Carpal Tunnel Syndrome (CTS) is a condition characterized by pain, numbness and/or tingling in the hand. This includes the palm and the 2nd, 3rd, and half of the 4th finger, usually sparing the thumb. Another indication of CTS is weakness in grip strength such as difficulty opening a jar to even holding a coffee cup. CTS can occur from many different causes, the most common being repetitive motion injuries such as assembly line or typing/computing work.
Here is a PARTIAL list of potential causes of CTS: heredity (a small sized tunnel), aging (>50 years old), rheumatoid arthritis, pregnancy, hypothyroid, birth control pill use, trauma to the wrist (especially colles fractures), diabetes mellitus, acromegaly, the use of corticosteroids, tumors (benign or malignant), obesity (BMI>29 are 2.5 more likely), double crush (pinching of the nerve in more than 1 place such as the neck and the carpal tunnel), heterozygous mutations in a gene (associated with Charcot-Marie-Tooth), Parvovirus b19, and others. Again, repetitive trauma is still the most common cause. Once the cause(s) of CTS has been nailed down, then treatment options can be considered.
From a treatment perspective, we’ve previously discussed what chiropractors typically do for CTS (spinal and extremity joint manipulation, muscle/soft tissue mobilization, physical therapy modalities such as laser, the use of a wrist splint – especially at night, work task modifications, wrist/hand/arm/neck exercises, vitamin B6, and more). But, what about using other “alternative” or non-medical approaches, especially those that can be done with chiropractic treatment? Here is a list of four alternative or complementary treatment options:
- Anti-inflammatory Goals: Reducing systemic inflammation reduces overall pressure on the median nerve that travels through the limited space within the carpal tunnel at the wrist. An “anti-inflammatory diet” such a Mediterranean diet, gluten-free diet, paleo-diet (also referred to as the caveman diet) can also help. Herbs that can helps include arnica, bromelain, white willow bark, curcumen, ginger, turmeric, boswellia, and vitamins such as bioflavinoids, Vitamin B6 (and other B vitamins such as B1 and B12), vitamin C, and also omega 3 fatty acids.
- Acupuncture: Inserting very thin needles into specific acupuncture points both near the wrist and further away can unblock energy channels (called meridians), improve energy flow, release natural pain reducing chemicals (endorphins and enkephlins), promote circulation and balance the nervous system. For CTS, the acupuncture points are located on the wrist, arm, thumb, hand, neck, upper back and leg. The number of sessions varies, dependant on how long the CTS has been present, the person’s overall health, and the severity of CTS.
- Laser acupuncture: The use of a low level (or “cold” laser) or a class IV pulsed laser over the same acupuncture points as mentioned above can have very similar beneficial effects (without needles)! One particular study of 36 subjects with CTS for an average of 24 months included 14 patients who had 1-2 prior surgeries for CTS with poor post-surgical results. Even in that group, improvement was reported after 3 laser treatments per week for 4-5 weeks! In total, 33 of the 36 subjects reported 50-100% relief. These benefits were reportedly long-term as follow-up at 1-2 years later showed only 2 out of 23 subjects had pain that returned and subsequent laser treatment was again successful within several weeks.
- Active Release Techniques (ART): ART releases scar tissue in the muscles that surround the median nerve. This release takes the pressure off of the nerve, and often resolves CTS. We’ve been treating Carpal Tunnel with ART successfully since 2000, and Dr. Hyman is the only ART provider in Denver who is also an ART instructor. Call us today to schedule your CTS evaluation. 303.300.0424
Some people object to the idea of squatting. They say it’s bad for you, not something anyone ever does, blah, blah, blah. I can tell you from 15 years of experience that the hips don’t lie: People who can’t drop into a full-range unweighted squat sooner or later will have back problems. It’s that simple.
The picture is me cleaning my grill before my dad arrived last weekend. If I couldn’t get into this squat easily, I’d be standing there stooped over at the waist. When stooping instead of squatting becomes a habit, something bad eventually happens. This is the person who blows out his or her back tying a shoe or picking up an empty dog food bowl.
Next time you’re in ask either myself or Dr. Stripling to check your squat for you. IF you can’t do it, we can probably teach you.
