Workplace Injury

Chronic Lumbar Disc Pain

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Your low back consists of 5 individual vertebrae stacked on top of each other. Flexible cushions called “discs” live between each set of vertebrae. A disc is made up of two basic components. The inner disc, called the “nucleus”, is like a ball of jelly about the size of a marble. This jelly is held in place by the outer part of the disc called the “annulus”, which is a tough ligament that wraps around the inner nucleus much like a ribbon wrapping around your finger.


Your low back relies on discs and other ligaments for support. “Discogenic Low Back Pain” develops when these tissues are placed under excessive stress, much like a rope that frays when it is stretched beyond its normal capacity. Most commonly, disc pain is not the result of any single event, but rather from repeated overloading. Your lumbar discs generally manage small isolated stressors quite well, but repetitive challenges lead to injury in much the same way that constantly bending a piece of copper wire will cause it to break. Examples of these stressors include: bad postures, sedentary lifestyles, poor fitting workstations, repetitive movements, improper lifting, or being overweight.

Approximately one third of adults will experience pain from a lumbar disc at some point in their lifetime. The condition is more common in men. Most lumbar disc problems occur at one of the two lowest discs- L5 or L4. Smokers and people who are generally inactive have a higher risk of lumbar disc problems. Certain occupations may place you at a greater risk, especially if you spend extended periods of time sitting or driving. People who are tall or overweight have increased risk of disc problems.

Symptoms from disc pain may begin abruptly but more commonly develop gradually. Symptoms may range from dull discomfort to surprisingly debilitating pain that becomes sharper when you move. Rest may relieve your symptoms but often leads to stiffness. The pain is generally centered in your lower back but can spread towards your hips or thighs. Be sure to tell your doctor if your pain extends beyond your knee, or if you have weakness in your lower extremities or a fever.

Repeated injuries cause your normal healthy elastic tissue to be replaced with less elastic “scar tissue.” Over time, discs may dehydrate and thin. This process can lead to ongoing pain and even arthritis. Patients who elect to forego treatment and “just deal with it” develop chronic low back pain more than 60% of the time. Seeking early and appropriate treatment like the type provided in our office is critical.

Depending on the severity of your injury, you may need to limit your activity for a while, especially bending, twisting, and lifting, or movements that cause pain. Bed rest is not in your best interest. You should remain active and return to normal activities as your symptoms allow. Light aerobic exercise (i.e. walking, swimming, etc) has been shown to help back pain sufferers. The short-term use of a lumbar support belt may be helpful. Sitting makes your back temporarily more vulnerable to sprains and strains from sudden or unexpected movements. Be sure to take “micro breaks” from workstations for 10 seconds every 20 minutes.

Upper Crossed Syndrome/Desk Neck

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Upper crossed syndrome

Your posture plays an important role in your overall health. Poor posture leads to chronic strain and discomfort. “Upper crossed syndrome” describes poor posture that results from excessive tightness in your shoulders and chest with weakness in your neck and mid-back. This combination forces your shoulders to roll inward and your head to project forward.

To help understand how upper crossed syndrome causes trouble, think of your spine as a telephone pole and your head as a bowling ball that sits on top. When the bowling ball is positioned directly over the top of the upright post, very little effort is required to keep it in place. If you tip the post forward and the ball begins to roll over the edge of the post, significantly more effort would be required from the muscles trying to hold it there. This effort results in chronic strain of the muscles of your neck and upper back.

The chronic strain is uncomfortable and may also lead to neck pain, upper back pain, headaches, TMJ pain, and ultimately- arthritis. This postural problem is exceptionally common in computer workstation users.

Correction of this problem is accomplished by stretching the tight muscles, strengthening weak muscles, and modifying your workstation. Treatment is aimed at reducing and eliminating symptoms through the use of Chiropractic adjustments, soft tissue release, acupuncture and trigger point therapy.

Do I have a cuff tear?

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​Infraspinatous

One of the most common causes of shoulder pain is a rotator cuff (RC) tear. To determine just how common this is, one study looked at a population of 683 people regardless of whether or not they had shoulder complaints. There were 229 males and 454 females for a total of 1,366 shoulders. (The participants’ average age was 58 years, ranging from 22 to 87 years old.)

The research team found 20.7% had full thickness rotator cuff tears. Of those with shoulder pain, only 36% had tears found on ultrasound. Of those without shoulder pain, 17% also had tears! Risk factors for an increased for tearing of the rotator cuff include a history of trauma, the dominant arm (ie your right arm if you’re right handed), and increasing age.

