Monday, April 12, 2010

Health Update: Low Back Pain

Slipped a Disc – What Is That Exactly?

101 Great Ways to Improve Your Health“I was digging a hole in my garden and hit a rock with the shovel. After clearing the dirt from around the rock, I bent over and reached into the hole. I couldn’t get a good grip on the rock and had to twist my body to get my arm under it. As I started to move the rock, I felt something ‘give out’ in my low back and felt immediate low back pain, but it wasn’t terrible. Like a fool, I gave it another try but this time, the pain in my back was really sharp when I twisted to reach under it. Then, it felt like a knife stabbing me when I tried to stand up. Since then, I can’t stand up straight and pain is shooting down my left leg.”

The intervertebral disk is like a shock-absorber located between each vertebra in our spine extending from the tail bone to the upper neck. When healthy, your disks truly do function as shock absorbers. There are two parts to the disk – the inner part (called the nucleus) which is the liquid-like center and the outer part (the annulus), which is tough, laminated and rubber-like whose job is to hold the nucleus in the center of the disk. The annulus has concentric rings which look similar to the rings of an oak tree trunk and the strength of these laminated rings is due to the fibers crisscrossing, creating a self-sealing, secure border for the nucleus center. In spite of this great anatomical structure, our disks degenerate and can crack or tear allowing the more liquid-like nucleus to leak out of the annulus creating the classic “slipped disk” (technically referred to as a herniated or ruptured disk). When the herniated disk presses into the nerve that goes down the leg, pain is felt along its course and can radiate all the way to the foot. There are five vertebrae and disks with a pair of nerves that go into each leg and depending which disk ruptures, pain will follow a different course down the leg, which is why we ask you if you feel the pain more in the back or in the front of the leg. When the disk tears prior to both disk herniation and leg pain, low back pain occurs because the nerve fibers that are normally only located in the outer third of the disk grow into the central portion of the disk, making it generate more pain.

So now for the important question, “…what can I do for it?” When you visit our office, we will ask you about how you injured your back. Often, the cause of a herniated disk can be the accumulation of multiple events over time. It certainly can happen after one major event, like our example of lifting a rock out of a hole, but that is usually the “straw that breaks the camel’s back” and not the sole cause. Many researchers have reported it is rare for a healthy disk to herniate. Rather, disk degeneration with tears already present sets up the situation where a bend plus a twist, “…finishes the job.” The orthopedic and neurological examination will usually clearly identify the level of herniation. Chiropractic treatment often includes traction types of techniques, some form of spinal manipulation or mobilization, extension exercises, physical therapy modalities like electric stimulation, low level laser, or ultrasound, and ice therapy. Core / trunk strengthening and posture management are also commonly applied and, proper bending/lifting/pulling/pushing techniques are taught. We realize that you have a choice in where you choose for your healthcare services. If you, a friend or family member requires care for low back pain, we sincerely appreciate the trust and confidence shown by choosing our services and look forward in serving you and your family presently and, in the future.


Health Update: Carpal Tunnel

Carpal Tunnel Syndrome (CTS) – It's Rush Hour!

101 Great Ways to Improve Your HealthDo you recall the last time you were driving along the highway and suddenly, traffic came to a screeching halt? After sitting in your car, waiting impatiently for any movement, you eventually arrive at the cause of the congestion – 4 lanes of traffic funneled into one lane, due to road construction. The fact it’s rush hour makes the whole issue more understandable but not less frustrating. On your next trip through the construction zone, you make sure to avoid rush hour and you fly through without hesitation – because its 2pm rather than 5pm.

