The Course of the Median Nerve and Carpal Tunnel Syndrome

6 Oct

Carpal tunnel syndrome (CTS) is a condition characterized by numbness, tingling, pain, and weakness in the thumb, index finger, middle finger, and the radial half of the ring finger, as well as the portion of the hand between these digits and the wrist. The condition results from compression of the median nerve as it passes through the wrist; however, if care is only directed toward alleviating pressure on the nerve within the carpal tunnel, lasting relief may not occur. This is because of the course of the median nerve itself.

Five nerves exit the cervical spine and join to form the brachial plexus at the base of the neck. Segments of the lateral and medial cords then combine to form the median nerve. From there, the nerve travels through the shoulder, down the upper arm, past the elbow, along the forearm, and finally through the carpal tunnel to terminate in the hand. The median nerve functions much like a two-lane road, carrying commands for movement and other body functions to muscles and tissues while relaying sensory information back to the brain. When this process is impeded by narrowing in the carpal tunnel, sensory nerves may misfire and motor nerves may be slow to activate—leading to the symptoms of CTS.

Compression, however, can occur at any point along the nerve’s path and may create the same symptoms as CTS. In some cases, compression exists in multiple locations simultaneously. For this reason, chiropractors examine the entire length of the median nerve to identify all potential points of entrapment. By applying pressure with the thumb over the most common compression sites and noting how quickly symptoms are reproduced, chiropractors can identify inflamed areas requiring treatment.

Once the points of compression are identified, chiropractors typically employ a combination of methods such as manual and soft tissue therapies, exercise training, splinting (particularly at night to maintain a neutral wrist position), and anti-inflammatory physiologic or nutritional approaches. They will also inquire about work and recreational activities, since highly repetitive hand movements—especially those involving forceful gripping or pinching—can worsen symptoms and may impede recovery.

Perhaps even more important than how chiropractors treat CTS is when they treat it. Because the condition typically develops from repetitive microtrauma, symptoms often begin subtly and intermittently then gradually increase in frequency and severity. Many individuals ignore or self-manage until the condition interferes too much with their daily life and work tasks. Unfortunately, delaying care can allow permanent nerve damage to occur, making complete resolution unlikely. The key takeaway is to seek chiropractic care for carpal tunnel symptoms sooner rather than later.

Pain Relief Chiropractic

4909 Louise Drive. Mechanicsburg, PA 17055

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Understanding Lumbar Disk Injuries

2 Oct

Low back pain can arise from a variety of structures in the lower back. When symptoms include pain, tingling, numbness, and/or burning that radiates into the buttock, thigh, calf, or foot, a potential cause may be injury to one or more intervertebral disks. These disks function to stabilize the lumbar spine, absorb forces, and facilitate its range of motion.

The lower back is comprised of five lumbar vertebrae separated by intervertebral disks positioned in the anterior portion of the spinal column. The nucleus pulposus is a gel-like structure in the center of the disk that provides much of the strength and flexibility of the spine. In young, healthy disks, the nucleus pulposus is composed of 66–86% water, with the remainder consisting mostly of type II collagen and proteoglycans. The annulus fibrosis, surrounding this core, is made up of concentric layers (lamellae) of fibrous connective tissue, each oriented at about 60 degrees to the adjacent layer. This crisscross radial-ply design provides significant strength and helps prevent leakage of the nucleus pulposus, much like the reinforcement of a radial car tire. Finally, each disk is anchored to the vertebrae above and below by cartilaginous endplates.

Common disk injuries include disk bulge (the annulus remains intact but the disk extends beyond its normal boundaries), disk herniation (the nucleus pulposus pushes through the annulus), disk tear (the annulus itself tears), disk endplate injury (the nucleus pulposus intrudes into the vertebral endplate), disk degeneration (progressive breakdown leading to loss of disk height). Less common conditions include infection or neoplastic (tumor) invasion of the disk space. Importantly, disk injuries are not always symptomatic, which is why guidelines often recommend against advanced imaging for uncomplicated low back pain, as an observed disk herniation may not necessarily explain the patient’s symptoms.

Several studies have shown that it is nearly impossible to herniate a truly healthy disk. Rather, when an apparent injury follows a perceived trauma such as lifting with poor posture, it usually represents the culmination of a longer degenerative process in which the disk ultimately places pressure on a nerve root. Long-term risk factors for disk degeneration include obesity, family history of disk disease, and physically demanding occupations or leisure activities.

The good news is that many disk injuries can be managed non-surgically in a chiropractic setting using a multimodal approach. This may include spinal manipulation and other manual therapies, therapeutic exercise, physiotherapy modalities, and adjunctive anti-inflammatory strategies such as cryotherapy, dietary modification, and supplementation. In the short term, treatment focuses on restoring normal motion around the disk and reducing nerve root irritation. Over the longer term, the goal is to stabilize the spine and correct biomechanical issues that may place excess stress on the disk. If symptoms do not respond adequately, referral to a specialist for more invasive interventions, including surgical options, may be warranted.

