comfortable by leaning or bending forward as this posture opens the holes in the spine (the foramen), taking pressure off the nerves.

Because spinal stenosis is a condition caused by wear-and-tear, some individuals may be at more risk than others, especially those with a history of spinal/disk injury, heavy labor, poor nutrition, or obesity.

The good news is that patients with spinal stenosis can benefit from non-surgical approaches!

In a 2019 randomized trial involving 259 seniors with spinal stenosis, researchers compared the effectiveness of three approaches: medical care (including epidural steroid injections), group-based exercise, or manual therapy (spinal mobilization performed by a doctor of chiropractic) with individualized exercise (stretches and strength training).

While participants in the medical care and exercise-only groups reported some benefits, the research team noted that the patients in the manual therapy plus individualized exercise group experienced greater improvements with respect to pain, function, and walking ability.

The “take-home” message here is that in all three measured outcomes—pain, function and walking ability—the chiropractic approach did the BEST!  If you suffer from spinal stenosis and its associated symptoms and walking limitations, PLEASE consider chiropractic not only as an option but perhaps as this study points out, the BEST option!

 

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.

Omega-3 Fatty Acids and the Brain

26 Dec

The omega-3 fatty acids DHA and EPA can reduce the risk for cardiovascular issues and even ease depressive symptoms, but can these healthy fats also help keep our minds sharp as we age?

In one study, researchers from the University of Pittsburgh School of Medicine monitored the diets of 260 healthy, cognitively normal older adults for ten years and found that participants who consumed blackened or broiled (but not fried) fish at least once a week had healthier brains over time. In fact, a comparison of MRIs revealed that these weekly fish consumers had greater gray matter volume in the areas of the brain responsible for memory (4.3%) and cognition (14%).

Previous research has shown that people who eat more seafood have a reduced risk for blood clots and white-matter abnormalities, both of which could impair brain function. Omega-3 fatty acids promote neuron growth in the brain, improve cerebral blood flow, and reduce cellular inflammation. Researchers have also observed that adults with lower blood levels of the omega-3 fatty acids DHA and EPA in late middle age had smaller brain volumes and cognitive dysfunction as older adults compared to their peers with higher blood levels of the omega-3 fatty acids. An analysis of data from the Framingham Study cohort revealed that participants with the highest DHA levels had a 47% reduced risk for all-cause dementia and 39% lower risk for Alzheimer’s disease.

In one systemic review, researchers found that omega-6 fatty acid levels are also important for brain health. Essentially, the investigators found significant evidence that cognitive decline and dementia were more likely in those who had higher omega-6 fatty acid serum levels. This is noteworthy because fast foods are often high in omega-6 fatty acids. According to the Centers for Disease Control and Prevention, 36.6% of adults in the United States consume fast food on any given day!

While some degree of cognitive decline is anticipated with age, these findings suggest that eating a healthy diet that’s high in omega-3 fatty acids and low in omega-6 fatty acids can help keep the mind sharp.

 

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 Injury, Severity, and Recovery

23 Dec

Experts estimate that whiplash associated disorders (WAD) from motor vehicle collisions (MVCs) affect about 300 for every 100,000 people in the Western each year. Suffice it to say, that’s a lot of people!

Crash tests have demonstrated that the risk for whiplash is much greater when the backrest is leaned backward and/or when a headrest is lacking (in older cars) or is too low in relation to the head. The key is to prevent the head from extending backward over the top of the seat, which can lead to more severe soft tissue injuries in the neck. While it’s not always possible to anticipate an MVC, past research has shown that looking forward at the time of the collision may reduce WAD injury/severity risk.

On the topic of necks, individuals with thinner necks have a greater risk for injury, which may explain why woman are more often affected by WAD than men. However, regardless of whether you are male or female, staying fit and keeping the neck muscles strong is important. It’s been suggested that individuals with a history of neck pain are more likely to experience more severe whiplash injuries, as are those in poor general health. There are conflicting studies that report that seat belt use may increase the risk for WAD, but after reviewing multiple studies, the consensus is that seat belts save lives, so buckle up!

In many cases, WAD patients may miss work, especially if they have a job with high physical demands. Patients with more severe injuries may miss up to twenty-five days of work, while those with minor injuries may still be out for up to ten days. One study found that about 31% of the 800 cases the researchers looked at took no time off work, 52% returned to work after only four days off, and 90% returned within thirty days off. About 4.9% of the patients in the study were still not working after twelve weeks.