So what does this have to do with CTS? This analogy depicts what essentially happens when CTS occurs. Picture an assembly line worker packaging cookies. The cookies come out of the oven 6 rows deep at a rapid pace. There are normally 6 people working the line, 3 on each side, but for the last two weeks, one of the workers has been out on maternity leave and no one was assigned to that position… leaving 5 workers doing the work 6 people usually share. Let’s say, conservatively, there are 25 cookies packaged per minute. In 60-minutes, 1500 cookies (25x60) are packaged; in an 8 hour day 12,000 cookies are packed, and in a 40 hour work week, 48,000 cookies are packaged (by each worker)! That’s a lot of fast, repetitive movements requiring bending forward and reaching, gripping, and moving the cookies into a tray and then stacking the trays.

If there are workers absent or the employer decides to speed up the line and force overtime, most of the workers will reach their limit and hurt. Especially those with other problems that make them more susceptible to CTS like low thyroid function, diabetes, obesity, age over 50, inflammatory arthritis, when taking birth control pills… get the picture!. Hence, when working too fast, just like when there are too many cars on the road during rush hour, the fast paced work inflames the tendons in the carpal tunnel and pinches the nerve. This creates pain and numbness/tingling that either slows the worker down or completely forces him/her to have to take time off from the job. When working at a slower, more comfortable pace, there is less friction between the carpal tunnel tendons and, therefore, no or significantly less nerve compression and CTS signs or symptoms, just like driving through the construction site without slowing down when avoiding rush hour.

Why is this? CTS occurs frequently in people who perform fast, repetitive hand movements like our cookie factory worker. That’s because there are 9 tendons attaching the muscles located in the upper forearm (on the palm side) to the fingers in the hand. These tendons travel very close together, especially as they pass through the carpal tunnel of the wrist. These tendons allow us to pick things up (grip and pinch), shake hands, hold babies delicately and function normally in our daily activities. As these 9 tendons pass through this tight tunnel, when it’s “rush hour” or, when fast, repetitive work is occurring, these 9 tendons rub together and they heat up, swell and the pressure inside the tunnel increases. Because the nerve (median nerve) passes through the same tunnel, as the tendons swell, the nerve is pinched or pressed up against the border of the tunnel and numbness / tingling occurs into the palm and fingers 2-4. We find ourselves dropping things, having a hard time buttoning clothes, threading a needle, opening jars, holding onto a steering wheel, and frequently, we wake up at night needing to shake and flick our fingers to “…wake them up.”

Because these symptoms gradually appear, we usually don’t run to our doctor until several months (and sometimes years) after the symptoms have been present. This makes it more challenging to treat CTS and all patients with these symptoms are encouraged to seek treatment as soon as problems start. There are frequently other problems in the neck, shoulder, and elbow because we tend to compensate, move differently and use other muscles when there is pain so the elbow, shoulder and neck become involved and require attention. This is why a chiropractor who treats all of these areas is the perfect choice. If you, a friend or family member require care for CTS, we would be honored to render our services.

Monday, April 5, 2010

Health Update: Fibromyalgia – What Exercises Should You Do?

Fibromyalgia – What Exercises Should You Do?

101 Great Ways to Improve Your HealthFibromyalgia (FM) is a chronic condition that gradually interferes with many aspects of one’s life. The challenge of treating FM is finding the right combination of approaches that positively impacts the structural, emotional, and chemical aspects of the body in such a way the FM patient can function “normally” in day to day activities. Exercise is one of the most important methods patients can use to successfully reach these goals.

First, because FM is a condition that is currently thought to affect the central nervous system where the threshold of reaching pain levels is lower than normal, pain is perceived when is shouldn’t normally be noticed. Therefore, the KEY to exercise integration is to start out SLOWLY and CONSISTENTLY. It is more important to work out in a way that muscles and joints can gradually accommodate to the new activity or movement. Many patients with FM are afraid to exercise for fear of hurting worse than they already do. In fact, many will report that, “…every time I exercise, I feel worse so I just don’t do it.” When asked what types of exercises they’ve tried, it becomes clear it wasn’t the exercise but rather the dose or amount of exercise they engaged in (often overdoing it) that made the next 48-72 hours quite uncomfortable with post-exercise soreness.

