Factors That Can Hinder Carpal Tunnel Syndrome Recovery

6 Jun

As with most musculoskeletal conditions, treatment guidelines for carpal tunnel syndrome (CTS) recommend non-surgical or conservative management initially, with surgery only in emergency situations or after non-surgical options are exhausted. So, is there a way to know who will respond best to non-surgical approaches?

To answer this, researchers conducted a two-stage study that included an initial evaluation followed by non-surgical treatment and a re-evaluation one year after non-surgical treatment concluded. The primary goal of the study was to assess factors contributing to the long-term effects of non-surgical treatment of CTS and to identify failure risk factors.

The study involved 49 subjects diagnosed with CTS, of which an occupational cause was identified in 37 (76%). Because some patients had CTS in both hands (bilateral CTS), a total of 78 hands/wrists were included in the study. Treatment included a total of ten sessions of whirlpool massage to the wrist and hand, ultrasound, and median nerve glide exercises performed at home. The subjects were divided into three age groups: <50, 51-59, ≥60 years old.

While most patients experienced significant improvement in both stages of the study, some did not. Patients with more severe cases, as evidenced by poor results on a nerve conduction velocity (NCV) test, were less likely to respond to care, which underscores the importance of seeking care for CTS as soon as symptoms develop. Furthermore, participants who continued to overuse their hands at work or who did not modify their work procedures or workstation to reduce the forces applied on the hands and wrist were less likely to report significant improvements at the one-year point. Interestingly, age was not found to be a significant risk factor, which is surprising, as past studies have reported that being age over 50 is a risk factor.

Not only are doctors of chiropractic trained in the same non-surgical treatment methods used in this study, but they can combine such approaches with nutritional counseling (to reduce inflammation) and manual therapies to improve function in the wrist and other sites along the course of the median nerve to achieve the best possible results for their patients.

 

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.

Chiropractic Care During Pregnancy for Back and Pelvic Pain

3 Jun

Low back pain (LBP) and posterior pelvic pain (PPP) are very common complaints during pregnancy. In fact, current estimates show that two-thirds of expectant mothers will experience back pain during pregnancy and one in five will report pelvic pain. These afflictions can have a significant impact on a woman’s quality of life and her ability to carry out everyday tasks. So, where does chiropractic care fit into this picture?

While some pain conditions associated with pregnancy may be related to changes in certain hormones, there is evidence that the growing fetus shifts the center of gravity forward in a woman’s body. This shift can greatly affect the biomechanics of the body and place added strain on the lumbar and sacroiliac joints, giving rise to pain in those areas.

A landmark 2014 study looked at the effect of chiropractic treatment on 115 pregnant women with LBP/PPP. In a nutshell, 52% improved with respect to pain and disability after just one week of care, 70% after one month, 85% after three months, and 90% after six months.

Interestingly, the patients who had LBP/PPP prior to pregnancy tended to have higher pain scores at the conclusion of the study than those without a previous history of LBP/PPP. This finding supports the theory that women who have a history of LBP prior to pregnancy are particularly good candidates for chiropractic care early in their pregnancy. Also, due to a common link between persistent LBP after pregnancy and pre-pregnancy LBP, chiropractic care post-partum may be equally important.

This study included many chiropractors in various locations, and treatment was not standardized to any one specific method or technique. That being said, high-velocity, low-amplitude spinal manipulative therapy was the most common approach utilized and is the “standard of care” utilized by most chiropractors around the world. As further research is conducted, it seems clear that the use of SMT during pregnancy will become “the norm.”

 

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.

Deep, Slow Breathing for Pain Management?

27 May

Deep slow breathing (DSB) has been widely used for managing various diseases of the heart and lungs as well as for psychiatric disorders including anxiety, depression, and stress-related conditions. There appears to be some research to support DSB as being helpful for pain management, but the results have been inconsistent. However, a 2012 study suggests that how you “think” while practicing DSB may be the key for reducing pain…

In the study, researchers monitored sixteen healthy adults as they performed DSB while in both a relaxed and distracted state. In the relaxed state, participants were instructed to focus only on taking slow, deep breaths while in the distracted state, participants had to actively manage their deep breathing in pace with instructions on a computer screen. In order to reduce any carry-over effects, the active/distracted portions of the study were spaced six months apart and participants were advised to avoid practicing DSB or meditation or to seek any outside education on the topic.

