The Neck & Shoulder Pain Relationship

In our hectic lifestyles of driving, hunching over computers, talking on the phone, not to mention stress arising from multiple sources, the muscles in the neck, upper back and shoulders seem to tighten up and hurt at the same time. The question is, between the neck and the shoulder, which one is the “chicken” and which is the “egg?”

The neck gives rise to the nerves that innervate the head (C1-3 nerve roots), the shoulders (C4-5), and the arms (C5-T2). Hence, there are 8 sets of nerves in the neck, 12 sets in the thoracic (middle back region), and 6 sets in the lumbar or low back region and 5 sets in the sacrum, all of which travel to a specific destination allowing us to move our muscles and to feel hot, cold, sharp, dull, vibration and position sense.

When these nerves get pinched or irritated, they lose their function and the ability to feel, making it challenging to button a shirt, thread a needle, or pick up small objects.  It can also make it difficult to unscrew jars, squeeze a spray bottle, or lift a milk container from the refrigerator. Hence, the nerves arising from the neck, when pinched, can have a dramatic effect on our ability to carry out our desired activities in which the shoulder, arm and hand use is required.

On the other hand, when the shoulder is injured (such as a rotator cuff tear or strain), this can also result in neck problems. There are several ways pain from the neck affects the shoulder and vice versa. When the shoulder is injured, pain “information” is relayed to the brain starting at the nerve endings located in the area of the shoulder injury, transmitting impulses between the shoulder and the neck, and finally from the neck to the sensory cortex of the brain. That information is processed and communication to the motor cortex prompts nerve signals to be sent back to the shoulder through the neck and to the injured area (in this case, the shoulder).

A reflex muscle spasm often occurs as a result, serving as kind of an “internal cast” as the muscle spasm tries to protect the injured shoulder. This can become a “vicious cycle” or never-ending “loop” until the reflex is interrupted (perhaps by a chiropractic adjustment). Another means by which both areas become injured has to do with modifications in function. We tend to change the way we go about our daily chores when an injury occurs to the shoulder, such as putting on a coat differently by leaning over to the opposite side.

These functional changes can also give rise to neck pain. Because of this reflex cycle, as well as the close anatomic relationship between the neck and shoulder, not to mention the “domino effect” of soft-tissue injuries which seem to change the function at the next joint level, it’s not surprising that both the neck AND the shoulder require simultaneous treatment for optimal treatment benefit. However, the good news is, regardless which one is the “chicken or the egg,” your treatment at Denver Chiropractic Center for shoulder injuries will almost always include the neck and vice versa.

We use a unique combination of Active Release Techniques Soft Tissue Treatment, adjustments, and physical therapy exercises. Research shows that this combination is best. We realize that you have a choice in where you get your healthcare services.  If you, a friend or family member requires care for neck pain, we sincerely appreciate the trust and confidence shown by choosing our services and look forward in serving you and your family presently and, in the future.

Carpal Tunnel Syndrome and Sleeping

Have you ever woken up in the middle of the night and noticed your hand sleeping to the point where you had to get out of bed and shake or flick your fingers to alleviate the numbness? If the numbness was primarily on the thumb-side half of your hand, it may have been carpal tunnel syndrome that woke you up. So, the question is, why is it such an issue at night?

To properly answer this question, let’s get familiar with the anatomy of the wrist.  There are 2 bones that make up the forearm – the ulna (on the pinky side) and the radius (on the thumb side). Just beyond that, there are two rows of four bones each called the carpal bones for a total of 8 small bones that make up the wrist joint. These carpal bones are arranged in a horseshoe or tunnel shape. When you look down at your wrist and wiggle your fingers quickly, you can see all the movement that occurs on the palm side of the wrist.  That’s a lot of movement!  You can also see the muscles on the upper half of the forearm moving rapidly as the fingers wiggle.

