Tag Archives: pain relief

Nocturnal Wrist Bracing for Carpal Tunnel Syndrome

8 Jan

Carpal tunnel syndrome occurs when pressure within the wrist restricts the function of the median nerve, leading to numbness, tingling, pain, and eventually weakness in the parts of the palm, thumb, index, middle and thumb-side of the ring finger. Management focuses on reducing pressure inside the carpal tunnel, which may include manual therapies, exercises, and activity modifications designed to decrease inflammation and help the tendons passing through the wrist glide more freely. In some cases, addressing hormonal or metabolic factors that contribute to inflammation, water retention, or impaired nerve health may also be necessary. One of the simplest and most effective strategies is using a wrist brace at night. But why is this so commonly recommended in clinical guidelines?

A key point is that the shape of the carpal tunnel is not fixed. The carpal bones form a concave arch, and the transverse carpal ligament forms the roof of the tunnel. When the wrist bends out of neutral alignment, the arch narrows and compresses the structures inside. These pressure increases are not subtle. A wrist positioned just 30 degrees into flexion or extension can triple pressure inside the carpal tunnel. At the extremes of flexion or extension, pressures can increase ten-fold. Even side-to-side wrist deviation can double or triple pressure on the median nerve and surrounding tendons. Not only does this directly stress the median nerve, but using the fingers while the wrist is bent causes the flexor tendons to generate heat and friction in a crowded space, which can promote inflammation and worsen symptoms.

During waking hours, we can consciously monitor our hand positions and adjust our activities to avoid these high-pressure postures. Overnight, however, this is impossible. Many patients with carpal tunnel syndrome experience sleep disturbances because their wrists naturally drift into prolonged flexion or extension while they sleep. A nocturnal wrist brace prevents this by keeping the wrist in a neutral, nerve-friendly position. Most braces look like a soft short arm cast that supports the wrist from the palm to the mid-forearm and prevents bending.

Wearing such a brace during the day would be impractical and could interfere with manual tasks—and continuous daytime bracing may even cause irritation where the ends of the brace contact the skin. For daily activity, other types of bracing and non-bracing options are more appropriate, such as ergonomic modifications for work tasks and using a soft, beanbag or memory-foam wrist support during computer use to reduce carpal tunnel pressure. However—and your chiropractor will likely emphasize this—over-reliance on bracing can hinder long-term recovery, as the muscles controlling the hand and fingers can weaken without regular use. That’s why it’s important to pair nighttime bracing with prescribed wrist exercises, frequent breaks, avoidance of extreme wrist postures, and healthy lifestyle habits that reduce systemic inflammation.

Pain Relief Chiropractic

4909 Louise Drive Suite 102

Mechanicsburg, PA, 17055

Tags: , ,

The Evidence Map of Low Back Pain Treatment Options

5 Jan

Low back pain is extremely common and remains one of the leading causes of disability worldwide, resulting in substantial healthcare utilization and cost. Because of this broad impact, identifying and implementing effective, safe, and cost-efficient strategies to diagnose, manage, and prevent low back pain is essential to improve patient outcomes and reduce overall healthcare burden. In 2022, researchers conducted a comprehensive analysis of the available evidence for ten commonly recommended treatments for low back pain—five medication-based and five non-medication-based—drawn from multiple clinical practice guidelines:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs) work by blocking the COX-1 and COX-2 enzymes responsible for producing prostaglandins, which influence pain sensitivity, inflammation, fever, and tissue blood flow. Evidence supports short-term improvements in pain and disability, but use is limited by potential side effects such as stomach irritation, increased bleeding risk, kidney strain, and caution in patients with certain heart conditions.
  • Acetaminophen (paracetamol) also blocks prostaglandin production, but its effects are largely restricted to the central nervous system. Importantly, available evidence shows little to no meaningful benefit for pain, function, or quality of life in patients with low back pain.
  • Opioids blunt incoming pain signals and alter how the brain interprets pain. Due to risks of misuse, dependence, and overdose, guidelines recommend restricting their use to severe acute pain or postoperative situations and strongly discourage long-term use.
  • Muscle relaxants can reduce muscle spasm through several central mechanisms. Evidence supports short-term symptom relief, but high-quality evidence is limited, and side effects—including drowsiness, dizziness, cognitive slowing, dry mouth, low blood pressure, nausea, drug interactions, and dependence—must be carefully considered.
  • Antibiotics are intended to treat infection. Evidence supporting their role in low back pain management is weak, inconsistent, and not broadly applicable.
  • Psychological or behavioral therapies can be especially valuable for patients with persistent or recurrent low back pain, as psychological factors strongly influence whether patients engage in behaviors that support or hinder recovery.
  • Staying active and avoiding bed rest are strongly recommended. Activity helps maintain function, reduce disability, and speed recovery.
  • Reassurance—emphasizing that low back pain is common, manageable, and rarely dangerous—reduces fear and catastrophizing and lowers the risk of progression to chronic pain.
  • Exercise, including both general physical activity and targeted movement strategies, provides modest but meaningful improvements in pain and disability. Exercise also reduces recurrence risk.
  • Manual therapy, which includes manipulation and mobilization, helps restore normal movement to the spine and associated tissues, reducing pain and disability. Practitioners often combine different manual techniques based on examination findings, patient preference, and clinical training and experience.

