Afleveringen
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Research regarding whiplash or whiplash associated disorders (WAD) classically focuses on neck pain; however, the data show acute thoracic spine / mid-back pain (MBP) occurs in 66% of WAD injures with 23% still complaining of MBP at one-year post-injury.
Itâs easy to visualize how the cervical spine or neck can be injured in an automobile collision (or sport-related collision or a fall) as the head, which weighs an average or twelve pounds, whips back and forth in a âcrack-the-whipâ like manner, often well beyond the normal, physiological range of motion. This same stretching (eccentric loading) followed by compression (concentric loading) also occurs in the mid-back, which can injure ligaments, joint capsules, neural structures, and more. Also, the thoracic spine contributes to 33% of flexion and 21% of rotation IN THE NECK, making the mid-back a vital spinal region that facilitates neck movement and function!
In WAD cases, mid-back pain often hides in the shadows of a more obvious and often more serious neck injury, as the brain typically perceives pain from the greatest source. Additionally, the neuronal input to the sensory cortex of the brain (the area of the brain that perceives pain) is most highly represented from the head, hands, and feet and less from the mid-back or torso.
The seat belt may also contribute to injuryâboth to the anterior chest region including rib cage, sternum, breast tissue, abdominal organs, as well as to the mid-back. The oblique angle of the chest-restraint is an important factor when discussing the mechanism of injury, as it causes trunk/torso rotation during the rebound or flexion phase of WAD. Another mechanism of injury includes blunt trauma, of which the driver is especially at risk due to the close proximity of the steering wheel and the chest. This can lead to contusion or bruising, fracture, and/or injury to the abdominal and/or chest organs (heart and lungs).
Obviously, the speed of impact, angle of the collision, bracing of the person (or lack thereof), and overall physical condition of the patient can greatly affect the outcome of WAD-related injuries. The importance of assessing the whole person is essential in obtaining an accurate diagnosis and establishing a comprehensive treatment plan for the WAD patient.
Chiropractic management focuses on the entire person, frequently uncovering complaints in other spinal regions as well as in the extremities in WAD-related injured patients. Moreover, treating postural issues such as a short leg, ankle pronation, oblique pelvis, forward head posture, protracted shoulders, and more is vitally important in obtaining satisfying patient outcomes!
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When treating patients with carpal tunnel syndrome (CTS), doctors of chiropractic can employ a variety of options to reduce pressure on the median nerve. While this can include dietary recommendations (to reduce inflammation), adjustments to address dysfunction elsewhere along the course of the median nerve, or even working with other healthcare providers to manage conditions that contribute to CTS (like diabetes), treatment will often focus on the wrist itself.
One such approach is referred to as neurodynamic techniques, or mobilization. In a study involving 103 patients with mild-to-moderate CTS, those who received treatment twice a week for ten weeks experienced greater improvements with respect to pain reduction, symptom severity, functional status, and nerve function than participants in a control group who received no treatment. The authors concluded, âThe use of neurodynamic techniques in conservative treatment for mild to moderate forms of carpal tunnel syndrome has significant therapeutic benefits.â
This finding is supported by two previous studies that found the use of manual therapies on the wrist can alter the shape of the carpal tunnel itself and allow more room for the tendons, blood vessels, and median nerve.
Additionally, studies show that when the wrist moves beyond a neutral position, it can alter the shape of the carpal tunnel and increase pressure on its contents. In a healthy wrist, full extension/flexion can double pressure in the carpal tunnel; however, for CTS patients, the pressure can increase as much as 600%. Thatâs why many treatment guidelines recommend wearing a wrist splint (especially at night) and modifying work and life activities to keep the wrist in a neutral position as much as possible.
The good news is that in most cases of CTS, patients will benefit from a conservative treatment approach; however, achieving a successful outcome can be more difficult if the patient delays treatment. Thatâs why itâs important to consult with your doctor of chiropractic when you experience the signs and symptoms associated with CTS (pain, numbness, tingling, or weakness in the hands or fingers) sooner rather than later.
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Zijn er afleveringen die ontbreken?
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The term whiplash associated disorders (WAD) describes a constellation of symptoms that includes (partial list) pain, stiffness/limited motion, dizziness, headache, depression/anxiety, and brain-fog. The condition is associated with accelerations/deceleration events like car accidents, sports collisions, or slip and falls. Such injuries are classified into four categories: WAD I (no/minimal complaints/injury), WAD II (soft-tissue injury â muscle/tendon and/or ligament injury), WAD III (nerve injury), WAD IV (fracture). More than 85% of those involved in a motor vehicle collision (MVC) experience neck pain, with 29-40% recovering within a little more than three months and about 23% still not having recovered after one year.
A 2016 systematic review generated treatment guidelines for patients with WAD and/or neck associated disorders (NAD) in the context of both a recent injury and for cases in which pain has persisted for longer than three months. Importantly, these guidelines were formed with input from several types of healthcare providers, including doctors of chiropractic, medical doctors, and physical therapists.
