Treatment on the Wrist for Carpal Tunnel Syndrome

6 May

When treating patients with carpal tunnel syndrome (CTS), doctors of chiropractic can employ a variety of options to reduce pressure on the median nerve. While this can include dietary recommendations (to reduce inflammation), adjustments to address dysfunction elsewhere along the course of the median nerve, or even working with other healthcare providers to manage conditions that contribute to CTS (like diabetes), treatment will often focus on the wrist itself.

One such approach is referred to as neurodynamic techniques, or mobilization. In a study involving 103 patients with mild-to-moderate CTS, those who received treatment twice a week for ten weeks experienced greater improvements with respect to pain reduction, symptom severity, functional status, and nerve function than participants in a control group who received no treatment. The authors concluded, “The use of neurodynamic techniques in conservative treatment for mild to moderate forms of carpal tunnel syndrome has significant therapeutic benefits.”

This finding is supported by two previous studies that found the use of manual therapies on the wrist can alter the shape of the carpal tunnel itself and allow more room for the tendons, blood vessels, and median nerve.

Additionally, studies show that when the wrist moves beyond a neutral position, it can alter the shape of the carpal tunnel and increase pressure on its contents. In a healthy wrist, full extension/flexion can double pressure in the carpal tunnel; however, for CTS patients, the pressure can increase as much as 600%. That’s why many treatment guidelines recommend wearing a wrist splint (especially at night) and modifying work and life activities to keep the wrist in a neutral position as much as possible.

The good news is that in most cases of CTS, patients will benefit from a conservative treatment approach; however, achieving a successful outcome can be more difficult if the patient delays treatment. That’s why it’s important to consult with your doctor of chiropractic when you experience the signs and symptoms associated with CTS (pain, numbness, tingling, or weakness in the hands or fingers) sooner rather than later.

 

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.

Can the Outcome of Back Pain Be Predicted?

2 May

When patients present with low back pain (LBP), they are frequently nervous and worried about whether they’re going to respond to the treatment—especially when it comes to getting out of pain and returning to their normal activities. A variety of studies have shown chiropractic care to be an effective option for the LBP patient, and though there is no “crystal ball”, there are some tests that doctors of chiropractic can perform during an examination that can help predict outcomes!

In fact, a meta-analysis of data from 43 studies published since 2012 suggests that centralization and directional preference, which may be present in 60-70% of LBP cases, offers important prognostic clues. Directional preference means that it’s possible to move the body in a manner that feels better to the patient. Centralization implies that it’s possible to move in a way that reduces the range of the pain to a specific region.

Here’s an example… Let’s say an LBP patient presents with radiating leg pain from their lower back with numbness and tingling in the leg and foot. The focus is to find a movement that REDUCES the leg pain/numbness, so their doctor of chiropractic asks the patient to bend forward, backward, and sideways, and to rotate their torso, looking for which direction is preferred, i.e., directional preference. When pain decreases AND centralizes (the leg pain disappears), then extension is the directional preference.

When centralization occurs, this is a favorable prognostic sign indicating that improvement can be expected. Likewise, when all positions or directions increase leg pain, this is a poor prognostic sign, meaning this is likely a more challenging case.

This helps doctors better advise patients about their condition and what to expect from care in both the short and long term so the patient can make REALISTIC goals and timely plans. Over or under reassuring patients is simply not appropriate! Directional preference also allows providers a means of determining what type of treatment to emphasize. For example, if the patient feels better bending backward and leg pain disappears, the provider will approach treatment and exercise recommendations from that direction.

Patient education is an important part of treatment, and educating patients on how this process can predict treatment outcome instills trust and places realistic goals in perspective so patients know what to expect. This improves compliance with care and confidence for both the healthcare provider and the patient.

 

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.

Can Chiropractic Help GERD?

29 Apr

There is a plethora of research supporting the benefits of chiropractic care for many musculoskeletal (MSK) complaints including low back pain, neck pain, headaches, and more. However, less research is available for non-MSK complaints like gastroesophageal reflux disease, or GERD. So, what can chiropractic offer patients with GERD, and why is this important?