There are 9 muscle tendons that travel through the carpal tunnel, as well as some blood vessels and most important, the median nerve sits on top of all those moving tendons. Just beneath the floor of the tunnel is a ligament called the transverse carpal ligament. The tendons inside the tunnel are surrounded by lubricating sheaths that make it easier for the tendons to slide back and forth as we wiggle our fingers, grip to open a jar, type on a computer, play a musical instrument, or so on. Without the tendon sheaths, the friction between the rubbing tendons would quickly build up heat, resulting in swelling, pain and numbness.  However, in spite of the lubricating function of the sheaths, when we work our fingers and hands too much, swelling and inflammation does occur.

So, why do we have numbness at night when we aren’t working, gripping and moving our fingers repetitively? The answer lies in how we sleep. Since we are asleep, we cannot control where we position our hands and wrists. Most of us curl up in a ball and tuck our hands under our chin or someplace cozy.  Normally, when we bend our wrists, the pressure inside the carpal tunnel doubles. However, a carpal tunnel patient already has a higher level of pressure in their wrist. So, when a carpal tunnel patient bends their wrist in the exact same way, the pressure goes up even more – that is, 3, 4, 5, or more times than a normal person without their wrist bent. That is why a wrist “cock-up” splint works so well at night!  It keeps the wrist straight so you can’t bend it.  Often, this allows the CTS patient to sleep through the night instead of waking up 2, 3, or more times with numbness, tingling, and/or pain on the thumb half of the hand.

At Denver Chiropractic Center, we have extensive experience using Active Release Techniques to treat carpal tunnel syndrome. We release scar tissue in the muscles adjacent to the nerve, and can take the symptoms away by relieving the pressure of that nerve (the Median Nerve). Call us today to schedule your initial exam where we’ll tell you whether you’re a candidate for our treatment approach. 303.300.0424

We realize you have a choice in where you get your health care and we sincerely appreciate your trust in choosing our service for those needs.  If you, a friend or family member require care for CTS, we would be honored to render our services.

Low Back Pain & Scoliosis

Low Back Pain & Adolescent Idiopathic Scoliosis

Scoliosis is a curvature of the spine that is shaped like a “C” or an “S” when looking at the person from behind. I’m sure you’ve noticed when you’re at a beach, at a swimming pool, or walking in an airport, some people have a high shoulder, walk with a bit of a limp if one leg is short, and may have a shoulder blade that sticks out more than the other. Scoliosis often develops for unknown reasons (hence the term, “idiopathic”) during the adolescent age range between 10 or 11 years old and can progress, not change or less often, improve up to age 16 to 18. During these 4-6 years, the time when the adolescent is growing quickly, the curve often worsens without any intervention but few studies have looked at what types of treatment or combinations of treatment work the best, especially non-surgical methods.

A recent study was conducted that looked at the response to non-surgical treatment using conventional medical treatment (MT) vs. conventional MT plus chiropractic, as well as conventional MT and “sham” (fake) chiropractic treatment.  This is a pilot study using a small population of patients in order to determine if a larger scale study would be important to run (which was determined to be the case).

The conventional medical treatment approach included two groups – observation (a “wait and watch” approach) in a braced group verses a non-braced group. The chiropractic treatment group received spinal manipulation using “diversified technique” which is widely used where the patient is treated while lying on their stomach, sides, and back and the type of manipulation used was the thrust type where the “cracking” sound occurs (which is caused by the release of gas from the joint capsules and is technically called cavitation). This was applied to the regions determined by the chiropractor as requiring the treatment by using palpation (touch) methods, postural examination, range of motion, and x-ray and all chiropractors involved had 6-hours of training to assure consistent and similar approaches were used. Treatments were administered (determined by a survey of many chiropractors) at 3x/week for a month, 2x/week for a month, 1x/week for a month, and 2x/month for 3 months or as needed for a total of 6 months. The “sham” or fake chiropractic treatment used the same treatment frequency and similar positioning of the patient but purposely did not obtain a joint cavitation or “crack” but still seemed “real” to the patient.

