Carpal Tunnel Syndrome (CTS) – What, Why, How?

WHAT?: Carpal Tunnel Syndrome or CTS, is the most common of the peripheral nerve conditions where the median nerve is compressed or pinched at the wrist. The resulting symptoms include numbness/pain in the wrist, fingers (index, third, and forth), multiple sleep interruptions due to hand/finger numbness requiring frequent shaking and flicking, difficulty in gripping or pinching such as buttoning a shirt, threading a needle, lifting a coffee cup, frequent dropping of objects, and the inability to perform work duties. Pain can even shoot up the arm towards the shoulder and into the neck. Because there are 9 tendons over which lies the median nerve that pass through the rather tight tunnel made up of the 8 carpal bones of the wrist, even a little swelling can create CTS.

WHY?: There are many possible causes but in general, whether its swelling, a spur, or a metabolic condition, the common denominator is median nerve pinch in the confined space within the carpal tunnel. A common cause of swelling can occur with performing repetitive motion work such as line assembly, meat packing, carpentry, and so on, and over time, the tendons inside the tunnel inflame or swell and the median nerve is pressed into the ligament that crosses over the roof of the tunnel on the palm side of the wrist. Once the contents inside the tunnel swell, all positions of the wrist other than neutral or, holding the wrist in line with the forearm further increases the pressure inside the tunnel. That is why sleeping with the wrist cocked in any direction often wakes up CTS patients. Those most at risk are women over 50 years of age. CTS can also be associated with other health conditions including (but not limited to) Lymes Disease, inflammatory arthritis, and hormone-related conditions including pregnancy, taking birth control pills (BCPs), hypothyroidism, diabetes, and menopause. Lifestyle issues that affect CTS may include high caffeine intake, smoking, alcohol consumption, as well as obesity.

HOW?: So the key question is how are we going to help those with CTS? First, we must identify all the possible reasons why CTS developed in the first place and manage those issues. Therefore, an ergonomic (work place) assessment or, discussing and possibly observing the patient at work can be very helpful. Sometimes, a few simple changes to a work station such as moving the monitor of a computer in line with the keyboard/mouse or adjusting the height of the computer can really help. Changing a tool handle type (pistol vs. straight grip), propping up a part that is frequently worked on, moving the product closer to where it is being assembled, eliminate overhead reach requirements, standing on a raised platform, and so on, may be most important in long term results. Identifying and treating any condition that may be participating in the cause like thyroid disease, diabetes, medication (like BCPs), and weight management, is very important. Wearing a night splint is also very productive. Unique to chiropractic, treatments include manipulation of the neck, shoulder, elbow, forearm, wrist and fingers, soft-tissue therapy including massage, mobilizing the forearm muscles and tendons, teaching carpal stretch and other upper extremity exercises, and nutritional counseling. Strategies here can include eliminating any suspected food allergy related products including dairy, glutens (wheat, oats, barley, rye), soy, corn, transfats, preservatives and some chemical additives. Increasing B-vitamins (especially B6), by increasing dark leafy vegetables and, increasing antioxidants including fruits and veggies. An anti-inflammatory vitamin program of fish oil, Vit. D3, magnesium, CoQ10, and a multiple vit./mineral may facilitate as well. Once CTS is controlled, preventing a recurrence is important by promoting good posture, exercise, and sticking with the life style adjustments described above. If you, a friend or family member requires care for CTS, we would be honored to render our services.

Weekly Health Update

Mental Attitude: Family Gatherings? If your family fights, or going home for the holidays triggers bad memories, you can cope. Don't expect the worst. Focus on catching up with a cousin or enjoying your favorite dish. Make a plan. Have a trusted relative ready to spring you from bad conversations. Set a time limit. Stop by for just 15 minutes. Or, if you can't bear to go, just RSVP "no". Mental health America

Health Alert: Why Canned Soups Can Be Dangerous to Your Health. The food processing world is reeling right now after a shocking new series of tests released by Consumer Reports revealed many leading brands of canned food contain BPA, a toxic chemical linked to health risks including reproductive abnormalities, neurological effects, heightened risk of breast and prostrate cancers, diabetes, heart disease and other serious health problems. BPA is used in the lining of cans and the toxin leaches from the lining into the food. A couple of servings of canned food can exceed scientific limits on daily exposure for children. The federal government is currently studying the dangers of BPA and advocates are calling for the FDA to ban the use of BPA in food and beverage packaging by the end of the year. Consumer Reports, Nov. 2009

Diet: Start Your Day With Whole Grains. A bowl of oatmeal or whole-grain cereal has benefits that last all day. The fiber and complex carbohydrates in the whole grains help you feel fuller for longer, so you'll be less tempted to overeat at lunch. They also help reduce LDL "bad" cholesterol and can be an important part of your weight loss strategy. American Journal of Clinical Nutrition, Dec. 2004

Exercise: How to Start an Exercise Program. Start Slowly. Most people do too much when they start exercising. It's OK to break up your exercise into segments. Even small quantities of exercise add up to big benefits. Begin with 10-15 minute chunks of activity, several times daily. Elaine Magee, MPH, RD

Chiropractic: Low Back Pain - What Increases Your Risk? Try this simple test: place your hand wide open on your friend's lower back. Have them simulate a variety of activities from dish washing to brushing their teeth. You will feel the back tightening immediately. Most people are in that position all day long. These "activities of daily living" cause most low back pain.

