Neck Pain Reducing “Tricks” (Part 3 of 3)

            This series has included exercise recommendations to self-manage neck pain, headache, upper back pain, and dizziness. This month’s topic involves enhancing coordination, which may be the most important topic in this three-part series!

            Coordination-based exercises are important because they stimulate our neuro-motor system and can help restore normal function. We can all relate to the challenge of learning new activities. In many cases, we may struggle with the basics, but over time, they become easier to perform and we're eventually able to accomplish these neuromuscular sequences without even thinking about it. When we are injured, we COMPENSATE and change our methods of doing the various tasks associated with our work and daily living. Unfortunately, these altered neuromotor sequences can become our “new normal” and can lead to other faulty compensatory motor functions (a negative vicious cycle). To “fix” this, we must First “Identify” the faulty pattern, Second “Fix” the faulty pattern consciously, Third “Practice” the new or proper method long enough so that, Fourth The proper/new/fixed method becomes automatic or “unconscious.” So, HOW do we re-establish proper motor function after an injury?

            We can all start stimulating the neuromotor system by adding coordination-based components to our current fitness program. For example, when performing an exercise, release slowly but keep resisting. This “eccentric” resistance (resistance as the muscle elongates) builds coordination while the “concentric” resistance (resistance as the muscle shortens/contracts) builds strength. Apply this principle to ALL resistance exercises, and remember only use a light amount of resistance when exercising your neck muscles – only 10-20% of a maximum push! Another “principle” that is applicable to ALL exercises is to start simple and slowly add or integrate more complex movements or start doing two things at once (like pinch a ball between your knees or stand on one leg while performing your neck exercises). Be “mindful” or THINK about what you are doing to further stimulate the nervous system. Some other ways to add variety to your exercises include incorporating sitting on a gym ball, jumping, or standing on a rocker or wobble board. MAKE IT FUN and challenging! ALWAYS build on what you have previously mastered!

            We realize you have a choice in whom 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 requires care for neck pain or headaches, we would be honored to render our services.

GREAT Exercises for Fibromyalgia

            Fibromyalgia (FM) is a chronic, stubborn condition that many people struggle with – some to the point of being totally disabled from doing the things that are personally fulfilling. In the past, we have discussed how important it is to have a multi-disciplinary group of healthcare providers to help the FM patient manage this relentless condition. This month, we are going to look at the available research regarding FM patients who incorporate exercise into their lifestyle vs. those who do not!

            There are MANY ways in which we can exercise – from simply contracting your abdominal muscles when you drive or sit at your desk to a full-body workout in a swimming pool. The KEY to exercise success is finding an exercise that you ENJOY, look forward to doing, and can foresee yourself doing for a long time into the future. To convince you of the benefits of exercise, let’s take a look at what has been published in peer-reviewed medical journals…

            In a “systematic review” of randomized clinical trials regarding FM and exercise training, researchers reviewed relevant studies published between 1966 and 2000. They reported that aerobic exercise reduced the number of tender points and improved cardiovascular fitness, global well-being, fatigue, and sleep in participants. This review clearly demonstrates that exercise is a very important component in the self-management of FM.

            Another study evaluated the effects of six months of pool-based exercises with six educational sessions in a 58 patient group that were divided between a treatment and a control group. They used a six-minute walking test, the Fibromyalgia Impact Questionnaire (FIQ), and several other tests and instruments that assess functional limitations, pain levels, social functioning, psychological distress, and quality of life. At the conclusion the trial, those who exercised experienced statistically significant improvement in ALL methods of assessment, CLEARLY demonstrating the importance of exercise!

            A similar study looked at exercise benefits and how long they lasted after the activity was discontinued following a twelve-week program. During the twelve weeks, the researchers measured and reported significant improvements in all nine measurements (physical function, general health perception, vitality, social function, mental health, balance, stair climbing, bodily pain, and role-emotional). During follow-up, researchers found that participants were only able to maintain two of the health benefits three months after they stopped exercising! This study shows how important it is to KEEP UP with fitness in order to maintain the best long-term results.

            Another study compared an aerobic exercise group vs. a group that only used relaxation and stretching techniques. The aerobic exercise group outperformed the stretch/relaxation group at the three-month point, and after one year, they reported a greater reduction of tender points and greater improvement if FIQ scores. The researchers concluded, “Prescribed graded aerobic exercise is a simple, cheap, effective, and potentially widely available treatment for FM.”

