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.

How Does Chiropractic Help Carpal Tunnel Syndrome?

11 Mar

Carpal tunnel syndrome (CTS) occurs when pressure is placed on the median nerve as it passes through bones and ligaments of the wrist in order to innervate a portion of the hand. This pressure can be cause by compression of the carpal tunnel due to mechanical injury or when other tissues near the median nerve become inflamed, either from disease or overuse.

When it comes to treating a patient with carpal tunnel syndrome (CTS), what separates chiropractic care from standard medical care? Both options recommend night wrist splints, anti-inflammatory measures, rest, and the “tincture of time.” Doctors of chiropractic are trained to provide manual therapies like manipulation and mobilization. Two studies show that these therapies can relieve pressure on the median nerve by improving the shape of the carpal tunnel itself.

In a study published in December 2018 in The Journal of Hand Surgery, researchers used dynamic ultrasound to capture images of longitudinal median nerve motion inside the tunnel as compressive forces were applied to the two sides of the wrist and distal forearm in both healthy and CTS patients. The researchers observed that the median nerve moved more within the carpal tunnel in patients with CTS compared to those without the condition.

In an anatomical study published in the journal Clinical Biomechanics (November 2018), lead author Dr. Elena Bueno-Gracia and colleagues measured the cross-sectional area of the carpal tunnel before and after manual manipulation and mobilization of the carpal bones. They observed both an increase in the front-to-back diameter of the tunnel AND a reduction in pressure on the median nerve. Additionally, the researchers noted that the shape of the carpal tunnel itself becomes more round following manipulative therapy. The research team reported that their findings are consistent with prior studies.

These studies demonstrate that the carpal tunnel is indeed dynamic/flexible and that manual techniques can alter its shape, providing more “breathing room” and allowing the contents within (i.e., the tendons and the median nerve) increased mobility with less friction.

Doctors of chiropractic are trained to provide manual therapies, which include mobilization and manipulation, of the spine and extremities of individuals with musculoskeletal conditions, including carpal tunnel syndrome.  Together with the “standard” therapies previously mentioned, proper exercises, and patient education, chiropractic is the perfect choice for non-surgical CTS 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.

Can Chiropractic Help Dysmenorrhea?

7 Mar

Primary dysmenorrhea (PD) is a very common gynecological disorder affecting 84.1% of women during childbearing age. The most common symptoms of PD include lower abdominal pain that can radiate to both thighs and/or to the low back. Other symptoms include tiredness, headache, nausea, constipation, and diarrhea. The condition precedes menstruation (in the absence of any organic pathology) and lasts approximately 48-72 hours. Primary dysmenorrhea is the most common reason for absenteeism from work or school, thus interfering with quality of daily life, which is associated with many direct and indirect costs.

There have been MANY proposed interventions for PD reported in the scientific literature. Most common are non-steroidal anti-inflammatory drugs (NSAIDs) and oral contraceptives, as both work similarly—they affect the cause of pelvic pain, which is reportedly mediated by the hormone-like fatty acid called prostaglandin factor 2x. However, both approaches carry negative side effects such as bleeding in the gut and hormone issues such as bloating and edema, respectively. Thus, the demand for new and alternative approaches with less associated risks has increased.

Spinal manipulative (SM) techniques for PD has been previously studied and proven to have positive benefits on pain perception and menstrual cramps, as well as affecting plasma (blood) levels of some chemical pain mediators. However, there appears to be a lack of agreement on where spinal manipulation should be applied. One study recommended that SM should be applied to the lumbosacral region (L5-S1) for symptom reduction in dysmenorrhea.

A more recent study found that “global pelvic manipulation” (GPM) performed on both sides of the pelvis to mobilize the sacroiliac joint (SIJ) and L5-S1 facet joint resulted in improvements related to low back pain and pressure pain thresholds in the SIJ, with a significant increase in serotonin.

Doctors of chiropractic specialize in the use of spinal manipulation therapy and are trained in many different techniques of lumbo-pelvic manipulation. For those struggling with PD, including a chiropractor as a member in your healthcare “team” makes perfect sense!

 

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.

Adding This To Your Diet May Help Your Memory…

25 Feb

Curcumin, a chemical found in turmeric that gives mustard and curry their yellow color, has long been known for its anti-inflammatory and anti-oxidant capabilities. Because of its prevalence in Indian cuisine, some researchers suspect that reduced inflammation in the brain from frequent curcumin use may explain why senior citizens in India have a lower prevalence of Alzheimer’s disease and better cognitive performance than older adults from other backgrounds.

In a 2018 study published in the American Journal of Geriatric Psychiatry, UCLA researchers examined what effects an easily absorbed curcumin supplement had on memory in individuals with AND without Alzheimer’s disease. The study utilized a double-blind, placebo-controlled study that included 40 adults (age 50-90) who had mild memory complaints. The patients were randomly assigned to one of two groups receiving either a placebo or 90 mg of curcumin two times a day for 18 months. Outcome measures used in the study included standard cognitive tests performed initially and again at six-month intervals, and curcumin blood levels were measured initially and again after 18 months. Positron emission tomography (PET) scans were utilized in 30 of the 40 subjects to determine the levels of amyloid and tau in the brain tissue at the start and after 18 months.

