Low back pain can arise from many conditions, one of which is a mouthful: spondylolisthesis. The term was coined in 1854 from the Greek words, “spondylo” for vertebrae and “olisthesis” for slip. These “slips” most commonly occur in the low back, 90% at L5 and 9% at L4. According to www.spinehealth.com and others, the most [...]
Carpal Tunnel Syndrome (CTS) results in numbness, tingling, and sometimes weak grip strength due pinching of the median nerve as it travels through the carpal tunnel at the wrist. There are many conditions that are similar to CTS, many of which we have discussed in the past. The following is a list of “13 fun facts” aimed at helping to properly identify CTS, knowing what to do about it, and at helping to make an informed decision as to whom to seek help for it.
- CTS is most common in women, age >50, who work in a repetitive, rapid moving manually demanding occupation (typing/computer work, line assembly work, waiting tables, and more).
- CTS is complicated by the presence of obesity, diabetes, hypothyroid, pregnancy, taking birth control pills, and other conditions that cause inflammation (rheumatoid arthritis and others).
- CTS may develop on the dominant side, the non-dominant side or both—each case is individual.
- CTS symptoms may FIRST present as morning or night time numbness that can wake the sufferer up once or many times during the night.
- CTS sufferers USUALLY wait for weeks, months or even years before seeking help for it, which is a risk factor for a delayed recovery – GET HELP ASAP!!!
- CTS can often be managed without surgery—especially IF you have it treated sooner rather than later.
- CTS surgery may be necessary if non-surgical care fails. This may be due to the nerve being damaged beyond a certain point (an EMG/NCV or, electromyography/nerve conduction velocity helps determine this along with an accurate history and examination).
- CTS non-surgical care includes: chiropractic manipulation of the wrist, elbow, shoulder and/or neck—depending on the case. All health care providers usually include a night wrist splint, anti-inflammatory measures, ergonomic modifications of work stations, and stretching exercises.
- CTS non-surgical success favors chiropractic because of the inclusion of the manual therapies. When only exercise, night splinting, and NSAIDS are used, the success rate drops off dramatically.
- Reduced thyroid function makes CTS worse because of the unique type of swelling associated with hypothyroidism called “myxedema.” Because of the confined space available in the carpal tunnel, a small amount of swelling can result in nerve compression and the classic numbness/tingling symptoms in the middle three fingers on the palm-side of the hand.
- CTS is worse at night because it is impossible to control the position of the wrist while we sleep. As a result, we tend to curl the wrist and hand under our chin, and when the wrist bends forwards or backwards, the pressure inside the carpal tunnel increases significantly due to the change in tunnel size. This is why wearing a wrist splint at night REALLY HELPS as it keeps the wrist from bending, keeping the tunnel as wide as possible, thus lowering the pressure within it.
- CTS patients respond well in some cases to vitamin B6. This is due to the healing effects of B6 (peridoxine) on neuropathy and/or it’s anti-inflammatory qualities. Other anti-inflammatory nutrients include ginger, turmeric, boswellia, bioflavinoids, white willow bark, quercetin, and others.
- CTS patients do not always improve after surgery. This can be due to the fact that the median nerve is frequently “pinched” in more than one area such as the neck, thoracic outlet (shoulder), pronator tunnel (elbow) as well as at the wrist. When more than one compression is present, this is referred to as “double” or “multiple crush syndrome.”
Quick mini-blog post about the olympics. The picture you are seeing in this post is a photo of Usain Bolt, the man who just TODAY broke the Olympic world record in the 100m. Notice that he is getting adjusted!
The power of an adjustment used by an Olympian when one HUNDREDTH of a second is all of the time in the world!
Link to story about Usain Bolt, Click HERE
Nothing like a little competitive edge with Chiropractic Care!
Enjoy the rest of your weekend! Take care, Dr. Patten.
