Chronic Pain

What is CTS?

~ Dr. Robert Speirs DC ~ Leave a comment

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Carpal tunnel syndrome (CTS) is a very common condition. According to a report by the Bureau of Labor Statistics (BLS), CTS ranks SECOND among the major disabling diseases and illnesses in ALL private industries. The BLS states that workers with CTS may eventually have to give up their livelihood. They cite one study in which almost half of all CTS patients changed their jobs within 30 months following their diagnosis. Due to the controversy surrounding the issue of CTS and worker’s compensation, workers do not always receive compensation benefits.
The KEY to long-term cost containment associated with CTS is EARLY DIAGNOSIS and PREVENTION! The challenge is getting the worker to identify early symptoms and NOT feel intimidated to report them, which could then lead to prompt care and possibly job modifications, resulting in the best chance of preventing a more complicated and far more costly problem.
Because of the many factors that contribute to and/or cause CTS, there is similarly no one way to prevent it from happening. Treating any/all underlying medical condition(s) is important. Using simple common sense can go a long way to help minimize some of the risk factors that predispose a person to work-related CTS and other cumulative trauma disorders (CTDs).
For example, watching and mimicking veteran workers can be a great guide as to how to maximize efficient work methods while minimizing unnecessary stresses and strains. Other preventative “tricks” include learning how to adjust the work area, handle tools, or perform tasks that minimize hand/wrist strain. Maintaining proper posture and exercise programs to strengthen the fingers, hands, wrists, forearms, shoulders, and neck may also help prevent CTS.
Many companies have taken action to help prevent repetitive stress injuries. In one study, 84% of the companies surveyed reported that they were modifying equipment, tasks, and processes as part of a prevention effort; nearly 85% analyzed their workstations and jobs; and 79% purchased more ergonomic equipment. Unfortunately, there is NO EVIDENCE that any of these methods can completely protect a worker against CTS. Often, the best approach is to relocate the worker to a less repetitive job, but this is not always an option.
Doctors of chiropractic can observe the worker through a video or during a factory tour/visit and often identify ergonomic problems that can result in a low-cost, easy modification. Simple modifications coupled with quality care, patient education, and cooperation from BOTH the worker and the employer can typically help yield the best outcome for the CTS patient.

Pregnancy and Low Back Pain?

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Did you know that 50-72% of women have low back pain (LBP) and/or pelvic pain during their pregnancy but only 32% do something about it? Let’s look closer!
Pregnancy-related low back pain (PLBP) can be a highly debilitating syndrome that accounts for the most common cause of sick leave for pregnant women. In 2004, Americans spent $26.1 billion dollars in an effort to find relief from back pain during pregnancy. Statistics show one out of ten women will experience daily DISABLING LBP for at least two years following delivery.
Because of the limited number of treatment options available for the pregnant woman due to mother and fetus safety, and given the high propensity of potentially disabling PLBP that can significantly limit function and quality of life, chiropractic care seems to be a natural choice for this patient population! Obviously, pharmaceuticals and surgery are NOT appropriate options for the expectant mother, even during the post-partum breast-feeding time period. Chiropractic offers a non-invasive and safe approach to managing lumbopelvic pain that uses many different approaches.
In a 2009 research paper, 78 women participated in a study that investigated disability, pain intensity, and percent improvement after receiving chiropractic care to treat pregnancy-related PLBP. Here, 73% reported their improvement as either “excellent” or “good.” For disability and pain, 51% and 67% (respectively) experienced clinically significant improvement! Researchers followed up with them eleven months later and found 85.5% reported their improvement as either “excellent” or “good!” For disability and pain, 73% and 82% (respectively) experienced clinically significant improvement!
So, what’s causing LBP in pregnant women? Because of the biomechanical changes that occur in the low back and pelvis over a relatively short amount of time during pregnancy, especially in the second and third trimesters, common pain generators include (but are not limited to): the sacroiliac joint, facet joints, shock-absorbing disks, and the many connecting muscles (strains) and ligaments (sprains). During the later stages of pregnancy, the hormone Relaxin prepares the pelvis for delivery by widening the pelvic girdle, which can also be problematic.
Treatment options within chiropractic often include spinal manipulation, lumbopelvic exercises, patient education, posture correction, massage, an SI belt, soft tissue mobilization, and more. Exercises that target the transverse abdominus, multifidus, and pelvic floor muscles help to stabilize the lumbopelvic region. The American College of Obstetricians & Gynaecologists recommends exercise at least three times a week during pregnancy, and studies report NO obstetric complications (pre-term labor, premature ruptured membranes, or changes to maternal or neonatal weight) with exercise.
So, the answer is clear! When PLBP strikes, seek chiropractic care to safely and effectively manage the pain and disability and so you can ENJOY YOUR PREGNANCY!!!
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 back pain, we would be honoured to render our services.