Second, is to choose a type of exercise you enjoy so it's more likely you'll stick with it. Popular exercise options include yoga, Pilates, biking, swimming, and walking. These exercises can also be combined. For example, one might perform 15 minutes of yoga, followed by a 15 minute walk on a daily, consistent basis. The use of an exercise bike and/or a treadmill, stepper, or elliptical type of exercise equipment allows you to monitor heart rate, speed, and other data that allows you to compare yourself between sessions. One of the new "kids on the block" exercise options includes the Wii-Fit which offers a scoring system with various types of exercise. This type of biofeedback can be educational, rewarding, and motivating as it helps you appreciate the benefits and improvements you've made over time. Pick a time of day when you can be consistent with the exercises so you’re not “fitting it in” your busy daily schedule – make it part of your daily routine, similar to brushing your teeth or taking a shower. The morning or evening may work best but many find a noon hour break a good time to exercise, as well.

Third, as you start to feel more in shape, gradually increase the intensity of the exercises. You may exercise for the same amount of time, say 30 minutes, but you’ll do a more intense work out such as walking faster, farther, or increasing the pace of the yoga, Pilates, swimming, etc. Try not to be too intense (over aggressive) or do too little (under aggressive). You know your personality better than anyone else – hold yourself back if you tend to be overly aggressive or, push yourself if you tend to be overly cautious. Expect the first 3-5 times you exercise to be challenging with associated post-exercise soreness but know you will adapt to the process.

The benefits of adding a well designed, graduated exercise program include: 1) strengthening ligaments, muscles, tendons and improving muscle tone; 2) increasing flexibility; 3) increasing blood flow to the muscle tissue; 4) increase endorphins-a morphine-like substance that has a natural pain relieving and sleep deepening effect that can help curb anxiety, depression as well as pain associated with FM; 5) reduces the risk of high blood pressure, high cholesterol, diabetes heart disease and stroke; and 6) promotes weight loss/control which in turn, reduces stress on your muscles and joints.

We recognize the importance of including chiropractic in your treatment of FM and realize you have a choice of providers. We would be honored to be part of your management team.

Health Update: Headache – What Can You Do?

Headache – What Can YOU Do?

Headaches are one of the most common complaints for which patients seek chiropractic care. Chiropractic is especially helpful in the treatment of headaches because the three nerves that exit the top of the spine (upper neck) are often the cause of or directly related to headaches. These three nerves travel into the head and have to pass through a very thick group of muscles in the upper part of the neck near where these muscles attach to the base of the skull. This is why when you have headaches and rub the back of the neck, the muscles may feel tight and or tender. In fact, if enough pressure is applied over one of these three nerves, pain will radiate into the head following the course of the nerve, sometimes all the way into the eyes. When chiropractic treatment is applied in the upper neck region, a reduction of the headache and neck pain occurs because the muscle tension is decreased and joint motion is restored.

The International Headache Society (IHS) has classified headaches into two main categories, primary and secondary. Primary headaches occur for no known reason and there are four groups of these: 1) migraine, 2) tension-type, 3) cluster, and 4) “other” primary headaches. Secondary headaches are those with a specific cause such as sinus/allergy headaches, those associated with eye strain, a known medical condition or those due to cold or flu. Both migraine and cluster headaches are “vascular” (related to the blood vessels expanding inside the head) resulting in a unique set of symptoms that includes nausea, vomiting, pounding/throbbing and can be quite debilitating.

The most common type is the tension-type of headache. A thorough history is necessary because there is no specific diagnostic test (lab or blood test) for tension-type headaches. Hence, the concept is to make sure the headache is not related to some other condition that is diagnosable by a blood or lab test and if present, having that condition properly managed. So, assuming all the tests come back “normal” and all other causes have been eliminated or “ruled out,” the most common type of tension-type headache is “episodic” or, occurs off and on, lasting minutes to days. The pain is usually described as, “…my whole head hurts.” There is typically tightness or tension (NOT throbbing) described in the neck muscles and the intensity ranges from mild to moderate, not usually severe, where laying down is needed. Physical activity does not usually make it worse and there is no sickness to the stomach (nausea/vomiting), and no intense reaction to bright lights or noise (like there is with migraine & cluster types of headaches). There are sub-types of tension headaches that can occur simultaneous with migraines headaches, but the classic “aura” (a before the headache warning associated with migraine headaches) is usually not present.