            There are MANY more studies that support the use of exercise as a very important form of care for FM. The common thread is this – a structured, patient-specific, graded aerobic exercise leads to an improved quality of life for the FM sufferer. 

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

Facts About Carpal Tunnel Syndrome and Sleep

            Have you ever woken up at night with numbness and tingling in your fingers and had to climb out of bed and shake your hands, flick your fingers, and/or rub your arms to “…wake them up?” Well, you’re not alone! In fact, this is one of the more common and often one of the FIRST symptoms of Carpal Tunnel Syndrome (CTS). So, WHY does this happen?

            The “carpal tunnel” is literally just a tunnel that MANY components of the body travel through on the way to the hand. The walls are made from eight small “carpal” bones and the “floor” of the tunnel is made by the transverse carpal ligament. These structures vary in size and shape and differ between males and females, which may be one reason CTS is more common among women than men. The contents of the tunnel include eight tendons that connect the muscles in the forearm to the index, third, ring, and pinky fingers. A ninth tendon that connects to the muscle that flexes the thumb also travels through the tunnel along with blood vessels. Perhaps most importantly, the median nerve that supplies sensation and strength to the palm side fingers (index, third and ring fingers) and the palm of the hand also travels through the carpal tunnel. The tendons to the fingers and thumb are “sheathed” and can swell due to the friction created by the tendon rapidly moving in the tight sheath. This is one reason why people who work in an occupation that requires fast, repetitive hand movements (such as assembly line work, carpentry, food preparation, for example) will often have problems with carpal tunnel syndrome.

            The pressure inside the wrist normally doubles when it is fully bent either forwards or backwards. However, because there is already greater pressure in the affected carpal tunnel of individuals with CTS (due to swollen tendons, for example), the pressure inside the carpal tunnel can increase much more when the wrist is bent. This added pressure can exacerbate the symptoms normally associated with CTS -- including numbness and tingling in the hands and fingers -- especially when the wrist is bent for a prolonged period of time, such as during sleep.

            Treatment associated with carpal tunnel syndrome includes the use of a night wrist cock-up splint, which keeps the wrist from flexing or extending during sleep and helps the swelling inside the carpal tunnel abate. Cock-up splints are not typically worn during the day, as they tend to interfere too much with normal activity and may actually worsen the condition depending on the length of time and the type of work the person is performing. Driving will often increase symptoms, and use of the cock-up splint can be effective during this time.

            Chiropractic management offers a unique form of treatment called manipulation and mobilization that is applied to the fingers, hand, wrist, forearm, and any other area where nerve compression might be present, which frequently includes the cervical spine/neck region. The shoulder and elbow may also require care.

            Anti-inflammatory measures including ice massage over the wrist and anti-inflammatory herbal preparations such as ginger, turmeric, and/or digestive enzymes taken between meals can help. Modifying the ergonomics of a CTS patient's workstation is a good idea in order to reduce the repetitive strain commonly associated with chronic carpal tunnel syndrome.

How to Prevent Whiplash! (Part 3)

            Previously, we discussed the topic of whiplash prevention which included the importance of a properly positioned head restraint, airbags, seat belts, and anti-lock braking systems. This month, we will conclude this important topic!

            Electronic Stability Control (ESC): The importance of the ESC safety feature becomes VERY APPARENT when you start to lose control on snow or ice. The ESC helps a driver retain control on slippery roads or when a driver needs to steer around an obstacle (like a fallen tree) at high speeds. As with anti-lock braking systems, ESC compares your intended steering and braking direction to the vehicle’s response related to side and turning acceleration and individual wheel speeds. The ESC can then apply the brakes to individual front or rear wheels and/or decrease engine power to help correct under- or over- steer conditions. It also controls the “all-speed traction control” by sensing drive-wheel slip during acceleration and individually applies the brake to the slipping wheel(s), and/or reduces the engine power until control is regained. Studies have shown ESC can reduce the risk of rollover, especially in sports utility vehicles (SUVs), some vans, and pickup trucks, due to their higher center of gravity. ESC is now a “standard safety feature” on most vehicles with a high roll-over risk. Though ESC cannot prevent a crash in all situations, it definitely helps avoid some! The Insurance Institute for Highway Safety reports that if ALL vehicles had ESC, about 10,000 fatal crashes could be avoided each year!

