Carpal Tunnel Syndrome (CTS) - Can It Be Prevented?

Carpal Tunnel Syndrome or CTS is a very common problem affecting many workers and is one of the most costly conditions afflicting today's workforce. It is most often caused by repetitive activity using rapid movements of the arms and hands and can lead to work loss and disability when not properly managed. CTS occurs when the median nerve that travels through the carpal tunnel (CT) located on the palm side of the wrist becomes pinched by the swelling of the 9 tendons that also travel through the CT and essentially, pinch the nerve up against the transverse carpal ligament. This results in numbness, tingling and/or pain of the index, middle and forth fingers.

Other symptoms include sleep interruptions where shaking and flicking of the fingers is required to allow for a return to sleep. This is frequently caused by sleeping with the wrist in a cocked position, increasing the pressure inside the already swollen carpal tunnel. This is why a cock-up wrist splint usually helps as it disallows the wrist from bending to the extremes and the nerve is not pressured or pinched as much. Other symptoms include weakness of the grip, making it a challenge to unscrew a jar, open a door, and even sometimes turn the key when starting a car. Driving can also be affected as the hands often fall asleep while holding onto a steering wheel.

Pain can also affect the rest of the arm and sometimes the neck area. The median nerve can also be pinched in more than one place and may include the neck, shoulder, elbow as well as the wrist making it necessary to have all the areas treated for a satisfying result.

People at greatest risk are women > men, workers who handle small tools, computer workers, fast repetitive line workers, and people older than 40 years of age. People with other health conditions including rheumatoid arthritis, Lymes disease, rubella, pregnancy, birth control pill use, diabetes mellitus and menopause are at an increased risk of developing CTS. Certain foods such as caffeine, tobacco, and/or alcohol may also contribute to CTS.

Though treatment is very important -the sooner the better- prevention is most important. In fact, some simple approaches can make a big difference! Some of these include modifying the position of a computer chair, keyboard, monitor, or mouse (work station modifications), alternate between different tasks to reduce the repetition of work, stretch your forearms and fingers before, during and after work, and treat any underlying conditions. When symptoms first occur, these recommendations, as well as wearing a night wrist cock-up splint and seeing your chiropractor, will often reverse the condition without difficulty. If you wait too long and nerve damage occurs, it becomes a more challenging process to manage CTS and at times, even surgery will not be very helpful.

Some of the non-surgical treatment approaches you might expect from your chiropractor include joint manipulation and/or mobilization applied to the neck, wrist, elbow and/or shoulder, the application of physical therapy modalities such as ultrasound, electrical stim, and/or low level laser therapy ("light" therapy), as well as the use of wrist splints.

The University of Maryland Medical Center cites two research articles on chiropractic treatment for CTS. They report good results are usually obtained and that these good results continued for at least 6 months after treatment ended. The same reference also recommends nutrition and supplements in the management of CTS. Some of these include: eliminate food allergens (often milk, cheese, eggs, ice cream, glutens/wheat-grains, soy, corn, and preservatives) and eating foods high in B-vitamins (dark leafy greens like spinach, kale, and sea vegetables), anti-oxidants (fruits - blueberries, cherries, tomatoes; vegetables - squash, bell peppers), avoiding refined foods, using olive oil and adding omega 3 fatty acids to the diet (fish oil). Other vitamins including a multivitamin, B complex, Vit. C, alpha-lipoic acid, MSM, resveratrol, Vit. D, Co-Q10, magnesium can also really help.

We realize that you have a choice in where you choose for your healthcare services. If you, a friend or family member requires care for CTS, chiropractic care is a logical first choice and we would be honored to offer our services to you.

Back School 101... 3 Ways To Prevent Making Your Back Pain Worse

Chiropractic care for patients with low back pain (LBP) not only includes spinal manipulation or adjustments but also patient education in regards to heat/ice, performing daily activities and exercise.

Heat vs. Ice: This topic is controversial, as often, patients will be told by their friends and family to use the opposite of what we may recommend to our patients. In general, when pain is present, there is inflammation... so use ice to reduce swelling and pain. When heat is inappropriately utilized during this inflammatory phase of healing, vasodilation or, an increase in blood supply to the already swollen injured area often results in an increase in pain. The use of heat may be safely applied later in the healing process during the reparative phase of healing, but as long as pain is present, using ice is usually safer and more effective.

Daily Activities: Improper methods of performing sitting, bending, pulling, pushing, and lifting can perpetuate the inflammatory phase, slow down the healing process, and interfere/prevent people from returning to their desired activities of daily living, especially work. Improperly performing these routine activities is similar to picking at scab since you're delaying the healing process and you can even make things worse for yourself.

Exercise: There are many exercises available for patients with low back pain. When deciding on the type of exercise, the position the patient feels best or, the least irritating is usually the direction to emphasize.

More specifically, for those who feel a reduction in pain when bending forward (referred to as "flexion-biased"), flexion exercises are usually indicated. Examples of these include raising a single knee to chest, double knee to chest, posterior pelvic tilts, sitting forward flexion, and hamstring stretches.

