Duncan Blog

Dr. Eric Duncan Blog

Duncan Chiropractic Group P.C.


Wednesday, December 30, 2009

Carpal Tunnel Syndrome (CTS) – What, Why, How?

WHAT? Carpal Tunnel Syndrome or CTS, is the most common of the peripheral nerve conditions where the median nerve is compressed or pinched at the wrist. The resulting symptoms include numbness/pain in the wrist, fingers (index, third, and forth), multiple sleep interruptions due to hand/finger numbness requiring frequent shaking and flicking, difficulty in gripping or pinching such as buttoning a shirt, threading a needle, lifting a coffee cup, frequent dropping of objects, and the inability to perform work duties. Pain can even shoot up the arm towards the shoulder and into the neck. Because there are 9 tendons over which lies the median nerve that pass through the rather tight tunnel made up of the 8 carpal bones of the wrist, even a little swelling can create CTS.

WHY? There are many possible causes but in general, whether its swelling, a spur, or a metabolic condition, the common denominator is median nerve pinch in the confined space within the carpal tunnel. A common cause of swelling can occur with performing repetitive motion work such as line assembly, meat packing, carpentry, and so on, and over time, the tendons inside the tunnel inflame or swell and the median nerve is pressed into the ligament that crosses over the roof of the tunnel on the palm side of the wrist. Once the contents inside the tunnel swell, all positions of the wrist other than neutral or, holding the wrist in line with the forearm further increases the pressure inside the tunnel. That is why sleeping with the wrist cocked in any direction often wakes up CTS patients. Those most at risk are women over 50 years of age. CTS can also be associated with other health conditions including (but not limited to) Lymes Disease, inflammatory arthritis, and hormone-related conditions including pregnancy, taking birth control pills (BCPs), hypothyroidism, diabetes, and menopause. Lifestyle issues that affect CTS may include high caffeine intake, smoking, alcohol consumption, as well as obesity.

HOW? So the key question is how are we going to help those with CTS? First, we must identify all the possible reasons why CTS developed in the first place and manage those issues. Therefore, an ergonomic (work place) assessment or, discussing and possibly observing the patient at work can be very helpful. Sometimes, a few simple changes to a work station such as moving the monitor of a computer in line with the keyboard/mouse or adjusting the height of the computer can really help. Changing a tool handle type (pistol vs. straight grip), propping up a part that is frequently worked on, moving the product closer to where it is being assembled, eliminate overhead reach requirements, standing on a raised platform, and so on, may be most important in long term results. Identifying and treating any condition that may be participating in the cause like thyroid disease, diabetes, medication (like BCPs), and weight management, is very important. Wearing a night splint is also very productive. Unique to chiropractic, treatments include manipulation of the neck, shoulder, elbow, forearm, wrist and fingers, soft-tissue therapy including massage, mobilizing the forearm muscles and tendons, teaching carpal stretch and other upper extremity exercises, and nutritional counseling. Strategies here can include eliminating any suspected food allergy related products including dairy, glutens (wheat, oats, barley, rye), soy, corn, transfats, preservatives and some chemical additives. Increasing B-vitamins (especially B6), by increasing dark leafy vegetables and, increasing antioxidants including fruits and veggies. An anti-inflammatory vitamin program of fish oil, Vit. D3, magnesium, CoQ10, and a multiple vit./mineral may facilitate as well. Once CTS is controlled, preventing a recurrence is important by promoting good posture, exercise, and sticking with the life style adjustments described above. If you, a friend or family member requires care for CTS, we would be honored to render our services.


Monday, December 28, 2009

How to Start an Exercise Program.

Start Slowly. Most people do too much when they start exercising. It's OK to break up your exercise into segments. Even small quantities of exercise add up to big benefits. Begin with 10-15 minute chunks of activity, several times daily.

Wednesday, December 23, 2009

Great Information About Getting Fit And Eating Healthy Starting RIGHT NOW… From Your Local Fitness Focused Doctor!

Dr. Duncan here. The New Year is upon us and if you are like most, you could be eating a little better and exercising a little more – and smarter! Who hasn’t been a little lazy and eaten a few things they shouldn’t over the holidays? Not me – HA! Or maybe you’d like to start eating right and exercising for the first time – and want to do it right…injury free. Either way, this free information will be very helpful and valuable to you. Here is a list of 10 great websites you can go to for FREE!... all kinds of information about exercise, eating right, staying healthy naturally and more. Isn’t it great to have good, free information right at your finger-tips to make things so much easier? And whether you are a rookie beginner or a seasoned pro, it is always a good idea to get a pre-injury evaluation with us. This helps detect any minor problems you may have that can become major issues if an exercise program is started or escalated. To get your pre-injury evaluation simply call my office at 810-225-2288 and we will schedule the time that works best for both of us.

