CTS, Exercise, and Chiropractic

Carpal Tunnel Syndrome (CTS) is a condition characterized by numbness, tingling, and/or pain located on the palm side of the wrist, hand and into the index, third, and half of the ring finger. It’s caused by pressure exerted on the median nerve as it passes through the “tunnel” located in the wrist. The “floor” of the tunnel is a ligament while the “walls” are made up of eight small carpal bones that lock together in the shape of a tunnel. There are nine tendons (tendons attach muscles to bones allowing us to move our fingers), sheaths covering the tendons, blood vessels, and the median nerve that ALL travel through the tunnel, so it’s packed pretty tight. ANYTHING that increases the size of any of these structures or anything “extra” that shouldn’t be there can increase the pressure inside the tunnel, pinch the median nerve, and result in the classic numb/tingling symptoms that wake people up at night, or interfere with work or driving.

In the Unites States (US), about 1 out of 20 people will suffer from CTS. Caucasians have the highest incidence rate and women are affected more than men by a 3:1 ratio between ages of 45-60 years old. Only 10% of the reported cases of CTS are under 30 years old. Occupational CTS (as of 2010) affects 8% of US workers with 24% attributed to manufacturing industry jobs. This equates to approximately 3.1 million cases of work-related CTS in 2010. The risk of developing CTS increases with age, diabetes, hypothyroid, pregnancy, taking birth control pills, having an inflammatory arthritis, being obese, pinched nerves in the neck, thoracic outlet, elbow, and others. Therefore, managing CTS requires a thorough evaluation in order to assure accuracy in the diagnosis. With this background information, let’s look at the question, WHAT CAN YOU DO TO HELP CTS? One answer is, don’t age – good luck with that! In addition to keeping your weight under control, exercise can be VERY effective and YOU can be in charge of that process, but we have to teach you the exercises.

1. The Carpal Stretch (“nerve gliding”): Place your palm on the wall near shoulder height with the fingers pointing down at the floor and press the palm of the hand flat on the wall. Lastly, reach across with the opposite hand and pull your thumb back off of the wall and hold for 5-15 seconds.
2. The Wrist Extensor Stretch: Do the same as #1 but place the back of the hand on the wall in front of you, again fingers pointing downward. Here, there is no need to stretch the thumb.
3. The “Bear Claw”: Make a fist and then open up the hand. Keep the small finger joints flexed while extending the knuckles at the base of each finger straight (not bent). Repeat 5-10x.
4. Putty Squeeze: Simply squeeze putty in your hand for two to five minutes until fatigued.
5. Yoga has been shown to reduce pain and improve grip strength in CTS patients!

Now the question, “…can these exercises prevent surgery?” The answer is “maybe.” They certainly help in some cases, but a multi-dimensional treatment plan is the BEST approach. This includes: 1) Chiropractic manipulation of the hand, wrist, elbow, shoulder, and neck; 2) Soft tissue “release” techniques of the muscles in the forearm, upper arm, shoulder, and neck; 3) Cock-up wrist splint to be used at night, and in some cases, at times during the day; 4) Ergonomic management of your work station or situation (to minimize repetitive insult to the area); 5) Nutritional support that may include an anti-inflammatory diet and nutrients (vitamins, minerals, herbs, etc.), and 6) Managing any contributing conditions like diabetes, hypothyroid, and/or the others. Here’s the GOOD NEWS: CHIROPRACTIC can manage these six steps, though some cases will require co-management with primary care and/or specialist.

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.

Whiplash Recovery

Exercise is an important part of whiplash treatment and is often overlooked by both patients and doctors. We will focus on several practical and effective exercises over the next several Health Updates. The first of this series can be called “brain exercises.”

This link offers you a 37 page PDF of a booklet that contains GREAT information and includes the exercises reviewed below:

Brain Exercise #1: Eyes Still, Move Head. Hold a pen a comfortable distance in front of your eyes and keep looking at it as you rotate your head from side to side ten times. Stop if you feel dizzy but keep trying after resting. Repeat three times a day.

Brain Exercise #2: Head Still, Move Eyes. Keep your head still (move only your eyes) while you move the pen left to right as far as you can ten times without losing sight of the pen. Stop if you feel dizzy but keep trying later in the day. Repeat three times a day.

