Pain

Can Carpal Tunnel Be Prevented? 

~ Dr. Robert Speirs DC ~ Leave a comment

​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!

Trigger points in the pectoralis minor muscle.

~ bryancobb ~ Leave a comment

The pectoralis minor is a small strap like muscle that is underneath (deep) to the pectoralis major. It originates on the third to fifth rib, near the costal cartilages. It’s insertion is on the coracoid process of the scapula. It acts to draw the scapula forward, downward, and inward at nearly equal angles ( think of rounding or shrugging your shoulders forward). This muscle is very often shortened and tight in people due to the high prevalence of desk jobs. This muscle pulls the shoulder blade forward resulting in the muscles in the back(rhomboid and mid traps) being chronically strained. Trigger points that form in the pec minor primarily refer pain over the anterior chest and shoulder, with spillover down the medial arm. Trigger points in the left side can mimic angina.

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.

Why am I so dizzy after my whiplash?

~ Dr. Robert Speirs DC ~ Leave a comment

Migrane​

Whiplash, or better termed “Whiplash Associated Disorders” (WAD), is a condition that carries multiple signs and symptoms ranging from neck pain and stiffness to headache, confusion, ringing in the ears, and more. But can WAD cause dizziness? Let’s take a look!

Dizziness is a general term that is used rather loosely by the general population. We’ve all experienced dizziness from time-to-time that is considered “normal,” such as standing up too quickly or while experiencing a rough flight.

Often, dizziness and problems with balance go hand in hand. There are three main organs that control our balance: 1) the vestibular system (the inner ear); 2) the cerebellum (lies in the back of the head); and, 3) the dorsal columns (located in the back part of the spinal cord). In this article, we will primarily focus on the inner ear because, of the three, it’s unique for causing dizziness. Our vision also plays an important role in maintaining balance, as we tend to lose our balance much faster when we close our eyes.

It’s appropriate to first discuss the transient, usually short episode of “normal” lightheadedness associated with rising quickly. This is typically caused by a momentary drop in blood pressure, and hence, oxygen simply doesn’t reach the brain quick enough when moving from sitting to standing. Again, this is normal and termed “orthostatic hypotension” (OH).

However, OH can be exaggerated by colds, the flu, allergy flair-ups, when hyperventilating, or at times of increased stress or anxiety. OH is also associated with the use of tobacco, alcohol, and/or some medications. Bleeding can represent a more serious cause of OH such as with bleeding ulcers or some types of colitis, and less seriously, with menstruation.

The term BPPV or benign paroxysmal positional vertigo, has to do with the inner ear where our semicircular canals are located. The canals lie in three planes and give us a 3D, 360º perspective about where we are in space. The fluid flowing through these canals bends little hair-like projections, which are connected to sensory nerves that tell the brain about our spatial position. If the function of these canals is disturbed, it can mix-up the messages the brain receives, thus resulting in dizziness. Exercises are available on the Internet that can help with BPPV (look for Epley’s and Brandt-Daroff exercises).

DANGEROUS causes of dizziness include: HEART – fainting (passing out) accompanied by chest pain, shortness of breath, nausea, pain or pressure in the back, neck, jaw, upper belly, or in one or both arms, sudden weakness, and/or a fast or irregular heartbeat.

STROKE – sudden numbness, paralysis, or weakness in the face, arm, or leg, especially if only on one side of the body; drooling, slurred speech, short “black outs,” sudden visual changes, confusion/difficulty speaking, and/or a sudden and severe, “out of the ordinary” headache. CALL 911 (or the number for emergency services if you’re outside the Canada) if you suspect you may be having a heart attack or stroke!

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.

 

Trigger points in the rhomboid muscles.

~ bryancobb ~ Leave a comment

This is another common muscle to get trigger points. It originates on the spinous processes of the T2-T5 vertebrae. It inserts on the medial border of the scapula. It’s main actions are to adduct the scapula pulling it back toward the spine, and to rotate the glenohumeral joint downward. This muscle also prevents wining of the scapula. This muscle is often overloaded by a sitting posture where the shoulders are rolled forward such as when using a computer. The Rhomboids are often weak and under trained in people. Trigger points in this muscle cause pain and ache in the upper back between the shoulder blade. Strength trading for this muscle is necessary to help prevent postural overload.

When Are My Shoes “Done”?

~ Dr. Robert Speirs DC ~ Leave a comment

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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.

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.

How long does Whiplash last?

~ Dr. Robert Speirs DC ~ Leave a comment

​watch

First, what is whiplash? It’s a lot of things, which is why the term WAD or Whiplash Associated Disorders has become the most common term for the main signs and symptoms associated with a whiplash injury. WAD is usually associated with a motor vehicle collision, but sports injuries, diving accidents, and falls are other common ways to sustain a WAD injury.

To answer the question of the month, in most cases, the recovery rate is high and favors those who resume their normal daily activities. The worse thing you can do when you sustain a WAD injury is to not do anything! Too much rest and inactivity leads to long-term disability. Of course, this must be balanced with the degree of injury, but even when the injury requires some “down time,” stay as active as possible during the healing phase.

Many people recover within a few days or weeks while a smaller percentage require months and about 10% may only partially recover. So what can be done to give you the best possible chance to fully recover as soon as possible?

During recovery, you can expect your condition to fluctuate in intensity so “listen” to your body, let it “guide” you during activity and exercise, and stay within “a reasonable boundary of pain” during your activity. Remember, your best chance for full recovery FAVORS continuing a normal lifestyle. Make reasonable modifications so you can work, socialize, and do your “normal” activities!

The KEY: Stay in control of your condition – DO NOT let it control you! Here are some tips:

1)  POSTURE CONTROL: Keep the weight of the head back by gliding your chin back until you “hit” a firm end-point. Then release it slightly so it’s comfortable—this is your NEW head position!

2)  FLEXIBILITY: Try this range of motion (ROM) exercise… Slowly flex your neck forwards and then backwards, then bend your neck to the left and then the right, and then rotate it to the left and to then to the right. THINK about each motion and avoid sharp, knife-like pain; a “good-hurt” is okay! Next, do the same thing with light (one-finger) resistance in BOTH directions. Try three slow reps four to six times a day!

3)  MUSCLE STRENGTH: Try pushing your head gently into your hand in the six directions listed above to provide a little resistance. Next, reach back with both hands or wrap a towel around your neck and pull forwards on the towel while you push the middle of your neck backwards into the towel doing the chin-tuck/glide maneuver (same as #1). Repeat three to five times slowly pushing, and more importantly, release the push slower! This is the MOST IMPORTANT of the strengthening exercises in most cases! Next, “squeeze” your shoulder blades together followed by spreading them as far apart as possible (repeat three to five times).

4)  PERIODIC BREAKS: Set a timer to remind yourself to do a stretch, get up and move, to tuck your chin inwards (#1) and do some of #2 and #3 every 30-60 minutes.

5)  LIFTING/CARRYING/WORK: Be SMART! Do not re-injure yourself. Change the way you handle yourself in your job, in the house, and while performing recreational activities.

6)  HOUSEHOLD ACTIVITIES: Use a dolly to move boxes and keep commonly used items within easy reach (not too high or low).

Be smart, stay educated, work within the range your body tells you is “safe” and most importantly, STAY IN CONTROL!!!