Carpal Tunnel Syndrome

Can Chiropractors Help With Your Carpal Tunnel Syndrome?

Carpal Tunnel Syndrome (CTS), named from the carpal bones in the wrist that form a tunnel around the nerve leading to the hand, is an injury usually caused by repetitive and forceful movements that result in swelling around the tendons and pinching of the median nerve, causing painful tingling, lack of muscle strength and control in the hand, and pain shooting from the hand up to the shoulder.

CTS is a risk to most workers, such as those who work on the computer and also store and assembly line workers, who receive micro-traumas to their hands and wrists on a daily basis due to awkward positioning, forceful and repetitive movements, and stressful activity. [1,2]

The usual treatment for Carpal Tunnel Syndrome can extend to heavy medication and surgery, however there are alternative methods of treatment that can alleviate the symptoms and effects arising from CTS. Chiropractic treatment for CTS has been studied against conventional non-surgical medical treatment by Davis et al. [1] and was found to be effective. This offers an alternative to sufferers who are intolerant to ibuprofen, or those who simply wish to avoid treating with medication. 

The median nerve in the wrist, which when trapped causes Carpal Tunnel Syndrome, connects to the spinal cord through the openings in the bones in the areas around the lower neck. If these bones in the spinal cord lose their ordinary position or motion, this can cause problems in the wrists or fingers.

Through chiropractic treatment, these bones can be reset to the correct position and can help to treat CTS.

If Carpal Tunnel Syndrome is detected early, then surgery can be avoided, and chiropractic treatment is the leading method of non-surgical treatment.

Chiropractic treatment usually involves various methods [3], with a combination of rest, ice, ultrasound, and electrical stimulation, including:

• By chiropractic manipulation therapy of the elbow and upper spine, where the joint’s soft tissue undergoes manipulation [4];
   
• Nutritional supplements in the diet such as B6, a vitamin that has had long-term promotion in its treatment of CTS;
   
• Electro-acupuncture treatment; bracing, a technique that has had extensive success, by limiting extension and flexion in the hand, and with compression on the median nerve may encourage recovery and ease the swelling in the tendons;
   
• Exercises for the wrist and hand designed to encourage recovery;
   
• Reassessing the ergonomics of the work place to minimize stress the best way as possible.

Recent studies, such as that by J. Burke et al (2007)[5], concluded that using manual therapy intervention such as soft tissue mobilization (STM) has been found to help improve the signs and symptoms of CTS, with improvements to nerve conduction latencies, wrist strength and motion.

Carpal Tunnel Syndrome can become a serious health problem, and if left too long may require surgery. If it’s caught early, then chiropractic treatment is an effective, drug-free method to ease the symptoms and pains caused by CTS, and provide long-term relief from CTS. 

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References
 
[1] P.T. Davis et al., J Manipulative Physiol Ther. 1998 (Jun);21 (5): 317-326 (1998)
 
[2] R.Valente and H. Gibson, J Manipulative Physiol Ther 1994;17(4):246–9 (1994)
 
[3] R. Perez de Leon & S. Auyong, J Chiropr Med. 2002 Spring; 1(2): 75–78. (2002)
 
[4] P.T. Davis and J.R. Hulbert, J Manipulative Physiol Ther 1998;21(5):356–62 (1998)
 
[5] J. Burke et al., J Manipulative Physiol Ther. 2007 Jan;30(1):50-61. (2007)

Degenerative Disc Disease

Degenerative Disc Disease and Chiropractic Care

Whether they first see the phrase in print or hear it for the first time in a doctor’s office, “degenerative disc disease” is a term that many chronic back pain sufferers will encounter. It’s part of a brand new vocabulary that many patients learn as they try to understand their condition and navigate healthcare choices. But what does it really mean?

Degenerative disc disease is not actually a disease at all. Rather, it refers to normal changes in your spinal discs that tend to occur naturally as your body ages. Spinal discs are the soft “separators” between your vertebrae that cushion the individual bones and give your spine its flexibility. Healthy ones are thick and soft. Unhealthy ones are thinner and more brittle.

Over the years, these discs may gradually become less effective as the amount of fluid inside is reduced or cumulative wear and tear damages the discs and raises the risk of bulging, rupture or disintegration. The truth is that by the time we reach middle age, most of us already have degenerating discs, whether we’re experiencing any pain or not. And even with our best imaging technology, it can be very difficult to tell whether this degeneration is actually the source of a patient’s problems.         