For recent-onset neck pain (0-3 months), the authors recommend multimodal care (multiple types); manipulation or mobilization; range-of-motion home exercise or multimodal manual therapy (for grades I-II NAD); adding supervised graded strengthening exercise (grade III NAD); and multimodal care (grade III WAD).
For persistent neck pain (more than 3 months), the review recommends multimodal care or stress self-management; manipulation with soft tissue therapy; high-dose massage; supervised group exercise; supervised yoga; supervised strengthening exercises or home exercises (grades I-II NAD); multimodal care or practitionerâs advice (grades I-III NAD); and supervised exercise with advice or advice alone (grades I-II WAD). For patients with persistent neck and shoulder pain, evidence supports mixed supervised and unsupervised high-intensity strength training or advice alone (grades I-III NAD).
The term, âmulti-modal careâ is defined as a grouping of manipulation, mobilization, and soft tissue techniques (myofascial release, contract-hold, trigger point therapy, muscle energy, and more). Multi-modal care may also incorporate the use of hot or cold packs, assisted stretching, advice to stay active or modify activity, and neck/shoulder exercise training. Doctors of chiropractic often take a multi-modal approach when treating patients with musculoskeletal pain, including those with whiplash associated disorders.
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As with most musculoskeletal conditions, treatment guidelines for carpal tunnel syndrome (CTS) recommend non-surgical or conservative management initially, with surgery only in emergency situations or after non-surgical options are exhausted. So, is there a way to know who will respond best to non-surgical approaches?
To answer this, researchers conducted a two-stage study that included an initial evaluation followed by non-surgical treatment and a re-evaluation one year after non-surgical treatment concluded. The primary goal of the study was to assess factors contributing to the long-term effects of non-surgical treatment of CTS and to identify failure risk factors.
The study involved 49 subjects diagnosed with CTS, of which an occupational cause was identified in 37 (76%). Because some patients had CTS in both hands (bilateral CTS), a total of 78 hands/wrists were included in the study. Treatment included a total of ten sessions of whirlpool massage to the wrist and hand, ultrasound, and median nerve glide exercises performed at home. The subjects were divided into three age groups: <50, 51-59, â„60 years old.
While most patients experienced significant improvement in both stages of the study, some did not. Patients with more severe cases, as evidenced by poor results on a nerve conduction velocity (NCV) test, were less likely to respond to care, which underscores the importance of seeking care for CTS as soon as symptoms develop. Furthermore, participants who continued to overuse their hands at work or who did not modify their work procedures or workstation to reduce the forces applied on the hands and wrist were less likely to report significant improvements at the one-year point. Interestingly, age was not found to be a significant risk factor, which is surprising, as past studies have reported that being age over 50 is a risk factor.
Not only are doctors of chiropractic trained in the same non-surgical treatment methods used in this study, but they can combine such approaches with nutritional counseling (to reduce inflammation) and manual therapies to improve function in the wrist and other sites along the course of the median nerve to achieve the best possible results for their patients.
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As screens (televisions, computers, and smartphones/tablets) become an increasingly important part of daily life, many people gradually take on a more slumped posture, which can place added strain on the neck and shoulders, raising the risk for neck pain and headaches. Luckily, itâs possible to improve forward head posture, rounded shoulder posture, and scapular instability with neck-specific exercises and chiropractic care.
In a 2018 study, patients with forward head posture performed either scapular stabilization or neck stabilization exercises for 30 minutes three times a week for four weeks. Participants in both groups experienced improvements related to their craniocervical angle and muscle activity around the upper back and neck, with greater results reported by the scapular stabilization group.
Several studies have shown similar results for improving forward head posture using both scapular and neck stabilization exercises. In another study, high schoolers with forward head posture performed scapular and neck stabilization exercises and exhibited good posture up to four months later.
A 2019 study looked at the effect of a six-week intervention featuring manual therapy and/or stabilizing exercises on 60 women with neck pain and forward head posture. Participants in both the manual therapy/stabilization exercise-combo group and the stabilization exercises-only group reported better outcomes with respect to head posture, pain reduction, and improved function, but the results were best in the combined treatment group. The authors concluded that manual therapy adds a meaningful role to a structured exercise program that addresses scapular and neck instability and forward head and rounded shoulder posture.
Doctors of chiropractic often incorporate exercise training in their treatment recommendations, especially when postural issues may contribute to the patientâs symptoms, like neck pain and headaches.
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While doctors of chiropractic enjoy helping their patients get better, the preference is to avoid injury in the first place, and if thatâs not possible, to reduce the risk for serious injury. This is especially important when it comes to car accidents, as whiplash associated disorders (WAD) injuries can persist for months to years and greatly reduce oneâs ability to carry out their normal activities.