Whiplash, as previously discussed, occurs quicker than the speed at which we can voluntarily contract our muscles in attempt to guard ourselves against injury. Hence, it is nearly impossible to properly brace in anticipation of an impending collision. When muscles, ligament, and joint capsules become injured, there is pain, and as a result, reflex muscle spasm occurs as the body attempts to “splint” the area to protect it. This sometimes sets up a vicious cycle which can make the pain last longer, hurt more intensely and / or hurt more frequently. Because of pain, as well as direct muscle injury that sometimes occurs in whiplash associated disorders (WAD), the natural tendency is to stop doing many activities and guard against motion both because of pain and the fear of it hurting worse. In both cases, the result is the same: muscle atrophy or shrinkage and muscle weakness due to not using the muscle.
There are other reasons that muscles become weak. When an injury occurs, a herniated or “ruptured” disc can injure the spinal nerves exiting the spine. The disc is like a jelly donut where the center is liquid-like surrounded by a thick ring of fibrocartilage and functions as a “shock-absorber” as it sits between 2 vertebral bodies
Think of the spinal nerves like electrical wires that connect a fuse box to a house.
The fuse box is the spinal cord and each wire represents the spinal nerves going to different parts of the house (body). In the cervical spine or neck, each wire goes to different parts like the head, shoulder, arm, and hand and innervates specific areas. Patients who have a pinched nerve from a whiplash injury describe their symptoms as numbness, tingling, pain and/or muscle weakness in a specific distribution or area.
There are 8 pairs of nerves in the neck that travel to different parts of the head (C1-3), the shoulders (C4, 5), and the arm (C6-T2). Let’s say a patient has numbness and tingling down the arm to the 4th & 5th fingers and the pinky side of the hand. That immediately tells us as chiropractors that the C8 nerve is injured (pinched) because that’s the pain pattern of the C8 nerve. Certain muscles are controlled by C8 that we can test in our office to determine if they are weak (abnormal) or strong (normal).
We grade the weakness between 0-5 (5=normal). The chiropractic treatment is aimed at un-pinching the nerve which results in a return of normal nerve function or no numbness/tingling and a strong C8 muscle (finger flexion strength). To accomplish this, we may use a combination of treatments such as chiropractic spinal adjustments, joint mobilization, specific traction, exercises, and/or modalities (electric stim, light therapy, ultrasound, kinesio taping or others).
Interestingly enough, even whiplash injuries that have happened years prior to seeking care can cause muscle weakness.
Fortunately, unless neurological damage is present (tested upon chiropractic neuro examination in the clinic), resulting muscular weakness can be fixed given the underlying cause of the problem is addressed.
Exercise therapies have been identified as one of the most effective forms of treatment for Fibromyalgia (FM). Unfortunately, in a study of 121 newly diagnosed FM patient files, less than half included an exercise recommendation. This statistic is alarming! This month’s article will focus on recent FM studies supporting the benefits of exercise.
The first study looked at the immediate effects of a 6-mo. combined exercise program and its impact on quality-of-life, physical function, depression, and aerobic capacity in 41 FM females. Also, it studied the impact of starting and stopping the program. A group of 21 women were placed into the exercise group and 20 into the control group. Questionnaires and a physical fitness screen were used to measure the outcome or benefits of the program vs. no intervention at baseline (initial), and after 6 months of exercise training followed by 6 months of no exercise training over a 30 month timeframe. Results highly favored the exercise training group over the control group in all parameters both during the exercise training (immediate effects) and during the no exercise 6 month time frames (long-term benefits).
A Chicago-based pilot (small-scaled) study evaluated the use of aerobic conditioning (VO2 max.) on 26 FM subjects at baseline and after a 12-week home-based aerobic exercise program. The exercises included a 30 minute program at 80% of the maximum heart rate, and also measured pain, disability, depression and stress. Results showed those who successfully completed the 12-week program demonstrated an increase in aerobic conditioning, and a trend towards less pain, disability and stress reduction. Those who were unable or unwilling to participate had significantly higher pain, disability and a trend toward more depression at baseline vs. those that completed the program. The conclusions suggest aerobic exercises benefits the FM patient’s quality of life and, VO2 max is a useful marker for measuring exercise benefits. Also, those scoring initially high in the pain, disability, depression/stress measures were more likely to fail and may benefit from a more comprehensive guided program.