Wellness/Prevention: Vinegar Health Benefits. Two tablespoons of apple cider vinegar before bed lowered glucose levels by 4%-6%. A study of rats found vinegar could lower high blood pressure. A study found people who ate oil and vinegar dressing on salads 5-6 times a week had lower rates of heart disease. For thousands of years, vinegar has been used for weight loss. White vinegar (and perhaps other types) might help people feel full. A 2005 study found those who ate a piece of bread along with small amounts of white vinegar felt fuller and more satisfied than those who ate just the bread.European journal of Clinical Nutrition, 2005

Whiplash: Body, Mind and Spirit – What is the Connection?

The term “whiplash” refers to an injury to the neck muscles, the muscle attachments (tendons), ligaments, and sometimes the disks that lie between the vertebral bodies of the spine. In a rear-end collision, the cause of whiplash occurs from a sudden, rapid acceleration of the body and neck as the car is pushed forwards. In these first 50-75 milliseconds following impact, the head remains in the same place while the body is propelled forward. This is followed by a “crack-the-whip” movement of the head and neck when the muscles in the front of the neck stretch like rubber bands and suddenly spring the head forwards, all occurring in less than 300 msec. The force on the head and neck is further intensified if the seat back is too springy, or angled back too far. Also, if the headrest is too low, the head may ride over the top and more injury can result.

The treatment of whiplash varies from “watchful waiting” to a multidisciplinary team approach that includes neurology, physical therapy, chiropractic, psychology, and possibly surgery (rare). In a recent article published in the American Journal of Physical Medicine and Rehabilitation (2009, March Vol. 88, No. 3, pp 231-8), the relationship between clinical, psychological and functional health status factors was investigated in a group of patients with chronic whiplash-associated disorder (WAD). A total of 86 patients with chronic WAD participated in the study and outcomes were tracked using questionnaires that measure pain, disability and psychological issues including depression, anxiety and catastrophizing. Physical examination factors included measuring the cervical range of motion. An analysis of the degree of neck disability and the relative contribution of physical vs. psychological factors revealed catastrophizing and depression played greater roles than did cervical range of motion. This suggests psychological factors play an important role in the outcome of whiplash.

The importance of this is that more than just the physical factors like range of motion should be focused on when treating chronic whiplash patients. Answering the patient’s questions, explaining the mechanism of injury and how that relates to their specific condition, and addressing depression, anxiety, coping, and other psychological issues is very important. Discussing treatment goals with patients is also very important. For example, making light of the injury by stating something like, “…you’ll be fine after the treatments,” may harm the patient as anything short of “fine” may be interpreted as failed treatment by the patient. It is also important not to paint too dismal of a picture as that can have negative psychological effects as well, as this may suggest that they will never improve. Explaining the difference between “hurt” and “harm” is of great value to the chronic whiplash patient as they are often told, “if it hurts, don’t do it.” This sends an unfortunate message to the patient that any activity where an increase in pain occurs is “bad” when in fact, that activity may help the patient get better in the long run. This can make or break an acceptable outcome as many may feel like they shouldn’t do anything and this can lead to unemployment, boredom, and the many psychological issues previously described. The best advice is to remain active and try to ignore discomfort by staying within “reasonable activity boundaries.” Reasonable activity tolerance is learned as time passes and trying different activities for different lengths of time. This type of coaching should be at the center of chronic whiplash management rather than over focusing on physical factors such as range of motion.

If you, a loved one, or a friend is struggling with whiplash residuals from a motor vehicle collision, you can depend on receiving a multi-dimensional chiropractic assessment and therapeutic approach at this office. We sincerely appreciate your confidence in choosing our office for your health care needs!

