Chiropractic Health Center & Holistic Healthcare Services

Low Back Pain: Spondylolisthesis

2011-12-26T06:00:00.000-06:00

Low back pain can arise from many conditions, one of which is a mouthful: spondylolisthesis. The term was coined in 1854 from the Greek words, “spondylo” for vertebrae and “olisthesis” for slip. These “slips” most commonly occur in the low back, 90% at L5 and 9% at L4. According to www.spinehealth.com and others, the most common type of spondylolisthesis is called “isthmic spondylolisthesis,” which is a condition that includes a defect in the back part of the vertebra in an area called the pars interarticularis, which is the part of the vertebra that connects the front half (vertebral body) to the back half (the posterior arch). This can occur on one, or both sides, with or without a slip or shift forwards, which is then called spondylolysis. In “isthmic spondylolisthesis,” the incidence rate is about 5-7% of the general population favoring men over women 3:1. Debate continues as to whether this occurs as a result genetic predisposition verses environmental or acquired at some point early in life as noted by the increased incidence in populations such as Eskimos (30-50%), where they traditionally carry their young in papooses, vertically loading their lower spine at a very young age. However, isthmic spondylolisthesis can occur at anytime in life if a significant backward bending force occurs resulting in a fracture but reportedly, occurs most frequently between ages 6 and 16 years old.

Often, traumatic isthmic spondylolisthesis occurs during the adolescent years and in fact, is the most common cause of low back pain at this stage of life. Sports most commonly resulting in spondylolisthesis include gymnastics, football (lineman), weightlifting (from squats or dead lifts) and diving (from over arching the back). Excessive backward bending is the force that overloads the back of the vertebra resulting in the fracture sometimes referred to as a stress fracture, which is a fracture that occurs as a result of repetitive overloading over time, usually weeks to months.

If the spondylolisthesis lesions do not heal either by cartilage or by bone replacement, the front half of the vertebra can slip or slide forwards and become unstable. Fortunately, most of these heal and become stable and don’t progress. The diagnosis is a simple x-ray, but to determine the degree of stability, “stress x-rays” or x-rays taken at endpoints of bending over and backwards are needed. Sometimes, a bone scan is needed to determine if it’s a new injury verses an old isthmic spondylolisthesis.

Another very common type is called degenerative spondylolisthesis and occurs in 30% of Caucasian and 60% of African-American woman (3:1 women to men). This usually occurs at L4 and is more prevalent in aging females. It is sometimes referred to as “pseudospondylolisthesis” as it does not include defects in the posterior arch but rather, results from a degeneration of the disk and facet joints. As the disk space narrows, the vertebra slides forwards. The problem here is that the spinal canal, where the spinal cord travels, gets crimped or distorted by the forward sliding vertebra and causes compression of the spinal nerve root(s), resulting pain and/or numbness in one or both legs. The good news about spondylolisthesis is that non-surgical approaches, like spinal manipulation in particular, work well and chiropractic is a logical treatment approach!

Low Back Pain: Where Is My Pain Coming From?

2011-12-19T06:00:00.000-06:00

Low back pain can emanate from many anatomical locations (as well as a combination of locations), which always makes it interesting when a patient asks, “…doc, where in my back is my pain coming from?” In context of an office visit, we take an accurate history and perform our physical exam to try to reproduce symptoms to give us clues as to what tissue(s) may be the primary pain generators. In spite of our strong intent to be accurate, did you know, regardless of the doctor type, there is only about a 45% accuracy rate when making a low back pain diagnosis? This is partially because there are many tissues that can be damaged or injured that are innervated by the same nerve fibers and hence, clinically they look very similar to each other. In order to improve this rather sad statistic, in 1995 the Quebec Task Force published research reporting that accuracy could be improved to over 90% if we utilize a classification approach where low back conditions are divided into 1 of 3 broad categories:

1. Red flags – These include dangerous conditions such as cancer, infection, fracture, cauda equina syndrome (which is a severe neurological condition where bowel and bladder function is impaired). These conditions generally require emergency care due to the life threatening and/or surgical potential.
2. Mechanical back pain – These diagnoses include facet syndromes, ligament and joint capsule sprains, muscle strains, degenerative joint disease (also called osteoarthritis), and spondylolisthesis.
3. Nerve Root compression – These conditions include pinching of the nerve roots, most frequently from herniated disks. This category can include spinal stenosis (SS) or, combinations of both, but if severe enough where the spinal cord is compromised (more commonly in the neck), SS might then be placed in the 1st of the 3 categories described above.

The most common category is mechanical back pain of which “facet syndrome” is the most common condition. This is the classic patient who over did it (“The Weekend Warrior”) and can hardly get out of bed the next day. These conditions can include tearing or stretching of the capsule surrounding the facet joint due to performing too many bending, lifting, or twisting related activities. The back pain is usually localized to the area of injury but can radiate down into the buttocks or back of the thigh and can be mild to very severe.

Low Back Pain and Scoliosis

2011-12-12T06:00:00.000-06:00

Scoliosis is a term used to describe a curvature of the spine that is not “normal.” The normal curves of the spine include an inward curve in the low back and neck and an outward curve in the mid-back when looking at the person from the side (“sagittal plane”). However, there should NOT be any curves when looking at a person from the front or back (the frontal plane), the spine should be straight. When there is a curve in the frontal plane, this is called scoliosis and it’s usually either a singe curve, shaped like the letter “C” or, a double (or more) curve, shaped like the letter “S”. Though there is a diagnostic code specific for scoliosis, it is not in itself a disease or a diagnosis and frequently, there are no or at worst, minimal symptoms associated with it. For this reason, most of the time, scoliosis is not noticed until the curve progresses significantly and a friend or family member makes a comment about it or a school screening picks it up.

The most common spinal location for scoliosis to develop is in the middle to upper back (called the thoracic spine) but it can also be located at the junction between the mid back and low back, as well as in the low back only or more rarely, in the neck only. Since there are rarely symptoms associated with scoliosis, the way it’s found is by observing one or more of the following:

• One shoulder is higher than the other
• One shoulder blade sticks out more than the other
• One side of the rib cage appears higher than the other (called a “rib hump”)
• One hip appears higher or more prominent than the other
• The waist appears uneven
• The body tilts to one side
• One leg may appear or actually be shorter than the other

The use of x-ray usually is appropriate to confirm the diagnosis, to measure the amount of curve, which can then be used for future comparison, and to rule out a possible unusual cause of scoliosis. Rarely is an MRI required – only in cases where neurological signs and symptoms exist and, in younger children (ages 8-11 years old) as scoliosis almost always occurs during the puberty timeframe when hormonal systems are kicking in, such as ages 12-14. When scoliosis occurs at ages less than 11, when there are neurological changes (reflex, muscle strength and/or sensory functions), and/or when the mid-back/thoracic curve bends to the left (as it almost always curves to the right), an MRI is appropriate to rule out spinal cord pressure.

The decision to treat or not to treat is dependent on 2 factors: 1) The “skeletal maturity of the patient” (how much growing is left for the person) and, 2) The degree of the curve. In general, the bigger the curve and the younger the patient, the greater the chance for curve progression or worsening. With that said, curves less 10° reportedly don’t require treatment but over 20° should be watched at 4-6 month intervals. If a curve progresses >5° and/or when the curve is >30° in an adolescent, the person should be treated - most doctors would utilize a back brace. Chiropractors can offer additional care by applying spinal adjustments, reducing leg length deficiencies when a compensatory lumbar/low back curve is present and by offering scoliosis-specific exercises.

Low Back Pain: An Unusual Cause?

2011-12-05T06:00:00.003-06:00

There are many causes of low back pain (LBP). Most of us can think of the time we bent over to lift a child, the heavy tongue of a trailer, a 5-gallon pail of water, or maybe simply sneezed too hard and threw out our back. These causes are common and most often associated with LBP. But, one unusual cause of LBP (not so unusual once you know about it) involves Vitamin D deficiency. Yes, you heard me – a VITAMIN DEFICIENCY!

One study reported on a 360 patient (90% women, 10% men) group being treated at spinal and internal medicine clinics over a 6-year time frame for LBP of 6 months or greater with no obvious cause. Doctors tested these patients for blood levels of vitamin D (25-hydroxy vitamin D), as well as calcium and alkaline phosphatase (an enzyme found in bone). Then, they administered Vitamin D supplements and the same tests were repeated. Their results are VERY INTERESTING! The findings showed 83% of the group studied (299 patients) had abnormally low levels of vitamin D before supplementation and after treatment of ONLY vitamin D, clinical improvement was seen in ALL the groups that had low vitamin D levels and in 95% of all 360 patients! THAT’S AMAZING! They conclude “Vitamin D deficiency is a major contributor to chronic low back pain,” and recommend screening for vitamin D deficiency and treatment with supplements which they say, “…should be mandatory...,” especially in areas that are “endemic” for vitamin D deficiency. They also conclude that bone softening diseases like osteomalacia may occur as a result of vitamin D deficiency, while many other studies have linked vitamin D deficiency with osteoporosis.

Another question then arises, what geographic regions are most susceptible to low sunlight and hence, vitamin D deficiency? One study showed that during the 8 months centered around summer in the US (March-October), for all locations from the southern tip of Texas to just south of Portland, OR, no difference was found in the vitamin D levels. But, in the winter months (November-February), a significant difference was seen where as latitude increased northward, the amount of vitamin D decreased “dramatically.” However, in lower latitudes (<25 degrees), no difference was found between summer vs. winter months. What about sun block? Does using it reduce vitamin D absorption from the sun? The answer is, YES. On “The Peoples Pharmacy” website (http://www.peoplespharmacy.com/2011/06/13/sunscreens-block-vitamin-d/), it was reported that the typical dose of vitamin D of 400 IU “…is probably inadequate to overcome a deficiency.” They recommend 10-15 minutes of time in the sun without sunscreen a few times a week or a higher dose of vitamin D3 (“…closer to 2000 IU of vitamin D”).

There are MANY other benefits – not just in terms of LBP – from taking vitamin D that have good scientific support. In fact, a PubMed search for “benefits of vitamin D” resulted in 554 studies, some of which included conditions such as, HIV, heart conditions (many), chronic illness in the elderly, osteoporosis, cancers (colorectal, prostate, breast and others), kidney disease, autoimmune diseases (celiac disease, MS, rheumatoid arthritis, many others), types I & II diabetes, and more! You get the picture, I’m sure.

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.

Happy Thanksgiving to All

2011-11-23T09:19:00.002-06:00

Happy Thanksgiving to all of our wellness family & friends! Thank you for your trust in our care and your faithfulness to our clinic! We appreciate you all and pray you have a wonderful Thanksgiving with your families & friends!

Be Blessed, Dr. Debbi & Daron Hannan

Whiplash - Who Will Recover?

2011-09-22T22:00:00.000-05:00

Whiplash, or Whiplash Associated Disorders (WAD), involves a cluster of symptoms and findings that include biomechanical or tissue injury findings, as well as psychological factors that accompany pain and disability. To answer the presenting question, who will recover from whiplash, a task force was set up to investigate this and research over a 10 year time frame was reviewed. They found the initial level of pain after the injury and the associated psychological factors are the two best predictors of whiplash recovery.

WAD results from a neck injury caused by a sudden back and forth movement of the head that often occurs during a car crash. The injury occurs because of the fact that the sudden movement happens in a shorter time frame than our ability to voluntarily contract our own neck muscles. Hence, even if we brace ourselves before the impact, we cannot avoid the sudden “crack the whip” phenomenon that occurs during a crash. It’s even worse is if the head is turned at the time of impact! Although most WAD sufferers recover within a few months, many report ongoing pain a year or more later. With about 2 million insurance claims registered per year in the US, the focus is shifting from what causes pain to what recovery predictors exist with the focus on managing those that are manageable.

One of the two predictors reported was the level of pain reported by the patient 3 weeks after a motor vehicle collision (MVC). In a group of over 3000 patients with WAD, this was reported to be, “…the single most important predictor of who recovers in a timely manner.” On a 10-point pain scale (10 being the most intense pain), patients with a score under 5 recovered more quickly.

The second of the two strong predictors was the patient’s belief or expectation of recovery. Again, at the 3 week mark following the crash, over 1000 WAD injured patients were asked how likely they felt they would recover fully and at 6 months, the disability level was compared to those expectations gathered at the 3 week point. They found a 4x greater chance of being placed in a “more disabled” group if at the 3 week point, the patient reported a poor outcome expectation for recovery. Those who were reportedly prone to “catastrophic thinking” also fared poorly. These are the patients who can’t stop focusing on pain – they believe the crash was, “…the worse thing that has ever happened to them.”

They also found patients wearing a neck collar to protect and immobilize the neck following a MVC were no better off compared to those not wearing a collar. In fact, in one group of patients, those who wore the collar were absent longer from work and utilized more pain killing medications compared to those who did not wear it.

Neck Pain and the Disk

2011-09-21T22:00:00.000-05:00

When we say to you, “…you have a cervical disk problem,” do you know what that means? I didn’t think so. As doctors, we talk about these things so often, we sometimes just assume you know what we’re talking about. So first, sorry about that! Now, let’s clear up the question, what is a cervical disk problem?

The term “cervical” means neck, just like the terms “thoracic” means mid-back and “lumbar” means low back. The term “disk” refers to the shock absorbing fibro-elastic cartilage that rests between each vertebra of the spine. Think of the disk as being similar to a jelly donut. The center of the disk is liquid-like (the nucleus), kind of like petroleum jelly, and the outer part (the annulus) is tough and strong and circles the nucleus center like the rings of an freshly cut oak tree stump. What makes the annulus/outer layer so strong is the type of tissue it’s made up of and, maybe most important, the opposing criss-cross pattern of each layer or ring of the annulus. Studies have shown that when the disk is pierced with a knife and then compressed, this criss-cross pattern of the annulus layers self-seals the cut, resulting in no leakage of the liquid center.

So, the question is, how can a disk rupture, herniate or “slip” if it’s so tough, strong, and self-sealing? The answer: as the disk ages or when it’s injured, tears or “fissures” in the disk fibers occur creating rents or channels for the liquid part to work its way out towards the edge and eventually break through the outer most layer – hence, the term “herniated disk.” It’s similar to stepping on that jelly donut until the jelly leaks out to the point where you can see it.

Here’s the strange part. Research tells us that about 50% of people have bulging disks (not quite herniated through) and 20% of us have herniated disks (that have popped through) but have NO PAIN AT ALL! That makes it tough since an MRI or CT scan may show a herniated or bulging disk but how do we know that’s the disk that’s clinically important – the one that’s creating the pain? That’s why we treat patients and not their image (MRI, CT scan or x-ray). Even though a disk may be bulging or herniated, we may not necessarily treat that particular disk if it’s not expressing itself clinically by creating a shooting pain down a specific area in a arm, usually below the elbow often into either the thumb or pinky side of the hand, with associated abnormal tests for strength and/or sensation. That’s why we check your reflexes, your strength, and sensation for each nerve. We’re checking to see if that herniated disk is “pinching” the nerve and if it is, we utilize manipulation, traction, PT modalities, and issue home traction units to try to “un-pinch” that nerve to avoid surgery.

Fibromyalgia and Exercise

2011-09-20T22:00:00.000-05:00

It is common knowledge that we all benefit from exercise. But, it is especially important for people with fibromyalgia (FM) to exercise as it reduces fatigue, increases energy, improves joint flexibility, and improves sleep quality and mood. In essence, exercise allows FM sufferers to live a more enjoyable and fulfilling life!

With that said, it is important to realize that not all exercises are right for every individual person. Therefore, when introducing new activities and exercises into your routine, do NOT do too many new or different exercises all at the same time as you will not be able to recognize those that may not be right for you. Rather, pick one or maybe two new exercises at the most and incorporate them into your routine so that you can “prove” that they “work for you.” Then, if you get worse, you’ll be able to confidently identify the exercise that may not be right for you.

The focus of deciding which exercises are “right for you” is usually based on the presence or absence of pain and hence, we should discuss pain. There are “good” and “bad” forms of pain. A “good” pain does NOT feel harmful – that is, knife-like or lancinating or, severe intense pain. Rather, it should feel, “…like a good stretch,” or, a pain that, “…hurts good.” In fact, sore muscles after exercising prove that you’ve accomplished something positive. It’s usually noticed the day or two after a new exercise or activity is started and then subsides gradually. It will actually “go away” quicker if you perform the same activity or exercise within a few days after the initial session and after the 2nd or 3rd time, it will usually not give you that “post-exercise soreness” type of pain and you can gradually increase the exercise after that point.

Here are some specific recommendations for implementing exercise safely and successfully. Because FM seems to exaggerate pain, make sure to:

1. Start out slow: Begin with only a few repetitions, move only so far (stay within “reasonable” pain boundaries), and do only 1 or 2 sets, maybe 5 minutes max of a particular maneuver. Remember, if you do too much and really hurt a lot afterwards, you may become afraid to exercise again and that’s the WORST thing that could happen!
2. Self-Massage, hot or cold: Consider light self-applied massage with or without moist heat (but no more than 20 minutes / hour – don’t “swell it up” by leaving heat on for longer than 30 minutes. If pain is more intense (>5/10 on a 0-10 scale, for example), use ice after exercising, usually for 15-20 minutes (on 15/off 15/on 15/off 15/on 15 = 1.25 hours), so it can act like a pump to remove swelling more efficiently. Talk to us about heat or cool rubs or gels.
3. Personalize: Because you’re unique, personalize your program so it becomes “yours.” Remember, you are not like the next person and you must design a program that “works” for you. Pick things you like to do so you look forwards to doing it – bike riding, brisk walking, swimming, canoeing, hiking off road, weight lifting (emphasizing low weight/high reps), and so on – PICK SOME ACTIVITIES THAT YOU LIKE TO DO!
4. Aerobic exercises: Consider starting with an aerobic (heart pumping) type of exercise. Many studies have reported that aerobics offer greater benefits compared to stretching, for the FM patient. Start with a low impact cardiovascular exercise like walking. Even sitting on a gym ball and gently bouncing for 5 minutes gets the heart pumping quite nicely and, it’s fun! Swimming and bicycling are good, non-pounding types of exercises as well.

Carpal Tunnel Syndrome - Treatment Recommendations

2011-09-19T22:00:00.000-05:00

Carpal tunnel syndrome or, CTS, is one of the most common causes of pain, loss of work, and work related disability in the United States. It affects approximately 50 per 1000 persons in the general population and the average lifetime cost of CTS (including medical bills and lost work time) is estimated to be about $30,000 per each injured worker. In 2003, there were more than 3.8 million visits made to health care providers for CTS.

The diagnosis of CTS is based on the patient’s complaints, the examination findings, and special testing such as electro-diagnostic tests (like Electromyography or EMG). The success or failure of treating CTS rests on the accuracy of the diagnosis. Often, patients with CTS will present after surgery complaining of the same symptoms they had prior to surgery, such as numbness and pain in the index, 3rd and 4th fingers, weak grip, sleep interruptions and so on, only to find that the median nerve is pinched higher up than the wrist, such as in the neck or elbow.

Treatment failure, as well as an increased likelihood of developing CTS, may also result from the presence of other “risk factors.” These include (but are not limited to) advancing age (>50 years old), females > males, and the presence of diabetes and/or obesity, which often coincide. Other risk factors include pregnancy (due to hormonal shifts and fluid retention), certain occupations (highly repetitive), strong family history of CTS, specific medical conditions like hypothyroidism, autoimmune and rheumatologic diseases, certain types of arthritis, kidney disease, trauma, anatomic predisposition of the wrist and hand (shape and size), infectious diseases, and substance abuse. The difficult thing in treating CTS is when multiple factors exist – like a female over 50 with a highly repetitive job and who is also obese. Obviously, the “best” treatment here would include weight management, and possibly work station modifications, in addition to the in-office treatment approaches. Patient compliance or, following the doctor’s recommendations is VERY important such as wearing the wrist splint at night, doing the carpal tunnel stretch exercises, weight management / dietary recommendations, and so on. Therefore, successful treatment for CTS relies on a balance between the patient and provider communicating about ALL the treatment options – surgical and non-surgical so the patient can make an informed decision. Since each patient is unique, the treatment approach must be tailored to that individual and may require, as previously stated, a number of treatment strategies aimed at patient specific issues.

Chiropractic is in a unique position for managing the CTS patient. This is because we look at the whole person, not just the wrist and, we offer the LEAST INVASIVE approach. Many times, there are issues in the neck, shoulder, elbow and forearm in addition to the wrist/hand that MUST BE carefully assessed in order to obtain a successful, satisfying result for the patient. We also consider the many “risk factors” described above and can assess or coordinate services with other health care providers so the many conditions described previously can be properly evaluated. So, the question remains, what do chiropractors do when treating a patient with CTS? Treatment often includes “the usual” such as wrist splinting during sleep, work modifications, and anti-inflammatory approaches (ice cupping, herbal, etc.). Unique to chiropractic are manipulation or adjustments (often to the neck, shoulder, elbow, forearm, wrist and hand), muscle tendon release techniques (possibly using tools to breakup adhesions, scar tissue, and the like), exercise training for the involved areas including the hand/wrist, as well as dietary strategies for weight management, metabolic syndrome (pre-diabetes) and so on.

Low Back Pain: Why Is It So Common?

2011-09-18T22:00:00.000-05:00

This question has plagued all of us, including researchers for a long time! Could it be because we’re all inherently lazy and don’t exercise enough? Or maybe it’s because we have a job that’s too demanding on our back? To properly address this question, here are some interesting facts:

1. The prevalence of low back pain (LBP) is common, as 70-85% of ALL PEOPLE have back pain that requires treatment of some sort at some time in life.
2. On a yearly basis, the annual prevalence of back pain averages 30% and once you have back pain, the likelihood of recurrence is high.
3. Back pain is the most common cause of activity limitation in people less than 45 years of age.
4. Back pain is the 2nd most frequent reason for physician visits, the 5th ranking reason for hospital admissions, and is the 3rd most common cause for surgical procedures.
5. About 2% of the US workforce receives compensation for back injuries annually.
6. Similar statistics exist for other countries, including the UK and Sweden.

So, what are the common links as to why back pain is so common? One reason has to do with the biomechanics of the biped – that is, the two legged animal. When compared to the 4-legged species, the vertically loaded spine carries more weight in the low back, shows disk and joint deterioration and/or arthritis much sooner, and we overload the back more frequently because, well, we can! We have 2 free arms to lift and carry items that often weigh way too much for our back to be able to safely handle. We also lift and carry using poor technique. Another reason is anatomical as the blood supply to our disks is poor at best, and becomes virtually non-existent after age 30. That makes healing of disk tears or cracks nearly impossible. Risk factors for increased back injury include heavy manual lifting requirements, poor or low control of the work environment, and prior incidence of low back pain. Other risk factors include psychosocial issues such as fear of injury, beliefs that pain means one should not work, beliefs that treatment or time will not help resolve a back episode, the inability to control the condition, high anxiety and/or depression levels, and more. Because there are so many reasons back problems exist, since the early 1990’s, it has been strongly encouraged that we as health care providers utilize a “biopsychosocial model” of managing those suffering with low back pain, which requires not only treatment but proper patient education putting to rest unnecessary fears about back pain.

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.

YOU MAY BE A CANDIDATE FOR CHIROPRACTIC CARE FOR LOW BACK PAIN! FOR A FREE NO-OBLIGATION CONSULTATION CALL 504.454.2000

Whiplash - Biomechanics and Costs

2011-09-15T22:00:00.000-05:00

Whiplash or Cervical Acceleration-deceleration Disorder (CAD) is primarily associated with motor vehicle collisions (MVCs) and in particular, rear-end collisions. Last month, we discussed how CAD can be prevented and focused greatly on paying attention while driving and, the position of the headrest. Whiplash is defined as an injury to the cervical spine (neck) caused by a rapid/sudden, usually unexpected, forceful movement. (Typically, forwards and backwards, if struck from in front or behind, or, a side to side movement if struck from the side.) Even worse, when coupled with the head being rotated at the time of impact, tearing of the ligaments, muscles, and joint capsules in the neck can cause a myriad of symptoms that can remain present for years, sometimes permanently. Some of these symptoms include:

• Neck and shoulder pain and/or stiffness
• Middle and low back pain
• Dizziness
• Vertigo (balance disturbance)
• Fatigue
• Numbness/Tingling
• Face/Jaw pain
• Cognitive dysfunction or brain injury (even without hitting the head directly)
• Sleep disorders

A report published in January 2011 discussed recent advances and a new law that goes into effect 9-1-11 regarding the design of head restraints that is aimed at significantly reducing the injury severity and consequently the costs associated with CAD. The Code of Regulations (CFR) describes the new bill, (FMVSS 202a) as a standard, “…to reduce the frequency and severity of neck injury in rear-end and other collisions.” This new law requires testing the absorbency (springiness), the locking mechanisms, and the height by making sure the restraint is above the center of gravity of the occupant’s head to reduce the “backset” (distance between the head and the restraint). This is done by testing the seat back and head restraint as a system to ensure the head restraint remains in its proper position throughout the collision. The concept is to reduce the rearward shift of the occupant’s head relative to their torso or to avoid extreme hyperextension. Companies have been manufacturing both dynamic, as well as static, head restraint systems in response to this new requirement that becomes fully effective on 9-1-11 for both front and rear seats. So, how does this equate to costs?

Between the years of 1988 and 1996 from 805,851 whiplash injuries, the National Accident Sampling System (NASS) reported the total annual cost of treatment, excluding damage to property, was $5.2 billion. This amount includes costs derived from medical, legal, insurance, productivity loss and work loss. The report estimates, by improving the seat back and head restraint position to the occupant’s head, a total reduction of 14,247 whiplash injuries is expected which will have a nearly $92 million total cost reduction through both direct injury costs and also the indirect societal costs!

Fibromyalgia - More Tips From Real Patients

2011-09-13T22:00:00.000-05:00

Last week, we listed many great “pearls” of wisdom direct from patients suffering with Fibromyalgia (FM), some of which we would like to directly focus on this month and expand as these truly arise from the heart of the experienced and deserve more attention (plus, we couldn’t include them all last month and can expand on them now).

1. “Keep a journal every day about what you do and how you feel.” Many times when discussing your symptoms of FM with us, it is very hard to remember important details and keeping a journal is REALLY appreciated as it serves as a reminder for the patient of the things that trigger a flair-up. The journal can often save an immense amount of time trying to determine what can be done to help the patient, such as when to employ biofeedback skills, like visualization. This is performed any time or place where you may find yourself in a situation that is totally out of your control and you sense your ability to cope is failing. At uncontrolled times such as this, shutting the eyes and visualizing a calming and relaxing scenario is usually very helpful and can be exercised as often or for as long as needed. Again, write down the most effective visualization scenarios or thoughts so you can refresh your memory from time to time.

2. “Sleep is very important. Try not to nap during the day so you can sleep better at night.” One of the biggest complaints from FM patients is sleep disturbance, whether it’s getting to sleep or waking up multiple times a night and/or not being able to return to sleep. Many “pearls” were found that dealt with sleep quality and methods for improving sleep. One of the most important issues is stated above – try to avoid napping during the day. Another is to go to sleep at the same time each night, or, to stay on a schedule that is consistent. Some recommended avoiding thoughts about the day that are stressful or situations you can’t control prior to going to sleep.

3. “Exercise on a regular basis.” This too, was a popular recommendation. Most felt “light exercises” was better, while a few favored strenuous exercises. Some gave specific recommendations like yoga, stretching, or swimming (“…because it’s easier on my joints.”). Some gave specific instructions like, “…Exercise! Keep those muscles and bones flexed and firm. But do not overdo it!” Another recommended wearing a sweat suit to keep the muscles warm. Most importantly, develop a routine that includes regular exercise doing something you like! This will ensure consistency and flow. Exercise also has the very important ability to reduce stress simply from “working out,” and stress reduction and control was mentioned by itself multiple times. Not mentioned is the fact that endorphins and enkephlins are released with exercise that can reduce pain, as they are “natural pain killers,” morphine-like substances our body produces.

4. Diet: This too, was popular and frequently mentioned. Some gave very detailed information about what to eat such as, “Balance your meals with a low-fat, high-protein diet. Drink plenty of water.” A low gluten diet is anti-inflammatory and very helpful.

5. Miscellaneous: Educate yourself about FM by gathering as much information as possible, reading about FM on a regular basis, starting or attending a support group, choosing a doctor who understands FM were also very common themes. Perhaps most important was, “accept your limitations,” and in doing so, don’t be afraid to ask for help – create a list of reliable friends and family who are willing to help out when needed.

Carpal Tunnel Syndrome - Diagnosis

2011-09-12T22:00:00.000-05:00

Carpal Tunnel Syndrome or, CTS, is a common condition that affects many people. The process by which it is diagnosed includes a careful history and examination that includes an orthopedic and neurological exam, sometimes special tests such as X-Ray, MRI, EMG/NCV, and special sensory tests (including vibrometry or neurometry). So, let’s discuss this process.

HISTORY: When you first arrive, you will be asked to complete some routine paper work that includes history-based information such as the mechanism of injury (how did CTS start), the onset (when the symptoms started), pain related issues (factors that increase or decrease the pain/symptoms), quality of symptoms (numb, tingling, achy, pins/needles), radiation of symptoms and location, severity (right now, on average past week, at best and at worst), timing of the symptoms (worse at night, in the morning, after certain work or home activities), and past history information. You will also be asked about your current health status such as heart disease, stroke, diabetes, thyroid disease, arthritis, and any other health related conditions that may be present. We will also do an inventory of your systems (cardiovascular-heart, pulmonary-lungs, genito-urinary or, bladder, kidney, sex organs), skin, musculoskeletal (muscles, bones, and joints), and neurological systems. This is all important as they can contribute to CTS.

EXAMINATION: The routine exam for CTS patients includes a careful evaluation of not only the hand and wrist, but also all structure from the neck down the arm, including the shoulder and elbow. That’s because a pinch of the nerve at any location from the neck down can contribute to CTS symptoms and treatment at these locations is often needed for a satisfying result. Categories of examination include:

• Observation: This includes posture, skin color/texture, and quality of movement such as being slow or careful with or without pain behavior like grimacing or verbal expressions of pain.
• Palpation: Touching areas including the neck, shoulder, elbow, wrist, and hand. We are looking for pain responses, numbness/tingling, temperature & moisture of the skin, muscle tone, joint grinding, and others.
• Orthopedic tests: This will include testing for nerve pinching in the neck, shoulder, elbow, or wrist; attempts to reproduce symptoms in the hands by bending and holding the bent wrist positions for 10-30 seconds, tapping the wrists with a reflex hammer checking for numbness into digits thumb through the 4th finger; stretching the fingers backwards to see how “stiff” they are comparing the two hands, and others.
• Neurological tests: Using various instruments that may include a sharp object like a pin, a dull object, light touch, vibration produced by a tuning or neurometer or vibrometer, a reflex hammer to test the reflexes in the arm (several locations), and possibly a 2-point discriminator which measures whether one can feel 2 points the same on the two sides or down to at least 6mm (1/4 inch). Testing muscle strength in the arms as well as grip strength is also commonly done.
• Special tests: These are less commonly performed but can include: blood tests (diabetes-sugar, thyroid, arthritis tests, Lymes Disease, others), EMG (electromyography), NCV (Nerve Conductance Velocity - these tests measure the speed at which a nerve transfers an impulse from point 1 to 2 such as neck to hand, elbow to wrist, across the wrist to the 2nd finger), X-Ray and/or MRI (Magnetic Resonant Imaging).