The primary outcome used to determine “success” was a reduction of the scoliosis curve measured on x-ray at a 6-month point. Using the standard medical model, those with curves of 20-25 degrees require careful observation, curves 26-40 degrees are potential candidates for bracing, those greater than 40 degrees are potential candidates for surgery and, an increase in curve by more than 5 degrees measured twice a year or every 6-months is considered failure.

The results are interesting. Of those receiving only conventional medical treatment, none improved and one failed. The same occurred in the conventional MT plus sham/fake chiropractic. NO ONE failed and one improved in the chiropractic treatment plus MT group making it the only successful non-surgical treatment approach in the study. The preliminary findings from this study are huge! Chiropractic treatment in this group of adolescent children was determined to be THE ONLY non-surgical approach that had the ability to maintain (not allow the curve to progress) or even better, improve the curve!

At Denver Chiropractic Center, we work with many patient who have scoliosis. We combine Active Release Techniques to release tight soft tissues, chiropractic adjustments to increase spinal mobility, and physical therapy exercises to help retrain the nervous system. Call us today to see how we can help. 303.300.0424

We realize you have a choice in where you get your healthcare services.  If you, a friend or family member requires care for low back pain, we sincerely appreciate the trust and confidence shown by choosing our services and look forward in serving you and your family presently and, in the future.

Denver Chiropractic Center Weekly Health News For You

Have you ever noticed that you seem to drag during November and December? Well, there’s a reason for this. As the days get shorter and you get less time in the sun, your brain produces less Serotonin, the feel good brain chemical. The result is usually a little fatigue, less energy than normal, and the annoying urge to eat sugar. This is why many of us gain weight this time of year.

The best defense is to essentially go with the flow. Cut yourself some slack, try not to totally cave in to it, and know that soon the days will start getting longer (December 22). Try to get outside for a walk or run at least 3 times a week, even if it’s just for 20 minutes. Try getting to the slopes or going out for some Nordic fun – snowshoeing or cross country. Open up those blinds and let the daylight in. It’ll help.

Mental Attitude: Commuting To Work Is Bad For Your Health! Spending hours each day behind the wheel or crammed in a public train or bus, commuting to and from work is bad for your health. Those who commuted reported more everyday stress, exhaustion, missed work days and generally poorer health. Those with longer commutes reported even worse health. Duke University, Oct 2011

Health Alert: Under Construction! Nearly all construction workers will experience one or more work-related injury or illness over a lifetime, plus a greater risk of premature death. Over a 45-year career, a construction worker has a 75% chance of a disabling injury, and a one in 200 chance of being fatally injured on the job. An individual who begins construction work at the age of 20 has a 15% chance of developing chronic obstructive pulmonary disease and an 11% chance of developing dust-related parenchymal chest X-ray changes. Center for Construction Research and Training, Oct 2011

Diet: Strawberries & Stomach Ulcers. Scientists discovered strawberry consumption might help reduce and or slow the formation of stomach ulcers caused by alcohol consumption, viral infections and nonsteroidal anti- inflammatory medications, like aspirin and ibuprofen. Plos One, Oct 2011

Exercise: Good Reasons. Exercise helps speed recovery from chemotherapy treatments, increases the ability to supply blood to the skin for cooling and increases the thickness of the cartilage in your joints. Surgeon General’s Report on Physical Activity and Health, 1996

Wellness/Prevention: Cranberry Juice vs. Cranberry Extracts. Cranberries have been recognized for their health benefits for years, especially in preventing urinary tract infections. However, it was found that drinking actual cranberry juice is much more effective in preventing a Urinary Tract Infection than simply consuming cranberry extracts. Food Science and Biotechnology, Oct 2011

Active Release: Posture and mobility. Do you ever catch yourself all hunched over, briefly horrified by your won bad posture? Recent research by Gray Cook from Functional Movement Screens points to poor posture and mobility of the thoracic spine as a contributing source of many problems- from hamstring injuries to back pain to headaches. We can help you with that. Active Release, spinal adjusting and rehab can all be used to improve posture and spinal mobility. If you have chronic back pain, we can help you. Give us a call: 303.300.0424

Thanks For Reading!