Another study looked at the effects of a 3x/week, 16-week exercise program in a chest-high pool of warm water measuring global symptoms and exercise adherence (compliance) levels. A group of 60 middle-aged FM women were compared to 20 healthy, similarly age matched females before and after a 16 week aquatic exercise program that included strength training, aerobic training and relaxation exercises. Tender point count, health status, sleep quality, physical endurance, psychologic and cognitive function were measured and, compliance at 12-months was studied. Again, the results revealed statistical improvement in most of the parameters tested in the FM exercise group and, 23 of the 60 were still exercising at 12 months. Again, the conclusions favor the need for exercises in the management of FM.
As noted in the initial paragraph, in spite of all the positive research support for including exercise training in FM patients, less than half of newly diagnosed FM suffers are given exercises as part of their treatment plan. The need for exercises to be part of the FM treatment plan is clear, and training needs to be initially structured to enhance compliance.
Note that specific exercise therapy should be advised under a Chiropractic physician or physical therapist. Some exercises will exacerbate the symptoms, especially if the exercise program is not specifically tailored to the individual.
Dr. Patten, Chiropractic Physician @drpatten
Carpal Tunnel Syndrome (CTS) is a common condition usually associated with repetitive strain from jobs that require a fast, constant movement of the arms and hands (such as working on an assembly line). Up to 9% of adult women develop CTS and the incidence increases after age 50. A common medical treatment approach has been a combination of drugs (including corticosteroids), diuretics, splinting at night, and modifying activities, often including a “light duty” status until the symptoms calm down. Prior to accepting surgery as, “…the only option left,” an “alternative treatment” approach of vitamin B6 (and of course, chiropractic manual therapies) is chosen by many. Many treatment approaches have been previously discussed; however, today, we’ll take a closer look at the vitamin B6 /CTS connection.
Research regarding the use of vitamin B6 or, pyridoxine, can be traced way back into the ‘70s and ‘80s when it was reported that B6 is involved in several metabolic pathways, including neural function (“neurotransmission”). This is how it helps CTS patients since CTS occurs as the consequence of a pinched (median) nerve at the wrist. Findings from the initial studies, though quite small in terms of the number of subjects, suggested B6 improved the symptoms of CTS (such as, numbness and tingling into the 2nd to 4th palm-side fingers) by raising the pain threshold (that is, the point when symptoms occurred). Another study reported improvements in pain scores and mild improvements in electromyography and nerve conduction velocity (EMG-NCV) studies. Another study reported that at least 7 patients in their study were B6 deficient when blood tested. Regarding the dose, one study reported that taking only 2mg of B6 was enough to improve the patient’s CTS symptoms, but 100mg was needed for the avoidance of surgery. In a large “retrospective literature review” of 994 CTS patient files, it was reported that when 494 patients were treated with 100mg twice a day, the rate of symptom alleviation was 68%, much higher than group that did not receive B6 (only 14.3%). Yet, controversy is still reported about the effectiveness of B6 and firm conclusions are lacking. Despite this uncertainty, 200 mg of vitamin B6 is frequently included as part of the non-surgical “package” (along with NSAIDs like ibuprofen, nighttime splints, and an ergonomic workstation evaluation).
So, how much B6 is “enough?” The recommended daily intake is only 2 mg or less for all ages, genders and lifestyles with an upper limit set at 100 mg/day. The main toxicity issue is sensory neuropathy, which (oddly) is very similar to the symptoms caused by CTS! The good news is that CTS symptoms rapidly disappear at doses < 1000 mg/day and most studies indicate no toxic neuropathy by taking doses between 40 and 500 mg/day. Hence, it is recommended to never exceed 500mg/day and most recommendations are in the 100-200 mg/day range. If symptoms improve, a gradual reduction in the dose after about 3 months is advised. Closer monitoring of symptoms in those taking >200mg/day is recommended, especially since the symptoms of toxicity and CTS are so similar. Other B6 toxicity symptoms include depression, fatigue, impaired memory, irritability, headaches, altered walking, and bloating. So, keep your eyes open if doses >200mg/day are taken. Other micronutrients to consider that are anti-inflammatory in nature include omega 3 fatty acids, vitamin D, magnesium (often in combination with calcium), Co-Q10, proteolytic enzymes, and herbs such as ginger, tumeric, boswellia, white willow bark and more.
