Chronic Pain

Why do so many suffer with CTS?

~ Dr. Robert Speirs DC ~ Leave a comment

​According to the literature, carpal Tunnel Syndrome (CTS) is one of the most prevalent upper extremity complaints. In fact, it IS the most common “compression neuropathy” (of which there are many) and affects 3-6% of adults in the general population. Additionally, CTS can affect BOTH hands in up to 50% of patients with the condition!

The CAUSE of CTS is often unknown and typically comes on gradually, making it difficult to determine a definite cause or specific “date of onset” for CTS.

Symptoms such as numbness, tingling, loss of dexterity, loss of strength (like pinch or grip), and the need to shake the hand or flick the fingers to restore sensation are ALL VERY COMMON CTS SYMPTOMS. The REASON for these symptoms boils down to one thing: The median nerve in the wrist gets pinched! The cause/s can include:

1)  Repetitive motion from either work or hobbies like assembly line work or playing a musical instrument can cause swelling within the carpal tunnel, placing extra pressure on the median nerve as it passes through.

2)  Obesity can contribute to CTS due to extra fluids or fatty deposits that can build up within the carpal tunnel.

3)  Pregnancy: Elevated levels of the hormones estrogen and progesterone can cause the body to retain fluids and increase pressure in the carpal tunnel.

4) Arthritis: Osteoarthritis can lead to CTS (such as when a spur forms inside the tunnel). Rheumatoid arthritis can lead to an autoimmune response and antibodies that end up attacking the cartilage of the joints in the wrist, which can lead to CTS.

5)  Hormone-related conditions: In diabetes mellitus, the blood becomes thicker due to high sugar levels (like syrup) and can’t pass through the small blood vessels, resulting in “neuropathy,” which can make CTS more likely. In hypothyroid, low thyroid function results in “myxedema,” a specific type of swelling that makes CTS more likely to occur.

6)  Trauma: A wrist fracture could cause the carpal tunnel to “collapse” or change in shape resulting in less space for the nerve to travel through.

7)  Mass lesions: A “ganglionic cyst” is a good example. This is where joint fluid leaks out and forms a “bump” on the INSIDE the carpal tunnel, which reduces space and increases pressure in this anatomical structure.

8)  Amyloidosis: This is a rare condition where a protein substance called “amyloid” builds up in any tissue or organ. If this occurs in the wrist, it can “pinch” the median nerve as it passes through.

9)  Sarcoidosis: This is the growth of small collections of inflammatory cells called “granulomas,” which can accumulate in different parts of the body. If it occurs in the wrist, pinching can occur.

10)  Multiple Myeloma: This is a type of cancer that affects the bone marrow, and inflammation in the wrist can occur creating the pressure increase on the median nerve that can lead to CTS.

11)  Leukemia: This too is a type of cancer that involves the white blood cells, and CTS can result from its effects on the tissues in the wrist.

12)  Anatomy: The size and shape of the carpal tunnel is hereditary, and some of us have a smaller tunnel than others. If CTS is present in multiple family members, this “genetic” factor may play a role.

There are other conditions that can “mimic” CTS, but doctors of chiropractic are trained to perform an accurate history and examination so treatment can be directed in the proper manner!

Trigger points in the Levator scapula

~ bryancobb ~ Leave a comment

The Levator scapula is a muscle in your neck that originates on the transverse processes of C1-C4 and inserts on the superior part of the medial border of the scapula. The primary actions of this muscle are to elevate the scapula and rotate the glenoid fossa downward. It also rotates the neck to the same side and assists in extension. When this muscle is tight it restricts neck rotation resulting in the classic “stiff neck”. With a forward head position the Levator is often stretched and over worked. To help combat this you must get the head back by releasing the anterior chest and neck muscles. Trigger points in this muscle refer pain into the angle of the neck and down the shoulder blade.

Hip Abductor Weakness

~ Dr. Robert Speirs DC ~ Leave a comment

Hip Abduction

* The gluteus medius contributes approximately 70% of the abduction force required to maintain pelvic leveling during single leg stance.

* Hip abductor strength is the single greatest contributor to lower extremity frontal plain alignment during activity.

* There is no “typical” presentation for hip abductor weakness, but the problem must be considered in any patient with lower chain symptomatology, particularly those with hip tendinopathy, greater trochanteric pain syndrome, iliotibial band syndrome, patellofemoral pain syndrome, ACL injury, medial knee pain, and lower back pain.

*Hip abductor weakness is often accompanied by lower crossed syndrome – a larger pattern of biomechanical dysfunction involving weakness of the abdominal wall and hypertonicity in the hip flexors and paraspinal musculature. Evaluation should include a relatively global assessment of lumbopelvic muscle and joint function. Additionally, clinicians should assess for the presence of foot hyperpronation in patients with hip abductor weakness.

