How Does Wrist Position Affect the Carpal Tunnel?

11 Apr

Carpal tunnel syndrome (CTS) is the most common “peripheral neuropathy” (pinched nerves in the arms or legs) and is known to be caused by prolonged repetitive, forceful grip-related tasks involving the hands. The condition occurs when pressure is placed on the median nerve as it passes through the carpal tunnel, either from inflammation, mechanical injury, or both.

The position of the wrist and hand are very important, as the pressure inside a healthy wrist “normally” doubles when we bend the wrist/hand. However, when CTS is present, the pressure doesn’t double at the extreme end-ranges of motion. Rather, when inflammation is present, pressure can increase up to six times at the end-ranges of motion! This can be highly problematic at night because we don’t have much control over how we position our wrist. Not only can increased pressure on the median nerve cause you to wake up but it can set the stage for worsening symptoms in both the short and long term. This is why doctors often advise CTS patients to wear a night splint and to avoid prolonged awkward wrist positions during the day when working.

In a 2014 study involving 31 healthy college students, researchers used ultrasonography to measure median nerve deformation as participants bent their wrists and performed finger movement-intensive movements. Investigators observed that the median nerve flattened out with as little as 30º of wrist extension and became swollen after students performed rapid mobile-phone keying for five minutes with a corresponding increase in the cross-sectional area of the carpal tunnel. In a follow-up experiment, the research team found that the motion involved with clicking a mouse repeatedly had an even greater effect on the median nerve. The authors concluded that the increased use of electronic devices, especially in non-neutral wrist positions, increases the risk of CTS.

A literature review performed in the same year came to a similar conclusion: prolonged exposure to non-neutral wrist postures increased CTS risk by at least twofold.

In order to reduce pressure on the median nerve, doctors of chiropractic often use a combination of wrist splinting, patient education (including tool/workstation modifications), nutritional recommendations, and manual therapies. In many cases, this can lead to a successful outcome without the need for more invasive treatments. However, when necessary, your chiropractor can refer you to the appropriate provider and/or co-manage the condition with them.

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.

How Does Chiropractic Stack Up for Low Back Pain?

8 Apr

Doctors of chiropractic offer a non-surgical, treatment protocol for both acute and chronic low back pain (LBP), as do several other healthcare delivery systems. However, due to patient preference and a rising concern for potentially harmful side-effects, many LBP patients seek management strategies that offer a natural, non-pharmaceutical approach, of which chiropractic is the most commonly sought after practitioner-type. So what evidence is there regarding the benefits of chiropractic vs. other forms of care in managing LBP and its associated pain-related functional loss?

A 2018 study published in the online Journal of the American Medical Association focused directly on this question by comparing patient outcomes of those receiving usual medical care to a second group of patients that also received chiropractic care.

Data was collected at three sites—two large military medical centers and one smaller hospital at a military training site—over the 3.5-year time period. Eligible participants included active duty United States service members between 18 and 50 years in age who were diagnosed with mechanical low back pain.

Patients in each group received usual medical care for six weeks that included self-care, medications, physical therapy, and pain clinic referral. Participants in one group also received chiropractic care that included spinal manipulative therapy in the low back and adjacent regions and additional therapeutic procedures such as rehabilitative exercise, cryotherapy, superficial heat, and other manual therapies.

Up to six weeks after the conclusion of care, the researchers reported that patients in the  chiropractic group scored higher with respect to LBP intensity, disability, perceived improvement, satisfaction, and medication use. The researchers concluded that this trial clearly shows the need for chiropractic care for those suffering from LBP—reminding the reader that current LBP guidelines have embraced chiropractic care as a FIRST line of treatment for LBP.

This is not the first study to show the benefits of chiropractic care, as prior high-quality studies have reported higher patient satisfaction levels, less medication use, higher quality of life scores, and less LBP-related disability and recurrence rates for patients receiving chiropractic treatment vs. usual medical care. This article was published in a highly regarded medical journal (JAMA) and CLEARLY supports the need for chiropractic care in the management of LBP.