One of the most important steps you can take is to focus on the road while driving and eliminate distractions, which includes not texting while driving. In one study, researchers observed that even using hands-free functions increased the risk a driver would drift into another lane, drive too closely to the car in front of them, and be less responsive to changing road conditions. Other common distractions include fiddling with the radio, eating, reading (yes, people do this!), talking with other passengers (especially if you turn your head to look at them), and driving while intoxicated, while under the influence of legal/illicit drugs or medications, or while tired.
Strategies to stay safe on the road include taking regular breaks (if driving a long distance), keeping your eyes moving (check mirrors frequently), not speeding or driving faster than road conditions allow, following traffic rules, using your signals, avoiding night and bad weather driving, heeding caution signs, and keeping your car properly serviced (including making sure there is enough air in your tires and that your tires are in good condition). Additionally, itâs important to respond quickly to vehicle recalls. As they say, âAn ounce of prevention is worth a pound of cure!â
Sometimes itâs not always possible to avoid an accident. Wearing a seatbelt can reduce the risk youâll be ejected from the vehicle in the event of an accident (which almost certainly results in fatality) or suffer more serious injuries. Making sure your head rest is properly adjusted can also reduce your risk for a serious head/neck injury.
Automobile manufacturers continue to implement safety improvements in their vehicles. For example, a review of data between 1995 to 2016 supports that vehicle safety design improvements reduced the frequency of rollover crashes from 7% to 3.5% when comparing 1995-1999 vs. 2010-2016 model year vehicles, respectively. Starting in 1997, General Motors (GM) introduced high retention seats in their new model cars, SUVs, vans, and light trucks. A recent study compared the 1991 to 2000 Fatality Analysis Reporting System (FARS) data to the 2001-2008 FARS data to evaluate the impact of high retention seats. The data show that in rear impacts, high retention seats reduced the fatality risk from 27.1% to 16.6% and the risk of serious injury by 70.2%.
If youâre involved in a car accident, even a low-speed collision, itâs important to be evaluated by a doctor of chiropractic to ensure any soft-tissue injuries that result are properly treated as soon as possible in order to reduce your risk for ongoing pain and disability.
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Carpal tunnel syndrome (CTS) has long been recognized as an occupational disease, and though the incidence of many other occupational diseases has decreased over time, CTS appears to be becoming more prevalent.
A 2019 study looked at the impact/benefit of wrist-specific exercises and oral enzyme therapy on automotive assembly line workers with CTS (excluding those treated previously or who had a positive history of hormone replacement or current pregnancy, inflammatory joint disease, trauma to the affected hand, polyneuropathy, other relevant conditions).
Participants in the exercise group performed the following exercises at home for nine weeks:
Deep âpush & pullâ: Massage the palm-side of the wrist using the thumb from the opposite hand for 30 seconds. âPrayer Positionâ: Place the palms together in front of your chest; press the fingers slowly against each other for five seconds and release for five seconds; press the palms together and then slowly lower the hands toward the floor. Repeat as tolerated, gradually increasing reps. Neuromobilization: Stand sideways to a wall; place the palm of the left hand on the wall, fingers pointing back to a â10 oâclockâ position. Start with the elbow bent and slowly straighten it while bending the head sideways toward the wall (left). Slowly bend the elbow and bend the neck/head to the right. Repeat six to eight times with each hand.The enzyme group took oral enzymes (which are known for their anti-inflammatory, anti-edematous, and analgesic effects) that included 2,000 mg pancreatin, 900 mg bromelain, 1,200 mg papain, 480 mg trypsin, 20 mg chymotrypsin, 200 mg amylase, 200 mg lipase, and 1,000 mg of rutin for nine weeks divided into two doses a day.
Compared with a third group that continued their usual activities, participants in both the enzyme and exercise groups reported improvements with their CTS symptoms. Nerve conduction velocity tests also revealed improved function in the median nerve.
Doctors of chiropractic commonly utilize a multi-modal approach when treating CTS, which often include manual therapies, nutritional recommendations, exercises, activity/modifications, and overnight wrist splinting.
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While tinnitus is commonly associated with a ringing sound in the ears, it can also involve a buzzing, hissing, or whistling noise. The sound can be intermittent or constant and can change in volume. The noise often intensifies in a quiet room when background noise is absent, such as at night, which can interfere with sleep. Approximately 50 million adults in the United States are affected by tinnitus, and up to 90% of people with tinnitus have some degree of noise-induced hearing loss. Though tinnitus can be due to many different causes, trauma-induced tinnitus from motor vehicle collisions is common.
Studies have demonstrated that an 8 mph (12.87 kmph) rear-end collision can result in 4.5g of neck acceleration, which can cause a sprain/strain injury to the neck that can lead to the cluster of symptoms that characterize whiplash associated disorders (WAD) such as neck pain, back pain, mental fog, headache, balance disturbance, depression, anxiety, tinnitus, and more.