1. Workoutz.com

Tons of great free workout videos – with new videos and advice added all the time.

2. Fitnessonline.com

Free topics include: Lose weight, build muscle, eat healthy, pregnancy fitness, fitness calculators and free newsletters.

3. Wellness.com

General Wellness, Wellness for Women, Wellness for Men, Family & Parenting, Exercise & Fitness, Diet & Nutrition, Relationships & Sex, Environmental Wellness, Personal Development, Pet Wellness

4. Mercola.com

One of the most visited natural health sites on the internet.

5. Fitnessmagazine.com

Healthy recipes, weight loss, health, beauty.

6. Crossfit.com

Effective and fun training for beginners up to professional athletes.

7. Bodyrock.tv

Videos for women interested in having a serious beach body by summer!

8. Menshealth.com

Provides information and tips on fitness, health, career, relationships, nutrition, recipes, weight-loss and muscle building.

9. Nutritiondata.com

Tons of free nutrition tools and information.

10. Videofiness.com

Fitness video reviews, forums to discuss and meet like-minded people, video exchange.

Tuesday, December 22, 2009

Spondylolisthesis - What Is That?

Abigail was competing in a gymnastics tournament last year and during one of her floor routines, noticed a sharp pain in her low back after performing a series of back hand springs. She said she landed crooked on the last of four back hand springs which resulted in immediate pain in the middle of the low back at the beltline. She has had pain in the low back before and initially, didn’t think this was any different from past episodes but when the pain didn’t improve after a week, she asked her parents if she could see their chiropractor for an adjustment. Her chiropractor took her history and was alerted by the mechanism of injury - the rapid onset of pain after bending backwards and landing crooked during her routine. The low back was carefully examined and during the range of motion testing, Abby’s backward bending test was very painful and limited in motion. When bending backwards at an angle with pressure applied in the low back, sharp pain stopped the test immediately. Her neurological tests were normal and she could bend over and touch her toes - in fact, that felt good. Her chiropractor had a strong suspicion of what had happened and ordered an x-ray to see if the preliminary diagnosis was accurate. The x-rays looked normal but with the history of extreme backward bending and immediate pain onset, a bone scan was ordered which was positive for a stress fracture in the back part of the vertebra. Unfortunately, this meant no gymnastics for 3 months and the use of a low back brace was recommended. The good news is that the back pain was gone within a month and follow-up x-rays 3 months later did not reveal a visible fracture line in the vertebra. Abby was able to resume gymnastics and competed with success and no low back pain.


So, what is spondylolistesis? As depicted in the side view low back x-ray (left), it is the sliding forward of one vertebra over another (see arrow). It occurs in about 7% of the western population and up to 30-50% in cultures that carry their young on their back (like a back pack). It is reported that most people who develop spondylolisthesis acquire this between ages 6 and 16 due to a developmental weakness in that part of the spine, though the cause can be traumatic, like in Abby’s case where rapid, uncontrolled backward bending occurs. It can also gradually occur over time (called “degenerative”), usually not found before age 50-60, where no single event can be recalled by the patient. There is also a congenital type that can be hereditary where one is born with it, though most authorities feel it is acquired at an early age. The good news is that it is often stable and does not require surgery. In the more severe case, the nerves and/or spinal cord can get pinched in which case surgery is necessary. The symptoms would then include leg pain, weakness, and/or numbness with or without significant low back pain. Most cases however, can be successfully managed without surgery and do not compromise the nerves or cord.

Chiropractic has been found to be very successful in managing patients with spondylolisthesis as the pain generator is often above or below the slipped vertebra. In fact, in one report, chiropractic was found to be more beneficial than medical care for this condition (Mierau D, et.al., J Manip Physiol Therap 1987;10:49-55). If you, a family member or a friend require care, we sincerely appreciate the trust and confidence shown by choosing our services and look forward in serving you and your family presently and, in the future.

Monday, December 21, 2009

Causes of Back Pain

Injuries: Spine injuries such as sprains and fractures can cause either short-lived or

chronic back pain. Sprains are tears in the ligaments that support the spine, and they can occur from twisting or lifting improperly. Back pain may be caused by more severe injuries that result from accidents and falls. American Academy of Orthopaedic Surgeons

