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 2^nd, 3^rd, and 4^th 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.

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.

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.

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

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 4^th 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 4^th & 5^th 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.