Additionally, this process can also accelerate the head, essentially slamming the brain against the inside of the skull, followed by a rebound into the opposite side of the skull. This can lead to bruising on the brain, which is commonly called a concussion but is more formally known as a mild-traumatic brain injury (mTBI). This type of injury shares many symptoms with WAD, including tinnitus. If symptoms persist, the condition is known as post-concussive syndrome (PCS).
This has led researchers to speculate that WAD and mTBI often co-occur, and treatment to address cervical spine dysfunction commonly observed in WAD patients may also help patients with PCS. In a 2015 study involving five patients with diagnosed PCS, researchers observed that when the patients received manual therapy treatment to address cervical spine dysfunction, they reported improvements in several symptoms associated with PCS.
Doctors of chiropractic are highly trained to manage cervical spine dysfunction, a common sequela following a motor vehicle collision. Frequently, the many symptoms associated with WAD, including tinnitus, improve once the dysfunction is managed through manual therapies applied to the muscles and joints in the neck. If you are suffering from the aftermath of an MVC, please see your chiropractor!
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Osteoarthritis (OA) is the most common form of arthritis and is caused when the smooth cartilage surface of an articulating/moving joint wears away until there is bone-on-bone contact that results in both loss of movement and pain. Although OA most commonly affects the joints under the greatest load (the hips and the knees), it can occur in any moving joint, including those that make up the shoulder.
Because cartilage lacks a direct blood supply, it relies on a process called diffusion in which nutrients are absorbed into cartilage when itâs compressed by movement. Anything that restricts the movement of the joint (like inflammation or injury) can slow or cut off its supply of nutrients, placing the tissue at risk for injury and degeneration.
When a patient presents for care involving OA of the shoulder, chiropractic treatment will generally focus on improving the motion of the affected joints with manipulation, mobilization, manual traction, manual massage, active release techniques, acupuncture, physical therapy modalities (such as ultrasound or electronic stim), nutritional counseling, and home-based exercises.
Here are some additional ways to self-manage osteoarthritis of the shoulder:
Stay Active: Movement/exercise is the BEST way to keep joint cartilage nourished and healthy. Many people can manage the pain often without medication by simply pacing themselves and by staying active. Eat a Healthy Diet: Keep your diet balanced and emphasize foods that reduce inflammation or swelling like omega-3 fatty acids (fish oil), ginger, turmeric, Boswellia, and more. Reduce the Load on the Joints: This includes losing weight, as well as modifying job/lifestyle activities that routinely place force on the affected joints. Get Plenty of Sleep: Several studies show that getting too little or too much sleep each night can lead to poor outcomes. Aim for seven to nine hours of restful sleep. Use Hot/Cold Packs: This is a great way to reduce inflammation. Supplements: Consider glucosamine and chondroitin.Generally, the more advanced the case, the longer it will take to achieve a successful outcome, if at all. Thatâs why itâs important to seek care sooner rather than later when you experience pain in the shoulder or any other part of the body.
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When someone is diagnosed with carpal tunnel syndrome (CTS), there seems to be an automatic assumption that surgery is imminent or at least inevitable. However, treatment guidelines for CTS that are intended to be followed by ALL healthcare professionals ALWAYS recommend an initial course of non-surgical treatment, NOT jumping directly to surgery. Unfortunately, evidence-based treatment guidelines are not always followed, and many patients are not given an option for anything other than surgery.
The following is an excerpt from a 2017 Washington State CTS treatment guideline:
All of the following criteria must be met for surgery to be authorized:
The clinical presentation is consistent with CTS The EDS [electrodiagnostic studies] criteria for CTS have been met The patient has failed to respond to conservative treatment that included wrist splinting and/or injectionMedical-based non-surgical care for CTS includes: neutral position wrist splints worn at night and (in certain cases) at times during the day (studies report that 30-70% of patients respond favorably within several months of initial wrist splint use); glucocorticoids injections into the carpal tunnel (these can provide short-term relief with about 50% of patients requiring surgery within one year); and forearm and wrist exercises.
Doctors of chiropractic often use a combined approach based on the patientâs unique case, which can include wrist splints and exercise training (as described above) along with manual therapies like manipulation and mobilization on the wrist and elsewhere along the course of the median nerve; physical therapy modalities such as laser therapy, ultrasound, and pulsed electromagnetic field; nutritional counseling, especially anti-inflammatory herbs like ginger, turmeric, and Boswellia; and ergonomic medications such as changing a workstation setup or the grip on tools used to perform job functions.
Studies show that, in most cases, mild-to-moderate CTS can respond to non-surgical approaches just as well as surgery (though without the potential side effects associated with going under the knife), which underscores the importance of seeking care for CTS as soon as possible.
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In the face of musculoskeletal pain, itâs common to restrict activity. Unfortunately, doing so can weaken the muscles and joints in the affected area, which can prolong pain and elevate the risk for future injury. Patients with osteoarthritis of the knee often fall into this trap. So, what type of exercises are best for improving knee strength in the presence of knee osteoarthritis?