When bending backwards results in pain reduction (referred to as "extension-biased"), standing and bending backwards, performing a sagging type of pushup ("prone press-up"), laying backwards on large pillows or on a gym-ball are good exercises. The dosage or duration exercises must be determined individually and it is typically safer to start with 1 or 2 exercises and gradually increase the number as well as repetition and/or hold-times. If sharp/"bad" pain is noted, the patient is warned to discontinue that exercise and report this for further discussion with their chiropractor. It is normal and often a good sign when stretching/"good" pain is obtained at the end range of the exercise.

We recognized the importance of patient education in our approach to managing low back pain cases, and look forward in serving you and your family presently and, in the future.

Carpal Tunnel Syndrome (CTS), What are my options??

Carpal Tunnel Syndrome or CTS, has been reported to be the most expensive of all work-related injuries, costing the average CTS patient about $30,000 in medical bills and lost work time over his or her lifetime. CTS is primarily found in adults, is 3x more frequently found in woman, and usually affects the dominant hand first. The pain can be quite severe and disabling. Certain occupations tend to cause CTS more than others, such as manual labor jobs (assembly-line / manufacturing, sewing, finishing, cleaning, meatpacking, food processing and packing occupations). Other jobs like computer work, playing a musical instrument and waitressing can also cause CTS. Certain medical conditions such as diabetes, obesity, pregnancy, the use of birth control pills, inflammatory arthritis and hypothyroidism can predispose patients to CTS. CTS is caused by a pinch to the median nerve that runs down the arm from the neck, through shoulder, elbow and wrist. The pinch can occur in one or more of these locations making it important to obtain a complete evaluation including the neck and upper arm - not just the wrist. There are a total of 9 tendons, ligaments, and blood vessels jammed into the tight confines of the carpal tunnel formed by 8 small carpal bones and the transverse carpal ligament that serves as the "roof" of the tunnel. Symptoms include burning, tingling, aching, and/or numbness primarily into the 2nd to 4th fingers and at times, the thumb. Some sufferers develop weakness in their grip making it hard to open jars, stubborn door knobs, holding onto a newspaper or steering wheel. Waking up multiple times at night is also a common complaint caused by sleeping with the wrist bent, which increases the pressure inside the tunnel, thus pinching the nerve more firmly.

A CTS diagnosis is made by reproducing the symptoms by further compressing the median nerve inside the tunnel. This is accomplished by applying pressure over the tunnel, by bending the patient's wrists 90 degrees backwards (dorsiflexion) and forwards (palmar flexion), compression over the proximal forearm, at the thoracic outlet (under the collar bone) and / or at the neck. Special tests like an EMG/NCV (electromyogram and nerve conduction velocity) can determine the degree of nerve damage and verify the diagnosis. At times, x-ray or MRI are helpful if arthritis or a bone spur is suspect, or to measure the size of the carpal tunnel. Laboratory blood tests to determine secondary causes, described earlier, can also be of benefit.
Treatment consists of 1. Rest; 2. Modifying the activity or workstation suspected of causing CTS; 3. Using a splint- especially at night and when driving; and 4. Managing any underlying disease condition. Managing inflammation is also important, which can be accomplished by the use of ice of. (Ice massage is very effective. This consists of freezing water in paper cups, tearing off the top half of the cup, and rubbing the ice against the skin for approximately 5 minutes. The sequence of sensations includes cold, burning, aching, and numbness ("C-BAN"). Make sure you quit when numbness is reached, as frost bite is a risk if performed for too long.) Anti-inflammatory medications like ibuprofen, naproxen, or herbal remedies such as ginger, turmeric, boswellia, and/or vitamins like bromelain & papain, vitamin B6, fish oil (omega 3 fatty acids, Vitamin D (2000-5000IU); calcium/magnesium are all potentially helpful. Manual manipulations to the joints of the neck, shoulder, elbow, wrist and hand and soft tissue manipulation to the muscles and tendons of the forearm and hand can also be used. Other non-surgical treatments include exercises and physical therapy modalities such as low level laser therapy, electrical stimulation, ultrasound, and others.
We realize you have a choice in where you choose for your healthcare services. If you, a friend or family member requires care for CTS, chiropractic care is a logical first choice and we would be honored to offer our services to you

Low Back Pain - Seasonal Injuries

Every season brings unique activities that require us to perform some physical activity we may not want to do but have no choice. In the winter, shoveling snow comes to mind (at least in some parts of the country) while spring, summer and fall may include yard clean up, mowing, and raking. All of these seasonal activities are, "...I have to.." activities of daily living (ADLs), rather than ADLs we want to do. Therefore, let's talk about shoveling snow since that time of year is upon some of us, though hopefully on its way out! Of course, if snow is not an issue based on where you live, this information can also be applied to gardening, digging a hole or some other yard related shoveling activity.