To boil it all down… B6 will help with Carpal Tunnel Syndrome, especially when used with chiropractic healthcare. Make sure you get a good QUALITY supplement. Carpal Tunnel Syndrome is a very common condition we see in the clinic.
2210 Pass Road, Gulfport, MS 39501
Neck pain is one of the most common complaints for which patients present to chiropractic offices. Headaches are also another very common problem and often go hand-in-hand with the presence of neck pain. So, the question that is frequently asked is,
“…why do headaches and neck pain often travel together?”
There are many types of headaches, some of which we have discussed previously with migraine and tension-type headaches being the most common. This month, the focus is on how headaches and the neck are related to each other and what YOU can do about it.
The relationship between neck pain and headaches is strong! In fact, in some cases, headaches will occur ONLY when the neck hurts. One reason is because the first three nerves that exit out from the top of the cervical spine (C1, 2 and 3) have to travel through the thick group of muscles that insert onto the back/base of the skull along the occipital rim. Because we carry a lot of stress in the neck muscles, when they tighten up, they squeeze or pinch those 3 nerves and pain then radiates into the back of the head and sometimes up and over the vertex to the eyes or behind the eyes. If you take your fingers or thumb and push firmly into those muscles at the very top of the neck or base of the skull, it often feels, “…like a good hurt.” This is because they are usually tight since most of us carry our head too far forwards and the muscles have to contract and constantly work to keep the head from gliding even further.
So, what can YOU do about it? Let’s talk about a few GREAT posture retraining exercises. Tuck in your chin to the point where the voice changes pitch (your voice will start to sound “funny”). At that point, release the chin slightly so the voice clears and stay in position! That is the posture or head position of choice. Initially, it will be very difficult to remember to hold that position very long because your muscles (and brain) aren’t used to it and, you’ll slip back into the old forward head carriage habit or chin poke position. So, be patient with yourself because it takes about 3 months of constant self-reminding to, “…keep that chin tucked,” before this new “habit pattern” is formed in the brain.
Another great exercise is an “offshoot” of this, where you tuck the chin in as far as you can (making a double or triple chin) holding that position for 3 seconds, and then tip the head back as far as you can without releasing the chin tuck and hold for another 3 seconds. Repeat this 2-3x / “set” and perform this multiple times per day.
A 3rd great exercise for improving the forward head carriage posture is performed by lying on your back on a bed so that the edge of the bed is at the middle of the neck and head is dangling off the bed. Take a tightly rolled up towel (a hand size towel works well) and place it under the neck so that is resting on the edge of the bed so that your head can fall back towards the floor. Take some deep breaths and concentrate on relaxing all your neck muscles. Periodically, slowly rotate your head left to right, right to left, and “feel” the different muscles stretch as you do this. If you can afford 15 minutes, that’s PERFECT! But, if you only have a few minutes it’s still GREAT!
Between maintaining a chin tuck upright posture and retraining the curve in your neck with the head hang off the bed exercise, you’ll feel (and look) much better!
Head and neck pain are just two (of the many) symptoms we treat at Patten Chiropractic.
Dr. Patten, Chiropractor in Gulport, MS
Low back pain (LBP) can have many causes. The primary goal of the chiropractic physician is to identify the main pain generator(s) and manage the patient accordingly. This requires a careful history, examination, and often, a low back/pelvic x-ray. So, how does this work?
When first presenting for care, the patient tells us about their complaint in the history portion of our evaluation. Here, we not only ask about the main reason for their appointment or, what’s bothering them now but also their past history. We also discuss old injuries such as slips and falls, sports injuries that date back to high school, motor vehicle induced injuries, as well as family history (we ask if family members have or have had low back trouble since it’s been reported that there is a genetic link identified for osteoarthritis). We also inquire about the patient’s current activity level and how well those activates are tolerated, often using tools completed by the patient that can be scored and compared periodically during care to track the benefits of treatment. When we finally return to the primary complaint history, we ask about the location, mechanism of injury, notable changes in the course of the condition, the onset date, pain related activities that increase or decrease pain, the quality of pain, radiation patterns, severity levels (such as a 0-10 scale), and timing issues such as, worse in the mornings vs. evenings.