The great news is that doctors of chiropractic frequently employ a multimodal treatment approach that includes manual therapy, exercise, reassurance, and activity recommendations—among the most strongly supported options in this evidence map!

Pain Relief Chiropractic

4909 Louise Drive Suite 102

Mechanicsburg, PA 17055

Tags: , , ,

The Four Grades of Whiplash Associated Disorders

15 Dec

Whiplash occurs when the head suddenly accelerates and then rapidly decelerates, placing
excessive strain on the soft tissues that support the neck. In addition to neck pain and stiffness, this
motion can produce a variety of symptoms collectively known as whiplash-associated disorders
(WAD). To better define and manage these injuries, the Quebec Task Force on Whiplash-Associated
Disorders (1995) developed a classification system that grades whiplash severity from I to IV.
WAD I is characterized by neck pain and stiffness without any objective findings on physical
examination. In other words, there is no loss of range of motion; no muscle spasm or guarding; no
swelling, bruising, or deformity; no neurological deficit; and no imaging abnormalities.
Approximately 15–25% of whiplash patients fall into this category.
In WAD II, neck symptoms are accompanied by physical examination findings such as
decreased range of motion, localized tenderness in neck muscles, muscle spasm, and sometimes
headache. However, there are no neurological deficits or abnormalities visible on diagnostic imaging.
About two-thirds of whiplash patients are graded WAD II.
At the WAD III level, patients present with both musculoskeletal findings (as seen in WAD
II) and neurological signs, which may include sensory loss (numbness or tingling), motor weakness
(reduced strength in muscles supplied by affected cervical nerves), altered reflexes, or radiating arm
pain. As with WAD I and II, the injury still involves soft tissues that typically do not appear on X-ray
or advanced imaging. Approximately 5–10% of whiplash patients fall into this grade of WAD.
The classification of WAD IV is utilized when there is structural damage to the cervical spine
that is present on diagnostic imaging and is usually associated with severe symptoms. Patients with
WAD IV typically require emergency treatment to stabilize the spine. Fortunately, fewer than 1–2%
of whiplash patients meet this criterion.
The good news is that WAD I, II, and III typically respond well to a multimodal chiropractic
approach aimed at reducing pain and restoring function as quickly as possible. Manual therapies may
include gentle, low-velocity, low-amplitude techniques; thrust manipulation (high-velocity, lowamplitude); facet gliding; long-axis cervical traction; passive range-of-motion exercises; massage;
trigger-point therapy; dry needling; or acupuncture. Adjunctive physical therapy modalities such as
electrical stimulation, therapeutic ultrasound, laser therapy, pulsed electromagnetic field (PEMF)
therapy, in-office or home cervical traction, and others are also frequently utilized. Exercise training
is a crucial component of care, as long-term improvement depends on patient self-management and
reduces provider dependency that can sometimes arise. In the event a patient does not respond to care
or if additional issues are present that fall outside the chiropractic scope, the case may be co-managed
with an allied healthcare provider.
Brent Binder, D.C.