Brain Exercise #3: Standing Balance Test. Stand with your feet close together (or, feet shoulder width apart if you feel unsteady). You should feel steady for 30 seconds with your eyes open AND closed. Try it (count to 30)! If you feel unsteady, this exercise should be repeated often until you feel improvement with the eyes closed! A variation is to place one foot in front of the other, switching feet after each test. Notice this one is more difficult. A third position is standing on ONE foot (switch sides after each test) with the eyes open AND again closed. This one is REALLY hard! Stand near a counter or corner of a room to “catch” yourself – don’t fall.

Notice that these exercises are NOT neck specific; there are others exercises for that. Rather, these incorporate eye/head movements, coordination/balance challenges and address symptoms such as dizziness, headache, post-concussion symptoms (memory loss, difficulty concentrating, etc.), and others. These exercises can be very helpful as they “exercise” our neuropathways, or the “wiring” within our nervous system so that information flows freely to and from our brain, spinal cord, and our various body parts. These help us function safer and better in ALL of our desired daily activities! We can train you in these exercises if you feel uncomfortable doing these on your own.

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 honored to render our services.

Weekly Health Update—Chiropractic: Asymmetric Hip Mobility and Neck Pain.

Mental Attitude: Be Right or Be Happy?
There's an old saying, "Would you rather be right or be happy?" In a small experiment involving one married couple, researchers tested this adage by measuring the self-reported quality of life scores of both the husband and wife over time if the husband were instructed to always agree with every opinion and request his wife made (the wife was not informed of this instruction). After 12 days, the experiment was halted because the husband found his wife becoming increasingly critical of everything he did. The husband's quality of life score fell from 7/10 on day one to 3/10 by day twelve. On the other hand, the wife's score increased slightly from 8/10 to 8.5/10 during the study. According to the study's authors, "It seems that being right is a cause of happiness, and agreeing with what one disagrees with is a cause of unhappiness… The results of this trial show that the availability of unbridled power adversely affects the quality of life of those on the receiving end… Many people in the world live as couples, and we believe that it could be harmful for one partner to always have to agree with the other. However, more research is needed to see whether our results hold if it is the male who is always right."
British Medical Journal, December 2013

Health Alert: Post-Traumatic Stress Disorder and Cardiovascular Problems.
There is concern that long-term, untreated post-traumatic stress disorder (PTSD) symptoms may increase a person's risk of developing cardiovascular health problems. Researchers detected the presence of myocardial ischemia in 17% of the participants with PTSD but only 10% of participants without PTSD.
Biological Psychiatry, December 2013

Diet: The Essentials.
Omega-3 and omega-6 fats are called essential fatty acids because we cannot manufacture them ourselves, meaning they must come from the foods we eat. These fatty acids are named for their carbon-to-carbon double bond on a carbon chain, and only plants are able to make a double bond at the third or sixth carbon position. There are no known animals that create their own omega-3 or omega-6 fatty acids.
New England Journal of Medicine, June 2012

Exercise: Dementia.
The Alzheimer's Association states 5.2 million Americans are affected by dementia and one in three seniors will die with some form of cognitive issue. Researchers claim dementia sufferers demonstrate improvements in cognitive functioning and their ability to perform daily activities when they engage in regular exercise.
University of Alberta in Edmonton, December 2013

Chiropractic: Asymmetric Hip Mobility and Neck Pain.
Over three hundred freshmen college students underwent an examination of their hip joints and were asked whether or not they suffered from neck pain. The results showed that the young adults with asymmetrical hip mobility were nearly three times more likely to also suffer from neck pain.
Journal of Manipulative and Physiological Therapeutics, July 2013

Wellness/Prevention: Life Satisfaction?
Does money bring happiness? In most developing countries, life satisfaction rises as a country's wealth increases and people are able to meet their basic needs. Once income reaches a certain level (around $36,000 USD), life satisfaction levels peak and begin to decline. Happiness dips because more money creates higher aspirations, leading to disappointment and a drop in life satisfaction if those aspirations are not met.
World Values Survey, December 2013

Fibromyalgia Dietary Considerations

In last month’s Health Update, we discussed fibromyalgia (FM) management from a multi-modal approach, which included dietary recommendations to reduce inflammation. We'll cover this topic in more detail this month…

Anti-inflammatory foods can be broken down into four categories: 1) Fruits and vegetables; 2) Protein Sources; 3) Fats and Oils; and 4) Beverages.