Mental Attitude: Think You Are Fat? Researchers found that normal weight teens who perceive themselves as fat are more likely to grow up to be fat. 59% of girls who felt fat as a teen became overweight in adulthood while 31% of girls who did not consider themselves fat during adolescence were found to be overweight. Normal weight girls were more likely than boys to rate themselves as overweight (22% of girls vs. 9% of the boys). One reason for weight gain in later years may be due to psychosocial stress, which can be associated with gaining weight. Under this scenario, the psychosocial stress related to having (or not having) an ideal body type, along with the perception of oneself as overweight, can result in weight gain. Another explanation may be that young people who see themselves as fat often change their eating habits by skipping meals, which can
lead to obesity. Also, a diet you can’t maintain over time will be counterproductive, as the body tries to maintain the weight you had before you started to diet. Norwegian University of Science and Technology, July 2012
Health Alert: Depression Is A World-Wide Problem. It’s widely believe that depression is a phenomenon of Western culture, but researchers who analyzed studies involving over 480,000 people across 91 countries have found the opposite is true. They estimate the rate of depression in Middle Eastern and some Asian countries (~9%) is twice that found in countries like the United States and Australia (~4%). World Health Organization, 2010
Diet: Bad BBQ News! Barbecue can sabotage your waistline. A 20 ounce T-bone steak can weigh in at 1,540 calories, with
124 grams of fat. A corn-fed 85% ‘lean’ cheeseburger has 750 calories and 45 grams of fat. Pork or beef ribs come from the fattiest part of the animal. Healthier options include pork tenderloin, skinless chicken breast, and lean ground beef. American Heart Association
Exercise: Good Reasons. Regular exercise maintains or improves joint flexibility, improves your glucose tolerance and reduces workdays missed due to illness. Surgeon General’s Report on Physical Activity and Health, 1996
Chiropractic: Motion and Nutrition. Cartilage is avascular, meaning it does not receive nutrition via blood vessels. Like a sponge, it takes in fluid and releases the fluid when compression is applied. This alternating compression and re-expansion allows it to receive its supply of nutrients and remove metabolic waste. Arthritis & Rheumatism, 1984
Wellness/Prevention: Lose To Gain? People who are overweight or obese could gain ten years worth of health benefits by simply losing 20 pounds. Modest weight loss (average 14 lbs) reduced the risk of individuals developing Type 2 diabetes by
58%. Weight loss of just 10% of a person’s body weight has been shown to have long-term impact on sleep apnea, hypertension, quality of life, and to slow the decline in mobility that occurs as people age. American Psychological Association, July 2012
Quote: “We can’t solve problems by using the same kind of thinking we used when we created them.” ~ Albert Einstein
In many cases, Carpal Tunnel Syndrome (CTS) results strictly from overuse activities though, as we have discussed previously. Other conditions such as, pregnancy, etc. can also be involved as a contributor and / or the sole cause. When these conditions are present, they must be properly treated to achieve a favorable result. However, the majority of cases are the result of a repetitive motion injury. So, the question remains: What is the role of the patient regarding activity modification during the treatment process of CTS? How important is it?
To answer this question, let’s look at a fairly common type of CTS case. The patient is female, 52 years old, moderately obese (Body Mass Index 35 where the normal is 19-25), and works for a local cookie packing company. Her job is to stand on a line where cookies are traveling down a conveyor belt after being baked and cooled. She reaches forwards with both arms and grasps the cookies, sometimes several at a time, and places them into plastic packaging which are then wrapped and finally removed from the belt and placed into boxes located at the end of the line. Each worker rotates positions every 30 minutes. A problem can occur when other workers fall behind or when there aren’t enough workers on the line, at which time the speed required to complete the job increases.
So now, let’s discuss the “pathology” behind CTS. The cause of CTS is the pinching of the median nerve inside the carpal tunnel or muscles of the forearm, located on the palm side of the wrist. The tunnel is made up of 2 rows of 4 carpal bones that form top of the tunnel while a ligament stretches across, making up the tunnel’s floor. There are 9 tendons that travel through the tunnel and “during rush hour” (or, when the worker is REALLY moving fast, trying to keep up with production), the friction created between the tendons, their sheaths (covering) and surrounding synovial lining (a lubricating membrane that covers the tendons sheaths), results in inflammation or swelling.
