Archive for February, 2012

Low Back Pain & Spinal Manipulation: How Does It Work?

February 3rd, 2012

For many years, Chiropractic has been at the forefront of treating low back pain (LBP) with both greater patient satisfaction and less lost time at work when compared to other non-surgical treatment approaches. There have been many explanations as to why chiropractic manipulation therapy (CMT) works but many of these studies include other treatment modalities or methods and the benefits are ,therefore, not clearly derived only from CMT. A recent study has tried to clear this up and the results are very interesting!

This study included two chiropractors and two a physical therapists (PT) from Canada and the US. What is unique about this study is that they measured clinical or symptomatic improvement by tracking improvement in activity tolerance using a standard questionnaire commonly used by chiropractors and PTs all over the world, as well as changes in the spinal stiffness using a valid/reliable instrument before and after CMT was utilized. The importance of these findings is that only CMT was utilized and hence, other forms of treatment commonly utilized by chiropractors did not cloud the findings. There were 48 patients included in the study and the initial 2 treatments were administered 3-4 days apart, followed by an assessment 3-4 days after the 2nd treatment. Assessments were also performed before and after each treatment. The assessments included use of the questionnaire and a stiffness measurement using the special instrument. Also, “recruitment of the lumbar multifidus muscle” (a muscle in the low back that helps stabilize the trunk or core) was measured by ultrasound. After each treatment, significant improvement was found in the overall pain level and in reduced spinal stiffness (which remained improved 3-4 days after the last/second treatment).

The study conclusions revealed less pain, more activity tolerance and less spinal stiffness after the administration of the 2 treatments. The greatest clinical improvement was found in those who had the most dramatic reduction in stiffness after each treatment. They found that the level of muscle recruitment was directly related to the degree of spinal stiffness. They also found that patients who received thrust manipulation (CMT) had immediate improvements with reduced pain, stiffness and improved muscle recruitment measurements. However, this same effect was NOT obtained when non-thrust mobilization techniques were used. This means many non-thrust manual techniques such as mobilization, massage, and other soft tissue release methods do not create the immediate benefits that were produced by thrust manipulation.

With this new information, we are now able to explain with confidence to patients the reasons why they typically feel better after the spinal adjustment. The patient can then appreciate receiving an answer that makes clear sense and has been “proven.” It’s important to realize that the “bonus” of receiving chiropractic care for low back pain includes not only just pain reduction, but more importantly, improvement in tolerating activities such as vacuuming, washing dishes, golfing, walking and of course, working.

We realize you have a choice in who you choose to provide your healthcare services. If you, a friend or family member requires care for low back pain, 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.

Posted in Back Pain | No Comments »

The Neck & Shoulder Pain Relationship

February 3rd, 2012

Given the close anatomical proximity between the neck and shoulder, it’s no wonder the two are intimately related. In our hectic lifestyles of driving, hunching over computers, talking on the phone, not to mention stress arising from multiple sources, the muscles in the neck, upper back and shoulders seem to tighten up and hurt at the same time. The question is, between the neck and the shoulder, which one is the “chicken” and which is the “egg?”

The neck gives rise to the nerves that innervate the head (C1-3 nerve roots), the shoulders (C4-5), and the arms (C5-T2). Hence, there are 8 sets of nerves in the neck, 12 sets in the thoracic (middle back region), and 6 sets in the lumbar or low back region and 5 sets in the sacrum, all of which travel to a specific destination allowing us to move our muscles and to feel hot, cold, sharp, dull, vibration and position sense. When these nerves get pinched or irritated, they lose their function and the ability to feel, making it challenging to button a shirt, thread a needle, or pick up small objects. It can also make it difficult to unscrew jars, squeeze a spray bottle, or lift a milk container from the refrigerator. Hence, the nerves arising from the neck, when pinched, can have a dramatic effect on our ability to carry out our desired activities in which the shoulder, arm and hand use is required.