First, letâs define two types of muscle activity that can occur during exercise: eccentric and concentric. During a bench press, when youâre pushing the barbell upward, the muscles in the chest shorten in a concentric motion. As you lower the bar downward, your pectoralis muscles lengthen, which is an eccentric motion.
A 2019 study that involved 54 seniors with knee osteoarthritis investigated which of the two phases builds better strength for the knee â the concentric/muscle shortening phase or the eccentric/muscle lengthening phase of muscle activity. The participants were split into three groups: CNC RT (concentric resistance), ECC RT (eccentric resistance), or CON (control group â no exercise/wait-list group). The two exercise groups received four months of supervised exercise training using traditional weight machines with proper set-ups and instructions that emphasized the concentric or eccentric phase of the exercise.
Each week, participants completed questionnaires to measure knee pain and disability. The researchers also recorded the maximum weight each subject could lift with respect to knee flexion, knee extension, and the leg press.
The results showed that BOTH exercise groups experienced strength increases in comparison to the control group, with the eccentric resistance group achieving greater gains on the leg press and knee flexion exercises, but not for knee extension. Both exercise groups also reported less pain and disability than the control group. The authors concluded that both types of resistance training effectively improved leg strength, pain, and function, and they recommend that the mode an individual emphasizes should be based on personal preference, goals, tolerance, and equipment availability.
This study is a great example of the many benefits that exercise can offer for an elderly population suffering from knee osteoarthritis. Doctors of chiropractic often prescribe exercises for patients with knee pain in addition to providing manual therapies, modalities, orthotics (knee braces and foot orthotics), as well as dietary and nutritional counselling for inflammation reduction and pain management purposes. Before throwing in the towel and jumping to a total knee arthroplasty (replacement), you owe it to yourself to seek less invasive management strategies FIRST.
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The cervical spine relies heavily on muscular support, particularly from the deep muscles in the front and back of the neck. Some experts estimate that up to 70% of the stability of the cervical spine arises from these deep neck muscles, particularly those in front of the spine. Studies have demonstrated that the rapid acceleration-deceleration forces that are placed on the neck during a motor vehicle collision can injure these deep neck muscles. Indeed, electromyographic (EMG) testing conducted on WAD patients has shown that those with higher pain intensity also had reduced deep muscle function in both the front and back of the spine. Treatment guidelines for non-specific neck pain recommend incorporating neck-specific exercises into the treatment process. But what about for WAD patients with neck pain?
A 2018 study that involved 26 patients with chronic WAD (symptoms lasting longer than three months) evaluated the role of neck-specific exercises (such as cranio-cervical flexionâtucking in the chin and approximating the chin toward the chest while looking straight ahead without bending the head forward) had in improving muscle performance, disability, and pain intensity over the course of a three-month time frame.
After three months, the researchers used a special type of diagnostic ultrasound to measure function in one large superficial muscle and two deep muscles that all reside in the front of the neck. Investigators observed that the participants in the neck-specific exercises (NSE) group experienced significant improvements with respect to muscle function, disability, and pain intensity that were not observed among those in a âwait listâ group who served as controls.
Hereâs where it gets more interesting⊠At the three-month point, the members of the control group were added to the NSE group, and three months later, the researchers observed that these participants experienced the same improvements that they previously noted in the first NSE group! This study supports the need for specific neck exercises to reduce pain and disability and improve function.
When the deep muscles are injured, itâs common for the body to recruit superficial muscles to help stabilize the body and maintain posture. While this can protect the deep muscles from further injury in the short term, it can decondition these muscles over time and allow fatty deposits to infiltrate its tissue. This helps to explain why exercises are so important in the recovery process from musculoskeletal injuries, especially since thereâs research that says that up to half of WAD patients will still experience pain and disability a year after their accident. This underscores the importance of seeking treatment for WAD as soon as possible in order to reduce the risk for chronicity and while the chances for full recovery are greatest.
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Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy, or pinched nerve, in the extremities. The condition is estimated to affect 3-6% of the population, often in both hands. Letâs discuss what causes CTS, its symptoms, how itâs diagnosed, and how itâs treatedâŠ
Causation: Carpal tunnel syndrome occurs when pressure is placed on the median nerve as it travels through the wrist. This can be due to inflammation caused by obesity, repetitive movements, pregnancy, arthritis, hypothyroidism, diabetes mellitus, trauma, mass lesions, amyloidosis, sarcoidosis, multiple myeloma, leukemia, and more. Women are at a greater risk for CTS than men, due to having a smaller wrist and possibly hormonal reasons.
Symptoms: Pain, numbness, and tingling are common CTS symptoms that affect the thumb, index finger, middle finger, and the thumb-side of the ring finger. Symptoms can radiate up into the forearm and even into the shoulder and neck. Weakness in grip strength and nighttime/sleep interruptions are also common symptoms.