 

 

Referenced from:
ChiroUp.com “Hip Abductor Weakness Clinical Pearls

A Few Sleep Tips From Us To You

~ Dr. Robert Speirs DC ~ Leave a comment

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Your mattress and the position you sleep in may affect your spine.

✓ Choose a mattress that provides medium or firm support, such as a traditional coil spring or adjustable airbed. Avoid waterbeds, thick pillow tops and soft, sagging mattresses.
✓ Always sleep on your back with a pillow either underneath your knees or on your side with a pillow between your knees. Avoid sleeping on your stomach.
✓ Keep your neck and back covered while sleeping to avoid drafts that could cause potential muscle spasms.

Here are a couple of tips to help you get in and out of bed more comfortably:
✓ To lie down: Sit on the edge of the bed, pull your arms to your sides and tilt your body into the bed, maintaining the bend of your knees at 45 degrees. Finally, bring your feet into in a lying position or roll onto your back.
✓ To get up: From a side-lying position with your knees bent, push your body upright into a sitting position, swinging your legs over the edge of the bed as you rise.

If you find that you wake up sore then you may be suffering from any number of conditions that get worse overnight.

Workstation Ergonomics

~ Dr. Robert Speirs DC ~ Leave a comment

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Ergonomics is the science of adjusting your workstation to minimize strain in the following ways:

✓ Maintain proper body position and alignment while sitting at your desk – Hips, knees and elbows at 90 degrees, shoulders relaxed, feet flat on floor or footrest.
✓ Wrists should not be bent while at the keyboard. Forearms and wrists should not be leaning on a hard edge.
✓ Use audio equipment that keeps you from bending your neck (i.e., Bluetooth, speakerphones, headsets).
✓ Monitors should be visible without leaning or straining and the top line of type should be 15 degrees below eye level.
✓ Use a lumber roll for lower back support.
✓ Avoid sitting on anything that would create an imbalance or uneven pressure (like your wallet).
✓ Take a 10-second break every 20 minutes: Micro activities include: standing, walking, or moving your head in a “plus sign” fashion.
✓ Periodically, perform the “Brugger relief position” (See video below) -Position your body at the chair’s edge, feet pointed outward. Weight should be on your legs and your abdomen should be relaxed. Tilt your pelvis forward, lift your sternum, arch your back, drop your arms, and roll out your palms while squeezing your shoulders together. Take a few deep cleansing breaths.

Carpal Tunnel Facts #1

~ Dr. Robert Speirs DC ~ Leave a comment

​If tingling/numbness primarily affects your thumb, index, third, and ring fingers, it very well could be carpal tunnel syndrome, or CTS. Chances are you’ve probably had this condition for months or even longer but it’s been more of a nuisance than a “major problem” and therefore, you probably haven’t “bothered” having it checked out. Let’s take a look at some “facts” about CTS!

WHAT IS CTS? CTS is basically a pinched nerve (the median nerve) that occurs on the palm side of the wrist that innervates the three middle fingers and the thumb on the palm side. This nerve starts in the neck, runs through the shoulder to enter the arm, and travels down the palm side forearm through the carpal tunnel. The carpal tunnel is made up by eight small bones (called “carpal bones”) that form the roof and walls of the tunnel. The floor of the tunnel is a ligament called the transverse carpal ligament. The median nerve lies immediately on the floor, and deeper inside the tunnel are nine tendons that connect the muscles of our forearm to the fingers, which allow us to make a fist and grip. When swelling occurs inside the tunnel, the nerve is pinched against the floor (ligament) and symptoms occur.

SYMPTOMS OF CTS: Symptoms typically start gradually with tingling, numbness, burning, itching, or a “half-sleep” feeling in the palm of the hand, thumb, and middle three fingers. The fingers can feel swollen and weak, though “swelling” is usually NOT visible. CTS can occur in one or both hands, but it is usually worse in the dominant hand. Initially, you may only notice symptoms at night or in the morning. As CTS worsens, sleep interruptions, grip weakness, difficulty distinguishing hot from cold, increased pain, pain radiating up the arm, and more may occur.

CAUSES OF CTS: There are many causes of CTS that often occur in combination: 1) Heredity or genetics — being born with a smaller wrist than others; 2) Trauma — a fall on the arm/hand (sprain or fracture); 3)  Overuse of the arms/hands (like repetitive line work, serving tables, or using a computer), 4) Hormonal causes — during menstruation, with pregnancy, during menopause, diabetes, hypothyroid, overactive pituitary gland; 5) Rheumatoid arthritis; 6) Fluid retention; 7) Cysts, tumors, or spurs inside the tunnel; 8) Vibrating tools, 9) Hobbies such as knitting, sewing, crocheting; 10) sports; or 11) an “Insidious” or unknown cause!

