Treatment Option Comparison for Carpal Tunnel Syndrome

7 Dec

Carpal tunnel syndrome (CTS) results from the compression of the median nerve as it travels through the wrist. Classic symptoms associated with CTS include numbness, tingling, and weakness in the thumb, index, middle, and ring finger. In non-emergency situations, treatment guidelines recommend patients undergo conservative care before considering more invasive procedures, like surgery. This month’s article will look at the differences between standard medical care vs. chiropractic care to treat CTS.

In a case study series, researchers divided 91 patients with confirmed signs and symptoms of CTS into two groups: one receiving standard medical care utilizing ibuprofen and night splints; and one group receiving chiropractic care including manipulation of the upper extremity bony joints and soft tissues, as well as spinal manipulation. Researchers monitored improvement with self-reports, nerve conduction, and vibrometric sensation testing of the affected hand.

Both treatment groups experienced improvements in comfort, finger sensation, and nerve conduction; however, vibrometric sensation testing revealed greater improvements among members of the chiropractic treatment group (3.05 decibels vs. 1.37 decibels).

The authors of the study point out that chiropractic provides an alternative form of non-surgical care, and patients with CTS should be offered the option, especially for those who cannot take a non-steroidal anti-inflammatory drug (NSAID) due to intolerance like stomach irritation or liver-kidney issues. Personal preference is also important in the decision making process for CTS.

Other CTS treatment options often offered by doctors of chiropractic include work modifications, ice therapy, and nutritional options such as ginger, turmeric, boswellia, bromelain, fish oil, and others. There are also CTS-specific stretching exercises that can be done multiple times per day at home and work. The treatment plan for the CTS patient will often include several of these options in order to achieve a satisfying outcome.

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 to Do for Chronic Low Back Pain

4 Dec

Low back pain (LBP) is a very common problem that many, if not most of us, have had at some point in life. In fact, about 80% of adults experience LBP in their lifetime, and it’s the leading cause of job-related disability and missed work days. According to the National Institutes of Health, more than 25% of adults have had a recent episode of LBP.

Men and women are equally affected by LBP, which can occur abruptly following a specific incident (such as over lifting), or it can develop slowly over time due to wear and tear. Studies show a sedentary lifestyle during the week can set the stage for developing LBP, especially when it’s followed by strenuous weekend workouts.

Although about 80% of acute LBP (lasting a few days to weeks) resolves with self-care or short-term management, about 20% of those with acute LBP will still have persistent symptoms after a year. So what can be done to manage chronic LBP and prevent disability?

One study looked specifically at maintenance spinal manipulative therapy (SMT) to determine its effectiveness in managing chronic LBP, which they defined as LBP that persists for more than six months. Researchers randomly assigned sixty patients to receive either 1) 12 treatments of sham SMT for one month; 2) 12 treatments of SMT for one month but no treatment thereafter; or 3) 12 treatments for one month followed by SMT twice a month for the following nine months.

The research team found that groups two and three experienced significantly lower pain and disability scores than the sham treatment group at the end of the first month. However, only the third group experienced more improvement in regards to pain and disability at the ten-month evaluation. In the absence of continued SMT, the second group’s pain and disability scores returned back to near pre-treatment scores. The authors concluded that SMT is effective for chronic nonspecific LBP, but to obtain long-term benefit, patients should continue to receive care on an ongoing basis.

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 Dizziness?

27 Nov

Many of us have had problems associated with dizziness from time to time and have not thought much about it. But when dizziness happens frequently, lasts a long time, or is severe, it definitely gets our attention and forces us to get it checked out.

BACKGROUND: To determine how common dizziness is and the personal burden it imposes on the population, a large-scale study examined 2,751 adults (aged 50+ years) using multiple measures for dizziness, hearing, tinnitus (ringing in the ears), and quality of life. An alarming 60% reported some type of vertigo. Interestingly, the researchers observed an association between tinnitus and vertigo. Also, the participants with vertigo reported lower quality of life scores than those without dizziness complaints. This study highlights the significant burden imposed by dizziness/vertigo stating that this is an “important public healthcare issue” that must be studied further.

CAUSES: The most common causes include benign paroxysmal positional vertigo (BPPV), acute vestibular neuronitis or labyrinthitis, Meniere’s disease, migraine headaches, and anxiety disorders. Less commonly, reduced blood flow to the brain/head (“vertebrobasilar ischemia”) and retrocochlear tumors can cause dizziness. The risk also increases with age.

TREATMENT OPTIONS: Most vertigo sufferers do not require extensive testing and can be treated in the clinic.  Benign paroxysmal positional vertigo and labyrinthitis are most often successfully managed by doctors of chiropractic with specific exercise to reposition the displaced “canaliths” or small stone-like material in the inner ear.

Treatment with a low-salt diet and diuretics (herbal options include: dandelion, ginger, parsley, hawthorn, and juniper) can also be helpful in resistant cases with fewer side effects than prescription vestibular suppressing medications. Consuming potassium-rich foods such as bananas, avocados, raisins, beans, squash, mushrooms, potatoes, yogurt, or fish is often wise when taking a diuretic. Chiropractors often provide nutritional counseling and can help guide you in this area as well.

 

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.

Whiplash Injury Prevention

20 Nov

Some studies have suggested that 85% of all whiplash injuries occur from rear-end collisions. So, what are some different ways that we might be able to avoid injury if such an event occurs?