When patients say, “…I have low back pain,” they may point to anywhere between the lower rib cage and their hip area. In other words, everyone interprets where their low back is located differently. So, when differentiating between low back pain and hip pain, one would think that the patient would either point to their low back or their hip, right? Well, where does hip osteoarthritis usually hurt? That’s what makes it so hard! The pain location can vary and move around in the same patient anywhere in the pelvic region including the groin (which is common), to the side of the pelvis, to the buttocks, the sacrum and in the low back. To make it even more challenging, degenerative or injured disks in the lower lumbar spine can refer pain directly into the hip area and also create localized low back pain. In fact, patients often have BOTH conditions simultaneously! Usually, during examination, we move the hip in the socket and feel for reduced motion and watch for pain patterns in certain positions. When comparing the two sides, we both can feel, “…a difference between the two.” The osteoarthritic (OA) hip is comparably more tight and painful with rotation movements. For example, the patient is seated with their leg crossed, trying to touch their knee to their opposite shoulder. In the OA hip patient, they may only be able to get it half way there compared to the other side and often complain of groin pain. The “ultimate test” is the x-ray that reveals the loss of the joint space – the “cartilage interval” – which narrows on the OA hip side.
How often is hip OA found? In a recent article, after reviewing 2000 patient files and 1000 x-rays of patients 40 years or older, 19% (~1 out of 5) demonstrated x-ray findings of hip OA. THAT’S A LOT! Chiropractic management of hip OA includes mobilization, manipulation, stretching the muscles surrounding the hip joint, leg length correction (sometimes requiring heel lifts in the short leg shoe), foot orthotics if the ankles roll in too far as that causes the knees knock and hips move inwards (like a card table with the legs partially folded, making the table top – or pelvis unstable), PT modalities (like ultrasound or electric stim), exercise/stretch instruction, nutritional strategies and others. If/when the time comes, we will help set up a referral to the orthopedic surgeon for joint replacement, as any “quarterback” of your care should.
Dr. Eric Patten, Chiropractor in Gulfport MS
I don’t typically name a patient of the week. or day. or year. If you’re reading this you know who you are. Below you will find a short story about her trip to the MD to get her blood pressure checked and to see if she still needed to take her blood pressure meds. I will use the fictitious name ‘Joan’ below.
Doctor: “So how are you feeling Joan”
Joan: Great – no problems at all.
Doctor: I see you were in last year for with back pain from a herniated disc – Did Dr. (Ortho) get that fixed?
Joan: No, I saw Dr. Patten instead.
Doctor: Wait. You didn’t take my referral and saw some Chiropractor? (I’m glad he knew I was a Chiropractor)
Joan: Yes, my mom referred me to see him. She had the same problem.
Doctor: So you had to see him 50 times, pay him a few thousand dollars and you’re still hurting and that’s why you’re here, right?
Joan: No, I saw him about 8 or 9 times when it was bad. Now I see him about every six weeks unless I do something stupid. (patient’s words, not mine)
Doctor: Well, he’s scamming you.
Joan: How is he scamming me?
Doctor: Because if that stuff worked you would only have to do it once.
Joan: (my favorite part) So I don’t have to take my blood pressure pills any more?
Doctor: If he told you to stop taking your meds I’m going to-
Joan: No. You don’t understand. You just told me to stop taking my medication.
Doctor: No I didn’t.
Joan: But if that stuff really works I should only have to take it once. I am here today to check if I need a refill on my blood pressure pills.
Doctor: Of course you do.
Joan: But nobody took my blood pressure.
Doctor: You just do. (doctor leaves)
Sometimes logic just works. Thank you for making my day.
Eric Patten, Chiropractor
Low back pain (LBP) can be localized and contained to only the low back area or, it can radiate pain down the leg. This distinction is important as the former, LBP only, is often less complicated and carries a more favorable prognosis for complete recovery. In fact, a large part of our history and examination is focused at this differentiation.