Pain Relief Chiropractic

4909 Louise Drive Suite 102

Mechanicsburg, PA 17055

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Monthly Pain Relief Update: Neck Pain / Headaches

28 Jul

Text Neck Syndrome and Chiropractic Care

Neck pain is a leading cause of disability worldwide, and after low back pain, it’s the second most common reason people seek chiropractic care. In the past two decades, a new contributor to neck pain has emerged: text neck syndrome, a condition linked to prolonged use of smartphones and other digital devices.

Text neck syndrome results from spending excessive time looking down at a screen. In more clinical terms, it’s caused by sustained neck and head flexion, which places strain on the muscles and soft tissues at the back of the neck. For every inch the head moves forward from its neutral position, the neck muscles must support approximately ten pounds of additional force—similar to how it’s harder to hold a bowling ball with your arm extended than when it’s held close to the body. Over time, the body adapts to this strain by altering posture, such as rounding the shoulders or altering the curves of the cervical and thoracic spine. These postural changes can impair range of motion and negatively affect joint health, increasing the risk of chronic neck pain and related conditions.

What’s especially concerning is that text neck syndrome is common among younger individuals. A history of neck pain in young adulthood is a known risk factor for more severe neck problems later in life. Research involving university students around the world has found that between half and two-thirds report signs of text neck. The risk is further increased among individuals who are overweight, physically inactive, and those who spend more than three hours each day engaged in sedentary leisure activities.

To reduce the risk of developing text neck syndrome and the neck pain that may come with it, experts recommend limiting time spent on electronic devices; taking regular breaks to stand, stretch, and walk around; holding devices at eye level; increasing physical activity; reducing sedentary behavior; maintaining a healthy weight; managing stress; and following an anti-inflammatory eating pattern, such as the Mediterranean diet.

For those already experiencing neck pain associated with device use, chiropractic care may offer relief. In addition to in-office manual therapies that help restore joint movement and reduce muscular tension, chiropractors can provide guidance on exercises to retrain the muscles of the neck, chest, and upper back, which may help correct postural faults and reduce the likelihood of recurring pain.

Pain Relief Chiropractic

painreliefcare.net

Mechanicsburg, PA

 (717) 697-1888

We are watching your back!

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Monthly update on Lower Back Pain

14 Jul

Chiropractic Treatment for Lumbar Spinal Stenosis

            Lumbar spinal stenosis is a condition caused by the narrowing of spaces within the lower spine, which can compress either the spinal cord or nerve roots. This pressure can lead to pain, numbness, or weakness—either locally or radiating down the legs—especially during activities that involve spinal extension (e.g., bending backward or prolonged standing) or compressive loading. While stenosis may result from trauma, congenital anomalies, or systemic diseases, approximately 80% of lumbar spinal stenosis cases are degenerative in origin. Common degenerative contributors include intervertebral disk bulging or herniation, facet joint hypertrophy (arthritis), ligamentum flavum thickening, spondylolisthesis (vertebral slippage), and osteophyte (bone spur) formation. How might chiropractic care help a lumbar spinal stenosis patient both avoid surgical intervention and return to their normal activities to as high a degree as possible?

In the medical model, initial treatment may include physical therapy and/or medications. If those fail to provide relief, a common next step is epidural steroid injections (ESIs), which aim to reduce nerve inflammation and provide temporary symptom relief. A 2025 systematic review of 90 randomized controlled trials found that ESIs can offer short-term improvement in pain and disability but do not result in long-term symptom resolution. If a patient experiences minimal relief after one to two injections, if relief lasts less than one month, or if neurological symptoms progress, further injections are generally not recommended. Clinical guidelines typically limit ESIs to a maximum of three per year, and suggest limiting repeated use to no more than two to three consecutive years due to risks such as bone loss, adrenal suppression, and soft tissue damage.

If the patient pursues chiropractic care, the aim of treatment would be to reduce neural compression by improving lumbar spine mobility and joint spacing. For lumbar spinal stenosis, current guidelines discourage high-velocity, low-amplitude (HVLA) spinal manipulation. Instead, they support gentler techniques such as flexion-distraction, mobilization, and instrument-assisted soft tissue therapies. Chiropractic care may also include targeted exercise, posture training, and neuromuscular re-education to support spinal health and nerve mobility.

Just as critical as in-office treatment is the home management component. Patients are encouraged to perform flexion-based and low-impact exercises—such as stationary biking, inclined treadmill walking, wall sits, and knee-to-chest stretches—which can reduce pressure on lumbar nerves. Core stabilization improves spine support, while posture training and ergonomic adjustments (e.g., lumbar support, avoiding prolonged standing, sleeping with knees elevated) help maintain relief. Lifestyle modifications such as weight loss, an anti-inflammatory diet (rich in omega-3s, vegetables, and whole foods), hydration, and use of ice, heat, or TENS units for pain control can further support long-term improvement.