Chiropractic treatment typically includes manipulation and mobilization of the neck, muscle release techniques, physical therapy modalities like electric stimulation, ultrasound, and others, exercise, stress and diet/nutritional management.

If you, a family member or a friend require care, we sincerely appreciate the trust and confidence shown by choosing our service. We are proud that chiropractic care has consistently scored the highest level of satisfaction when compared to other forms of health care provision and we look forward in serving you and your family presently and in the future.

Health Update: Whiplash – Can This Affect My Memory?

Whiplash – Can This Affect My Memory?

"Doctor, is it normal for people after a whiplash injury to notice problems with memory. I can’t seem to remember things I just recently did since my car accident?”

This is a common complaint occurring as a result of a whiplash injury, but it’s not commonly known, leaving those who are suffering wondering, “…what’s wrong with me?” Whiplash is an injury that classically occurs as a result of a car crash at any speed, even at low speed! This is because at low speed, there is little to no damage to the car, and the forces from the crash are not absorbed by the crushing metal. As a result, those forces are transferred to the contents inside the car – that is, the passengers. This sometimes results in a significantly greater injury compared to crashes that occur at twice the speed because the latter results in crushing metal. The actual injury that occurs in whiplash is caused by the sudden, rapid movement of the head resulting in varying degrees of injury to the neck, as well as to the contents inside the skull – that is, the brain. The brain literally “bangs” into the inside walls of the skull when the head is rapidly accelerated during a car crash. The resulting injury is a concussion. What’s interesting is that most patients injured in a car crash often don’t mention a concussion nor is it usually asked about at the doctor’s office as other, more obvious injuries are dwelt with. The condition is usually referred to by one of two names: post-concussive syndrome or mild traumatic brain injury (MTBI).

"Doctor, when I’m reading a book or magazine, sometimes I have to re-read the passage several times before it sinks in. It’s as though I lose my concentration and I can’t focus on what I just read. The other day, I was talking to a group of co-workers and I lost my place in the middle of the discussion and had to ask, ‘…now where was I?’ I notice this is happening a lot since the car accident.”

This can be very embarrassing, frustrating, and scary for patients suffering with MTBI. Other symptoms associated with this include difficulty in focusing (blurred vision), headaches, having difficulty in pronouncing certain words (“tongue twisted”), having difficulty in understanding what was said, difficulty remembering numbers or groups of numbers like phone numbers, addresses, birthdates, and so on. These symptoms can range from mild to severe and can be very disruptive, making work and everyday tasks challenging.

How long does it last? MTBI can completely clear up in 2 to 6 months without problems or, it can hang on for 2 years or longer, and may even become a permanent residual from the car crash. In one study, continued problems after a 2 year time frame were reported in close to 20% of those injured 2 years earlier. This study suggests that about 1 out of 5 may continue to suffer with MTBI and the associated brain-related problems for at least 2 years following a car crash. However, another study reported the long term “higher cognitive function” (such as the ability to communicate through written or spoken language) is usually not affected by whiplash injuries. However, they preface that with by reporting that a more commonly injured group with more mild brain problems was found.

As chiropractors, we are trained to do a thorough history, orthopedic and neurological examination, and ask specific questions about mild traumatic brain injury. It is important to discuss this information with those suffering from whiplash injuries as frequently, MTBI patients think something is “…seriously wrong” and harbor unnecessary anxiety.

We realize that you have a choice in where you choose for your healthcare services. If you, a friend or family member requires care for whiplash, chiropractic care is a logical first choice and we would be honored to offer our services to you.