Carpal Tunnel Syndrome – More Than Just a Wrist Problem

8 Jan

Carpal tunnel syndrome (CTS) is a common condition that affects around 6-12% of the population and can result in significant pain and disability. The financial costs associated with CTS can be staggering – ranging from $45,000 to $89,000 per patient over a six-year period when productivity loses are taken into account.

Historically, doctors and researchers have described CTS as the result of compression of the median nerve as it travels through the bony carpal tunnel at the wrist. However, there is recent evidence that CTS is a more complex pain syndrome with multiple studies showing women with CTS exhibit widespread pressure pain hypersensitivity, thermal pain increases, and what’s called “enhanced wind-up in extra-median nerve territories.” In other words, the central nervous system seems to be involved, affecting the whole body, not just the wrist and hand.

Traditionally, the management of CTS has included conservative interventions primarily focused on relieving wrist and hand symptoms using splints, manual therapies, modalities (ultrasound, laser), and exercise—with surgery recommended if the patient fails to respond treatment. In looking at CTS as a product of the central nervous system (CNS), therapies that target desensitizing the nervous system may be more effective.

A 2017 randomized clinical trial compared manual therapy with surgery for improving BOTH pain and central sensitization (“nociceptive gain”) in CTS patients. Here, researchers randomly assigned 100 women to either a manual therapy group who received one session per week for three weeks including “desensitizing manoeuvres of the CNS” or a surgical intervention group (50 in each group). The research team evaluated pressure pain thresholds (PPT), thermal pain thresholds (hot or cold – HPT or CPT), and pain intensity at baseline, three, six, nine, and twelve month intervals following the intervention.

After one year, those in the manual therapy group experienced higher increases in PPT over the carpal tunnel at three, six, and nine months and greater decreases in pain intensity at three-months than those who underwent a surgical procedure. Otherwise, the outcome measurements were similar for both groups.

The significance of this study supports that a non-surgical, manual therapy approach (in which chiropractic specializes) is more effective in the short term and equally effective in the long term as surgery for BOTH pain and central sensitization (PPT only – not HPT/CPT for either group).

A Simple Remedy for Chronic Low Back Pain?

4 Jan

Low back pain (LBP) affects about 80% of adults at some point in their life, and its impact on work, recreation, and overall quality of life can be devastating if it transitions into chronic LBP (low back pain that persists for more than three months).

So, is there really a simple remedy for chronic LBP (cLBP)? Since back pain is often multifactorial in its causation, the simple answer is “probably not”. BUT, a 2017 study reports that simply taking vitamin D can offer significant benefits for the cLBP patient.

In the study, researchers provided participants (68 patients with a history of cLBP and low vitamin D levels) with an oral dose of 60,000 IU of vitamin D3 every week for eight weeks. The research team measured pain intensity and disability using common outcome assessments at baseline and at two, three, and six months post treatment. They also collected blood samples to measure vitamin D serum levels.

The data show that not only did the patients’ vitamin D levels improve from 12.8 ng/mL (+/- 5.73) at baseline to 36.07 (+/- 12.51) at eight months with 45 (66%) of the patients attaining a normal level of >29 ng/mL, but the participants also report significant improvements in pain and disability throughout the course of the study.

The authors conclude that vitamin D supplements can improve pain and function in cLBP patients with vitamin D deficiency. Hence, this is a VERY SIMPLE remedy!

It is well known that vitamin D deficiency is a very common problem, with up to 75% of teens and adults having suboptimal levels. Past research has demonstrated vitamin D deficiency may be a risk factor for many disorders including cancer, heart disease, diabetes, and depression. It appears that we can now add cLBP to the long list of conditions that vitamin D supplementation may benefit.

Chiropractic services frequently include nutritional counseling, diet management, and other wellness-related services in the quest of optimizing patient health, well-being, and quality of life.