Not all back pain is Sciatica!
We’ve all heard of the word “sciatica” and it (usually) is loosely used to describe everything from LBP arising from the joints in the back, the sacroiliac joint, from the muscles of the low back as well as a pinched nerve from a ruptured disk. Strictly speaking, the term “sciatica” should ONLY be used when the sciatic nerve is pinched. The sciatic nerve is made up of five smaller nerves (L4, 5, S1, 2, 3) that arise from the spine and join together to form one large nerve (about the size of our pinky) called the sciatic nerve – like five small rivers merging into one BIG river. Sciatica occurs when any one of the small nerves (L4-S3) or, when the sciatic nerve itself, gets compressed or irritated. This can be, and often is caused from a lumbar disk herniation (the “ruptured disk”), a mis-positioned vertebra (such as a forward slip of the vertebra called “spondylolisthesis”), pressure from an arthritic spur off the spine where the nerve exits (“spinal stenosis”), or, from a tumor near or around the nerve. A term called “pseudosciatica” (a non-disk cause) includes a pinch from the piriformis muscle where the nerve passes through the pelvis (in the “cheek” or, the buttocks), which has been commonly referred to as “wallet sciatica” as sitting on the wallet in the back pocket is often the cause. When this occurs, the term “peripheral neuropathy” is the most accurate term to use. Other “pseudosciatic” causes include referred pain from the facet joints which is described by the patient as a “deep ache” inside the leg, or from a metabolic condition where the nerve is affected such as diabetes and other conditions. Here again, the term, “neuropathy” is the better label when diabetes, hypothyroid, lead poisoning, alcohol toxicity and/or others is the culprit. Direct trauma like a bruise to the buttocks from falling or hitting the nerve during an injection into the buttocks can also trigger “sciatica.”
The symptoms of sciatica include low back pain, buttocks pain, back of the thigh, calf and/or foot pain and/or numbness-tingling. If the nerve is compressed hard enough, muscle weakness can occur making it hard to stand up on the tip toes creating a limp when walking. In the clinic, we will raise the straight leg and if pinched, sharp pain can occur with as little as 20-30° due to the nerve being stretched as the leg is raised. If pain occurs anywhere between 30 and 70° of elevation of either the same side leg and/or the opposite leg, this constitutes a positive test for sciatica (better termed, “nerve root tension”). When a disk is herniated into the nerve, bending the spine backwards can move the disk away and off the nerve resulting in relief, which is very diagnostic of a herniated disk. Having a patient walk on their toes and then heels and watching for foot drop as well as testing the reflexes, the sensation with a sharp object, and testing the reflexes at the knee and Achilles tendon can give us clues if there is nerve damage. The GOOD NEWS is that chiropractic methods of manipulative therapy and manual therapy can resolve this problem FREQUENTLY, thus avoiding unnecessary surgery! So, check with us FIRST, before electing for surgery!!!
There are many jobs that place people at risk for carpal tunnel syndrome (CTS), but I bet you wouldn’t have thought of musicians. First and most important, I don’t want to scare anyone from playing a musical instrument as many of us find music to be a very important “release mechanism” or, an escape from reality (at least for a while) in our busy lives. Playing music uses part of the brain that doesn’t get enough stimulation and has been found to improve learning skills in children and can improve (as well as prevent) Alzheimer’s Disease in the more mature sector of the population. So PLEASE, continue playing your instrument or if you don’t play, start taking lessons on your favorite instrument – something an increasing number of adults are beginning to do!