The bottom line, make sure your health care provider is thorough and checks everything from the neck to the hand as often, many other conditions above the wrist frequently contributes to CTS symptoms.

Low Back Pain: The Importance of Patient Education

2011-09-11T22:00:00.000-05:00

It’s been reported that educating the patient about their condition reduces unnecessary anxiety and fear, which in turn, allows a more swift resolution of their condition. The intensity of low back pain (LBP) can sometimes be so severe, the patient can hardly move without getting a sharp, knife-like pain that stops them in their tracks. When one experiences this kind of pain, it’s very easy to assume what’s causing this, “….must be lethal!” Or perhaps, “how can anything hurt this bad and not be cancer?” These types of thoughts can lead to unnecessary (and frankly, inappropriate) behavior including fear of activity (including work), anxiety, depression, and poor coping skills. In this regard, all LBP guidelines include the important recommendation of offering appropriate reassurance and advice through patient education as it is KEY to reducing this unnecessary fear and anxiety. This includes educating the patient as to what hurts them (anatomical tissue damage), why it hurts so badly (the inflammatory cycle), and what they can and should do to get out of the acute, painful stage as quickly as possible (“RICE” or, Rest, Ice, Compress, Elevate).

Education is related to experience. Stop and think about how a child manages pain. When they fall down and skin their knees, the intensity of their crying can be deafening! It’s obvious the child’s the reaction is exaggerated, as exemplified by that blood curdling scream. The reason for this heightened reaction is due to the lack of experience or, “knowledge” about this type of injury – they don’t realize the pain will dissipate with a few minutes and as a result, they over react. As we age, skinning our knees is more irritating mentally than it is painful – we look at it, after muttering a few words under our breath (which won’t be repeated here), and then we go about our daily routine, knowing fully well that it will hurt for a while and eventually get better. Studies have shown that people who have graduated from high school or college have a higher pain threshold than those who have not. This may be because, through learning about the body in science class, they understand the anatomy and physiology (structure and function) behind a cut on the skin. As a result, there is no overreaction, just a “reaction.”

So, when can this educational process start? The answer is simple – as soon as possible; and actually, before we become patients! A recent study published in the journal “SPINE,” found 8 year old school children were capable of out-performing a similar aged “control” group that were not educated on management and prevention of low back pain. Tests were administered initially, at 15 days and at 98 days after beginning the education process. They used a comic book as the method to educate the 266 member group of 8 year olds while a “control” group of 231 kids did not receive the comic book educational tool. Initially, the 2 groups scored similarly (about 73% correct answers for both groups). The comic book was given to the 266 kid group at day 8 and both groups were retested again at the 15 and 98 day time points. The results showed the group receiving the comic book education about LBP scored significantly higher at 15 days and retained the information at 3 months. Though no one will know if the educated kids will be less prone to develop chronic pain due to this gain of knowledge, the increased likelihood certainly exists.

The take home message is, use the internet and all other resources to learn as much as you can about your back condition. A great website to help you is www.spine-health.com.

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.

YOU MAY BE A CANDIDATE FOR CHIROPRACTIC CARE FOR LOW BACK PAIN! FOR A FREE NO-OBLIGATION CONSULTATION CALL 504.454.2000

Whiplash: Can It Be Prevented?

2011-09-08T22:00:00.000-05:00

Whiplash, or cervical acceleration-deceleration disorder (CAD) often occurs in car collisions. So, the question is raised, “…can it be prevented?” To answer this we must first consider the obvious facts about minimizing your distractions when you drive: intoxication, engaged conversation (especially if you’re trying to make eye contact), talking on your cell phone or worse, texting while driving (equal to 3 mixed drinks!!!), messing with the radio, GPS, or other “gadgets” in the car, eating while driving, putting on makeup, shaving, and yes, even reading a book while driving! If you’re getting tired pull over for a “power nap.” Even a 15-20 min. “shut eye” session can really help. But these things are obvious (and WELL DOCUMENTED)! What other factors, like features in cars can minimize or possibly prevent injury in the event of a crash?

The headrest is a very most important feature in the vehicle for preventing or at least reducing the degree of injury in a crash. Unfortunately, most people do not bother setting the headrest at the correct height, as it’s usually in a position that is too low. When this occurs, the head can slide over the top of the headrest which can actually result in greater injury as it acts like a fulcrum allowing the head to hyperextend over it. It can also make the injuries associated with whiplash much worse. The proper height of the headrest should be no lower than the top of the ear level but in a lot of cases, the top third of the head may be a better choice, especially if the headrest is small in size or, if the seat is reclined. The angle of the seatback is important with reference to headrests because when the seatback is reclined, there is a certain amount of “ramping” that occurs in rear-end collisions. This is because when the seat is reclined back, the seatback can act literally like a ramp and your whole body can slide up the ramp/seatback and your head can end up over the top of headrest. Therefore, keep the seatback as vertical as you can tolerate. The degree of “spring” or bounce of the seat back also affects the speed or acceleration of the rebound that occurs in a crash but unfortunately, the seat’s “springiness” can’t really be changed.

Seat belts and airbags are a great pair of safety features as they work together to reduce the chances of a serious injury, as well as whiplash. The seatbelt’s job is to stabilize the trunk and prevent the occupant from being ejected from the vehicle while the airbag protects the chest, neck and head from hitting the steering wheel or windshield. Seatbelts arrived on the scene in the 1970s, shoulder restraints shortly thereafter, and airbags in 1985. An 8 year study by the U of Pittsburgh reported on over 7000 spine injured patients, and found a significant reduction of spine related injuries when both seatbelts and airbags were utilized. The National Highway Traffic Safety Administration advises at least a 10-inch distance between the steering wheel and the breastbone in order to avoid airbag injuries, which reportedly occur within the first 2-3 inches of the airbag.

The “take home” message here is when you combine: 1. Staying alert by avoiding all the many distractions that can lure your eyes off the road; 2. Slowing down when you see or sense trouble, and, 3. Making sure your seatbelt is fastened (and those of your passengers, as well) and your airbag still works, you can be quite confident you are doing your part in preventing injury (including whiplash) for both yourself and potentially others!

"My Neck Is Killing Me!"

2011-09-07T22:00:00.000-05:00

When patients present with neck pain, they always ask, “where is the pain coming from?” Of course, this can only be answered after a careful history and thorough evaluation is completed, which is what we do in this office. Let’s take a closer look at what this involves.

The History: This includes a careful description of how the injury occurred, if there was an injury. For example, in a slip and fall injury, it makes a difference if the patient fell forwards, sideways, or backwards; if they landed on their knees, hips, buttocks, back or if they hit their head on the ground. Also, if there was a dazed feeling or loss of consciousness in the process. If there was a head strike, were there any signs of concussion: fatigue, mental “fog,” headache, difficulty communicating or forming words or sentences. When there is no specific injury, we will ask if there were perhaps one or more, “mini-“ or “micro-“ injuries that may have occurred sometime within 2-3 days prior to the onset of the neck pain. The cumulative effect of several small “micro-injuries” can result in a rather significant onset of symptoms several days later. The next batch of information gathered includes factors that increase and decrease the pain, the type of pain quality (sharp, dull, throb, burn, itch, etc.), pain location – “…put your finger on where it hurts and “does it radiate into the arms or legs, severity (pain level 0-10), and timing such as, “it’s worse for the 1st 30 min. in the morning and then loosens up.” Information regarding past history, family history, medical history (surgeries, medications), social history, habits (caffeine, tobacco, alcohol, etc.), and a systems review (heart, lungs, stomach, nervous system, etc.).

The Physical Exam: This includes vital signs (blood pressure, etc), observation – the way the head is positioned (forwards, to the side, rotated, etc.); palpation – touch/feel for muscle spasm, trigger points, spinal vertebra position and motion; range of motion, orthopedic and neurological tests. The exam procedure may also include x-ray, depending on each case.

The Diagnosis: This is determined after taking all your information and “…putting the puzzle pieces together” to determine what is causing your pain.

The Treatment: Chiropractic spinal manipulation (often referred to as “adjustments”) is performed by applying energy or force to the misaligned or fixed vertebra structures by one of many methods depending on the patient’s size, pain level, tolerance, and so on. Other “manual” treatment approaches include soft tissue therapy such as trigger point therapy, active release, massage, vibration, and others. The use of physical therapy modalities such as ice, heat, electrical stimulation, ultrasound, light – laser therapy, and/or others, again, depending on your specific situation and needs can also be very helpful. Similarly, exercises to teach you how to hold your proper posture, to improve flexibility or range of motion, and to strengthen the muscles that are weak really help to make the adjustments “hold” and the beneficial effects last longer. A work station/job assessment may also be needed if that appears to be irritating your condition.

Fibromyalgia - Tips From Real Patients

2011-09-06T22:00:00.000-05:00

We have discussed fibromyalgia (FM) from many perspectives but what we haven’t done yet is listen to what actual FM patients have to say about what works and what doesn’t work. Rather than reading about what “the experts” say about FM and what to do for it, let’s take a different perspective – let’s talk to those who have FM and hear what they have to say about the “do’s and don’ts.”

Consider the following great “pearls of wisdom” for those suffering from FM:
• Stick to a schedule—it helps.
• Know when you’re pushing too much, and listen to what your body is telling you.
• Keep a journal every day about what you do and how you feel.
• Focus on the 4 P’s: pacing, problem solving, prioritizing, and planning.
• Work on your communication skills, and don’t be afraid to ask for what you need.
• Exercise and diet are very important.
• Acknowledge your limits—recognize what you can and can not do.
• Exercise if you can—swimming helps me because it’s easier on my joints.
• Don’t overdo it or your symptoms will really kick in.
• Know your limitations—if you’re tired, know when to rest.
• Join a support group—or even start one yourself.
• Stay informed—there's a lot of research and helpful information out there.
• Find a doctor who really sits down and listens to you and understands your pain.
• Use your friends and family as support.
• Learn about Fibromyalgia by reading up on the subject.
• Accept help when you need it.
• Wear a sweat suit when you exercise on the stationary bike; the heat may help to soothe your muscles.
• Sleep is very important. Try not to nap during the day so you can sleep better at night.
• It’s important to take your medication as prescribed.
• Balance your meals with a low-fat, high-protein diet. Drink plenty of water.
• Stretching, swimming, walking, and a little yoga may help you deal with the pain.
• Keep moving and enjoy life.
• Exercise! Keep those muscles and bones flexed and firm. But do not overdo it!
• Write down the things that may have brought about your pain.
• Keep this list on your refrigerator as a reminder.
• This is just one way to help you manage the severity of your next "bad" day.
• List the people you can rely on ahead of time to help you on your "bad" days.
• Just knowing that you have backup may help reduce your stress.
• Your support network can help with completing important tasks.
• For example, on a "bad" day, ask them to run an errand or pick up your children from school.
• Sometimes, they could just be there to listen.

Carpal Tunnel Syndrome and Other Injuries

2011-09-05T22:00:00.000-05:00

Carpal Tunnel Syndrome (CTS) is a very common complaint often associated with repetitive motion related jobs. There are 9 tendons traveling down the arm from the elbow that “merge” or come together in the relatively tight carpal tunnel, kind of like when 4 lanes of traffic suddenly narrow into 1 lane. We all know what happens when there is road construction during rush hour – traffic comes to a screeching halt and you have to sit there and wait, and wait, then move an inch or two, painfully waiting to reach the end of the construction zone. However, when its not rush hour, traffic may not slow down much at all because there simply aren’t many cars on the road. This analogy is VERY similar to CTS as the 9 tendons and median nerve are the lanes of traffic that merge together as they travel through the tight carpal tunnel in the wrist. When a worker, let’s say a typist, works long hours at the computer typing as fast as possible (like heavy traffic during rush hour), the repetitive rubbing of the tendons in the tunnel creates friction, heat, swelling, and eventually pinching of the nerve resulting in the classic numb thumb and first four fingers. They have to stop shake their hands and flick their fingers to get the them to “wake up” and then they can resume typing again, but have to stop and go and shake/flick the hands/fingers several times during the day. As a result, they either have to take a break and rest or, compensate by shifting their body into different positions in attempt to reduce the strain on the wrist tendons.

Some of the ways we shift in attempt to reduce strain includes raising the elbows away from the sides of the body, shrugging the shoulders up towards the ears, moving the head and neck into different positions like poking the chin out, slouching, plus combinations of all or some of these. Over time, these compensatory faulty postures end up straining the other surrounding joints and when this occurs, the collection of all painful areas is referred to as “cumulative trauma disorders” or, CTDs. As you can see, it’s important to treat or manage the CTS condition early on so we can avoid the progression into the other CTDs or else, treatment will also have to address many other conditions such as (partial list): tennis and/or golfer elbow (tendonitis), shoulder tendonitis, neck or cervical strain, and/or radiating neck to arm pain (cervical disc injury with radiation of pain into the arm). CTDs can also be a contributing cause to mid and low back pain. As these conditions gradually occur, the longer it takes to stop the progression and sometimes, many of these conditions can become permanent.

There are a lot of ways we can avoid the cascade of events that lead to CTS and other CTDs, some of which include: 1. Early intervention (treatment) – chiropractic care works particularly well at this stage. 2. Taking “mini-breaks” during the work day such as a 1-minute every 30-60 minutes to stretch the neck, shoulders, forearms, hands and fingers. 3. Performing specific carpal tunnel / wrist stretches (placing the palm of the hand on a wall at shoulder level, keep the elbow straight, pointing the fingers down towards the floor). 4. Wearing a cock-up splint, especially at night (this prohibits extreme wrist bent positions and the numbness feeling that can wake us up at night). 5. Modifying a workstation, such as moving the computer monitor so the neck/head point straight ahead. Work station modifications can also reduce awkward hand/wrist positions that overload the tendons of the wrists by lowering the mouse and/or keyboard if they are too high, or padding a sharp countertop edge to prevent it from digging into the forearm and further pinching the nerve.

Low Back Pain: Where Does The Pain Come From?

2011-09-04T22:00:00.000-05:00

“Were does the pain come from?” is probably the most commonly asked question we hear as chiropractors and frequently, the patient is not told the answer to this simple question. The problem is, the question is not so simple. This is because there are many structures in the low back that share a common nerve supply and hence, the pain arising from those structures is located in the same area of the back. For example, the back portion of the disk, the facet capsule and some of the deep muscles in the spine are all innervated by the same nerve and therefore hurt is a similar location. In all honesty, the only way to try to isolate the pain generator is to inject a local anesthetic to block the pain for a short while. This is like when you go to the dentist and they “numb” your tooth so you don’t feel the pain when they work on it. After a few hours, you start to feel some “life” coming back to your mouth and soon it regains its full feeling. Of course, no one would consider “numbing” the back just to figure out exactly where the pain is arising as really, it’s not that important. This is because the chiropractic treatment approach is similar regardless of the exact tissue that is involved. However, it DOES matter in cases where a nerve root is shooting pain down the leg caused by a herniated disk vs. a localized pain in the back that doesn’t radiate. Hence, we doctors of chiropractic will work hard to differentiate these two distinct types of conditions as the treatment is definitely different.

In 1995, the Quebec Task Force recognized the importance of this distinction and recommended all health care providers concentrate on differentiating the nerve root / herniated disk case from what is called “mechanical low back pain.”

The facet joint, when sprained / injured, hurts worse when bending backwards and feels good bending forwards. This is exactly the opposite for the herniated disk where bending backwards helps reduce pain and often reduces the shooting leg pain as well, while bending over even a little can create a sharp stabling pain in the back that may shoot down the leg. Of course, there are variations of this and, to make matters more complicated, BOTH the disk and the facet can generate pain at the same time, so it’s not always this cut and dry.

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.

YOU MAY BE A CANDIDATE FOR CHIROPRACTIC CARE FOR LOW BACK PAIN! FOR A FREE NO-OBLIGATION CONSULTATION CALL 504.454.2000

Whiplash Facts

2011-09-01T22:00:00.000-05:00

Whiplash is a fairly common condition that occurs when the neck is suddenly forced forwards and backwards, usually from motor vehicle collisions. Before 1928, whiplash was sometimes called “railway spine” as it was used to describe injuries that occurred to people involved in train accidents. Since 1928, much has been studied and reported about this condition and in 1995, the term, “whiplash associated disorders” or WAD, was introduced. The WAD classification of whiplash patients includes 3 main category (WAD I, II and III) and a few years later, WAD II was broken into 2 sub-categories (WAD I, IIa, IIb, III). This occurred because some patients in WAD II took a longer time to heal than others. Here are the basic definitions of WAD I, II, III:

1. WAD I: Patients have complaints but no objective findings meaning we cannot reproduce your pain during our examinations
2. WAD IIa: Patients have complaints with objective findings but a normal range of movement of the neck and no neurological findings (normal strength and sensation ability)
3. WAD IIb: Same as WAD IIa except here, neck movements are decreased
4. WAD III: Here, neurological abnormal findings (weakness and/or sensation) are present.
5. WAD IV: Includes fractures and dislocations. Because of this unique difference, this category is often left out of the research that uses this category system to determine prognosis of the WAD case.

This system is very useful as it has the ability to predict the results in a case long before the conclusion of the case.

We have discussed the cause of whiplash in previous articles and what happens when we are hit from behind unexpectedly. In essence, we cannot guard against the abnormal forces that occur in the neck as it all happens faster than we can voluntarily contract our muscles. Also, the myth about no car damage = no injury is just that – a myth! In fact, in low speed impacts, less damage to the car transfers greater forces to the contents inside because the energy of the force is not absorbed by crushing metal (elastic vs. plastic deformity).

Symptoms of whiplash vary widely. Most common symptoms include neck pain and stiffness, headache, shoulder pain/stiffness, dizziness, fatigue, jaw pain, arm pain, arm weakness, visual disturbances, ringing ear noises, and sometimes back pain. If symptoms continue and chronic WAD occurs, depression, anger, frustration, anxiety, stress, drug dependency, post-traumatic stress syndrome, sleep disturbance, and social isolation can occur.

Diagnosis is based on the history, physical exam, x-ray, MRI, and if nerve damage occurs (WAD III), an EMG. Treatment includes rest, ice and later heat, exercise, pain management and avoiding prolonged use of a collar. Chiropractic includes all of these as well as manipulation, mobilization, muscle release methods, and patient education. Prompt return to normal activity including work is important to avoid the negative spiral into long term disability.

Neck Pain – Can Chiropractic Really Help?

2011-08-31T22:00:00.000-05:00

Neck pain is a very common problem affecting up to 70% of the adult population at some point in life. Though there are specific causes of neck pain such as arising from a sports injury, a car accident or “sleeping crooked,” the vast majority of the time, no direct cause can be identified and thus the term nonspecific is applied. There are many symptoms associated with patients complaining of neck pain and many of these symptoms can be confused with other conditions. Wouldn’t it be nice to know what neck related symptoms are most likely to respond to chiropractic manipulation before the treatment has started? This issue has been investigated with very favorable results!

The ability to predict a favorable response to treatment has been termed, “clinical prediction rules” which in general, are usually made up of combinations of things the patient says and findings from exams. In a large study, data from about 20,000 patients receiving about 29,000 treatments, was collected and analyzed to find out what complaints responded well to chiropractic treatment. The results showed that the presence of any 4 of these 7 presenting complaints predicted an immediate improvement in 70-95% of the patients: 1. Neck pain; 2. Shoulder, arm pain; 3. Reduced neck, shoulder, arm movement; 4. Stiffness; 5. Headache; 6. Upper, mid back pain, and 7. None or one presenting symptom. Items not associated with a favorable immediate response included “numbness, tingling upper limbs,” and “fainting, dizziness and light-headedness in 4-12% of the patients. The “take-home” message here is that was far more common to see a favorable response (70-95%) of the patients compared to an unfavorable response (4-12%), supporting the observation that most patients with neck complaints will respond favorably to chiropractic treatment.

So, what do we do as chiropractors when a patient presents with neck pain? First, after gathering preliminary information such as name, address and insurance information, a history of the presenting complaint is taken. This consists of information including what started the neck complaint (if you know), when it started, what makes it worse, what makes it better, the quality of pain (aches, stiff, numb, etc.), the location and if there is radiating complaints, the severity (0-10 pain scale), timing (such as worse in the morning, evening, etc.), and if there have been prior episodes. Various questionnaires are included that are scored so improvement down the road can be tracked and a past history that includes a medication list, past injuries or illnesses, family history and a systems review are standard. The exam includes vital signs (BP, pulse, height, weight, temperature and respiration), palpation, range of motion, orthopedic and neurological examination. X-ray and/or other “special tests” may also be included, when needed. A review of all the findings are discussed and after permission to treat is granted, a chiropractic adjustment may then be rendered. A list treatment options may include: 1. Adjustments; 2. Soft tissue therapy (trigger point stimulation, myofascial release); 3. Physical therapy modalities; 3. Posture correction exercises and other exercises/home self-administered therapies; 4. Education about job modifications; 5. Co-management with other health care providers if/when needed.

Fibromyalgia - How To "Live With" FM

2011-08-30T22:00:00.000-05:00

Fibromyalgia (FM) is a condition that produces widespread pain that can literally change the life of a FM patient, but as they say, “..life must go on!” Therefore, this Health Update is dedicated to discussing ways to empower you with tips to make FM as least activity restricting as possible. Ways to gain self-control of FM include the following:
1. Exercise: There are two forms of exercise you should include in your self-management program. One is light aerobic exercises such as walking and/or water exercises with the objective to increase your heart rate. The other is strength training with a low weight / high repetition approach emphasizing the part of the exercise where you slowly release the weight back to the start position (the eccentric part of the exercise). Here is a list of tips from the National Fibromyalgia Association that should help:
a. Start slow – don’t overdo it the first few times you exercise as post-exercise soreness is normal but, it’s exaggerated in the FM patient.
b. Listen closely to your body’s feedback! Increase the activity according to your tolerance – NOT TOO QUICKLY!
c. Start with only a few minutes of gentle exercise and work your way up.
d. Walking is a GREAT form of exercise. It can be done inside (in the winter, for example), outside, and/or in water (to reduce weight bearing loads).
e. Track your progress by keeping a log of what and how much you’re doing. This can be accomplished by wearing a pedometer (that measures steps), a heart monitor (that measures pulse rate), and keep track of the distance and time, when possible. Make notes how you felt during and after the exercise.
f. Stretch before and after exercising.
g. Keep your chiropractor informed and work as a “team” to advance your program.
2. Sleep: A poor sleep pattern is the “norm” for FM patients. The pain associated with FM usually interferes with sleeps, which leads to more pain followed by more sleep disturbance – it’s a vicious cycle that needs to be broken. The National Sleep Foundation and others recommend the following steps to help us sleep:
a. Stick to a sleep schedule. Go to bed at a similar time each night, even on weekends.
b. Room temperature – keep it cool, not too warm!
c. Caffeine – avoid this especially towards evenings (coffee, tea, soda, and/or chocolate).
d. Alcohol – avoid before bedtime as it can keep you awake.
e. Exercise – in the afternoon, NOT before bedtime.
f. Nap as needed but ONLY briefly – like 20 min. max.!
g. Be comfortable – wear soft PJ’s and consider a white noise machine.
h. Bedtime routine – consider reading, listening to soft music – whatever works for you! Once you find a routine that works, stick with it!
3. Diet: Talk to your chiropractor about food allergy, gluten sensitivity, diabetes, thyroid function, medication/vitamin use and any other unique issues that pertain to you.
4. Emotional control: Engage your family, good friends, your healthcare providers, and consider FM support groups. Meditation, deep breathing and visualization exercises as well as cognitive therapy can also be very effective.

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

Carpal Tunnel Syndrome and Exercise

2011-08-29T22:00:00.000-05:00

We have discussed the topic of Carpal Tunnel Syndrome (CTS) exercises previously but this topic is so important, it warrants another look at this subject from a different perspective. Please keep in mind there are many exercises that will help patients with CTS, including a general, aerobic exercise program where walking, elliptical, stepping, cycling, rowing, swimming and more will facilitate either directly or indirectly. In other words, just “staying in shape” will greatly enhance your health and is therapeutically beneficial for many conditions, including CTS. Remember, if your BMI (Body Mass Index) is over 25 (especially 30) and/or, if your waist size is greater than 35” and especially 40”, the risk of CTS increases significantly. Therefore, diet and exercise are important components of improving your overall health– including conditions like CTS! Here are 5 exercises and/or suggestions for managing CTS:

1. Circles This exercise will strengthen the wrist & forearm muscles, increase the wrist’s range of movement/flexibility, and decreases wrist pain. This can be done multiple times a day as a “mini-break” from keyboard/computer work, as well as a “morning warm-up.” Slowly rotate your wrist/hand from a palm up to a palm down position and repeat up to 10 times.

2. Prayer Stretch Stretching helps to breakup adhesions that form in the carpal tunnel. Place the palms together, fingers straight & pointing up (prayer position). Keeping the heels of the hands together, slowly lower the hands and raise the elbows so that the angle at the wrist decreases. Push your fingers together for 5 sec. Hold for 10 seconds and repeat up to 10 times, depending on time availability. Do this multiple times a day.
3. Strengthening Using a hand weight or TheraTubing, assume the same position as #1 above and slowly raise the weight or stretch the tubing by flexing the wrist with the palm in each of 4 positions: palm up, thumb up, palm down and pinky up. Use your opposite hand to support your wrist with the pinky up exercise

4. Ergonomics Consider modifying your workstation, especially if your monitor is off to a side or too high, if your elbows are bent more than 90°, if your forearms are digging into the edge of the desk, use a trackball mouse so your arm can stay still, consider a larger screen, and an “ergonomic” keyboard (one that is not flat); use a “good” chair with adjustable arms to rest the forearms on.
5. Posture Sit “tall” with your chin tucked in (no “chin poking!”), relax your shoulders (no shrugging), feet flat on the floor or on a box, and take mini-breaks” at your workstation. If you have to, set a timer for every 30-60 minutes that will remind you to stretch.

Two more “tricks” that really help: 1. Reduce your stress on the job – treat others like you would like to be treated (get along with your co-workers); 2. Enjoy your job!

Low Back Pain and Spinal Fusions

2011-08-28T22:00:00.000-05:00

You may think it’s odd to discuss low back pain (LBP) from the perspective of spinal fusion because as chiropractors, we do not perform surgery and so, why discuss it? It is important that we discuss research such as this so we can make the informed treatment decisions with our patients after we’ve considered all the facts in each specific case. Now, there are certainly times when a surgical procedure for back and leg pain is necessary and appropriate for some patients, but the problem is, there are also some patients who have been told they need spinal surgery when, in fact, they may be better off NOT proceeding with surgery. So, the question is, what happens to those patients who elect not, vs. those who do choose to proceed with surgery?

That question was addressed in a study where a total of 1450 patients injured at work were followed over a 2-year time frame. There were a total of 725 patients who proceeded with the fusion surgery and the other 750 elected NOT to have the surgery. A fusion surgery can be described as when two or more vertebra are fused together, usually because there are neurological problems such as shooting leg pain, weakness and/or numbness in one or both legs. The conditions treated in this study included herniated disks, degeneration of the disk, and radiating leg pain. There were primarily 3 factors that were compared between the two groups, namely, 1) ability to return to work; 2) disability (the inability to work), and 3) opiate (narcotic) drug use. Other factors compared included the need for re-operations, complications, and death.

The results showed, in general, those who proceeded with surgery had significantly more problems compared to those who did not have surgery. For example, only 26% returned to work, compared to 67% returned to work. The total number of days off work were 1140 vs. 316 days, respectively. There were 17 vs. 11 deaths, respectively and, 27% of the surgical group required re-operations with a 36% complication rate. Also, there was a 41% increase in the use of narcotic medication with 76% continuing the use after surgery.

Again, there are times when surgery is absolutely the right choice. Those times include when there is a loss of bladder or bowel control, progressively worsening neurological symptoms in spite of non-surgical care, and of course, unstable fractures, cancer/tumor and infections, but that’s about it! In other words, if you don’t have one of the before mentioned conditions which do require surgery, don’t be too quick to jump at the chance of “getting it fixed” with surgery. As the study suggests, the post-surgical results favor those who elected NOT to have surgery. Also, when in doubt, don’t trust the opinion of only one surgeon – always get a 2nd or even 3rd opinion. It is also very important to consider your current level of function or, your ability to do your desired tasks and, unless there is a significant loss in that ability, consider additional time with non-surgical treatment. The non-surgical treatment you can expect to receive from chiropractic includes (but may not be limited to) spinal manipulation, exercise training, physical therapy modalities (ice, heat, electrical stimulation, ultrasound, traction, etc.), dietary counseling, and job modification information.

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.

YOU MAY BE A CANDIDATE FOR CHIROPRACTIC CARE FOR LOW BACK PAIN! FOR A FREE NO-OBLIGATION CONSULTATION CALL 504.454.2000.

What Really Causes Whiplash?

2011-08-25T22:00:00.000-05:00

Whiplash is a non-medical term for a condition that occurs when the neck and head move rapidly forwards and backwards or, sideways, at a speed so fast our neck muscles are unable to stop the movement from happening. This sudden force results in the normal range of motion being exceeded and causes injury to the soft tissues (muscles, tendons and ligaments) of the neck. Classically, whiplash is associated with car accidents or, motor vehicle collisions (MVCs) but can also be caused by other injuries such as a fall on the ice and banging the head, sports injuries, as well as being assaulted, including “shaken baby syndrome.”

The History Of Whiplash. The term “Whiplash” was first coined in 1928 when pilots were injured by landing airplanes on air craft carriers in the ocean. Their heads were snapped forwards and back as they came to a sudden stop. There are many synonyms for the term “whiplash” including, but not limited to, cervical hyperextension injury, acceleration-deceleration syndrome, cervical sprain (meaning ligament injury) and cervical strain (meaning muscle / tendon injury). In spite of this, the term “whiplash” has continued to be used usually in reference to MVCs.