Denver Chiropractic Center

303.300.0424

Dr. Glenn Hyman

Dr. Jeff Stripling

Weekly Health News for You 10/10/2011

Dr. Hyman is back in the office after taking a week off. He looks rested and is ready to see you!

4 members of our staff did the Denver Rock n Roll 1/2 Marathon on October 9, here are their times:

Dr. May 1:57

Keri B, Office Manager, 2:04

Dr. Stripling 2:04

Erin Young, LMT, 2:05

Mental Attitude: Money Can Be Depressing? Rates of depression are higher in countries with higher per capita incomes. 121 million people worldwide have depression. Severe depression can lead to suicide and causes 850,000 deaths every year. The United Sates and France had the highest depression rates. Higher incomes can be related to more work hours and a lowered quality of life. 15% of people in high-income countries were likely to become depressed during their lifetime, compared with 11% of those in low or middle-income countries. British Medical Journal, Aug 2011

Health Alert: You Are Getting Very Sleepy. Insomnia affects 23% of US workforce, costing $63.2 billion annually. Insomnia is a condition characterized by difficulty falling asleep and remaining asleep. It includes a wide spectrum of sleep disorders, from not enough sleep to lack of quality sleep. Sleep, Aug 2011

Diet: Bad Habits? People entering the movies were given a bucket of either just-popped, fresh popcorn or stale, week-old popcorn. Moviegoers who didn’t usually eat popcorn at the movies ate much less stale popcorn than fresh popcorn. Moviegoers who typically had popcorn at the movies ate about the same amount — regardless it was fresh or stale. When we’ve repeatedly eaten a food in an environment, our brain comes to associate the food with that environment and we keep eating as long as those environmental cues are present. Personality and Social Psychology Bulletin, 2011

Exercise: Runners Drinking Too Much? 50% of recreational runners may be drinking too much fluid during races. 37% of runners drink according to a preset schedule or to maintain a certain body weight and 9% drink as much as possible. Expert guidelines recommend runners drink only when thirsty. 30% incorrectly believe they need extra salt while running,

British Journal of Sports Medicine, June 2011

Chiropractic: Careful. In work-related nonspecific low back pain, the use of health maintenance care (treatment after initial disability was resolved) provided by Physical Therapist (PT) or Medical Physician (MD) services was associated with a higher disability (injury) recurrence than in the use of Chiropractic (DC) services.

Journal of Occupational and Environmental Medicine, April 2011

Quote: “A question that sometimes drives me hazy: am I or are the others crazy?” ~ Albert Einstein

Active Release Techniques: Sore Knees. The knee joint is a very complex joint. Various layers of muscles tendons and ligaments both move and support the knee. While there may be many causes of knee pain, we’ve found at Denver Chiropractic Center the common cause is tight quads transmitting force to the patellar tendon (the tendon that connects the knee cap to the shin). ART to the both the tendon and quadriceps muscle, along with rehab and stretching, can fix things up in 4-8 visits. If you or someone you know is dealing with knee pain, give us a call. 303.300.0424.

How one Denver Chiropractor’s son recovered from a broken foot in under a week & why Active Release is great for headaches.

My middle son, Jason, turned 4 a couple of weeks ago. The day after his birthday, he woke up limping. We took him to the pediatrician, and after an xray of his hip and another of his foot, the diagnosis was a broken second metatarsal (those long bones that start just after your toes).

The treatment? Wear a walking boot for 10 days then another x-ray. Well, after 6 days, he declared himself all better and refused to wear the boot. Since he figured out how to work the velcro on it, we pretty much couldn’t stop him. So he ran around without it.

At his re-exam and re-x-ray, the doctor (a pediatric orthopedist) declared him healed.

From limping badly on a broken foot to running around like a maniac in 6 days. 6 days! Oh, to be so young & quick to heal.