Interestingly, in both circumstances, participants experienced similar reductions in negative feelings (tension, anger, and depression). However, the researchers only observed improvements with respect to pain thresholds, autonomic activity (skin conductance or sympathetic tone), and thermal detection for cold and hot stimuli when participants were relaxed.

Hence, it appears to be important that focused concentration on inhaling and exhaling or “thinking about” each breath in DSB and removing distracting thoughts is KEY to achieving increasing sympathetic arousal and improving mood processing. These findings may help to explain why mindful mediation, or mindfulness, benefits patients and why Eastern disciplines such as yoga, Qi-Gong, and Tai Chi are associated with reduced pain and improved mood.

Doctors of chiropractic often advise patients to reduce stress as part of management process for chronic pain conditions, with DSB being a great choice. This study shows that when done in a relaxed state, not only can patients experience mood-related benefits but they may also be able to reduce the effect of pain on their daily lives so they can perform their usual work and life activities.

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 Mid-Back Pain – How Can This Happen?

20 May

Research regarding whiplash or whiplash associated disorders (WAD) classically focuses on neck pain; however, the data show acute thoracic spine / mid-back pain (MBP) occurs in 66% of WAD injures with 23% still complaining of MBP at one-year post-injury.

It’s easy to visualize how the cervical spine or neck can be injured in an automobile collision (or sport-related collision or a fall) as the head, which weighs an average or twelve pounds, whips back and forth in a “crack-the-whip” like manner, often well beyond the normal, physiological range of motion. This same stretching (eccentric loading) followed by compression (concentric loading) also occurs in the mid-back, which can injure ligaments, joint capsules, neural structures, and more. Also, the thoracic spine contributes to 33% of flexion and 21% of rotation IN THE NECK, making the mid-back a vital spinal region that facilitates neck movement and function!

In WAD cases, mid-back pain often hides in the shadows of a more obvious and often more serious neck injury, as the brain typically perceives pain from the greatest source. Additionally, the neuronal input to the sensory cortex of the brain (the area of the brain that perceives pain) is most highly represented from the head, hands, and feet and less from the mid-back or torso.

The seat belt may also contribute to injury—both to the anterior chest region including rib cage, sternum, breast tissue, abdominal organs, as well as to the mid-back. The oblique angle of the chest-restraint is an important factor when discussing the mechanism of injury, as it causes trunk/torso rotation during the rebound or flexion phase of WAD. Another mechanism of injury includes blunt trauma, of which the driver is especially at risk due to the close proximity of the steering wheel and the chest. This can lead to contusion or bruising, fracture, and/or injury to the abdominal and/or chest organs (heart and lungs).

Obviously, the speed of impact, angle of the collision, bracing of the person (or lack thereof), and overall physical condition of the patient can greatly affect the outcome of WAD-related injuries. The importance of assessing the whole person is essential in obtaining an accurate diagnosis and establishing a comprehensive treatment plan for the WAD patient.

Chiropractic management focuses on the entire person, frequently uncovering complaints in other spinal regions as well as in the extremities in WAD-related injured patients. Moreover, treating postural issues such as a short leg, ankle pronation, oblique pelvis, forward head posture, protracted shoulders, and more is vitally important in obtaining satisfying patient outcomes!

 

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.

Chiropractic Methods for Treating Neck Pain

13 May

When it comes to neck pain, many patients seek out chiropractic care. In fact, there are several studies demonstrating that manual therapies performed by doctors of chiropractic can offer significant benefits for non-specific or mechanical neck pain as well as neck pain arising from injuries related to sports, car accidents, and falls. What are some of these manual therapies?

Spinal manipulative therapy (SMT) involves moving the head and neck to a firm end-range of movement followed by a fast, thrust aimed at specific joints that are fixed, subluxated (partially out of position), and tender. The thrust is described as a “high-velocity, low amplitude” (HVLA) movement, and it’s also called “an adjustment”, which is more unique to the chiropractic profession. Joint cavitation (the “cracking” sound) often occurs as gas (nitrogen, oxygen, carbon dioxide) either forms within or is released from the joint.