Why Whiplash Occurs. As noted previously, we cannot voluntarily stop our head from moving beyond the normal range of motion as it takes only about 500 milliseconds for whiplash to occur during a MVC, and we cannot voluntarily contract our neck muscles in less than 800-1000 msec. The confusing part about whiplash is that it can occur in low speed collisions such as 5-10 mph, sometimes more often than at speeds of 20 mph or more. The reason for this has to do with the vehicle absorbing the energy of the collision. At lower speeds, there is less crushing of the metal (less damage to the vehicle) and therefore, less of the energy from the collision is absorbed. The energy from the impact is then transferred to the contents inside the vehicle (that is, you)! This is technically called elastic deformity – when there is less damage to the car, more energy is transferred to the contents inside the car. When metal crushes, energy is absorbed and less energy affects the vehicle's contents (technically called plastic deformity). This is exemplified by race cars. When they crash, they are made to break apart so the contents (the driver) is less jostled by the force of the collision. Sometimes, all that is left after the collision is the cage surrounding the driver.

Whiplash Symptoms. Symptoms can occur immediately or within minutes to hours after the initial injury. Also, less injured areas may be overshadowed initially by more seriously injured areas and may only “surface” after the more serious injured areas improve. The most common symptoms include neck pain, headaches, and limited neck movement (stiffness). Neck pain may radiate into the middle back area and/or down an arm. If arm pain is present, a pinched nerve is a distinct possibility. Also, mild brain injury can occur even when the head is not bumped or hit. These symptoms include difficulty staying on task, losing your place in the middle of thought or sentences and tireness/fatigue. These symptoms often resolve within 6 weeks with a 40% chance of still hurting after 3 months, and 18% chance after 2 years. There is no reliable method to predict the outcome. Studies have shown that early mobilization and manipulation results in a better outcome than waiting for weeks or months to seek chiropractic treatment. The best results are found by obtaining prompt chiropractic care.

Headaches & Chiropractic Treatment

2011-08-24T22:00:00.000-05:00

We are often asked, “..what do chiropractors do for headaches?” To answer this question, let’s look at what a patient might expect when they present with headache complaints.

The last three “Health Updates” reviewed the differences between tension-type headaches, migraine headaches and dangerous types of headaches. Keeping in mind those differences, the history and examination will focus on differentiating between these three types of headaches.

The presenting patient will be given the “usual” paper work to fill out that includes biographical information (name/address, type of insurance, HIPAA forms, and so forth), as well as a history, past history, medication list, family history, current habits, and systems review. Specific questionnaires about headaches that can be scored and compared to future scores are particularly helpful in determining the percentage of change in the condition. The main historical piece of information that differentiates the tension vs. migraine headache is the presence or absence of nausea or vomiting, which is unique to migraines. Migraine headaches are usually preceded with an “aura” or, a pre-headache symptom such as ringing in the ears, flashes of light in the visual field, a numbness or tingling sensation – some odd type of “hint” that a migraine may soon strike, often within 30 minutes after the aura. This is important as a chiropractic treatment given prior to the onset of the migraine can sometimes stop the migraine from starting or progressing. Migraines will often occupy half the head vs. tension-type headaches that often occupy both sides. The history can also give us information about things that may trigger a headache (primarily migraines) such as odors, certain foods (like chocolate, nuts, spicy food), and this can lead to specific diet oriented treatment recommendations.

The physical exam include observing the patient’s posture, head carriage, skin color/moisture and touching the muscles (palpation) feeling for spasm/tightness, temperature/moisture, pain location or radiation. Various “orthopedic tests” include movements of the head and neck in attempt to reduce, reproduce or increase symptoms with the primary goal of trying to figure out which structures may be generating the pain. Cervical range of motion tests are performed to see which movements increase or decrease the pain. The neurological exam – testing reflexes, muscle strength, sensation (sharp/dull) may reveal areas of the skin on the head that are either increased / hypersensitive or reduced in sensation (numb). Looking in the back of the eyes is a unique place where blood vessels can be viewed and increased blood pressure, diabetes, increased pressure in the head and more can sometimes be detected, which can help determine if a dangerous headache is lurking. A cranial nerve exam is also sometimes done as part of the neurological examination.

The chiropractic treatment protocols for headaches include (but are not be limited to): Spinal manipulation or mobilization (this is applied to the areas of the neck and/or upper back where the joints are either fixed, displaced, or are applied to a region where the neurological function may be compromised), exercise training, traction, electrical current, ultrasound, stress and diet management.

Fibromyalgia and Sleep

2011-08-23T22:00:00.000-05:00

Fibromyalgia (FM) is a condition that has produced more diverse opinions from researchers and physicians than almost any other condition. This has made finding a health care provider who is willing to manage the FM patient very challenging. Similarly, patient perceptions vary widely from those who strive to live a normal life despite their symptoms vs. those who are unable to cope and “give in” to the disorder. FM occurs in about 2% of the population with the majority of sufferers being women. Common symptoms include muscle aches, joint pain, sleep disturbance and widespread body tender points or areas. The term “fibrositis” was first reported in 1904 to describe patients with these symptoms with many names being used including myositis, myalgia, fibrosis, myofibrositis, psychogenic rheumatism, and probably others! Not until the mid 1970’s did the term “fibromyalgia” become the accepted term, getting rid of the “-itis” suffix which means “inflammation” and adopting the “-algia” suffix, which means condition or pain. In the 1990s, the American College of Rheumatology published distinct criteria for diagnosing FM requiring 11 of 18 tender points to be identified on examination, but this too has been criticized with new recommendations to accept widespread pain, sleep disturbance, and long-term or chronic symptoms as being appropriate to establish the diagnosis. Most recently, a central nervous system (CNS) origin rather than a localized inflammatory condition is now the current accepted area of the body that is the focus of cause and treatment.

Sleep or, the inability to get to deep sleep (which takes 3-4 hours of continuous sleep), has been identified as a major symptom of FM. Similarly, many of the symptoms of poor sleep coincide with the symptoms of FM such as fatigue, poor concentration, irritability, and diffuse pain. While certain medications and herbal remedies have been focused on and discussed, little has been reported on the changes the patient can make to facilitate sleep. The first order of business to help the sleep pattern is to make sure there are no underlying conditions such as sleep apnea or thyroid disease. Second, what is the FM patient’s sleep habit(s) or routine? This includes the time they go to sleep, the time prior to falling asleep once in bed, how many times do they wake up at night and the length of time to fall back asleep, how rested do they feel in the morning and how long does it take “to wake up” and what has to be done – coffee, meds, etc., to feel “awake.” Third, identify other reasons for waking – pets in bed, a snoring partner, babies/kids or elderly care, and/or working swing or night shifts. The “treatment” of the FM patient for sleep disturbance includes discouraging daytime long naps – short naps are OK limited to 30 minutes max and at least 8 hours before bedtime. Here’s a summary list of recommendations:

1. Reduce room distractions (no pets, no TV);
2. Comfortable sleeping temperature and noise level – consider a white noise or “sound machine;”
3. Establish a bedtime and awakening time based on the number of hours that it “usually” takes for that person to feel “rested;”
4. Start a “wind-down” 60-90 min. before bedtime – reading, writing – to relax and “let go” of the day’s events;
5. Avoid stimulating books or movies before bedtime;
6. Writing down cares or worries of the day in a journal 45-60 minutes before bedtime;
7. Avoid next day planning during the “wind-down” time period;
8. Perform deep breathing exercises at bedtime;
9. Avoid caffeine, nicotine, and alcohol pre-bedtime;
10. Limit exercise after 3 hrs before bedtime;
11. Avoid longer than 30 min. naps less than 8 hrs pre-bed time;
12. Avoid eating 3 hours before bedtime;
13. Avoid clock watching;
14. If unable to fall asleep within 15-20 minutes, get up and engage in relaxation exercise and return to bed when feeling sleepy;
15. Consider a softer mattress (harder is NOT always better);
16. Some sleep centers advocate at least 40 minutes of strong light exposure after rising in the mornings.

Carpal Tunnel Syndrome: Can We Prevent It?

2011-08-22T22:00:00.000-05:00

The cause of carpal tunnel syndrome (CTS) is commonly associated with repetitive motions or, working long hours with fast hand movements such as on an assembly line, food packing line, waitress work, or on a computer keyboard and mouse. However, there are many other possible causes that are less commonly discussed such as pregnancy (caused by generalized water retention), birth control pills (same reason), obesity (same reason), rheumatoid arthritis, hormonal disorders such as diabetes, thyroid disease, and menopause and others. Of course, if one combines a fast repetitive job with a hormonal disorder, the chances are increased even more for developing CTS. Essentially, any condition that results in an increase in swelling within the carpal tunnel (wrist), will potentially cause CTS so injuries like sprains/strains, fractures, sports injuries, tendonitis and so forth are all potential causes of CTS. Common symptoms of CTS include: numbness in the 2nd to 4th fingers/hand, pain in the same location, waking up at night needing to shake or “flick” the fingers, driving related numbness, weakness in the grip, difficulty buttoning a shirt, and performing fast repetitive tasks (sewing, crocheting, knitting, cooking) or awkward wrist position tasks (auto mechanic, waitress, musicians, electricians, plumbers, carpenters).

Knowing the cause is important when considering CTS prevention. It is also important to realize the pressure within the carpal tunnel doubles in people without CTS and increases six times in people with CTS when we flex or extend our wrist up or down so sleeping with the wrist straight REALLY HELPS! This is why patients wear a wrist “cock-up splint” so they don’t accidentally bend their wrist when sleeping. Night splints like this are also very effective so the swollen tendons and/or other structures in the carpal tunnel can properly “rest.” If a person has a history of CTS that comes and goes, depending on how active they are, wearing a night splint as a prevention approach is appropriate. The use of a wrist splint during the day is often NOT a good idea if it impedes one’s ability to do their normal or needed tasks. This is because we will irritate the forearm where the splint hits when we flex / extend the wrist and localized bruising can result (sometimes increasing the symptoms of CTS). Using a splint on long drives can also be helpful as driving frequently irritates CTS.

Mayo Clinic offers the following as a list of precautions that may help in reducing the onset, or if present, the frequency/intensity of CTS symptoms:
1. Reduce your force and relax your grip
2. Take frequent breaks
3. Watch your form
4. Improve your posture
5. Keep your hands warm

Here is the URL for more detailed information: http://www.mayoclinic.com/health/carpal-tunnel-syndrome/DS00326/DSECTION=prevention

Though these strategies can help, make sure you properly manage any existing “other problems” listed in the middle of the 1st paragraph. Also, as discussed in prior Health Updates, chiropractic management offers a great non-surgical solution to the management of CTS and should FIRST be utilized before considering surgery!

Low Back Pain and Weight

2011-08-21T22:00:00.000-05:00

Have you ever been told (or at least heard it said): if you could just drop a few pounds, your low back pain would improve? It’s pretty well accepted that excess weight contributes to low back pain. So, if that’s the case, which dietary approach is “…the best?”

Even though weight loss is very important, it can be very challenging for patients because it takes commitment to achieve long term success. Sure, we can lose weight with the Adkins Diet, the Mediterranean Diet, the South Beach Diet, through Weight Watchers and a host of other approaches. But, why do we seem to gain it right back once we discontinue the diet plan? There must be a way to take the weight off and then keep it off.

We have a very similar genetic makeup to our Paleolithic (cave man era) ancestors. Since this is a fact, we can look at the type of food that the cave man consumed and logically draw the conclusion that the “Paleodiet” or “caveman diet” would be a great alternative to our current diet. Thankfully, this does not mean that we change our wardrobe and lifestyle to the point that we go back and live in caves and throw spears to hunt and gather!

What it does mean, however, is we consume similar foods: grass fed animal meat (the more lean the better) and food that grows off the land – that is, fruits and vegetables. These foods are easily broken down and assimilated without alerting our body’s defense system (the autoimmune system) that some foreign particle is inside of us resulting in an army of antibodies showing up to ward off these enemy particles. By avoiding this autoimmune response, at the same time, we are reducing or avoiding all together the inflammatory process, which is a common denominator to all illnesses including musculoskeletal conditions.

So, what do we eat too much of now that the cave man didn’t eat? The answer is gluten! Most flour based products (bread, pasta, cookies, cake, and many more) contain gluten and are “pro-inflammatory” or, cause systemic inflammation. Over time, this can lead to weight gain, diabetes mellitus, heart disease, stroke, as well as a host of many other conditions. The reason glutens are bad is that our bodies are not genetically able to handle the breakdown of these large “macromolecules.” When glutens are detected, we produce antibodies to attack these particles that are resting on the intestinal wall, which, in turn, is damaged in the process, resulting in a “leaky gut” allowing absorption of the large particles. This in turn, results in yet further autoimmune responses as these large (normally not absorbed) macromolecules are detected in our blood stream furthering the inflammatory process. This damage leads to further malabsorption syndromes (“leaky gut”) and a vicious cycle is created. So, what can we do to prevent this from happening and, how can we reduce the inflammation through our diet?

Easy! Just stop eating glutens! Go to the grocery store’s “gluten-free section” and buy products that are gluten-free. Over time, your weight will drop, your energy levels will increase, and the mental fog lifts – you’ll feel 10 years younger and, you’ll be able to enjoy life more completely. Sound too good to be true? Try it – prove me wrong - I dare you!

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.

YOU MAY BE A CANDIDATE FOR CHIROPRACTIC CARE FOR LOW BACK PAIN! FOR A FREE NO-OBLIGATION CONSULTATION CALL 504.454.2000.

Mild Traumatic Brain Injury – What’s That?

2011-08-18T22:00:00.000-05:00

When you woke up today, you thought this was like any other Tuesday. You packed the kid’s lunches and off to school they went. You’re on your way to work and everything is on schedule- it’s a good day! You are stopped at a red light when out of nowhere, someone crashes into the back end of your car and you feel your head snap back over the headrest and then bounce forwards, almost hitting the steering with your forehead. Everything goes blank for a second or two. “What just happened?” Initially, you’re in “shock,” and after checking to make sure you’re not bleeding, you notice that your neck and head are hurting in a way that’s new to you. When the police arrive and start asking you questions about what had happened, you try to piece together the sequence of events of the collision but you’re not quite sure how it all fits together. Your memory just isn’t real clear. Within the first few days, significant neck pain and headache overshadow everything else but you begin to notice that you’re ability to “think clearly” is just not quite right. Your memory seems fuzzy, you lose your train of thought easily, sometimes in the middle of a discussion, and you are tired – really tired! Taking a nap several times a day is needed. The other day, you were discussing a project with a group of co-workers and you had to ask “…now where was I?” several times during the discussion as you lost your place in the middle of a thought.

Mild traumatic brain injury or, MTBI, is exactly what is described above. Many patients do not even mention these things to their chiropractor when they present after a car crash as it’s hard to describe these symptoms and many feel it’s just because they are tired or upset about the accident. When directly asked if any of these symptoms exist, the patient is often surprised and say, “…how did you know?” They are even more surprised when they learn there is an actual reason and explanation for feeling this way. Most of the time, the patient has to be asked if these symptoms exist! This is actually “normal” behavior for those suffering from MTBI.

To better understand how this occurs, think of the more catastrophic situation where the person hits their head to the point of creating an internal bleed and is unconscious. In this case, it’s easier to appreciate the presence of a “brain injury.” With severe head trauma, the person usually has significant memory loss, having no memory of the accident and maybe worse, not being able to recognize family or friends. Losing the memory of days, weeks, months or years of time is common with these severe head injuries. However, in MTBI, there is less bruising to the brain and consequently, there are less severe symptoms. Though the symptoms are similar, MTBI is in a way, a mild form of the above. With MTBI, the person does NOT have to hit their head on anything to bruise the brain. This is because the speed at which the head is propelled forward and back literally slams the brain into the inside walls, creating the bruising. Because the brain is suspended inside our skull, damage to some of the nerve cells occurs, most commonly the brain stem, the frontal lobe and/or the temporal lobe. Depending on which part of the brain is injured, the physical findings may include problems with walking, balance, coordination, strength/endurance, as well as difficulties with communicating (“cognitive deficits”), processing information, memory, and altered psychological functions. Recognizing these symptoms and managing MTBI in a coordinated approach with a neuropsychologist is sometimes needed.

Dangerous Headaches

2011-08-17T22:00:00.000-05:00

This week's topic will address dangerous headaches. To keep this in perspective, most headaches are NOT dangerous. In fact, tension-type headaches and migraines are very common and remain the focus of most health care providers and patients who suffer from headaches. With that said, it’s important to discuss the signs and symptoms that might help all of us differentiate between headaches that are safe versus those which are not safe.

The most important factor to consider is when the “typical” headache is suddenly “different.” Some of these “different” symptoms may include slurred speech, difficulty communicating or formulating thought, seizures, fainting or loss of consciousness (even for a few seconds), memory lapses, double or blurred vision, profound dizziness, numbness in the face or half of the body, an “alarm” should sound off telling you to get this checked ASAP as these symptoms, when they deviate from “the norm” may be indicative of a more serious condition. This can be challenging as seizures are often related to migraines and might be a common symptom of a migraine headache for some migraine sufferers.

Signs of a dangerous headache include:
1. A headache that starts suddenly, especially if it's of a severe degree.
2. Headaches that start later in life, especially after the age of 50.
3. A change in the quality of headaches.
4. Visual changes, including double vision or loss of vision.
5. Weakness, numbness, or any other neurological symptoms.
6. Fevers – especially of rapid onset.
7. Change in mental status including sleepiness, hallucinations, speech changes or confusion.
8. Weight loss.

If there is ever ANY doubt about a dangerous headache, your physician should be contacted.
Typically, the migraine patient will notice a fairly consistent set of symptoms and even though the headaches can vary in intensity, the sequence of events is fairly consistent. Dangerous headaches are the ones that deviate significantly from that migraine sufferer’s “norm.” For example, suppose a patient’s “typical” migraine is: aura (bright, flashy lights in the visual field or, a strange odor precedes the migraine about 30 min. before the headache strikes), followed by a gradually increasing pain in half of the head which worsens to a point of nausea and sometimes vomiting if something isn’t done to stop it (such as a chiropractic adjustment and/or some form of medication). If this is that patient’s “usual,” IF any of the 8 items previously listed above accompany the headache, it should be further evaluated – often requiring an EEG (electroencephalogram) and/or MRI (Magnetic Resonant Image). The EEG will test for any electrical signal changes in the brain and the MRI will show space occupying structures such as tumors, bleeding, infection, aneurism, and if performed with a contrast agents, arterial malformations (that is, abnormal networks of blood vessels).

Fibromyalgia Facts

2011-08-16T22:00:00.000-05:00

Fibromyalgia (FM) is a condition that is characterized by widespread, generalized pain “all over” the body that does not follow any specific anatomical pathway like the course of a nerve, muscle, or blood vessel. It is often diagnosed only after all other conditions have been eliminated by using various testing approaches such as blood tests, x-ray, CT or MRI Scans, and others. Controversy exists between health care providers (HCP’s) as some believe that FM either doesn’t exist at all or if it does, it’s grossly over diagnosed while others feel most patients have some form or degree of FM. Because of this common split in beliefs, patients may be treated poorly by those non-believing HCP’s, which often alienates them from seeking further care for FM.

Recent literature suggests FM is disorder of “central pain processing” or, a specific situation where the pain threshold (the point where pain is felt) is reached sooner than what is normal. Fibromyalgia has been classified into 2 separate groups – primary and secondary FM. Primary FM is diagnosed when no known cause can be identified while secondary FM is related to a specific cause such as a disease or condition. Conditions that have been reportedly associated with FM include irritable bowel syndrome (IBS), TMJ (jaw disorders), chronic low back pain, and headaches. There are genetic as well as environmental factors associated with FM. Researchers have found that there is a strong familial component with 1st degree relatives where an 8 fold greater risk of developing FM compared to the general population exists. These people are also more likely to have one of the other associated conditions previously mentioned (IBS, TMJ, headaches). Environmental factors can lead to FM in 5-10% of the cases. Some of these include physical trauma such as car accidents, following infections such as parvovirus, Epstein-Barr virus, and Lyme disease. Psychological stress, hormonal alterations such as hypothyroid, drug side effects, vaccination reactions and certain catastrophic events such as war are included in the “environmental factors” category. Gender differences include woman being 2-3 times more likely to suffer from FM than men.

So, what are the treatment options for FM? Typically, if you go to a medical doctor, you can expect various forms of drug therapy – possibilities include anti-depressants, anti-anxiety meds, and sleep aids but with these, watch out for grogginess, side effects and some habit forming/dependency problems. Pain killers or analgesics – opioides are NOT appropriate but often prescribed and narcotics can also be habit forming. Tylenol is perhaps the safest but is not very effective. Anti-inflammatory include aspirin, ibuprofen but watch for stomach irritation and blood thinning problems. Dr. Christopher Morris, MD reports that drug treatments for FM have, “…very limited success in providing significant improvement in most patients.” He recommends behavior modification for sleep improvement, exercise (walking, water exercises, strength training, yoga, tai chi, Qi Gong), as well as cognitive behavioral therapy, massage therapy, chiropractic, acupuncture, biofeedback, hypnosis, and dietary modification. Examples of dietary changes include avoiding foods with certain additives including MSG (monosodium glutamate) and aspartame where in one study, “complete resolution” of FM symptoms was reported.

Patients with FM NEED a “quarterback” to guide them in their management of FM and chiropractic is the PERFECT choice as many of these holistic approaches are utilized or can be coordinated through our office.

Carpal Tunnel Syndrome: Nerve Gliding Exercises

2011-08-15T22:00:00.000-05:00

There are many different exercises that can be done for carpal tunnel syndrome (CTS) and we’ve discussed some of these in the past.

To understand “why” gliding exercises are helpful, let’s review the anatomy. There are 9 tendons that move through the narrow carpal tunnel at the wrist. This confined space is literally jammed full and when we move our hands and fingers in a fast, repetitive manner, we produce friction and therefore heat between the tendons that attach the muscles in the forearm to the fingers in the hand. These tendons are in “sheaths” that wrap around the tendon and provide lubrication for the sliding tendon. If the friction/heat builds up too quickly, swelling occurs, which increases the pressure inside the confined space of the carpal tunnel. The median nerve sits on top of all these sheathed tendons and when they expand or swell, the nerve gets pushed up into the roof of the tunnel (the transverse carpal ligament). An analogy would be a river or lake rising to a point where a bridge that goes over the river is eventually engulfed by the rising water. Any object under the bridge would get pushed into the bottom of the bridge (which would represent the median nerve being pinched up against the bridge, or transverse carpal ligament. When nerves are pinched, depending on how hard the pinch, there is numbness, weakness, pain and tingling. If the nerve is damaged, the symptoms are more severe. Therefore, in treating CTS, a combination of ice massage over the carpal tunnel (for about 5 minutes or until numb), chiropractic joint manipulation, a splint at night to prevent wrist bending (which increases CT pressure) and EXERCISE are very important. Follow our recommendations as the when to start the exercises – too soon may actually irritate CTS more!

The concepts behind gliding exercises include: 1. Break up adhesions that form between the sliding tendons and their sheaths; 2. Move blood and other fluids OUT of the tunnel; 3. Improve the range of movement of the wrist and fingers joints. So here they are:

1. FINGER EXTENSIONS: a. Hold the arm out straight at shoulder height (near a wall); b. Rotate your arm so the palm faces downwards; c. Bend the wrist backwards as hard as possible by pressing the palm of the hand against the wall. d. Reach over with the opposite hand, grab the thumb and pull back so that a firm “good hurt” stretch is felt in the forearm and HOLD for 5-10 seconds. Repeat this 3 times, pulling the thumb a little harder each time. Repeat this on both sides (so you can see what the difference is in terms of flexibility) 3x/day or as directed.

2. BEAR CLAW to FULL FIST: a. Same start position as “1”; b. bend the wrists back & fingers pointing up, so that the palms face away from you and open up the fingers & thumb (the “high 5” position); c. Flex/bend only the tips of your fingers keeping the base of the finger knuckles straight (“Bear Claw”); hold 5 seconds and then repeat a. & b. but change “c” so that you make a full fist by bending all the hand joints; hold 5 seconds and repeat the entire cycle 3 times (hand open – bear claw – hand open – full fist x3) and repeat multiple times a day or as directed.

Low Back Pain and Balance Exercises

2011-08-14T22:00:00.000-05:00

Low Back Pain and Balance Exercises

You may recall last month, we talked about the relationship between low back pain and balance, particularly our unfortunate increased tendency to fall as we “mature.” This month, we’re going to look at ways to improve our balance by learning specific exercises that utilize the parts of our nervous system that regulate balance or, proprioception. Particularly, our cerebellum (back of the brain that regulates coordination), the vestibular system (the inner ear where the semi-circular canals are located), the ascending tracts in our spinal cord (the “highways” that bring information to the brain from our feet and the rest of our body), and the small “mechano-receptors” located in our joints that pick up our movements as we walk and run and sends that information through our nerves, up the spinal cord tracts to the brain. Here are some very practical exercises to do, “…for the rest of our lives.” Start with the easy ones!

1. Easy (Level 1): Standing eyes open/closed - Start with the feet shoulder width apart, look straight ahead to get your balance and then close the eyes and try not to sway counting to 30 by, “…one thousand one, one thousand two, one thousand three, etc.” Repeat this with your feet closer together until they touch each other. You can make this harder by standing on a pillow or cushion -- but don’t start that way!

2. Medium (Level 2): Lunges - from a similar starting position as #1, step forwards with one leg and squat slightly before returning back to the start position. Repeat this 5x with each foot/leg. As you progress, you can take a longer stride and/or squat down further with each repetition. You can even hold onto light dumbbells and/or close your eyes to make it more challenging.

3. Hard (Level 3): Rocker or wobble board exercises - use a platform that rocks back & forth or, wobbles in multiple directions. Rock back and forth, eyes open and then closed, once you get comfortable on the board. You can rotate your body on the board, standing straight ahead (12 o’clock) followed by 45 degree angles as you work your way around in a circle at 45 degree increments (12, 1:30, 3, 4:30, 6, 7:30, 9, 10:30 and back to noon). Repeat these eyes open and closed. The Wii Balance board is a fun way to exercise – check that out as well.

You can “improvise” and mix up different exercises and create your own routine. Just remember, stay safe, work slowly until you build up your confidence and keep challenging yourself.

We realize you have a choice in whom you choose for 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.

YOU MAY BE A CANDIDATE FOR CHIROPRACTIC CARE FOR LOW BACK PAIN! FOR A FREE NO-OBLIGATION CONSULTATION CALL 504.454.2000.

What Happens in “Whiplash?”

2011-07-05T05:00:00.000-05:00

Whiplash is a slang term for an injury that occurs to the neck after the head has been literally “whipped” either forwards and backwards or sideways after a sudden jar. Therefore, this can occur from a slip / trip and fall, a bar room brawl, as well as from the classic car accident or motor vehicle collision. But what REALLY happens in a “whiplash” injury? To answer this, let’s talk about: 1. The mechanism of injury; 2. The different types of injuries; and 3. The treatment options.

1. The Mechanism of injury: Let’s take the example of a rear-end crash from a motor vehicle collision (MVC). In this scenario, the “target” vehicle is struck from behind by the “bullet” vehicle propelling it forwards.

Phase 1 The neck/spine straightens: At about 75-100 msec. (that’s milliseconds!), the car is propelled forward but you – the driver remains stationary so the car seat pushes your body forward but your neck/head stay behind. This creates the classic “S-shaped curve” in your spine.

Phase 2 The neck/spine curves back: At about 150 msec., the head extends back and “hopefully” hits a properly positioned headrest or else it keeps going back injuring the spinal structures in the front of the spine. If the head extends back too far, back of the spine injuries then occur.

Phase 3 The neck/spine curves back to a maximum: At about 175 msec., the tissues in the back of the spine compress while those in front of the spine fully stretched and act like rubber bands getting ready to spring the head/neck forwards (phase 4).

Phase 4 Rebound: At about 200-300 msec., the tissues in the front of the neck propel the head/neck forwards and injury can occur to the structures in the back of the spine from over stretching or, in the front of the spine from over compression.

All of this occurs in LESS TIME than what we can NORMALLY voluntarily contract a muscle, which takes about 500 msec., so even when we anticipate the impending crash and we brace ourselves, we can’t really stop our neck from going through these movements.

2. Types of injuries: The term “sprain” refers to ligament (tough non-elastic tissue that holds bone to bone) injury and “strain” muscle/tendon (elastic tissues that move our bones) injury. There are 3 grades of sprain & strains (mild, moderate, and severe). When these tissues are injured, there is usually a loss of movement and neck pain but not arm numbness or pain. When there is nerve injury, there is arm pain, numbness &/or weakness and generally, this is more serious but usually manageable without the need for surgery. When fractures occur, it’s either stable or unstable and may require surgery &/or a rigid collar.

3. Treatment: Most whiplash injuries are safely managed by chiropractic approaches (fractures are the exception). Studies have shown that early movement results in a better result than wearing a collar or, not allowing movement. Therefore, gentle mobilization and manipulation approaches “…as soon as tolerated” favor a better outcome or result. There are many different techniques we use to help speed up the recovery process. Prompt treatment is important!

Fibromyalgia – Can Chiropractic Help… Who Says?

2011-06-30T05:00:00.000-05:00

Fibromyalgia (FM) is one of the most commonly diagnosed soft tissue conditions in most branches of health care, including chiropractic. A paper was recently published with the primary purpose to review the existing literature / published research to determine what aspects of chiropractic treatment are the most commonly used and, to determine the quality of those treatment approaches. The emphasis of the study was to look at non-drug, conservative forms of therapy, rather than medication based approaches.

Commonly utilized chiropractic treatment options found to be beneficial include massage, muscle strengthening exercises, acupuncture, spinal manipulation, movement/body awareness, vitamins, herbs, and dietary modification. Cognitive behavioral therapy, not typically a chiropractic specific form of care, was also reported to be of significant benefit, as well as aerobic exercise. This study places chiropractic in a very favorable position in the management of FM.

Chiropractic is unique in that it encompasses many non-drug, non-surgical forms of treatment, making it appealing to many who do not want to risk the chances of drug related side effects and post-surgical complications. Patients with FM require a multi-dimensional treatment approach and a health care provider versed in whole-body, holistic concepts is in the best position to help this population.

Fibromyalgia can be primary where the specific cause is not well understood or secondary to an underlying injury or condition. Sometimes, it is difficult to determine the exact cause as other conditions can be present and/or arise simultaneously with FM making it difficult to differentiate between primary and secondary. When other conditions are present, sometimes attending those specific conditions will improve the status of FM and focus on treatments that address all of the patient’s physical and emotional health issues yields the most patient satisfying results.

