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Spinal Manipulation AFTER Surgery HELPS!

Unfortunately, low back pain (LBP) is something MOST of us cannot avoid. There is solid evidence that chiropractic care is one of the most effective methods of treating LBP, but there are times when a referral for surgery is needed. What about manipulative therapy (MT) AFTER surgery? Is this a good idea? Does it help?

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Carpal Tunnel Syndrome vs. Cubital Tunnel Syndrome

Carpal Tunnel Syndrome (CTS) belongs to a group of disorders referred to as “cumulative trauma disorders,” or CTDs. The word “cumulative” refers to the cause being repetitive motion, usually fast and prolonged. Over time, the wear and tear on the upper extremities accumulates and symptoms begin to occur and possibly worsen. This can result in changes in movement intended to avoid further injury that then overstress another part of the arm, which can lead to a second injury. Like dominos, injury after injury can eventually result in multiple conditions between the neck and hand. Let’s take a look at two of the more common CTDs…

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CTS “Facts” Continued

CarpalTunnel

Last month, we covered what Carpal Tunnel Syndrome (CTS) is, its symptoms, causes, who is at risk, and how it's diagnosed. This month, we’ll center our focus on CTS treatment.

How is CTS treated? For the best success, treatment should begin as early as possible. Unfortunately, most people wait a long time before they get to the point where the symptoms interfere with daily activity enough to prompt them to act quickly and make an appointment. Once the cause or causes of CTS are determined, treatment can address ALL the presenting contributing conditions. The FIRST course of care should be NON-SURGICAL, though this is not always practiced – so be aware! Non-surgical care includes the following:

  1. Chiropractic:
    • Manipulation: This usually includes adjusting the small bones of the hand, the wrist, the forearm, elbow, shoulder, and/or the neck.
    • Soft-tissue therapy: This includes loosening up the overly tight forearm muscles where the median nerve runs through (on the palm side of the forearm).
    • Modalities: Such as electrical stimulation and/or laser/light therapy can be very beneficial in reducing swelling or inflammation. In chronic CTS, ultrasound may be helpful as well.
    • Nutritional: Nutrients such as vitamin B6 have been shown in studies to be effective in some cases. Also, anti-inflammatory herbs (ginger, turmeric, bioflavinoids) and/or digestive enzymes (bromelain, papain, and others) taken between meals are quite effective.
  2. Anti-inflammatory: The first important distinction is that ice can be very effective depending on how long the CTS has been present. In particular, ice cupping or rubbing ice directly on the skin over the carpal tunnel is the most effective way to use ice as an anti-inflammatory agent. When doing so, you will experience four stages of cooling: Cold, Burning, Achy, Numb or, “C-BAN.” It’s important to remember this as you are REALLY going to want to quit in the burning/achy stages when it feels uncomfortable. Once the skin over the wrist/carpal tunnel gets numb (which takes about four to five minutes) QUIT as the next “stage” of cooling is FROST BITE! Most medical practitioners promote the use of NSAIDs (non-steroidal anti-inflammatory drugs) like Advil, aspirin, or Aleve. However, these carry negative side effects including gastritis (burning in the stomach that can lead to ulcers), or liver and/or kidney damage. Try the nutritional anti-inflammatory approach FIRST as they are extremely helpful without the bad side effect potential!
  3. Diet: An ant-inflammatory diet, like the Paleo-diet or gluten free diet, serves as a great tool in reducing the inflammatory markers in the body. Though only 7-10% of the population has celiac disease (gluten intolerance), it’s been estimated that over 80% of us are gluten “sensitive.” Reducing systemic inflammation can make a BIG DIFFERENCE in the management of many conditions including CTS!
  4. Mechanical: Wrist “cock-up” splints can also be REALLY HELPFUL, especially for nighttime use. The reason for this is because when our wrist is bent forwards or backwards, which frequently occurs when sleeping, the pressure inside the carpal tunnel increases, and over time (minutes to hours), the increased pressure in the tunnel exerts compression on the median nerve which then creates numbness into the thumb, index, third and half of the fourth finger, which can wake you up out of a sound sleep. Keeping the wrist straight at night prevents you from curling your wrist under your jaw while sleeping.
  5. er station, line position, machine controls, pace or rate of repetitive movements, and more) is VERY effective.

NOTE: ALL of the above can be managed through the services offered at our clinic!

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 Carpal Tunnel Syndrome, we would be honored to render our services.

It’s All in the Wrist… and Hand… and Fingers…

The carpal tunnel is located at the base of the palm. It is made up of bones, tendons and a thick ligament, all of which encircle the median nerve. Carpal Tunnel Syndrome (CTS) occurs when this nerve becomes pinched or inflamed, usually a result of repetitive motion from typing or any other sustained activity that overuses this area. An injury to the wrist or hand can also result in nerve damage to the carpal tunnel.

Symptoms range from numbness, tingling and pain to loss of muscle strength. Numbness is most prevalent in the thumb, index and middle fingers, and is often first noticed upon waking.

Who Gets Carpal Tunnel Syndrome?
CTS is the most common nerve disorder of the hands, but the majority of cases occur in women between 40 and 55, and 60% of all work injuries are due to CTS. Common occupations at high risk for CTS are secretaries, carpenters, weightlifters and meat packers. Young women can also develop CTS during pregnancy because of hormonal effects upon ligaments and tendons.