Condition Of The Month: Thoracic Joint Restriction

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Your spine is made up of 24 bones stacked on top of each other with a soft “disc” between each segment to allow for flexibility. Normally, each joint in your spine should move freely and independently. When one or more of your spinal vertebra is slightly misaligned and restricted, we call this condition a “spinal segmental joint restriction”. A “thoracic joint restriction” means that this misalignment or restriction is located in your upper or mid-back region.

To help visualize this, imagine a normal spine functioning like a big spring moving freely in every direction. A spine with a joint restriction is like having a section of that spring welded together. The spring may still move as a whole, but a portion of it is no longer functioning.

Joint restrictions can develop in many ways. Sometimes they are brought on by an accident or an injury. Other times, they develop from repetitive strains or poor posture. Being overweight, smoking, strenuous work, and emotional stress can make you more susceptible to problems.

Restricted joints give rise to a self-perpetuating cycle of discomfort. Joint restriction causes swelling and inflammation, which triggers muscular guarding leading to more restriction. Since your spine functions as a unit, rather than as isolated pieces, a joint restriction in one area of your spine often causes “compensatory” problems in another. Think of this as a rowboat with multiple oarsmen on each side. When one rower quits, the others are placed under additional stress and can become overworked.

Joint restrictions most commonly cause local tenderness and discomfort. You may notice that your range of motion is limited. Movement may increase your discomfort. Pain from a restricted joint often trickles around your rib cage or up & down your spine. Be sure to tell your chiropractor if your symptoms include any chest pain, shortness of breath, unusual cough, indigestion or flu- like complaints.

Long-standing restrictions are thought to result in arthritis – much like the way a slightly misaligned wheel on your car causes premature wearing of your tire.

You should recognize that your problem is common and generally treatable. Chiropractic care has been shown to be the safest and most effective treatment for joint restrictions. Our office offers several tools to help ease your pain. To speed your recovery, you should avoid activities that increase your pain. Be sure to take frequent breaks from sedentary activity. Yoga has been shown to help back pain sufferers so consider joining a class or picking up a DVD.

Diet & Fibromyalgia

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Fibromyalgia (FM) is a common condition that affects about five million Americans, often between ages 20 and 45 years old. FM is very difficult to diagnose primarily because there is no definitive test like there is for heart, liver, or kidney disease. Equally challenging is the ability to effectively treat FM as there are frequently other conditions that co-exist with FM that require special treatment considerations. Typically, each FM case is unique with a different group of symptoms and therefore, each person requires individualized care.

Fibromyalgia symptoms can include generalized pain throughout the body that can vary from mild to severely disabling, extreme fatigue, nausea/flu-like symptoms, brain “fog” (“fibro-fog”), depression and/or anxiety, sleeping problems and feeling un-refreshed in the mornings, headaches, irritable bowel syndrome, morning stiffness, painful menstrual cramps, numbness or tingling (arms/hands, legs/feet), tender points, urinary pain or burning, and more!

So, let’s talk about ways to improve your FM-related symptoms through dietary approaches. When the FM symptom group includes gut trouble (bad/painful gas, bloating, and/or constipation), it’s not uncommon to have an imbalance between the “good” vs. the “bad” bacteria, yeast, and problems with digestion or absorption. Think of management as a “Four Step” process for the digestive system:

1.  REMOVE SENSITIVITIES: Consider food allergy testing to determine any foods the FM patient has a sensitivity for. Frequently, removing gluten, dairy, eggs, bananas, potatoes, corn, and red meat can benefit the FM patient. The use of anti-fungal and / or anti-bacterial botanicals (as opposed to drug approaches such as antibiotics) can be highly effective. A low allergy-potential diet consisting of fish, poultry, certain vegetables, legumes, fruits, rice, and olive and coconut oil is usually a good choice.

