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. 

[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)

If you are pregnant and suffering from low back pain, a neighbor or a friend has probably suggested you visit a chiropractor because a chiropractor was able to help them during their pregnancy. The discussion probably left you curious, is that good advice or just a single success story? Additionally, you may be wondering whether chiropractic is safe during pregnancy and how much low back pain improvement the average pregnant woman can expect to get. 

After looking at several scientific publications on these exact topics, the appropriate conclusion seems to be that “chiropractic evaluation and treatment during pregnancy may be considered a safe and effective means of treating common musculoskeletal symptoms that affect pregnant patients. The scarcity of published literature warrants further research.” (Borggren, 2007)

So basically the answers are:
• Yes, chiropractic is safe during pregnancy.
• Yes, chiropractic helps common musculoskelatal probelms during pregnancy (including back pain).
• Your friends experience isn’t just one woman’s story. Many women are finding relief and the results are being sporadically published in medical journals too.
• More research under more controlled conditions is needed for the purposes of educating primary care physicians and obstetricians about chiropractic care during pregnancy.

Here are a few additional details about the prevalence of low back pain during pregnancy and the number of women being referred for treatment.
• 57 – 69% of women complain of low back pain during pregnancy
• Only about 32% of women report these symptoms to their primary doctor
• Only about 25% of primary doctors recommend seeking treatment for the pain.

Clearly this is a big problem with 2 in 3 having pregnancy-related back pain. Also a big problem is that they are generally not talking to their obstetricians and primary care physicians about it and that these professionals are not referring them to effective treatment options.

Chiropractic treatments can be quite effective for pregnancy-related back pain with just a few visits for the majority of women seeking help. In a small study of 17 women:
• Sixteen of 17 (94%) saw clinically important improvements in low back pain with chiropractic care.
• The average pain rating went down from 5.9 to 1.5 (on a scale of 0 to 10).
• It took an average of 1.8 visits and 4.5 days to get clinically important pain relief.

We hope this article gave you hope that many pregnant women do get significant, rapid relief from low back pain. If you are currently pregnant with low back pain, you probably have many questions not answered by this article. Perhaps you’ve never had chiropractic care before or you want to know how we adjust our techniques to work with pregnant patients. The best way to get answers to your questions is with an initial consultation. The only way for us to know whether you are a good candidate is for you to come see us, so call for an initial appointment today.

Bibliography
Borggren, C. L. (2007, Spring). Pregnancy and chiropractic: a narrative review of the literature. J Chiropr Med, 6(2), 70-74.
Khorsan, R., Hawk, C., Lisi, A., & Kizhakkeveettil, A. (2009, Jun). Manipulative therapy for pregnancy and related conditions: a systematic review. Obstet Gynecol Surv, 64(6), 416-27.
Lisi, A. (2006, Jan-Feb). Chiropractic spinal manipulation for low back pain of pregnancy: a retrospective case series. J Midwifery Womens Health, 51(1), 7-10.
Stuber, K., & Smith, D. (2008, ul-Aug). Chiropractic treatment of pregnancy-related low back pain: a systematic review of the evidence. J Manipulative Physiol Ther., 31(6), 447-54.

In this video, Dr. Terry Schroeder, head coach for the US Men’s Olympic Water Polo team and some of his athletes discuss the vital role that chiropractic plays in sport and life. Now the head coach of the team, Dr. Schroeder competed for the US in 4 Olympics himself. He also happens to be a chiropractor.
Elite athletes know that any small difference in preparation, fitness, function or flexibility can make the difference between a Gold and a Silver medal – or no medal at all. In the video, Dr. Schroeder shares how every member of the men’s team now includes chiropractic adjustments in their regime. Although some were reluctant at first, after seeing the results teammates were getting, they all eventually came around. After all elite athletes are always looking for ‘an edge’.
In the sport of water polo, necks and shoulders take a constant beating from defenders. The shoulders in particular are prone to overuse injuries and hyper-extension. Shoulder injuries will sideline a player completely making it nearly impossible to train in the pool. As athletes of all level know, missing practice while recovering from an injury is vital time lost. Prevention and proactive care is the better route.
In the video you’ll hear Dr. Terry Schroeder’s personal story of how he was first introduced to chiropractic and also see him adjusting players on a portable adjusting table right on the pool deck.
We hope that be sharing examples of Olympic athletes using chiropractic care we can help spread the word among collegiate, high school and recreational athletes. Whatever your sport, we can help you achieve peak performance and prevent injuries.

Sleepless in America?

