Chronic Pain

The Bird Dog

~ Dr. Robert Speirs DC ~ Leave a comment

Bird Dog

Today we are going to look at one of the most effective exercises to protect your lumbar spine from discogenic injury, the bird dog. A great way to work on both posterior chain and rotational stability, the bird dog is safe, effective and simple.

  • Get on your hands and knees (four point position) with your knees and hands, hip and shoulders width apart.
  • Your back is in neutral position (slightly arched) and your chin must be tucked in.
  • Activate your lower abdominals (transversus abdomini) by bringing your belly button inward and by activating your pelvic floor muscles 20 to 30% of maximal contraction.
  • Maintain a steady abdominal breathing while you simultaneously lift one leg backwards and the opposite arm overhead keeping your back in neutral position.
  • Return to the initial position and repeat with the other leg and arm.

2 sets of 10 reps as part of your regular core/stability routine will have you well on your way to a life-proof low back!

Image and instructions from physiotec.ca 

Is Surgery Always Required?

~ Dr. Robert Speirs DC ~ Leave a comment

​Carpal tunnel syndrome (CTS) is the most common peripheral entrapment neuropathy—that is, it’s the most common place to trap a nerve in the extremities (arms or legs). CTS affects 6-11% of adults in the general population, and it occurs in women more often than men. The cause is often difficult to determine but the most common reasons can include trauma, repetitive maneuvers, certain diseases, pregnancy, being over the age of 50, and obesity.

So, is surgery the only answer? The short answer is NO! In fact, in a recent randomized clinical trial published in the Journal of Pain, researchers observed similar improvements in function when they compared the outcomes of patients who underwent surgery vs. those who received manual therapies (such as those performed several times a day at chiropractic clinics around the world) at both six months and one year later. The improvements included increased strength, function, and decreased hypersensitivity in both the surgical and non-surgical groups. Interestingly, the manual therapy group did BETTER at the one and three month assessments when compared with the surgical group (again, with no difference at six and twelve months)!

The median nerve, the culprit behind CTS, starts in the neck and travels down through the shoulder, elbow, forearm, and finally through the carpal tunnel, which is made up of eight small carpal bones that form the arch of the bridge. Entrapment of the median nerve occurs when the normally tight quarters within the carpal tunnel combine with the inflamed nine sheathed muscle tendons that push the nerve into the floor of the tunnel (a ligament), which results in CTS! The goal of therapy—both surgical and manual therapy—is to reduce the pressure within the tunnel and free up the compression of the median nerve.

Manual therapies focus on joint mobilization and manipulation to reduce joint fixations, muscle release techniques in the forearm and hand, stretching techniques, and at-home exercises that emphasize a similar stretch, the night brace, and management of any underlying contributing factor. These “underlying factors” might include diabetes, hypothyroid, taking birth control pills, weight management, and inflammatory arthritis.

 

CTS SUrgery

Trigger points in the pectoralis Major muscle.

~ bryancobb ~ Leave a comment

The pectoralis major or “pecs” is commonly thought of as the chest muscle. It originates on the clavicle, sternum, costal cartilage , and the external oblique aponeurosis. It inserts on the intertubercular groove of the humerus. Its main actions are to adduct the shoulder and to internally rotate the humerus. This muscle gets chronically shortened by a rounded shoulder forward posture such as from prolonged sitting. Tightness in this muscle can cause strain in the rhomboids and traps. When trigger points form in this muscle they refer pain into the anterior shoulder, as well as the anterior chest and medial aspect of the arm. Trigger points in the pecs can also cause nipple hypersensitivity. Trigger points in the left pec muscle can mimic heart pain.

Lumbar Spine Stabilization

~ Dr. Robert Speirs DC ~ Leave a comment

L Spine Stabilization

This is a great way to increase the stability of your lower back.

  1. Lie with your stomach over a therapeutic ball while stabilizing yourself with your feet and arms and keep your head in line with your body.
  2. Tighten your abdominal muscles to flatten the spine by pulling your belly button towards your back and hold the contraction throughout the exercise.
  3. Bend one knee and lift it up towards the ceiling.
  4. Lower the leg and repeat on the other side.

 

CTS at Night.

~ Dr. Robert Speirs DC ~ Leave a comment

​For those who have carpal tunnel syndrome (CTS), it’s no surprise that CTS is frequently most expressive during the night, often to the point of interrupting sleep and/or making it difficult to fall back to sleep. So why is that?

The primary reason for nighttime CTS symptoms has to do with the wrist, as it is very difficult to sleep with the wrist held in its “ideal” or least irritating position. In fact, most people favor “curling” the back of the hand under the chin or bending the hand/wrist backwards under the head. When the wrist is bent in either direction, it can increase the pressure inside the wrist, which can generate the various symptoms associated with CTS.