On the other hand, when the shoulder is injured (such as a rotator cuff tear), this can also result in neck problems. There are several ways pain from the neck affects the shoulder and vice versa. When the shoulder is injured, pain “information” is relayed to the brain starting at the nerve endings located in the area of the shoulder injury, transmitting impulses between the shoulder and the neck, and finally from the neck to the sensory cortex of the brain. That information is processed and communication to the motor cortex prompts nerve signals to be sent back to the shoulder through the neck and to the injured area (in this case, the shoulder). A reflex muscle spasm often occurs as a result, serving as kind of an “internal cast” as the muscle spasm tries to protect the injured shoulder. This can become a “vicious cycle” or never-ending “loop” until the reflex is interrupted (perhaps by a chiropractic adjustment). Another means by which both areas become injured has to do with modifications in function. We tend to change the way we go about our daily chores when an injury occurs to the shoulder, such as putting on a coat differently by leaning over to the opposite side. These functional changes can also give rise to neck pain. Because of this reflex cycle, as well as the close anatomic relationship between the neck and shoulder, not to mention the “domino effect” of soft-tissue injuries which seem to change the function at the next joint level, it’s not surprising that both the neck AND the shoulder require simultaneous treatment for optimal treatment benefit. However, the good news is, regardless which one is the “chicken or the egg,” chiropractic treatments of shoulder injuries will almost always include the neck and vice versa.

We realize that you have a choice in where you choose your healthcare services. If you, a friend or family member requires care for neck pain, 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.

Posted in Neck Pain | No Comments »

Carpal Tunnel Syndrome: Prevention

February 3rd, 2012

People who spend a lot of time performing activities that require a high level of force, repetition, or use vibrating tools are at risk of developing carpal tunnel syndrome (CTS). Other activities such as driving, playing musical instruments, knitting, using a sander, screw drivers, air wrenches, waitress work, or assembling small parts are also associated with increased CTS risk. The good news: there are ways we can reduce the risk of developing CTS. Some of these include the following:

  1. Stay Healthy: There are many conditions that contribute to the onset and/or make CTS worse. Exercise, maintain a healthy weight (Body Mass Index – BMI – of 25 or less), stop smoking (or better yet, never start), take your thyroid medication (if indicated), keep your blood sugar normal (obesity leads to diabetes which often worsens CTS), and do your carpal tunnel exercises multiple times a day.
  2. Ergonomics: Use “ergonomic” principles when arranging your workstation such as sitting properly at your home and work computers. The placement of your desk, the computer monitor, the keyboard (consider a convex keyboard rather than the flat type), the mouse (and type of mouse – the track ball mouse requires no arm movement, only the thumb), paperwork space and location. The type of chair and its height are also very important. Avoid desks that have sharp edges as they can compress the forearms and pinch the CTS nerve.
  3. Posture: The position in which you sit is important! Sit in an upright position, head/chin tucked in, feet on the floor or on a box, elbows resting on adjustable arms of the chair bent about 90 degrees, and keep your wrists fairly straight/neutral. Avoid slouching, reaching out with the elbows less than 90 degrees, head shifted forwards and shoulders rounded and feet not positioned under you. When you talk on the phone, STRONGLY consider a headset! Pinching the phone between your shoulder and ear with your head bent sideways for any length of time is a ticket to disaster for developing CTS and/or other types of cumulative trauma disorders (pinched nerves in the neck, shoulder tendonitis/bursitis, elbow tendonitis and more).
  4. Plan your activities: Pay careful attention to your daily routine for activities that may increase your risk of developing or perpetuating CTS. For example, these activities can increase your chance of developing or worsening CTS: playing a musical instrument, knitting, carpentry, playing video or computer games for hours, working on cars, operating vibrating tools, using forceful gripping such as spray bottles, using a crutch, cane, wheelchair, engaging in certain sports such as long-distance cycling that load the arm and hand, skiing – waterskiing requires a firm grip on the handle and snow skiing requires firm gripping on the ski pole.
  5. Sleep: It is impossible to control the position we put our hands/wrists in at night. Therefore, it is essential to wear wrist splints so we avoid bending the wrists in our sleep. Many of us curl up in a ball and tuck or bend the wrists and hands under our chin. In a “normal” wrist, the pressure inside the carpal tunnel DOUBLES when we bend our wrists! If we have CTS, the pressure goes up exponentially or, 6-8 times because of the increased pressure that’s there already because of the CTS. Use a pillow that is designed for you, we’ll help you with that!
  6. Take a break! It’s important to pace yourself if your work or play includes fast, repetitive activities. It’s easy to get lost into what you’re doing so a timer to remind you that an hour has gone by and to take a break is a wise purchase. There are computer programs that flash on your screen, “Time to stretch!” Some of these may include the actual exercise so you don’t forget what to do. If not, talk to us about what exercises are good to do either at the workstation and/or at home for CTS.