Treatment of CTS
Traditional physicians often inject corticosteroids into the area, which will temporarily relieve pain and swelling, but this does not actively treat the problem. When CTS is severe, surgery is often recommended, but this should be a last resort, since surgery can result in scarring and weakening of the ligament, and symptoms can eventually recur.

Chiropractic manipulation has been proven effective in treating CTS because chiropractors are nervous system experts. After X-ray or electromyography studies, your chiropractor can determine the extent of injury and the exact mode of manipulation necessary to alleviate the problem. Adjunct treatment LCT 1000 Deep Tissue (Class IV) Laser may be the most advanced and effective way to alleviate pain and promote healing for CTS sufferers.

Wrist support is very helpful in resting the area and relieving symptoms, even during sleep. Patients with CTS are also encouraged to take breaks and vary their activities during the day to avoid overuse of the area, and to wear fingerless gloves to promote warmth and flexibility in the hands and wrists.

What if it Still Hurts?
Some people do not respond to typical treatment of the wrist because the painful nerve compression is occurring not only in the wrist, but also further along the nerve path to the neck or at multiple locations. The effects of the compression at the lower area is exaggerated by the other higher up compression. This is called Double Crush Syndrome and can be helped with chiropractic management that includes spinal manipulation and physical therapy.

Reprinted with permission from Think Teachers Magazine.

What if Your Back Pain is a Herniated Disc?

What is a herniated disc?
Discs are shock absorbers for the spine – they’re flexible, almost gelatinous disks between vertebrae that cushion the spine and permit full range of motion. Sometimes these discs can degenerate and herniate, which means material from inside the disc can leak out. This can cause a great deal of pain, because when a disc herniates it presses on spinal nerves. Approximately 90% of disc herniations occur toward the bottom of the spine, known as the lumbar spine. A herniated disc with a pinched nerve can be extremely painful.

What are the symptoms of a herniated disc with a pinched nerve?
Symptoms of this nerve impingement are weakness in extending the big toe and ankle (foot drop), numbness can be felt on top of the foot, and can radiate into the buttock. If a different nerve is involved, the ankle reflex is lost and the patient cannot rise to their toes using their ankle. Pain in this case radiates down to the sole or outside the foot.

How is a herniated disc treated non-surgically?
Pain from a herniated disc often resolves on its own over time, as the prolapsed material is reabsorbed by the body, but until this happens (usually between four and six weeks) there can be considerable pain.

Bed rest is not recommended beyond a day or two for a herniated disc with a pinched nerve. Even in these cases, regular movement is advised to maintain muscle tone. Pain medication, cold and/or heat therapy, electrostimulation, bracing, traction, steroid injections and hydrotherapy are often used to control discomfort until the condition resolves.

While many people turn to medications and even surgery, they are very often ineffective and sometimes not necessary. It is during this period that chiropractic manipulations and physical therapy are often recommended, and in 80 to 90% of cases of a herniated disc with a pinched nerve, no surgery is required. New technological advances, such as class IV deep tissue laser and spinal decompression, comprise some of the latest non-surgical therapeutic modalities that can successfully resolve the problem and eliminate the need for surgery.

Other treatment options include medication to reduce the pain associated with herniated discs and, in severe cases where conservative treatments fail to relieve the symptoms, surgery may be performed to remove the protruding portion of the disc. Rarely, the entire disc may be removed and spinal stability may need to be provided by fusing metal hardware, or in some cases, an artificial disc may be implanted. Surgery should always be the last resort because of the statistically high failure rate and long recovery time.

Reprinted with permission from Think Teachers Magazine.

Questions About Sciatica Answered

What is Sciatica?
Back injury doctors will tell you that sciatica is a condition in which pain originating from the low back or buttock area travels down one or both legs. The pain of sciatica has been described as achy, sharp, tingling, or has sometimes been likened to electric shocks. Pain can be mild, moderate or severe, infrequent or constant, depending on the degree of nerve involvement.

What Causes Sciatica?
Sciatica is usually caused by compression of the sciatic nerve, a large nerve originating at the base of the spine. This compression can be caused by subluxations (misalignment) of the lower spine; herniated or bulging discs; pregnancy and childbirth (when pelvic bones shift and the tissues surrounding them are softer and more movable); tumors or diabetes.

Sciatica is often a result of Piriformis Syndrome. The piriformis muscle is located in the lower spine and is involved in hip rotation. The sciatic nerve is located directly beneath the piriformis muscle, so any injury or disorder affecting this muscle can result in pinching of the sciatic nerve.

How Does a Back Pain Specialist Treat Sciatica?
Initially the doctor will need to accurately diagnose the cause of a patient’s sciatica. This involves taking the patient’s medical history, conducting a thorough physical and neurological examination and employing various diagnostic tests, including X-ray, MRI, CT scans and, if needed nerve testing including electromyography. In most cases, sciatica can be treated non-surgically and non-invasively.

Therapy will be customized based on the most effective way for the patient’s body to begin to heal itself, and may include physical therapy, ice/cold therapy, electrical stimulation (TENS), and spinal manipulation. Advanced therapies such as spinal decompression and deep tissue medical laser therapy can also create dramatic results.

Reprinted with permission from Think Teachers Magazine.