Carpal Tunnel Syndrome – OVERVIEW (Part 2)

12 Mar

This discussion picks up from last month as we review the “nuts & bolts” of carpal tunnel syndrome (CTS). We left off at “CLINICAL PRESENTATION”…

CLINICAL PRESENTATION (continued): A weakness in grip and pinch strength usually follows an initial loss of sensation in the second to fourth palm-side fingers. The intensity of weakness is more dependent on the amount of pressure versus duration of time of numbness. In other words, if a high degree of pressure suddenly occurs inside the carpal tunnel (like a fracture with bleeding into the tunnel), the patient may feel weakness right away. But usually, CTS is a slow, smoldering condition and if weakness occurs, it comes on slowly and most patients cannot say for sure when their weakness symptoms started.

PHYSICAL EXAM: It is important to assess other possible areas for neurological compression, such as the neck, shoulder (thoracic outlet), elbow, and/or forearm. Also, it’s necessary to rule out “co-morbidities” or other conditions that contribute to CTS. The list is long but includes diabetes, hypothyroid, pregnancy/birth control pills/recent menopause, kidney disease, arthritis, Lyme disease, multiple sclerosis, and more. The physical exam may also include a sensory exam and a motor exam as well as specific orthopedic provocative tests that can reproduce CTS symptoms. Your doctor may also order an EMG/NCV (electromyography/nerve conduction velocity) but NONE of these tests are 100% sensitive and specific—that is, there are false-positives and negatives. Lab and blood tests can help tease out some of the other possible conditions (listed above). X-ray, MRI, CT scan, and ultrasound may help identify spurs, fracture, cysts, and other space occupying causes of CTS, but no one test is enough.

TREATMENT: Chiropractic offers manual therapies such as manipulation, mobilization, massage, and myofascial release of not just the wrist and hand but also the cervical spine, shoulder, elbow, and forearm regions, if the median nerve is impeded in places beyond the wrist. Doctors of chiropractic often utilize night splints and recommend rest, job modifications, and anti-inflammatory agents such as ginger, turmeric, bioflavonoid, and proteolytic enzymes. Because being overweight can increase one’s risk for CTS, lifestyle improvements aimed at cutting excess mass may be recommended as well. MDs may prescribe anti-inflammatory drugs and help manage co-morbidities such as diabetes, hormone replacement, hypothyroid, and the like. Often, a coordinated “team approach” of care providers works best. Surgery may be necessary in some cases but usually ONLY after all the above fails.

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 & Foot Orthotics: A Great Combination for Back Pain!

8 Mar

When treating patients with low back pain (LBP), doctors of chiropractic have three common goals: 1) pain management; 2) posture alignment or correction; and 3) prevention. When warranted, the use of corrective prescription foot orthotics can help achieve all three goals.

In a 2017 study, researchers recruited 225 adult subjects with chronic low back pain (cLBP) and randomly assigned them to one of three treatment groups: 1) shoe orthotics only; 2) chiropractic care (included spinal manipulation, hot or cold packs, and manual soft tissue massage) with shoe orthotics; or 3) a non-treatment group.

The primary outcome measures used to track change over time included a numerical pain rating scale and a functional rating questionnaire (Oswestry Disability Index – ODI) at baseline and after six weeks of treatment, with follow-up three, six, and twelve months later.

After six weeks, only the first two groups experienced improvements in both average back pain intensity and function, with the orthotic plus chiropractic group reporting even greater functional improvement.

While podiatrists have long suggested the use of foot orthotics for some cases of LBP because of the effect foot function has on the “kinetic chain,” it was not until the last decade that researchers in other fields have reported the effects the feet have on knee, hip/pelvic, and back function.

Studies have now demonstrated the adverse effects of hyperpronation (rolling in) of the foot on pain, function, and alignment of the pelvis. These studies point out the importance of not overlooking foot dysfunction as a potential (and important) contributing factor when managing patients with 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.

If You Try a “Gluten-Free” Diet…

26 Feb

Gluten is found in wheat, oats, barley, and rye, and for those with Celiac Disease and non-celiac gluten sensitivity (NCGS), gluten can be very dangerous, even lethal. But many people opt to avoid foods containing gluten as part of an anti-inflammatory diet and there seems to be little-to-no argument that anti-inflammatory diets are indeed a very healthy choice.

One study reported that a Mediterranean-style diet can reduce cardiovascular risk factors and can help resolve both metabolic syndrome and non-alcoholic fatty liver disease. Additionally, there are several published studies describing how an anti-inflammatory diet can reduce pain associated with conditions such as rheumatoid arthritis. One such study reported a striking reduction in pain, joint inflammation, and morning stiffness duration reduction utilizing this type of diet—and these improvements persisted when researchers followed-up with participants a year later!

Because low-grade inflammation has now been identified as the driver of most chronic degenerative diseases, it is important to understand that low-grade chronic inflammation manifests itself both locally and systemically through a variety of inflammatory mediators. Many of these can be measured in a blood test and are commonly found in patients with chronic diseases such as atherosclerosis (hardening of the arteries) and osteoarthritis.

Individuals who do their best to cut gluten from their diet often seek out gluten-free versions of their favorite foods. Is there anything these people should know?

Well, an article in the November 2017 issue of Consumer Reports notes that gluten-free foods made with rice flour may contain high levels of arsenic and other heavy metals. The article also points out that those who restrict foods containing gluten tend to eat fewer whole grains, which may result in increased heart disease risk due to lower fiber intake.

What the authors of the article don’t point out is that consuming more fruits and vegetables can make up for this deficit, as these foods can also be high in fiber. The good news is that gluten-free whole grains such as amaranth, freekeh, quinoa, buckwheat, millet, teff, and sorghum are great, healthy substitutes.