The good news: with consistent effort, as many as 70% of patients with lumbar spinal stenosis can improve or maintain stable symptoms without ever needing surgery. Only about 30% of patients progress to requiring surgical intervention—typically when pain is disabling, function is severely limited, or neurologic decline occurs.

Watching your back,

Dr. Binder

Pain Relief Chiropractic

painreliefcare.net

(717) 697-1888

Member of Chiro-Trust.org

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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Decision-Making Factors for Carpal Tunnel Syndrome Care

17 Apr

While carpal tunnel syndrome (CTS) is a very common condition, controversy still exists among researchers and healthcare professionals regarding best practices for managing the condition. Most studies on musculoskeletal disorders, including CTS, focus on identifying treatments that provide symptom relief rather than exploring the factors influencing patients’ decisions, particularly when choosing between surgical and non-surgical options.

A December 2024 meta-analysis reviewed six studies that examined CTS treatment from the patient’s perspective, revealing four key decision-making themes:

  • Return to Normalcy – Does this treatment effectively relieve symptoms and restore quality of life, allowing for uninterrupted sleep and daily activities?
  • Patient-Centered Care – Is treatment information clear, specific, and accessible? Are patients given options, or are they simply told what their treatment will be?
  • Work Considerations – Will treatment require time off work or job modifications? Will the doctor provide necessary documentation for the employer? Will the patient be able to return to their usual job, or must they consider a career change?
  • Expectations – How quickly will relief occur? What is the likelihood of full recovery? If this treatment fails, what are the next steps?

The authors emphasized the importance of healthcare providers considering multiple decision-making factors and prioritizing clear communication and shared decision-making in CTS care. This approach enhances patient satisfaction and may lead to better treatment outcomes.

Chiropractic care provides CTS patients with a non-surgical treatment option that incorporates manual therapies to restore mobility to the median nerve, not only at the wrist but along its entire course from the neck to the hands. In addition, chiropractors may use complementary approaches such as night splinting, exercise training, physical therapy modalities, ergonomic assessment and modifications, and anti-inflammatory strategies. If necessary, care may be co-managed with other healthcare professionals who provide services beyond a doctor of chiropractic’s scope of practice.

Pain Relief Chiropractic

Painreliefcare.net

Mechanicsburg, PA

 (717) 697-1888

Member of Chiro-Trust.org

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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Impact of Forward Head Posture on Breathing and Balance

10 Apr

Ideally, the head should rest on the neck with the external auditory meatus (ear opening) aligning with the acromion process (bony end of the shoulder) when viewed from the side. When we have good neck posture, it’s hard to believe the head weighs the same as a recreational bowling ball. Unfortunately, most people don’t have ideal posture. Studies estimate that a significant portion of the population—especially those who spend prolonged hours on screens—exhibits forward head posture. Research suggests that for every one inch the head shifts forward, the load on the cervical spine increases by approximately 10 lbs., placing excessive strain on the neck muscles and joints, which can result in neck pain. Forward head posture can also affect balance and breathing. Here’s how…

Our body maintains balance through the careful coordination of three systems. Most people are familiar with the vestibular system in the inner ear and our visual system as being important for balance, but many are less familiar with the proprioceptive system. Proprioceptors are special nerve cells in tendons, muscles, and joints that provide feedback about where the various parts of the body are in relation to one another. The soft tissues in the neck are particularly rich in proprioceptors, and the excess stress and strain caused by forward head posture can impair their function, which in turn can affect balance, coordination, and spatial awareness.

 Forward-head posture leads to a rounded upper back (thoracic kyphosis), restricting lower rib mobility and diaphragm efficiency. This may reduce forced vital capacity, inspiratory reserve volume, and peak expiratory flow, leading to shallower breathing and decreased oxygen intake. Essentially, forward head posture means you can’t breathe as deeply and have less lung capacity and oxygen intake, potentially leading to lower fitness, less vitality, brain fog, and difficulty maintaining focus. Patients with forward head posture also tend to overuse the chest and neck muscles when breathing, which can affect the ability of these muscles to contribute to other activities.

Chiropractic care for forward head posture typically involves a multimodal approach, including spinal adjustments to improve cervical mobility, myofascial release to relieve muscle tension, postural retraining exercises to strengthen stabilizing muscles, and ergonomic recommendations to help patients maintain proper head positioning throughout daily activities. If proprioception or breathing deficits are observed, additional strategies will be employed both in the office and at home to help restore normal function as quickly as possible.

Pain Relief Chiropractic

Mechanicsburg, PA

Painreliefcare.net

 (717) 697-1888

Member of Chiro-Trust.org

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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