For more than one in three Americans, getting a good night’s sleep isn’t as easy you might think.  According to a recent poll by the National Sleep Foundation[1], a combination of daily stress and lifestyle choices (including nighttime activities as well as eating and exercise habits) is causing more than a third of the U.S. population to get fewer hours of sleep than they need.  Not surprisingly, the same proportion report that sleepiness has in some way affected their quality of life.

The Long-Term Prescription for Quality Sleep.

Many studies have focused on the time we devote (or don’t devote) to sleep.  However, a good night’s sleep is about more than just quantity.  It’s also about quality.  If you’re sleeping poorly, experts point out that developing a sensible routine and avoiding certain behaviors around bedtime can improve your chances of falling asleep quickly and sleeping soundly through the night.  Here are a few of their suggestions:

• Go to bed at the same time each evening and wake up at the same time each morning.
• Exercise regularly but avoid increasing your heart rate within two or three hours of bedtime.
• Eat dinner early enough in the evening so that digestion doesn’t interfere with bedtime.
• Drink plenty or water but avoid drinking hot or cold liquids before or after bedtime.
• Reduce or eliminate caffeine and other stimulants in your diet.
• Sleep on your back and/or your side.  Don’t sleep on your stomach!

When it Comes to Sleep, Little Things Matter More Than You Might Think.  And They Add Up.

While finding more effective ways to manage stress and making adjustments to your lifestyle can take some time, there are several “little” things you can do right away that may improve the quantity and quality of sleep you get.  These things focus on your sleeping environment itself:

• Make your room is as dark as possible at bedtime.
  • Reduce background noise.
  • Keep your bedroom at a cool, comfortable temperature.
  • Sleep on an appropriate mattress.
  • Choose the right pillow.

Is Your Pillow Doing Its Job?

Let’s face it.  You probably don’t give a lot of thought to the pillow you sleep on.  And you probably didn’t give your pillow much thought when you purchased it either.  The truth is that most people don’t.  It’s not unusual for a person (or a couple) to spend thousands of dollars on a high-quality mattress but then buy pillows that don’t support the head and neck properly.  That’s because—while they understand that sleeping on the wrong mattress can quickly lead to a backache—they aren’t aware that poor alignment of the neck and upper back during sleep can lead to other, more subtle problems that they may not associate with the spine.

If a person’s head is supported by the pillow at a level that’s either too high or too low relative to the rest of the body, the neck and upper back can be placed under stress.   Similar stress can also occur if their upper back is not supported along with the neck (so that the head tilts forward), or if the head is allowed to roll sideways when the person is sleeping on his or her back.  Symptoms include snoring, insomnia and waking up with a headache, stiff neck or numbness in the arms and hands.  If you’re experiencing these sorts of symptoms, you may be sleeping on the wrong pillow.

What Makes a Pillow “Right”?

Choosing a pillow is a very personal decision.  The pillow that’s right for someone else may not be right for you.  Nevertheless, we’ve provided some basic guidelines that will make it easier for you to choose the right one.  The right pillow:

• Supports your head at the proper height whether you’re sleeping on your side or on your back.
• Supports both your head and neck in a neutral position while you’re sleeping on your side (Make sure there is no gap between the pillow and your neck!).
• Provides adequate support for both your neck and upper back while you’re sleeping on your back.
• Keeps your head tilted in the proper neutral position while you’re sleeping on your back.
• Prevents your head from rolling sideways while you’re sleeping on your back.
• Is easy to move on.

In general, you’re looking for a pillow that supports your neck, cushions your head and keeps your spine in alignment.  It must be comfortable!

Purchasing Tips

• Know what you like.  Do you prefer a pillow that’s “bouncy” or one that can be “molded” to the shape of your head and neck?  How “dense” do you like your pillow to feel?   Is it important to you that the material “breathes” and offers good insulation from heat and cold?  Maybe you prefer a pillow made of synthetic or hypo-allergenic material?  The more clearly you can describe your preferences, the more likely it is that a knowledgeable salesperson will be able to help you find your ideal pillow.

• Don’t skimp.  Like most things, pillows can differ a great deal in the quality of their construction and materials.  They also (naturally) differ a great deal in their price.  Buy a better quality pillow if you can, since they’re generally made of materials that will provide better support, comfort and durability.  But keep in mind that the first priorities are comfort and function.  Just because a pillow is expensive doesn’t mean it’s right for you.

• Take the time to “test drive” and compare.  Many department stores, mattress retailers and specialty bedding shops will have sample pillows that you can try.  If possible, follow the “Ten Minute Rule” and test drive pillows in your favorite sleeping positions.  Remember—you and your pillow will be spending about eight hours together every night for several years, so it makes sense to choose wisely now.

• Avoid buying a matched set of pillows for yourself and your partner.  Keep in mind that your partner probably needs a different pillow that you do.