In past newsletters, we’ve discussed a gluten-free diet aimed at reducing inflammation, the core of all disease processes. We’ve also discussed the importance of sleep quality, exercise, and other effective treatment approaches.

We take pride in providing quality, evidence-based care and appreciate the opportunity to do so when patients choose our clinic for their chiropractic care. We realize that there are many healthcare options available. If you, a friend or family member require care for fibromyalgia, we would be honored to offer our services.

Carpal Tunnel Syndrome (CTS) – What Does Research Show?

2011-06-29T05:00:00.000-05:00

So often we hear, “…well if it’s so good, show me the proof!” Chiropractic case management of CTS has been well established for many years. And yet, we still hear skepticism from patients, MD’s, insurers, employers, and others about the benefits of chiropractic management of CTS. If we can, “show them the data” regarding the effectiveness of chiropractic for CTS patients, we will finally be able to help more people with this potentially disabling condition.

So, let’s take a look at the evidence that supports the benefits of chiropractic for CTS:

1) Davis PT, Hulbert JR, Kassak KM, et al. “Comparative efficacy of conservative medical and chiropractic treatments for carpal tunnel syndrome: a randomized clinical trial”
J Manipulative Physiol Ther. 21.5 (June 1997): 317-326.

The most important finding reported in this 91 patient study was that chiropractic treatment was equally effective in reducing CTS symptoms as medical treatment. The chiropractic care included ultrasound, nighttime wrist supports and manipulation of the wrist, arm and spine. Medical care included ibuprofen (800 mg, 3x/day for 1 wk, 800 mg, 2x’day for 1 wk, & 800 mg as needed for 7 wks) plus a night wrist splint. Both groups did equally well but given the side-effect potential of ibuprofen on the stomach, liver, and kidneys, a strong argument for the non-drug, chiropractic approach can be made.

2) Bonebrake AR, Fernandez JE, Marley RJ et al. “A treatment for carpal tunnel syndrome: evaluation of objective and subjective measures” J Manipulative Physiol Ther. 13.9 (Nov-Dec 1990): 507-520

CTS sufferers (n=38) received chiropractic spinal manipulation and extremity adjusting. Also, soft tissue therapy, dietary modifications or supplements (B6) and daily exercises were prescribed. After treatment, results showed improvement in all strength and range of motion measures. Also, a significant reduction in pain and distress ratings was reported.

3) Mariano KA, McDougle MA, Tanksley GW “Double crush syndrome: chiropractic care of an entrapment neuropathy” J Manipulative Physiol Ther. 14.4 (May 1991):262-5

In 1973, Upton and McComas first proposed the presence of the "double crush syndrome." Their hypothesis was that when a nerve is pinched anywhere along its route, it makes the rest of the nerve more sensitive to otherwise “normal” stimulation. A case report of a man with both cervical radiculopathy and carpal tunnel syndrome, i.e., "double crush syndrome" was presented. Chiropractic management consisted of chiropractic manipulative therapy as well as ultrasound, electrical nerve stimulation, traction and a wrist splint. The experimental basis, clinical evidence, etiology, symptomatology and findings of this condition are discussed. The Double Crush Syndrome helps explain why cervical/neck manipulation helps many CTS patients.

Whiplash: Body, Mind and Spirit – What is the Connection?

2011-06-28T05:00:00.001-05:00

The term “whiplash” refers to an injury to the neck muscles, the muscle attachments (tendons), ligaments, and sometimes the disks that lie between the vertebral bodies of the spine. In a rear-end collision, the cause of whiplash occurs from a sudden, rapid acceleration of the body and neck as the car is pushed forwards. In these first 50-75 milliseconds following impact, the head remains in the same place while the body is propelled forward. This is followed by a “crack-the-whip” movement of the head and neck when the muscles in the front of the neck stretch like rubber bands and suddenly spring the head forwards, all occurring in less than 300 msec. The force on the head and neck is further intensified if the seat back is too springy, or angled back too far. Also, if the headrest is too low, the head may ride over the top and more injury can result.

The treatment of whiplash varies from “watchful waiting” to a multidisciplinary team approach that includes neurology, physical therapy, chiropractic, psychology, and possibly surgery (rare). In a recent article published in the American Journal of Physical Medicine and Rehabilitation (2009, March Vol. 88, No. 3, pp 231-8), the relationship between clinical, psychological and functional health status factors was investigated in a group of patients with chronic whiplash-associated disorder (WAD). A total of 86 patients with chronic WAD participated in the study and outcomes were tracked using questionnaires that measure pain, disability and psychological issues including depression, anxiety and catastrophizing. Physical examination factors included measuring the cervical range of motion. An analysis of the degree of neck disability and the relative contribution of physical vs. psychological factors revealed catastrophizing and depression played greater roles than did cervical range of motion. This suggests psychological factors play an important role in the outcome of whiplash.

The importance of this is that more than just the physical factors like range of motion should be focused on when treating chronic whiplash patients. Answering the patient’s questions, explaining the mechanism of injury and how that relates to their specific condition, and addressing depression, anxiety, coping, and other psychological issues is very important. Discussing treatment goals with patients is also very important. For example, making light of the injury by stating something like, “…you’ll be fine after the treatments,” may harm the patient as anything short of “fine” may be interpreted as failed treatment by the patient. It is also important not to paint too dismal of a picture as that can have negative psychological effects as well, as this may suggest that they will never improve. Explaining the difference between “hurt” and “harm” is of great value to the chronic whiplash patient as they are often told, “if it hurts, don’t do it.” This sends an unfortunate message to the patient that any activity where an increase in pain occurs is “bad” when in fact, that activity may help the patient get better in the long run. This can make or break an acceptable outcome as many may feel like they shouldn’t do anything and this can lead to unemployment, boredom, and the many psychological issues previously described. The best advice is to remain active and try to ignore discomfort by staying within “reasonable activity boundaries.” Reasonable activity tolerance is learned as time passes and trying different activities for different lengths of time. This type of coaching should be at the center of chronic whiplash management rather than over focusing on physical factors such as range of motion.

Low Back Pain and Balance

2011-06-27T05:00:00.001-05:00

What do low back pain and balance have to do with each other? Well, a lot! First (and most obvious), poor balance can lead to falling, which is the number one cause of injuries after the age of 70 (which includes low back pain). Unfortunately, as we age, we lose both balance AND bone density – a double whammy when it comes to falling as this combination can result in fractures of the vertebra which commonly occur in the lower back region. Below is a chart that shows what the “normal” length of time we should be able to stand on one foot (eyes open and eyes closed):

Age Eyes Open Eyes Closed
20-59 30 sec. 25 sec.
60-69 23 sec. 10 sec.
70-79 14 sec. 4 sec.

As this chart illustrates, over time, we rapidly lose our ability to balance, especially when we close our eyes. In fact, many of us cannot stand on one leg with our eyes closed for more than a few seconds well before the age of 59! Try it! Stand up in a corner of a room or in a doorway where you can grab onto the wall or door jams if you lose your balance. (We certainly do not want you to fall during this test!) Look at your watch or a clock with a second hand and count out loud in time with each second on the clock, “one thousand one, one thousand two, one thousand three, …..”-- you get the idea. Once you have the rhythm down, try counting first with your eyes open for up to 30 seconds and then try it again but with the eyes closed. Quite different, isn’t it? Now switch legs and try it again – eyes open first and then eye closed counting in time with the passing of each second. If you’re not pleased with you performance, try it over again a few times. If you’re like most of us, you may feel a little inadequate right now. Most of us need to start including some “balance exercises” into our daily routine.

So, why is it that we lose our balance so easily as we age? This is mostly because we become less active or, more sedentary as we advance in age, partially because we’re not interested in doing activities that require balance, but also because of fears, like of falling down. Remember, when we were young(er), we romped around and bounce off walls and fell all the time. It was “routine” to come home from school with grass stains on our knees and backyard sports always resulted in falling, sometimes pretty hard! Rolling down a hill to purposely getting dizzy was quite attractive to us as kids – but certainly not now! In fact, getting on the floor to play with the grandkids usually leaves us sore for at least a few days. Now, I’m not suggesting we all run out and start rolling down hills, jump up and down or purposely fall down but, including active “balance” exercises into our daily routine should be THE LEAST we should do. So, go for a brisk walk or a slow jog, ride a bike, walk in the park on uneven ground – it’s good for our “proprioception!”

Next month, we’ll chat about balance exercises! We realize you have a choice in where you choose your healthcare services and we appreciate your trust in us!

Fibromyalgia: How Do I know I Have It?

2011-06-23T05:00:00.000-05:00

“I wake up every morning with this stiff, sore lower back pain. When I roll over to get out of bed, I feel like a log and almost have to fall out of bed. When I finally get to my feet, I’m all bent over and can’t stand upright for what seems like forever! It takes a couple of hours before it gradually loosens up enough so I don’t have to shuffle with each step. I was told by a friend that I might have something called fibromyalgia and should ask my chiropractor. What do you think?”

To answer this inquiry, let’s first define fibromyalgia (FM) so that we can compare the two properly. FM is a condition that is diagnosed basically by eliminating all other possible causes, including inflammatory joint conditions, by running various blood tests such as an arthritic profile. This usually includes tests for rheumatoid arthritis, gout, lupus, and infection. A Lymes disease test is often included as that condition can often manifest as a chronic back condition from any cause. There are essentially no blood tests, x-ray or other imaging tests, or neurological tests that can specifically diagnose FM. It is when all these tests come back negative, that the diagnosis of FM is then entertained. The history is probably the most important aspect of the clinical encounter that helps in the diagnosis of FM. Most of these patients will report that the onset is gradual, often present for years. There is usually no specific cause though there are specific conditions (such as irritable bowel syndrome, trauma, rheumatoid arthritis and others) that can result in “secondary fibromyalgia” where the cause is well known. The big differentiating historical feature is the presence of widespread, whole body pain – NOT just low back pain, as reported in the first paragraph above. In FM, there is often pain in the legs, arms, torso, back, neck and these people basically, “…hurt all over.” Typically there is no radiating pain down the leg or arm that follows a specific nerve pathway and no exam findings of neurological deficits. Another unique feature of FM includes sleep dysfunction. In many cases, sleep interruptions occur 2, 3 or more times a night, often with difficulty in returning back to sleep. The quality of pain is often described as numbness, tingling, burning, achy, deep, boring, and most importantly generalized in location (all over the body). The intensity is usually reported as high (>6/10 pain scale scores). The past history usually includes multiple visits to many different types of doctors and many attempts at different medications is common – most of which do not help significantly.

Even with these unique historical features that are consistent with the diagnosis of FM, it is still necessary to “rule out” other conditions by running tests as previously described. This is especially important when FM is secondary to other conditions as FM can get “lost” in the shuffle, overshadowed by the other condition.

Treatment for FM includes many of the same methods for treating other musculoskeletal conditions. Spinal manipulation, soft tissue release techniques (massage therapy, trigger point therapy, myofascial release), and various forms of physical therapy (low level laser therapy – LLLT, ultrasound, interferential electrical current – IFC, and pulsed magnetic therapy can also improve function, reduce pain, and reduce the need for medications. Cognitive therapy, addressing psychosocial issues, can also be very effective. One of the most important treatment approaches is exercise. This has been consistently described as being an important form of care for the FM patient. In addition, dietary management using an anti-inflammatory diet (gluten free diet) and supplementation (a multiple vitamin, calcium/magnesium, omega 3 fatty acids, Vit. D, and CoQ10) can also be very effective.

Carpal Tunnel Syndrome (CTS) – What, Why, How?

2011-06-22T05:00:00.000-05:00

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.

Whiplash! Do I Need an Attorney?

2011-06-21T05:00:00.001-05:00

When you hear the word, “whiplash,” it brings to mind many different thoughts – motor vehicle collision (MVC), neck pain, headaches, concussion, jaw pain, litigation, car damage estimates – possibly a new car, medical costs, doctor’s appointments, sleepless nights, and more. Questions typically asked when a MVC occurs include the following: 1. Do I need to get an attorney? 2. What can I expect for recovery time from my neck pain? 3. Why is it taking so long to get my car fixed? 4. Should I talk to the insurance company when they call? 5. I have to give a deposition next week. What is that? 6. My case didn’t settle and we’re going to court. How do I prepare for that? 7. The insurance company is offering $XXXX.XX for a settlement. What do you think my problems will be down the road?

Let’s take a look at these!

1. Should you obtain the services of an attorney? If you want to significantly reduce your stress when it comes time to negotiating with the insurance company, especially towards the end of the process, then YES! Needless to say, you HAVE TO seek council if you plan to not settle and need to go to court. However, you do not have to get an attorney immediately unless you just don’t want to deal with the insurance company at all. Typically, it’s worth having an attorney as they are experienced in “…the process.”
2. Recovery from neck pain can vary between a simple strain at 2-6 weeks to a herniated disk that may require surgery. We recommend you ask us this question about once a month as it will help you decide about this as well as questions 1 and 7.
3. The insurance company may delay the payment of the car repair costs for a number of reasons. Until the insurance company inspects the car’s damages, they will not authorize the repair shop work, which can take weeks!
4. If you have hired an attorney, he/she will communicate for you. If not, it is appropriate for you to communicate with the insurance company. The important thing is to NOT settle the claim until you’re sure you can do all of your pre-MVC activities without difficulty or pain, which often can take a full year or more.
5. These are call “discovery depositions” where you will be asked questions about the accident such as, where you hurt, what you can and can’t do since the MVC, what tests and treatment you’ve received and what the results were. Your attorney will tell you the strengths and weaknesses of your case. The deposition “process” is quite easy and there is no reason to feel intimidated. Most attorneys are very courteous and will treat you kindly so don’t worry unnecessarily!
6. Preparing for court is similar except you can’t ask questions – they ask & you answer! Your attorney will tell you to answer only the question being asked and your attorney will later be able to ask you to clarify what was “left out.” Always be kind, courteous, and NEVER let the other attorney get you angry!
7. See #2 above. If you have ongoing radiating pain in your arm (from your neck) or leg (from your low back), the “prognosis” for complete recovery is less favorable. Similarly, if you have ligament damage in your neck, there will probably be an accelerated pace of arthritis formation that may not bother you much for 5-10 years or longer but may later in life. We, as your expert witness, will describe your “impairment” and bring this to the jury’s attention.

We hope this information is appreciated! We realize that you have a choice in where you go for your health care needs. We truly appreciate your consideration in allowing us to help you through this potentially difficult process.

Low Back Pain and Bone Density

2011-06-20T05:00:00.001-05:00

So, what does bone density have to do with low back pain? The relationship between bone density and back pain is quite intimate. In fact, when the degree of bone density declines to the point of fracture, back pain becomes very real. The classic condition and cause of spinal pain associated with the loss of bone density is compression fracture.

Compression fractures occur when the strength of the bone decreases to a point where minor trauma and sometimes, no trauma whatsoever can result in fracture. Compression fractures affect the vertebral body (front of the spine) most often in the upper lumbar or lower thoracic spine but the pain associated with these types of fractures frequently radiates into the low back and pelvic region. In the elderly osteoporotic spine, these types of fractures usually do not result in spinal cord injury or nerve damage but this is quite the opposite when compression fractures occur in younger, normal bone density individuals. This is because when the bone is dense (or normal), the vertebral body basically explodes or bursts shifting some of the bony fragments back into the spinal canal where the spinal cord is located. When bone density decreases, there is no bursting of fragments – only collapse, resulting in pain but no neurological damage. Besides pain, another problem with compression fractures is that the once upright or vertical spine is now bent and angles forward shifting the patient’s weight to the front. This shift places yet more pressure on both the fractured vertebra and the surrounding vertebra which increases the risk of fracture to the surrounding adjacent vertebra. Therefore, multiple compression fractures are not uncommon when brittle bones occur from osteoporosis.

So who is more at risk for osteoporosis? The usual predictors include age, (older than 65), gender (female), race (Asian or Caucasian), low body weight, and previous fracture. Others include smoking, previous use of corticosteroids, a family history of fracture, excessive alcohol use, and rheumatoid arthritis. Additionally, vitamin D deficiency, thyroid or parathyroid increased function, and celiac disease (gluten intolerance) as well as poor balance (repeated falls), muscle weakness and a DEXA (dual-energy X-ray absorptiometry) T-score of -1.1 to -2.4 (osteopenia) or -2.5 or greater (osteoporosis) are also important predictors of brittle bone disease or osteoporosis. To best determine your risk using these factors, go to FRAX (www.sheffield.ac.uk/frax) developed by the World Health Organization (WHO) to determine your 10-year fracture probability (do not just use of the T-score on the DEXA scan).

From a treatment standpoint, it depends on the age of the patient, the degree of osteoporosis, and whether fracture has already occurred. In the younger, osteopenic person (that is, no fractures have occurred yet but bone density is low), non-medication approaches such as weight bearing exercise, no smoking, calcium / vitamin D supplementation, and minimize the other risk factors described above may be the proper choice. For others already with fracture, medication (bisphosphonates such as Actonel, Boniva, & Fosamax) may be appropriate. Further, injecting a cement into the bone (called kyphoplasty) may be appropriate for some.

Fibromyalgia – Coping Strategies, “What Can I Do?”

2011-06-16T05:00:00.000-05:00

Fibromyalgia (FM) is one of the most common conditions associated with chronic pain affecting up to 5% of the population. It is characterized by pain in the muscles and joints and is associated with generalized, whole body muscle stiffness, body aches, sleep disruption, and headache. Stress is often a component of FM. Women are 2-3 times more likely to suffer from FM.

So the question is raised, “what can I do to reduce the pain and suffering that I feel from FM?” The answer is multifactorial as there are many treatment approaches reported to be helpful. Perhaps the most prevalent is exercise. This seems logical as often, the presence of pain is misinterpreted as a reason to rest or reduce activity. This inappropriate thought leads to de-conditioning or weakening of muscles, stiffness in joints, lowered aerobic capacity and a host of negative physical and mental effects that can have negative effects on quality of life. Because many patients with FM are “out of shape,” the worst approach with exercise is jumping into it too quickly. The post-exercise soreness when people first engage in a new activity can be profound if the introduction into exercise is too vigorous, and again, the pain intensity may be misinterpreted as a reason to discontinue any and all future exercise programs.

Therefore, the key to success is realizing pain thresholds are reached faster in the FM patient and hence, a slow but steady introduction into exercising is needed.

For example, start out with a walking program of 5 minutes, 1-3 times a day, and gradually increase it to 10, 15, 20 and eventually, 30 or more minutes per session. Stretching exercises of the overly tight postural muscles like the hamstrings, calf muscles, hip flexors, lower, middle, and upper back muscles are very helpful. Applying light resistance during the stretch using a “slow motion” approach improves results.

In general, low-impact activities like water exercise, swimming, bicycling, and elliptical (low setting) are great options. Using light dumbbells/hand weights emphasizing high rep/low weight is also very effective.

Another highly successful type of exercise are balance stimulating exercises. That is, using a rocker board, wobble board, gym ball, and/or foam pad to incorporate balance challenges into the exercise process is very effective. Consistent exercise is a key to success.

Also, don’t set your goals too high as you may be setting yourself up for disappointment. Rather, make realistic goals and “grow” with the exercise process, changing and modifying goals on a monthly or quarterly basis.

Carpal Tunnel Syndrome: Why Braces?

2011-06-15T05:00:00.000-05:00

For those of you who have had Carpal Tunnel Syndrome, you probably know all about braces. These are devices worn on the wrist that stop you from bending the wrist up or down. They may be worn anytime of the day if they don’t interfere too much with one’s current activity but are especially worn at night. One might think it would be more important to wear these during day when we are active and moving our fingers and hands a lot as we go about our normal work or play activities – not at night when we’re basically just laying there doing nothing but sleeping, right? Wrong! It’s more important to wear these at night. This is because we cannot control our hand/wrist position at night as we tend to curl up in a ball when we sleep and the wrist gets cocked up or down, often to the end point of the range. So, why is this so bad? To answer that question, let’s look at the chart below on the left.

In the chart (above left), you are looking at a cross section of the wrist through the carpal tunnel. This illustrates the many structures that are inside the tunnel making it very compact or tight. Notice the small white circles in the middle of the tunnel. Those are the tendons that pass through the tunnel – there are 9 of those and they attach the muscles in our forearms (on the palm side) to our fingers so we can shake someone’s hand or carry a suitcase (grip). Just to the left of center, on top of all the tendons sits the median nerve, which is just below the “roof” of the tunnel (the transverse carpal ligament). Now, normally, the pressure inside the carpal tunnel will approximately double when we bend our wrist, putting more pressure on the nerve and pushing it into the roof (ligament), which creates the numbness and/or weakness in our grip. But in the CTS sufferer, there is already more pressure in the tunnel due to the swollen tendons so when the wrist is flexed or extended, the pressure goes up much more the twice – more like 6 times more pressure – hence, more symptoms. So, if we’re sleeping with our wrist bent either way, the pressure pushing the nerve against the roof is a lot more than normal – 6x more! Now, can you see the reason for the “night splint?” It is VERY effective in keeping the wrist straight or “in a neutral position,” which is needed to allow the nerve to NOT be pinched so it can heal.

Regarding braces, there are MANY different kinds of braces available and deciding which one to use is no easy task, not to mention the fact that they come in different sizes! When you are treated for CTS at this office, we will fit you with the proper size brace, if it’s necessary. We realize you have a choice in 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.

Interesting Facts About Whiplash

2011-06-14T05:00:00.001-05:00

We all know the most common causes of “whiplash” are injuries that typically arise from automobile accidents or, motor vehicle collisions (MVC’s) although whiplash can also occur from slip and fall and virtually, any injury where your head is whipped backwards. But there are many things about whiplash you may not be aware of, which is the reason for this month’s Heath Update on whiplash.

For example, did you know the effect whiplash has on public health (in general) is tremendous? The number of cases occurring annually is frequently quoted as 1,000,000 per year, but this is based on an outdated (1971) and incomplete dataset. A more recent figure of 3 million per year is considered to be more accurate because it’s based on several governmental databases and it accounts for the expected number of unreported cases by the NHTSA (National Highway Traffic Safety Administration). That’s a huge difference! The updated figure accounts for whiplash victims not attended to by emergency medical services. In less catastrophic accidents, the injured party may not appear to be significantly injured at the scene of the MVC and decline emergency care and hence, the MVC will to unreported to a governmental data collection center.

Another interesting study surveyed over 3500 chiropractors who were asked if they commonly applied cervical (neck) spinal manipulation to patients who had known herniated or protruded disks (in their neck). Over 90% of the chiropractors indicated they found it safe and effective to utilize cervical adjustments (manipulation) in this patient population. It is VERY important for you to know this as frequently, you may be told by your medical doctor (or next door neighbor), “…don’t let anyone crack your neck!” Now, you can rest assured that in the experience of MANY chiropractors (not just me), significant benefits can be achieved by this treatment approach. Moreover, the sooner neck adjustments are applied, the better the results - so don’t wait to get a chiropractic treatment after an MVC!

Another interesting study investigated the “proper” or “best” seated position in a car during a rear-end collision, based on an analysis of many previously published studies on this topic. Because the seated position of the person involved in a MVC is related to the degree of the injury, the factors studied included the angle of the seat back, seat-bottom angle, the density of the foam in the seatback, the height above the floor [of the knees], and the presence of armrests in cars. They found that the seat back angle of 110-130 degrees reduced disk pressure and low back muscle activity but 110 degrees – MAX. – was found to minimize the forward positioning of the head. A 5 degree downwards tilt of the seat bottom further reduced the pressure in the low back disks and muscle activity as measured by EMG (electromyography). The use of armrests and the use of a lumbar support were also found to be important to reduce injuries associated with MVCs. This combination was reported to be optimum for all of us to use in order to minimize the bodily injury in a rear-end MVC. Other important factors included firm dense foam in the seat back, an adjustable seat bottom (for angle, height, and front to back distance), horizontal & vertical lumbar support adjustments (…best if they pulsate to reduce the static load encountered in a crash), seat shock absorbers, and seat adjustments for front to back to adjust for different patient heights.

What Causes Low Back Pain?

2011-06-13T05:00:00.001-05:00

I can’t tell you how many times a day this question is asked! Obviously, there are MANY causes of low back pain (LBP) but you may be surprised about some of the following:

1. Trauma: Let’s start with the easy one – falling down, over lifting, twisting, pushing, pulling, bending over, sporting activities, work activities, sex, sneezing, raking, shoveling……OK, I could fill the page with possible injuries that can cause LBP so I’ll stop here. We’ve all sprained an ankle or a finger and based on statistics, most of us have also suffered from LBP as a result of a single event injury. These types of injuries include sprains (ligament injuries), strains (muscle/tendon injuries), disk injuries (tears, ruptures), and include many possible findings including subluxations (areas where vertebrae stop working well together or have shifted from their proper location). When there is radiating leg pain that travels below the knee, a pinched nerve may be involved, often caused by disk pressure or a combination of things.

2. Insidious or, “I don’t know what I did!”: Believe it or not, this is probably the most common cause of LBP we see as the majority of people can’t recall anything as causing their LBP. The “cause” in these cases often stems from a series of events that accumulate to a point where pain/swelling occurs, often hours or even days after several over-use activities may have been performed. Thus, more investigation into the activities that preceded the onset of LBP needs to be considered. We can usually uncover several possible culprits but we can’t ever be 100% certain that we’re right about the cause(s). In some cases, people will wake up with LBP, while others don’t have it until they’ve been active.

3. Biomechanical causes: This category might be involved in the 2nd category discussed but deserves a separate discussion because of the many possibilities. First, we are 2 legged / not 4 legged animals and that by itself puts a lot of pressure on our lower backs. In fact, 2/3rds of our weight is carried from the waist up and as a result, just bending over for a pencil can, “…throw the back out.” For example, a 180# person lifts about 120# of body weight just by bending forward! Another common problem is one leg being shorter than the other. It has been reported that 87% of us have unequal leg lengths and when the shift measures 7-9mm (about ¼ inch), the probability of back, hip, or sciatica pain is 2x greater. When the difference is 16mm, there is an 8x greater chance of having back trouble. The “fix” in this case can be quite simple as using heel lifts in the short leg shoe. Flat feet and ankle pronation can also create an unstable pelvis and can contribute to LBP so foot orthotics can also be very helpful in the management of LBP. Obesity (body mass index >30) has been identified as a risk factor for a lot of conditions including LBP and a weight management program can be highly effective.

4. Dangerous loading activities: It has long been known that jobs where 50-100# is lifted or carried, especially if frequently handled, have an increase in occurrence of LBP. Using proper lifting methods is very important in jobs like this!

Fibromyalgia: Vitamin Recommendations

2011-06-09T05:00:00.000-05:00

Fibromyalgia (FM) can be characterized by pain that is widespread, not limited to a single anatomical area but rather can affect the arms, legs, trunk, head and neck. This Health Update will concentrate on a few specific vitamin recommendations with the understanding that a “good” diet such as one low in glutens (wheat, oats, barley, rye), rich in fruits, vegetables, and lean meats, with an emphasis of omega 3 rather than omega 6 fatty acids, can be highly effective in and of itself. More importantly, it doesn’t make sense to abuse your diet and expect any vitamin recommendation to be highly effective. So the plea is, PLEASE practice a good “anti-inflammatory” diet, such as that briefly outlined above PLUS take the following vitamins:

1. Multivitamin/mineral: This captures a little of everything and serves as a foundation (like the base of a pyramid) for more specific vitamin recommendations. In most cases, it is wise to skip iron as this is not usually a missing nutrient for most people and can be toxic for some. If however, iron has been recommended for you, feel free to include it.

2. Magnesium (Mg): Magnesium is a missing nutrient as most foods do not include Mg and it is a vital nutrient in many of the pathways where proteins, fats, and carbohydrates are broken down in the body. Since it cannot be easily obtained through the diet, a supplement of Mg is wise.

3. Omega 3 fatty acids: There must be a balance between the anti-inflammatory omega 3 and the pro-inflammatory omega 6 fatty acids. Most people consume far more omega 6 vs. omega 3 fatty acids (instead of the other way around) by consuming things like fast foods and potato chips. There are long lists of omega 3 and omega 6 foods available on the internet – just “search” these and try to achieve a 3:1 omega 3 vs. omega 6 ratio. When choosing this supplement, many options will be available such as, “1000 mg of Fish Oil.” But, take a careful look at the label to determine how many pearls/pills are recommended per day as this can vary quite a bit. There are two primary active ingredients abbreviated EPA and DHA that are the important part of “fish oil.” Generally, about 1000mg of each per day is ideal, which usually requires 3-4 pearls per day (which may mean 3-4000mg of “fish oil” -- not “one-a-day”).

4. Vitamin D: Even if you don’t read magazines or newspapers, you probably have heard some of the many wonderful things about Vitamin D. Some of these benefits include anti-cancer (cervix, prostate, and others). It’s also been reported as an anti-depressive and more effective for reversing the symptoms of SAD (Seasonal Affective Disorder) than stimulation using the correct type of light. It is a strong anti-inflammatory and hence, has a role in the treatment of most diseases as most conditions include an inflammatory component. The FDA has recently raised the minimum recommended daily allowance from 400 IU to 2000 IU/day. It has been reported that 70% of people living in the sunbelt are Vitamin D deficient as the ONLY good source of Vitamin D is from sunlight and most of us avoid too much sun for skin cancer reasons.

CoQ10: This is a very strong anti-oxidant and it’s been highly recommended for anyone with any heart related conditions. Anit-oxidants have MANY health benefits! Try 100mcg/day.

Schedule an appointment to get a complete Nutrition Check-up from the neck-up and find out what supplements to take for all your challenges.

Musicians and Carpal Tunnel Syndrome

2011-06-08T05:00:00.000-05:00

There are many jobs that place people at risk for carpal tunnel syndrome (CTS), but I bet you wouldn’t have thought of musicians. First and most important, I don’t want to scare anyone from playing a musical instrument as many of us find music to be a very important “release mechanism” or, an escape from reality (at least for a while) in our busy lives. Playing music uses part of the brain that doesn’t get enough stimulation and has been found to improve learning skills in children and can improve (as well as prevent) Alzheimer’s Disease in the more mature sector of the population. So PLEASE, continue playing your instrument or if you don’t play, start taking lessons on your favorite instrument – something an increasing number of adults are beginning to do!