            Traction Control (TC) Systems: TC (also called ASR - Acceleration Slip Regulation) is designed to prevent loss of traction from the drive wheels when the gas pedal is applied too fast by the driver. When a wheel “slips,” TC senses this and continually adjusts the braking pressure to ensure maximum tire-to-road contact. This is especially useful on icy and/or wet roads to prevent a loss of control. The best way to understand TC is that it’s the reverse or opposite of ABS (anti-lock braking system), as TC limits over acceleration while ABS prevents too much deceleration. For example, when a light turns from red to green and the pavement is icy and the wheel(s) begin to slip, TC will instantaneously slow the wheel(s) down to eliminate the spinning.

            Daytime Running Lights (DRL): These are lights that automatically switch on when a vehicle is moving, typically emitting white, yellow, or amber light. This is a low-cost method to improve the visibility of a vehicle with the objective to reduce daytime crashes. 

            OTHERS: Blind Spot Detection Systems are usually markers on the side of the rear-view mirrors to help drivers keep track of nearby motorists in blind spots. If another car is in a blind spot and a driver activates their turn signal, the system will alert the driver with a sound or light to bring the other vehicle to their attention. This is projected to reduce approximately 450,000 crash cases per year! Another is the Back-up Warning System which sounds an alarm if an object or person is behind the vehicle. Similarly, a Forward Collision Warning with Automatic Braking detects when a driver is about to collide into a vehicle in front by sounding an alarm, flashing a light, or both. The brakes are automatically applied to warn drivers of a hazard. The Lane Departure Warning system warns you that you’re drifting out of your lane by a sound, light, and/or steering wheel vibration. Some system will even nudge you back into your lane!

Neck Pain – The MOST Important Exercises (Part 2)

            As stated last month, exercises that focus on improving posture, flexibility, strength, and coordination are important for creating a well-rounded cervical rehabilitation program. Our discussion continues this month with stretching and strengthening exercises.

            STRETCHING: Since our neck muscles have to hold up our 12 pound (~5.5 kg) head, it’s no wonder why our neck muscles seem to be tight almost all the time. Here are two ways to stretch the neck: 1) You can simply drop the chin to the chest, look at the ceiling, try to touch your ear to your shoulder (without shoulder shrugging) on both sides, and rotate the head left to right and vice versa (six directions). 2) You can use gentle pressure with your hand and assist in the active stretch by gently pulling into the six directions described in #1 by applying “over-pressure” at the end-range of motion (staying within “reasonable pain boundaries”).

            STRENGTHENING: Most people have a forward head carriage, meaning their head normally rests in front of their shoulders. The further forward the head sits, the greater the load on the muscles in the back of the neck and upper back to hold it up. This position promotes a negative spiral or “vicious cycle” that can lead to many complaints including (but not limited to) neck pain, headaches, balance disturbances, and in the long-term, osteoarthritis. There are two important groups of muscles that require strengthening: the deep neck flexors and deep neck extensors.

1)      The deep neck flexors are muscles located directly on the front of the cervical spine and are described as being “involuntary” or unable to be voluntarily contracted. Hence, we have to “trick” the voluntary outer “extrinsic” (stronger) muscles into NOT WORKING so the deep, intrinsic ones will contract. You can do this by flexing your chin to the chest and pushing your neck (not head) back over your shoulders into resistance caused a towel wrapped around the back of the neck. If you feel your chin raise towards the ceiling, you’re doing it WRONG! Keep the chin tucked as close to the chest as possible as you push your neck (not your head) backwards. If you’re doing it correctly, your chest should raise towards the ceiling as you push your chin down and neck back. Try it!

2)      The deep neck extensors are strengthened in a very similar way EXCEPT here you DO push the back of HEAD back into your towel while keeping your chin tucked tightly into your chest. Do three reps, holding each for three to five seconds and switch between the two for two to three sets.

            We will finish this discussion next month with important coordination exercises!

Fibromyalgia – “How Do I Know I Have It?”

