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Carpal Tunnel Syndrome- try Active Release techniques at Denver Chiropractic Center before surgery

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.

Our 14th Anniversary and This Week’s 1-Page Health News

Those of you who want these weekly 1-Page Health News emails sent directly to your email can go to denverback.com and fill out the little form on the upper left part of the page.

May marks another year for Denver Chiropractic Center. For those of you keeping score, that’s 14 years down, and now in our 15th year.

Last week was the busiest week we’ve ever had. Ever. And we’d like to thank you. Your trust, support and referrals are what make our existence and growth as a business possible. We look forward to being here to help you for a few more decades. Once again, thanks.

We’d also like to wish all the moms out there a Happy Mothers Day.

Here’s this week’s 1-Page Health News:

Mental Attitude: Berry Good News. Men who regularly consume foods rich in flavonoids (such as berries, apples, certain vegetables, tea and red wine) may significantly reduce their risk for developing Parkinson’s disease. Flavonoids are naturally occurring, bioactive compounds present in many plant-based foods and drinks. Neurology, April 2012

Health Alert: Stressed? The risk for coronary heart disease and stroke increases by 30% in a person whose partner has cancer. The cause is probably the negative stress to which the cancer patient’s partner is exposed. Previous studies show that stress can affect the nervous system, blood pressure, and inflammation, increasing the risk of developing coronary heart disease and stroke. Centre for Primary Healthcare Research in Malmö, April 2012

Diet: Pain Relief. The supplement Methylsulfonylmethane gave osteoarthritis patients relief from symptoms of pain and physical dysfunction. Osteoarthritis Cartilage, 2008 Exercise: Being Fit. Improving or maintaining physical fitness appears to help obese and overweight children reach a healthy weight. During a four-year study, obese and overweight girls and boys who achieved fitness were 2.5 to 5 times more likely to reach a healthy weight than those who stayed underfit. Obesity, April 2012

Active Release Techniques: Sciatica. Many people with sciatica are worried that it’s coming from a ruptured disc. While this is sometimes true, in most cases, muscles are pressuring the sciatic nerve and causing symptoms down the back of the leg. The piriformis is a likely suspect, as are the hamstrings. Using Active Release Techniques to relieve the tension in these muscles can take the pressure off of the nerve and fix the problem.

Wellness/Prevention: Obesity and Watching TV. In a study of obesity among European children, Dr. Yannis Manios, Assistant Professor at Harokopio University in Athens, writes, “We found that many countries are lacking clear guidelines on healthy eating and active play. However, there is good evidence linking sedentary behavior (like TV watching) with subsequent obesity. Obesity Reviews, March 2012 (Um, this is not brilliant work.)

Quote: “Simple diet is best; for many dishes bring many diseases; and rich sauces are worse than heaping several meats upon each other.” ~ Pliny

Neck Pain: Manipulation vs. Mobilization – What’s Better?

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.

Carpal Tunnel Syndrome treatment at Denver Chiropractic Center – How can our Active Release Techniques (ART) treatment help you?

Carpal Tunnel Syndrome (CTS) is a very common problem. The American Association of Orthopedic Surgeons (AAOS) reported that in 2007, there were 330,000 carpal tunnel release surgeries performed. (WHOA!) The main reason to have the surgery is to “open up” the tunnel. That is, the transverse carpal ligament or “floor” of the tunnel is released so the contents inside the tunnel are able to move more freely, reducing the pressure inside the tunnel.

Essentially, this is the goal of any treatment (surgical or not): improving the depth of the tunnel, thus reducing the pressure from inside the tunnel allowing the tendons to slide better as the muscles on the palm-side forearm contract to move the nine tendons that pass through the tunnel and attach to the fingers and thumb.

However, there are non-surgical methods for reducing the pressure within the tunnel that should be first attempted as surgery is always reported to be the “…last resort” for good reason. There can be surgical complications, the effects may be only partial, and there is an average of 30% grip strength loss following the transverse ligament surgical release. So, the question is, how can chiropractic approaches reduce the pressure inside the carpal tunnel without somehow changing the length of the transverse carpal ligament?

By going beyond traditional chiropractic care and using Active Release Techniques (ART), we can often release the transverse carpal ligament by hand, taking pressure off of the nerve and relieving symptoms. We can also address possible muscular entrapment sites for the median nerve, like the pronator teres muscle. These muscular entrapments mimic Carpal Tunnel Syndrome, but can be easily released with ART treatment. In the last 15 years, we’ve helped literally hundreds of patients avoid carpal tunnel surgery by using Active Release Techniques. We don’t claim to have a 100% success rate, as some cases do require surgery. But we believe it’s best to try us first and see what we can do.

The use of a night splint to keep the wrist in a straight or slightly “cocked-up” position is also highly beneficial as the pressure inside the tunnel goes up as much as 6-8x when CTS is present when the wrist bends.

If you, a friend or family member require care for CTS, we would be happy to help. Just call 303.300.0424 to set up your first appointment.

Maintenance Care for Chronic Low Back Pain

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.

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