Normally, when we chew and swallow food, it passes through the lower esophageal sphincter (LES), a ring of muscle that opens to let food pass into the stomach and then closes to prevent food and acids from flowing back into the esophagus. If the LES is weak or relaxes inappropriately, individuals can experience the symptoms associated with GERD, including an acidic taste in the mouth, chest pain, choking, difficulty or inability to swallow, nausea, and/or burning sensation in the stomach and/or chest. More than 60 million Americans experience GERD at least once a month with 15 million adults suffering daily from the condition. The persistence of GERD can damage the esophagus, which can lead to inflammation and a breakdown in the lining leading to erosions, ulcerations, fibrotic scarring, and though rare, it can lead to cancer of the esophagus.

Common causes of GERD include (not all-inclusive): hiatal hernia, in which the stomach slides or rolls up above the opening in the diaphragm allowing acids that normally stay in the stomach to flow easily into the esophagus; excess weight from obesity or pregnancy, which can apply pressure against the stomach promoting acid reflux into the esophagus; a diet rich in fatty and/or spicy foods, chocolate, peppermint, coffee, or alcohol; eating late at night; poor posture (slumped); smoking; certain medications; and stress.

In a 2016 study, 22 middle-aged adults with a history of GERD (mean 20.4 months) received between three and sixteen treatments consisting of thoracic spinal manipulation, diaphragm mobilization, traction of the cardia, and posture correction—all of which can be provided in a chiropractic setting. All but two patients reported significant improvements that persisted up to three months following the conclusion of care.

In addition to the manual therapies listed above, your doctor of chiropractic can teach you exercises and offer nutritional advice to help manage GERD without the use of medications.

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.

Is There a Difference Between Whiplash and Non-Whiplash Neck Pain?

22 Apr

When we hear the term “whiplash injury,” we likely think of car crashes, though whiplash can result from other causes, like a fall or sports collision. Though whiplash is associated with a variety of symptoms, neck pain with lower pain thresholds (called central sensitization) is one of the most common. Neck pain can also occur in the absence of trauma or a known pathology. This is called mechanical neck pain (MNP).

Past research has shown that the combination of manual therapies (including mobilization and manipulation) and neck-specific exercises can benefit patients with neck pain, but is there a different treatment response between whiplash patients and MNP patients?

A 2017 study evaluated this very question. The authors recruited 28 patients with either grade I or II whiplash (pain with or without exam findings but no neurological losses) and 22 MNP patients. The patients in the MNP group were only included if their symptoms could be provoked by changes in cervical posture, neck movement, and palpation of certain neck muscles. The research team measured neck pain intensity, neck-related disability, pain area, cervical range of motion, and pressure pain thresholds (the amount of pressure measured to induce pain using a spring-loaded pressure gauge) both initially at baseline and again after six treatment sessions.

The results showed that whiplash sufferers initially had significantly higher pain-related disability, larger pain area, and central sensitization. In spite of this, the investigators observed that after six treatments, the patients in both groups achieved similar improvements with respect to cervical range of motion (flexion/extension, left/right side bending, and rotation), neck pain intensity, neck pain-related disability, pain area, and pressure point thresholds. However, the whiplash patients continued to experience a lower pain threshold than participants in the MNP group.

The good news for whiplash patients is that another 2017 study demonstrated that treating painful myofascial trigger points can help restore pain thresholds. Doctors of chiropractic frequently utilize the two treatment approaches from this study—manual therapy and specific neck exercises—in addition to other management approaches to achieve successful outcomes for patients with neck pain, either whiplash or MNP.

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.

Let’s Have Some “Pillow Talk!”

18 Apr

Individuals with neck pain may find it difficult for get a night of restful, restorative sleep due to pain keeping them awake or interrupting their slumber. Not only can a restless night make it more difficult to complete tasks related to everyday living or make neck pain worse, but poor sleep habits over time can raise one’s risk for chronic disease and even early death—perhaps as much as physical inactivity or a bad diet. When treating a patient with neck pain, doctors of chiropractic often inquire about the patient’s sleeping position and pillow, as addressing these factors may be important for getting a good night’s rest.