Thursday, October 29, 2009

Ear Infections in Children

FROM: Journal of Clinical Chiropractic Pediatrics 1997 (Oct); 2 (2): 167–183Joan M. Fallon, D.C., F.I.C.C.P. Objective: To conduct a pilot study of chiropractic adjustive care on children otitis media using tympanography as an objectifying measure, and to propose possible mechanisms whereby subluxation is implicated in the pathophysiology of otitis media. Design: Case Series Setting: Subjects presented in a private clinical practice in New Rochelle, New York. The subjects were referred by various sources including pediatricians, other MSs, chiropractors and parents. Participants: 332 children who presented consecutively with previously diagnosed otitis media, aged 27 days to 5 years Main outcome measures: A survey of the parent/guardian was used to determine historical data with respect to previous otitis media bouts, age of onset of initial otitis media, feeding history, history of antimicrobial therapy, referral patterns, and birth history. Otoscopic and tympanographic data was collected as well as data concerning the number of adjustments administered to produce resolution of the otitis media. Data with respect to recurrence rates over six months was also collected. Results: The average number of adjustments administered by types of otitis media were as follows: acute otitis media (n=127) 4.0+/- 1.03, chronic/serous otitis media (n=104) 5.0 +/- 1.53, for the mixed type of bilateral otitis media (n=10) 5.3 +/- 1.35 and where no otitis was initially detected on otoscopic and tympanographic exam (but with history of multiple bouts) (n=74) 5.88 +/- 1.87. The number of days it took to normalize the otoscopic examination was for acute 6.67 +/- 1.9 chronic/serous 8.57 +/- 1.96 and mixed 8.3 +/- 1.00. The number of days it took to normalize the tympanographic examination: acute 8.35 +/- 2.88, chronic/serous 10.18 +/- 3.39, and mixed 10.9 +/- 2.02. The overall recurrence rate over a six month period from initial presentation in the office was for acute 11.02%, chronic/serous 16.34%, for mixed 30% and for none present 17.56%. Conclusion: To our knowledge this is the first time that tympanography has been used as an objectifying tool with respect to the efficacy of the chiropractic adjustment in the treatment of children with otitis media. As tympanography has been used extensively in the medical assessment of children with otitis media, it also serves as a bridge from which the chiropractic field and the medical field can begin to communicate with respect to otitis media. The results indicate that there is a strong correlation between the chiropractic adjustment and the resolution of otitis media for the children in this study. This pilot study can now serve as a starting point from which the chiropractic profession can begin to examine its role in the treatment of children with otitis media. Large scale clinical trials need to be undertaken in the field using tympanography as an objectifying measure. In addition, the role of the occipital adjustment needs to be examined. This study begins the process of examining the role of the vertebral cranial subluxation complex in the pathogenesis of otitis media, and the efficacy of the chiropractic adjustment in its resolution.

Tuesday, October 20, 2009

Try walking

If you don’t exercise – or hate the gym – just go for a walk. Aerobic or cardiovascular exercise lowers risk of stroke and heart disease, helps lower weight, and keeps bones strong. If you're just starting, try a 10-minute walk and slowly build from there. webMD.com

Monday, October 5, 2009

Case Study reveals visual evidence of the positive hydrating effect that DRX9000™ Non-Surgical Spinal Decompression treatment has on the inter-vertebr

Tampa, FL, FEBRUARY 20, 2008: The DRX9000 aims to relieve pain by enlarging intra-discal spaces, reducing herniation, and decreasing intra-discal pressure during treatment. A case report underwritten with a grant from Axiom Worldwide is now featured in issue 2 of US Musculoskeletal Review 2007. The case study titled, Magnetic Resonance Imaging Findings after Treatment with a Non-surgical Spinal Decompression System (DRX9000™)-Case Report reveals the pre- and post-MRI findings of a 33-year old male with a six year history of low back pain. Prior to treatment with the DRX9000 an MRI of the lumbar spine revealed moderate degenerative disc disease of the lumbar spine with loss of disc signal at most levels, as well as disc bulges at L3/L4, L4/L5, and L5/S1. The patient also reported an overall pain level of 6 on a 0-10 scale. The patient underwent DRX9000 treatment over a six-week period. At his final DRX9000 treatment, the patient reported a pain level of 0. Follow-up MRI showed an increase in intra-discal signal on T2-weighted sagittal images at L2/L3, L3/L4, L4/L5, and L5/S1, reflecting an improvement in disc morphology. The authors conclude, “Our case report demonstrates the positive hydrating effect that the DRX9000 treatment has on the inter-vertebral disc.”