For the rest of us, the sooner you can do something about that painful problem, the sooner you can get on your (slightly longer) road to recovery. Anyway, here’s Jason in the boot, preparing for his dream job as a Jedi Knight:

Interesting Image
Health News For You…
Mental Attitude: Fat and Happiness. Humans have an intimate relationship between their emotional state and what they eat. In this study, researchers found the levels of sadness among the subjects who received fatty acids were 50% lower than those who had not. Eating fat appears to be a mood-lifter.Journal of Clinical Investigation, July 2011

Health Alert: Rising Health Costs. The United States spent $2.3 trillionon health care in 2008, more than three times the $714 billion spent in 1990, and over eight times the $253 billion spent in 1980.
Kaiser Family Foundation, March 2010

Diet: Blueberries and Cancer. Blueberries are full of antioxidants, flavonoids and other vitamins that help reduce free radicals in cells. Free radicals can cause cellular damage, one of the factors in the development of cancer. Blueberries are rich in vitamin C, which helps the immune system and helps the body absorb iron. Blueberry juice and other products may be nutritious but often contain less fiber than the whole fruit, and added sugar or corn syrup may decrease their nutritional value. University of Alabama at Birmingham, July 2011

Exercise: Eating Before Swimming? A review of 536 autopsies revealed 79.4% of those who had accidentally drowned had visible stomach contents. It’s suspected there may be a link between eating before swimming and drowning as blood is diverted to the intestine during digestion, possiblycausing circulation problems while the individual is swimming. This may reduce blood flow to the brain, resulting in loss of consciousness and potentially drowning the swimmer. Medicine, Science and the Law, July 2011

Chiropractic: Effective For Whiplash. 26 of 28 patients (93%) with chronic whiplash syndrome improved following chiropractic treatment.According to the authors, before the publication of this article, no conventional treatment was proven to be effective for treating whiplash.Injury, November 1996

Wellness/Prevention: Investing With Prevention. Preventing heart disease before it starts is a good long-term investment in the nation’s health. Every dollar spent on building trails for walking or biking saves $3 in medical costs. Companies that invest in workers’ health with comprehensive worksite wellness programs and healthy work environments have less absenteeism, greater productivity and lower healthcare costs.
American Heart Association, July 2011

Quote: “Anyone who doesn’t take truth seriously in small matters cannot be trusted in large ones either.”
~ Albert Einstein

Active Release Technique: Headaches Active Release is a great treatment for headaches. By releasing scar tissue that’s putting pressure on the small nerves that go up to the head (occipital nerves) even long-standing headaches can resolve. If you or someone you care about is suffering from headaches, email or call us today!

Denver Active Release Techniques providers- make sure you get what you pay for!

I just got done treating a new patient who was very angry with another provider.

You see, this person advertises that she is an Active Release provider. So when the patient went to see her, the provider said, “well, I’m not really certified, but I do the same things.”

This particular patient has been seeing ART providers all over the country (she travels a lot for work). She knows Active Release. And she knows that the Denver provider she saw was not a Denver Active Release Techniques provider, regardless of the advertising.

After her bad experience, she called the ART office and asked who are the most credentialed ART providers in town. There are 2 of them, myself, and my good friend Dr. Michelle Clark. In my humble opinion, the two of us are your best options. (We practice separately.)

Regardless, before you make an appointment with someone who advertises that they do Active Release, go to www.activerelease.com, click on find a provider, and enter that provider’s name in the box. If the provider’s name doesn’t come up, he or she probably isn’t certified (you can also call their toll free number to verify, it’s on the site).

You can also search by zip code. The locator will pull up certified providers. Then look for the little squares which indicate which ART certifications each provider has completed. The ones with the most squares are the ones who have done the most work to improve their ART skills. In this world of internet advertising, anyone can say anything they want. Make sure you get what you’re paying for by doing your homework up front.

Active Release is great, and we hope you find a provider who can help you.

Back from teaching for Active Release Techniques & NEW summer hours.