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 Brain Exercises Help Those with ADHD?

25 Mar

For many individuals—especially those with attention-deficit/hyperactivity disorder (ADHD) and attention-deficit disorder (ADD)—staying “on task” can be a challenge. Though medications are commonly used as a first line treatment for these conditions, research has shown the benefits may only last for a few years. University of California, Irvine scientist Dr. James M. Swanson even reports that pharmacological interventions for ADHD offer no lasting, long-term benefits. Because of this, researchers have been on the lookout for non-drug treatments to improve mindfulness, and it appears meditation may be one useful approach.

Mindful meditation is the process of sitting silently and focusing on your breathing. If you notice your attention starting to wander, return your focus to your breath. Not only will this help you relax but this practice may improve the connections in the brain circuitry that are responsible for maintaining focus. Dr. Swanson notes that individuals with ADHD/ADD appear to have reduced activity in this area of the brain.

In one study that included 50 adults with ADD, researchers observed that those who participated in mindfulness-based cognitive therapy (MBCT) achieved comparable results to standard medications for ADHD/ADD with respect to motivation and inhibitory regulation.

In a 2017 study involving 82 patients with anxiety, researchers found that just ten minutes of mindful meditation helped participants stay better focused on their daily tasks. Researcher Dr. Mengran Xu adds, “Our results indicate that mindfulness training may have protective effects on mind wandering for anxious individuals.”

Mindfulness can also reduce anxiety and depression symptoms, which can also benefit individuals with ADHD/ADD, as the conditions can often co-exist. In one study, researchers found that engaging in one hour of mindful meditation not only reduced anxiety symptoms but also reduced stress and improved arterial function. Doctors of chiropractic often include meditation concepts as part of their treatment recommendations, especially in the promotion of prevention and wellness.

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.

Neck Posture BEFORE a Car Wreck – Is It Important?

22 Mar

Abnormal postures of the neck—straight and reversed (kyphotic) curves, for example—are commonly encountered after an individual has experienced a motor vehicle collision (MVC). Many studies discuss the mechanism of injury during a rear-impact MVC that result in a straight or kyphotic curve, but few have considered the importance of this abnormal posture being present BEFORE the MVC and the role that plays regarding the degree of the resulting injury.

A group of researchers looked at this very issue and compared what happens to the cervical spine that is “normal” (lordotic) vs. straight vs. reversed (kyphotic) in a classic rear-end MVC. When the neck flexes or bends forward, the facet joints in the cervical vertebrae open up and the facet capsules and associated ligaments stretch or elongate. To determine what degree of injury would arise among the three postures, researchers measured the amount of stretch/elongation in these ligaments using a validated mathematical model of the human head-neck complex. With a normal lordotic posture, the greatest load during the simulated rear-end collision occurred high in the neck at C2-3, in the back part of the cervical spine, and from C3-4 to C6-7, on the sides of the cervical spine.

Most importantly, as the normal lordotic curve reduced to a straight and then further into a kyphotic or reversed curve, the researchers observed increases in the elongation magnitudes in the facet joints by up to 70%! Excessive elongation of the ligaments and join capsules can result in tearing and subsequent laxity to the facet joints as well as the surrounding ligamentous supporting tissues.

Laxity in these supporting tissues can lead to excessive movement between each vertebra and predispose them to accelerated degenerative changes leading to spinal instability over time. This study provides quantitative kinematic data that is level- and region-specific and supports the clinical findings that abnormal spinal curvatures increase the likelihood of whiplash injury severity.

Chiropractic focuses on the “3-P’s” – Pain management, Posture correction, and Prevention through the use of manual therapies, posture correction techniques, exercise training specific to each individual, and lifestyle management through diet and stress management strategies. The importance of restoring abnormal posture of the cervical spine is well illustrated by this study. Discuss this with your doctor of chiropractic to minimize your risk of injury in the event of a future trauma!

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 Cervical Spine Cause Shoulder Pain?