Spinal mobilization (SM) is a low-velocity, low amplitude movement that is typically slow and rhythmic, gradually increasing the depth of a back-and-forth movement, often combined with manual traction. Here, joint cavitation is less common.

Exercise training that focuses on strengthening the deep neck flexor muscles and other exercises that are specifically designed for each individual patient based on their specific needs can result in better treatment outcomes compared to a generalized, non-specific exercise program. Studies in which SMT/SM and exercise are combined report better long-term outcomes than SMT/SM alone, but SMT/SM typically out-performs exercise therapy alone.

Physical therapy modalities (PTM) can include ultrasound, interferential, low and high volt, galvanic current, diathermy, lasers (class 3B and IV primarily), ultraviolet, ionto- and phono- phoresis, pulsed electro-magnetic field, hot/cold, and more.

Muscle release techniques (MRTs) include massage therapy, myofascial release, trigger point therapy, muscle energy techniques, active release therapy, gua sha, and many more.

Cervical traction devices can be used either in the office or at home, depending on the patient’s needs; however, it’s common for both approaches to be used. The obvious benefits of home traction include the ability to repeat its use multiple times a day, and it’s generally more cost effective. Types include static traction that can be applied sitting or supine (on the back) and intermittent traction, which is typically performed supine and is computerized, and hence, is often limited to in-office use only.

Which approaches are used in the course of care depend on the preference of the patient as well as the treating chiropractor. It’s important to discuss your preferences with your chiropractor when seeking 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.

Where Is This Shoulder Pain Coming From?

9 May

When people say, “My shoulder hurts,” they often point to different areas in the vicinity of the shoulder such as the base of neck, the collar bone, the scapula (shoulder blade), the chest, and/or their arm. The challenge with the shoulder is that it’s anatomically comprised of three joints: the glenohumeral joint, or GHJ (ball-and-socket); the acromioclavicular joint, or ACJ (collar bone and scapula); and the scapulothoracic joint, or STJ (shoulder blade and rib cage). Some researchers even argue that the sternoclavicular joint, or SCJ (collar bone and sternum), should also be considered part of the shoulder.

From a musculoskeletal standpoint, the list of conditions that can cause shoulder pain is quite lengthy (and NOT all-inclusive): avascular necrosis (the bone dies due to lack of blood flow), nerve injury (neck and/or peripheral), thoracic outlet syndrome, fractures in/around the shoulder, bursitis, shoulder dislocation, frozen shoulder, impingement, arthritis (several types), rotator cuff injury, sprains, tendinitis or rupture, and labral tears (cartilage rim around the socket).

One of the most common causes of shoulder pain is impingement, which may occur with many of the above-mentioned conditions. This is technically referred to as “subacromial impingement” (SAI), which is essentially a reduction of the normal gap between the ball and socket, thus limiting the amount of room the joint has to function. Classic symptoms include pinching and pain when trying to put a coat sleeve on or raising the arm horizontally.

To complicate matters, conditions elsewhere in the body can also refer pain to the shoulder. In 2018, a study noted instances in which athletes failed to respond to routine treatment for shoulder pain but experienced improvements in pain and function when treatment addressed dysfunction in the cervical spine. Non-musculoskeletal conditions can also result in shoulder pain, such as gall bladder disease, which classically refers pain to the right scapula/shoulder blade. Other abdominal organ conditions that can refer pain to the shoulder include pancreatitis, an ovarian cyst, an ectopic pregnancy, as well as post-surgical referred pain. A heart attack classically refers pain to the left shoulder and left arm but may also include the abdomen, jaw, and/or mid-back. A lung condition such as a blood clot (pulmonary embolism), infection (like pneumonia), or lung cancer or tumors may also refer pain to the shoulder.

Doctors of chiropractic are trained to evaluate the whole patient and identify contributing factors for the patient’s chief complaint. In instances in which a non-musculoskeletal issue is suspected, the patient may be referred to the appropriate healthcare provider. However, a combination of manual therapies (manipulation/mobilization), exercise, ergonomic modifications, nutritional counseling, and physical therapy modalities can result in a satisfying outcome in most cases of shoulder pain.

 

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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