We realize you have a choice in who you consider for your health care provision and we sincerely appreciate your trust in choosing our service for those needs. If you, a friend or family member require care for CTS, we would be honored to render our services.

Posted in Carpal Tunnel Syndrome | No Comments »

Carpal Tunnel Syndrome: Prevention

February 3rd, 2012

People who spend a lot of time performing activities that require a high level of force, repetition, or use vibrating tools are at risk of developing carpal tunnel syndrome (CTS). Other activities such as driving, playing musical instruments, knitting, using a sander, screw drivers, air wrenches, waitress work, or assembling small parts are also associated with increased CTS risk. The good news: there are ways we can reduce the risk of developing CTS. Some of these include the following:

  1. Stay Healthy: There are many conditions that contribute to the onset and/or make CTS worse. Exercise, maintain a healthy weight (Body Mass Index – BMI – of 25 or less), stop smoking (or better yet, never start), take your thyroid medication (if indicated), keep your blood sugar normal (obesity leads to diabetes which often worsens CTS), and do your carpal tunnel exercises multiple times a day.
  2. Ergonomics: Use “ergonomic” principles when arranging your workstation such as sitting properly at your home and work computers. The placement of your desk, the computer monitor, the keyboard (consider a convex keyboard rather than the flat type), the mouse (and type of mouse – the track ball mouse requires no arm movement, only the thumb), paperwork space and location. The type of chair and its height are also very important. Avoid desks that have sharp edges as they can compress the forearms and pinch the CTS nerve.
  3. Posture: The position in which you sit is important! Sit in an upright position, head/chin tucked in, feet on the floor or on a box, elbows resting on adjustable arms of the chair bent about 90 degrees, and keep your wrists fairly straight/neutral. Avoid slouching, reaching out with the elbows less than 90 degrees, head shifted forwards and shoulders rounded and feet not positioned under you. When you talk on the phone, STRONGLY consider a headset! Pinching the phone between your shoulder and ear with your head bent sideways for any length of time is a ticket to disaster for developing CTS and/or other types of cumulative trauma disorders (pinched nerves in the neck, shoulder tendonitis/bursitis, elbow tendonitis and more).
  4. Plan your activities: Pay careful attention to your daily routine for activities that may increase your risk of developing or perpetuating CTS. For example, these activities can increase your chance of developing or worsening CTS: playing a musical instrument, knitting, carpentry, playing video or computer games for hours, working on cars, operating vibrating tools, using forceful gripping such as spray bottles, using a crutch, cane, wheelchair, engaging in certain sports such as long-distance cycling that load the arm and hand, skiing – waterskiing requires a firm grip on the handle and snow skiing requires firm gripping on the ski pole.
  5. Sleep: It is impossible to control the position we put our hands/wrists in at night. Therefore, it is essential to wear wrist splints so we avoid bending the wrists in our sleep. Many of us curl up in a ball and tuck or bend the wrists and hands under our chin. In a “normal” wrist, the pressure inside the carpal tunnel DOUBLES when we bend our wrists! If we have CTS, the pressure goes up exponentially or, 6-8 times because of the increased pressure that’s there already because of the CTS. Use a pillow that is designed for you, we’ll help you with that!
  6. Take a break! It’s important to pace yourself if your work or play includes fast, repetitive activities. It’s easy to get lost into what you’re doing so a timer to remind you that an hour has gone by and to take a break is a wise purchase. There are computer programs that flash on your screen, “Time to stretch!” Some of these may include the actual exercise so you don’t forget what to do. If not, talk to us about what exercises are good to do either at the workstation and/or at home for CTS.