So from a patient’s point of view, this bit of language—degenerative disc disease—can be both confusing and frustrating since it suggests a diagnosis but doesn’t usually come with a clear set of treatment options attached.  In some ways, it may actually seem like a “catch-all diagnosis” or “un-diagnosis”.

Can I Benefit From Chiropractic Care if I Have Degenerative Disc Disease?

Sometimes patients who’ve been told they have degenerative disc disease wonder if chiropractic adjustments can still help them or if they’re safe.

The answer to these questions depends on the patient’s individual circumstances, including whether the damaged discs are herniated or ruptured (bulging or broken) or have caused other conditions, such as osteoarthritis (a breakdown of the tissue that protects joints) or spinal stenosis (a narrowing of the channel within the spine that holds the spinal cord).  

Chiropractic physicians are specially trained to diagnose the underlying causes of back pain and to recognize when specific types of treatment may be either ineffective or harmful in situations where patients have degenerative disc disease. Since they are often skilled in a wide range of conservative, non-surgical therapies, most chiropractors will recommend low-force, non-thrusting techniques in situations involving disc degeneration and related complications. They may also employ traditional spinal adjustments based upon the results of a careful evaluation of the patient.

Chiropractic care generally focuses on addressing back pain at its source as well as improving the spine’s stability and mobility. While there is no cure for degenerative disc disease, an effective treatment plan will usually combine manual therapies (such as manipulation or massage) with supervised exercise and/or nutritional programs and lifestyle changes designed to minimize its impact.

If you’re wondering what chiropractic care could do for you or someone you care about, please call Dr. Wintermute at (949) 559-7999 today to schedule a consultation.

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Bibliography
 
Degenerative Disc Disease - Topic Overview. (2011, July 21). Retrieved September 2011, from WebMD: http://www.webmd.com/back-pain/tc/degenerative-disc-disease-topic-overview
 
Arn Strasser, D. (n.d.). How a Chiropractor Treats Degenerative Disc Disease. Retrieved September 2011, from spineuniverse.com: http://www.spineuniverse.com/experts/how-chiropractor-treats-degenerative-disc-disease
 
New York Times Back Pain In-Depth Report. (n.d.). Retrieved September 2011, from nytimes.com: http://health.nytimes.com/health/guides/symptoms/back-pain-low/print.html
 
Peter F. Ullrich JR, M. (n.d.). Degenerative Disc Disease. Retrieved September 2011, from spine-health.com: http://www.spine-health.com/conditions/degenerative-disc-disease/what-degenerative-disc-disease

Chiropractics vs Back Surgery

Comparing the Risks: Spinal Manipulation versus Back Surgery 

While most people seeking medical care for back or neck pain recognize that they may have treatment options (often including chiropractic care and surgery), many do not understand the potential benefits and risks associated with those choices.

Patients who ask family, friends or coworkers for advice all too often hear secondhand stories about healthcare “miracles” or “nightmares” experienced by a friend’s uncle, a wife’s boss or a father’s golfing buddy.

The clinical facts—on the other hand—are often less accessible to the average person and tend to leave a smaller impression. However, for those who want a broader perspective on their treatment options, there are several high-quality research resources available. The American Journal of Medicine and Spine (among others) have featured information on the risks involved with surgery and spinal manipulation.

Headline:  Both Surgery and Manipulation Present Risks

Patients who are suffering with neck pain and considering both surgery and chiropractic treatment should be aware of the risks and discuss them openly with their healthcare providers.

In the case of any surgery, there may be serious complications from anesthesia, excessive bleeding, blood clots that lead to pulmonary embolism and infection. These general risks are added to the more specific risks of surgery on the spine. These may include a dural tear (the dura surrounds the spinal cord and a tear can cause leaking of cerebrospinal fluid), spinal cord injury and persistent or increased pain from an unsuccessful procedure.

Spinal manipulation may also cause dangerous complications. Spinal manipulation has been associated with disc herniation, cauda equina syndrome (pain, weakness or loss of bladder and bowel function) and vertebrobasilar accident (a tear in a major artery of the neck). These complications can be just as serious as the complications associated with surgery. 