In the fruits and vegetables category, whole fruits, berries, and vegetables in general are rich in good things like vitamins, minerals, fiber, anti-oxidants, and phytochemicals. In particular, green and brightly colored vegetables and whole foods (such as broccoli, chard, strawberries, blueberries, spinach, carrots, and squash) are great choices.

Besides being low in calories, high in fiber, rich in vitamin/minerals and more, berries EVEN taste good! For example, one cup of strawberries contains >100mg of vitamin C (similar to a cup of orange juice), which helps our immune system function. One cup of blueberries includes a little less vitamin C but it has minerals, phytochemicals, and anti-oxidants at only 83 calories per cup. A cup of cranberries has only 44 calories (it can also help with bladder infections), and a cup of raspberries has 64 calories and has vitamin C and potassium. Less common, but equally nutritious, are loganberries, currants, gooseberries, lingonberries, and bilberries. Put these, or a mixture of these, on salads, yogurt, or a whole grain cereal and enjoy a VERY satisfying snack or meal! The health benefits of phytochemicals and flavonoids include cancer prevention, bladder infection treatment, and may even help your eyesight (such as from lutein in blueberries and raspberries).

Protein sources include fish/seafood, especially oily ocean fish like salmon and tuna, as these are rich in omega-3 fatty acids. Soy and soy foods like tofu and tempeh as well as legumes are great plant sources of protein, though some doctors may recommend staying away from soy. Nuts such as walnuts, almonds, pecans, and Brazil nuts are also great protein sources.

Fats and Oils: Omega-3 fatty acids can be found in flax seeds, canola oil, and pumpkin seeds, as well as cold-water oily fish. Other fats that are anti-inflammatory include monounsaturated fatty acids, which are found in olive oil, avocados, and nuts and have been found to be cardiovascular disease “friendly” as well. Other healthy oils include rice bran oil, grape seed oil, and walnut oil.

Beverages: Our bodies need water! Of course, tap, sparkling, or bottled water are great sources of water. So are 100% juices, herbal tea, low-sodium vegetable juice, and if tolerated, low or non-fat milk.

Meal suggestions include: Breakfast – oatmeal with fresh berries and walnuts; Snacks – whole fruits, nuts, seeds, and fresh vegetables; Lunch and Dinner – choose fish and less fatty red meats; cook with olive and canola oil; load up a salad with fresh vegetables and fruit, avoid deep fried foods – rather, bake, broil, poach, or stir-fry instead. Fill up HALF of your dinner plate with dark green or brightly colored vegetables. Avoid the following: junk food, high-fat meats, sugar (sodas, pastries, candy, rich desserts, and sweetened cereals), highly processed foods, trans-fats and saturated fats (i.e., bacon and sausage), and white flour products (get 100% whole grain instead). Some research suggests not eating “nightshade plants” like tomatoes and eggplant.

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

Weekly Health Update—Chiropractic: Pain Affects Quality of Life.

Mental Attitude: The Importance of Self-Worth.
Reflecting on better times can help the downtrodden take steps to escape their poverty. In an experiment conducted in a New Jersey soup kitchen, 150 participants were asked to recount a proud moment or memorable achievement prior to taking a series of problem-solving tests. A control group took the tests without a positive affirmation beforehand. The affirmation group performed dramatically better than the control group with a difference in scores representing roughly a 10-point increase in IQ. Participants in the affirmation group were also more likely to seek out help from local government or charity programs that are used by only a fraction of those eligible.
Psychological Science, December 2013

Health Alert: Inflammatory Proteins?
A recent study shows there is an abnormal amount of an inflammatory protein called PAR2 in the abdominal fat tissue of overweight and obese people. Previous research has shown that PAR2 is also increased on the surface of human immune cells by the excessive consumption of fats and sugars. This finding links obesity and fattening diets with changes in immune cells and inflammation levels within the body.
The FASEB Journal, December 2013

Diet: Facebook and Diet?
"Appearance exposure" on the Internet has been linked to body image disturbances among adolescent girls. A recent study found an association between time spent on Facebook and poor body image among adolescent girls who internalize a thin ideal physique, which may lead to eating disorders.
Cyberpsychology, Behavior, and Social Networking, December 2013

Exercise: Reduces Fatigue in Cancer Patients.
An analysis of 56 studies involving over 4,000 cancer patients discovered that aerobic exercise, such as walking or cycling, reduces fatigue in those undergoing treatment. Fatigue is a common and problematic side-effect of cancer and cancer treatment. This exhaustion may last for months or years and make a patient less inclined to continue any further treatment. Previously, doctors recommended rest to treat cancer-related fatigue; as it turns out, the proper course may be physical activity.
The Cochrane Library, November, 2012

