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