We realize you have a choice in who you consider for your health care provision and we sincerely appreciate your trust in choosing our service for those needs. If you, a friend or family member require care for CTS, we would be honored to render our services.

Posted in Carpal Tunnel Syndrome | No Comments »

Fibromyalgia: The Challenges of Diagnosis

February 3rd, 2012

Fibromyalgia (FM) is a chronic condition where the diagnosis is made by elimination since there are no specific lab tests for diagnosing FM. In the past, we’ve discussed the different types of FM, the lack of good diagnostic tests, many management recommendations derived from interviews with FM patients, and more.

One of the many causes of FM involves the autoimmune system, thus suggesting that FM may be an autoimmune disease. In summary, the autoimmune system is very important system for all of us, as it controls the means by which our body fights off unwanted foreign particles like viruses, bacteria, and a host of other triggers that can negatively affect our body. The autoimmune process is best explained by example: Let’s say a certain type of food is eaten to which the person has an allergy. As particles from that food are absorbed into the blood stream, the body senses that something is wrong –foreign particles are there that shouldn’t be there. As a result, our body produces antibodies, which function like an army trained to “fight” the foreign particles. If the body’s autoimmune system handles it without a problem, the person may not even know anything is “wrong” or that this process is going on. However, if the foreign particle is not handled easily or properly, all kinds of symptoms can occur. In this food allergy example, stomach pain, nausea, cramping, diarrhea and perhaps hives on the skin may even occur. Another common autoimmune example occurs in the spring when flowers bloom, grass grows, trees bud, and so on. Many of us suffer from what is commonly referred to as “hay fever” and possible symptoms include a runny nose, itchy watery eyes, and sneezing (lots of it).

FM is sometimes thought to be associated with rheumatoid arthritis but the scientific evidence is not in full agreement with this theory either. More consistent evidence for causation seems to support the following possibilities: 1. Following trauma or injury. 2. A central nervous system origin (the topic of last month’s FM Health Update). 3. Changes in muscle metabolism. 4. A decrease in muscle blood flow.

However, there are still those who support the cause of FM being triggered by an infectious agent like a virus in susceptible people, even though no specific agent has yet to be identified. For those who state that FM is not an autoimmune disease, they do admit FM may have an “autoimmune component” to it. One study reported, “…that scientists have discovered a new antibody in the blood of many FM patients,” which was reported in the Journal of Rheumatology. Subsequently, a new test was developed for detection of the “Anti-Polymer Antibody” (APA) that was reportedly found in more than 60% of FM patients with severe symptoms. The idea of a specific blood test for FM is certainly welcomed by all experts and clinicians who manage FM as a reported $16 billion/year in direct medical costs are associated with FM. Unfortunately, when comparing the APA levels in FM patients to those with rheumatoid arthritis and controls with neither, the APA levels were not able to distinguish between the groups. Unfortunately, until better testing methods are developed, doctors and researchers will continue to look for the “gold standard” FM test.

If you, a friend or family member requires care for FM, we sincerely appreciate the trust and confidence shown by choosing our services!

Posted in Fibromyalgia | No Comments »

Fibromyalgia: The Challenges of Diagnosis

February 3rd, 2012

Fibromyalgia (FM) is a chronic condition where the diagnosis is made by elimination since there are no specific lab tests for diagnosing FM. In the past, we’ve discussed the different types of FM, the lack of good diagnostic tests, many management recommendations derived from interviews with FM patients, and more.

One of the many causes of FM involves the autoimmune system, thus suggesting that FM may be an autoimmune disease. In summary, the autoimmune system is very important system for all of us, as it controls the means by which our body fights off unwanted foreign particles like viruses, bacteria, and a host of other triggers that can negatively affect our body. The autoimmune process is best explained by example: Let’s say a certain type of food is eaten to which the person has an allergy. As particles from that food are absorbed into the blood stream, the body senses that something is wrong –foreign particles are there that shouldn’t be there. As a result, our body produces antibodies, which function like an army trained to “fight” the foreign particles. If the body’s autoimmune system handles it without a problem, the person may not even know anything is “wrong” or that this process is going on. However, if the foreign particle is not handled easily or properly, all kinds of symptoms can occur. In this food allergy example, stomach pain, nausea, cramping, diarrhea and perhaps hives on the skin may even occur. Another common autoimmune example occurs in the spring when flowers bloom, grass grows, trees bud, and so on. Many of us suffer from what is commonly referred to as “hay fever” and possible symptoms include a runny nose, itchy watery eyes, and sneezing (lots of it).