Ok, now that the “disclaimer” is over, we can discuss why musicians are at risk for developing CTS and how you and I can prevent CTS from becoming a “monster!” Playing a musical instrument utilizes our fingers in a rapid, repetitive way, similar to a typist or keyboard worker. Also, some instruments require the hands and wrists to be placed in awkward positions, which is bad because the tendons, as they rub against each other inside the tunnel, create friction, heat and swell up, thus pinching the median nerve. If the wrist is bent, the pressure inside the carpal tunnel goes up a lot more than when it’s kept straight, and this is especially true if there are already problems present like a mild case of CTS. In brief , the anatomy of the carpal tunnel includes 9 tendons, some blood vessels, and the median nerve which are, in a sense, jammed into a tight, confined space. Think of pulling a napkin through a napkin ring that is just a little bit too small – you REALLY have to work to pull the napkin through, right? Well, this is kind of what happens when one develops CTS. Instead of having a napkin and ring that match so the napkin easily pulls through, those with CTS have a tight, constricted tunnel (napkin ring) which really squeezes the contents, including the median nerve. The result of pinching a nerve is numbness, tingling, burning, and/or a “half-asleep” feeling in fingers 2, 3, and 4 (that is, the index, middle and ring fingers).

When you watch a piano player, their palms are pointing down towards the floor while they play. The two long bones in the forearm, the ulna and radius, are parallel when the palms are up and cross over one another when the palms are down. The median nerve travels down from the neck, axilla, upper and lower arm and finally through the carpal tunnel to innervate the middle three fingers. There is more pressure on the median nerve when the palms are pointing down compared to up, but it would be impossible to play the piano palms up! Other instruments like the flute, trombone, trumpet, and many others require the arms and hands to be raised up to around the head level while the instrument is played. This places more pressure on the median nerve in the axilla area, referred to as the thoracic outlet. Many musicians practice multiple hours a day and the repetitive motion can really irritate the median nerve, and can result in CTS.

Again, PLEASE do not stop playing your musical instrument! Rather, take multiple breaks when practicing, do carpal tunnel stretch exercises, and seek chiropractic care as we can usually manage CTS successfully without the need for surgery.

Whiplash: What Are The Odds of a Permanent Injury?

2011-06-07T05:00:00.001-05:00

I’m sure you’ve heard someone claim, “…you’re not really injured – you’re just going for a big settlement!” Or, “…that person isn’t really hurt, they’re just in it for the money!” Though there are cases that may fit this scenario, the majority of people who are injured in a motor vehicle collision would gladly forfeit any settlement to have their health and sometimes their life back. So, where in this process does the truth lie? Do most people “fake” their complaints or, are they really in pain? And, is there a way to determine who is more likely to suffer with problems long after their case is settled?

To answer this question, the Quebec Task Force (QTF), published two studies to investigate what types of whiplash injuries, which they term “whiplash associated disorders” (WAD), sustained in a rear end or side impact motor vehicle collision might end up with no residual injury vs. those more likely to become permanently disabled or impaired. The first of the two studies published in 1995 introduced 3 categories of injuries:
1. Those with neck pain, stiffness or tenderness only - no clinical (exam) findings;
2. Neck complaints and clinical findings including decreased ranges of neck motion;
3. Neck complaints and loss of neurological function including numbness or weakness in arm strength and/or altered reflexes.

The QTF then set out to investigate whether this approach could indeed accurately predict those more vs. less likely to end up with significant disability with ongoing problems. They published these results in 2001 and found if they broke down the 2nd category into two groups, those with vs. without neck motion loss, those patients who fell into the 2nd group (with neck motion loss) and the 3rd group (those with neurological signs) were more likely to suffer long term disability compared to those in groups 1 and 2a (without neck motion loss). However, these conclusions have been challenged by many as being too simple because they do not include the psychological problems like depression, anxiety, and poor coping abilities, all of which play an important role in predicting long term disability. Also, treatment strategies must include aspects to deal with the post-traumatic stress disorder, anxiety, depression and coping, not just the biological injury aspects. A convincing study published in 2008 looked at 226 studies on this subject and reported on 7 prognostic factors and found that 50-75% of people with current neck pain will report neck pain again 1-5 years later. Older age and psychosocial factors including psychological health, coping patterns, and the need to socialize were the strongest predictors. Three other potential predictors that require more investigation include the presence of arthritis, genetic factors, and compensation policies.

The bottom line or best advice to minimize our chances of having chronic, disabling neck pain after a car crash is, don’t stop living! That is to say, carry on with work and hobbies as much as you possibly can so that you don’t fall into the negative spiral of disability. If you feel yourself slipping, get help sooner than later! Pain relief and function restoration are strong goals and chiropractic has been found to be one of the first and most effective forms of treatment recommended by all treatment guidelines published on whiplash management. Comparing potential side effects, medications carry a significant list of negative effects while chiropractic carries very few and, a host of positive benefits.

Running and Low Back Pain

2011-06-06T05:00:00.001-05:00

Have you ever noticed every time you go running, you have lower back pain either during or after the run? If so, I’m sure you’re wondering if you should quit running, find an alternative sport, or simply stop all activity and adopt a sedentary lifestyle. If you love the benefits of running and want to continue, is there anything you can do to make running tolerable? First, NEVER stop doing activity and adopt a sedentary lifestyle – it will start a slow decline with an unhappy ending! So let’s see if we can make running work for you!

1. STRETCH: In general, stretching helps “warm up” your muscles and joints and can prevent the low back from hurting during or after your run. In past newsletters, we’ve reviewed simple stretches that can be done from a sitting position (when you’re in a hurry), as well as others. Yoga based exercises are also excellent!
2. FOOT STRIKE: The “proper” gait or, method your feet hit the ground is very important! To avoid low back injuries (not to mention foot, ankle, knee or hip injuries), run SMOOTHLY so the heel strike is gliding/glancing vs. a hard vertical load. The foot then “ROLLS” from heel to toe, first on the outside of the foot and then shifts to the inside during which time the arch flattens out, getting ready to “spring” you forward. The heel then lifts up and you push off the ball of the foot and big toe.
3. RUNNING POSTURE: Lean forwards when you run – DON’T run vertically like a Po-Go stick! By doing this, your momentum will be to move forwards – NOT downwards into the pavement (like a “jack hammer”)!
4. CORE STRENGTHENING: By keeping your “core” (midsection) strong, your back is more supported and less likely to become injured. Core exercises include pelvic tilts, the “dead-bug”, bridges, prone swimmers, lunges, squats, sit-ups, arch-ups, side bridges, 4-point kneeling/opposite arm/leg, and many others. These can be done on the floor and/or with a gym ball. Balance exercises are also very important!
5. RELAX: Have you ever noticed when some people run, they just look “tight” and uncomfortable. RELAX – don’t shrug your shoulders up to your ears; let your arms hang down bent at your sides; don’t clench your teeth or make a fist – RELAX!!!
6. PADDED INSOLES: There are many brands of padded insoles – try some and see how they work for you.
7. RUNNING SHOES: The key here is TRY THEM ON and walk around inside the store. There are a lot of good supportive shoes so just find a brand that works for you!
8. FLAT FEET: This is common and NOT a reason to stop running. Ask us about foot orthotics and the function and importance of the arches.

Fibromyalgia: The Dirty Dozen of Exercise

2011-06-02T05:00:00.000-05:00

Fibromyalgia (FM) is a common chronic condition that affects millions of people. The overview of the symptoms is widespread pain in the muscles accompanied by pain, fatigue, and “…just feeling wiped out!” Sleep deprivation is a common problem and some feel sleep loss for any reason -- stress, past injury, current illness, etc. -- can result in FM and restoring sleep is a key component to treatment. Here are 14 key points to consider to effectively “manage” or gain control of FM (as there is no “cure”):

1. Keep Moving: Exercise of a REGULAR BASIS. The presence of pain is NOT a reason to NOT exercise – a common mis-belief about FM. Exercise is not only good for your muscles but it also helps improve the circulation, maintain bowel regularity, and reduce stress.
2. Talk To Your Doctor: Always discuss your fitness plans with us, your chiropractor! It’s important to have a structured plan to follow and most importantly, START SLOWLY!
3. “Learn” Your Limitations: Around the house, at work and in the gym, learn what you can handle by slowly introducing new activities into your routine. Don’t feel guilty about taking multiple breaks during your day!
4. Remember to Stretch: To improve flexibility, improve muscle tightness, and reduce pain, gentle stretching exercises are VERY rewarding! These can be done at any time of the day and also as a “warm up” and “cool down” before and after your exercise session.
5. Make It Fun: Choose exercises that appeal to you such as bicycling, swimming, or walking – make it fun! Exercise in a location that is appealing such as walking in a park, or in the woods. Take your dog (or the neighbor’s dog) for a walk. Try to achieve thirty minutes of movement-based exercise each day.
6. Set Realistic Goals: Don’t try to run a marathon on your first day of exercise. You need to determine what you can handle by gradually introducing the activity. For example, start with a 5 or 10 minute walk and set a goal of 30 minutes by the end of the 1st or 2nd week. Then work on speed or pace. Make sure the exercises you choose do not aggravate your condition further.
7. Make Sleep a Priority: Restless, non-restoring sleep is a common complaint of FM patients. Exercise can really help faulty sleep patterns. Set a sleep schedule – go to bed and wake up at the same time each day. Also, talk to us about nutritional options.
8. Block Out Distractions: Use ear plugs, “noise machines,” or an eye mask to block out sleeping distractions.
9. AVOID Caffeine: Coffee, chocolate or caffeine rich soda can disrupt sleep patterns well into the night. Avoid these for at least four [4] hours before bedtime.
10. Reduce Stress: Just struggling with FM is stressful enough! Yoga, meditation, deep breathing and relaxation exercises can be extremely helpful is reducing stress.
11. Learn To Say No: It’s OK to say “no.” We’re all too busy but with FM, additional worries and stress really take their toll!
12. Socialize Wisely: Socialize with people who have a positive attitude – choose your friends wisely. Remember, the glass is always at least “half-full!”

What Is Carpal Tunnel Syndrome?

2011-06-01T05:00:00.000-05:00

So what IS CTS? According to the National Institute of Neurological Disorders and Stroke (National Institutes of Health), CTS occurs as a result of the median nerve, which is located in the middle of the forearm and hand on the palm side, getting pinched or squeezed at the wrist. This results in numbness, or tingling and later, weakness in the part of the hand that is innervated by the median nerve (palm and index, 3rd and half of the 4th fingers). The reason this occurs so frequently is primarily due to the way the wrist is designed. There are 8 little wrist bones that make up the “tunnel”

There are 9 tendons that travel through the tunnel and the median nerve sits on top of the 9 tendons, just under the “roof” of the tunnel (a ligament). When the hands and fingers have to move rapidly such as when typing, playing piano, working on a fast paced, repetitive motion job (eg., packing cookies, meat packaging, etc.), the tendons rub together and create friction. As a result, the tendons swell and the median nerve gets squeezed or pinched between the swollen tendons and the roof (ligament). This process results in the symptoms: numbness, tingling, burning, itching, “half-asleep,” driving numbness, difficulty picking up things with the finger tips, buttoning a shirt, grip/pinch weakness (opening a jar weakness), difficulty in differentiating between hot and cold, and sleep interruptions from the numb/tingling sensations. If not properly treated, the muscles at the base of the thumb can shrink (“atrophy”).

Chiropractors are appropriately trained to diagnose and treat CTS – most importantly, WITHOUT SURGERY! The following represents a logical, effective chiropractic treatment approach for CTS: 1) Joint manipulation: this includes the hand, wrist, forearm, and in some cases, the elbow, shoulder, and neck; 2) Muscle release techniques: this may include deep tissue active release technique, spray and stretch, mobilization, contract/relax techniques, and teaching you how to perform some of these on your own; 3) Exercises: wall/wrist stretches, isometric and isotonic resistance; 4) Cock-up wrist splint use, especially at night; 5) Ergonomic modifications (workstation issues); 6) Physical therapy modalities such as low level laser therapy.

How to Improve Your Odds of Crash Survival

2011-05-31T05:00:00.001-05:00

You might ask, what does this headline have to do with chiropractic? It’s often said case management or patient care is much more than just what we do to our patients (such as in chiropractic, applying a spinal adjustment). The patient education portion of our care plan can frequently make or break a successful outcome in a case. It is the goal of this Health Update to potentially save your life by empowering you with the knowledge needed when it’s time to purchase your next car. This is about what specific automobile features contribute to crash survival – hence, saving lives!

Did you know the car you choose can improve the odds of crash survival by 400%? In the popular magazine Consumer Reports, they wrote, “Ultimately, safety is active and passive, balancing the ability to avoid an accident and to survive one.” Typically, the first thing we do as consumers when we consider safety in a particular car is to look at the crash-test results. While this is important, we must first consider the size and weight so we compare crash-test results between cars in the same weight class since statistics show there are two times as many occupant deaths annually in small vs. large cars. Keeping size and weight in the foreground, when evaluating crash-test results, the front and rear end “crumple zone” of the car should be designed to absorb crash forces by buckling and bending in a serious collision. If you’ve ever watched race cars crash, you usually see car parts bend and break off as they bounce off the guard rail or other cars, sometimes to the point where all that is left is the cage surrounding the driver. Amazingly, the race car driver often climbs out of the cage and walks away, seemingly unharmed.

The next important car feature to consider is a car with a structurally superior passenger compartment. Look for a high quality “restraint system” made up of 3 components: seat belts, airbags, and head restraints. These work together to keep us safe and in place during a crash while the outside of the car crumples, absorbing the energy of the crash.

So where do you look to get this information? There are several resources available:

1. The NHTSA (National Highway Traffic Safety Administration) tests front end impacts at 35 mph, and in 1997 added side impact tests at 38 mph. They also test for the rollover potential for SUVs and trucks and grade the results for each category from 1 to 5 stars representing the likelihood of suffering a life-threatening injury in a crash.
2. Since 1995, the IIHS (Insurance Institute for Highway Safety) has used a method reviewed by Consumer Reports as being more realistic by crashing only half of the vehicle at similar speeds into fixed barriers, since most crashes are not direct, whole car strikes.
3. Consumer Reports is a 3rd option. They integrate the data from both NHTSA and IIHS and gives us their “CR Safety Assessment,” and run 40 new cars each year through numerous individual tests.

Other important “accident avoiding” features often overlooked include: Tires - greatly impact braking and emergency handling so REPLACE them as needed; Braking-check for the distance required to stop the car at different speeds- the shorter, the better; Emergency Handling-data about accident avoidance and choosing a vehicle with electronic stability control (ESC), especially in SUVs is wise; Acceleration-the quicker a car can get to highway speeds, the better; Driver position and visibility-a good view of the surroundings, especially the “blind spots” is important. We realize you have a choice in where you go for your health care needs and we truly appreciate your consideration in allowing us to help you.

“Did You Do Your Exercises – Did You Brush Your Teeth?”

2011-05-30T05:00:00.001-05:00

Has your chiropractor ever asked, “Did you do your exercises?” How did you respond? If you’re like 96% of the general population, you probably scrambled, looking for excuses that your chiropractor would “buy.” Of course, we’re not out to humiliate you or make you feel….too bad… about not being the “perfect patient” who does exactly what we request. In fact, only about 4% of you will indeed continue your exercises after the pain stops reminding you to do them. So, what are some “tricks” we can “play on ourselves” so we actually do our exercises? Certainly, we know there must be a way. For example we have successfully adopted brushing our teeth on a regular basis so we should be able to add exercise to our daily “habits.”

Last month, we discussed some simple “on-the-go” exercises you can do in as little as 30-60 seconds of time, if time is that tight. We talked about the importance of doing some stretches to interrupt the cycle of back stress and strain by taking a “mini-break” and stretch out from a chair. I hope you’ve tried these as they fit right into the picture of back pain prevention. This month, I’m going to give you another option…..no, let’s call it a “must” so that you “just do it.” Maybe it’s the sound, smell and pain associated with the dental drill that scares us into brushing our teeth; that makes that process a morning and evening habit. Well, let’s assume you’ve had back pain and at a time it was bad, you commented (if you're a mother), “…this is worse than childbirth!” For the non-mothers out there, remember how you felt when you couldn’t move because the pain felt like a knife stabbing you in the back? I want you to remember those times when you were so worried about whether you would ever feel right again, and when you said, “…I WILL to do my exercises! I don’t ever want to go through this again!” If you can remember that, your ability to become disciplined and regular about exercise will work.

So here’s what I want you to do: The FIRST thing you do in the morning, before your hectic day begins, move to the carpet floor of your bedroom or bathroom and go through the following: 1) Abdominal crunches 15-20 reps – you can use any type of sit-up you’ve learned; 2) Hamstring stretches – bring your knee to your chest by grabbing behind your knee and then slowly straighten your knee until you “feel the burn” in the back of your thigh – hold for 5-10 seconds and do 5-10 reps….enough to feel looser than when you started; 3) Bridges – bend your knees, feet flat on the floor, raise your butt off the floor – push your heels into the floor at the same time, and raise up until your thighs line up with your body. Hold for 5 seconds and repeat 5-10 times; 4) Side-ways sit-ups – roll on your side and lift your upper body and legs towards the ceiling and repeat it 5-10 times; 5) Push-ups: From your feet or your knees, depending on your arm strength, do 5-10 reps in slow motion to make it harder. When you’ve finished with these (it takes about 5 minutes), then brush your teeth! Repeat this process before bed at night, just like you do when you brush your teeth. WHEN (not “if”) you do this, I “PROMISE” you will feel better, more alert (better than a cup of coffee) and, your back will bother you less. Remember the promise you made to yourself when you last hurt badly? Try these and keep your promise!

Fibromyalgia and Exercise: The Jury is In!

2011-05-26T05:00:00.000-05:00

As heath care evidence accumulates, hopefully this translates into better treatments for patients. Fibromyalgia in particular, has been a frustrating disease for many patients and physicians since drug treatments seem to provide little benefit.

One treatment that has been studied extensively is supervised aerobic exercise and strength training. The prestigious scientific review group called Cochrane (Cochrane Database Syst Rev 2007;4:CD003786) recently reviewed the exercise evidence in fibromyaglia. The conclude that: "there is 'gold' level evidence (www.cochranemsk.org) that supervised aerobic exercise training has beneficial effects on physical capacity and FMS [fibromyalgia] symptoms. But have you started yet? Is aerobic exercise and strength or resistance training part of your daily routine? If not, then I have to ask, why not?

For many patients they may need a personal trainer or a skilled doctor of chiropractic, who will help you to work around and instead of your injuries and help to keep you motivated, on tract, and accountable. If you've sprained your low back in the past this can severely limit your ability to exercise pain-free. The spine IS the core of the body so it needs to be flexible and healthy for you to exercise effectively over the long-term. Taking drugs to cover up the pain while you train can lead to further injury. You need to listen to your body to know when to slow down and take it easy. Muscle pain is inevitable with exercise. Joint pain is another story and needs to be avoided.

I have found that adding chiropractic care to your active lifestyle can help keep you going as embark on this new and hopefully long journey.

For others, long-term inactivity has led to weight gain that needs to come down first before hitting the gym. And when weight-loss is occurring it is hard to repair muscle strain, so it is very easy to over-train which usually results in the patient quitting their new program

Exercising while you are excessively overweight will often lead to failure and injury to your knees or spine. So it is important to proceed with caution. Don't enter a marathon tomorrow. I want you to start right to ensure the best chances for success.

Our clinic offers complementary consultations to see how chiropractic can fit into your new exercise lifestyle. Just call Crystal at 504.454.2000 to schedule an appointment. If you have fibromyalgia, you need to get moving. Start today!

What Isn’t Carpal Tunnel Syndrome?

2011-05-25T05:00:00.001-05:00

That’s a strange question….well, maybe not as crazy as it sounds! Knowing what isn’t carpal tunnel syndrome, or CTS, may help you avoid an unnecessary surgery for a condition that looks very similar to CTS. Because CTS is such a common problem, it’s not uncommon for other conditions to be mistakenly called “CTS.” Because of that, subsequent surgical treatment will fail. So, what are similar conditions you should know about? You’ll be surprised at the possibilities: Pronator tunnel syndrome, cubital tunnel syndrome, radial tunnel syndrome, thoracic outlet syndrome, cervical radiculopathy, peripheral neuropathy, De Quervain’s Disease, fracture/trauma, degenerative joint disease (osteoarthritis), ganglion cysts, rheumatoid arthritis (RA), serum lupus erythymatosus (SLE), scleroderma, syringomyelia, multiple sclerosis, pregnancy, obesity, hypothyroid, gout, diabetes mellitus, Paget’s Disease, acromegaly, mucopolysaccharidoses, eosinophilic fasciitis, hyperlipidemia…

Obviously, you get the picture. There are MANY conditions that can either contribute and/or “cause” CTS. So, let’s discuss how we can determine what the condition is that may be causing CTS. CTS is “likely” if none of the above causes or contributes to these symptoms of CTS:
1. Numbness/tingling in the distribution of the median nerve in the hand only (not forearm) affecting the 2nd and 3rd (sometimes part of the 4th) fingers.
2. The need to shake and “flick” your fingers repeatedly during certain activities such as writing, sleeping, typing, driving, reading/holding a book / newspaper.
3. Waking up at night due to numbness.
4. Difficulty buttoning a shirt, picking up fine things, unscrewing a jar, riding a bike and more.

It may be necessary and appropriate to have some blood tests performed to help “rule out” (that means, “…get rid of..”) some of the above long list of conditions. Some of these blood tests include (but are not limited to): a sedimentation rate (ESR), rheumatoid factor (RA), ANA antibody test (for SLE), uric acid (for gout), glucose (for diabetes mellitus), thyroid profile (for hypothyroid), lipid profile and even a Lyme’s disease test to rule out the possibilities of that! If any of these blood test return “positive,” get those conditions treated FIRST before consenting to CTS surgery so you can avoid having a poor / unsatisfying result. Remember, you can always have surgery later, but you can’t “undo” the surgery after the fact (if it doesn’t help).

Therefore, why not consider a non-surgical treatment FIRST and if that fails, AND, blood tests prove none of the above conditions are present, THEN you can feel more comfortable that no underlying condition is present that is causing or adding to CTS. Some of the common non-surgical treatments you can expect from our chiropractic approach for CTS include: wrist manipulation / mobilization, active release technique (ART) applied to the flexor forearm muscles, night wrist splint use, low level laser therapy, activity modifications, ergonomic or work station modifications. Once you’re sure no other underlying metabolic cause or contributor is present, call us and we will help you with our non-surgical, no negative side-effect treatment approach!

“The Only Proven Effective Treatment” for Chronic Whiplash?

2011-05-24T05:00:00.001-05:00

You may have wondered, “If I get hurt in a car accident, who should I go to for treatment of my whiplash problem?” This can be quite a challenge as you have many choices available in the healthcare system ranging from drug-related approaches from anti-inflammatory over-the-counter types all the way to potentially addicting narcotic medications. On the other side of the fence, there are nutritional based products such as vitamins and herbs as well as “alternative” or “complementary” forms of treatment such as chiropractic, exercise, and meditation, with many others in between. Trying to figure out which approach or perhaps combined approaches would best serve your needs is truly challenging. To help answer this question, one study reported the superiority of chiropractic management for patients with chronic whiplash, as well as which type of chronic whiplash patients responded best to the care. The research paper begins with the comment from a leading orthopedic medical journal stating, “Conventional [meaning medical] treatment of patients with whiplash symptoms is disappointing.” In the study, 93 patients were divided into three groups consisting of:
Group 1: Patients with a “coat-hanger” pain distribution (neck and upper shoulders) and loss of neck range of motion (ROM), but no neurological deficits;
Group 2: Patients with neurological problems (arm/hand numbness and/or weakness) plus neck pain and ROM loss); and,
Group 3: Patients who reported severe neck pain but had normal neck ROM and no neurological losses.

The average time from injury to first treatment was 12 months and an average of 19 treatments over a 4 month time frame was utilized. The patients were graded on a 4-point scale that described their symptoms before and after treatment.

Grade A patients were pain free;
Grade B patients reported their pain as a “nuisance;”
Grade C patients had partial activity limitations due to pain; and
Grade D patients were disabled.

Here are the results:

Group 1: 72% reported improvement as follows: 24% were asymptomatic, 24% improved by 2 grades, 24% by 1 grade, and 28% reported no improvement.
Group 2: 94% reported improvement as follows: 38% were asymptomatic, 43% improved by 2 grades, 13% by 1 grade, and 6% had no improvement.
Group 3: 27% reported improvement as follows: 0% were asymptomatic, 9% improved by 2 grades, 18% by 1 grade, 64% showed no improvement, and 9% got worse.

This study is very important as it illustrates how effective chiropractic care is for patients who have sustained a motor vehicle crash with a resulting whiplash injury. It’s important to note the type of patient presentation that responded best to care had neurological complaints and associated abnormal neck range of motion. This differs from other non-chiropractic studies where it is reported that patients with neurological dysfunction responded poorly when compared to a group similar to the Group A patient here (neck/shoulder pain, reduced neck ROM, and with normal neurological function). We realize you have a choice in where you go for your health care needs and we truly appreciate your consideration in allowing us to help you through this potentially difficult process.

Simple “On-The-GO” Low Back Exercise

2011-05-23T05:00:00.000-05:00

“Doc, I try to do my exercises but I have to hit the ground running in the morning….to get the kids ready for the school bus….I have morning meetings….I’m not a morning person….I’m pulled in 100 directions during the day….I forget about them until I’m in bed….I exercise on my job and that’s enough…."

I’m sure we’ve all rationalized our inability to keep up with exercises, especially after our episode of low back pain (LBP) subsides. In fact, only about 4% of LBP patients continue doing their exercises after their pain subsides. That means 96% of us with chronic, recurring low back pain DO NOT exercise even though we know we should. We feel bad, even guilty for not exercising. So, what can we do to “trick” ourselves into being more compliant with our low back exercises?

First, let’s accept the fact that most of us cannot consistently “fit in” exercise into our busy schedules. With that said, the TIMING of when to do the exercise may be more important than even doing them at the same time every day. In other words, do a few exercises when you need them the most. For example, if you’re working at a computer for more than 1 hour, and you start to feel back pain from the prolonged sitting – especially if your work station set up is less than ideal – do one or two sitting exercises right at your work station, BEFORE your back pain gets any worse. If you wait too long, the exercises may not be of much benefit. Setting a timer next to your screen that beeps every hour is a good reminder to do one or two simple exercises and only takes a minute or two. Many inexpensive digital watches can be set to beep on the hour/every hour or, you can set a “timer” to beep after 60 minutes as a “gentle” reminder. Some cell phones also have a timer feature. Here are three sit down low back exercise options (try them all and decide which one(s) feel most productive/helpful):

1. “Crossed Knee Stretch”: Cross your legs; pull the crossed knee towards your opposite shoulder (feel the pull in your buttocks); arch your low back and at the same time, twist or rotate to the side of the crossed knee. Hold for 5-10 seconds and repeat up to 3 times. Repeat this on the opposite side.
2. “Sit Twists”: Reach across with your right hand and grasp your left leg at mid-thigh. Twist/rotate your back to the left and pull with your arm. Hold 5-10 seconds / repeat 3 times. Repeat this on the opposite side.
3. “Sit Floor Touches”: Bend over as if to touch the floor or tie a shoe. Hold 5-10 seconds.

If you do the math, it would take a minute for #1 and #2, 30 seconds for #3 (total 2.5 min.). If that’s too long, hold for 5 seconds. If that’s too long, do 1 rep, not 3. You get the idea…..MAKE IT WORK! Modify the dose to fit your schedule or ability to stretch. If you do this AT THE TIME you start to feel tight or sore, you can PREVENT a LBP episode!

Fibromyalgia: Exercise Recommendations

2011-05-19T05:00:00.001-05:00

Fibromyalgia (FM) is a chronic condition that affects the muscles of the body in a generalized way, producing pain that is usually located in many areas. This widespread pain can impact many aspects of one’s life and disrupt jobs, hobbies, and relationships. Last month, we discussed dietary strategies that can be employed to minimize the inflammatory process in the body. This month, we will continue the concept, “…what else can I do to help myself?” When you adopt the dietary recommendations described last month with the exercise recommendations that will be presented here, this combination will have a dramatic effect on minimizing the activity disabling qualities of fibromyalgia.

Let’s break exercise down into three categories: strengthening, stretching, and aerobics. It is recommended you choose exercises from each category that are most appealing to you so you can develop a “regular habit” with these approaches. Recognize that as long as you’re breathing, you will need to exercise. It’s not like, “…once I get into shape, I can stop and enjoy my healthy condition that I’ve worked hard to achieve.” Hence, make exercise automatic – something that you “look forward” to doing (not dreading). Presented here are three categories of exercises – choose several from each category and mix them up – and do it EVERY DAY!!!

STRETCHING STRENGTHENING AEROBICS
A. LAY ON YOUR BACK A. LAYING DOWN A. LAYING DOWN
1. Single knee to chest 1. Ab crunch-ups 1. “Dead Bug”
2. Double knee to chest 2. Bridges – lift butt off floor 2. Bicycle
3. Pelvic Tilts – flatten the back 3. Push-ups (from knees or feet) 3. Prone-superman
4. Cross leg knee to chest 4. Lay of your side sit-ups 4. Bend knees/roll side to side
5. On stomach, raise arms/legs
B. STANDING B. STANDING B. STANDING
1. Backward bending 1. Jump ups – single/dbl leg 1. Run in place
2. Toe touches (knees straight!) 2. Push hands together 2. Jumping Jacks
3. Side to side bends 3. Squats – ¼, ½, or full 3. Rope jumping
4. Arm Circles: side & over head 4. Lunges – FW, Sideways 4. Step up/down: Front
5. Neck Rolls – left & right 5. Neck Resistance-FW, sides 5. Step up/down: Sideways
C. SITTING C. SITTING C. SITTING
1. Single knee to chest 1. Ab lean-backs (from chair) 1. Horizontal arm circles
2. Cross leg - pull knee up 2. Squeeze knees together 2. Thera-tube arm movements
3. Cross leg - push knee down 3. Shlder shrugs: Grasp seat 3. Raise arms over head/down
4. Reach across trunk twists 4. Arm resistance-TheraTube 4. Knee repetitive kicking
5. Bruegger’s Stretch* 5. Push hand against moving head
* Bruegger’s Stretch: Sit up VERY straight, extend the arms back (straight elbows) spread fingers, tuck chin, breath full/slowly and repeat 3 times.

Note, we can help teach these to you if you’re not sure how to do these!

Carpal Tunnel Syndrome – Why is it so common?

2011-05-18T05:00:00.000-05:00

Carpal tunnel syndrome or, CTS, is a condition where a nerve (called the median nerve) is compressed in a relatively tight or restricted space (called the carpal tunnel), resulting in altered nerve function that includes numbness and weakness. In order to fully understand what CTS is, let’s devote this Health Update to better understanding the anatomy of the carpal tunnel.