18 Mar

Subacromial impingement (SAI) is a common injury in sporting activities that require overhead motions, especially among pitchers, quarterbacks, and swimmers. Not everyone responds to treatment to the same degree, and a new study that reviewed two specific cases may offer a possible reason: the neck.

One of the two cases involved a high school football quarterback and the other a collegiate swimmer. Both participants presented with signs and symptoms of subacromial impingement with minimal neck complaints and few clinical signs that initially supported neck involvement.

Of interest, both patients had poor posture that included forward head carriage and rounded forward shoulders. During the initial examination, both had shoulder pain and weakness while raising their arm up from the side, a “classic” sign of rotator cuff muscle injury and subacromial bursitis. However, neither case did well when treatment addressed only the shoulder, prompting their doctors to test whether or not the patients’ poor posture had a role in their shoulder discomfort.

Once the patients performed chin retraction exercises followed by chin retraction plus extension exercises (three sets of ten repetitions) to improve their posture, they experienced a complete improvement in shoulder impingement and muscle weakness.

The author suspects that both patients experienced intermittent irritation of the C5 nerve root in the neck, which innervates the rotator cuff muscles, leading to their shoulder pain and weakness. In both cases, the two athletes performed home-based exercises and returned to their sports and did not have further problems during the rest of the season.

These two cases are GREAT examples of why doctors of chiropractic evaluate the whole patient to identify any and all factors that may contribute to a patient’s chief complaint. It is very common to find cervical spine joint dysfunction in patients with shoulder pain, and success in treatment favors treating both areas, of which (as noted in these case studies) the neck may be the most important focus.

What is Hip Impingement? Can Chiropractic Help?

14 Mar

Femoroacetabular impingement (FAI) is a pathological hip condition found in 17% of the population, and it’s caused by abnormal contact between the ball of hip and the socket. To be more precise, it’s the head-neck junction that impinges against the rim of the acetabulum. There are three types of FAI: cam, pincer, or a combination of the two. The cam deformity (also called “pistol-grip”) is from too much bone at the head-neck junction and is found in 65-75% of FAIs (often active young men 20-30 years old). The pincer deformity is from too much bone off the front of the acetabular rim (like a spur), and it is often seen in middle aged, active women. Less than 10% have both cam and pincer deformities together.

In some cases, FAI can arise without either a cam or pincer deformity and occurs as a consequence of extreme hip movements like those associated with ballet, gymnastics, or weight lifting (squatting). There are actually several types of impingement syndromes in the spine-pelvic region, but we will focus on that which occurs at the hip joint specifically, the FAI syndrome.

The pain associated with FAI results from repeated abutment, or contact, between the two bones leading to injury of the adjacent cartilage and/or labrum, which is a crescent-shaped band of cartilage that stabilizes, lubricates, and cushions the hip joint. Over time, repeated trauma can lead to hip joint osteoarthritis (OA). In fact, in a large population study, researchers observed cam and/or pincer deformities in 71% of males and 37% of females with hip OA.

The clinical presentation of FAI is usually found in healthy, active adults between 20-50 years in age. In older patients, it’s frequently accompanied by hip OA. Anterior FAI presents with pain in the front of the hip, groin, pubic bone, and/or anterior thigh and often arises from activities that include running/sprinting, kicking sports, hill climbing, and prolonged/repeated sitting in low chairs – any activity where the hip flexes forward (knee-to-chest positions).

Impingement from pincer deformities can also give rise to posterior FAI, or pain in the back of the hip joint. When this occurs, pain in the buttock and sacroiliac joint (SIJ) have to be differentiated from pain arising from the low back and/or SIJ. Repeated hip hyperextension such as from fast walking and hiking downhill are common causes.

So, can chiropractic help? Short answer – YES! The current research shows that non-surgical care for FAI should include avoiding activities that impinge the hip (discontinuing or modifying a sport or daily activity), reducing inflammation, and exercising to stretch the hip flexors and strengthen hip extensors. Once a proper diagnosis is made, your doctor of chiropractic can advise you on the best ways to manage your FAI.

 

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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