2.  IMPROVE DIGESTIVE FUNCTION: The presence of bloating and gas is usually indicative of poor digestion, and the use of a digestive enzyme with every meal can be highly effective!

3.  RESTORE THE “GOOD” BACTERIA: Probiotics (with at least 20-30 billion live organisms) at each meal are often necessary to improve the “good” gut bacteria population, which will likely also improve immune function.

4.  REPAIR THE GUT: If the gut wall is damaged, nutrients like l-glutamine, fish oils, and n-acetyl-d-glucosamine may help repair it.

This process will take several months, and some of these approaches may have to be continued over the long term. Doctors of chiropractic are trained in nutritional counseling and can help you in this process. As an added benefit, many FM sufferers find the inclusion of chiropractic adjustments to be both symptomatically relieving and energy producing.

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

Carpel Tunnel in a nutshell

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Here it is: carpal tunnel syndrome (CTS) in a nutshell!

 

WHAT: CTS is caused by an injury to the median nerve (MN) as it travels through the wrist.
WHERE: The eight small carpal bones and a ligament form a tunnel in which tendons and nerves pass through to reach the hand.
HOW: The MN gets pinched/irritated from repetitive stress.
WHY: The tunnel is tight as it includes the MN and nine rapidly moving muscle tendons!
PROGRESS: CTS usually starts slow and often progresses over weeks, months, even years.
SYMPTOMS: Pain, numbness, tingling, and/or weakness of the hand, sparing the little finger.
PROGNOSIS: CTS is easier to treat shortly after it starts, and waiting too long to seek care may lead to worse outcomes.
RISK FACTORS: 1) family history (genetics); 2) women are more likely to suffer from CTS than men; 3) age over 50; 4) manual jobs; 5) pregnancy; 6) conditions like diabetes, hypothyroid, rheumatoid arthritis (RA), osteoarthritis, autoimmune diseases (includes RA, certain types of thyroid disease), gout, kidney disease (especially dialysis patients), Down syndrome, amyloidosis, acromegaly, tumors on the median nerve; 7) medications (those that affect the immune system such as interleukin-2, possibly corticosteroids), anti-clotting drugs such as warfarin, hormone replacement, BCPs; 8) obesity; 9) smoking; 10) alcohol abuse; and 11) trauma/injuries (fractures, tendonitis).
TREATMENT: Ideally, treatment should begin as soon as possible after symptoms first start, but this RARELY occurs due its slow and gradual onset. Non-surgical care includes anti-inflammatory care (ice, anti-inflammatory nutrients—ginger, turmeric, bioflavonoids; NSAIDs like ibuprofen), wrist splinting (primarily at night), corticosteroid injections, job/ergonomic modifications, exercises (yoga, stretching, strengthening, and aerobic fitness), low level laser therapy, ice, acupuncture, and chiropractic care. Chiropractic care includes MANY of the above PLUS manual therapies applied to the neck, shoulder, arm, wrist, and hand.Carpal Tunnel

Chiropractic as THE alternative to Opioids.

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In 2015, two million Americans had a substance abuse disorder involving prescription pain relievers; with more than 20,000 overdose deaths related to these drugs. In the past decade, death rates and substance use rates quadrupled in parallel to sales of prescription pain relievers.

Chronic LBP is a primary generator for opioid prescriptions. This year, both JAMA and Annals of Internal Medicine have published and supported new clinical practice guidelines that recommend prescribing spinal manipulation over medication for LBP patients.

“For acute, subacute, or chronic low back pain, physicians and patients initially utilize spinal manipulation and delay pharmacologic management.”

Research shows that low back pain patients who undergo chiropractic care have improved outcomes with lower rates of opioid use, surgery, and overall healthcare costs.

Not surprisingly, various governing bodies, including the FDA, CDC, and 37 State Attorney General’s, have concurred that physicians and healthcare decision makers should consider non- pharmacologic therapy for LBP patients. In fact, the 2018 Joint Commission guidelines mandate that hospitals include conservative options for chronic musculoskeletal pain management, specifically naming chiropractic as a potential option.