In a review of radiologic studies of 2,553 shoulders, researchers found full-thickness rotator cuff tears in 11.75% and partial thickness tears in 18.49% of the subjects for a total of 30.24% having some degree of tearing. In this group, about 40% of tears were found in pain-free shoulders. The researchers concluded that rotator cuff tears are common and frequently asymptomatic.

Both of these studies support the necessity to FIRST consider the patient’s clinical presentation and then correlate that with the imaging results. In other words, the presence of a RC tear on an image (usually MRI or ultrasound) does NOT necessarily mean there is pain (and vise versa)!

So what other things could be causing the shoulder pain? There are many: impingement, tendonitis, bursitis, muscle strain, capsular (and other ligament) sprain, frozen shoulder, and osteoarthritis (the “wearing out” type). Also, rheumatoid arthritis, lupus, polymyalgia rheumatica and other autoimmune types of “arthropathies,” fibromyalgia, a herniated cervical disk, shoulder dislocations, whiplash injuries, and more!

Most importantly, we must NOT forget to include referred pain to the shoulder from an impaired heart (such as coronary heart disease or heart attack), lung, liver, or gall bladder as these problems commonly refer pain to the shoulder and may represent a MEDICAL EMERGENCY!

Snapping Hip. Not as horrific as it sounds.

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The muscle responsible for flexing your hip toward your trunk, is called the Psoas. This muscle begins on your lower spine and passes through your pelvis to attach onto the top of your femur (thigh bone). Along this course, the muscle travels across the front of your hip socket and over several bony prominences. If the muscle is too tight, its tendon may rub over these “bumps”. This occasionally produces an audible snapping sound, hence the moniker, “snapping hip”, aka “psoas tendinopathy”.
The tendon can be irritated by an acute injury, but more commonly from overuse- particularly repeatedly flexing your hip toward your trunk. The condition is also known as “dancer’s hip” or “jumper’s hip”, as movements associated with these activities are known culprits. Likewise, the condition is frequently seen in athletes who participate in rowing, track and field, hurdling, running (especially uphill), soccer, and gymnastics.

Your symptoms may include a “snapping” sound or sensation when you flex and extend your hip- although many cases are silent. Repeated rubbing causes inflammation and subsequent deep groin pain that can radiate to the front of your hip or thigh. Long-standing problems can trigger weakness or even limping.

The diagnosis of snapping hip is frequently overlooked. In fact, some studies show that identification is often delayed more than two years, while other potential causes are pursued. Fortunately, your problem has been recognized, and our office has several treatments to help you recover.

Psoas problems often start when one group of muscles is too tight, while another is too loose. Your home exercises will help to correct this problem. Depending upon the severity of your condition, you may need to avoid certain activities for a while. You should especially avoid repetitive hip flexion. Prolonged seated positions can encourage shortening of your hip flexors so be sure to take frequent breaks. Patients with fallen arches may benefit from arch supports.

Biceps Tendon Injury. The “suns out, guns out” injury.

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arnold-schwarzenegger-biceps_0

Your biceps muscle attaches to your shoulder through two strong fibrous bands called “tendons.” The term “biceps tendinitis” means that one of these bands has become painfully irritated from strain or degeneration. Sometimes the tendon may be strained by an accident or lifting injury. Biceps tendinitis more often results from repeated pinching of the tendon beneath the bony part of your shoulder

from a condition called “impingement.” Repeated overhead activity, like throwing, swimming, gymnastics, and racquet sports are known culprits. Biceps tendinitis is often accompanied by other conditions, like rotator cuff tears or injuries to the cartilage around the rim of your shoulder joint. Factors that make you more likely to develop biceps tendinitis include: improper lifting techniques, inflexibility, poor posture, or repetitive overloading.

Your symptoms likely include a deep, throbbing ache over the front of your shoulder. The pain often refers toward the outside of your arm. The main job of your biceps muscle is to flex your elbow and turn your palm up, so overhead movements or activities that require flexion of your elbow may cause pain. Patients often report increased discomfort when initiating activity. Night time symptoms are common, especially if you lie on your affected shoulder. Be sure to tell your doctor if you notice popping, catching, or locking during movements, as this may suggest an additional problem. A painful, loud “pop” followed by relief with a visible bulge in your biceps (Popeye deformity) suggests that your tendon has ruptured.