Axiom Worldwide manufactures and distributes its flagship products, the DRX9000 True Non-surgical Spinal Decompression System™, DRX9000C™, and DRX9500™ in medical markets around the globe. Axiom also manufactures a digital electroceutical device, the EPS8000™, for use in relieving pain and for use in muscular rehabilitation. Axiom prides itself on providing safe, non-surgical alternatives that patients should consider prior to undergoing surgery. For additional information or to receive a copy of the Case Report featured in Issue 2 of US Musculoskeletal Review 2007

Wednesday, September 30, 2009

Posttraumatic Fibromyalgia

Fibromyalgia (FM) has a long reputation for being a controversial diagnosis. Some health care providers (HCPs) feel FM is a legitimate condition that warrants treatment and research while others feel it’s a “garbage can diagnosis” that HCPs throw patients into when they’re not sure what diagnostic label to use for a patient’s condition. Regardless of the personal beliefs of individual HCPs, there have been two general classifications of FM - primary and secondary. Primary FM occurs when there is no underlying health condition participating in the patient’s overall health status and onset of FM. Secondary FM results from an underlying condition that contributes significantly to the patient’s health status, such as irritable bowel syndrome and over time, gives rise to the onset of FM.

Posttraumatic FM belongs to the secondary FM classification when the traumatic related injury results in the patient developing FM. A Canadian study reported that 25-50% of FM patients reported a traumatic event just before the FM symptoms began. This study surveyed different specialty physician groups to determine which issues were most important in causing the onset of widespread chronic pain after a motor vehicle trauma. Five factors were studied to determine how important each was to the HCP in arriving at a FM diagnosis in a case study of a 45 year-old female with a whiplash injury who developed chronic generalized pain, fatigue, difficulties in sleeping and diffuse muscle tenderness. These five factors included:

1. The number of FM cases diagnosed weekly by the HCP
2. The patient’s gender
3. The force of the initial impact
4. The patient’s psychiatric history before the trauma
5. The initial injury severity

Also described as important were the patient’s pre-injury health status, fitness level and psychological health. All HCP groups were reluctant to blame the car accident as causing FM, but rather placed more importance on the patient attitude, personality, and level of emotional stress. The least important of the five points were numbers 3 and 5. The orthopedic group also included “ongoing litigation” as a cause but as a group, they were the least likely to agree on the FM diagnosis (29%) in the 45 year old case study. Rheumatologists were highest at 83%, followed by general practitioners at 71%, and physiatrists at 60%. A most interesting observation was that once the data was analyzed, ONLY the patient’s pre-accident psychiatric history remained in the model of predicting agreement or disagreement with the FM diagnosis.

Posttraumatic FM can result from any type of trauma, not just motor vehicle collisions. Other “secondary” FM causes besides trauma, can include systemic conditions such as irritable bowel syndrome, chronic fatigue syndrome, and other internal disorders that in part, alter the person’s ability to obtain restorative sleep. Hence, an important focus of treatment should be placed on helping the FM patient obtain restful sleep. Chiropractic management strategies have included manipulation, mobilization, soft tissue therapies, physiological therapeutic agents such as electrical stimulation, ultrasound, the training for home use of traction, the use of nutritional counseling and supplementation, and the training of exercise. Many studies support success with this multidimensional approach to treating FM as chiropractic attacks the FM condition from multiple directions, often yielding highly satisfying results. We are committed to help you or a loved one that may be suffering with FM, and sharing this information may be one of most significant acts of kindness you can give.

Wednesday, September 23, 2009

Whiplash and Muscle Weakness

Whiplash involves the stretching of nerves, muscles, and ligaments. The forces are so great during even low speed collisions, that the muscles cannot resist the forces. The injury of whiplash produces inflammation to repair the damaged tissues. During this time, fast movements of your head and neck will result in pain, so most patients become overly cautious and move their neck very little. Unfortunately over time, because of the lack of muscle use, you become weak. This sets up the difficult combination of both damaged ligaments and weak muscles. Now there is little strength and support for the neck. This may make you very vulnerable to a future injury. Even slight movements can produces flare-ups when the muscles are too weak. The patient may feel their head to be heavy. Sometimes patients’ injuries can be so severe that dizziness develops due to the asymmetrical muscle and nerve activity. This is called cervicogenic vertigo. If you get dizzy when you move your head, then you may have this condition.
While it may seem intuitively obvious that addressing weak neck muscles are important to a full recovery, few patients will do them unless prompted and explained by their doctor. Specific muscles need to be strengthened in a way that does not cause further damage to the ligaments. If the muscles are tight in certain areas, then stretching or deep tissue massage, or trigger point therapy, can help to loosen areas and decrease pain.
But the most important thing you can do on a daily basis is to keep exercising. Studies have shown this to be effective in whiplash treatment when there is a mechanical neck disorder. A specific exercise program can be prescribed by a doctor of chiropractic Special attention should be made to your posture and x-rays, and how specifically you were injured. Only in this way, will the treatment be effective and not risk further trauma.
Exercises such as rolling the head around the shoulders should be avoided since the neck is not a ball and socket joint like the shoulder. In some directions, the joints will have excessive laxity and the muscle exercises should be done in the neutral position versus at the end range or limit.
Because the ligaments are so badly damaged in whiplash, it’s important to maintain the supporting muscles (both strong and flexible), to keep the spine stable and pain free.