Chiropractic care is not a replacement for traditional medical treatment of LBP, rather a complementary tool to integrate within your current management paradigm. We hope that you will continue to consider our office for those cases that may be favorably served by conservative manual therapy. We are grateful for your confidence and will work hard to maintain your trust.

Do I Need an MRI?

~ Dr. Robert Speirs DC ~ Leave a comment
Low back pain is a very common complaint. In fact, it’s the #1 reason for doctor visits in the United States! The economic burden of LBP on the working class is astronomical. Most people can’t afford to be off work for one day, much less a week, month, or more! Because of the popularity of hospital-based TV dramas over the past two decades, many people think getting an MRI of their back can help their doctor fix their lower back problem. Is this a good idea? Let’s take a look!
Patients will often bring in a CD that has an MRI of their lower back to a doctor of chiropractic and ask the ultimate question, “….can you fix me?” Or, worse, “…I think I need surgery.” Sure, it’s quite amazing how an MRI can “slice” through the spine and show bone, soft tissues, disks, muscles, nerves, the spinal cord, and more! Since the low back bears approximately 2/3 of our body’s weight, you can frequently find MANY ABNORMALITIES in a person over 40-50 years old. In fact, it would be quite odd NOT to see things like disk degeneration, disk bulges, joint arthritis, spur formation, etc.!
Hence, the “downside” of having ALL this information is the struggle to determine which finding on the MRI has clinical significance. In other words, where is the LBP coming from? Is it that degenerative disk, bulged disk, herniated disk, or the narrowed canal where the nerve travels? Interestingly, in a recent review of more than 3,200 cases of acute low back pain, those who had an MRI scan performed earlier in their care had a WORSE outcome, more surgery, and higher costs compared with those who didn’t succumb to the temptation of requesting an MRI!
This is not to say MRI, CT scans, and x-rays are not important, as they effectively show conditions like subtle fractures and dangerous conditions like cancer. But for LBP, MRI is often misleading. This is because the primary cause of LBP is “functional” NOT “structural,” so it’s EASY to get railroaded into thinking whatever shows up on that MRI has to be the problem.
Here is how we know this, when we take 1,000 people WITHOUT low back pain between ages 30 and 60 (male or female) and perform an MRI on their lower back, we will find up to 53% will have PAINLESS disk bulges in one or more lumbar disks. Moreover, we will find up to 30% will have partial disk herniations, and up to 18% will have an extruded disk (one that has herniated ALL the way out). Yet, these people are PAIN FREE and never knew they had disk “derangement” (since they have no LBP). When combining all of these possible disk problems together, several studies report that between 57% and 64% of the general population has some type of disk problem without ANY BACK PAIN!
Hence, when a patient with a simple sprain/strain and localized LBP presents with an MRI showing a disk problem, it usually ONLY CONFUSES the patient (and frequently the doctor), as that disk problem is usually not the problem causing the pain!  So DON’T have an MRI UNLESS a surgical treatment decision depends on its findings. That is weakness, numbness, and non-resolving LBP in spite of 4-6 weeks of non-surgical care or unless there is weakness in bowel or bladder control. Remember, the majority of back pain sufferers DO NOT need surgery!
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 back pain, we would be honored to render our services.

Preventing Fibromyalgia?

~ Dr. Robert Speirs DC ~ Leave a comment

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​Fibromyalgia (FM) is a common cause for chronic pain (pain that lasts three or more months) and afflicts 4% of the general population in the United States! FM commonly affects the muscles and soft tissues – not the joints (like arthritis); however, many FM sufferers are mistakenly diagnosed with arthritis, so it may take years before they get an accurate diagnosis. There are NO known accurate diagnostic tests for FM, which is another reason for a delayed diagnosis.

In order to answer the question, “Can fibromyalgia be prevented?” we must first find the cause of FM. There are two types of FM: PRIMARY and SECONDARY. Primary FM occurs for no known reason, while secondary FM can be triggered by a physical event such as a trauma (e.g., car accident), an emotional event or a stressful situation (e.g., loss of a child), and/or a medical event such as a condition like irritable bowel syndrome, rheumatoid arthritis, or systemic lupus erythymatosis (SLE). Any condition that carries chronic or long-lasting symptoms can trigger FM, and some argue that the lack of being able to get into the deep sleep stage may be at the core of triggering FM since sleep disorders are a common finding in FM sufferers!