Several factors suggest a WAD patient may experience a slower or more limited recovery: a history of neck pain; loss of neck motion measured post-MVC; increased sensitivity to cold stimulation; high pain levels post-MVC; less severe crash-type; dizziness, arm pain or numbness; low back pain; and poor expectations of recovery.

The good news is that treatment guidelines have consistently recommended spinal manipulation— he primary form of treatment provided by doctors of chiropractic—for managing whiplash-related injuries.

 

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.

Spinal Manipulation and Headaches

19 Dec

Cervicogenic headache (CGH) refers to headaches caused by dysfunction in the neck, and experts estimate that 18% of chronic headache patients have cervicogenic headaches. Spinal manipulative therapy (SMT) is a form of treatment most commonly provided by doctors of chiropractic, and several studies have demonstrated that SMT is highly effective for patients suffering musculoskeletal disorders of the neck, including those with cervicogenic headaches. However, there remains little consensus on the appropriate number of SMT treatments to achieve maximum benefits for CGH.

In a 2018 study, a team of researchers conducted a large-scale study involving 256 chronic CGH patients to determine how many treatments are needed to achieve optimum results using SMT for CGH. The investigators randomly assigned participants to one of four dose levels (0, 6, 12, or 18 visits) of SMT for six weeks. The type of SMT consisted of a manual high-velocity, low-amplitude (HVLA) thrust manipulation in the cervical and upper thoracic regions. The location of the spinal adjustment was determined by a brief, standard spinal palpatory examination from the occiput to T3 to assess for pain and restricted motion. For older patients and/or those in acute pain, the manual therapy was modified to a low-velocity, low-amplitude mobilization. To control for visit consistency and provider attention, patients continued to receive a light massage treatment once a patient’s assigned number of visits was satisfied, until the six-week treatment period ended.

After the conclusion of the treatment phase of the study, the participants used a headache diary to keep track of their headaches for the next year. The results showed that the patients who received the most SMT treatments had fewer headaches over the following twelve months. More specifically, the researchers calculated that six additional SMT visits resulted in about twelve fewer days with headaches over the next year.

If you suffer from headaches, consider consulting with a doctor of chiropractic to determine if cervical dysfunction is a potential cause or contributing factor and whether you are a candidate for spinal manipulative therapy.

 

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.

Traction for Low Back Pain?

16 Dec

In the past, we’ve written about the use of mechanical traction for patients with neck pain. But what about the low back pain (LBP) patient? Can traction help reduce pain and improve function for this group? Let’s see what the scientific literature has to say about traction for the lower back and whether it has merit.

In a 2018 systematic review, researchers analyzed data from previous studies regarding the use of traction on the lumbar spine. They identified 37 randomized clinical trials that reported on five different types of traction: mechanical, auto-traction, manual, gravitational, and aquatic. Not only did the research team observe great variability in the types of traction used, but they also saw differences with respect to the amount of force, rhythm, session duration, and treatment frequency. To add yet more variables, patient characteristics often included a mixture of acute, subacute, and chronic LBP patients, with or without sciatica and without consistency in the clinical diagnoses.

With so many varieties of low back traction being used on patients with a large mix of diagnoses in the acute, sub-acute, and chronic stages of their condition, the review was unable to make an overall determination about the effectiveness of traction. However, some of the studies that included well-defined patient populations did show promise.

For example, the authors discussed a small pilot study that utilized inversion traction. This form of traction is unique because it is designed to be done at home, making it far more cost-effective and practical. The participants in this study all had a single herniated disk in their lower back with sciatica (pain radiating down the leg following the course of the pinched nerve). The methods of the study were straightforward. A group of patients awaiting surgery for their herniated disk were randomly assigned to one of two groups: physical therapy (PT) ONLY or PT plus inversion traction (IT). While the research team tracked improvement using a variety of criteria, their ultimate definition of success was defined as cancellation of the surgery.

The results CLEARLY showed that the group receiving PT alone did worse than PT + IT group, as 22.2% vs. 76.9% of each group avoided surgery, respectively. The authors concluded that inversion traction is a form of traction that resulted in a significant reduction in the need for surgery, and they recommended a larger study be carried out to further validate their results.

For some patients, traction may be useful in the management of low back pain, depending on their unique case. Doctors of chiropractic often treat patients with low back pain using a combination of spinal manipulation, mobilization, nutritional advice, exercise recommendations, and more—including in-office or at-home traction, if warranted.

 

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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