Wednesday, September 16, 2009

Help Relieve Back Pain With Exercise..

In addition to chiropractic adjustments, strengthening weak muscles can help relieve pain. Pelvic tilts and lower abdominal exercises can help by relieving pressure on the lumbar facet joints caused by contracting low back muscles

Tuesday, September 15, 2009

Exercise: Pick An Activity You Enjoy

A huge mistake people make when exercising is forcing themselves into an activity they do not care for. If you are a swimmer then swim. If you are not, then it is probably best to stay out of the pool. People are most successful starting an exercise program if they get to participate in an activity they like and choose. Of course, it is okay to try something different but if you do not enjoy it, then it will not be long until you quit your new exercise program.

Monday, September 14, 2009

Preventing Back Pain

While 80% of us will suffer a severe back pain episode at some point in our lives, most of us at any given time should be more concerned about preventing or aggravating back pain, rather than resolving a set-back. As they say, an ounce of prevention is worth a pound of cure. There are two aspects to prevention of back pain: keeping strong and flexible, and avoiding mistakes during movements.

As far as exercise is concerned, nothing is more beneficial to the spine than walking. Remember that your spine is your “core,” and the core is activated with fast-paced walking. Most of us don’t think of how the spine is affected with walking, instead focusing on the legs. Make walking part of your daily routine. Walk a few blocks or across town to run an errand, rather than getting into a car for these short trips. Park a few blocks away when you have to use the car, so that you can get in a few minutes of walking. Some of us spend five minutes circling in a parking lot just to get a space close to the front door or we get frustrated when we can’t find a space close to the gym! In contrast to sitting, which increases pressure on our disks, walking strengthens muscles and dissipates the pressure on our lower disks.

Keep the back flexible through slow stretching in all of the different ranges. Tight muscles at the back of the thighs-the hamstrings are an often neglected area that affects the lower spine tremendously. To stretch these muscles, stand upright and put on foot on the back of a chair or sofa. Slowly bend forward and hold this position for 30-40 seconds. It should cause a tight burning pain at the back of the leg. It should not cause a shooting pain down your leg, or increase pain in the lower spine. If it does, then see a health care provider immediately. When the hamstrings are flexible, this allows the pelvis to rotate forward when you bend over. If the hamstrings are not flexible, then the lower spine will bend too much to accomplish any lifting task.

The second aspect to preventing back pain is avoiding mistakes, such as lifting with your back, instead of your legs. This is especially true if an object is very heavy. Sometimes the object is light, but we lift in an awkward position, standing with most of our weight on one leg, then bending and twisting, such as getting grocery bags from a back seat, or moving and positioning a child safety seat. Especially avoid twisting motions of the lower spine while bending over. Also, use one of your hands to help brace your spine, which will decrease the pressure on your disks.

Tuesday, September 8, 2009

Headaches From The Neck?

Cervicogenic headache is the term used to describe a headache that has its cause in the neck region. It used to be thought headaches were caused by something in the head itself, but researchers have now learned that neck injuries can produce head pain.
A study from Norway (Acta Neurol Scand 2007;Nov.20; Sjaastad O, Bakketeig LS) showed that about 4% of the population will have this type of headache. Taking medications to cover the pain will not ultimately correct a mechanical neck problem.
The symptoms of a cervicogenic headache are as follows: one-sided head pain and same side shoulder and arm pain. Patients also have limited mobility of the neck region. Rarely a patient may also have a migraine trait such as nausea, vomiting, or throbbing sensations. Because of these different signs from a typical migraine headache a physician may have overlooked the neck as a potential source for the cause of your head pain. Self-diagnosing your headache can be even worse since potentially serious causes of your head pain, such as high blood pressure may go undiscovered and left untreated. In any case it’s unlikely that your headache has been caused by a deficiency of pain pills in your diet. There are also unintended side effects that have to be considered when weighing any health care option.
Another study from Norway (Funct Neurol 2007;22:145; Drottning M, Staff PH, Sjaastad O) looked at causes of cervicogenic headaches, specifically whiplash injuries of the neck. In this study, 587 whiplash patients were followed over a six-year period. About 8% of the whiplash sufferers developed a cervicogenic headache six weeks after the initial trauma. Thirty-five percent of these patients were still suffering six years later.
Our clinic specializes in the treatment spine-caused head pain especially cervicogenic headache. To determine this we have to perform a comprehensive examination of your spine to see if sprains of your cervical or thoracic joints are present and review whether you’ve suffered a trauma in years past that could have affected the posture and mobility of these delicate spinal structures.
For patients who do not go down the road of medications for treating their head pain chiropractic care can be a more healthful option.