One study evaluated the pressure inside the carpal tunnel while participants slowly moved their wrists. The researchers found many movements didn’t need to exceed 20 degrees before the pressure increased enough within the carpal tunnel to generate symptoms.

Because it doesn’t take a lot of movement to build up excessive pressure in the wrists of those with CTS, many doctors recommend the use of a “cock-up splint” for the non-surgical treatment of CTS in order to help keep the wrist in a neutral position.

Wrist posture is also an important factor during the day. One study looked at typing on a tablet PC, which allowed people to work in non-traditional settings. As screen size reduced, the posture required to type became more limited and accelerated the usual rate of pain onset in the neck, elbows, and wrists.

This study also looked at three different positions used when working on touch-screen devices: desk, lap, and bed. The healthy subjects completed six, 60-minute typing sessions using three virtual keyboard designs: standard, wide, and split. The researchers monitored the position of the wrist, elbow, and neck while the participants typed and followed up each session with questionnaires designed to measure discomfort.

The research team reported that typing in bed required greater wrist extension but resulted in a more natural elbow position than typing at a desk. The angled split keyboard significantly reduced the wrist deviation vs. the standard or wide keyboard designs. All three regions—the neck, elbow, and wrist—exhibited more movements (13% to 38%) towards the end of the one hour sessions, which correlated with a significant increase in pain in every body region investigated. Overall, using a wider keyboard while sitting at a desk was the most tolerable position among study participants.

 

176

How can I calm down my WAD symptoms?

~ Dr. Robert Speirs DC ~ Leave a comment

Cervical Strain

​Whiplash is really a slang term for the rapid back and forth whipping of the head on the neck, usually associated with motor vehicle accidents. The title “Whiplash Associated Disorders”, or WAD, describes it best because it includes ALL of the MANY signs and symptoms of the disorder.

WAD basically comes in three sizes based on the degree of injury. A WAD I is present when there is pain but no physical examination findings; WAD II occurs when there are exam findings but no neurological loss (numbness or weakness); and WAD III includes loss of neurological function.  There is also a separate WAD level that includes fractures and dislocations (WAD IV).

There are many things that can be done by the patient to assist in the healing process for WAD. The first well-studied recommendation is to “continue with your usual activities.” Try to keep active and not change your routine. The good news is that WAD (especially types I and II) usually resolves without complication, and recovery is even more likely to occur if you don’t deviate much from your routine.

For those whose symptoms are more severe and/or not resolving, mobilization and manipulation of the neck and back are very effective treatment options. In addition to treatments you’d receive in a chiropractic office, there are MANY things you can do at home as “self-help strategies.” Some of these include (“PRICE”):

1)  PROTECT: Though it’s important to continue with your usual daily activities, this is dependent on both the degree of tissue injury and your pain tolerance. So do as many of your usual daily activities as possible, but AVOID those that result in a sharp, lancinating type of pain or those where recovery from the pain is delayed.  Therefore, this category may require modifying your ADLs (activities of daily living). A cervical collar (hard orsoft) should NOT to be used UNLESS you have an unstable injury (fracture or a grade III sprain).

2)  REST: Doing too much is like picking at a cut (which can delay healing) and doing too little can lead to a delayed healing response as well. Staying within reasonable pain boundaries is a good guide.

3) ICE > HEAT: Ice reduces swelling, and your doctor will typically recommend it over applying heat, especially on a recent injury. Heat draws fluids in, and while it may feel good, it can make your symptoms worse.

4)  COMPRESS: We can basically ignore this when referencing neck pain. This pertains better to wrapping an ankle, knee, wrist, or elbow with an elastic compression orthotic or brace.

5)  ELEVATE: This too is meant for the acute stages of an extremity injury like a foot or ankle.

Exercises unique for neck pain in the acute, subacute, and chronic stages of healing are perhaps the most important of the self-help approaches. In the ACUTE phase, try these…

1)  Range of Motion: Once again, stay within “reasonable pain boundaries” as you move your head forwards, backwards, side to side, and rotate left and right. These can be done either with or without LIGHT resistance applied using one or two fingers placed against your head. Limit the repetitions to three slow reps in each direction and emphasize the release of the movement.

2)  Chin/head Glides: Tuck in the chin (think of creating a double or triple chin) followed by poking the chin/head out.

In the SUBACUTE and CHRONIC phases of healing, the importance of strengthening the deep neck flexors cannot be over emphasized. Please refer to last week’s article for a description of this (see #3 of the 6 recommendations listed).

When Are My Shoes “Done”?