Ok, now that the “disclaimer” is over, we can discuss why musicians are at risk for developing CTS and how you and I can prevent CTS from becoming a “monster!” Playing a musical instrument utilizes our fingers in a rapid, repetitive way, similar to a typist or keyboard worker. Also, some instruments require the hands and wrists to be placed in awkward positions, which is bad because the tendons, as they rub against each other inside the tunnel, create friction, heat and swell up, thus pinching the median nerve. If the wrist is bent, the pressure inside the carpal tunnel goes up a lot more than when it’s kept straight, and this is especially true if there are already problems present like a mild case of CTS. In brief , the anatomy of the carpal tunnel includes 9 tendons, some blood vessels, and the median nerve which are, in a sense, jammed into a tight, confined space. Think of pulling a napkin through a napkin ring that is just a little bit too small – you REALLY have to work to pull the napkin through, right? Well, this is kind of what happens when one develops CTS. Instead of having a napkin and ring that match so the napkin easily pulls through, those with CTS have a tight, constricted tunnel (napkin ring) which really squeezes the contents, including the median nerve. The result of pinching a nerve is numbness, tingling, burning, and/or a “half-asleep” feeling in fingers 2, 3, and 4 (that is, the index, middle and ring fingers).
When you watch a piano player, their palms are pointing down towards the floor while they play. The two long bones in the forearm, the ulna and radius, are parallel when the palms are up and cross over one another when the palms are down. The median nerve travels down from the neck, axilla, upper and lower arm and finally through the carpal tunnel to innervate the middle three fingers. There is more pressure on the median nerve when the palms are pointing down compared to up, but it would be impossible to play the piano palms up! Other instruments like the flute, trombone, trumpet, and many others require the arms and hands to be raised up to around the head level while the instrument is played. This places more pressure on the median nerve in the axilla area, referred to as the thoracic outlet. Many musicians practice multiple hours a day and the repetitive motion can really irritate the median nerve, and can result in CTS.
Again, PLEASE do not stop playing your musical instrument! Rather, take multiple breaks when practicing, do carpal tunnel stretch exercises, and seek chiropractic care as we can usually manage CTS successfully without the need for surgery.
Dr. Patten @ Patten Family Chiropractic in Gulfport, MS.
See our Carpal Tunnel Page
Other Carpal Tunnel Syndrome blog posts, click here
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Fibromyalgia (FM) is a chronic condition that impacts its victims in every aspect of their lives.
The day has to be planned around how one might feel at certain times of the day and is always in the foreground of a FM victim’s mind. Many chiropractic patients who present for treatment of FM ask us about what resources are available for them and therefore, this is the subject of this Health Update.
The National Fibromyalgia Association (NFA) was founded in 1997 in Orange, California and has become the largest nonprofit (501c3) FM specific organization. The initial goal was to help patients with FM find doctors who were willing to treat and manage FM patients as this was a BIG CHALLENGE and remains an important focus of the organization today. The mission of the NFA is to improve the quality of life for the FM patient and to find a team who embraces that premise by creating and offering many programs, high profile media campaigns, and providing training to support group leaders across the country. Their philosophy is to, “…empower patients and to provide them with a new level of hope for the future.” To that effect, the NFA evolved to include the development of an educational web site, the publication of an international magazine (“Fibromyalgia AWARE”), as well as developing medical education programs. The NFA website includes a “Resource” tab at the their homepage that leads to a listing of many great options that can be accessed at the click of a button:
Here is an interesting place for health care providers and patients with FM to review research articles on FM from 1981 to 2002, with over 300 references available:
Another good resource for information on FM is the New York Times Health Guide:
There are many places one can acquire information about FM. The list provided here barely scratches the surface. The important thing is to get your information from a credible source. There is a lot of mis-information concerning fibromyalgia treatment. We have had outstanding results treating fibromyalgia in our Chiropractic clinic. If you, a friend or family member requires care for FM, we sincerely appreciate the trust and confidence shown by choosing our services at Patten Family Chiropractic in Gulfport, MS!
See also our Fibromyalgia Page.
When patients present in the chiropractic
clinic with low back pain, it is not uncommon
for pain to arise from areas other than the low
back, such as the hip.
There are many tissues in the low back and hip region that are susceptible to injury with have overlapping pain pathways that often make it challenging to isolate the truly injured area. Hip pain can present in many different ways.