Whiplash – Who Will Get Better?

19 Feb

Though most patients with a whiplash injury improve within a few months, about 25% have long-term pain and disability that may persist for many months or years.

 

Now, a team of scientists from Northwestern Medicine Feinberg school of Medicine reports that it may be possible to determine which whiplash patients will develop chronic pain, disability, and/or post-traumatic stress disorder (PTSD) within one to two weeks of their injury—leading to specialized treatment that may reduce their risk for developing a chronic condition.

 

Using a specialized form of MRI that measures the fat and water ratio in the neck muscles, the researchers found that greater fat infiltration into these muscles indicated rapid muscle atrophy. The presence of fat in the muscle is not related to the person’s weight, size, or shape and is believed to represent an injury that is more severe or serious than what might be expected from a typical low-speed car crash.

 

However, though the lead investigator notes that the fat infiltration into the muscle appears to be a response to an injury, what has actually been injured—muscle, nerves/spinal cord, and/or more—remains a mystery.

Another study by the same research team found that chronic pain whiplash victims also exhibited a high level of muscle fat in their legs—indicating atrophy. The researchers hypothesize that these patients may have partially damaged their spinal cord, as this group of patients also reported feeling weak and clumsy when walking.

Current research indicates that when managing whiplash cases, early return to activity, movement restoration, and exercises that specifically target the deep neck flexors lead to better outcomes than a “wait and watch” approach.

Doctors of chiropractic also utilize manipulation, mobilization, exercise training, diet, and nutrition, and encourage a return to a normal lifestyle as quickly as possible when treating patients with a whiplash injury.

Sick & Tired of Neck Pain?

15 Feb

For most of us, neck pain has reared its ugly head more than once. In fact, there are estimates that anywhere from one-in-ten to one-in-five people will experience an episode of neck pain in a given year. Though some studies report that between 33% and 65% of these people will recover within twelve months, many individuals will experience either a relapse of their neck pain or their neck pain will become a chronic health issue.

So what can a doctor of chiropractic do about it? The answer is simple: spinal manipulation (SM) and exercise. Spinal manipulation is the most common form of treatment delivered in a chiropractic setting, and many studies note that neck pain is the second most common reason patients seek chiropractic care (back pain is number one). Regarding exercise, patients may be advised to engage in stretching exercise, strengthening exercises, or both.

For example, after an hour of seated computer work, one might experience muscle fatigue from prolonged static postures, especially for those outside of a neutral position. For this scenario, here’s a great STRETCH option to do every 30-60 minutes (yes, SET A TIMER): 1) Tuck the chin (and keep it tucked); 2) reach with the right hand over the top of the head and gently pull the right ear toward the shoulder while the left hand reaches down to the floor (as if to pick up a dollar bill); 3) next, nod the head (as if gesturing “yes”) multiple times; 4) follow this by shaking the head left to right (as if gesturing “no”); 5) repeat steps one through four with the head/neck flexed forward and backwards, “searching” for the tightest spots and “work” them until they loosen up. Repeat on the opposite side.

Here is an exercise to STREGTHEN the neck muscles. 1) Tuck in the chin while looking straight ahead; 2) place the back of your second and third fingers under your chin and nod (up/down) against mild resistance; 3) repeat five to ten times SLOWLY; 4)  repeat steps one through three with head/neck flexed forward and then again backwards (looking towards the ceiling). Repeat multiple times each day.

The KEY is to set the timer to remind you to do these! If you have significant forward head carriage and rounded shoulders, your doctor of chiropractic can show you addition important exercises, but this will be a great start for you to gain control over that chronic, recurring neck pain that you’ve been putting up with for far too long!

Why Is Shoulder Pain So Common?

12 Feb

Shoulder pain is common. If fact, it’s highly likely that many of you reading this currently have or have had a shoulder injury, as studies suggest that about 90% of us will tear our rotator cuff, labrum, and/or capsule at some point in time during our lives. So why is this so common? More importantly, what can be done about this?

The reason for the high prevalence of shoulder pain is due to the anatomy of the shoulder. The shallow “socket” allows for the shoulder’s great range of motion, but with this excellent mobility comes a decrease in stability, as a joint can’t be BOTH stable AND highly mobile. So from a prevention standpoint, consider the following: 1) Don’t reach into the back seat to lift your heavy briefcase or purse to the front seat. 2) Take “mini-breaks” when working overhead. 3) Follow an exercise program that maintains strength in your shoulders. 4) Get help when you know the task you’re about to attempt is going to be a challenge. This list could go on and on but the last point is crucial: don’t feel insecure about asking for help with difficult tasks! As the saying goes, “An ounce of prevention is worth a pound of cure.”

An important goal regarding recovery from a shoulder injury involves restoring the joint space between the ball and socket joint and the “roof” of the shoulder or acromion process (or “acromiohumeral distance”, or AHD). A shoulder impingement injury typically occurs when this space is reduced, resulting in a tighter fit that pinches pain-sensitive structures when one attempts to raise their arm up over their head.

To reduce impingement, try the popular “pendular exercise” by holding a 5-15 lbs (2.26-6.80 kg) weight so that the arm swings loosely like the pendulum of a clock. The weight pulls the shoulder joint open, reducing impingement. Another exercise is gripping the seat of a chair while leaning to the opposite side (focus on relaxing the shoulder while leaning) to open or separate the joint. The joint can also be opened using elastic therapeutic tape. A 2017 study found that taping over the front and back deltoid muscle from insertion to origin worked best to open the AHD to reduce impingement. Doctors of chiropractic can also utilize manipulation and mobilization to open the AHD.

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