When this happens, there just isn’t enough room inside the tunnel for the additional swelling and everything gets compressed. The inflamed contents inside the tunnel push the median nerve (that also travels through the tunnel) against the ligament and pinched nerve symptoms occur (numbness, tingling, and loss of the grip strength). The worker notices significant problems at night when her hands interrupt her sleep and she has to shake and flick her fingers to try to get them to “wake up.” She notices that only the index to the 3rd and thumb half of the 4th finger are numb, primarily on the palm side.
At this stage, the worker often waits to see if this is just a temporary problem that will go away on its own and if not, she’ll make an appointment for a consultation, often at her family doctor (since many patients don’t realize Active Release Techniques Soft Tissue Treatments REALLY HELP this condition). In an “ideal world,” the primary care doctor first refers the patient to the ART provider for non-surgical management. Other treatment elements include the use of a night wrist splint and (one of the MOST IMPORTANT) “ergonomic management.” That means work station modifications, which may include slowing down the line, the addition 1 or 2 workers, and reducing the reach requirement by adding a “rake” that pushes the cookies towards the worker/s. Strict home instructions to allow for proper rest and managing home repetitive tasks are also very important. Between all these approaches, our office is quite successful in managing the CTS patient, but it may require a workstation analysis.
It all starts with the initial examination. Call our office at 303.300.0424 right now to schedule yours.
Does mobilization (MOB) get less, the same, or better results when compared to spinal manipulative therapy (SMT)? To answer this question, let’s first discuss the difference between the two treatment approaches.
Mobilization (MOB) of the spine can be “technically” defined as a “low velocity, low amplitude” force applied to the tissues of the cervical spine (or any joint of the body, but we’ll focus on the cervical region). This means a slow, rhythmic movement is applied to a joint or muscle using various methods such as stretching.
Spinal Manipulative Therapy (SMT) can be defined as a “high velocity, low amplitude” type of force applied to joint which is often accompanied by a audible release or “crack,” which is the release of gas (nitrogen, oxygen, and carbon dioxide).
Some joints “cavitate” or “crack” while others are less likely to release the gas. Studies that date back to the 1940s report an immediate improvement in a joint’s range of motion occurs when the joint cavitates. Many people instinctively stretch their own neck to the point of release, which typically, “…feels good.” This can become a habit and usually is not a big problem. However, in some cases, it can lead to joint hypermobility and ligament laxity.
As a rule, if only a gentle stretch is required to produce the cavitation/crack, it’s typically “safe” verses the person who uses higher levels of force by grabbing their own head and twisting it beyond the normal tissue stretch boundaries. The later is more likely to result in damage to the ligaments (tissue that strongly holds bone to bone) and therefore, should be avoided.
Since SMT is usually applied in a very specific location (where the joint is fixated or “stuck”, or, partially displaced), it’s obviously BEST to utilize chiropractic, as we chiropractors do this many times a day (for years or even decades) and we know where to apply it and can judge the amount of force to utilize, especially the neck where there are many delicate structures.
Back to the question: Which is better, MOB or SMT? Or, are they equals in the quest of rid of neck pain? A recent study of over 100 patients with “mechanical neck pain” (strain/sprain) showed that those who received SMT had a significantly better response than the MOB group as measured by a pain scale, a disability scale and 2 tests that measure function!
In our clinic (Denver Chiropractic Center) we’ve found that the best approach uses BOTH. Mobilization in the form of Active Release Technique combined with safe and gentle (never forced) adjustments get better results in a shorter time frame. It all starts with the initial exam, so call us to schedule yours – 303.300.0424.
When people think of chiropractic, they immediately think of low back pain and are often surprised to find out that chiropractic can benefit many conditions such as carpal tunnel syndrome, tennis elbow, rotator cuff tears, as well as hip, knee, and ankle conditions. There is also research support for manipulation (a key component of chiropractic) and its role in managing “somatovisceral” related conditions such as pneumonia, dizziness, stage 1 hypertension, PMS, asthma, colic, and bed wetting.