            Fibromyalgia (FM) is a condition where widespread generalized pain limits a person's ability to function, sometimes to the point of complete disability. This month, we'll look at identfying markers that may be used to determine whether a patient has FM or not.

            Chronic pain that arises from the muscles and joints affects nearly 20% of the adult population, with the highest percentages found among females and those in lower income brackets. It is very challenging to determine “the cause” of chronic pain, probably because it is influenced by and interacts with various physical, emotional, psychological, and social factors. Several studies have reportedly shown that the levels of certain neurotransmitters (chemicals that help our nerves transmit information) including serotonin, glutamate, lactate, and pyruvate are elevated in patients with localized chronic myalgias (like FM) and therefore may be potential biomarkers for various conditions causing chronic pain. Unfortunately, elevations in these potential markers are not specific or unique to FM.

            However, researchers have identified muscle alterations in in fibromyalgia / chronic widespread pain patients. More studies are needed to confirm these findings before they have the potential for use as a diagnostic criteria for FM.

            For the time being, in order to establish a diagnosis of FM, we must rely on the following:

1)                  The presence of widespread pain by using the “Widespread Pain Index” or WPI.

2)                  Determining the severity of the symptoms by using the “Symptom Severity Score” or SS score of which there are two parts:

·        Scoring fatigue, waking unrefreshed, and cognitive symptoms using a 0-3 scale, 3 representing the most severe or disturbing of these daily functions.

·        Adding up additional symptoms associated with FM, resulting in a 0-3 range depending on the number of the “other symptoms.”

            Using the WPI and the SS scores, FM can be identified if one of the following two situations has been presend for three or more months:

• WPI score > 7 and SS score > 5
• WPI score between 3 and 6 and SS score > 9

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

Carpal Tunnel Syndrome and Neck Pain – The Great Mystery!

            Carpal Tunnel Syndrome (CTS) develops when the median nerve is pinched at the palm-side of the wrist causing numbness in the index, third, and thumb-side half of the ring/fourth finger. Since the median nerve passes through the neck, it's possible that dysfunction in the neck can interfere with the median nerve, resulting in carpal tunnel syndrome-like symptoms. Sometimes the median nerve can be "pinched" in both the neck and the wrist in what's known as double crush syndrome.

            Though many patients benefit from both surgical and non-surgical CTS treatment approaches, it is not uncommon for the results to fall short of a total resolution of symptoms. In these unsuccessful cases, it's possible the median nerve is "pinched" at one or more locations other than the area the treatment focused on. In some cases, the hand symptoms and other signs of CTS can improve following treatment to relieve cervical dysfunction. The opposite can also be true with neck pain and related symptoms improving when the carpal tunnel is treated.

            The concept of “differential diagnosis” has to do with considering multiple possible causes that can create similar symptoms, and one by one, ruling “in” or “out” each diagnosis by performing various tests with the ultimate goal of coming away with one solid diagnosis. Of course, the problem with this is that there is often more than one diagnosis at play, and in such cases we must determine which one is primary vs. secondary.

            Taking our topic this month as an example, a chiropractor may often see cervical spine x-ray findings such as degenerative disk spaces, osteoarthritic spurring, or narrowing of the foramen that the spinal nerves pass through in route to the arm and hand. However, they may not be sure if these findings are “clinically important” or even contribute to a “cervical radiculopathy” or pinched nerve in the neck. It's possible to see these same x-ray findings in patients with no radiating arm symptoms whatsoever. Similarly, patients with radiating arm / hand complaints may have NONE of these findings! The same holds true with bulging and/or herniated disks in the neck because these may or may NOT cause any radiating symptoms. When a chiropractor is able to reproduce arm and hand symptoms during an examination of the neck that are similar to CTS, this increases the doctor's suspicion that at least a portion of the hand complaints may be attributed to nerve compression from the neck. When both neck and wrist findings co-exist, tests like EMG (electromyography) and NCV (nerve conduction velocity) can really help in some cases, but in other instances, the degree of nerve loss (the amount of damage) may not be enough to be accurately assessed with such diagnostic tools.

            The “bottom line” is that all health care practitioners start “conservative” and wait until all approaches have been exhausted prior to recommending surgery. As described in previous articles, there are MANY non-surgical approaches that chiropractors can provide and you owe it to yourself to try these conservative approaches first!