Charlie Horses and Management Strategies

28 Dec

At some point in time, most of us have had a “Charlie horse” or muscle cramp. In fact, 50% of adults over the age of 50 suffer from night cramps. Doctors of chiropractic are often asked by their patients, “Where do these come from? Why am I having these? What can I do to get rid of them?”

 

The most common type of muscle cramp is caused by exercise, hence the label “exercise-associated muscle cramps” (EAMC). Though EAMCs are common in both recreational and professional athletes, the actual cause remains unclear. Therefore, treatment is often based on anecdotal studies rather than sound scientific evidence.

With that said, a thorough analysis of previous studies published between 1955 and 2008 concluded that the two most widely discussed theories for the cause of EAMC are 1) dehydration and the resulting electrolyte imbalance/depletion and 2) neuromuscular causes. The authors of the analysis concluded that the actual cause is “…likely due to several factors coalescing to cause EAMC.” In other words, it’s sort of like “a perfect storm”, as several causes interact to result in the cramp, which is why treatment and prevention strategies for EAMC can vary considerably.

The recommended care for acute EAMC is to apply a steady, moderate static stretch to the muscle followed by gathering a proper history to determine if any predisposing conditions exist that can trigger EAMC. Prevention should focus on fluid and electrolyte balance (replacement) and/or neuromuscular training.

Specific physical problems that can increase the rate and/or intensity of muscle cramps include conditions affecting the endocrine system (hormonal imbalance), the metabolic system (loss of fluids and electrolytes), and/or the neurological system (such as nerve injury or damage). Common areas for muscle cramping include the calf, front of the thigh (quadriceps), and back of the thigh (hamstrings).

A thorough history and physical examination may include a nutritional assessment, which can lead to treatment strategies tailored for each unique, individual patient. Additionally, it’s a good idea to review what medications a patient is taking as they may play a role in the development of cramps. For example, diuretics commonly prescribed for high blood pressure and other heart-related conditions may lead to potassium depletion.

Some helpful natural remedies for those with persistent muscle cramping may include a mineral/electrolyte replacement such as calcium, potassium, and/or magnesium. Anti-inflammatory nutritional care such as ginger and turmeric and/or muscle relaxing approaches such as valerian root can also be helpful. Other anti-cramping natural substances include Cassia oil and capsaicin. Riboflavin has been used preventatively with success 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 – Part II

21 Dec

Last month, we discussed whiplash injury prevention by focusing on the physical characteristics of crashes. This included information about head restraints, collision speed, seat back position, body size differences, air bags, and more. This month, we’ll focus on the MOST important aspect of whiplash prevention: driver distraction!

According to a survey of 6,000 drivers conducted by the National Highway Traffic Safety Administration (NHTSA), 20% of those surveyed in the 18-20 years old age group and 30% of those 21-34 years of age claimed texting does not affect their driving.

Of the 6,000 drivers surveyed, 6% reported having been in a crash in the prior year and 7% had been in a near-crash, with men being at a slightly higher risk than women. Young drivers, those 18-20 years old, had the highest incidence of crash or near-crash experiences (23%) compared with all other age groups while interestingly, drivers aged 65 years and older had the lowest (8%). The younger drivers reported almost double the number of crashes (17%) as drivers in their early 20s (9%) and up to four-times more than the other age groups (4-6%).

Of the 718 drivers who were involved in a crash or near-crash in the previous year, 6% reported phone usage at the time (4% talking, 1% sending a text or email, and 1% reading a text or email). The young driver (18-20 years old) group, reported the highest cell phone use (13%) at the time of the crash or near-crash (2% talking, 8% sending a text or email, 3% were reading a text or email). The highest incidence of talking on the phone at the time of crash/near-crash was in the age 25-34 years old group (10%). Not too long ago, we reported statistics comparing texting to drunk driving, and the data was sobering. Researchers from the Monash University Accident Research Centre in Australia found that texting severely impaired driving skills, as participants spent 400% more time with their eyes off the road!