Research clearly shows that chiropractic manipulation out performs other forms of treatment for acute, subacute and chronic low back pain. But, the question remains, can “maintenance chiropractic” PREVENT problems down the road? Ironically, two medical doctors in August of 2011 published an article in a leading medical journal (SPINE) entitled, “Does maintained spinal manipulation therapy for chronic nonspecific low back pain result in better long-term outcome?” The study’s objective was to determine if treating chronic low back pain patients (pain >6 months) after a course of 12 treatments in the first month would do better, the same or worse if treatments were continued at 2-week intervals for an additional 9 months. They compared 3 groups of patients: 1.) 12 treatments of “sham” (placebo) manipulation over a 1-month period. 2.) 12 treatment of “real” spinal manipulative therapy (SMT) for 1 month but no treatments for the subsequent 9 months. 3.) The same as #2 but with treatments every 2 weeks over the next 9 months. To determine the differences between these 3 groups, the authors measured pain and disability scores (using questionnaires), generic health status (questionnaire), and back-specific patient satisfaction (questionnaire) at 1, 4, 7 and 10-month intervals.
The results showed that groups 2 (SMT for 1 month only) and 3 (SMT for 1 month + every 2 weeks for 9 months) had significantly lower pain and disability scores than the 1st group (sham/placebo group) at the end of the 1st month or, 12 visits. However, only group 3 (treatments were continued for 9 months at 2 week intervals) showed more improvement in pain and disability scores at 10 months. Equally important, the scores for the non-maintained group 2 patients returned to near their pre-treatment levels by month 10!
The authors concluded that not only is spinal manipulative therapy effective for chronic low back pain, but more importantly, REGULAR ADJUSTMENTS EVERY 2 WEEKS after the initial course of concentrated care (3x/week for 4 weeks) was needed, “…to obtain long-term benefit,” suggesting that, “…maintenance SM after the initial intensive manipulative therapy,” is appropriate care to obtain long-term results.
This study FINALLY supports the recommendations made by chiropractors for many years –regular adjustments are beneficial to obtain a higher quality of life, less pain and less disability! While this study didn’t include Active Release Technique, we have observed that combining ART with adjustments is much more effective than adjustments alone. If you’re dealing with back pain, call us. We can help 303.300.0424.
Denver Chiropractic Center is now scheduling appointments for Massage Therapy!!!!
According to Newsweek there are many beneficial reasons to choose massage therapy, here are the top 4:
1. Pick Your Spot: You don’t have to massage the part of the body that hurts most. If you’re shy about letting a massage therapist touch your aching lower back, for instance, she could help by massaging your shoulders instead. This is because massage creates chemical changes that reduce pain and stress throughout the body. One way it does this is by reducing a brain chemical called substance P that is related to pain. In a TRI study, for example, individuals with a form of muscle pain called fibromyalgia showed less substance P in their saliva (and they reported reduced pain) after a month of twice-weekly massages.
2. De-Stress, Stay Healthy. Massage may boost immunity. Several studies have measured the stress hormone called cortisol in subjects’ saliva before and after massage sessions, and found dramatic decreases. Cortisol, which is produced when you are stressed, kills cells important for immunity, so when massage reduces your stress levels and hence the cortisol in your body, it may help you avoid getting a cold or another illness while under stress.
3. Blood Pressure Benefits: Massage reduces hypertension, suggests a good deal of research. This may be because it stimulates pressure receptors that prompt action from the vagus nerve, one of the nerves that emerges from the brain. The vagus nerve regulates blood pressure, as well as other functions. In a 2005 study at the University of South Florida, hypertension patients who received 10 massages of 10 minutes each over three weeks showed significant improvements in blood pressure compared to a control group who simply rested in the same environment without any massage.
4. Technique Tactics: There’s little evidence to support one kind of massage over another, so don’t worry about whether your therapist is schooled in Shiatsu, Swedish or some other technique. The key is pressure firm enough to make a temporary indentation in the skin.
Schedule your appointment today! 303.300.0424