~ Dr. Robert Speirs DC ~ Leave a comment

168

Running shoes need to be replaced every 250 miles. There are three basic options:

 

✓ Motion Control Shoes – Designed for people with low or no arches, these shoes are for runners who strike the ground on the outer edge of their foot. Avoid overly stiff shoes as these decrease you perception of ground strike and lead to new injuries.

 

✓ Stability or Neutral Shoes – Designed for people with normal or average arches and running mechanics. The shoe contains some cushioning to absorb shock and prevent injuries and some rigidity to avoid pronation.

 

✓ Cushioned Shoes – Designed for people with high arched feet. Their footprint will typically leave a thin band along the foot’s edge. As they run weight is distributed from heel strike to the outer edge of the foot and small toes that bear the brunt of “lift off.” This shoe is more flexible and absorbs the shock created by the lack or rotation (under-pronation) created by their running style.

Workers compensation cases highlight the value of chiropractic care

~ Dr. Robert Speirs DC ~ Leave a comment

160801-F-DB969-034

A newly published analysis of 5511 workers compensation cases highlights the value of chiropractic care: “those injured workers who first saw a chiropractor experienced shorter first episodes of compensation (vs. physical therapy alone)”.

If you or someone you know has suffered a job-related injury, call us today. Our goal is to provide the most effective care that gets you back to work ASAP!

https://www.ncbi.nlm.nih.gov/pubmed/27638518

Do you have Carpal Tunnel Syndrome?

~ Dr. Robert Speirs DC ~ Leave a comment

​Carpal Tunnel Syndrome is VERY common. If fact, it affects 3-6% of the general population, and up to 50% of those afflicted have it in both hands! So what makes it so common? Here are several reasons:

1) ANATOMY: The wrist is made up of eight small “carpal” bones that allow the wrist to bend and twist in many different positions. If you were to look at the wrist “head on,” you’d notice it is shaped like a tunnel where the eight little carpal bones make up the “roof” and the transverse carpal ligament is the “floor.” You’ll also notice nine tendons and their sheaths that pass through the carpal tunnel and attach the forearm muscles to the fingers on the palm side of the arm, blood vessels, and the median nerve. When there is less available space within the carpal tunnel (due to inflamed tendons, for example), the added pressure can compress the median nerve and result in numbness, tingling, and weakness, mostly into the second to fourth fingers.

2) JOBS: People with occupations that require fast, repetitive movements and/or a firm grip with little rest have a higher likelihood of developing CTS.

3) GENDER: Women have a greater risk of developing CTS than men due to smaller wrists and hormonal changes that may result in swelling in the wrist.

4) AGE: Individuals over age 50 have a greater risk of developing CTS, especially females.

5) GENERAL HEALTH ISSUES: There are a host of conditions that can cause and/or aggravate CTS. Some of these include rheumatoid arthritis, diabetes, osteoarthritis, low thyroid function, and space-occupying issues like a ganglionic cyst inside the tunnel. Certain medications, such as birth control pills, and some forms of chemotherapy can also cause CTS. A pinched nerve in the neck or shoulder can alter median nerve function, which can exacerbate CTS symptoms.

6) TRAUMA: A fall onto an outstretched arm can sprain and/or fracture the wrist. If a fracture occurs, the onset of CTS can be very rapid, and quick realignment of the fracture is very important.

Chiropractic care offers a non-surgical solution to CTS, which includes splinting (primarily at night and when driving but usually less often during the day as we tend to “fight” against the splint), anti-inflammatory measures (ice, nutrients such as ginger, turmeric, bioflavonoids), and manual therapies—manipulation of the fingers, hand, wrist, elbow, shoulder, and neck (as indicated) and muscle release techniques to the forearm are very helpful. There are also effective exercises that patients can do at home that include joint range of motion and muscle stretching techniques.

 

Shrug

Trigger points in the trapezius muscle.

~ bryancobb ~ Leave a comment

The trapezius muscle is a large diamond shaped muscle in you mid/upper back and neck. This muscle is one of the most common sites where trigger points can form. This muscle originates on the Nuchal ligament and the spinous processes of C6-T12. It inserts on the spine of the scapula, the acromion process, and the distal clavicle. The upper fibres elevate the shoulder and rotate the glenoid fossa (shoulder socket) upward. The lower fibres assist this motion as well as help depress the shoulder. The middle fibres of this muscle strongly adduct the scapula. This muscle is susceptible to postural overload such as sitting at desk all day. Trigger points on the lateral upper edge refer into the lateral neck and temples, causing “tension neck ache”as well as headache pain.Trigger points in the middle and lower fibres refer pain into the posterior neck and shoulder.