Wednesday, June 9, 2010

Health Update: Fibromyalgia

Fibromyalgia: The Challenges of Diagnosis

Fibromyalgia (FM) is a chronic condition where there is widespread / whole body pain that is often difficult to diagnose.  Some patients may spend years of going to different doctors, undergoing many tests (of which most, if not all, are “negative”), and they may be diagnosed with different conditions such as rheumatoid arthritis, hypothyroidism, or mononucleosis before a diagnosis of FM is finally given.  Needless to say, this process can be very frustrating!

The reason for this dilemma is that there is no single diagnostic test (blood test, x-ray/image finding, etc.) that verifies the diagnosis of FM, leaving doctors in a position to “rule out” all other possible “diagnose-able” conditions first, before considering FM as “the” diagnosis.  Another challenge is the fact that FM symptoms vary widely from one person to the next and even vary within the same person at different times of the year.  There are a few “guidelines” doctors can use to help secure the diagnosis of FM.

One such guideline is from The American College of Rheumatology (ACR) which requires that “widespread” pain be present throughout the body for at least 3 months (“widespread” is defined as pain on both sides of the body, above and below the waist).  The ACR also has identified 18 points on the body of which at least 11 of the 18 “tender points” must be present to secure the diagnosis of FM.  There is debate as to the accuracy of this rather stringent criteria as FM symptoms can come and go and vary, making the 11 of 18 tender point findings sometimes change between visits.  Hence, widespread pain above/below the waist on both left/right sides of the body for at 3 months has become a more accepted indicator for diagnosing FM.

Yet another challenge in pinning down the diagnosis is that the FM sufferer may experience signs and symptoms seemingly unrelated to FM, such as stomach ache/digestive problems or headaches. This can lead the doctor down other paths before considering FM as a diagnosis.

Fibromyalgia can be primary (no other condition caused it) or secondary (other condition(s) lead to the development of FM).  Hence, the diagnosis process focuses on identifying conditions which can be identified through standard diagnostic tests, often overshadowing the diagnosis of FM.  Testing for conditions such as lupus, multiple sclerosis, sleep apnea, diabetes, Crohn’s Disease, and/or others, often makes sense to both you and your doctor, but adds to the delay in diagnosing FM.  Here are some suggestions to help your doctor through this diagnostic maze:

Ask questions:  Ask about what each test is for and what the next plan is if the tests are negative.  By increasing your understanding, this will reduce your frustration in this process.

Keep records:  Obtain a copy of EVERY test you have and share the information with any new doctor or specialist.  This can save time and money!

Find the “right” doctor:  Find a doctor you can trust and “talk to.” Not all doctors “believe” FM exists and some are close minded to considering it.  Try to locate a doctor with a lot of experience with FM cases and is willing to “…work with you.”

Build a good relationship: Be open, honest and avoid anger, skepticism and don’t be confrontational.  Be upfront about what is frustrating you about your symptoms.

Take care of yourself: Ultimately, “success” of treating FM demands a “team” effort between you and your doctor.  Managing stress (eg., deep breathing exercises), obtain care that works (eg., chiropractic, massage), eat a healthy diet (eg., gluten-free), exercise regularly but don’t overdo it, and get plenty of sleep and rest.

101 Great Ways to Improve Your Health

If you, a friend or family member requires care for FM, 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: Low Back Pain

Would Traction Help My Back Pain?

Traction is a common form of treatment for patients with low back pain.  By definition, traction is the “act of pulling a body part.”  That basically means traction can be applied to an arm, leg, finger, toe…..virtually any body part that one can get a hold of.  Here, the focus of traction is being applied to the lower part of the spine and the primary objective is for pain relief and restoring function.  Traction “works” by applying a force that separates and increases the space between joints.  It also stretches the surrounding soft tissues, including ligaments, joint capsules, muscles and tendons.  Spinal traction can be applied manually (with the hands) or by a device with either the use of complicated computerized equipment or, by a gravity assisted means such as using the body’s weight and gravity as the traction force.

Common conditions of the spine for which traction is often utilized include low back sprains and strains, disk herniations (“slipped disks”), and spinal stenosis.  Spinal stenosis occurs when there is a narrowing of the hole or canal through which a nerve root exits the spine or where the spinal cord travels, often caused by arthritic spurs.  Hence, it is most common after the age of 60 years old.  Traction has been shown to improve circulation, reduce inflammation, and by movement of the joints, it may also reduce the nerve’s excitability, resulting in pain reduction.

The “dose” of traction from a clinical experience standpoint, is determined by patient comfort.  It must “feel good” to be safe.  Remember, too much of anything changes it from being beneficial to being potentially harmful.  Therefore, when determining the dose of traction for the first time, we advise the patient to pay careful attention to the way they feel during the time traction is being applied. Often, it feels good at first but may become uncomfortable as time passes. If there is sharp pain, radiating pain (such as down a leg), or, if it is just not comfortable, traction should be discontinued and the recovery time should be reported.

A “typical” dose is 10-15 minutes of time, and the traction force can be continuous or intermittent, kind of like turning on a water faucet and leaving it running vs. turning it on and off.  With intermittent traction, we can vary the time that the force is applied such as 30 seconds on and 10 seconds off.  Generally, the total treatment time can be longer with intermittent traction (such as 15 minutes) compared to continuous traction, where 10 minutes may be utilized.  The traction weight or force can be gradually increased, depending on tolerance and individual patient response to the prior weight.