Diagnosis: The patient history is very important for diagnosing CTS, as it provides the doctor information to help determine if CTS is likely or if another condition is causing the patientâs symptoms, such as ulnar tunnel syndrome or dysfunction elsewhere along the course of the median nerve. The âflick signâ (flicking the fingers to âwake them upâ) predicts electrodiagnostic abnormalities 93% of the time with a false-positive rate of <5%. Other in-office tests include provocative tests (reproducing symptoms), neurological tests for sensation (sharp vs. dull), and strength-muscle tests. More advanced electrodiagnostic tests (EMG/NCV or electromyogram/nerve conduction velocity) can quantify the severity of CTS and verify the diagnosis.
Treatment: All treatment guidelines recommend conservative, non-surgical care prior to surgery unless there is a unique, unusual case like trauma (fracture), or some other unusual situation. THIS IS WHERE CHIROPRACTIC SHINES! Besides âusualâ non-surgical care (night splinting, anti-inflammatory measures, exercises, and ergonomic modifications), chiropractic treatment includes manual therapies such as soft tissue release techniques and joint manipulation. A 2018 study reported that following manipulative therapy, patients experienced an increase in the front-to-back diameter and roundness of their carpal tunnel, which reduced pressure on the tunnelâs contents. Chiropractors also perform manual therapy based on neurodynamic techniques, which a 2019 study concluded were highly effective in a group of patients with mild-to-moderate CTS.
Itâs important to note that patients are more likely to achieve a successful outcome if they seek treatment earlier in the course of the disease than if they wait months or even years. If you experience the symptoms associated with CTS, seek care sooner rather than later!
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Experts estimate that whiplash associated disorders (WAD) from motor vehicle collisions (MVCs) affect about 300 for every 100,000 people in the Western each year. Suffice it to say, thatâs a lot of people!
Crash tests have demonstrated that the risk for whiplash is much greater when the backrest is leaned backward and/or when a headrest is lacking (in older cars) or is too low in relation to the head. The key is to prevent the head from extending backward over the top of the seat, which can lead to more severe soft tissue injuries in the neck. While itâs not always possible to anticipate an MVC, past research has shown that looking forward at the time of the collision may reduce WAD injury/severity risk.
On the topic of necks, individuals with thinner necks have a greater risk for injury, which may explain why woman are more often affected by WAD than men. However, regardless of whether you are male or female, staying fit and keeping the neck muscles strong is important. Itâs been suggested that individuals with a history of neck pain are more likely to experience more severe whiplash injuries, as are those in poor general health. There are conflicting studies that report that seat belt use may increase the risk for WAD, but after reviewing multiple studies, the consensus is that seat belts save lives, so buckle up!
In many cases, WAD patients may miss work, especially if they have a job with high physical demands. Patients with more severe injuries may miss up to twenty-five days of work, while those with minor injuries may still be out for up to ten days. One study found that about 31% of the 800 cases the researchers looked at took no time off work, 52% returned to work after only four days off, and 90% returned within thirty days off. About 4.9% of the patients in the study were still not working after twelve weeks.
Several factors suggest a WAD patient may experience a slower or more limited recovery: a history of neck pain; loss of neck motion measured post-MVC; increased sensitivity to cold stimulation; high pain levels post-MVC; less severe crash-type; dizziness, arm pain or numbness; low back pain; and poor expectations of recovery.
The good news is that treatment guidelines have consistently recommended spinal manipulationâ he primary form of treatment provided by doctors of chiropracticâfor managing whiplash-related injuries.
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A 2009 study that monitored over 8,800 elderly French adults found that an individualâs blood pressure can fluctuate with the seasons. In particular, the researchers observed that as temperatures fell, both systolic and diastolic blood pressure could rise to unhealthy levels, but they were unable to determine why.
However, a study published just five years later may have solved the mystery. The solution has to do with the molecule nitric oxide. Nitric oxide is a vasodilator, meaning that it causes the walls of blood vessels to relax and expand, with a resulting reduction in blood pressure.
Researchers have discovered that nitric oxide is stored in the dermal vasculature at levels much greater than are found circulating in the bloodstream. When exposed to long-wave ultraviolet (UVA) rays, the skin releases some of that stored nitric oxide into the bloodstream. Because individuals tend to spend less time in the sun during the winter months, there are fewer opportunities for the skin to release nitric oxide into the blood, dilate blood vessels, and moderate blood pressure. This may also help to explain why stroke and blood vessel rupture (aneurism) are more common in the winter months among the elderly.
How can one maintain healthier levels of nitric oxide in their bloodstream when itâs not convenient to spend time in the sunshine? The answers may be found in diet and exercise.
A 2018 study found that eating leafy greens and root vegetables and drinking beetroot juice effectively increased nitrate plasma (blood) levels for the purpose of enhancing exercise performance.