HEADREST: It’s important that your headrest is high enough so that your head and neck doesn’t roll over it in a collision, which can increase the risk of injury to the neck and head. Additionally, be careful to keep your head within eight cm (3.14 in) of the headrest while driving. By reducing the spacing between your head and the headrest, you can lower your risk for sustaining a brain injury in a rear-end collision. Today’s cars may also feature an active head restraint system that adjusts the head rest in an effort to shorten the distance between the head and the headrest when an accident occurs. ADVICE: Check the position and condition of your head restraint!

SEAT BACK POSITION: At least one study has concluded that vehicle occupants may have a higher injury risk if the seat back is fully upright. On the other hand, a seat back that leans too far back may serve as a ramp for the body during an accident, which could slide the head over the headrest. This too can increase the risk of injury. ADVICE: Recline the seat back somewhat while driving, but not too far.

BODY SIZE EFFECTS: A literature search study reviewed the potential injury effects as it relates to differences in anatomical size, head-neck orientation, the facet joints (small gliding joints in the back of the cervical spine), and neck muscles mass. The authors of the study reported that smaller sized necks, head positions outside of neutral (vs. looking straight forwards), and smaller muscle mass increased the potential for neck injury in a rear-end collision. ADVICE: Strengthen/exercise your neck muscles.

AIR BAGS & SEAT BELTS: Though these are not an “option” and have become “standard equipment” in cars, it’s clear that airbags and seat belts have saved far more lives compared with the injuries (including some deaths) that can be attributed to them. According to one source, more than 30,000 lives have been saved by front and side airbags. ADVICE: Make sure you act on any recall involving your airbag (and any recalls involving your car in general) and WEAR your seatbelt!

FACTORS DIFFICULT TO STUDY: Given all the variables involved in “real-world” car crashes, it is very difficult to predict which criteria are most important for injury prevention. For example, vehicular weight/size difference, multiple collisions—from different directions, readiness for impact, etc. The BEST ADVICE  – Stay alert, keep your eyes on the road, and don’t speed.

 

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 Pain Management Strategies

16 Nov

Because the human head weighs between 12-15 pounds (5.44-6.80 kg), the neck and upper back muscles must constantly work to maintain an upright posture. Due to our use of computer and electronic devices, many people have forward head posture (FHP), meaning their head rests forwards on the neck more than it should. In fact, studies show that every inch of FHP places an additional 10 pound (4.53 kg) burden on the muscles in the upper back and neck to keep the head upright. It’s no wonder why a common complaint is, “My head feels so heavy and my neck feels compressed—I constantly have to rest my head on the back of the couch when I sit.” So, what can we do about this?

POSTURE: Reducing FHP is essential. To do this, tuck in your chin (creating a “double chin”) and speak as you do this. You will notice a change in your voice quality—HOLD for ten seconds and then release JUST ENOUGH for the voice to clear and try to KEEP this position throughout the day. It takes about three months to retrain old bad posture habits so be patient!

SLEEP: If your neck is narrower than your head (the case for most of us), your pillow needs to be thicker on the edge to support your cervical spine.

ACTIVITY: You may have to assess which activities (such as sports) are most important to you and either modify how you do it and/or change when and how long you engage in such actions. If your goal is to improve in an activity, gradually increase the frequency, intensity, and duration over time. If you hurt and can’t recover within a “reasonable” time frame (such as 24-48 hours), then you overdid it.

Chiropractic offers MANY therapeutic tools to help those with neck pain, which include spinal and extremity manipulation, soft tissue therapy, physical therapy modalities (like ultrasound), nutritional counseling, and exercise training. Your doctor of chiropractic can give you advice on sleeping posture and prescription pillows, home cervical traction options, and more. The goal is not only to manage your neck pain, but more importantly,  to teach you self-management strategies so YOU can control of this often disabling condition and reduce the need for prolonged 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.

Shoulder Pain – What Exercises Are Best?

13 Nov

The shoulder is a unique joint because it has a great range of motion. Unfortunately, that benefit is negatively balanced with poor stability. This is likely why between 20-25% of the population is afflicted with shoulder pain at some point in life.

One of the greatest challenges in managing shoulder pain of musculoskeletal origin (it can also be a referred pain from a visceral organ like the gall bladder or from the heart) is its slow recovery rate. Some studies show that only about 50% of all new episodes of shoulder complaints have a complete recovery within six months. Add in the aging process, conditions that can slow recovery (like diabetes), and hobbies and jobs that increase the risk of re-injury and it’s understandable why it may not be possible for some patients to make a full recovery.

So, what can doctors of chiropractic do to help those with shoulder pain? The use of manipulation, mobilization, and modalities such as class IIIb and class IV laser (and others) can help a lot. But most importantly, exercise training is the KEY to a successful outcome.

Because of the slow recovery time for shoulder injuries, it is IMPORTANT to gradually introduce exercises at the correct time. In the initial acute stage, the following are appropriate:

Pendulum exercises: Like the pendulum of a clock, let the arm hang freely and gently swing while grasping a light weight (2.5-5 pounds, or 1.13-2.27 kg) – DO NOT try to lift the weight!

Finger walks up a wall: Face a wall and slowly walk your fingers up the wall but STOP at the point of pain. Remember, the first goal is to restore pain-free motion.

Once pain levels have improved and range of motion has been restored, resistance exercises are necessary to regain full function. TheraTube or TheraBand exercises are very practical, as you can travel with these and perform them anywhere. Here is a sample protocol: https://youtu.be/HKdm-2WYxDQ

Start with only three repetitions for each of these movements and SLOWLY release the tubing to help build coordination. If the protocol is too difficult, move toward the anchor point/door to reduce the tension on the tube. Be patient with your progress. It’s a slow but a consistent routine that will get you to your desired goals.

 

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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