The carpal tunnel is made up from 8 bones (2 rows of 4 carpal bones that are stacked on top of each other) that are arranged in the shape of a horse shoe. The “roof” of the tunnel is a ligament (transverse carpal ligament) that stretches tightly across the two ends of the horseshoe completing the formation of a tunnel – actually, an upside down tunnel when looking at the palm side of the wrist). The contents of the tunnel include 9 tendons and their covering (sheath), blood vessels and on top of all that just under the roof is the median nerve – the culprit that creates most of the symptoms of CTS. The cause of CTS is simply anything that causes the contents inside the tunnel to swell, which then compresses the median nerve up into the roof or ligament, pinching the nerve. This can create numbness, tingling, the falling asleep sensation and weakness. It’s important to point out that the median nerve starts out from the neck, passes through the shoulder, past the elbow, through the wrist’s carpal tunnel and ends in the hand – specifically fingers 2,3, and 4. Therefore, the ENTIRE nerve must be looked at for all CTS cases as pinching can occur anywhere along its course from the neck to the hand.

The treatment is simple: “PRICE” – P protect R rest I ice C compress E elevate – accomplished by bracing (especially at night), ice cup massage (5 min. until numb 5x/day), rest (light duty work), and therapy (see your chiropractor!).

Whiplash & Chiropractic Treatment

2011-05-17T05:00:00.001-05:00

The term ‘whiplash’ represents a collection of symptoms that occur as a result of a soft tissue injury of the neck. This includes over stretching and/or tearing of muscles, tendons, ligaments, disk tissue and/or nerve injuries due to the extreme movements that occur during a whiplash event (usually arising from a car accident). We have discussed the mechanism of injury and the symptom complex that can arise in past articles.

So the question is – how many patients who sustain a whiplash injury actually improve and recover compared to those that don’t? In one study, it was stated that 43% of patients will suffer long-term symptoms after a whiplash type of injury. More specifically, if a patient is still symptomatic after 3 months following the injury, “…then there is almost a 90% chance that they will remain so.” They go on to state that no conventional treatment has proven to be effective in helping these chronic cases. The purpose of their study was to determine the effectiveness of chiropractic treatment in a group of chronic whiplash patients. To do this, they studied 28 patients (20 women and 8 men, between ages 19-66, mean 39) over a 2-year time frame, injured in motor vehicle collisions. Their symptom severity was graded on an A to D scale (A=minimal symptoms vs. D=disabling symptoms, with B= nuisance and C=Intrusive or partially disabling). Those in Groups C & D either had to significantly modify their work or, they lost their jobs and relied on continual use of medications. The chiropractic treatment included spinal manipulation (adjustments), controlled resistance of muscles to improve stability and coordination, and the use of ice. Treatment from an emergency facility and/or their general practitioner and physical therapy had been previously utilized for on average 15.5 months, before entering this chiropractic-based study. Initially, 27 of the 28 were classified into symptom groups C or D and symptoms included neck pain (82%), neck stiffness (36%), and other complaints of headache, shoulder, arm and back pain. Following treatment 26 of the 28 (93%) improved, 16 by one symptom group and 10 by two symptom groups and this degree of improvement was assessed and agreed upon by both an orthopedic surgeon as well as by a chiropractor. Seventeen (61%) improved to a point of satisfaction where care was discontinued after the 1st assessment with 4 of the 17 considering return for treatment due to a return of symptoms. Litigation was still pending in 20 of the 28 cases at the time the study concluded.

This study is very important as over 90% of chronic whiplash cases improved from chiropractic management well beyond the point of improvement obtained through standard emergency, family practice and physical therapy. Other studies have pointed out that early intervention or treatment with chiropractic manipulation and management approaches generally results in a more favorable response compared to waiting for longer time periods. To be able to obtain this level of success after an average of 15.5 months is truly remarkable!

Chiropractic methods often utilized for patients with a “whiplash” injury include spinal manipulation (or adjustments), mobilization techniques (this includes stretching, figure 8 movements, manual traction), muscle release work (this includes trigger point therapy, myofascial release/friction massage, and others), and promoting self-help approaches (this includes exercise, home traction methods, computer station modifications and other job modifications as indicated, and others).

What Can I Do To Reduce My Risk For Low Back Pain?

2011-05-16T05:00:00.000-05:00

Low back pain (LBP) can have many causes such as genetics, acquired abuses, body type (especially obesity – body mass index or BMI >30), gender, as well as cultural aspects that predispose one to acquire low back trouble. So, the question remains, “what can I do to reduce my risk for developing low back pain?”

The answer, like the cause is – you guessed it – multifactorial. Since we can’t change our genetics, we’ll have to accept that one. But, we can change our BMI by keeping our weight to a reasonable amount. In an April 2010 study from Norway, 60,000 men and women provided BMI information and 20.9% of the men and 26.3% of the women indicated they had chronic low back pain. The authors found a direct relationship to a high BMI and an increased prevalence of LBP. Similar results attributing obesity to LBP were also reported in a meta-analysis published in January 2010 in the American Journal of Epidemiology (2010; 171(2):135-154).

So, what is, “…a reasonable amount of weight?” When using the BMI, a BMI of 18.5 to 25 is considered “normal,” while 25-30 is described as overweight and >30 represents obesity. We should also mention anything LESS than 18.5 is considered underweight and that’s not good either as many nutritional needs of the body are compromised and too little weight can negatively affect bone health leading to osteoporosis and a myriad of other problematic health issues.

You may be wondering what a body mass index or BMI is, as its quite important and is quickly gaining respect in the medical world. In fact, it has been suggested to include the BMI along with the other “vital signs” pairing it up with blood pressure (BP), pulse, breathing rate, height, weight, and temperature. The BMI is a formula of height and weight and it’s a rough calculation of our total body fat, which is related to the risk of disease and death. However, according to the National Heart, Lung and Blood Institute (NHLBI) it’s a little more complicated than that as people with greater muscle mass (such as a body builder) will have a higher BMI, suggesting they are overweight. At the other end of the spectrum, older individuals who have lost muscle mass may be still be overweight but their BMI will not reflect that.

The NHLBI reports 3 factors of importance when defining obesity and its many negative health effects, including the increased prevalence of LBP. The 3 factors are: 1) The BMI; 2) The waist measurement; 3) The presence of other negative health factors including: high BP, high LDL-cholesterol, low HDL-cholesterol, high triglycerides, high blood sugar, a family history of heart disease, physical inactivity and smoking cigarettes. If you have a waist size >35” for woman, >40” for men, AND 2 or more risk factors, simply put, you MUST lose weight! Even a small weight loss of 10% (such as 30# if you’re 300#), will help lower your risk of developing diseases associated with obesity such as heart disease, high cholesterol related diseases, stroke, certain types of cancers and type 2 diabetes.

Exercises For Carpal Tunnel Syndrome

2011-05-11T05:00:00.001-05:00

Carpal tunnel syndrome (CTS) is a common condition resulting in hand and sometimes neck and arm complaints. This can include numbness or tingling in the fingers, leading to dexterity problems such as difficulty buttoning clothing or picking up small objects. There are also issues with strength loss / weakness noticed such as when turning door knobs, opening jars, and even problems with turning the key to start a car. One big problem with CTS is people often wait too long before having it treated thinking it will “…go away” or disappear just like it started. CTS rarely gets better without some form of treatment and seeing a chiropractor makes perfect sense prior to considering surgical intervention.

So, the question remains, “what can I do for CTS?” There are several things a CTS sufferer can do to help manage this condition. Some risk factors such as gender and age cannot be changed but other factors can be changed including taking “mini-breaks” throughout the work day and/or work station modifications, managing weight as obesity (defined as a BMI >30 and a waist size >35” for women and >40” for men), wearing a wrist splint, as well as performing exercises to stretch the wrist area.

A study out of the University of Oklahoma reported 2 out of 3 patients with mild to moderate CTS avoided surgery by performing specific exercises. The concept of a 5-minute warm-up stretch each day before starting the workday is similar to a runner stretching before a run to prevent injury.

Step A: Extend and stretch both wrists and fingers acutely as if they
are in a standing push-up position. Hold for a count of 5.
Step B: Straighten both wrists and relax fingers.
Step C: Make a tight fist with both hands.
Step D: Then, bend both wrists down while keeping the fist. Hold for a
count of 5.
Step E: Straighten both wrists and relax fingers, for a count of 5.
Step F: Then, let your arms hang loosely at the side and shake them
for a few seconds.

This exercise should be repeated 10 times and can be repeated several times a day.

Chiropractic is a perfect choice when considering a health care provider for the treatment of CTS as these exercises can easily be taught to you at our office. In addition, many other non-surgical treatment options for CTS are available.

Whiplash – What Can I Do To Help?

2011-05-10T05:00:00.001-05:00

Whiplash occurs when the neck is suddenly and forcefully jerked, and is typically associated with car crashes. The speed at which the neck is forced upon impact is faster than we can contract our muscles in attempt to stop the forceful movement. This results in muscle, tendon, and/or ligament over-stretching, even tearing. Symptoms include stiff and painful neck movements, weakness or, the head “feels heavy” making it challenging to “hold up” as well as headache, and sometimes dizziness, ear noises, TMJ or jaw pain, and “mental fog.” What should be done if a whiplash injury occurs?

The amount or degree of damage to the soft tissues – that is, the muscles, tendons, ligaments, and disks of the neck -- will be the deciding factors as to how much rest vs. activity should be initially performed. If there are no fractures, dislocations or other injuries resulting in an unstable cervical spine (neck), studies have shown rest and a soft collar is actually harmful when compared to early return to activity and exercises. Chiropractic treatment, which essentially exercises the joints of the neck, has been shown to speed recovery when performed sooner rather than later after a whiplash injury. A handy way to classify the injury includes four categories: 1) Pain with no significant abnormal clinical findings; 2) Pain with mild clinical findings and range of motion loss; 3) Pain with neurological injury (resulting in radiating arm pain); and 4) Pain associated with fracture and/or dislocation. Those suffering with category 1 or 2 injuries should minimize rest, collar use, proceed with life’s activities and not be afraid to do desired activities. More aggressive exercise and, utilizing chiropractic adjustments as soon as possible is very effective in the first two categories of injury. Category 4 (fractures and dislocations) injuries require the use of a rigid collar usually for 4-6 weeks as rest/protection is imperative. Category 3 demands careful monitoring by your chiropractor as neurological problems like arm pain and numbness, muscle strength weakness, must be watched during the healing process. The use of ice is helpful with all four categories of injury and exercise training is important and can be started sooner in the first two categories of injury.

What can you do if you sustain a whiplash injury? The first order of self-help is the use of ice. This is a much better choice over the use of heat as ice reduces swelling and pain while heat can increase swelling because it brings in more blood flow into an already swollen area. The heat may feel good during its use but most patients report the pain either returns shortly thereafter or feels worse. Ice and heat can be alternated but ice should be emphasized by using ice for 10 minutes, heat 5 minutes, and repeat the ice / heat / ice approach starting and ending with ice. One session usually equals 40 minutes (ice/heat/ice/heat/ice for 10+5+10+5+10, respectively, = 40 min.), and several sessions can be repeated each day. The old adage of “ice for 24 hours followed by heat” does NOT apply here as ice or “contrast therapy” of ice/heat/ice/heat/ice can be performed for as long as there is pain or, for several weeks or longer. The good news is that you will never hurt yourself by using ice but, you can make it hurt worse by using heat too soon so, when in doubt, use ice! The next, very important, recommendation is to utilize exercises to stretch and strengthen the neck and upper back region. The “general rule” of exercise is slow repetitions staying within “reasonable” boundaries of pain. That is, a good, stretch type of pain is encouraged while avoiding sharp pain. We have discussed several very practical neck stretches and strengthening exercises previously and we will again address this in the future. Posture correction of chin tucks, keeping your head back over your shoulders is very helpful as well. 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 whiplash, chiropractic care is a logical first choice and we would be honored to offer our services to you.

Why Does My Back Always Hurt?

2011-05-09T05:00:00.001-05:00

Low back pain is a very common problem affecting 80-90% of all of us at some point in our lifetime. Why is that you ask? There are many reasons. One of the biggest reasons is that we are 2-legged animals carrying 2/3rds of our weight above our waist. Studies have shown deterioration or arthritis occurs much sooner in us vs. our 4-legged animal counterparts. A 180 lbs man carries roughly 120 lbs above the waist. This means, every time he bends over, in order to stand upright, he needs to lift 120 lbs PLUS whatever he is lifting. Hence, the argument of, “…but I only bent over to lift a pencil and my back went out,” seems on the surface as impossible but in reality, the man in our example is lifting the pencil plus 120 lbs. Now, let’s add to that the point that a 5 pound weight equals 50 pounds when held out in front with the arms stretched out straight. Now, if that’s not bad enough, now, let’s assume all of this is happening from a bent forward position, with a twist at the waist, with out stretched arms, while lifting a 20 pound object. Get the idea? It’s amazing our back doesn’t get injured every day as we lift 2 bags of groceries into the far end of a car trunk, or, when lifting our 30 pound child in and out of a car seat, height chair, or when they are screaming and pushing away from us as we try to lift them!

In order to further appreciate why the low back is so vulnerable to injury, some basic understanding of anatomy is needed. When we’re born, the back is made up of 33 segments of which 5 fuse by the time we’re about 18 years old to make up the sacrum (bottom of the spine) and 4 fuse to make up the coccyx (tail bone), leaving 5 lumbar (low back), 12 thoracic (mid-back) and 7 cervical (neck) vertebra. These are stacked up on top of each other like building blocks and are connected to each other by a shock absorbing disk in the front and two smaller facet joints in the back, acting like a tripod. In the low back, we’re supposed to bear about 80% of our weight in the front and 20% in the back but, if our abdominal muscles are a bit out of shape and the pelvis rotates forwards, the curve in the low back increases and overloads the back of the vertebra (facets) making them vulnerable to injury. The disk becomes injured when we bend/lift/twist. This can tear the outer tough fibers of the disk, allowing the central more liquid-like material to leak out. If this happens, the leaking or “herniated” disk can put pressure on the nerve that exits the spine and travels down our leg. If the pain pattern includes the back of the leg, it’s commonly referred to as “sciatica.”

OK, enough about anatomy. What can we do to reduce the chances of having periodic low back pain? Obviously, staying in shape is very important. Certain muscles of the body must be tight to keep us upright or standing. These muscles need to be stretched on a regular basis. For example: the hamstring muscle. We’ve all had to perform hurdler types of exercises and remember how tight they feel!

Fibromyalgia Challenges

2011-05-05T05:00:00.001-05:00

Fibromyalgia (FM) is a condition that usually affects different organ systems in the body, causing a number of symptoms. Some of these include:

1) The muscles (the musculoskeletal system): tender, achy, stiff, tight muscles, trigger or tender points all over the body;
2) The nerves (the nervous system): headaches, light headedness, sleep disruption, depression, anxiety, numbness/tingling (overlaps with the cardiovascular system);
3) The stomach and intestines (the gastrointestinal system): diarrhea, constipation, irritable bowel, leaky gut, heart burn, lack of appetite, abdominal cramping;
4) Breathing (the respiratory system): hyperventilation, rapid / shallow breathing patterns;
5) The heart (the cardiovascular system): racing heart rate – palpitations, feeling cold all the time, numbness/tingling (overlaps with the nervous system);

Because of the multiple systems involved, there are many challenges to managing Fibromyalgia. Studies suggest a balance between several approaches works best. Some of these approaches include biomedical treatments, organ-specific treatments, and cognitive interpersonal treatments. Within these categories, the following can be broken down further:

1) General – those treatments directed at the whole body such as anti-inflammatory measures. These include (but are not limited to) medications (corticosteroids, NSAID’s – such as Advil, Aleve) and nutrients (ginger, turmeric, boswellia, Vitamin D, and others). Other anti-inflammatory measures include diet, such as the Paleo Diet or “caveman diet.” This diet eliminates grains or flour-based products from the diet. That means no more breads, pastas, crackers, cookies – anything made with flour. This approach emphasizes consuming fruits, vegetables, grass-fed lean meats and fish. The main ingredients in grains that are of concern in the Paleo Diet are gluten and lectins
2) Central – those treatments directed at the chemical factors in the brain that control mood, depression, anxiety and so on. These include (but are not limited to) medications (tricyclic antidepressants, muscle relaxers like Cyclobenzaprine, SSRI, SNRI and Trmadol) and certain nutrients (neurotransmitter support such as 5-HTP – tryptophan, DHEA, phenylalanine, and others).
3) Psychotherapy and active behavioral therapy – treatments that are supportive of nervous system such as cognitive behavior therapy, aerobic exercise, patient education, multidisciplinary therapy, hypnotherapy, biofeedback, and strength training.
4) Passive physical intervention – chiropractic therapy, massage therapy and other forms of manual therapy, and acupuncture.

The goal of this article is to look at fibromyalgia from a holistic perspective so that those struggling with FM and similar conditions can better appreciate the concept of multidisciplinary treatment, of which chiropractic care plays a significant role. Coordination of care and finding the “right” health care providers cannot be over-emphasized.

Do I Have to Have Surgery For Carpal Tunnel Syndrome?

2011-05-04T05:00:00.001-05:00

“For the last few months, I’ve been waking up at night with numbness and tingling in my hand. Lately, I’ve been waking up more often, 3-4 times a night and I’m having a hard time falling back to sleep. When I drive, my hands fall asleep within a few minutes and I have to shake my hand and fingers to wake them up. This has gotten to the point where I have to do something but I really don’t want surgery. What are my non-surgical options?”

CTS or, carpal tunnel syndrome is a condition where a nerve (called the median nerve) that travels down from the neck into the arm and through the wrist becomes pinched and inflamed. Common symptoms include numbness, tingling, dexterity problems (such as difficulty buttoning shirts), and opening jars due to weakness in grip and pinch strength. Sleep interruptions and loss of many daily activities, including work, occur because of CTS.

There are many non-surgical approaches to the treatment of CTS that should be utilized before surgery is considered, according to the American Academy of Neurology. In one study, 40% of neurologist polled recommended non-surgical care due to the potential side effects of surgery, some of which being severe, resulting in lengthy work loss post-surgically. A partial list of non-surgical care options include:

1. Rest – Giving the inflamed CTS time to heal is therapeutic but not always an option.
2. Activity/job modifications – Avoiding certain activities or modifying them by taking breaks during the work day, slowing down the pace of the job, altering the position of the job task, such as propping up a part so that the wrists do not have to bend to the extremes, or when necessary, complete avoidance of the job task.
3. Wrist Splint – This is a brace that maintains the wrist in a neutral position so it cannot easily bend. When the wrist flexes or extends, the pressure inside the carpal tunnel (on the palm side of the wrist) increases significantly, placing additional pressure on the already pinched median nerve. Wrist splints are especially useful at night.
4. Nerve Gliding Exercises – These are exercises that stretch the wrist joint and muscle tendons (as well as the median nerve inside the carpal tunnel), with the objective of breaking adhesions that limit the normal glide or movement of the nerve in the forearm and wrist.
5. Manual therapy techniques – These include manipulation of the arm including the forearm, wrist, and hand and sometimes the neck and shoulder, when needed. The objective is to improve the range of motion of the joints and soft tissues that may be participating in the process of median nerve pinching.
6. Anti-inflammatory medication / nutrients – Medications include aspirin, ibuprofen, naproxen and similar prescription drugs. Nutritional options including herbs (such as ginger, turmeric, boswellia), digestive enzymes, and Vitamin B6 may also help. Ice is also anti-inflammatory and direct, on-the-skin ice massage is quite effective.

Chiropractic is a perfect choice when considering a health care provider for the treatment of CTS as many of the above non-surgical techniques are utilized by our office. We realize that you have a choice in who you are considering for your health care provision and we sincerely appreciate your trust in choosing our service for those needs.

Whiplash – Can This Affect My Memory?

2011-05-03T05:00:00.001-05:00

"Doctor, is it normal for people after a whiplash injury to notice problems with memory. I can’t seem to remember things I just recently did since my car accident?”

This is a common complaint occurring as a result of a whiplash injury, but it’s not commonly known, leaving those who are suffering wondering, “…what’s wrong with me?” Whiplash is an injury that classically occurs as a result of a car crash at any speed, even at low speed! This is because at low speed, there is little to no damage to the car, and the forces from the crash are not absorbed by the crushing metal. As a result, those forces are transferred to the contents inside the car – that is, the passengers. This sometimes results in a significantly greater injury compared to crashes that occur at twice the speed because the latter results in crushing metal. The actual injury that occurs in whiplash is caused by the sudden, rapid movement of the head resulting in varying degrees of injury to the neck, as well as to the contents inside the skull – that is, the brain. The brain literally “bangs” into the inside walls of the skull when the head is rapidly accelerated during a car crash. The resulting injury is a concussion. What’s interesting is that most patients injured in a car crash often don’t mention a concussion nor is it usually asked about at the doctor’s office as other, more obvious injuries are dwelt with. The condition is usually referred to by one of two names: post-concussive syndrome or mild traumatic brain injury (MTBI).

"Doctor, when I’m reading a book or magazine, sometimes I have to re-read the passage several times before it sinks in. It’s as though I lose my concentration and I can’t focus on what I just read. The other day, I was talking to a group of co-workers and I lost my place in the middle of the discussion and had to ask, ‘…now where was I?’ I notice this is happening a lot since the car accident.”

This can be very embarrassing, frustrating, and scary for patients suffering with MTBI. Other symptoms associated with this include difficulty in focusing (blurred vision), headaches, having difficulty in pronouncing certain words (“tongue twisted”), having difficulty in understanding what was said, difficulty remembering numbers or groups of numbers like phone numbers, addresses, birthdates, and so on. These symptoms can range from mild to severe and can be very disruptive, making work and everyday tasks challenging.

How long does it last? MTBI can completely clear up in 2 to 6 months without problems or, it can hang on for 2 years or longer, and may even become a permanent residual from the car crash. In one study, continued problems after a 2 year time frame were reported in close to 20% of those injured 2 years earlier. This study suggests that about 1 out of 5 may continue to suffer with MTBI and the associated brain-related problems for at least 2 years following a car crash. However, another study reported the long term “higher cognitive function” (such as the ability to communicate through written or spoken language) is usually not affected by whiplash injuries. However, they preface that with by reporting that a more commonly injured group with more mild brain problems was found.

As chiropractors, we are trained to do a thorough history, orthopedic and neurological examination, and ask specific questions about mild traumatic brain injury. It is important to discuss this information with those suffering from whiplash injuries as frequently, MTBI patients think something is “…seriously wrong” and harbor unnecessary anxiety.

I Slipped a Disk – What Is That Exactly?

2011-05-02T05:00:00.002-05:00

“I was digging a hole in my garden and hit a rock with the shovel. After clearing the dirt from around the rock, I bent over and reached into the hole. I couldn’t get a good grip on the rock and had to twist my body to get my arm under it. As I started to move the rock, I felt something ‘give out’ in my low back and felt immediate low back pain, but it wasn’t terrible. Like a fool, I gave it another try but this time, the pain in my back was really sharp when I twisted to reach under it. Then, it felt like a knife stabbing me when I tried to stand up. Since then, I can’t stand up straight and pain is shooting down my left leg.”

The intervertebral disk is like a shock-absorber located between each vertebra in our spine extending from the tail bone to the upper neck. When healthy, your disks truly do function as shock absorbers. There are two parts to the disk – the inner part (called the nucleus) which is the liquid-like center and the outer part (the annulus), which is tough, laminated and rubber-like whose job is to hold the nucleus in the center of the disk. The annulus has concentric rings which look similar to the rings of an oak tree trunk and the strength of these laminated rings is due to the fibers crisscrossing, creating a self-sealing, secure border for the nucleus center. In spite of this great anatomical structure, our disks degenerate and can crack or tear allowing the more liquid-like nucleus to leak out of the annulus creating the classic “slipped disk” (technically referred to as a herniated or ruptured disk). When the herniated disk presses into the nerve that goes down the leg, pain is felt along its course and can radiate all the way to the foot. There are five vertebrae and disks with a pair of nerves that go into each leg and depending which disk ruptures, pain will follow a different course down the leg, which is why we ask you if you feel the pain more in the back or in the front of the leg. When the disk tears prior to both disk herniation and leg pain, low back pain occurs because the nerve fibers that are normally only located in the outer third of the disk grow into the central portion of the disk, making it generate more pain.

So now for the important question, “…what can I do for it?” When you visit our office, we will ask you about how you injured your back. Often, the cause of a herniated disk can be the accumulation of multiple events over time. It certainly can happen after one major event, like our example of lifting a rock out of a hole, but that is usually the “straw that breaks the camel’s back” and not the sole cause. Many researchers have reported it is rare for a healthy disk to herniate. Rather, disk degeneration with tears already present sets up the situation where a bend plus a twist, “…finishes the job.” The orthopedic and neurological examination will usually clearly identify the level of herniation. Chiropractic Health Center offer a free exam to determine if you would be a candidate for Non-Surgical Spinal Decompression, some form of spinal manipulation or mobilization, extension exercises, physical therapy modalities like electric stimulation, low level laser, or ultrasound, and ice therapy. Core / trunk strengthening and posture management are also commonly applied and, proper bending/lifting/pulling/pushing techniques are taught.

Our DRX Program is an excellent solution for herniated & bulging discs. You can check out our websites for more information about the DRX 9000 @ both-hannanwellness.com & ladrx9000.com.

Fibromyalgia: The Challenges of Diagnosis!

2011-04-28T05:00:00.000-05:00

Fibromyalgia (FM) is a chronic condition where there is widespread / whole body pain that is often difficult to diagnose. Some patients may spend years of going to different doctors, undergoing many tests (of which most, if not all, are “negative”), and they may be diagnosed with different conditions such as rheumatoid arthritis, hypothyroidism, or mononucleosis before a diagnosis of FM is finally given. Needless to say, this process can be very frustrating!

The reason for this dilemma is that there is no single diagnostic test (blood test, x-ray/image finding, etc.) that verifies the diagnosis of FM, leaving doctors in a position to “rule out” all other possible “diagnose-able” conditions first, before considering FM as “the” diagnosis. Another challenge is the fact that FM symptoms vary widely from one person to the next and even vary within the same person at different times of the year. There are a few “guidelines” doctors can use to help secure the diagnosis of FM.

One such guideline is from The American College of Rheumatology (ACR) which requires that “widespread” pain be present throughout the body for at least 3 months (“widespread” is defined as pain on both sides of the body, above and below the waist). The ACR also has identified 18 points on the body of which at least 11 of the 18 “tender points” must be present to secure the diagnosis of FM. There is debate as to the accuracy of this rather stringent criteria as FM symptoms can come and go and vary, making the 11 of 18 tender point findings sometimes change between visits. Hence, widespread pain above/below the waist on both left/right sides of the body for at 3 months has become a more accepted indicator for diagnosing FM.

Yet another challenge in pinning down the diagnosis is that the FM sufferer may experience signs and symptoms seemingly unrelated to FM, such as stomach ache/digestive problems or headaches. This can lead the doctor down other paths before considering FM as a diagnosis.

Fibromyalgia can be primary (no other condition caused it) or secondary (other condition(s) lead to the development of FM). Hence, the diagnosis process focuses on identifying conditions which can be identified through standard diagnostic tests, often overshadowing the diagnosis of FM. Testing for conditions such as lupus, multiple sclerosis, sleep apnea, diabetes, Crohn’s Disease, and/or others, often makes sense to both you and your doctor, but adds to the delay in diagnosing FM. Here are some suggestions to help your doctor through this diagnostic maze:

• Ask questions: Ask about what each test is for and what the next plan is if the tests are negative. By increasing your understanding, this will reduce your frustration in this process.
• Keep records: Obtain a copy of EVERY test you have and share the information with any new doctor or specialist. This can save time and money!
• Find the “right” doctor: Find a doctor you can trust and “talk to.” Not all doctors “believe” FM exists and some are close minded to considering it. Try to locate a doctor with a lot of experience with FM cases and is willing to “…work with you.”
• Build a good relationship: Be open, honest and avoid anger, skepticism and don’t be confrontational. Be upfront about what is frustrating you about your symptoms.
Take care of yourself: Ultimately, “success” of treating FM demands a “team” effort between you and your doctor. Managing stress (eg., deep breathing exercises), obtain care that works (eg., chiropractic, massage), eat a healthy diet

Carpal Tunnel Syndrome & Chiropractic

2011-04-27T05:00:00.001-05:00

“When I try to thread a needle, button my shirt, or crochet, I can’t seem to feel my finger tips. I’ve also noticed when unscrewing jars, my grip feels weak. In fact, I almost dropped a cup of coffee the other day. I wake up 3-4 times a night and I have to shake my hand and flick my fingers to wake them up. Gripping the steering wheel is becoming a challenge and I have to change hands frequently while I drive. I’ve had this off and on for the last 5 years but this last year it seems to be getting worse. I’m really getting concerned. Can you help me?”

If this history sounds familiar, you may be suffering from carpal tunnel syndrome or CTS. It’s a very common disorder affecting millions each year. Its also one of the biggest problems for certain types of industries such as meat packaging plants, textile manufacturers, and virtually any job that requires fast, repetitive movements commonly used on assembly lines in many lines of work.

CTS is the result of pinching of the Median Nerve as it travels from the neck into the arm, through muscles in the forearm and into the hand through the carpal tunnel. Pressure on the nerve at any of these locations can create the symptoms of CTS. This tunnel is quite small in size and included inside the tunnel are 9 tendons, blood vessels, and the median nerve. When the muscles of the forearms and hands are overworked, they inflame and swell. Because the carpal tunnel is normally so tight, the increased swelling inside the tunnel pushes and pinches the median nerve creating the classic pain, numbness, tingling, and sometimes burning sensations often described by people suffering with CTS.

Certain situations make people more vulnerable or prone to develop CTS. CTS is more common in woman than men by 3 or 4:1. This is partially because women’s bone structure is smaller and therefore their Carpal Tunnel is smaller too.

Women also experience fluid retention or build up during menstruation leading to symptoms like swollen fingers and swollen and painful breasts. Swelling in the already tight, confined space of the carpal tunnel will increase their susceptibility for developing CTS. Another hormone related cause or contributing factor is the use of birth control pills (BCPs). Since there are many different types of BCPs and each woman is unique and different, finding the BCP with the “right balance” of hormones where the swelling side effect is minimized is very important and should be discussed with the doctor who prescribed the BCPs.

Age (>50 years) is also a risk factor and with our aging work force, this is becoming a big issue. Other conditions like hypothyroid, diabetes, certain types of arthritis, and hypertension / congestive heart failure where an increase in fluid retention occurs can also increase the chance of developing CTS. Obviously, occupation type plays an important role as previously mentioned. Many jobs today require the use of computers and we’re finding the position of the monitor, the keyboard and mouse, are very important.