Chiropractic: Pain Affects Quality of Life.
Over half of older adults in the United States have experienced bothersome pain in the previous month, impairing their physical function and underscoring the need for proper health care. Three-quarters of older adults with pain reported having pain in multiple locations, such as in the back, hips, and knees. Additionally, pain was strongly associated with decreased physical capacity.
PAIN, December 2013

Wellness/Prevention: Fight Fat with Heat?
People who live in well-heated homes above 73.4 degrees Fahrenheit (23 degrees Celsius) are less likely to be obese, or have a high body mass index, compared with individuals who keep their dwellings cooler. People may eat less and burn more energy when residing in a warmer indoor environment. At temperatures above 73.4 degrees Fahrenheit, heat must be lost to maintain a constant body temperature and this process (such as sweating) requires energy. Coupled with decreased appetite and food intake, the additional energy expenditure could lead to weight loss.
Obesity, November 2013

What Kind of Headache Do I Have? (Part 2)

Last month, we discussed three types of headaches: Tension Headache (the most common), Cluster Headaches (a vascular headache – less common, short duration but REALLY painful), and Sinus Headaches. Migraine headaches were discussed the month before last. In keeping with the theme, ONE more headache type will be discussed: Rebound Headaches, followed by anti-inflammatory herbal remedies, and finally, “Headache Triggers.”

Rebound headaches are the result of pain killer overuse. Of course, one would think of pain killers like aspirin, acetaminophen (Tylenol), or ibuprofen (Advil, Motrin, Nuprin, etc.) as well as many prescription drugs as being “friendly” and commonly reached for when a headache or any other ache or pain occurs. But, as the old saying goes, "…too much of a good thing can be bad!" These culprits, instead of helping, can actually hurt you! One theory for the cause of rebound headaches is that too much of these meds can cause the brain to shift into an excited state that triggers the headache. Another theory is that these headaches result from too sudden of a drop of the medicine in the bloodstream, which would only occur if the medication was being taken at a high dose for a relatively long period of time. According to the Migraine Research Foundation, EVERY 10 SECONDS, someone in the United States goes to the emergency room with a migraine or headache due to the intense pain, severe nausea or dehydration, drug interactions, or side effects from headache medications! DON’T BE ONE OF THEM!!!

As mentioned last month, PLEASE FIRST try an anti-inflammatory herb like ginger (Zingiber officinale), turmeric (Curcuma longa), Feverfew, passionflower (Passiflora alata), Peppermint (menthe piperita), ginko (ginko biloba), caffeine (Coffea Arabica), black or green tea, Valerian (Valeriana officinalis), Coriander Seed (Coriandrum sativum), Dong Quai (Angelica sinensis), Lavender Oil (Lavandula angustifolia), Rosemary (Rosmarinus officinalis), Lime or Linden (Tilia spp.), horseradish (Armoracia rusticana), honeysuckle (Lonicera japonica), and more!

So what triggers headaches? Here are a few of the more commonly researched triggers: weight [in females, a BMI of 30 (mild obesity) = 35% greater risk, and BMI of 40 (“severe obesity”) = 80%]; personality (traits such as rigidity, reserve, and obsessivity); “let-down” or weekend headaches (breaking your routine, like staying in bed until noon); odors and fumes (e.g., fresh paint); dehydration (drink water AND eat fruits/veggies to get more water); skipping meals (hunger is a common trigger); physical exertion (certain sports like running, weight lifting); too much caffeine (small amounts help, but too much can trigger headaches); inactivity (sedentary lifestyles trigger – 30 min./day cardio, 5x/week is ideal); sleep deprivation (those averaging six hours have more frequent & severe headaches); and certain foods like red wine, beer, MSG, chocolate, aged cheese, sauerkraut, and processed meats like pepperoni, ham, and salami. Foods that can reduce headaches include those high in magnesium: spinach, tofu, oat bran, barely, fish oil, olive oil, white beans, sunflower, and pumpkin seeds. In addition to GOOD CHIROPRACTIC CARE, headache management requires a multidimensional approach for best results!

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 headaches, we would be honored to render our services.