Hands-free devices are NOT without risks either. Put simply, the brain is distracted when talking, as attention is displaced from the road to the conversation—especially if the conversation is heated! Interestingly, the Texas A&M Transportation Institute reported that voice-to-text offers no safety advantage over manual texting while the AAA Foundation for Traffic Safety reported voice-activated in-car technologies “dangerously undermine driver attention.”

To summarize, avoid all distractions while driving and keep your eyes on the road!

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 Is Torticollis?

18 Dec

Torticollis, also called wry neck or loxia, represents a category of neck conditions which exhibit a twisting position of the head and neck outside of a normal neutral position. There are many potential causes for torticollis from sleeping in a faulty position to an injury to the neck, like whiplash. However, it’s commonly labeled as “idiopathic,” which basically means, “We don’t know what caused it.”

Torticollis often occurs out of the blue with no obvious cause or history such as, “When I woke up, I couldn’t turn or move my head!” It can occur at any age and may disappear on its own in a few days to weeks, but in rare cases, it can persist for months or years.

Because it can be quite alarming, most people quickly seek healthcare services, which can include visiting a doctor of chiropractic. Once the more serious causes of torticollis are ruled out (such as a severe type of infection like a retropharyngeal abscess or bacterial meningitis, fracture, neoplasm, cervical dystonia, etc.), conservative care can proceed.

If a patient has a family history of torticollis, they may have a more serious form of torticollis called cervical dystonia. This usually begins between 31-50 years of age and if left untreated, it can become permanent.

Chiropractic care often includes stretching in which manual cervical traction, spinal mobilization, and myofascial release techniques help to restore the lost range of motion and faulty posture. Once enough motion has been restored, your doctor of chiropractic may utilize spinal manipulation, which often hastens the recovery rate of torticollis. Your chiropractor may also use physical therapy modalities and or provide instruction on home-based exercises and other self-management strategies.

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.

Exercises for Hip Pain

14 Dec

There are two types of muscles that help facilitate motion in our hips and lower extremities: tonic and phasic.

Tonic (postural) muscles are always working or contracting to keep us upright. Therefore, these muscles tend to be tight and short. When we sleep, they contract or shorten and are taut upon waking and need to be stretched on a regular basis.  Examples of tonic muscles include the hamstrings and the iliopsoas or hip flexors muscles. Here are two great stretches for these muscles:

Iliopsoas stretch: 1) Stand and take a step forward with the left leg into a front straddled position.  2) Rotate the left side of the pelvis forward so that it becomes square with the right side of the pelvis. 3) Perform a posterior pelvic tilt by flattening the curve in the low back while rocking the pelvis forward to create a strong stretch in the left groin/front of the hip. 4) Lean backward to the right to further increase the left groin/hip stretch.  Hold for five to ten seconds and repeat this on the opposite side. Practice these stretches multiple times a day.

Hamstrings stretch: 1) Lie on your back and place the left leg on a door jam with the right leg flat on the floor extending through the opening of the doorway.  2) Push the left leg into the door jam and hold for three to five seconds and then scoot closer to the door jam to stretch the hamstring.  Hold for one to two minutes and repeat this on the opposite side, multiple times a day.

Phasic muscles, on the other hand, only work when needed and tend to be weak. These require strengthening, not stretching. Examples of phasic muscles include the abdominal and buttock muscles. Here are two great strengthening exercises for these muscles:

Abdominal strengthening: 1) Lying on the floor, place your hands behind your low back. Bend one knee/leg while keeping the other straight. 2) Lift your breastbone toward the ceiling one to two inches (2.54 to 5.08 cm) and hold for ten seconds. Repeat multiple times until the abdominal muscles are fatigued.

Buttocks strengthening: 1) Squeeze your buttocks together multiple times a day when sitting or standing. 2) Lie on your back with your knees bent and your feet flat on the floor. Raise your buttocks so it lines up with your trunk while pushing your heels into the floor. Hold for ten seconds and repeat five to ten times.

Depending on the nature of your hip pain, your doctor of chiropractic may recommend further exercises that you can perform at home as part of your treatment plan.

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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