Get an Expert Opinion from the Doctor Who Understands Your Neck and Back Best

If you’re not sleeping as well as you used to, or if you’re waking up with a headache, stiff neck or numbness in your arms or hands, we invite you—and your pillow—to visit our office.  As chiropractic physicians, we understand that the way you sleep affects your health.  And that your health affects the way you live your life.  Call today to schedule an appointment.  Sometimes a small thing (like a new pillow) can make a big difference!

Bibliography

(n.d.). Retrieved August 11, 2011, from The Better Sleep Council: http://bettersleep.org/

CBS The Early Show. (2009, February 11). Purchasing the Right Pillow. Retrieved August 10, 2011, from http://www.cbsnews.com/stories/2007/06/19/earlyshow/main2947304.shtml

Gordon, S. J., Trott, P., & Grimmer, K. A. (2002). Waking cervical pain and stiffness, headache, scapular or arm pain: Gender and age effects. Australian Journal of Physiotherapy(48), 9-15.

National Sleep Foundation. (n.d.). 2010 Sleep in America Poll Summary of Findings. Retrieved August 10, 2011, from http://www.sleepfoundation.org/sites/default/files/nsaw/NSF%20Sleep%20in%20%20America%20Poll%20-%20Summary%20of%20Findings%20.pdf

 If you are an office worker you probably spend at least six or seven hours a day sitting on the job. Add more time sitting in the car, at dinner and lounging with some late night TV and the total hours of sitting rockets up to somewhere around ten hours.

When is the last time you thought about how you sit?

Probably never or a long, long time ago.

Promise yourself that you’ll take a critical look at how you sit after you read this article. If you are sitting and reading this online, go ahead and freeze right now and really think about how you are sitting. Compare your sitting position to this checklist:

Proper Sitting Posture Checklist

• Sit with your legs uncrossed with ankles in front of the knees.
• Place both feet firmly on the floor. Get yourself a footrest if your feet don’t reach.
• Your knees should be lower than your hips and the back of your knees should not touch the seat.
• If your chair has an adjustable backrest, move it to support the arch in your low back. If you don’t have a backrest, ask your employer about getting one or invest in it yourself.
• Get up and move around every hour. Take a break from sitting even if you cannot stop working. Make a phone call standing up or close your office door and lie down for a few minutes on your stomach. At the very least, shift your sitting position occasionally.

Why Sitting Posture is Important

Good posture is important for long term health and disease prevention just like daily tooth brushing. And, similar to tooth brushing, habits are formed early and can be hard to break later in life.

Good sitting posture reduces the stress and strain on ligaments. Ligaments are responsible for holding the joints together, so ligament stresses can make you prone to joint injuries. Proper posture also reduces muscle fatigue. When muscles are able to work efficiently they use less energy and don’t get tired as easily. Abnormal motions or positions that are repeated over and over again on a daily basis are contributors to degenerative arthritis and joint pain.

Most adults would readily agree that posture is important. Most of that group would also admit that they don’t actively think about posture…it just happens. For the next 30 days, make an effort to really think about your posture and pause a couple times per day to compare your current position to the checklist provided above. It takes about 30 days of focus to break an old habit or develop a new one, so if you concentrate on your sitting posture for 30 days, you’ll be well on your way to a lifetime of better musculoskeletal health.

As always, if you need a recommendation for a good chair or back rest, ask any member of our team.

By: Kevin Venerus D.C.

www.AdvancedBackSolutions.com

Many people use the term sciatica incorrectly. Sciatica is pain along the path of the sciatic nerve which extends from the lower back down each leg. Sciatica is a symptom (like itching), it is not a diagnosis (like Parkinson’s disease). Sciatica can range from an occasional nuisance to excruciating pain that makes walking near impossible. There can be multiple underlying reasons for your sciatic nerve pain. A chiropractor can help find the root cause of the problem with an exam and may also order some diagnostic imaging such as an x-ray, MRI or CT scan to examine the underlying structures. 

To answer the question, ‘what is sciatica’ it is helpful to explain some of the relevant anatomical structures. The sciatic nerve is both the longest and the widest nerve in your body. It begins in the lower back as five separate nerves that extend from five different vertebrae – L4, L5, S1, S2, and S3. These nerves meet up to form one large bundle which runs through the buttocks and down the entire length of the leg. The sciatica nerve is responsible (directly or indirectly) for nearly all the sensation in your leg including the skin of the thigh and gluts.

Sciatica occurs when there is compression or irritation of the sciatic nerve. The pain is felt in the low back and leg, but the site of the pain isn’t always the site of the underlying issue. Since the sciatica nerve is so long and travels around or through the large muscles of the buttocks, it takes an expert to determine if the pain is coming from disc compression, from muscle spasms or from something else. Again, sciatica is a symptom, not a diagnosis.