Saturday, September 5, 2009

After my car accident, why do i hurt so much???

There are many different reasons why injuries sustained in car crashes result in chronic or long term pain. First, there are several types of tissues in the neck that can give rise to pain. The most intense pain comes from the tissues with the greatest density of nerve fibers, such as the joint capsules and the ligaments holding the bones of the neck together. There are many ligaments in the neck that are vulnerable to being over-stretched and injured in a motor vehicle collision. The mechanism of a “whiplash” injury in a rear-end collision is unique. Upon impact, the vehicle rapidly accelerates forward while the head momentarily remains in its original position, resulting in an initial straightening of the neck followed by extension. At the extreme end-range of backward extension motion, the ligaments in the front of the neck are over stretched and can tear. Within milliseconds, the head is then propelled forwards into flexion which can then injure the ligaments in the back of the neck placing a significant amount of force on the joint capsules and ligaments holding the bones in close proximity. Another reason the neck is injured is the speed at which the head and neck “whip” in the backwards and forwards directions after the impact. This occurs faster than what we can voluntarily contract our neck muscles to resist–within 600 milliseconds! Therefore, even if we brace ourselves in preparation for an impact, we can’t avoid injury to the ligaments and joint capsules. Damage to the ligaments is difficult to “prove” by conventional x-ray, which is why bending views or, flexion/extension x-ray methods are needed. When there is damage to the ligaments, the vertebra will shift forwards or backwards excessively compared to neighboring vertebra. This can be measured to determine the extent of ligament laxity or damage and can help explain why neck pain can be so intense and/or chronic. Not all car accidents occur from behind. In fact, only about 1/3 occur from this direction. One study investigating which direction created greater degrees of injury reported 57% of chronic pain patient group occurred from rear-end collisions. It also found that woman sustained more ligamentous injury compared to men and that frontal and rear end collisions resulting in significantly higher levels of ligament injury compared to side impacts

Another well published reason why neck pain can “hurt so much” after a car crash is that the sensory input from the injured area to the brain can be so extreme that it leaves an “imprint” in the sensory portion of the nervous system and it becomes hypersensitive or sensitized, resulting in a lower pain threshold or being more sensitive to pain. This is similar to the “phantom limb” phenomenon that often occurs after a leg is amputated where the brain still “feels” leg pain after the limb has been removed. This has also been reported to be a reason for the significant constellation of symptoms often accompanying “whiplash” injuries. A partial list of associated symptoms with whiplash injuries includes neck pain, headache, TMJ / jaw pain, dizziness, coordination loss, memory loss, cognitive difficulty in formulating thought, communicating, losing your place during conversation, and more.

Understanding whiplash and all of its nuances regarding signs and symptoms, x-ray requirements and measurement techniques, and treatment / management strategies are well understood at this office. Chiropractors have a unique advantage over other health care providers as manual therapies, including spinal manipulation, have been shown to yield higher levels of satisfaction and faster recovery rates compared to other forms of health care. We pride ourselves in performing thorough history and physical examinations, offering high quality evidence-based therapeutic approaches and teaching necessary home-based, self-management procedures. If you, a loved one, or a friend are struggling with whiplash residuals from a motor vehicle collision, you can depend on receiving a multi-dimensional assessment and therapeutic approach at this office.

Monday, August 31, 2009

Carpal Tunnel Syndrome

What is it? Carpal Tunnel Syndrome (CTS) occurs when a nerve on the palm side of the wrist is pinched. It is named after the area of the wrist from where the symptoms occur. The Carpal Tunnel is basically a horseshoe shape made from 8 small carpal bones and the ends of the horseshoe are connected with a ligament thus completing the “tunnel.”

What are the symptoms? CTS symptoms include pain from swelling of the tendons inside the CT. When the nerve pinch occurs, numbness, tingling, or a half asleep sensation into the 2nd, 3rd, and 4th fingers occurs. This is often worse at night due to the wrist being bent when asleep. This often wakes the person and shaking/flicking the hand/fingers is needed to “wake them up.” Grip weakness is also associated with CTS such as difficulty opening jars.

Friday, August 28, 2009

Neck Pain - Non-surgical options.

There are many treatment options for those suffering from neck pain. There is conventional medical care where the family doctor will usually prescribe a muscle relaxant, anti-inflammatory, and/or pain killer to help patients through episodes of acute neck pain. However, many patients with neck pain have been through the process of treatments associated with medications and simply cannot tolerate the adverse side effects of stomach pain common with anti-inflammatory drugs such as ibuprofen (Advil, Nuprin, Mediprin, etc.), Aleve (Naproxen), or aspirin. Others don’t like the groggy, drunk-like feelings associated with pain killers or the sleepiness associated with muscle relaxants. Therefore, these patients often turn to complementary / alternative care.