4909 Louise Dr. Suite 102 Mechanicsburg, PA 17055 (717) 697-1888

Tags: , , ,

Internal vs. External Shoulder Impingement Syndrome

8 Dec

Most adults will experience shoulder pain at some point during their lifetime, and it’s estimated
that nearly one-third of adults are affected each year. Among the many possible diagnoses, shoulder
impingement syndrome accounts for roughly half of all shoulder pain cases. However, current
understanding indicates that shoulder impingement syndrome is not a single diagnosis, but rather a cluster
of symptoms that can arise from multiple anatomical and biomechanical factors. The condition is
typically classified as either internal or external, depending on where and how the impingement occurs.
The shoulder complex functions as an integrated system of four joints that together allow for an
exceptional range of motion. The glenohumeral joint that joins the humerus (upper arm bone) with the
glenoid fossa of the scapula is the primary joint responsible for most shoulder movement. It is stabilized
by the rotator cuff muscles, labrum, and surrounding ligaments. Under ideal conditions, this joint moves
freely to perform tasks like lifting, throwing, or reaching overhead. But when mechanical forces, either
within the joint itself or external to it, disrupt that motion, the result may be pain, inflammation, and
limited movement. Over time, chronic irritation may lead to scar tissue formation and even degenerative
changes.
External impingement occurs when the acromion or coracoacromial ligament compress the
rotator cuff during arm elevation. While anatomical variations such as a hooked acromion can predispose
some individuals to impingement, the most common contributors are poor scapular control, forward
shoulder posture, rotator cuff weakness, or degenerative changes from repetitive overhead activity or
aging.
Internal impingement, on the other hand, occurs when the humeral head pinches the rear portion
of the rotator cuff between the greater tuberosity and the posterior glenoid rim during high-velocity
overhead movements such as throwing or serving. Contributing factors often include posterior capsule
tightness, shoulder instability, scapular dyskinesis, excessive external rotation, and repetitive overuse.
Internal impingement is more common among younger, athletic, or physically active individuals.
While surgery is occasionally indicated as a first-line intervention in specific cases (such as
significant structural damage or full-thickness rotator cuff tears), clinical guidelines overwhelmingly
recommend conservative management as the initial approach, with chiropractic care serving an excellent
choice! Treatment typically aims to restore normal movement patterns within the shoulder complex
through a multimodal approach that may include manual therapies, joint mobilization, specific exercises,
physiotherapy modalities, traction, and postural retraining. The goal is to reduce inflammation, restore
joint motion, release adhesions, address trigger points, and strengthen weakened muscles.
The good news is that conservative care has a high success rate for both internal and external
impingement—especially when treatment begins early—helping most patients recover without the need
for surgery.
Brent Binder, D.C.

4909 Louise Dr. Suite 102 Mechanicsburg, PA 17055 (717) 697-1888

Tags: ,

What Is Iliotibial Band Syndrome?

10 Nov

Up to one-in-five adults experience knee pain each year, and many seek chiropractic care to find relief from both pain and disability. While knee pain can have many causes, when discomfort is concentrated on the outside of the knee in active adults, iliotibial band syndrome (ITBS) is an important condition to consider.

The iliotibial band is a tough, fibrous band of fascia that runs from the iliac crest at the top of the pelvis down to the outer surface of the tibia just below the knee. It serves as a dynamic stabilizer of both the knee and the hip during walking and running, and research has shown that it also stores and releases elastic energy during these activities, much like a spring.

Pain from ITBS rarely begins with a single traumatic event. Instead, it typically develops after a gradual increase in running loads, such as taking on longer distances or increasing speed. The condition is estimated to account for up to 14% of all running-related injuries, but there is still debate about the exact mechanism of injury. The traditional explanation is that the band becomes irritated as it rubs back and forth over the bony prominence of the lateral femoral epicondyle as the knee bends and straightens. More recent studies, however, suggest that the band is firmly anchored to the femur and that repetitive knee motion instead compresses the soft tissues beneath it, leading to pain. A third view emphasizes the role of weak hip muscles, which reduce pelvic control and place greater strain on the ITB, creating a sprain-like overload.

Because there is no blood test or imaging procedure that can definitively diagnose iliotibial band syndrome, clinicians rely on a combination of history and physical examination while ruling out other potential causes of lateral knee pain such as meniscus injury, synovial plica syndrome, or bone stress fracture. Iliotibial band syndrome is most strongly suggested when tenderness is present directly over the lateral femoral epicondyle, when pain worsens with prolonged running, downhill activity, or stair descent, and when there is no evidence of catching, locking, or clear trauma that would indicate another problem. Findings on clinical tests such as Noble’s compression test, Ober’s test, or Renne’s test can further support the diagnosis.

Treatment of ITBS usually requires a multimodal approach. Patients often need to modify their activity levels to reduce strain on the ITB, while also addressing underlying inflammation. Rehabilitation exercises to strengthen the hip and core muscles and improve posture can restore balance, while manual therapies may be used to improve the movement of joints and soft tissues. In some cases, orthotics or footwear changes are recommended to correct ankle or foot mechanics that place additional stress on the knee. As with most musculoskeletal conditions, the earlier care is initiated, the better the outcomes. With prompt attention, patients can usually expect a satisfactory recovery that allows them to return to their usual recreational and occupational activities without lingering limitations.

Pain Relief Chiropractic

4909 Louise Drive Suite 102

Mechanicsburg, PA 17055

Tags: ,

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.

Tags: , , , , , ,

← Older Entries
Newer Entries →