Low Back “ON-THE-GO” Exercises (Part 1)

Low back pain (LBP) is a reality in most of our lives at one point or another. It can range from being a “nag” to being totally disabling. Let’s look at some exercises for the low back that can be done from a SITTING position so that they can be: 1) Performed in public (without drawing too much attention) and 2) Repeated every one to two hours with the objective to AVOID LBP from gradually getting out of control (STOP the “vicious cycle” so LBP stays “self-managed”).

RULES: 1) DON’T do any exercise that creates SHARP pain; 2) Stay within “reasonable” pain boundaries; 3) DO these multiple times a day WHEN you feel tight, stiff, sore (take 10-30 sec. every hour rather than 15 min. twice a day).

SITTING LOW BACK EXERCISE OPTIONS:

1. SITTING BEND OVERS: 1) Slowly bend forward from a seated position and attempt to reach the floor; 2) Spread the knees as needed to allow for a full range of motion; 3) Hold for 3-10 seconds or until it feels “loose.” 4) Do the opposite – sit and arch your low back as far back as is comfortable. Repeat frequently for short hold-times – make it “fit” your time limitations/schedule!
2. SITTING HIP / BACK STRETCH: 1) Cross your leg; 2) Raise the knee to the opposite shoulder; 3) Arch the lower back until you feel an increase stretch in your buttocks; 4) Twist your trunk to the side the knee is raised; 5) Move your knee up/down and around to “feel” for the tightest “knots” and “work” them loose; 6) Modify by bending forward 7) REPEAT on the opposite side.
3. SITTING TRUNK ROTATIONS: 1) Slowly twist your shoulders and trunk to one side while keeping your knees straight; 2) Reach back and pull for additional stretch if comfortable; 3) Hold for 3-10 seconds or, until it feels “loose;” 4) REPEAT on the opposite side. Remember, DO these MANY times a day (at least once every hour). We have many others as well (ask us)!

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.

Weekly Health Update—Chiropractic: Does Knuckle Cracking Cause Arthritis?

Mental Attitude: Good News Regarding Dementia.
Several recent studies show that the rate of developing dementia and Alzheimer's disease is declining due to increased education and improvements in both health care (treatment of key cardiovascular risk factors such as high blood pressure and high cholesterol) and lifestyle (regular exercise).
New England Journal of Medicine Perspective, December 2013

Health Alert: Don’t Mix Your Drinks!
A growing trend among young adults is mixing energy drinks with alcohol. Research has shown that college students tend to drink more heavily and become more intoxicated on days they consume a combination of energy drinks and alcohol than on days when they only drink alcohol. While the United States no longer permits manufacturers to premix high-caffeine products with alcohol, mixed drinks such as vodka and Red Bulls are becoming more popular. The public health implications include physical risks to individuals from blacking out, alcohol poisoning, and even exposing the community to dangerous situations in which young adults may be "wide awake drunk" after a night of partying.
Journal of Adolescent Health, December 2013

Diet: Two-Thirds of 13-Year-Old Girls are Afraid of Gaining Weight!
Using data concerning 7,000 teenagers, United Kingdom researchers found that two of every three 13-year-old girls are afraid of gaining weight or being overweight. The researchers also noted that half of the girls surveyed avoid fatty foods and 26% restrict their calories.
University of Bristol, December 2013

Exercise: Boost Your Energy Naturally.
Regular physical activity can improve your muscle strength and boost your endurance. Exercise and physical activity deliver oxygen and nutrients to your tissues and help your cardiovascular system work more efficiently. When your heart and lungs work more efficiently, you have more energy to devote to daily life activities.
Mayo Clinic, November 2013

Chiropractic: Does Knuckle Cracking Cause Arthritis?
Previous studies have NOT shown a link between knuckle cracking and hand osteoarthritis. One study even suggested that knuckle cracking helped prevent osteoarthritis. This study showed that 18.1% of those who cracked their knuckles regularly had hand osteoarthritis compared with 21.5% of those who did not crack their knuckles.
Journal American Board of Family Medicine, April 2011

Wellness/Prevention: An Apple a Day Keeps the Doctor Away.
Experts in the United Kingdom (UK) estimate that if everyone over the age of 50 simply ate one apple each day, this act alone would prevent about 8,500 vascular-related deaths each year. Previous studies estimate that prescribing statins to all adults over 50 years old could prevent a similar amount of vascular-related deaths annually but the mass prescription of statins in the UK could also result in an extra 10,000 diagnoses of diabetes and an extra thousand cases of muscle disease. The study did not note any potential negative effects from mass apple consumption.
British Medical Journal, December 2013