Weekly Health Update

Mental Attitude: Diet Moodiness? Low-Fat vs. Low-Carb. A recent study shows a short-term improvement in the moods of people who went on a low-fat and low-carb diets. However, mood gains did not last for people on low-carb diets. People in both groups got the same daily calorie budget. They also met regularly with a dietitian and completed mood surveys several times during the study. By the end of the year, people in both groups had lost the same amount of weight, about 30 pounds. Mood improvements DID last for people on the low-fat diet. Researchers suggest the low-carb diet may have been "so far removed" from normal eating patterns that it became a lot of work and a social burden. Archives of Internal Medicine

Health Alert: Too Fat? According to the annual America's Health Rankings, spending to treat the health effects of obesity, $86 billion last year, will quadruple over the next decade, and almost half of US adults will be obese by 2018. If obesity rates held at current levels, on the other hand, the US would save nearly $200 billion in health care costs. Henry J. Kaiser Family Foundation

Diet: Unsaturated Fats Protect the Heart. Fat is needed in our diet - about 25-35% of our daily calories. However, not all fats are equal. Unsaturated fats - like those found in canola, olive and safflower oils - lower LDL "bad" cholesterol levels and may help raise HDL "good" cholesterol. Saturated fats - like those found in butter and palm oil - and trans fats raise LDL "bad" cholesterol. Even good fats have calories, so eat in moderation. American Heart Association Nutrition Committee

Exercise: How to Start an Exercise Program. Use Whatever Gets You Going. Some of us need a little something extra to keep us exercising from week to week. For some, this could be working out with an mp3 player like an iPod. For others, it could be listening to audiobooks as you walk, or watching favorite TV shows while you use the treadmill or stationary bike. Elaine Magee, MPH, RD

Chiropractic: Causes of Back Pain. Injuries: Spine injuries, such as sprains and fractures, can cause either short-lived or chronic back pain. Sprains are tears in the ligaments that support the spine, and they can occur from twisting or lifting improperly. Back pain may be caused by more severe injuries that result from accidents and falls. American Academy of Orthopedic Surgeons

Wellness/Prevention: Posture Survey. Poor posture can lead to a variety of health problems over time. Take a moment to do your own survey: take a look at people in their 40's, 50's, 60's and 70's. If people have bad posture, they almost always LOOK unhealthy. On the flip side, people with good posture will almost ALWAYS look healthy.

Fibromyalgia – Coping Strategies, “What Can I Do?”

Fibromyalgia (FM) is one of the most common conditions associated with chronic pain affecting up to 5% of the population. It is characterized by pain in the muscles and joints and is associated with generalized, whole body muscle stiffness, body aches, sleep disruption, and headache. Stress is often a component of FM. Women are 2-3 times more likely to suffer from FM.

So the question is raised, “what can I do to reduce the pain and suffering that I feel from FM?” The answer is multifactorial as there are many treatment approaches reported to be helpful. Perhaps the most prevalent is exercise. This seems logical as often, the presence of pain is misinterpreted as a reason to rest or reduce activity. This inappropriate thought leads to de-conditioning or weakening of muscles, stiffness in joints, lowered aerobic capacity and a host of negative physical and mental effects that can have negative effects on quality of life. Because many patients with FM are “out of shape,” the worst approach with exercise is jumping into it too quickly. The post-exercise soreness when people first engage in a new activity can be profound if the introduction into exercise is too vigorous, and again, the pain intensity may be misinterpreted as a reason to discontinue any and all future exercise programs.

Therefore, the key to success is realizing pain thresholds are reached faster in the FM patient and hence, a slow but steady introduction into exercising is needed.

For example, start out with a walking program of 5 minutes, 1-3 times a day, and gradually increase it to 10, 15, 20 and eventually, 30 or more minutes per session. Stretching exercises of the overly tight postural muscles like the hamstrings, calf muscles, hip flexors, lower, middle, and upper back muscles are very helpful. Applying light resistance during the stretch using a “slow motion” approach improves results.

In general, low-impact activities like water exercise, swimming, bicycling, and elliptical (low setting) are great options. Using light dumbbells/hand weights emphasizing high rep/low weight is also very effective.

Another highly successful type of exercise are balance stimulating exercises. That is, using a rocker board, wobble board, gym ball, and/or foam pad to incorporate balance challenges into the exercise process is very effective. Consistent exercise is a key to success.

Also, don’t set your goals too high as you may be setting yourself up for disappointment. Rather, make realistic goals and “grow” with the exercise process, changing and modifying goals on a monthly or quarterly basis.

We realize that there are many healthcare options available. If you, a friend or family member require care for fibromyalgia, we would be honored to offer our services.