As noted in the May, 2009 issue of Consumer’s Report for low back pain, chiropractic was the most sought after form of treatment, but there has been no extensive review of neck pain regarding evidence-based treatment approaches - at least not until February, 2008. An international “team” representing 9 countries screened over 31,000 titles of articles published between 1980 and 2006, reviewed more than 1200 articles and eventually reported on 552 studies in their final report. Their findings included the following:

In the US, 54% utilized complementary (alternative) treatment approaches compared to 37% that obtained conventional medical care.
Neck pain was the 2nd most common reason Americans obtained chiropractic care.
Chiropractic was found to be the most frequently reported form of treatment for upper back or neck pain (ahead of massage therapy, relaxation therapy, acupuncture).
Those who obtained complementary AND conventional medical care were much more likely to perceive the complementary/alternative therapy as being helpful (61% vs. 6.4% for neck conditions and 39.1% vs. 19% for headaches).
Women more commonly obtained care than men for neck/shoulder pain (29% vs. 18% men) over a 4-6 year time frame.
Manual therapy (mobilization, manipulation, stretching) was associated with greater pain reduction in the short-term among patients with acute whiplash when compared with usual medical care, soft collars, passive modalities, or general advice.
For non-whiplash neck pain (without arm radiating pain), manipulation or mobilization, exercise, low level laser therapy (LLLT), and “…perhaps acupuncture…” were reported as more effective than no treatment, sham, or other alternative interventions.
For both whiplash and non-traumatic neck pain, supervised exercise with or without manual therapy was favored over usual medical care or no care.

What does all this mean? Simple! Everyone who is suffering from neck or upper back pain should seek chiropractic care which includes manipulation, mobilization, exercise training, and activity modifying advice, as these approaches have been found to be more effective than usual medical care! Why waste time with a “wait and watch” with or without drug intervention approach when the evidence favors chiropractic related interventions. If you, a friend, or a loved one is struggling with neck or upper back pain, we will properly assess your condition and administer the appropriate care that is required. We will coordinate care with other health care services when necessary. This recommendation may represent one of most significant acts of kindness you can offer those that you truly care about.

Sunday, August 23, 2009

Help with Fibromyalgia

Fibromyalgia affects millions of Americans each year. The back and neck pain, sleep problems, headaches and so on add up to a syndrome that has a lot of disease over-lap. Patients with headaches are more likely to suffer from fibromyalgia. Irritable bowel syndrome is also more common. It’s important not think of all of these different symptoms as different diseases. In fibromyalgia, the nervous system is feeding pain signals more quickly to your brain. Even if your injuries are relatively minor, this heightened sensitivity makes them more painful.

Irritated spinal nerves can cause back pain but also refer pains into the arms and chest, or the knee and leg. These are not all separate problems. In many patients with fibromyalgia, they have several areas of their spine that show signs of injury. Multiple spinal injuries can give a “widespread pain” picture, which is fibromyalgia. Many patients do not realize that spinal problems can also refer pain to the stomach, and neck injuries can cause headaches. These all seem like separate problems needing different solutions. The spine is the common factor in many fibromyalgia cases.

Since widespread muscle pain is characteristic of fibromyalgia, some patients choose rest to ease their pain. This can be disastrous. Rest feels good temporarily, but weakened muscles only make joint problems worse. Rest for greater than two days can actually worsen back pain. Many fibromyalgia patients choose to decrease activities and not exercise. This can create even greater pain. Several studies have shown that graduated exercise programs can help ease muscle pain in patients with fibromyalgia. This is also the best way to help the joints of the spine and other areas, which might also be causing pain. Preserving movement is key to keeping your quality of life at a high level.

When you combine exercise with good nutrition, including anti-oxidants, you’ll have the best chance to treat your fibromyalgia symptoms more naturally. Eating a diet that does not promote inflammation is as important as maintaining an optimal weight. You cannot heal on soda pop and hamburgers.

Medications and surgery are not the first line of treatments for fibromyalgia. In fibromyalgia you need to treat your symptoms with a comprehensive and natural approach that addresses problems in a global manner.

By using chiropractic adjustments to make sure the spine is flexible and pain-free, you can engage in more rigorous activities or exercises. As exercise becomes less painful, strength can be improved. Diet and proper rest round out the holistic approach.

Friday, August 14, 2009

Losing work because of you back pain!