Surgery is rarely required for biceps tendon problems unless you are a young athlete or worker who performs exceptionally heavy physical activity and have completely ruptured your tendon. The most effective treatment for the majority of biceps tendinitis patients is conservative care, like the type provided in our office. Initially, you may need to avoid heavy or repetitive activity, (especially overhead activity and elbow flexion) as returning to activity too soon may prolog your recovery. You should specifically avoid military presses, upright rows, and wide grip bench presses until cleared by your doctor. You may use ice over your shoulder for 10-15 minutes at a time each hour. The exercises described below will be a very important part of your recovery and should be performed consistently.

Another tunnel injury? Seriously?

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Your radial nerve begins in your neck and travels past your elbow en route to its final destination in your hand. Just beyond your elbow, this nerve passes through a 2-inch area on the back of your forearm called the “Radial tunnel”. “Radial tunnel syndrome” means that your radial nerve has been compressed or irritated within this space-leading to forearm pain or hand weakness.

Radial tunnel syndrome is thought to result from muscular overuse, especially prolonged or excessive wrist extension or rotation. The most common cause of compression comes from excessive tightness in a muscle called the “Supinator”. Workers whose jobs require heavy or repetitive wrist movements are at an increased risk for this disorder. Occasionally, the radial nerve can become irritated from direct compression by a tight band or brace. The condition may be more common in those who have diabetes or thyroid problems.

Symptoms from irritation of the radial nerve depend upon which specific nerve fibers are irritated. The most common symptoms include pain, numbness, tingling or decreased sensitivity along the top of your forearm radiating toward your hand and thumb. The symptoms often mimic those of “tennis elbow.” When the nerve fibers that control muscle function become compressed, you may experience weakness when trying to extend your fingers, hand or wrist. Seventy percent of radial tunnel patients also have problems in their neck or upper back.

Conservative treatment of radial tunnel syndrome is generally successful. Fixing the problem means limiting excessive or repetitive wrist movements, especially extension and rotation. In severe cases, a splint may be necessary to limit your motion. Try to avoid compression of your forearm, particularly from tight bands or braces. Use of a tennis elbow brace will likely aggravate your symptoms. You may find relief by applying ice or ice massage to the area for 10-15 minutes at a time.

Can Carpal Tunnel Be Prevented? 

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​Prevent

Carpal Tunnel Syndrome (CTS) is a VERY common condition where the median nerve is compressed or squeezed as it passes through the wrist. One reason that it’s so common is because MANY daily activities require fast, repetitive use of the fingers, hands, and arms, and the friction of the rapidly moving muscle tendons inside the tunnel results in swelling and compression of the nerve. So, can CTS really be prevented?

There are many factors associated with CTS, and some risks can be prevented. For example, some conditions like diabetes, rheumatoid arthritis, and IBS increase the risk of CTS. Therefore, it would be safe to assume those who better manage such conditions would have a lower risk for developing CTS.

Due to the many factors associated with CTS, there is no “one size fits all” when it comes to treatment and prevention of CTS. With that said, here are some VERY effective methods:

1)  Ergonomic workstation modifications: Altering the work space (monitor height, keyboard/mouse style, different chair, chair/desk height, etc.) to reduce the number and speed of movements needed to perform commons work tasks.

2)  Rest periods: Insert “micro-breaks” into a busy task. Combine breaks with stretching exercises of the wrist/hand/fingers and vary job tasks between fast and slow repetitive types.

3)  Exercise: Shake the fingers and hands, lean back in a chair with the arms/shoulders stretched back (“Brugger’s Exercise”), move the neck (chin tucks, rotations, etc.), bend the hand/wrist backwards on a wall or the desk’s edge, self-massage and deep tissue release of the forearm and hand muscles. Do regular aerobic exercise (walking, swimming, biking, etc.) several times each week.

4) Posture: Sit up straight, elbows about 90° on height-adjustable arm rests or comfortably at the sides, forearms parallel to the floor; knees level or slightly lower than the hips, feet flat on the floor or on a footrest or box, if needed. Place typing materials at eye level / avoid prolonged head/neck rotation. Use a wrist rest for the keyboard and mouse, and use a headset when on the phone.

5)  Reduce hand tool forces: Choose a tool that allows the wrist to remain neutral. Avoid side to side and flexion/extension wrist positions—especially if they’re prolonged! Tool handles should NOT dig into the palm of the hand or the wrist, and should not have sharp edges. A textured handle can improve grip. Minimize vibration from power tools. Wear shock absorbing gloves. Avoid cold work environments and cold tools.