When it comes to a “good” position for the head while sleeping, most experts would recommend assuming a position that most closely mimics a good upright posture. If lying on the back, the head should not be forced toward the chest (hyper-flexed) or dropped too far backward into hyper-extension. When lying on the side, the head should not be forced upward or downward, away from the neutral position. If you habitually sleep on your stomach—which is generally NOT a good position for the neck due to the prolonged static rotation—you may want to consider a very thin pillow (or not using a pillow) to not force the neck too far up or down when rotated. Placing a body-pillow between the knees that extends up in front of the pelvis and chest can function as a “kick-stand” to keep you from rolling onto your stomach during the night.

What about pillow materials?  There are many to choose from, such as feathers, foam (memory and others), water, buckwheat, and/or combinations of these. While there is probably not a “best” choice, there are characteristic differences that are worth discussing. For example, memory foam molds nicely to the contours of the head and neck but can be hot and may have an unpleasant odor. Latex foam has the advantage of molding well to contours without becoming hot and comes in various densities to suit preferences, which can be quite helpful for those with neck pain and headaches. Generally, higher density foam offers less breakdown and more support. Latex is also resistant to mold and dust mites, another distinct advantage. Feathers and down pillows can mold to fit the body contours nicely but have a tendency to lose that initial position as the feathers often spread out while sleeping. Some people are also bothered by allergies or skin sensitivities making feather pillows and certain types of foam undesirable. Buckwheat hulls tend to mold well and be cool but then can be noisy when moving. Mattress firmness should also be taken into consideration, as the amount of “sinking in” will affect the pillow thickness decision.

If musculoskeletal pain is interfering with your sleep, consult with your doctor of chiropractic to help determine the best position and pillow for your individual case. Your chiropractor may also offer nutritional recommendations with the aim of improving sleep quality.

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.

What Is Patellofemoral Pain?

15 Apr

While chiropractic care commonly focuses on improving function in the spine to reduce neck pain and back pain, in many cases achieving a successful outcome is only possible when treatment addresses conditions elsewhere in the body. For example, ANY painful condition of the knee can alter one’s gait pattern, which can result in abnormal movement in the ankle, pelvis, and lower back, potentially leading to musculoskeletal pain in those areas as well. In this article, we’ll focus on patellofemoral (PF) pain, or pain that arises in the region of the knee cap, as it’s one of the more common knee conditions.

The anatomy in and around the patella is unique in several ways. First, the patella is the largest “sesamoid” (free-floating) bone of the body. The role of all sesamoid bones is to improve the function of the muscle/tendon connecting to the sesamoid bone by optimizing the angle of action. In effect, it acts like a pulley, which significantly improves the strength and force of the muscle. The quadriceps muscles attach above at the pelvis and below at the upper pole of the patella. The patella then glides in a grove, or track, located in the distal femur (thigh bone) and a tendon then attaches the lower pole of the patella to a bony prominence located just below the knee on the proximal tibia, or upper “shin bone.”

When we flex and extend our knee, the patella slides up and down in the track as the quadriceps contract and relax. This occurs automatically when walking, running, climbing, etc. Of the four muscles that make up the quadriceps, three (rectus femoris, vastus lateralis, and vastus intermedius) pull the patella up and out when we extend or straighten the knee and only one (vastus medialis) pulls the kneecap up and inward. To compensate for this disadvantage, the vastus medialis normally fires first during knee extension, which allows for proper patellar tracking and normal function.

A 2018 study published in the Archives of Medicine and Rehabilitation looked at the “neural drive” of the four quadriceps muscles in 56 women with or without PF pain. Subjects were asked to sustain an isometric, or static knee, extension contraction at 10% of their maximum effort for 70 seconds. Specialized nerve testing tools measured the average firing rates at various time points during muscle contraction.  In the non-PF pain subjects, the vastus medialis fired at higher rates vs. the largest muscle (the vastus lateralis) that pulls the patella up and out. This was the opposite case in the women with PF pain, which investigators suspect may cause and/or perpetuate PF pain.

This finding has led to the recommendation of isolating the vastus medialis with a specific strengthening exercise. This is accomplished by emphasizing the last ten degrees of full knee extension by completely locking or straightening out the knee in extension followed by only a slight bend. This is repeated 10-20 times with or without weight, depending on the degree of injury, pain, and muscle weakness. Your doctor of chiropractic can help train you in performing this exercise properly, as well as offer other highly effective exercises and treatments for knee 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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