I just got back from sunny San Diego last weekend, where I was teaching for Active Release Techniques. It’s hard to believe that I’ve been an ART provider for 11 years, and an instructor for 9 years. I’m still the only ART instructor in Denver.

Anyway, the weather was beautiful (I flew out in rain and snow here) and the hotel was right on the bay. Here I am in front of some sort of famous racing sail boat that seemed to be a big deal to boat-savvy people (I get seasick so I’m no boat guy).

Me in SD
As always, working hard in tough places

The sunny, breezy weather got me thinking about summer time, and summer hours. So, starting May 31 (the day after Memorial Day) our office hours will be as follows:

Monday: 9-5

Tuesday: 9-7

Wednesday: 9-5

Thursday 9-7

Friday 9-3

The catch here is that I, Dr. Glenn Hyman, won’t be in on Fridays during the summer, but I WILL be here Monday through Thursday (until 7 Tuesdays and Thursdays). A lot of you have been asking for later hours with me for years, and I’m happy to oblige.

As many of you know, I have 3 little sons, ages 5,3 & 1, and I just want to spend a little more time with them this summer. So that’s why I’m going to take some Fridays off. But don’t worry, we’ll still be open on Fridays, Dr. Stripling will be here on Fridays (and the other days, too.).


Getting ready for next season

Well, after three seasons of training for Xterra triathlons by myself, I’ve decided I don’t really know what the hell I’m doing. So I’ve begged my friends at Mile High Multisport (www.milehighmultisport.com) to coach me.

Lucky for me, Pete and Kathy Alfino agreed. So Kathy Alfino is going to serve as my coach. I can’t describe how excited I am.

After 3 years of finishing at the back of the pack (yes, I know that finishing is an accomplishment) it’s time to start moving up. So I’ll keep you posted in the ol’ blog about my progress. I’m planning on training through the off season so I can get better. I’m going to keep swimming, biking, and running all winter long.

Kathy Alfino qualified for the Ironman World Championships in Kona, and she’s one of the main reasons my family and I have decided to go out there for the big race. As an official ART Ironman Provider (one of 2 in Denver) I’m looking forward to working on the athletes on the Big Island.

How will Meredith and I survive a 6-hour flight with the boys (ages 5,3,1)? That’s a damn good question.

I’ve been doing a little lifting in the interlude here. Did the P90x Shoulders and Arms workout today. I went kind light on the weights as I’ve been incredibly busy at work. Thanks for reading!!

By the way- Happy 3rd birthday to Jason!

L to R- Zachary, Meredith, Jason, Me, Andrew

A patient’s question about sciatica

Dear Glenn,

Here’s another question from a patient:

Hello Dr. Hyman,

I’ve been experiencing an annoying pain that originates
in my glute and goes down the back of my leg. You treated
a friend of mine for sciatica (I’m assuming that’s what
this is). Can you help me and how?

The answer:

“Sciatica” refers to pain in the sciatic nerve’s
distribution, down the back of the leg. It’s caused
most commonly by one of two problems:

Pressure on the nerve from a bulging disc.
Pressure on the nerve from the muscles in the area.

The muscular cause is way more common.

The first step is to perform a thorough examination
and make sure your problem is not caused by a
herniated disc. If it is, that can be treated,
but treatment is different.

If I determine that the pain comes from the muscles,
I will identify the muscles involved and release them.
I do this by applying gentle tension to the muscle and
combining that with specific movements. This is
known as Active Release Technique®, which I am
certified to provide (I’m also an ART instructor).

If the joints in your low back and pelvis
are stiff and contributing to the problem,
they may be adjusted. Adjustments are a
gentle way to loosen joints. Very little
force is used with adjustments and they
usually feel great.

The first step is to make an appointment and let
me determine what’s causing your sciatica, then
we can determine the correct treatment plan.

On average, 4-8 visits are required.
……….

If anyone that you know is suffering from
sciatica, tell him or her to call us at
303.300.0424. We can help.

Glenn Hyman
http://www.denverback.com