First, a few facts that help us appreciate why back pain is so common when we shovel: 1. When we bend over, approximately 2/3rds of our body weight is being lifted in addition to what we're lifting. Hence, a 180# person has to lift 120# of body weight every time he or she bends over. 2. A 5# weight equals 50# to our back when it is held out in front of us - consider the 10-20# weight on the end of a shovel! 3) Our legs are much stronger than our back and arms. If a person can bench press 300#, they can usually leg press 500# - almost 2x more weight. Yet, most of us use our arms, not our legs, when shoveling. 4) Most of us bend over using poor technique, lift the shovel with the arms and back (not the legs), and rapidly extend and twist the back when we throw the substance from the shovel - 3 bad things! 5) Then, this faulty action is repeated many, many times, and on top of that, it is not something we're used to doing and hence, we're not physically adapted or "in shape" for shoveling. With all of these "truths," it's no wonder why we often can barely move after an hour of shoveling! So what can we do about it?
I suppose hiring the neighborhood kid to do our shoveling makes the most sense but we're not that smart! We can't change the fact that most of our body's weight lies above our waist so that one we're stuck with and, we're not going to lose weight in time for shoveling. But, we can certainly put less material on the shovel so the load on our back is less. It's important to squat down using our strong leg muscles while keeping our back as vertical/straight as possible- DO NOT BEND OVER. Try sticking out your fanny (to keep an inward curve in your back), lift the shovel / load of material straight up with your legs, maintaining that arched back / butt out position. Keep your arms / elbows straight and walk the shovel load over to the dumping location - DON'T try and throw the load a distance by twisting your body. Take multiple breaks and switch sides so you don't "beat up" the same muscle groups repeatedly.
If you do hurt your back - using an analogy of a cut on your skin -avoid picking at the cut so it can heal. If your back hurts after shoveling, use ice/rest followed by gentle stretching and modified activities - DON'T go back out and shovel (ie, don't pick at your cut!). Some wise considerations for shoveling include warming up before starting, staying "in shape" by regular exercise throughout the year, maintaining a good nutritional diet and getting enough sleep.
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.

Benefits of Laughter

Sometimes we like to post health related articles that have nothing to do with Chiropractic.

Laughter increases secretion of catecholamines & endorphines, which increases oxygenation of the blood, relaxes arteries, increases heart rate, decreases blood pressure - - all have a positive effect on all cardiovascular & respiratory ailments, as well as an increased immune system response. American Journal of Medicine, 1995

Retail Prescriptions Out Of Control!

Total Prescriptions = 3.9 billion; Sales = $270.2 billion; Prescriptions per capita = 12.8. The number of people with at least one prescription increased from 67% in 2000 to 74% in 2006. National Association of Chain Drug Stores, 2009 & Express Scripts, 2008

Chiropractic: New Study about Headaches

Headaches are a common complaint in patients presenting for professional care, including chiropractic management. Patients with headaches seek chiropractic care because they find manipulation or adjustments applied to the cervical spine and upper back region are highly effective in reducing the intensity, frequency and duration of the headache pain. This is because the cervical spine / neck, is often the origin of the headache as the three nerves in the upper neck (C1, 2 and 3) pass through the thick, overly taught neck muscles in route to the scalp / head. When the muscles of the neck are in spasm, the nerves get “pinched” or squeezed by the overly tight muscles resulting in headache pain. Each nerve runs to a different part of the head and therefore, pain may be described as “…radiating over the top of head (sometimes into the forehead and eyes),” or, into the head and over the ear, sometimes reaching the temple. Also, an area located in the back and side of the head is the area where the C1 nerve innervates, so pain may also be reported in that location. When more than one of the C1-3 nerves is pinched, the whole side to the top of the head may be involved.

In the October 2009 issue of The Spine Journal, Western States Chiropractic College, Center for Outcomes Studies, reported benefits are obtained with the utilization of spinal manipulation in the treatment of chronic cervicogenic headaches. The word “chronic” means at least 3 months of headache pain has been present. This new study compared 2 different doses of therapy using several outcome measures including the pain grade, the number of headaches in the last 4 weeks and the amount of medication utilized. Data was collected every 4 weeks for a 24 week period and patients were treated 1-2 times/week and separated into either an 8 or a 16 treatment session with half the group receiving either spinal manipulative therapy or a minimal light massage (LM) control group.

The results of the study revealed the spinal manipulation group obtained better results than the control group at all time intervals. There was a small benefit in the group that received the greater number of treatments with the mean number of cervicogenic headaches reduced by 50% in both pain intensity and headache frequency.

The importance of this study is significant as there are many side effects to medications frequently utilized in the treatment of headaches. Many patients prefer not taking medications for this reason and spinal manipulation therapy (SMT) offers a perfect remedy for these patients. Couple SMT with dietary management, lifestyle modifications, stress management, and a natural, vitamin/herbal anti-inflammatory (such as ginger, turmeric, boswellia) when needed, a natural, holistic approach to the management of chronic headaches is accomplished.

We are proud that chiropractic care has consistently scored the highest level of satisfaction when compared to other forms of health care provision and look forward in serving you and your family presently and in the future.