FM is sometimes thought to be associated with rheumatoid arthritis but the scientific evidence is not in full agreement with this theory either. More consistent evidence for causation seems to support the following possibilities: 1. Following trauma or injury. 2. A central nervous system origin (the topic of last month’s FM Health Update). 3. Changes in muscle metabolism. 4. A decrease in muscle blood flow.

However, there are still those who support the cause of FM being triggered by an infectious agent like a virus in susceptible people, even though no specific agent has yet to be identified. For those who state that FM is not an autoimmune disease, they do admit FM may have an “autoimmune component” to it. One study reported, “…that scientists have discovered a new antibody in the blood of many FM patients,” which was reported in the Journal of Rheumatology. Subsequently, a new test was developed for detection of the “Anti-Polymer Antibody” (APA) that was reportedly found in more than 60% of FM patients with severe symptoms. The idea of a specific blood test for FM is certainly welcomed by all experts and clinicians who manage FM as a reported $16 billion/year in direct medical costs are associated with FM. Unfortunately, when comparing the APA levels in FM patients to those with rheumatoid arthritis and controls with neither, the APA levels were not able to distinguish between the groups. Unfortunately, until better testing methods are developed, doctors and researchers will continue to look for the “gold standard” FM test.

If you, a friend or family member requires care for FM, we sincerely appreciate the trust and confidence shown by choosing our services!

Posted in Fibromyalgia | No Comments »

The Whiplash Syndrome: Ringing in the Ears

February 3rd, 2012

The term “whiplash” usually brings to mind neck pain, headaches and/or a stiff neck. However, there are other symptoms associated with whiplash that we don’t usually think of, such as ringing in the ears or, tinnitus. In the absence of whiplash, there are many people who experience an occasional ringing or sound of some sort in their ears. The ringing may seem to keep time with the heartbeat or, in cadence with breathing and is more common over the age of 40, and more common in men. The sound can be a buzzing, ringing, roaring, hissing or high pitched noise that usually lasts only seconds or minutes at the most. So, think of those times when you’ve noticed tinnitus and ask yourself, “…how would that affect me if that noise never stopped or lasted for hours?”

Before we discuss the association of tinnitus with whiplash, let’s review some facts about tinnitus. There are two primary types of tinnitus: Pulsatile and Nonpulsatile. Pulsatile tinnitus is often caused by sounds created either by blood flow problems in the face or neck, muscle movements near the ear, or changes in the ear canal. The non-pulsatile tinnitus is usually caused by nerve problems involving hearing in one or both ears. The later is sometimes described as a sound coming from inside the head. The most common cause of tinnitus is from hearing loss that occurs from aging – technically called presbycusis. However, it can also occur from living or working in a loud environment. Tinnitus can occur with many types of hearing loss and can be a symptom of almost any ear disorder. Other common causes include earwax buildup, certain medication side effects (aspirin, antibiotics), too much caffeine or alcohol intake, ear infections – which can lead to rupture of the eardrum, dental problems, TMJ or jaw problems, following surgery or radiation therapy to the head or neck, a rapid change in environmental pressure (airplane rides, elevators, scuba diving), severe weight loss from malnutrition or dieting, bicycle riding with the neck extended for lengthy timeframes, high blood pressure, nerve conditions (MS, migraine headache), as well as other conditions such as acoustic neuroma, anemia, labyrinthitis, Meniere’s disease, otosclerosis and thyroid disease. The good news is that most of the time, tinnitus comes and goes and does not require treatment. When tinnitus is associated with other symptoms, does not get better or go away, or is in only one ear, it is wise to consult with us. Spinal manipulation and other chiropractic treatment approaches are often VERY helpful in resolving tinnitus with the benefits of avoiding the need for medications, all of which carry secondary side effects. Chiropractic approaches are also highly effective when tinnitus is accompanied by dizziness or vertigo, usually requiring treatment applied to the upper neck area.