If similarly severe complications may result from either course of treatment, how can a patient weigh the risk of each option? Managing risk isn’t just about understanding “worst-case”-type scenarios, it’s also about understanding how likely these and other complications are to occur. This is where some additional research findings can help. 

How Frequently Do Serious Complications Actually Occur?

In April 2010, the journal Spine (published by Lippincott Williams & Wilkins) included an article that summarized the incidence of adverse events in spinal surgery based on the authors’ review and analysis of the existing literature.

They found complication rates for spinal surgery ranging from 5% to 19%. Similarly, the American Journal of Medicine in 2002 published the results of a study that examined the incidence of serious adverse events for spinal manipulation. By comparison, researchers involved in that work reported complication rates ranging from one out of every 400,000 manipulations to one out of every two million.

So now we can see that the risk of a serious adverse event from spinal manipulation is extremely low relative to the risk posed by surgery. That’s one reason that the Mayo Clinic and many other reliable healthcare organizations around the world consider spinal manipulation very safe when performed by someone trained and licensed to provide this type of chiropractic care.

Whenever we talk about risk, it’s always important to remember that almost everything we do can be ‘associated’ with some type of adverse event. Driving a car, handling scissors, and even eating dinner can all lead to serious complications. The best way to handle these risks, including the risks of spinal manipulation, is to understand them and keep them in perspective.

Healthcare providers are uniquely qualified to help you do that. If you or someone you care about is interested in chiropractic care—including its potential benefits and risks — please call Dr. Wintermute at (949) 559-7999 to make an appointment.

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References
 
Dekutoski, MD, M. B., Norvell, PhD, D. C., Dettori, PhD, J. R., Fehlings, MD, PhD, FRCSC, FACS, M.G., & 

Chapman, MD, J. R. (2010). Surgeon Perceptions and Reported Complications in Spine Surgery. Spine, 35(9S).  Retrieved August 31, 2011, from http://www.medscape.com/viewarticle/721611

Staff, M. C. (n.d.). Chiropractic adjustment: Risks - MayoClinic.com. Mayo Clinic. Retrieved August 31, 2011, from http://www.mayoclinic.com/health/chiropractic-adjustment/MY01107/DSECTION=risks

Stevinson, MS, C., & Ernst, MD, PhD, E. (2002). Risks Associated With Spinal Manipulation. The American Journal of Medicine, 112(7), 566-571. Retrieved August 31, 2011, from http://www.sciencedirect.com/science/article/pii/S0002934302010689 

Straight Talk About Foot Orthotics

Good spinal health is built from the ground up, starting with the feet.

For years medical researchers and healthcare providers have recognized that problems there can cause posture changes that eventually trigger a variety of musculoskeletal issues in other parts of the body (particularly the ankle, knee, hip and back).

Studies have also shown that even slight foot problems can negatively affect athletes’ performance and predispose them to a broad range of sports-related injuries.

What Are Orthotics and How Can They Help?

Orthotics are shoe inserts that are specially designed and manufactured to correct an abnormal or irregular walking pattern by promoting proper alignment and balance.  They’ve improved the quality of life for millions of people, and it’s become very common for physicians to recommend them to address many different patient needs:

• Reducing pain and/or fatigue
• Providing targeted foot support
• Relieving pressure or stress on an injured or sensitive area
• Preventing or limiting deformity
• Improving foot positioning and function
• Restoring balance

Reinforcing or supplementing other therapies (particularly chiropractic adjustments)

Foot orthotics are medical devices that can significantly change the way a person stands, walks and runs (and therefore the way his or her body absorbs and distributes related forces). For this reason, it’s important that the person wearing them clearly understand their benefits, risks and limitations.  It’s also important that the person use them correctly.

What Every Patient Should Know About Orthotics

There is no “one-size-fits-all” answer when it comes to orthotics. What works for another family member or neighbor will probably not work for you!

Getting the right prescription for your particular needs is all about working effectively with your healthcare provider to define your own goals and develop a complete understanding of your foot’s unique structure and function.

For instance, orthotics can be very sport-specific—the performance requirements of a hiker will not be the same as those of a skier or a football player.
 