The curcumin group experienced significant improvements in memory and attention skills while members of the placebo group did not. Participants in the curcumin group also performed 28% better on memory assessments and reported mild improvements in their mood. Moreover, their brain PET scans showed significantly less amyloid and tau signals in the amygdala and hypothalamus, parts of the brain associated with memory and emotional functions.

The only reported side effects were mild abdominal pain and nausea, which affected four of the curcumin group participants. The authors are planning a larger study that will include people with mild depression to see if curcumin can also serve as an anti-depressant. It will also allow researchers to assess whether curcumin’s memory enhancing effects will vary according to people’s genetic risk for acquiring Alzheimer’s, their age, or the extent of their cognitive problems.

These preliminary results are exciting, as it appears that taking curcumin could provide meaningful cognitive benefits over the years. Doctors of chiropractic frequently council patients on diet and supplementation through the use vitamin, minerals, herbal formulas, and more, of which turmeric/curcumin is a common recommendation, especially given it anti-inflammatory benefits for musculoskeletal conditions.

 

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 Whiplash Treatment Outcomes Be Predicted Early On?

21 Feb

Whiplash associated disorders (WAD) refers to a collection of neck-related symptoms that are most commonly associated with car crashes. Experts estimate that up to 50% of acute WAD-injured patients will develop some form of long-term disability. Being able to predict who is more likely to develop long-term disability is VERY important, as it can place a substantial burden on not only the patient and their family, but society as a whole.

In order to determine which risk factors may predict whether or not WAD patient is at increased risk for long-term disability, a recent study analyzed findings from twelve systemic reviews. The researchers found that higher levels of post-injury pain and disability, higher WAD grades (WAD II & III), cold hypersensitivity, post-injury anxiety, catastrophizing, compensation and legal factors, and early-use healthcare each raise the risk for ongoing disability. The research team also determined the following are NOT associated with prolonged recovery: post-injury MRI or x-ray findings, motor dysfunction, or factors related to the collision.

In essence, this study looked at prognostic factors for a “typical” acute or newly injured WAD patient and found that those with severe neck pain and anxiety, who are seeking or have sought legal advice, and who had early healthcare use are at greater risk of a prolonged recovery. The type of accident (rear-end, T-bone, front-end, crash speed), examination findings, and x-ray findings do not appear to increase the risk of becoming chronic.

These findings parallel other studies regarding the association of chronic pain and psychosocial factors prolonging recovery including non-specific chronic low back pain as well as other conditions – even carpal tunnel syndrome! The authors emphasize the need for future studies to focus on how this type of information can be used in the treatment planning of WAD patients in the acute stage in order to PREVENT the progression to chronicity.

Doctors of chiropractic often see WAD-injured patients weeks or months after their accident, after they’ve been managed by primary care as well as by various specialty services. However, some patients will elect to seek chiropractic care soon after an accident. Future studies need to focus on the outcome of care rendered by different provider types to determine if one form of care minimizes the chronicity spiral that unfortunately exists. Until then, rest assured that exercise, self-management strategies, and independence from prolonged care is the foundation and mission of the chiropractors associated with ChiroTrust!

 

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 Adjustments Help Headaches?

18 Feb

Experts report that 157 million work days are lost each year in the United States due to headaches at a cost of about $50 billion in work absenteeism and medical expenses. According to current estimates, about 18% of chronic headache patients are believed to have cervicogenic headaches (CGH), or headaches that originate from dysfunction in the neck.

Many CGH sufferers utilize complementary and integrative health treatment approaches for neck pain and headaches, of which spinal manipulative therapy (SMT) is the most common. While past studies have demonstrated SMT to be a superior form of treatment for CGH, no one has investigated how many treatments are needed to achieve the maximum clinical benefit for CGH patients – at least not until recently!

In order to determine what dose of SMT may best benefit patients with headaches originating from the neck, researchers randomized 256 CGH patients into four treatment groups that received 0, 6, 12, or 18 SMT treatments over the course of six weeks. The researchers found a dose-dependent relationship between SMT and days without CGH over the following year with patients in the 18 visit group experiencing 16 fewer days with CGH over the next twelve months than those in the zero treatment group.

The chiropractic spinal manipulative therapy treatment used in the study consisted of high-velocity, low-amplitude thrust manipulation in the neck and upper back regions (specifically, occiput to T3) aimed at sites with detected joint dysfunction (fixation or pain), which is typically the method most chiropractors determine where to apply spinal manipulation.

This study is VERY important for a few reasons: 1) it proves SMT helps patients with CGH; 2) it provides doctors of chiropractic with an idea of how many visits it may take to obtain optimum results; and 3) it can be used as a guideline when managing CGH patients, stressing the important point that EACH patient is UNIQUE and modifications may be appropriate depending on each case.

 

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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