6)  Diet: Cut down on caffeine and smoking. Avoid obesity—a known risk factor of CTS! Consider an anti-inflammatory diet (Paleo, Mediterranean).

7)  Splints: A wrist cock-up splint at night prevents prolonged faulty positions and REALLY helps!

This is a partial list of preventative measures that can REALLY help. Doctors of chiropractic treat the WHOLE person and can teach you the right exercises, ways to modify your diet, offer manual therapies and modalities, and help guide you in your self-management of CTS, as this can be a lifelong affliction. A multi-modal treatment approach generally works best!

Cubital Tunnel Syndrome…. Ever heard of it?

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Your cubital tunnel is the groove on the inside of your elbow, also called the “funny bone.” The funny part about the funny bone is that it is not actually a bone but rather a nerve, called the ulnar nerve. Your ulnar nerve begins in your neck and passes through the cubital tunnel on its way to your hand.

When you flex your elbow, the ulnar nerve is required to both stretch and slide through your cubital tunnel. If your ulnar nerve is “stuck” in the tunnel and does not glide when you flex your elbow, this leads to traction and irritation of the nerve. This is called “cubital tunnel syndrome.” The nerve may also be irritated from direct compression, like leaning your elbow on the edge of a desk or from arthritic spurs. Cubital tunnel syndrome is the second most common nerve compression problem in the arm, behind carpal tunnel syndrome.

Irritation of the ulnar nerve in the cubital tunnel causes pain, numbness or tingling that radiates from your elbow into your fourth and fifth fingers. Your symptoms can vary from a vague increased sensitivity to pain. The symptoms are common at night and are often progressive over time. In severe cases, you may begin to lose grip strength and fine muscle control.

Cubital tunnel syndrome is commonly seen in baseball, tennis and racquetball players. Workers who keep their elbows flexed such as holding a tool or telephone, or those who press the ulnar nerve against a hard surface like a desk, are at an increased risk for this disorder. Cubital tunnel syndrome affects men three to eight times as often as women and is more common in those who have diabetes or are overweight.

You should try to avoid prolonged elbow flexion or direct pressure over your elbow. Our office may prescribe a nighttime elbow splint that limits flexion.

Is Surgery Always Required?

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​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

Feels just like Carpal Tunnel but isn’t Carpal Tunnel……

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Your Median Nerve begins in your neck and travels down your arm on its way to your hand. This nerve is responsible for sensation on the palm side of your first 3 ½ fingers and also controls some of the muscles that flex your fingers. The median nerve can sometimes become entrapped near your elbow as it travels through a muscle called the “pronator teres”. Compression of the median nerve by the pronator muscle is called “Pronator Syndrome.”

Pronator syndrome is often brought on by prolonged or repeated wrist and finger movements, i.e., gripping with the palm down. Carpenters, mechanics, assembly line workers, tennis players, rowers, and weight lifters are predisposed to this problem. The condition is more common in people with excessively developed forearm muscles and is also more common in your dominant arm. Pronator syndrome most often affects adults age 45-60 and females are affected about four times more frequently than males. People who suffer from diabetes, thyroid disease, and alcoholism have an increased risk for developing pronator syndrome.

Pronator syndrome produces symptoms very similar to a more common cause of median nerve compression called “carpal tunnel syndrome”. Symptoms of pronator syndrome include numbness, tingling, or discomfort on the palm side of your thumb, index, middle finger, and half of your ring finger. The discomfort often begins near the elbow and radiates toward your hand. Your symptoms are likely aggravated by gripping activities, especially those that involve rotation of the forearm, like turning a doorknob or a screwdriver. Unlike carpal tunnel syndrome, pronator syndrome symptoms are not generally present at night. You may sometimes feel as though your hands are clumsy. In more severe cases, hand weakness can develop.

To help resolve your condition, you should avoid activities that involve repetitive hand and forearm movements. Perhaps the most important aspect of your treatment plan is to avoid repetitive forceful gripping. You may apply ice packs or ice massage directly over the pronator teres muscle for ten minutes at a time or as directed by our office. In some cases, an elbow splint may be used to limit forearm movements. If left untreated, pronator syndrome can result in permanent nerve damage. Fortunately, our office has several treatment options available to help resolve your symptoms.