Chiropractic management of CTS includes wrist, forearm/elbow, shoulder and neck adjustments, corrective exercises, the use of night splints, and an anti-inflammatory diet. Also, correcting the “ergonomic factors” or, job-related causes is of utmost importance. This is why a chiropractor who treats all of these areas and has the specialized knowledge about CTS is the perfect choice of health care providers. If you, a friend or family member require care for CTS, we would be honored to render our services.

Whiplash – The Importance of Seatbelts!

2011-04-26T05:00:00.001-05:00

Whiplash is a very common problem afflicting millions of people each year. In fact, there are more than 6 million car accidents each year in the United States alone. Death associated with car accidents occurs every 12 minutes and each year, motor vehicle collisions (MVC) kill 40,000 people. For people aged between 2 and 34 years old, MVCs are the leading cause of death. Another sobering statistic is somebody is injured in a car crash every 14 seconds and about 2 million people receive permanent injuries in car crashes each year. Over a five-year period, over 25% of ALL drivers were involved in a motor vehicle collision. The cost of car accidents averages $1000 for each American per year resulting in a $164.2 billion total cost each year in the United States. Approximately 250,000 children are injured and car crashes, meaning approximately 700 kids are injured daily. Car crashes are the leading cause of acquired disability. Hopefully, these rather startling statistics have gotten your attention. Last month, we discussed various effective ways of reducing the likelihood of even being in a motor vehicle collision (MVC). As an appropriate follow-up, this discussion will cover seatbelts and their role in injury prevention and life-saving capabilities.

In general, the available evidence available is clear – seatbelts save lives! Regarding backseat passengers, wearing a seatbelt is 44% more effective at preventing death than riding unrestrained. Similarly, for those positioned in the rear of a van or sport utility vehicle, the use of rear seatbelts is 73% better at preventing a fatal outcome during a car crash. In more than one half of all fatal car accidents, the victims are not properly restrained. The National Highway Traffic Safety Administration (NHTSA) in 2008 reported the use of seatbelts increased 1% over 2007 with 83% of drivers wearing their seatbelts. The use of seatbelts increased to 90% on highways versus 80% on surface streets (in town). In states where rear seatbelts are required, 85% of adult backseat passengers complied versus states not mandating rear seat seatbelt use where only 66% of the passengers complied. The NHTSA has launched a campaign, "Click It or Ticket" and has provided a guide to seatbelt safety promoting the proper use of the seatbelt and have provided the following safety seatbelts tips:

• Make sure your seat belt fits snugly. Seat belts worn too loosely can cause broken ribs or injuries to your abdomen.
• Place the lap belt low on your hipbones and below your belly. Never put the lap belt across your belly.
• Place the shoulder belt across the center of the chest between the breasts.
• Never slip the upper part of the belt off your shoulder. Seat belts that are worn too high can cause broken ribs or injuries to your belly.
• The most effective safety protection available today for passenger vehicle occupants is lap/shoulder seat belts combined with air bags.

There is a common myth that seatbelts cause injuries at low speeds and therefore, it is better to not wear the seatbelt when simply traveling in town. There is overwhelming evidence in almost all circumstances, seatbelts save lives, even at low speed collisions. Because the forces that occur in low-speed crashes are transferred to the contents due to the lack of crushing metal and less vehicle damage, the occupants of a car struck at a low speed can be thrown about significantly… striking the windshield, side window and other contents inside the car. 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 whiplash, 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

2011-04-25T05:00:00.001-05:00

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.

Fibromyalgia & Chiropractic Care

2011-04-21T05:00:00.001-05:00

Do you wake up feeling tired, washed out, and dragged down? Do you have generalized pain throughout your body that doesn’t seem to respond to anything you’ve tried? Do you wake up multiple times a night and fight getting back to sleep? These are classic symptoms of fibromyalgia (FM). However, when caught early and treated appropriately, FM can resolve or at least be controlled. Chiropractic care and management of FM is very effective and is becoming increasingly popular among FM sufferers. The goal of managing FM is to return you to a productive, enjoyable lifestyle allowing you to function and perform all of your desired activities.

Chiropractic care is the most popular and sought after form of alternative care or complementary medicine as 20% of American men and women utilize chiropractic care at some point in their lives. Of all the health care options, few have been found to be as satisfying to their patients as chiropractic with 80% of those seeking chiropractic treatment reporting significant pain relief, better functioning and an increased sense of wellbeing. Still, many ask questions such as, what is the science behind chiropractic and, what exactly does a chiropractor do?

The original hypothesis or theory of chiropractic that led to its founding in 1895 is that skeletal or bone misalignments cause nerve interference resulting in pain, loss of function, and a host of other symptoms related to the nervous system. The entire body is connected through bones, joints, muscles, ligaments, tendons, with their supporting circulatory or blood flow system and nervous system. When the skeletal structure is in good alignment, the body can handle the many stresses and challenges we all face on a daily basis. When there is a breakdown in this system, symptoms manifest and when left untreated, these symptoms can develop into chronic pain, including conditions such as fibromyalgia. Chiropractors focus to reduce pain and the many other symptoms by correcting the imbalances in the skeletal system with the objective of reducing nervous system dysfunction. Many of the techniques utilized in chiropractic care include manipulation of not only the bony structures, but also the muscles, tendons, and ligaments through various forms of manual or hands-on therapy, stretching, posture correction methods, exercise, lifestyle modification recommendations including diet and nutritional management, and activity modifications. Chiropractic care also includes discussions and instructions for modifying methods of performing tasks including bending, lifting, pulling, pushing in both at work and home activities. Work station modifications are also thoroughly investigated, especially when symptoms are consistently worse after the work day.

Patients with fibromyalgia classically have generalized pain and tender spots throughout their body and often present with back pain, neck pain, headaches, as well as arm and/or leg pain. Chiropractic care can effectively reduce the pain associated with FM by reducing bony misalignments, restoring muscle tone, and improving posture. Proper exercise training has been found to be very important in maintaining long-term control of FM and is included in the management of FM. Diet and nutritional counseling may also be beneficial. Research has been very supportive of chiropractic care for patients suffering from FM.

We recognize the importance of including chiropractic in your treatment planning and realize you have a choice of providers. If you, a friend or family member requires care for FM, 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.

Carpal Tunnel Syndrome (CTS) – It's Rush Hour!

2011-04-20T05:00:00.001-05:00

Do you recall the last time you were driving along the highway and suddenly, traffic came to a screeching halt? After sitting in your car, waiting impatiently for any movement, you eventually arrive at the cause of the congestion – 4 lanes of traffic funneled into one lane, due to road construction. The fact it’s rush hour makes the whole issue more understandable but not less frustrating. On your next trip through the construction zone, you make sure to avoid rush hour and you fly through without hesitation – because its 2pm rather than 5pm.

So what does this have to do with CTS? This analogy depicts what essentially happens when CTS occurs. Picture an assembly line worker packaging cookies. The cookies come out of the oven 6 rows deep at a rapid pace. There are normally 6 people working the line, 3 on each side, but for the last two weeks, one of the workers has been out on maternity leave and no one was assigned to that position… leaving 5 workers doing the work 6 people usually share. Let’s say, conservatively, there are 25 cookies packaged per minute. In 60-minutes, 1500 cookies (25x60) are packaged; in an 8 hour day 12,000 cookies are packed, and in a 40 hour work week, 48,000 cookies are packaged (by each worker)! That’s a lot of fast, repetitive movements requiring bending forward and reaching, gripping, and moving the cookies into a tray and then stacking the trays.

If there are workers absent or the employer decides to speed up the line and force overtime, most of the workers will reach their limit and hurt. Especially those with other problems that make them more susceptible to CTS like low thyroid function, diabetes, obesity, age over 50, inflammatory arthritis, when taking birth control pills…..you get the picture!. Hence, when working too fast, just like when there are too many cars on the road during rush hour, the fast paced work inflames the tendons in the carpal tunnel and pinches the nerve. This creates pain and numbness/tingling that either slows the worker down or completely forces him/her to have to take time off from the job. When working at a slower, more comfortable pace, there is less friction between the carpal tunnel tendons and, therefore, no or significantly less nerve compression and CTS signs or symptoms, just like driving through the construction site without slowing down when avoiding rush hour.

Why is this? CTS occurs frequently in people who perform fast, repetitive hand movements like our cookie factory worker. That’s because there are 9 tendons attaching the muscles located in the upper forearm (on the palm side) to the fingers in the hand. These tendons travel very close together, especially as they pass through the carpal tunnel of the wrist. These tendons allow us to pick things up (grip and pinch), shake hands, hold babies delicately and function normally in our daily activities. As these 9 tendons pass through this tight tunnel, when it’s “rush hour” or, when fast, repetitive work is occurring, these 9 tendons rub together and they heat up, swell and the pressure inside the tunnel increases. Because the nerve (median nerve) passes through the same tunnel, as the tendons swell, the nerve is pinched or pressed up against the border of the tunnel and numbness / tingling occurs into the palm and fingers 2-4. We find ourselves dropping things, having a hard time buttoning clothes, threading a needle, opening jars, holding onto a steering wheel, and frequently, we wake up at night needing to shake and flick our fingers to “…wake them up.”

Because these symptoms gradually appear, we usually don’t run to our doctor until several months (and sometimes years) after the symptoms have been present. This makes it more challenging to treat CTS and all patients with these symptoms are encouraged to seek treatment as soon as problems start. There are frequently other problems in the neck, shoulder, and elbow because we tend to compensate, move differently and use other muscles when there is pain so the elbow, shoulder and neck become involved and require attention. This is why a chiropractor who treats all of these areas is the perfect choice. If you, a friend or family member require care for CTS, we would be honored to render our services.

Whiplash – Cell Phones & Other Driving Distractions!

2011-04-19T05:00:00.001-05:00

Whiplash is caused by a sudden movement of the head, usually caused by a motor vehicle collision (MVC) but it can also occur in sports and from slip and fall injuries. The combination of the weight of the head (approximately 15 pounds) and the length and strength of the neck predisposes the neck to be injured when a sudden force is applied. This is also caused by the fact the neck muscles cannot tighten quick enough to prevent injury in these types of injuries. People with slender necks (i.e., women > men) are more prone to injury.

The purpose of this article is to discuss some VERY effective ways to reduce the likelihood of being in a MVC of which the obvious include don’t drink and drive, don’t use your cell phone and drive, and don’t “text” on your phone while driving. Instead, use a hands-free phone or better yet, pull over to talk as you can’t concentrate or fumble around dialing/texting, and still pay proper attention to what you’re supposed to be doing – that is, driving!

According to a study conducted by the University of Utah, the distraction resulting from talking on a cell phone when driving is more significant than being intoxicated (0.08% blood-alcohol). Driving inattentively is estimated to be a factor in 20-50% of all police-reported MVC’s of which 8-13% are caused by driver distractions (cell phones is estimated to be 1.5-5% of that). One study reported both hands-free and hand-held cell phones were similar, reducing the driver response time to about a 40th percentile compared to a “normal driver.”

It’s believed the “cognitive workload” or, the “thinking” part during conversation causes the primary distraction, not the use of the hands. When compared to talking with a passenger, the University of South Carolina reported planning to speak put far more demands on the brain than listening. Talking to other passengers or on a cell phone are not the only or, the most common of the driving distractions.

The two most common causes of distraction-related accidents are “rubbernecking” (looking at outside objects/events) and adjusting the car radio/CD player. Cell phone use was reportedly 8th on that list. The use of a cell phone to text is limited because it is relatively new. However, a preliminary report from the University of Utah found a 6-fold increase in distraction related accidents when texting. The obvious concerns include the eyes off the road and in some cases, the hands off the wheel required for texting/email. Of interest, about 50% of drivers between 16 and 24 years of age compared to 22% of 35-44 year olds have admitted to texting while driving. Some recent highly publicized MCV’s caused by texting drivers include a May 2009 Boston trolley car driver and, the 2008 Chatsworth train collision that killed 25 people.

A July of 2009 Virginia Tech report of video footage of 200 long haul truck drivers who drove over 3 million combined miles, reported 81% of safety critical events involved driving distractions. They found texting had the greatest relative safety risk at 23 times more likely with their eyes being off the road for 4.6 out of a 6 second during a safety critical event. Another significant cause of driver distraction is drowsiness, which increased the driver’s risk of a crash or near-crash by 4 times, reaching for a moving object increased the risk by 9 times, looking outside/rubbernecking = 3.7 times, reading = 3 times, applying makeup = 3 times, dialing a cell phone = 3 times and talking or listening on a hand-held devise = 1.3 times. Eating while driving is also a risk.

As a service to you, we would appreciate it if you would share this information with family and friends so we can all drive more safely and live longer, healthier lives! 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 whiplash, chiropractic care is a logical first choice and we would be honored to offer our services to you.

Low Back Pain – Seasonal Injuries

2011-04-18T05:00:00.001-05:00

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.

Fibromyalgia – What Exercises Should You Do?

2011-04-14T05:00:00.009-05:00

Fibromyalgia (FM) is a chronic condition that gradually interferes with many aspects of one’s life. The challenge of treating FM is finding the right combination of approaches that positively impacts the structural, emotional, and chemical aspects of the body in such a way the FM patient can function “normally” in day to day activities. Exercise is one of the most important methods patients can use to successfully reach these goals.

First, because FM is a condition that is currently thought to affect the central nervous system where the threshold of reaching pain levels is lower than normal, pain is perceived when is shouldn’t normally be noticed. Therefore, the KEY to exercise integration is to start out SLOWLY and CONSISTENTLY. It is more important to work out in a way that muscles and joints can gradually accommodate to the new activity or movement. Many patients with FM are afraid to exercise for fear of hurting worse than they already do. In fact, many will report that, “…every time I exercise, I feel worse so I just don’t do it.” When asked what types of exercises they’ve tried, it becomes clear it wasn’t the exercise but rather the dose or amount of exercise they engaged in (often overdoing it) that made the next 48-72 hours quite uncomfortable with post-exercise soreness.

Second, is to choose a type of exercise you enjoy so it's more likely you'll stick with it. Popular exercise options include yoga, Pilates, biking, swimming, and walking. These exercises can also be combined. For example, one might perform 15 minutes of yoga, followed by a 15 minute walk on a daily, consistent basis. The use of an exercise bike and/or a treadmill, stepper, or elliptical type of exercise equipment allows you to monitor heart rate, speed, and other data that allows you to compare yourself between sessions. One of the new "kids on the block" exercise options includes the Wii-Fit which offers a scoring system with various types of exercise. This type of biofeedback can be educational, rewarding, and motivating as it helps you appreciate the benefits and improvements you've made over time. Pick a time of day when you can be consistent with the exercises so you’re not “fitting it in” your busy daily schedule – make it part of your daily routine, similar to brushing your teeth or taking a shower. The morning or evening may work best but many find a noon hour break a good time to exercise, as well.

Third, as you start to feel more in shape, gradually increase the intensity of the exercises. You may exercise for the same amount of time, say 30 minutes, but you’ll do a more intense work out such as walking faster, farther, or increasing the pace of the yoga, Pilates, swimming, etc. Try not to be too intense (over aggressive) or do too little (under aggressive). You know your personality better than anyone else – hold yourself back if you tend to be overly aggressive or, push yourself if you tend to be overly cautious. Expect the first 3-5 times you exercise to be challenging with associated post-exercise soreness but know you will adapt to the process.

The benefits of adding a well designed, graduated exercise program include: 1) strengthening ligaments, muscles, tendons and improving muscle tone; 2) increasing flexibility; 3) increasing blood flow to the muscle tissue; 4) increase endorphins-a morphine-like substance that has a natural pain relieving and sleep deepening effect that can help curb anxiety, depression as well as pain associated with FM; 5) reduces the risk of high blood pressure, high cholesterol, diabetes heart disease and stroke; and 6) promotes weight loss/control which in turn, reduces stress on your muscles and joints.

We recognize the importance of including chiropractic in your treatment of FM and realize you have a choice of providers. We would be honored to be part of your management team.

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

2011-04-13T05:00:00.000-05:00

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.

Chiropractic Treatment of Whiplash

2011-04-12T05:00:00.001-05:00

Whiplash is basically an injury to the muscles, the muscle attachments (tendons), ligaments, and sometimes the nerves that exit the cervical spine. The degree of injury is highly variable and depends on many factors, some of which include gender/body size (slender woman are especially at risk), awareness of the impending collision, head position at time of impact, the angle of the seat back (bent back is worse that upright), the position of the headrest (too low is common), the amount of vehicle damage (less damage can be worse due to energy transferred to the contents/occupants), the speed of the collision, and many others.

Therefore, when discussing the treatment approaches used by chiropractors, it is not appropriate to generalize since each case is so unique. With that said, when a whiplash patient visits a chiropractor, the first step is obtaining as much information as possible. A thorough history and examination are important in determining the treatment plan and help to determine severity of the injury. Chiropractors often offer different types of treatment that may include: manipulation, physical therapy modalities such as muscle stimulation, relaxation, ultrasound, low level laser therapy, cervical traction, and others. Spinal manipulation (often referred to as an adjustment) addresses joint dysfunction and can be performed with one of several approaches. The first and quite common approach uses a high velocity, low amplitude (quick) approach where joint cavitation (the “crack”) often occurs. Another approach is a low velocity, low amplitude technique where mobilization is used, which is more of a stretch to the end-range of intersegmental (between the vertebrae) motion and rarely, is there joint noise/cavitation. Varying degrees of “amplitude” or, the degree of stretch can be used, depending on patient comfort.

Muscle relaxation or stimulation is performed for muscle dysfunction, which may include relaxation or stimulation techniques. Gentle stretches to a muscle that has excessive tightness or, repeated contractions of a weak (“inhibited”) muscle is also commonly utilized and very helpful when muscle dysfunction is present.

Exercises are frequently prescribed by chiropractors. An example includes the McKenzie exercises, while others include stabilization and sensorimotor exercises. These are taught in a supervised manner and when it is safely performed and understood, they can be performed at home, work, outside the office setting. It may require a few sessions to ensure accuracy of the exercise performance. Because of muscle spasm, joint dysfunction, and pain, patients often develop faulty postures or compromised movements that become “bad habits.” To break these “bad habit” positions/postures, stabilization and sensory-motor retraining exercises can be very helpful. These exercise retrain the nervous system to achieve better coordination and control movements and to maintain stability of the weakened neck muscles.

Advice on bend/lift/pull/push and/or work related activity is extremely important in order to avoid repeat exacerbations or “flare-ups” if not properly dwelt within the clinic. Advice on recreational and home related activities is also very important for the same reasons.

The chiropractic whiplash treatment plan is unique for every individual person given the significant number of variable initially discussed. One or more of the approaches discussed may be utilized. If needed, chiropractors often partner with other doctors if there are medication or surgical requirements. If you, a loved one, or a friend is struggling with whiplash residuals from a motor vehicle collision, you can depend on receiving a multi-dimensional chiropractic assessment and therapeutic approach at this office. We sincerely appreciate your confidence in choosing our office for your health care needs!

Spondylolisthesis - What Is That?

2011-04-11T05:00:00.001-05:00

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.

Fibromyalgia – Does This Sounds Familiar?

2011-04-07T05:00:00.001-05:00

“I am exhausted and hurt all over. I can’t get to sleep at night and when I do, I wake up at the drop of a dime. I went to my doctor and they ran some blood tests and took some x-rays and said that nothing was wrong. I just don’t know what is wrong or what to do about it.”

This is a classic history obtained from a patient suffering from fibromyalgia or FM. Because the onset of fibromyalgia is slow and gradual, it is common for patients to postpone visiting their health care provider until the symptoms are quite significant. The diagnosis may also be delayed as many healthcare providers do not feel fibromyalgia is a legitimate medical condition and minimize the symptoms frequently categorizing them as "depressed," which postpones an appropriate diagnosis and treatment.

The classic definition as defined by the American College of Rheumatology includes at least a three-month duration of symptoms with the presence of 11 out of 18 potential tender points although diffuse, widespread pain not necessarily restricted to these exact locations may also represent an appropriate diagnostic finding in fibromyalgia.

Fibromyalgia is more common in females and affects approximately 2% of the population in the United States. The risk of developing fibromyalgia increases with age, usually developing during early and middle adulthood but can also develop in children and older adults. Other risk factors include a positive family history where one may be more likely to develop FM if a relative suffers with the same condition.

A major risk factor of developing fibromyalgia includes is disturbed sleep pattern and this remains controversial as to whether sleeping disorders are a direct cause or simply the result of fibromyalgia. However, in either case, people with FM cannot obtain deep "restorative" sleep and feel fatigued and tired upon waking in the morning. Sleep disorders including sleep apnea and restless leg syndrome are often present in patients with fibromyalgia.

Certain conditions such as rheumatoid arthritis, irritable bowel syndrome, hypothyroid, and other endocrine/hormonal conditions may preceded the onset of fibromyalgia in which case the condition is considered "secondary fibromyalgia." Hence, a diagnostic evaluation usually includes a blood test for hypothyroid, autoimmune diseases such as rheumatoid arthritis, and a complete blood count to rule out infections and/or anemia. In most cases, these tests prove negative and the diagnosis is made by excluding other possible primary conditions.

Other causes can include physical and/or emotional trauma where a high-level of stress can trigger this condition. Although experts still debate why patients with fibromyalgia hurt so intensely, the current explanation centers around a theory called central sensitization. This is essentially a lower pain threshold where patients with FM feel pain much sooner than those without it because of increased sensitivity in the brain and/or spinal cord to incoming pain signals.

Treatment of FM relies on a multidiscipline, multifactorial approach including stress reduction, obtaining enough sleep, exercising regularly, pacing yourself, and maintaining a healthy lifestyle, including diet and exercise. Medications to facilitate sleep, treat depression and any other underlying medical conditions may be appropriate. Other highly effective treatments, according to the Mayo Clinic website, include chiropractic treatment, massage therapy, and/or acupuncture. The concepts of chiropractic treatment includes restoring movement in restricted spinal joints resulting in improved nerve function and subsequently, improved overall function and reduced pain. Chiropractic care also includes soft tissue therapies, physical therapy modalities, nutritional counseling, patient education and many utilized in-house massage therapy. We recognize the importance of including chiropractic in your treatment of FM and realize you have a choice of providers. We would be honored to be part of your management team.

Carpal Tunnel Syndrome (CTS) What Are My Options?

2011-04-06T05:00:00.001-05:00

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.

Whiplash and Work

2011-04-05T05:00:00.001-05:00

Does this sound familiar? It’s fictional but a rather typical scenario affecting thousands of American drivers:

“Last week, I was waiting at a red light and a car came up from behind and ran into the back end of my car. It was a low speed collision without a lot of damage to either of our cars. Surprising, I felt quite a jolt and my head even hit the headrest. I didn’t bother getting the name or phone number from the person that hit me because I didn’t hurt at the time and besides, there was no real damage that I could see to my car or the other person’s car.

“About a half hour later, I noticed my neck felt stiff when I turned to check traffic on my right and I felt really sharp pain before I could turn the whole way. The pain was bad enough to make me yell and when I brought my head back to the front, the pain didn’t go away – in fact it felt worse. When I woke up the next day, I could hardly turn my head at all and, I had a terrible headache. The pain was so bad that even 4 Advil didn’t touch it.

“I couldn’t decide what type of doctor to see for this. I knew if I went to my family doctor, he’d put me on a bunch of pills but I have to drive forty five minutes to my job and I have two small kids that require my attention. I had seen an ad for a chiropractor a while back and I wondered what they would do for something like this. I knew I had to do something and fast!

“So I decided to go to a chiropractor a friend of mine recommended and I was really surprised when I got there. The doctor was really attentive and seemed to know exactly what was going on. It was explained to me that I may have been hurt MORE than I might have been had the speed of the other car been going even faster because crushing metal absorbs the shock where in my case, no car damage resulted in more shock to me. This made sense because I had some books on the other seat that flew off when I was hit, which I forgot about until we were talking. I also learned that even if I knew I was going to get hit, I wouldn’t have been able to brace myself enough to avoid injury as the speed of the force moves the head and neck quicker than what I can tighten my muscles. The chiropractor showed me some charts that helped explain all this and why my neck hurt and where the headaches come from. I also learned NEVER assume no car damage means no injury.

“The best part was right after the adjustment, I felt immediate improvement with better movement and less pain. I also was told to put ice on my neck, which helped a lot more than heat did. I’m now doing exercises and really feel good! I can’t tell you how happy I am that I chose a chiropractor to help me!”

Patients who have similar experiences are afraid of having a long, drawn out problem and missing work. You have many choices when it comes to choosing a health care provider for your injury and other health care needs. I truly appreciate your trust and confidence in our service when choosing to visit my clinic when you need help!

Low Back Pain (…or is it?)

2011-04-04T05:00:00.001-05:00

Have you ever had leg pain and immediately blamed your low back? Me too! Many patients (and unfortunately, many doctors) conclude this to be “sciatica” or a “pinched nerve.” When this diagnosis is wrong, it can lead to an inappropriate type of treatment, delaying appropriate care, or worse, it may result in death due to a missed diagnosis of a blood clot. There is currently a government campaign seeking to warn the public about this hard-to-diagnose 'silent killer.'
Here’s the news flash that was recently released (updated 8:28 a.m. CT, Mon., Sept. 15, 2008): “WASHINGTON - Far too many Americans are dying of dangerous blood clots that can masquerade as simple leg pain, says a major new government effort to get both patients and their doctors to recognize the emergency in time.”
"It's a silent killer. It's hard to diagnose," said acting Surgeon General Dr. Steven Galson, who announced the new campaign Monday. "I don't think most people understand that this is a serious medical problem or what can be done to prevent it."
Blood clots make headlines when seemingly healthy people collapse after prolonged sitting, such as long airplane flights or being in similarly cramped quarters. Vice President Cheney suffered one after a long trip last year. NBC correspondent David Bloom died of one in 2003 after spending days inside a tank while covering the Iraq invasion.
According to the Surgeon General’s new campaign, there are about 100,000 deaths associated with blood clots each year. Risk factors include increasing age (especially over 65), recent surgery or fracture, falls, car crashes, prolonged bed rest, smokers, obesity, pregnancy, and hormone replacement drugs including birth control pills. Other less controllable causes can include genetic conditions so it is important to tell your doctor if a relative has ever suffered a blood clot.
People with these factors should have "a very low threshold" for calling a doctor or even going to the emergency room if they have symptoms of a clot, said Galson, who issued a "call to action" for better education of both consumers and doctors, plus more research.
Symptoms include swelling; pain, especially in the calf; or a warm spot or red or discolored skin on the leg; shortness of breath or pain when breathing deeply. Unfortunately, studies suggest only a third of patients who need protective blood thinners for major surgery get them. And patients can even be turned away despite telltale symptoms, like what happened to Le Keisha Ruffin just weeks after the birth of her daughter, Caitlyn. In her case, after being turned down by several visits to the doctor and ER, only after a very hot bath did her leg swell to 3-4 times its normal size, tipping off the doctors to make the right diagnosis.
Don’t wait for your medical doctor or our office to make the diagnosis if you’re suspicious of a blood clot. Ask us if it’s a possibility. Rest assured that we have been properly trained to diagnose this condition and we work with other health care providers when needed.

Fibromyalgia – Important “Fibro Facts”

2011-03-31T05:00:00.001-05:00

So you think you may suffer from Fibromyalgia (FM) and you’re trying to find out more information about FM…..but where do you start? Certainly you can “Google” the word “fibromyalgia” and spend the rest of the day, week, or maybe month reading about the symptoms, clinical signs, the many treatment options and the different types of doctors who treat FM patients. You will certainly learn a lot! But you will still most likely remain confused as to what to do about it.

First, what is fibromyalgia? It is a chronic (long standing) painful condition resulting in widespread pain throughout the body and it’s usually difficult to isolate a cause or reason for such significantly disabling symptoms. It is very common, affecting 3-6% of the general population (global) and 6-12 million Americans (2-4% of the US population). Woman are affected more than men (75-90% are women), and it is typically diagnosed between 20-50 years of age. It affects people physically, emotionally, and socially. The symptoms can fluctuate but it never completely disappears. The cause, though still debated, points to the central nervous system in which a “minor” pain signal reaching the brain is somehow magnified and perceived as more intense (this is called “central sensitization”). This makes the FM patient hypersensitive to normal stimulations like a hug or a when hitting a bump in the road with the car.

How is it diagnosed? Prior to 1987, it was not recognized by the AMA as an illness or cause of disability. In 1990, The American College of Rheumatology (ACR) reported the initial criteria for diagnosing FM. There are no blood tests, x-rays, biopsies, EEG’s, EMG’s or other tests for FM. Hence, a thorough history (frequently revealing fatigue, sleep problems, mental fog, depression, headache, and bowel problems) and examination ruling out other disorders is appropriate. Diagnosis includes a history of widespread, chronic pain and the presence of multiple tender points (at least 11 of 18) located all over the body.

What is the treatment? Pain management has been the focus and this can include medication, ice/heat, exercise, lifestyle adjustments, counseling when anxiety/depression are issues, dietary strategies, sleep management, but perhaps most important is education – about FM and how to “live with it.” That is, learning how to “control it” since no one has found the “cure.” Exercise in short durations of time by walking or swimming (not too strenuous). Expect post-exercise soreness so don’t overdo it initially, or you’ll be “convinced” you shouldn’t be exercising. Diet – avoid glutens/grains and emphasize fruits, vegetables, lean meats (grass fed chicken, beef, and fish), and consider nutritional support from a multiple vitamin, calcium/magnesium, fish oil (omega 3 fatty acids), Vit D3, and Co-Q10. Find a good “team” of doctors – chiropractic, family doc, and rheumatologist who YOU are comfortable with and who will work together for you. Don’t expect miracles – it may lead to disappointment.

Carpal Tunnel Syndrome and Risky Jobs

2011-03-30T05:00:00.001-05:00

Carpal Tunnel Syndrome or CTS, is one of many “repetitive strain injuries” or RSI’s and it’s one of the most common work place injuries, second only to low back pain! The term “Carpal Tunnel Syndrome” was first used in 1939 and since the 1950’s, this disabling overuse injury to the hand has been one of the most frequent work injuries reported. So, what jobs carry the greatest risk for developing CTS?

Basically, any job that requires fast, repetitive movements of the hands with little rest can be considered a potential “risky job.” A partial list of the causes of RSI’s including CTS are: stress, tension/tightness of the arm muscles, inflammation of the wrist tendons, repetitive movements like keyboard/mouse work, poorly designed workstations, poor posture including awkward wrist/hand positions required on the job, heavy lift/carry workloads, vitamin deficiencies, and neck / spine complaints. Couple these jobs with age > 50, and being female – especially if she takes oral contraceptives (as they retain fluids), during pregnancy or menopause.

Here’s a list of jobs we can consider “risky”:

• Typists: When typing speeds reach 60 words / minute, for 8 hrs a day, there can be up to 25 tons of pressure each day exerted in the wrist. Frequent breaks are NEEDED!