In 2020, researchers observed that schoolteachers in South Africa with greater physical fitness levels had higher levels of nitric oxide in their blood, as well as lower systolic and diastolic blood pressure readings. The research team concluded, âThese results may suggest that even moderate physical activity could increase nitric oxide synthesis capacity, which in turn may mitigate the development of cardiovascular disease in this population.â
The take home message is that to maintain a healthier blood pressure, consider getting plenty of sunshine, eating leafy green and root vegetables (or drink beetroot juice), and exercising!
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One of the symptoms commonly associated with whiplash associated disorder (WAD) is headaches. The current research suggests that up to 50% of patients who experience whiplash-associated headaches may continue to suffer from them for up to a year or more, and many of those will continue to have headaches as late as five years following their whiplash injury event. There are many potential causes for WAD-related headaches, which can include cervical injury, jaw dysfunction (TMJ), psychological distress (depression and anxiety), brain structure abnormalities (concussion), and/or overuse of headache medications.
To address these potential causes of whiplash associated headaches, treatment may include the following:
MANUAL THERAPIES: Mobilization and manipulation, which are commonly used by doctors of chiropractic, have been demonstrated to be effective for reducing pain and improving function for many conditions, including WAD and headaches of cervical origin. Treatment may also involve massage and physical therapy modalities, depending on the patientâs needs.
EXERCISE: A review of research published between 1990 and 2015 found that craniocervical, cervicoscapular, and posture correction exercises can be helpful in the treatment of whiplash-related headaches.
STAY ACTIVE: Try to carry on with normal activities within pain tolerances, as movement is needed to keep soft tissues healthy and to ensure a continuous supply of nutrients to the cervical disks. Donât use a cervical collar to immobilize the neck unless directed to do so by your doctor.
NUTRITIONAL SUPPORT: There are several vitamins and supplements that have been shown to reduce inflammation and/or reduce pain. These include flavonoids, curcuminoids, omega-3 fatty acids, taurine, and vitamin D. Adopting an anti-inflammatory diet can also aid in the healing process.
Doctors of chiropractic frequently use a combination of these approaches when managing WAD patients to help reduce pain and disability and assist the patient in returning to their normal activities as soon as possible.
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With many sports requiring overhead movements that can place the shoulder at the extreme end of its range of motion, itâs not surprising that shoulder injuries are so common among athletes. For instance, up to 50% of NCAA college football players have some history of shoulder injury, which comprises about 10-20% of total injuries in the sport. When looking at collegiate quarterbacks, one study found that shoulder injuries accounted for more than half of injuries among players in the position. When it comes to sport-related shoulder injuries, these are the three most common (and to complicate matters, they often co-occur):
1) SLAP (or labrum) tears: Superior (top) Labral tear from Anterior (front) to Posterior (back) tear is a term used to describe a torn piece of cartilage located along the rim of the socket. The labrum adds depth to the cup, which helps to stabilize the ball in the socket. Individuals with a SLAP tear will often report a loss of motion and power, a feeling like their shoulder could pop out of socket, and a deep ache that is hard to pinpoint when attempting overhead movements.
2) Shoulder instability or dislocation: With contact sports, thereâs the opportunity for a collision that can dislocate the ball of the shoulder joint (the end of the humerus bone) from the shoulder socket. Because the muscles in the front of the shoulder tend to be larger and stronger, the dislocation will more often occur in that direction. Symptoms can include a severe, sudden initial pain followed by short bursts of pain as well as swelling and a noticeable deformity in the appearance of the shoulder.
3) Rotator cuff tears (RCTs): This is common in sports that require repetitive overhead motion like baseball (especially among pitchers), swimming, and tennis. Symptoms include a deep, hard to locate ache, weakness, and reduced range of motion (especially overhead or to the back).
In general, early/prompt care yields the best results. While there are instances when a prompt surgical procedure is warranted, treatment guidelines typically emphasize non-surgical therapies first with surgery only after all other options have been exhausted.
Chiropractic management of these conditions will often involve a multi-modal management approach that includes manual manipulation and mobilization to the shoulderâs multiple joints, the neck, and the mid back; specific shoulder exercise instruction; physical therapy modalities (ice, electrical stim, ultrasound, laser, pulsed magnetic field, and more); and nutritional recommendations.
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Carpal tunnel syndrome (CTS) is a condition that occurs when the median nerve is compressed as it passes through the wrist. One treatment option available to patients is carpal tunnel release surgery, which severs the carpal tunnel ligament to reduce pressure on the affected nerve to resolve the numbness, pain, tingling, and weakness symptoms associated with CTS. When is surgical treatment for CTS necessary and when should a non-surgical option be pursued?