CTS RISK FACTORS: 1) Gender: Women are three times more likely to develop CTS, possibly because they generally have a smaller carpal tunnel than men, in addition to hormonal differences; 2) Diabetes or other metabolic disorders; 3) Adults, especially >50 years old; 4) Job demands.

CTS DIAGNOSIS: Your doctor of chiropractic will review your patient history and then evaluate the neck, shoulder, arm, and hand, as ALL can be involved in producing CTS-like symptoms. He/she may also order blood tests (to check for diabetes, thyroid levels, rheumatoid arthritis, etc.) and/or an EMG/NCV (electromyogram/nerve conduction studies) to test for nerve damage.

We will FINISH THIS interesting discussion next week covering: Treatment, prevention, and research.

Facts

Trigger points in the masseter muscle

~ bryancobb ~ Leave a comment

The masseter is the main muscle that moves your jaw. It originates on the zygomatic arch and maxilla, and inserts on the coronoid process and Ramus of the mandible. It’s actions are to elevate the mandible and close the jaw. The deep fibres of this muscle also retrude the mandible. This muscle commonly harbours trigger points as a result of teeth grinding. Trigger points in this muscle are often also associated with tmj dysfunction. Trigger points in the upper part of this muscle will refer pain to the upper molars and maxilla often felt as sinusitis. Trigger points in the lower portion of this muscle refer to the lower molars and temple. All trigger points can cause tooth sensitivity

So I’ve got Whiplash; now what?

~ Dr. Robert Speirs DC ~ Leave a comment

WRD 2

​Whiplash, or “Whiplash Associated Disorders” or WAD, is the result of a sudden “crack the whip” of the head on the neck due to a slip and fall, sports injury, a violent act, or most commonly, a motor vehicle collision (MVC), particularly a rear-end collision. In describing “what can I expect” after a whiplash injury, one thing is for certain, there are many faces of whiplash, meaning the degree of injury can range from none to catastrophic depending on many factors, some of which are difficult or impossible to identify or calculate. Let’s take a closer look!

Even though the good news is that most people injured in a car crash get better, 10% do not and go on to have chronic pain, of which about half have significant difficulty working and/or doing desired everyday activities. There is a “great debate” as to the way experts describe “chronic whiplash syndrome” (CWS) as well as how these cases should be managed. Some feel there is something PHYSICALLY wrong in the CWS patient, especially if severe neck or head pain persists for more than one year. There is some proof of this as Dr. Nikolai Bogduk from the University of Newcastle in Australia and colleagues have used selective nerve blocks to anesthetize specific joints in the neck to determine exactly where the pain is generated. The patient then has the option to have that nerve cauterized or burned and pain relief can be significant in many cases. Dr. Bogduk and his group admit that these CWS patients have more psychological symptoms, but they feel this is the result of pain, not the CAUSE.

On the other hand, experts such as Dr. Henry Berry from the University of Toronto report the EXACT OPPOSITE. He argues that it’s not JUST the physical injury that has to be dealt with but also the person’s “state of mind.” Dr. Berry states that when stepping back and looking at all the complaints or symptoms from a distance, “…you see these symptoms can be caused by life stress, the illness ‘role’ as a way of adjusting to life, psychiatric disorders, or even [made up by the patient].” Berry contends that it’s important to tell the patient their pain will go away soon, advises NO MORE THAN two weeks of physical therapy, and sends people back to work ASAP.

Oregon Health Sciences University School of Medicine’s Dr. Michael D. Freeman, whose expertise lay in epidemiology and forensic science, disagrees with Dr. Berry stating that the scientific literature clearly supports the physical injury concept and states, “…the idea that it is a psychological disturbance is a myth that has been perpetuated with absolutely no scientific basis at all.” Dr. Freeman states that 45% of people with chronic neck pain were injured in a motor vehicle crash (which includes three million of the six million of those injured in car crashes every year in the United States).

Here’s the “take home” to consider: 1) CWS occurs in about 10% of rear-end collisions; 2) Some doctors feel the pain is physically generated from specific nerves inside the neck joints; 3) Others argue it’s a combination of psychological factors and care should focus on preventing sufferers from becoming chronic patients.

Many studies report that chiropractic offers fast, cost-effective benefits for whiplash-injured patients with faster return to work times and higher levels of patient satisfaction.

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

How can I reduce stress on my spine while standing?

~ Dr. Robert Speirs DC ~ Leave a comment

STress

To avoid extra stress on your spine while standing:

✓ Avoid high-heeled shoes or boots

✓ Use a footrest measuring 10% of your height

✓ To decrease stress on your back and feet consider leaning on a tall chair.

✓ If excessive standing can’t be avoided, consider shock-absorbent shoes or an anti-fatigue mat.

✓ When transitioning from a sitting workstation to a standing desk, begin gradually by standing 20 minutes per hour and not necessarily in a continuous period. Add an extra 10 minutes per hour each day as long as there is no prolonged stiffness or discomfort.