While sciatica is most often associated with pain, other symptoms may be present such as tingling, numbness, or muscle weakness. The pain can be nearly constant or intermittent. If you think you are experiencing sciatic nerve pain, keep a record of the location, duration and intensity of the pain. Your specific history plays an important role in determining the cause of the pain.

Treatment for sciatica depend on the underlying cause, so there is no one recommended course of treatment for all sciatic pain sufferers. Chiropractors use a variety of non-invasive approaches that include spinal manipulation, physical therapy, targeted stretching and active muscle release. They’ll also discuss the role that nutrition and hydration play in reducing tissue inflammation and keeping discs healthy. The spine, discs, muscles and soft tissue all have a role to play in sciatica and should be evaluated and treated as a connected system.

The most important thing to take away from this article is that sciatica (sciatic nerve pain) is a symptom of an underlying condition. You’ll only start to get better once the underlying condition is identified and this is done through a combination of an exam, history and recommended diagnostic imaging.

By Kevin Venerus D.C.

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 didn’t 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.

How far and often will you be running? If you are a casual runner (less than ten miles per week), then a basic running shoe will be fine. If you are training for a marathon, consider making a true investment in your running shoes for optimal performance.

Consider the arch in your foot. Those with a high arch, need a running shoe with a curved shape. If you have an average arch, a semi-curved shoe might be the best fit. Those with a low arch or flat feet need a straight shape shoe.

Understand pronation, which is the rolling of the foot from heel to toe through the foot strike. A proper or neutral pronation is hitting the outside of the heel and up to ball of your foot evenly across the front. This is how your foot reduces the stress of impact. Underpronation means that the outside of your foot takes most of the shock instead of finishing in the neutral position. Overpronation is too much roll across from the outside to the inside of your foot.

To determine your level of pronation, look at the shoes you walk or run in. Most everyone will begin on the outside of the heel, the real indicator is the wear on the forefoot. If most of the shoe wear is:

•             On the medial (inside) side then you Overpronate

•             On the lateral (outside) side then you Underpronate

•             Uniform across the forefoot then you have a Neutral Stride

Where will you be running? Most people run on pavement or sidewalks, so most running shoes are designed with this in mind. However, if you are going to be running on uneven or softer surfaces (such as mountain trails or grass), look at shoes intended for those kinds of surfaces.

Shop for running shoes late in the afternoon, as feet are at their peak size at this time of day. When trying on the shoe, make sure there is a full thumb width between the end of the longest toe and the end of the shoe. In a properly fit running shoe, the toe box will allow the toes to move freely. The heel should not slip or rub against the shoe and the sole should flex with ease where the foot flexes.

Go to a store that specializes in running shoes or at least to a sporting goods store. The sales associates will be able to help you make a decision on the best shoe for you.

If you run often, consider purchasing more than one pair of running shoes. This way, you can rotate them. If you run often, your shoes should be replaced every six months or so.

Do consider price so your budget isn’t blown, but don’t sacrifice comfort and durability in the process.

Runners have a wide selection of styles, colors and levels of comfort from which to choose when looking at running shoes. Remember, whether you are a casual runner or a serious runner, comfort and excellent support are essential for the best performance!

By: Kevin Venerus D.C.

• Back pain is the number one disability for those under age 45.
• In theUnited States of Americaalone, there is an expected 31 million people with lower back pain at any given time.
• Back pain runs second, after only the common cold, as the top reason for visiting a healthcare provider in theUnited States.
• Experts place the likelihood of any person to experience some type of back problem in their lifetime at about 80%. That’s four out of every five people!
• Over 50 billion dollars are spent per year in the pursuit of clearing up cases of back pain.
• Around 30 to 40 percent of all workplace absences are due to back pain.
• Approximately one quarter of U.S. adults reported having low back pain lasting at least one whole day in the past three months, and 7.6 percent reported at least one episode of severe acute low back pain within a one-year period.
• One-half of all working Americans admit to having back pain symptoms each year.
• Approximately 2 percent of theU.S.work force is compensated for back injuries each year
• Lower back pain accounts for two thirds of all back pain-related cases.
• More than two-thirds of back strains are caused by lifting and other exertions like pulling and pushing.
• Most cases of back pain are mechanical or non-organic—meaning they are not caused by serious conditions, such as inflammatory arthritis, infection, fracture or cancer.

The key to proper treatment of back pain is to understand the cause. Remember, pain is always a sign that something else is wrong and if continually ignored may lead to more serious harm. Chiropractors are experts in assessing the root cause of your back pain and putting you on the right course to recovery.

By Kevin Venerus D.C.