So, how does whiplash cause tinnitus? There are primary as well as secondary causes that can give rise to tinnitus after whiplash. After looking at the long list of causes above, direct trauma to the head such as hitting the side window, the back of the seat, the steering wheel, mirror and/or windshield makes obvious sense. Secondary causes often involve the TMJ or jaw which is commonly injured in whiplash. By itself, TMJ can cause ear pain, tinnitus, vertigo (dizziness), hearing loss, and headaches. Because many nerves that innervate the neck and head arise from the neck as well as from the cranial nerves, spinal manipulation of the neck as well as certain cranial manipulations can have a dramatic benefit in treatment of whiplash induced tinnitus.

We realize you have a choice in where you choose your healthcare services. If you, a friend or family member requires care for whiplash, 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.

Posted in Whiplash | No Comments »

The Whiplash Syndrome: Ringing in the Ears

February 3rd, 2012

The term “whiplash” usually brings to mind neck pain, headaches and/or a stiff neck. However, there are other symptoms associated with whiplash that we don’t usually think of, such as ringing in the ears or, tinnitus. In the absence of whiplash, there are many people who experience an occasional ringing or sound of some sort in their ears. The ringing may seem to keep time with the heartbeat or, in cadence with breathing and is more common over the age of 40, and more common in men. The sound can be a buzzing, ringing, roaring, hissing or high pitched noise that usually lasts only seconds or minutes at the most. So, think of those times when you’ve noticed tinnitus and ask yourself, “…how would that affect me if that noise never stopped or lasted for hours?”

Before we discuss the association of tinnitus with whiplash, let’s review some facts about tinnitus. There are two primary types of tinnitus: Pulsatile and Nonpulsatile. Pulsatile tinnitus is often caused by sounds created either by blood flow problems in the face or neck, muscle movements near the ear, or changes in the ear canal. The non-pulsatile tinnitus is usually caused by nerve problems involving hearing in one or both ears. The later is sometimes described as a sound coming from inside the head. The most common cause of tinnitus is from hearing loss that occurs from aging – technically called presbycusis. However, it can also occur from living or working in a loud environment. Tinnitus can occur with many types of hearing loss and can be a symptom of almost any ear disorder. Other common causes include earwax buildup, certain medication side effects (aspirin, antibiotics), too much caffeine or alcohol intake, ear infections – which can lead to rupture of the eardrum, dental problems, TMJ or jaw problems, following surgery or radiation therapy to the head or neck, a rapid change in environmental pressure (airplane rides, elevators, scuba diving), severe weight loss from malnutrition or dieting, bicycle riding with the neck extended for lengthy timeframes, high blood pressure, nerve conditions (MS, migraine headache), as well as other conditions such as acoustic neuroma, anemia, labyrinthitis, Meniere’s disease, otosclerosis and thyroid disease. The good news is that most of the time, tinnitus comes and goes and does not require treatment. When tinnitus is associated with other symptoms, does not get better or go away, or is in only one ear, it is wise to consult with us. Spinal manipulation and other chiropractic treatment approaches are often VERY helpful in resolving tinnitus with the benefits of avoiding the need for medications, all of which carry secondary side effects. Chiropractic approaches are also highly effective when tinnitus is accompanied by dizziness or vertigo, usually requiring treatment applied to the upper neck area.

So, how does whiplash cause tinnitus? There are primary as well as secondary causes that can give rise to tinnitus after whiplash. After looking at the long list of causes above, direct trauma to the head such as hitting the side window, the back of the seat, the steering wheel, mirror and/or windshield makes obvious sense. Secondary causes often involve the TMJ or jaw which is commonly injured in whiplash. By itself, TMJ can cause ear pain, tinnitus, vertigo (dizziness), hearing loss, and headaches. Because many nerves that innervate the neck and head arise from the neck as well as from the cranial nerves, spinal manipulation of the neck as well as certain cranial manipulations can have a dramatic benefit in treatment of whiplash induced tinnitus.

We realize you have a choice in where you choose your healthcare services. If you, a friend or family member requires care for whiplash, 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.

Posted in Whiplash | No Comments »