“I can’t believe how much my low back hurts! I don’t know if I can go to work with it like this!” Does this sound familiar? Have you ever missed work because of low back pain? Well, if you have, you’re certainly not alone! In fact, over 80% of the general population seeks some type of health care provision at some point in life because of low back pain and many of those lose work time. Lost work time is often associated with not being able to tolerate certain positions such as prolonged sitting, standing, bending, twisting, reaching, or combinations of these. Sometimes, just getting to work is next to impossible as the car ride alone may intolerable! There is nothing more depressing than not being able to move due to the sharp knife-like feeling in the back every time you try to change positions.

However, it’s one thing to lose a day or two or even a week of work but what about those that can’t work for longer time periods, like several weeks or even months? This can become life altering as avoidance of moving for fear of that knife-like sensation in the back can quickly lead to muscle weakening, weight gain, lethargy, depression, and a host of other negative residuals. Many articles have been published in the past that tried to identify ways determine early on in the course of back treatment, who might be at greatest risk of not improving or becoming disabled. The term, “yellow flags” has been used to describe such factors and some success in identifying those prone to becoming disabled has been reported. In May 2009, another attempt to identify injured workers who were at risk for becoming disabled or, not being able to return to work for at least 3 months was published. Of the 346 injured workers that were followed for 6 months after the sick leave period began, 47% failed to return to work. There were five questions found to adequately screen those who were not able to return to work or were at greatest risk of becoming disabled. The 5 questions included:

1. Do you expect to return to work within 6 months?
2. How much does the pain interfere in your daily activities?
3. It is not advisable to be physically active?
4. Do you feel generally nervous?
5. Do you feel generally scared?

The good news is that chiropractic manages these types of acute back pain quicker and better than any other form of health care. This is reflected by the highest percentage of consumers seek chiropractic over any other form of alternative health care for back pain relief according to the May, 2009 issue of Consumer’s Repo

Thursday, August 13, 2009

The Herniated Disc

Patients that present with neck pain along with arm numbness, pain, and/or weakness, often ask, “…what’s causing this pain down my arm?” The condition is often caused from a bulging or herniated disk pinching a nerve in the neck. The cause of this complaint can include both trauma as well as non-traumatic events. In fact, sometimes, the patient has no idea what started their condition, as they cannot tie any specific event to the onset.

The classic presentation includes neck pain that radiates into the arm in a specific area as each nerve affects different parts of the arm and hand. Describing the exact location of the arm complaint such as, “I have numbness in the arm and hand that makes my 4th and pinky fingers feel half asleep,” tells us that you have a pinched C8 nerve. This nerve can also be pinched at the elbow and make the same two fingers numb. The difference between the two different conditions is when the nerve is pinched in the neck, the pain is located from the neck down the entire arm and into digits 4 & 5 of the hand. When the nerve is pinched at the elbow, the pain/numbness is located from the elbow down to the 4th & 5th digits, but no neck or upper arm pain exists.

Examination findings usually include limitations in certain cervical (neck) ranges of motion (ROMs) - usually in the direction that increases the pinch on the nerve. Another common finding is the arm is often held over the head because there is more stretching on the nerve when the arm is hanging down and pain in the neck and arm increases. Hence, raising the arm over the head reduces the neck/arm pain. To determine where the nerve is pinched, there are a number of different compression tests that can recreate or increase the symptoms. Some compression tests include placing downward pressure on the head with the head pointing straight ahead, bent or rotated to each side. Other compression tests are performed by pressing in areas where the nerve travels such as in the lower front aspect of the neck, in the front of the shoulder where the arm connects to the chest/trunk, at the elbow and at the wrist. If there is a pinched nerve, numbness, tingling and/or pain will be reproduced when pressure is applied to these regions. Other tests include testing reflexes and muscle strength in the arm. When a nerve is pinched, the reflexes will be sluggish or absent and certain movements in the arm are weak when compared to the opposite side. Another very practical test is called the cervical (neck) distraction test where a traction force is applied to the neck. When neck and/or arm pain is reduced, this means there is a pinched nerve. This test is particularly useful because when pain is reduced, the test supports the need for a treatment approach called cervical traction. It has been reported that the use of cervical traction when applied 3x/day for 15 minutes each, at 8-12 pounds, 78% of 81 patients reported a significant improvement in symptoms, which is very effective. Other forms of care that can be highly effective include spinal manipulation, spinal mobilization, certain exercises, physical therapy modalities, and certain medications.

If you, a friend, or a loved one are struggling with a herniated disk in the neck with associated arm complaints, we will properly assess your condition, run the appropriate tests, and administer the appropriate care that is needed. We also coordinate services with other health care providers when necessary. This recommendation may represent one of most significant acts of kindness you can give to those that you care about.