 
Not all orthotics are created equal, and the differences matter. The prefabricated orthotics that can be purchased at shoe stores, pharmacies and sporting goods stores are not the same as the custom orthotics prescribed by a healthcare provider. Do not confuse them!

Mass-produced products are tailored for the “typical” foot and are unlikely to address problems specific to any one individual’s foot.

In some situations, such products can actually make a medical condition worse, cause new problems or increase the risk of injury. So while they’re usually less expensive than custom orthotics, they may not actually solve your particular problem.
     
Orthotics don’t actually correct foot or ankle problems. They are intended to realign the structures of the foot to improve function, reduce pain and decrease the risk of injury.
 
Needs can change over time and your orthotics should too. The structure and function of the foot can change as people age. So too can people’s lifestyle and priorities. Your healthcare provider can work with you to ensure that your prescription is still the right one for you.

Long-term use of orthotics may pose its own risks. Any time that you provide outside help to the structures normally responsible for supporting and moving parts of your body (casts or braces are good examples), you are essentially asking them to do less. And if you provide that help over a sufficiently extended period, you run the risk that your bones, muscles and connective tissues may become weaker as a result. The unintended consequence is that you may actually become less capable and more reliant on your devices to do the work your body used to do.

Your healthcare provider will talk with you about how to use your orthotics correctly and manage any long-term risk that he or she believes may exist.
      

Prescribing orthotics is arguably as much an art as a science. Don’t underestimate the role of professional judgment in prescribing orthotics. Experts acknowledge that there are few widely-accepted standards and that we can’t always predict successfully how an individual will respond to a particular prescription.

In fact, recent research has demonstrated that individuals with the same condition can respond very differently to identical orthotic therapy.

There’s even evidence that the same patient can respond to a prescription inconsistently or can respond just as favorably to two entirely different (even contrary) prescriptions. This means that some trial and error may be necessary to get the results both you and your healthcare provider are looking for and that good communication is critical. Without accurate and timely feedback from you about how well your orthotics are doing their job, it’s impossible for your healthcare provider to make the adjustments that will eventually lead to success.


How Your Chiropractor Can Help

There’s a close relationship between the way your feet work and the way the rest of your musculoskeletal system supports your body. So even if your feet themselves don’t actually hurt, they could be contributing to other health problems that you’re experiencing.

After your chiropractor has examined you carefully and talked with you about your situation, he or she can help you decide whether foot orthotics should be part of your broader treatment plan. Call Dr. Wintermute at our office today to learn more - (949) 559-7999.

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References and Resources
 
Gina Kolata, Close Look at Orthotics Raises a Welter of Doubts.  Orthotic Shoe Inserts May Work, but It’s Not Clear Why.  New York Times Fitness and Nutrition.  January 17, 2011.  Accessed August 2011.
http://www.nytimes.com/2011/01/18/health/nutrition/18best.html?pagewanted=all

Nigg, BM et. al., Effect of Shoe Inserts on Kinematics, Center of Pressure, and Leg Joint Movements During Running.  Medicine & Science in Sports & Exercise.  February 2003.  Accessed August 2011.
http://journals.lww.com/acsm-msse/Abstract/2003/02000/Effect_of_Shoe_Inserts_on_Kinematics,_Center_of.21.aspx

Best Foot Forward with Chiropractic.  Journal of the American Chiropractic Association.  January 2001.  Accessed August 2011.
http://www.acatoday.org/pdf/focus_january2001.pdf

What Exactly Are the B Complex Vitamins?

The B group of vitamins is probably the most commonly misunderstood of the vitamins, simply because the B vitamins are several distinct vitamins lumped together.

Additionally, the fact that the vitamins in this group are known by both letter, number and name is confusing to many people. Here is a quick list of the B vitamins found in the Vitamin B complex group.

• B1 is also thiamin
• B2 is also riboflavin
• B3 is also niacin
• B5 is also pantothenic acid
• B6 is also pyridoxine
• B7 is also biotin
• B9 is also folic acid
• B12 is also cobalamin

You should note that there are four additional substances in the B complex group, though they are not known as vitamins. They are choline, lipoic acid, PABA and inositol. When you purchase B complex vitamins, these four will not be included.

Furthermore, one or two of the recognized B vitamins may also be omitted. B5 and B7 are so widely available in food that most people get plenty of these vitamins even if they aren’t eating a healthy diet.