Weekly Health Update

Mental Attitude: Teaching the Mind to Treat Insomnia. Changing bad sleep habits and clearing the mind with medication may offer drug-free alternatives to traditional insomnia treatments. Researchers say insomnia is not a nighttime-only affliction but a 24-hour problem of hyperarousal. Teaching deep relaxation techniques during the day can help improve sleep at night. Insomniacs who started medication showed improvement in sleep quality and quantity. They also took less time to fall asleep, woke fewer times and had fewer symptoms of depression. Ramadevi Gourineni, MD, Northwestern Memorial Hospital

Health Alert: Poll: Majority of Americans Support Medical Malpractice Reform. 54% favor making it harder to sue doctors and hospitals for making mistakes taking care of patients, while 32% are opposed. The rest are undecided or don't know. Limits on jury awards in malpractice cases could reduce the federal deficit by $54 billion over 10 years, according to the Congressional Budget Office, because doctors caring for Medicare and Medicaid patients would order up fewer tests to guard against being sued. Henry J. Kaiser Family Foundation

Diet: For Heart Health, Look to the Sea. A heart-healthy diet includes fish twice a week. Why? Fish is low in saturated fat and high in healthy omega-3 fatty acids. Omega-3 fatty acids help lower levels of trigylcerides, a type of fat in the blood. They may also help lower cholesterol, slowing the growth of plaque in arteries. The best fish: salmon, tuna, trout and sardines. Also, don't drop the filets in the deep fryer - you'll negate the health benefits. American Heart Association

Exercise: Just Walk. One of the easiest ways for most people to work in exercise is to walk. Wearing a pedometer adds extra motivation by keeping you working toward a goal. This works particularly well for people who have a sit-down job or live a sedentary lifestyle. You could aim for 10,000-15,000 steps a day, starting with 5,000 steps (or less) and working your way up. Elaine Magee, MPH, RD

Chiropractic: Mechanical Causes of Back Pain. A mechanical problem is due to the way your spine moves or the way you feel when you move. Perhaps the most common mechanical cause of back pain is a condition called intervertebral disk degeneration, which means that the disks located between the vertebrae of your spine are breaking down with age. As they deteriorate, they dehydrate, lose their elastic cushioning and weaken. When stress is applied to the back, the surrounding soft tissue can inflame and cause pain. American Academy of Orthopaedic Surgeons

Wellness/Prevention: 80% Chance of Back Pain!. How can you be part of the 20% who do not get low back pain? Take care of your back by daily stretching, watch how you lift, avoid repetitive trauma and get routine chiropractic adjustments. Prevention is the key to decreasing your risk of debilitating low back pain. Occupational Safety and Health Administration

Weekly Health Update

Mental Attitude: Eating Dark Chocolate May Lower Stress Hormones. A new study shows eating the equivalent of one dark chocolate candy bar (1.4 ounces) each day for two weeks reduced levels of the stress hormone cortisol, as well as the "fight-or-flight" hormones known as catecholamines in stressed people. Dark chocolate is also rich in a class of antioxidants called flavonoids, which have been linked to a number of health benefits. Researchers are investigating other dark chocolate benefits such as improved insulin sensitivity, reduced blood pressure, and improved mood. Journal of Proteome Research, Nov. 2009

Health Alert: Still Smoking? Even after Surgeon General Luther Terry documented smoking causes lung cancer in January 1964, people continue to smoke (17.5% of US adults in 2005 - 29th ranked in the world). Here are the 5 countries with the highest percentage of adults who smoke. (1) Austria 36.3% (2) Greece 35.0% (3) Hungary 33.8% (4) Luxembourg 33.0% (5) Turkey 32.1%. Daily Smokers Health Data, 2005

Diet: Serve Up the Heart-Healthy Food. Load your plate with fruits and vegetables - five to nine servings a day - to help lower (bad) LDL cholesterol. Antioxidants in these foods may provide the benefit. Or, it may be that when we eat more fruits and veggies, we eat less fat. Foods enriched with plant sterols, such as margarine spreads, yogurts, and other foods, can also help lower LDL cholesterol. American Journal of Clinical Nutrition, Feburary 2006

Exercise: How to Start an Exercise Program - Set Up a Non-Food Reward System. Reward Yourself when you accomplish one of your fitness goals. Perhaps your goal could be: staying on track with your exercise for a full week or month, or reaching a milestone in terms of miles ran, etc. Your reward should be a NON-FOOD, such as a movie, massage or pedicure. Elaine Magee, MPH, RD

Chiropractic: Myth: Exercise is bad for your back pain. First, we need to make sure any torn tissue or broken bone is not causing your back pain and the acute inflammatory response has slowed enough to make stretching and exercise beneficial. Once this is established, regular exercise can speed up recovery and help reduce the risk of future episodes of low back pain. Focused stretching and a gradual exercise program are best. Always consult with your chiropractor before starting an exercise program to be sure you are not running the risk of re-injuring yourself and the exercises are being done properly. Marcus Strutz, DC

Wellness/Prevention: A Cup of Tea for Your Health. Short-term and long-term consumption of black tea by people with coronary artery disease restored blood vessel function to levels similar to that of healthy subjects. Circulation, 2001