The short answer is that surgery should only be considered as a first option in an emergency situation, such as a serious wrist fracture that pinches the median nerve. Beyond that, treatment guidelines generally advise patients to exhaust non-surgical, conservative approaches before consulting with a surgeon. Aside from potentially higher healthcare costs and a prolonged recovery, surgery also carries the risk for serious complications. Another thing to consider is that the current research suggests that jumping straight to surgery may not necessarily produce better long-term outcomes than non-surgical treatment options.
In one randomized clinical trial, researchers recruited 120 female CTS patients to receive either surgery or a conservative treatment approach that involved manual therapies. The research team evaluated each patient after one month, three months, six months, and one year. In the short termâone month and three monthsâthe results favored the conservative approach. However, both groups reported similar outcomes after six months and one year.
The same research team repeated the study with another group of female CTS patients and reported similar results. In the short term, conservative care achieved greater results while both approaches had similar outcomes over the long term.
A systemic review that looked at results from ten studies involving patients with confirmed CTS in one or both hands came to a similar conclusion. The review found that non-surgical care provided more satisfying results in the short term with both approaches achieving similar results over time.
While these studies show that conservative treatment to reduce pressure in the carpal tunnel is an effective option for the CTS patient, doctors of chiropractic will also examine the full course of the median nerve to identify other places the it may be compressed, such as the neck, shoulder, and elbow. Median nerve compression in these areas can often co-occur with CTS and will need to be addressed to achieve a satisfactory result.
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Neck pain is one of the most common complaints that drive patients to seek chiropractic care. Sometimes the cause of injury is a known traumatic event, but in many cases, neck pain is the result of wear and tear from poor postureâforward head posture in particular.
The head, which weighs 10-11 lbs. (4.5-5 kg), typically rests above the shoulders. When an individualâs head leans forward to look at a computer screen or to look downwards at their smartphone/tablet, the muscles in the rear of the neck and upper back/shoulders need to work harder to keep the head upright.
Experts estimate that for each inch (2.54 cm) of forward head posture, the head feels about 10 lbs. heavier to the muscles that attach to the back of the head and neck. To illustrate this, pick up a 10-pound object like a bowling ball and hold it close to your body. Then, hold it away from your body with your arm outstretched and feel how much heavier it seems and the strain it places on your body to maintain that position for even a short time.
In the short term, forward head posture is something the body can manage, but over time, the muscles can fatigue and the strain can injure the soft tissues in the back of the neck, shoulders, and upper back. To adapt, some muscles may become stronger (and some may atrophy), the shoulders can roll forward, the cervical curve can straighten, etc. Researchers have observed that forward head posture can also reduce neck mobility, especially with rotation and forward flexion movements. While these changes can lead to several negative health issues, neck pain is perhaps the most obvious and common.
When a patient presents for chiropractic care for neck pain, postural deficits will likely need to be addressed to achieve a satisfactory outcome. This can be achieved with manual therapies to restore proper motion in the affected joints and with exercises to retrain the muscles that may have become deconditioned. Additionally, a patient will need to develop better postural habits, especially when interacting with their electronic devices. While the process can take time, the good news is that itâs possible to reduce forward head posture, which can also lower the risk for neck pain recurrence.
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When it comes to managing a low back condition, the goal of chiropractic treatment is for the patient return to their normal daily activities as soon as possible. This not only means addressing low back pain but also low back disability, including impaired postural control and reduced spinal stability, which can manifest in reduce position sense, increased postural sway, and impaired balance.
Movement control and spinal stability are controlled the deep muscles, the superficial muscles, and the nervous system that sends information to and from the brain. Dysfunction in ANY of these can result in lumbar spine instability.
To complicate matters, when an injury is present, the body will alter its neuromotor patterns as a protective mechanism. However, this can lead to some muscles becoming overworked while others may become deconditioned. If unaddressed, additional musculoskeletal conditions may result in nearby parts of the body, which explains why patients will often present with multiple seemingly unrelated complaints.
In addition to manual therapies like manipulation and mobilization to restore proper joint movement, treatment for low back pain may also include core stabilization/strengthening exercises and balance exercises.
For abdominal strengthening, one exercise that works well is a spine-sparing sit-up. Place the hands behind the lower back to prevent flattening of the lumbar curve and lift the head and chest as a unit a few inches off the floor, hold for ten seconds, and repeat to tolerance (five to ten reps to start out with).
To strengthen your sides, try a side-bridge or side-plank (from feet or knees), holding for ten seconds and repeating as tolerated.
To strengthen the back, try the front plank. Rest on your forearms in a push-up position for ten seconds and repeat as tolerated. The bird dog is another good exercise. Kneel on your hands and knees and raise the opposite arm and leg without twisting the trunk and hold for ten seconds, repeat with the other arm/leg.
For improved balance, stand on one leg with your eyes open or closed (if able) as long as you can. This stimulates the neuromotor system. Be safe, and do these in a corner to prevent falling!
Make these exercises a habit. Consistency will help improve low back function and youâll reduce your risk for a future episode of low back pain!
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