• Computer users: The proper position is feet flat on the floor (adjustable chair necessary), arms at the side with elbows bent slightly MORE THAN 90 degrees; sitting up “tall” in the chair (prop a pillow, water bottle, or rolled up towel behind your back if necessary), tuck in the chin (avoid chin poking), and MOST IMPORTANT – TAKE BREAKS AS NEEDED.

• Musicians: If you think about it, what task requires faster, repetitive movements of the fingers in awkward positions? For example, playing a flute. Or, how about piano, trumpet, saxophone, guitar, violin, drums... wait a minute! Just about every instrument requires awkward hand positions and fast repetitive movements! It’s no wonder a large percentage of musicians develop CTS / RSIs! Again, the secret is taking meaningful breaks and stretching and when it’s uncontrolled, come see us (but DON’T wait too long)!

• Line workers: There are many types of jobs where standing on a line while working in fast/repetitive environments such as assembling an engine, packing cookies, pushing wires into a harness, inserting screws, packing meat or fish, using vibrating tools, carpentry tasks such as screw driver use, hammering, sawing, lifting/carrying materials……..you get the picture! These jobs are notorious for CTS!

• Other RSI’s: include tennis elbow, golfer’s/bowler’s elbow, cubital tunnel syndrome (numbness in the pinky), de Quervain’s disease (thumb tendonitis), and sports injuries (sprains/strains). Postal workers, cake decorators, dentists and hygienists, as well as waiters are all at risk for developing CTS.

The bottom line is: 1. Take multiple breaks. 2. Work at your own pace. 3. Wear a wrist brace at night. (If recommended) 4. See a chiropractor (us!) to loosen up those tight hand, forearm, shoulder and neck joints and muscles to relieve nerve pressure. DON’T jump right to surgery – it’s the “last resort.”

We realize that you have a choice in who you are considering 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.

Whiplash – What is the Best Type of Treatment?

2011-03-29T05:00:00.001-05:00

Whiplash usually occurs when the head is suddenly whipped or snapped due to a sudden jolt, usually involving a motor vehicle collision. However, it can also occur from a slip and fall injury. So the question on deck is, which of the health care services best addresses the injured whiplash patient?

This question was investigated in a published study titled, A symptomatic classification of whiplash injury and the implications for treatment (Journal of Orthopaedic Medicine 1999;21(1):22-25). The authors state conventional [medical] treatment utilized in whiplash care, "is disappointing." The authors’ reference a study that demonstrated chiropractic treatment benefited 26 of 28 patients with chronic whiplash syndrome. The objective of their study was to determine which type of chronic whiplash patient would benefit the most from chiropractic treatment. They separated patients into one of 3 groups: Group 1: patients with "neck pain radiating in a 'coat hanger' distribution, associated with restricted range of neck movement but with no neurological deficit"; Group 2: patients with "neurological symptoms, signs or both in association with neck pain and a restricted range of neck movement"; Group 3: patients who described "severe neck pain but all of whom had a full range of motion and no neurological symptoms or signs distributed over specific myotomes or dermatomes." These patients also "described an unusual complex of symptoms," including "blackouts, visual disturbances, nausea, vomiting and chest pain, along with a nondermatomal distribution of pain."

The patients underwent an average of 19.3 adjustments over the course of 4.1 months (mean). The patients were then surveyed and their improvement was reported:

Group 1
24% Asymptomatic
24% Improved by Two Symptom Grades
24% Improved by One Symptom Grade
28% No Improvement

Group 2
38% Asymptomatic
43% Improved by Two Symptom Grades
13% Improved by One Symptom Grade
6% No Improvement

Group 3
0% Asymptomatic
9% Improved by Two Symptom Grades
18% Improved by One Symptom Grade
64% No Improvement
9% Got Worse

These findings show the best chiropractic treatment results occur in patients with mechanical neck pain (group 1) and / or those with neurological losses (group 2). The exaggerated group (group 3) was the most challenging and, the only group where a small percentage worsened. The good news is, the number of cases that responded well to chiropractic treatment (groups 1 & 2) far out number those that don’t (group 3). Hence, most patients with whiplash injuries should consider chiropractic as their first choice of health care provision.

Low Back Pain: Fix the Problem First and You Won't Need to Worry about the Pain

2011-03-28T05:00:00.001-05:00

It's gotten a bit confusing how we sometimes look at our health. When pain strikes the low back we usually think we just got a new problem or injury. But why then was coughing, shaving, or doing the laundry, so different this time? These are things we do everyday. Rarely is a new episode of low back pain brought on by a well-defined injury or trauma. Trauma in most cases is usually quite trivial. We confuse pain as a signal for something that is physically changing each time.

So what is the problem? The problem is joint sprain or subluxation. This is a ligament problem and occurs with small micro traumas over many years, or sometimes with acute events such as car accidents or falls. Over time the ligaments stretch, causing the joints and vertebrae to displace, irritating the delicate nerve fibers. But over a few days or weeks, the pain that accompanies this injury gradually lessens, and in many cases goes away all on its own. But has the problem also gone away? Likely not, because when ligaments are traumatized, the repair mechanism involves scar tissue, which is less elastic than the original, and makes the joint vulnerable to re-injury and sometimes impairs the free and symmetrical motion of the spine. The doctor of chiropractic examines for this type of joint sprain using palpation for tenderness and edema, and x-rays to see the directions the vertebrae have moved towards. These specific analyses can tell us the vulnerable directions and how the vertebrae need to be repositioned to promote good alignment and good posture.

The adjustment is designed to reduce this misalignment, and induce more symmetric motion. When movements are asymmetrical in the spine, they can lead to premature degeneration of the spine and arthritis. This may be why a simple task such as lifting a laundry basket can flare up the back so easily. You may be lifting with good form and posture but with an asymmetrical spine, the loading is very off balance. Sometimes the disks are so damaged that a simple sneeze is enough to cause excruciating pain. So when these trivial events seem to trip you up, it means there is an underlying problem that is not getting corrected.

Our office is always available for complementary consultations. Just call Crystal at 504.454.2000 to make an appointment to speak to a doctor of chiropractic-start getting at the problem...not just the pain.

Fibromyalgia: I Have It… Now What?

2011-03-24T05:00:00.000-05:00

“…I was told by my doctor that I have fibromyalgia and I don’t know what to do. I’ve noticed that over the last couple of years that I’ve been having a progressively harder time doing simple tasks that I used to take for granted like folding laundry, ironing, cooking, cutting up vegetables, sewing, driving a car, holding a book, and even sleeping has become very challenging. I have to take many breaks while I’m doing these tasks and even take a nap in the middle of the day. I never used to have to do that! My family doctor initially seemed interested in helping me. He listened to me, took some blood, took some x-rays, and then said ‘….everything looks fine.’ His conclusion was that I must have fibromyalgia – I’ve never even heard of that! He prescribed many different drugs. One was to help me sleep but all it did was knock me out to the point where I couldn’t get up in the morning and felt so groggy that I couldn’t function. Then, he tried this other one and I felt like I wanted to crawl out of my skin! I’ve tried 3 or 4 different drugs and the side effects were all worse than what I’m dealing with, without the drugs. He finally concluded, ‘…you’ll just have to learn how to live with it.’ Well, thank you very much, doctor! Tell me HOW to do that?”

That feeling of helplessness and not knowing what to do next is a common complaint among fibromyalgia (FM) sufferers and the fact is, many patients with FM simply CAN’T just “…learn to live with it,” and need guidance.

One such patient recently presented in such situation. After a detailed history, the chiropractor checked her vital signs, performed a physical exam that included observation, palpation, range of motion, physical performance testing, orthopedic and neurological tests and then sat down to discuss the findings and what specific things chiropractic could offer her. The chiropractor laid out a treatment that consisted of the following:

1. Leg length correction: she had a 12mm short right leg, a tipped pelvis with a compensatory curve in the low back. Heel lifts were recommended.
2. Foot orthotics: she had flat feet and rolled in ankles that were altering her gait pattern.
3. Exercises: she was quite deconditioned (out of shape) and needed help with flexibility, strength and endurance, balance/coordination, and aerobic function.
4. Spinal manipulation: She had areas in her spine that were not properly moving and she had to compensate and use other parts too much, setting up faulty movement habits.
5. Nutritional counseling: She was consuming too many glutens (wheat, oats, barley, rice) which can make you feel tire/fatigued/”wiped out” all the time. She was placed on a strict gluten-free diet and encouraged to use of several nutrients.
6. They discussed “realistic goals.” This was probably the MOST important part for her. She was told NOT to expect a “cure” but rather, a means of “controlling” FM. It was emphasized that expecting “too much” will set her up for disappointment and treatment failure. They discussed ways she could control or minimize the symptoms of FM and what the role of chiropractic played in that management process. They also discussed finding a family doctor who was willing to work with her chiropractor.

She is doing very well, independent of regular doctor visits, and is for the first time in a long time, happy with her ability to control her FM condition

Non-Surgical Treatment for CTS

2011-03-23T05:00:00.001-05:00

Carpal tunnel syndrome (CTS) is basically a pinched nerve on the palm side of the wrist. It is very common and symptoms can vary from periodic tingling to a debilitating disorder that can stop activities at home and work. The cause is usually gradual due to repeated movements, especially fast paced motions such as prolonged practicing of a musical instrument, typing, various hobbies (knitting, crocheting), as well as fast paced and/or firm gripping when assembling products on a line at work. Initially, symptoms can include tingling or numbness that gradually increases in frequency, intensity and duration followed by weakness in pinch or grip.

Because the symptoms can slowly and gradually appear, most people wait a while, sometimes years, before they seek treatment for CTS. It is important to recognize the initial signs and properly manage the condition AS EARLY AS POSSIBLE to avoid a potentially disabling CTS condition. Early treatment may be minimal and only require learning proper exercises or making minor activity modifications.

The following is a list of symptoms that should warn you to seek treatment for CTS: sleep interruptions due to numb hands/fingers (usually the 2nd, 3rd, and 4th fingers), the need to shake or flick your fingers, numbness with driving/holding onto the steering wheel, difficulty in buttoning clothing, dropping objects/weak grip or pinch, age over 50 (with these symptoms), and others. If you have other conditions such as diabetes, thyroid disease, obesity, hormone replacement/birth control pills or are pregnant, CTS is more common.

When you arrive at our clinic, we will conduct a thorough history and physical exam to determine if you are a candidate for non-surgical care. Treatment will include, along with restoring motion to the joints affected by the condition, advice on sleep (such as the use of a wrist splint at night), job/work station modifications (include working with your employer), teaching of exercises so you can help yourself in the treatment process, and other education approaches to help you avoid future episodes of CTS.

Because of the gradual onset of symptoms including finger numbness, wrist pain and/or loss of joint motion, the elbow, shoulder and neck often become affected and require treatment and exercise in order to obtain a good result. One exercise for stretching the forearm is performed by placing the palm of your hand on a wall in front of you (fingers pointing downward) while keeping your elbow straight. Then, reach over with your opposite hand, grasp your thumb and pull it back until you feel a “good stretch” in your forearm. Other exercises to the shoulder and neck may be appropriate and can be discussed. Most importantly, don’t wait too long after symptoms start! The faster you present to our office, the better the outcome of treatment will be.

YOU MAY BE A CANDIDATE FOR DRUG FREE RELIEF!
FOR A FREE NO-OBLIGATION CONSULTATION CALL 504.454.2000

Whiplash and Your Ligaments

2011-03-22T05:00:00.001-05:00

Most people who get a whiplash-like injury think it is caused by a problem in their muscles. It's easy to see this why this may be the case since muscle pain following car accidents is so common. Deep pain and even spasm can occur after severe trauma resulting in daily pain and even headaches. Since our 10-12 pound head is attached to our necks, by muscles that go into the shoulder region, whiplash can feel like a muscle pull and taking muscle relaxants seems a reasonable approach.

Although tears of muscles fibers do occur in whiplash, these can heal rather quickly due to the rich blood supply. The ligaments such as disks hold the joints of the neck together keeping the nerves from being pressed upon and stretched. These are the structures that are critically injured during whiplash. The muscles that contract to protect the joints from moving too much are generally less of a problem than when the ligaments are injured. A recent study (BMC Musculoskelet Disord 2006;21:103) showed that after whiplash, the strength of the neck ligaments is further reduced. This means that you are more susceptible to getting injured if you previously suffered a trauma.

To detect ligament injuries you can look at MRIs immediately after the trauma. In many cases they can show small tears or the inflammation and swelling that goes with tears of these important structures.

You can also have stress x-rays taken in the positions of forward and backward bending. These types of x-rays can show which ligaments have been traumatized and are allowing the bones of the neck to move too much. When this increased motion is severe, this is called instability. Some newer MRI machines can scan in different positions so that the tears and their motion effects are seen with one test. Some people may find the MRI scanner to be a bit restrictive or claustrophobic. X-rays are usually the most practical and least costly choice.

A thorough examination is needed following whiplash, including these stress x-rays. Neurological tests are also required to see if your nerves have been injured. Our office is always available to consult with you about your health concerns. Just call Crystal at 504.454.2000 to schedule an appointment. A proper care plan begins with an accurate diagnosis. It's important to know about the condition of your ligaments after a whiplash, it's not just a pulled muscle.

Chiropractic Care For Low Back Pain – What Does the Research Say?

2011-03-21T05:00:00.001-05:00

There has been a debate for years regarding the use of spinal manipulation and its benefits in the treatment of low back pain. Since the founding of chiropractic in 1895, the initial reaction against the early pioneer chiropractors resulted in doctors of chiropractic (DC’s) being incarcerated for “…practicing medicine without a license.” But chiropractors kept forging ahead and because of obtaining good results and helping millions of people, by 1971, Medicare adopted coverage for chiropractic – a first in chiropractic’s history. In 1975, the US Department of Health, Education, and Welfare invited an international group of health care provider types (MD’s, DC’s, DO’s, etc.), to share with each other at the National Institute of Health, and determine what the “current” research status of spinal manipulative therapy was at that time. Recommendations for future needed research resulted and the proceedings were published in: The DHEW Publication No. (NIH) 76-998 “The Research Status of Spinal Manipulative Therapy.” That landmark gathering stimulated a plethora of research that was to follow over the course of the next 30+ years and continues today. Due to the overwhelming positive benefits of chiropractic published in many research studies, by the late 1980’s, most insurance companies included coverage for chiropractic care. Today, many chiropractors practice in multidiscipline health care centers that include DC’s, MD’s, and PT’s others. The following list of research studies has had a significant impact in vaulting chiropractic to its current accepted status in the health care system (the URL is included for further study):

1) Meade TW, Dyer S, Browne W, Townsend J, Frank AO. British Medical Journal 1990 (Jun 2); 300 (6737):1431-1437. http://www.chiro.org/LINKS/ABSTRACTS/LBP_of_Mechanical_Origin.shtml

2) Manga P, Angus DE, Papadopoulos C, Swan WR. A Study to Examine the Effectiveness and Cost-effectiveness of Chiropractic Management of Low-Back Pain. 8/1993; Ontario, Canada. http://www.chiro.org/LINKS/GUIDELINES/Manga_93.shtml

3) Bigos S, et. al., 1994, Agency for Health Care Policy and Research (AHCPR). http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=hstat6.chapter.25870

4) Meade TW, Dyer S, Browne W, Frank AO. Randomised Comparison of Chiropractic and Hospital Outpatient Management for Low Back Pain: Results from Extended Follow up. British Medical Journal 1995 (Aug 5); 311 (7001): 349–351 http://www.chiro.org/LINKS/ABSTRACTS/Chiropractic_and_Hospital_Outpatient.shtml

5) Luo X, Pietrobon R, Sun SX, Liu GG, Hey L. Estimates and Patterns of Direct Health Care Expenditures Among Individuals With Back Pain in the United States. Spine 2004 (Jan 1); 29 (1): 79–86. http://www.ncbi.nlm.nih.gov/pubmed/14699281

At this clinic, we are most appreciative to have the opportunity to provide care to our patients and strive to make the experience highly satisfying. If you, a family member or a friend requires care, we sincerely appreciate the trust and confidence shown by choosing our services. 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.

Fibromyalgia and Sleep Deprivation

2011-03-17T05:00:00.000-05:00

The link between fibromyalgia (FM) and sleep is well established. Some feel FM is caused by a lack of deep sleep, which usually takes about 4 hours of continuous sleep to achieve. Overtime, the inability to fully relax due to the lack of deep sleep results in a gradual tightening of the muscles, which further prohibits deep sleep. FM symptoms include a widespread, generalized muscle aching, chronic fatigue, lack of drive, depression, irritability, gut or bowel problems, tingling or numbness, and others. It is most common in woman between 40 and 60 years of age and is the third most common rheumatologic disorders.
Because these symptoms are usually chronic (present for at least 3 months), depression is a common complaint. This is due, in part, to the inability to get enough deep sleep that, in turn, results in less patience, less tolerance, and a decreased ability to cope with every day stresses. This can lead to inactivity, weight gain, poor dietary habits and sometimes, substance abuse. Unfortunately, all of this self-perpetuates the condition and frequently, anti-depressant medication and/or herbal approaches are helpful in breaking this cycle. Sleep aids can also be helpful since this may be at the core of the condition.
Chiropractic care addresses spinal dysfunction, faulty posture as well as lifestyle issues such as stress, diet and exercise when managing the complex issues associated with fibromyalgia. Co-management with other health care partners such as counseling with a clinical psychologist may also be beneficial. If FM is secondary to a disorder such as irritable bowel syndrome, dietary management is an important treatment aspect.
Most patients with FM will benefit from increasing their activity level, gradually working towards a rigorous exercise program. Vigorous exercise increases endorphin levels, which block pain and elevates mood. The exercise approach should include both strength enhancement, such as circuit training with weights, and increasing aerobic activities, such as fast-paced walking. These have been shown in studies to help patients with both stress reduction as well as reducing the chronic fatigue associated with FM. Overall, pain levels are reduced by the addition of exercise though this may seem hard to believe since people with FM already have muscle pain. Exercise is also important in maintaining a healthy weight and improving self-confidence. If post-exercise soreness occurs after exercising, chiropractic approaches can be very beneficial.
If the side effects of medication outweigh the benefits, or if you’re looking for a non-drug approach to FM, the combination of nutrition, exercise, and chiropractic care should strongly be considered. This approach is specifically utilized at our clinic.

Carpal Tunnel and the Magic Bullet

2011-03-16T05:00:00.001-05:00

Patients with severe carpal tunnel symptoms often become desperate in their search for a cure. Most patients with chronic diseases fall prey to this, looking for the one answer, the one magic pill or magic bullet that will rid them of all their troubles now and forever.

In carpal tunnel care, you may have looked for the magic splint, the best surgeon, the one exercise, the one vitamin or herb or magnet, to find relief of your pain. As carpal tunnel symptoms worsen, affecting not only our daily lives and even our jobs, the urgency to find the one thing becomes greater and greater.

It's no wonder there's no shortage of promises and potions out there to deliver you the magic bullet. Perhaps you could look at this problem in another way? Not the one thing that has thus far eluded you, but rather the many things you've found difficult to face and take care of, the things that may prevent problems but only if you faithfully adhere to them. What I'm getting at is this: there are many pieces to the carpal tunnel puzzle and you can think of hand pain more of as a signal that the final straw that is finally breaking the camel's back.

Yes it is true that those with vitamin deficiencies get more nerve symptoms and taking B6 can help some people with their symptoms. But B6 is part of the B-complex that we should be getting everyday in our diets. Whether you have symptoms or not, you should be eating right, and that means lots of vegetables. Most of us will benefit from correcting our lack of vitamin intake by taking different vitamins in supplement form.

Or maybe we are overweight; it's true of 60% of Americans. We need to maintain an ideal weight whether or not our hands hurt. Or perhaps we have a neck problem that we are not addressing. Sometimes neck problems cause hand pain and sometimes they do not. Whether or not the neck itself is causing your hand to hurt, you should get your neck fixed so that movements are free and symmetrical.

Lastly, exercise and stretching should be party of everyone's daily routine, not just those with hand symptoms.

If you need help with implementing these different approaches to your health, give Crystal a call at 504.454.2000 to schedule a consultation with a doctor of chiropractic, one who looks at the total picture of health.

Whiplash Associated Disorders

2011-03-15T05:00:00.001-05:00

Is the speed of a car crash directly proportional to amount of injury sustained to the occupants? One would expect more injury to occur when the speed of the collision is faster. Sometimes, this is the case – especially when car accidents occur at highway speeds.

However, what about the cases where a patient ends up in a lot of pain even when the speeds are quite slow, especially when there is little to no damage to the vehicle? , The answer to this seemingly paradoxical relationship has to do with plastic vs. elastic deformity.

This may be more simply understood if you think of “plastic” as something (in this case, your car) breaking apart vs. “elastic” as bouncing off without deforming or breaking apart. Therefore, in plastic deformity, there is more damage to the vehicle and in elastic deformity, there is little to no damage. When there is more metal crushing or more vehicular damage (plastic deformity), the G-forces associated with the crash are absorbed by the crushing metal, which in turn, exerts LESS G-forces to the contents inside the vehicle (ie, the occupants), resulting in less injury. On the other hand, in the stiffer, less damaged vehicle, the energy is not absorbed by crushing metal (elastic deformity), resulting in the contents or occupants inside the vehicle being jostled or thrown about to a greater extent (due to the higher G-forces are exerted) and are at a greater risk for a higher degree of injury.

To illustrate this point, let’s say that, we have a car that hits a solid brick wall at 10 mph that crushes in the front of the car 5 inches. In the second scenario, let's keep the car at a speed 10 mph, but because of a different car design (stiffer frame such as a solid bumper-to-bumper chassis), the crush in this instance is only 2 inches.

In the first example, the acceleration is found to be 8 G’s of force. In the second example, acceleration is equals about 20 Gs of force. Thus, a collision with the same velocity, but with a crush amount smaller by 2.5 times will have a resulting G force 2.5 times larger.

Facts such as these are VERY important for you, your family and your doctor to appreciate, especially if there is legal action being taken in the case. Therefore, it is important for you to choose a health care provider who understands and appreciates the potential impact this information carries when addressing your health related needs and communicating this information to others involved in a case.
Robbins MC. Lack of relationship between vehicle damage and occupant injury. SAE 970494

Did You Know This About Low Back Pain?

2011-03-14T05:00:00.001-05:00

If you have low back pain (LBP), you are certainly not alone. Almost everyone at some point has back pain that interferes with work, daily activities, and/or recreation. Americans spend at least $50 billion each year on LBP. It is the most common cause of job-related disability and a leading contributor to lost work time. Back pain is second to headaches as the most common neurological condition in the United States. Fortunately, most occurrences of LBP go away within a few days. Others take much longer to resolve or lead to more serious conditions (1).
There are two types of low back pain – acute and chronic. Most episodes of acute LBP last from a few days to weeks, are not neurological and usually do not carry a high level of surgical risk. The cause of LBP can be difficult to isolate because often, while the cause is cumulative where multiple events over time, the last activity the patient recalls is “bending over for a pencil.” This, by itself is not likely to cause an acute onset of LBP. Low back pain can be caused by trauma such as sports injuries, work around the house such as garden work, car accidents, and others. Chronic low back pain, by definition, is LBP that lasts more than 3 months and the cause can be more difficult to identify and is often cumulative and superimposed on a prior condition such as degenerative disk or joint disease. A real problem is the rate of recurrence or, chronic, recurrent low back pain where pain may subside but returns at various rates of frequency and duration. This category affects a high percentage of the population and represents the true challenge in spine care management (1, 2).
As people age, their bone strength and muscle stretch, strength and tone usually decreases due to lack of activity. When the disks begin to lose fluid and flexibility, their ability to cushion the vertebrae and function as “shock absorbers” also decreases. Disks can tear, bulge, and/or herniate which results in localized LBP and/or radiating pain that follows the course one or more of the 31 pairs of nerve roots (eg., “sciatica” down the back of the leg). Soft tissues such as joint capsules and ligaments lose their capacity to stretch and can tear more easily, resulting in a sprain or strain (muscle/tendon injury). Other conditions that either cause or contribute to LBP include arthritis, obesity, smoking, pregnancy, stress, poor posture and/or physical health, and can lead to unsatisfied patients if these co-contributors are not properly identified and discussed. Less commonly, LBP can be caused by a more serious condition such as cancer, fracture, infection, spinal cord compression, and various internal conditions (3). Emergency care may be indicated in these circumstances.
Your doctor of chiropractic will perform a complete examination, consider other contributing causes, and will treat the problem(s) causing the LBP condition. If needed, working with other allied health care providers will be arranged. Exercise, dietary recommendations, ergonomic or work modifications, spinal manipulation, and modalities will all be considered to help eliminate or control of the LBP. Methods of self-managing the LBP will be emphasized.
1. http://www.ninds.nih.gov/disorders/backpain/detail_backpain.htm
2. http://www.spine-health.com/conditions/lower-back-pain/lower-back-pain-symptoms-and-treatment-options
3. Bigos S, Bowyer O, Braen G, et al. Acute Low Back Problems in Adults. Clinical Practice Guideline. Rockville, Md: US Department of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research; 1994.

Fibromyalgia – What is it... Exactly?

2011-03-10T05:00:00.001-06:00

There are many conditions that can be attributed to specific causes with a clear origin and means of diagnosis. However, there are also conditions that are obscure and can only be diagnosed by eliminating other, more common conditions. Fibromyalgia (FM) is one of those conditions where the degree of pain and disability can be profound and life quality interrupting, yet all the tests come back negative and there are no other conditions to explain the collection of symptoms. It is at that point when the diagnosis of fibromyalgia is typically made.

FM is typically a chronic (symptoms have been present for at least 3 months) condition where the patient complains of widespread, generalized muscle, ligament and tendon pain accompanied with fatigue and multiple tender points on the body that hurt with only light pressure. To be considered “widespread,” it usually affects both sides of the body and is both above and below the waist. It occurs in approximately 2% of the population in the US and women are 3-4 times more likely to develop FM. The risk of FM increases with age and can be secondary to other physical or emotional trauma, or it can occur all by itself. No obvious pattern usually exists as signs and symptoms can vary depending on weather, stress, physical activity, and even the time of day.

Sleep quality is an issue that seems well agreed upon as regardless of the number of hours in bed, the deep, restorative stages of sleep are seldom reached. Other sleep disorders frequently associated with FM include sleep apnea and restless leg syndrome.

Causation for the most part is unknown but genetics (family traits), infections (can trigger or worsen FM), and after physical or emotional trauma (eg., post-traumatic stress disorder) have been linked to FM. An explanation as to why it hurts so much centers around a theory called “central sensitization.” This is basically a low threshold for pain because of increased sensitivity in the brain to the incoming pain signals. Certain chemical (neurotransmitters) changes in the brain have been identified resulting is hypersensitivity creating an overreaction to pain signals.

The American College of Rheumatology has established two diagnostic criteria that include 1) widespread pain lasting at least 3 months, and 2) at least 11 out of 18 positive tender points using just enough pressure to whiten the fingernail bed. There are no direct blood tests to confirm a diagnosis of FM but other conditions can affect or cause FM can be diagnosed with blood testing. These include thyroid disease (thyroid function blood tests), inflammatory arthritis such as rheumatoid (ESR), and a complete blood count to assess anemia and infection.

We take pride in providing quality, evidence-based care and appreciate the opportunity to do so when patients choose our clinic for their chiropractic care. We realize that there are many healthcare options available. If you, a friend or family member require care for fibromyalgia, we would be honored to offer our services.

Carpal Tunnel Syndrome (CTS) – A New Treatment Approach!

2011-03-09T05:00:00.001-06:00

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 of numbness/pain in the wrist, index, third, and forth fingers, multiple sleep interruptions, frequent shaking and flicking of the hand/fingers, difficulty in gripping or pinching such as buttoning a shirt, threading a needle, lifting a coffee cup, frequent dropping of objects, the inability to perform work duties – especially fast, repetitive work tasks can have a devastating effect on a person’s quality of life.

While treatments traditionally have involved activity modification, night splints, anti-inflammatory medication, and in advanced/severe cases surgery, a recent study comparing different vitamin approaches reports promising results with the use of alpha-lipoic acid (ALA) and gamma-linolenic acid (GLA). This combination was described as a logical early stage treatment aimed at “neuroprotection” or, to limit and correct nerve damage caused by CTS. The doses utilized for 90 days in 112 subjects with moderately severe CTS were 600 mg/day of ALA and 360 mg/day of GLA. This combination was compared against a commonly recommended multiple vitamin B complex that included 150 mg of B6, 100 mg of B1, and 500 mcg of Vit B12 per day for the same 90 day period. Questionnaires regarding CTS symptoms and function and electromyography (EMG) were utilized to track the outcomes in the study. The ALA/GLA treated group was statistically significantly improved when compared to the other B-complex vitamin approach. This included significant improvements in both symptom scores and functional impairment compared to only a slight improvement in the vitamin B group. Similarly, EMG was significantly improved in the ALA/GLA and unchanged in the vitamin B group.

Because there are many contributing causes of CTS, a multi-dimensional treatment plan will usually yield the best long-term results. Because repetitive motion / cumulative trauma are often associated with the onset and perpetuation of CTS signs and symptoms, ergonomic issues must be addressed. This includes perhaps a period of time when slower “light duty” work is necessary and consideration for workstation modifications, when feasible. Because most people do not ‘run to the doctor’ with the early signs of CTS, over time, many CTS patients develop abnormal movement patterns by minimizing hand/wrist motions. Instead, they start to shrug the shoulder and lean the body to one side. Hence, management addressing neighboring joint problems at the elbow, shoulder, and neck is needed. A condition called “double-crush” where the nerve is pinched in more than only at the wrist but also at the elbow, shoulder, and/or neck results in a significantly worse CTS presentation. These patients require treatment at all areas involved, not just at the wrist if long-term, satisfying results are to be obtained.

Metabolic conditions including diabetes mellitus, hypothyroid, obesity, pregnancy, the use of birth control pills, and others also contribute or, can even by themselves cause CTS. Chiropractic has traditionally viewed the body as a whole, treating the person from the ground upwards paying attention to posture, leg length, pelvic tilt, shoulder and head tilt. The use of manipulation of not only the wrist and hand, but also the elbow, shoulder, neck and back has yielded the best results rather than focusing only on the hand/wrist. The traditional use of night splints, work station/ergonomic modifications, as well as diet and exercise are also commonly addressed by chiropractors when managing CTS patients. We take pride in providing quality, evidence-based care and appreciate the opportunity to do so when patients choose our clinic for their care and we realize there are many healthcare options available. If you, a friend or family member requires care for CTS, we would be honored to offer our services.