The “KEY” to managing FM has consistently been and probably always will be EXERCISE and SLEEP. So, if FM is preventable, daily exercise and getting the “right kind” of sleep are very important ways that may reduce the likelihood for developing the condition! Since emotions play a KEY ROLE in the cause and/or effect of FM, applying skills that keep life’s stressors in check is also important. This list can include hobbies like reading a good book, playing and/or listening to music, or meditation. The combination of exercise with mindful meditation using approaches like Tai Chi, Yoga, Qi Gong, and others has had positive impacts on FM patients such as improved balance and stability, reduced pain, enhanced mental clarity, and generally improved quality of life. Managing physical conditions that are associated with FM (such as irritable bowel syndrome, rheumatoid arthritis, or systemic lupus erythymatosis) is also important in managing and/or preventing FM.

Another management strategy of FM is diet. As most patients with FM will agree, certain foods help and others make the FM symptoms worse. In a survey published in the Journal of Clinical Rheumatology, 42% of FM patients reported certain foods exacerbated their symptoms. Of course, each individual case is unique, so keeping a food log or journal can be very helpful to determine dietary “friends” vs. “enemies.” The first step is to eliminate certain foods for four to six weeks, such as dairy and/or gluten. Most patients report a significant improvement in energy (less fatigue) while some report less pain when problem foods are eliminated from their diet. Generally, a diet rich in fruits, vegetables, and lean proteins can have a positive impact on the FM patient. Consider eating multiple small meals vs. two or three large meals during the day, as this can keep blood sugar levels more stable and reduce fatigue.

So back to the question, can fibromyalgia be prevented? Maybe…maybe not. Since the medical community doesn’t know the exact cause, it’s hard to answer this question. However, being proactive and implementing the strategies used to better manage FM may help in preventing it as well!

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

Chiro & Concussions

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​Whiplash Associated Disorders (WAD) is the appropriate terminology to use when addressing the myriad of symptoms that can occur as a result of a motor vehicle collision (MVC). In a recent publication in The Physician and Sports Medicine (Volume 43, Issue 3, 2015; 7/3/15 online:1-11), the article “The role of the cervical spine in post-concussive syndrome” takes a look at the neck when it’s injured in a car accident and how this relates to concussion.

It’s estimated about 3.8 million concussion injuries, also referred to as “mild traumatic brain injury” (mTBI), occur each year in the United States. Ironically, it’s one of the least understood injuries in the sports medicine and neuroscience communities. The GOOD NEWS is that concussion symptoms resolve within 7-10 days in the majority of cases; unfortunately, this isn’t the case with 10-15% of patients. Symptoms can last weeks, months, or even years in this group for which the term “post-concussive syndrome” (PCS) is used (defined as three or more symptoms lasting for four weeks as defined by the ICD-10) or three months following a minor head injury (as defined by the Diagnostic and Statistical Manual of Mental Disorders).

There have been significant advances in understanding what takes place in the acute phase of mTBI, but unfortunately, there is no clear physiological explanation for the chronic phase. Studies show the range of force to the head needed to cause concussion is between 60-160g (“g” = gravity) with 96.1g representing the highest predictive value in a football injury, whereas as little as 4.5g of neck acceleration can cause mild strain injury to the neck. In spite of this difference, the signs and symptoms reported by those injured in low-speed MVCs vs. football collisions are strikingly similar!

Research shows if an individual sustains an injury where the head is accelerated between 60-160g, it is HIGHLY likely that the tissues of the cervical spine (neck) have also reached their injury threshold of 4.5g. In a study that looked at hockey players, those who sustained a concussion also had WAD / neck injuries indicating that these injuries occur concurrently. Injuries to the neck in WAD include the same symptoms that occur in concussion including headache, dizziness/balance loss, nausea, visual and auditory problems, and cognitive dysfunction, just to name a few.

The paper concludes with five cases of PCS that responded well to a combination of active exercise/rehabilitation AND passive manual therapy (cervical spine manipulation). The favourable outcome supports the concept that the neck injury portion of WAD is a very important aspect to consider when treating patients with PCS!

This “link” between neck injury and concussion explains why chiropractic care is essential in the treatment of the concussion patient! This is especially true when the symptoms of concussion persist longer than one month!

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 honoured to render our services.