When considering the anatomy of the low back (lumbar spine) and hip, and the nerves that innervate the hip come from the low back, it’s no wonder that differentiating between the two conditions is often difficult. Complaints may include the inside, outside, front or back of the thigh, the knee, the buttocks, the sacroiliac joint, or the low back and yet, the hip may truly be the pain generator with any of these presentations. To make diagnosis even more complex, the hip pain patient may present one day with what appears to be sciatic nerve pain (that is, pain shooting down the back of the leg to the knee if mild or, to the foot if more severe) but the next time, with only groin pain. When pain radiates down a leg, the almost automatic impression by both the patient and the health care provider is, “…it’s a pinched nerve.” But again, it could be the hip and NOT a pinched nerve that is creating the leg pain pattern. Throwing yet another wrench in the works is the fact that a patient can have more than one condition at the same time. So, they truly MAY simultaneously have BOTH a low back problem AND a hip problem. In fact, its actually unusual to x-ray the low back of a hip pain patient without seeing some low back condition(s) like degenerative disk disease, osteoarthritis (spurs off the vertebrae), or combination of these. So, how do we differentiate between hip vs. low back pain when it is common for both low back and hip pain to often coincide?
During our history, we often ask the question, “…what activities make your pain worse?”
If the patient replies that weight bearing activities like standing, walking, getting up from sitting, etc., provoke the pain (and they point to the front or side of the hip), a hip related diagnosis is favored but, it STILL may be arising from the low back or both! If they say, “…crossing my right leg over the other hurts in my groin,” that’s getting more hip pain specific as hip rotation is frequently lost before the forward flexion motion. When we ask the hip pain patient to point to the area of greatest discomfort, they usually point to the front of the hip or groin, and less often to the inner and/or anterior thigh or knee. Non-weight bearing positions like sitting or lying are almost always immediately pain relieving. When there is arthritis in the hip, motion loss is often reported and may include a shorter walking stride and pain usually gets worse the longer these patients are on their feet. Initiating motion often hurts, sometimes even in bed when rolling over. During the chiropractic examination, with the patient lying on the back with the knee and hip both bent 90˚, moving the bent knee outwards or inwards will almost always reproduce hip/groin area pain. Pulling on or, applying traction to the affected leg usually, “…feels good.” Knee & ankle reflexes and sensation are normal but muscle strength may be weak due to pain. Bending the low back into different positions does not reproduce pain if the pain is only coming from the hip. Though challenging sometimes, we are well trained to be able to differentiate between hip and low back pain and will treat both areas when it is appropriate.
Fortunately, both low back and hip pain are treated similarly by Dr. Patten in his chiropractic clinic in Gulfport, MS. Typically treatment depends upon diagnosis, but it is important to know that they both respond very favorably to chiropractic care.
Dr. Eric Patten, Chiropractor @ Patten Family Chiropractic
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High blood pressure is also very common, affecting about 50 million Americans. Could they be linked? Yes, but not in the way you may think. Some doctors question whether taking pain pills actually corrects the cause of the headache. But there are also other, perhaps more seemingly silent concerns. Is simply cutting the fire alarm when the house is on fire ever a good idea? If your headache is coming from a problem such as a sprained and subluxated neck, is taking a pill going to do anything to help the joint injury?
We all see the TV commercials and the long pill aisles at the supermarket. We must be consuming quite a bit and that is true. But could the excessive use of these drugs be causing another problem, one that may not be explained on the pill bottle label?
Researchers have looked at over-the-counter medications such as acetaminophen (e.g. Tylenol) and ibuprofen (e.g. Advil), to see if taking them over the long-term elevates the risk for developing high blood pressure (Hypertension 2005;46:500. Women’s Health Study I and II) The study investigated 5,123 women between the ages of 34 and 77 and followed them over many years.
Compared with women who did not use acetaminophen, the relative risk for those who took >500 mg per day was 1.93 (1.30 to 2.88) among older women. and 1.99 (1.39 to 2.85) among younger women. A relative risk of 1.93 is a 93% increase in risk. The range was a 30% increase to a 185% increase.
For nonsteroidal anti-inflammatory drugs (e.g. ibuprofen), the risk of developing high blood pressure in older women also increased, ranging from a 78% to a 161% elevation. For younger women, the increased risks ranged from a 10% increase to a 132% increase.
Dr. Patten, Chiropractor in Gulfport, MS
See also: our Headache page
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