There are gaps in the numbers of the B vitamins because our understanding of them has evolved over time. Initially there was only a single B vitamin.

Later it was recognized that what had been referred to as a single vitamin, actually had many components. These component parts where numbered 1,2,3,4, etc… Even later it was determine that some of these components (such as B4) did not meet the criteria of being a vitamin and they were dropped. That’s how we ended up with 8 B-vitamins with non-sequential numbers.

One thing that all the B vitamins share is that they are water soluble. Any excess vitamin B is not stored, but rather is excreted in the urine. That means that all the B vitamins need to be constantly replenished from our diets.

B vitamins are found in whole unprocessed foods including grains, meats and vegetables. In general, the more processed that food is, the lower the content of all the B vitamins.

A daily multi-vitamin is a great way to ensure that you are getting all the B complex Vitamins your body needs on a daily basis.

One of the most commonly recognized uses of the B vitamins is an energy booster. Many popular energy drinks that claim a natural boost of energy without sugar or caffeine are high in B vitamin complex.

There are too many components in the Vitamin B complex to discuss the health benefits, deficiencies and Recommended Daily Allowance for the whole group in a single article. Look for future articles about each of these important nutrients.

If you have questions about your current nutrition and supplement plan, just ask Dr. Wintermute. She is here to help!

Bibliography
B Vitamins MedlinePlus. (n.d.). Retrieved 8 10, 2011, from National Institutes of Health: http://www.nlm.nih.gov/medlineplus/bvitamins.html

Micronutrient Information Center. (n.d.). Retrieved 8 11, 2011, from Linus Pauling Institute at Oregon State University: http://lpi.oregonstate.edu/infocenter/vitamins.html

Surgery or Chiropractic for Chronic Sciatica Sufferers?

Pain coming from compression or irritation of the sciatic nerve is called sciatica. Sciatica — which can include pain, tingling, numbness and muscle weakness — is really a symptom indicating an underlying problem, not a diagnosis in and of itself. This article will explore in detail the findings of a recent controlled study comparing spinal manipulation (chiropractic) and surgery for people whose sciatica did not respond to traditional medical treatment approaches.

The study discussed here was conducted by the National Spine Center in Alberta Canada and published in October of 2010 in the Journal of Manipulative and Physiological Therapeutics. The 40 study participants all had sciatica lasting over 3 months which had not responded to treatment with pain medications, lifestyle modifications, physical therapy, massage therapy or acupuncture. They had all been referred by their primary care physicians to spinal surgeons who had deemed them appropriate surgery candidates.

Instead of having all the patient proceed with surgery, they were split into two groups — one group to undergo a surgical microdiscectomy and the other group to be treated with standardized chiropractic spinal manipulation by a single chiropractor. (If not satisfied with the results they obtained from their assigned method, the patients were allowed to switch to the other treatment plan after 3 months.)

So what happened? Both groups made significant improvements over baseline scores — meaning that they saw noticeable improvements whereas previous approaches had failed. A full 60% of the study participants benefitted from chiropractic spinal manipulation to the SAME degree as if they underwent surgery. And, after 1 year there was no difference in outcome success based on the treatment method. That means that a full 60% of people referred for surgery by their primary care physicians and accepted as surgical candidates by the neurosurgeon could actually get similar results with chiropractic. That is a lot of potentially unnecessary cutting, anesthesia and ER time.
 
There is one paragraph in the results section of this study that is easy to overlook, but incredibly important. There were originally 120 candidates of which 60 met the study criteria and were asked to participate. Of these 60, 20 refused. Why? Because they had never been offered spinal manipulation as an alternative to surgery! They didnít want to participate in the study and be randomly placed in the surgery group without first trying the spinal manipulation! This is incredibly telling. Not only does it demonstrate that there is still a lot of education about chiropractic that needs to happen among the public and among primary care providers, it also demonstrates that people understand the risks and costs of surgery and want to exhaust other possibilities first.

This was the first study to ever look at people who had failed traditional medical management of sciatica. Currently most patients that fail "conservative care" are referred for a surgical evaluation. Now we know that 60% of these folks could avoid surgery and get similar long-term outcomes with chiropractic.
Please share this article with anyone considering surgery for sciatica.

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CEO and Founder of HealthXL

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