The Cochrane Report found traction is most effective for cases of sciatica or nerve root pressure creating leg pain. Also, it’s best when used in conjunction with other treatment approaches.  In a chiropractic setting, manual traction (where the doctor uses their hands to apply the force) is often utilized along with side to side or figure-8 movements to achieve better results.  Spinal manipulation, muscles massage, myofascial release techniques, exercise training for both stretch and strengthening purposes and patient education such as teaching proper bend/lift/pull/push techniques are often utilized to achieve the most satisfying results when managing patients with low back pain.

101 Great Ways to Improve Your Health We realize that you have a choice in where you choose for your health care 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: Whiplash

Whiplash & Chiropractic Treatment

The term ‘whiplash’ represents a collection of symptoms that occur as a result of a soft tissue injury of the neck. This includes over stretching and/or tearing of muscles, tendons, ligaments, disk tissue and/or nerve injuries due to the extreme movements that occur during a whiplash event (usually arising from a car accident). We have discussed the mechanism of injury and the symptom complex that can arise in past articles.

So the question is – how many patients who sustain a whiplash injury actually improve and recover compared to those that don’t? In one study, it was stated that 43% of patients will suffer long-term symptoms after a whiplash type of injury. More specifically, if a patient is still symptomatic after 3 months following the injury, “…then there is almost a 90% chance that they will remain so.” They go on to state that no conventional treatment has proven to be effective in helping these chronic cases. The purpose of their study was to determine the effectiveness of chiropractic treatment in a group of chronic whiplash patients. To do this, they studied 28 patients (20 women and 8 men, between ages 19-66, mean 39) over a 2-year time frame, injured in motor vehicle collisions. Their symptom severity was graded on an A to D scale (A=minimal symptoms vs. D=disabling symptoms, with B= nuisance and C=Intrusive or partially disabling). Those in Groups C & D either had to significantly modify their work or, they lost their jobs and relied on continual use of medications.

  The chiropractic treatment included spinal manipulation (adjustments), controlled resistance of muscles to improve stability and coordination, and the use of ice. Treatment from an emergency facility and/or their general practitioner and physical therapy had been previously utilized for on average 15.5 months, before entering this chiropractic-based study. Initially, 27 of the 28 were classified into symptom groups C or D and symptoms included neck pain (82%), neck stiffness (36%), and other complaints of headache, shoulder, arm and back pain. Following treatment 26 of the 28 (93%) improved, 16 by one symptom group and 10 by two symptom groups and this degree of improvement was assessed and agreed upon by both an orthopedic surgeon as well as by a chiropractor. Seventeen (61%) improved to a point of satisfaction where care was discontinued after the 1st assessment with 4 of the 17 considering return for treatment due to a return of symptoms. Litigation was still pending in 20 of the 28 cases at the time the study concluded.

This study is very important as over 90% of chronic whiplash cases improved from chiropractic management well beyond the point of improvement obtained through standard emergency, family practice and physical therapy. Other studies have pointed out that early intervention or treatment with chiropractic manipulation and management approaches generally results in a more favorable response compared to waiting for longer time periods. To be able to obtain this level of success after an average of 15.5 months is truly remarkable!

Chiropractic methods often utilized for patients with a “whiplash” injury include spinal manipulation (or adjustments), mobilization techniques (this includes stretching, figure 8 movements, manual traction), muscle release work (this includes trigger point therapy, myofascial release/friction massage, and others), and promoting self-help approaches (this includes exercise, home traction methods, computer station modifications and other job modifications as indicated, and others).spinalcordstimulation/

We realize 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.


Tuesday, June 1, 2010

Health Update: Neck Pain

How Can I Get Rid of This Neck Pain?

A Massage Therapist's Guide to Treating Headaches and Neck Pain including DVD “I’ve been having this pain in my neck for a long time and it just won’t go away!  It’s getting to a point where I have to do something and I’m not sure which route to go.  Some of my friends have suggested chiropractic but I’m just not sure.  Can you give me any advice?”

Neck pain is a very common complaint that chiropractors treat on a regular basis.  Most people will experience neck pain during their lifetime requiring professional care and the choice between chiropractic or some other form of health care certainly exists.  Chiropractic is a non-drug, non-surgical option many find appealing because of the many side effects of medications and no one wants to consider surgery unless it’s absolutely necessary and everything else has been tried first.

The Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders published some good, sound statements about neck pain of which a few include:

In most cases, don't expect anyone to find a single "cause" for your neck pain. 
Stay as active as you can; simple exercises and reducing mental stress can help. 
A combination of therapies, including chiropractic care, may be needed. 

First, trying to identify the “cause” of your neck pain is often tricky and sometimes impossible to trace.  Don’t worry, that’s “normal” as most patients cannot trace it to one specific cause because it’s multifactorial or, caused by more than one event, often over a period of time.

Second, staying active and performing exercises can greatly help to reduce and sometimes prevent neck pain.  One particular exercise that can be done multiple times per day and even in public places, as it’s not too conspicuous, is called chin tucks. Let’s try it together!  While sitting, look straight ahead and tuck your chin towards your chest or, glide your head backwards.  Hold the tucked position until you feel fatigue, which usually takes 5-15 seconds, and then slowly release the head poking your chin forwards in the opposite direction. Looking at this from the side, it sort of looks like a chicken when they walk!

 Repeat this exercise and emphasize the slow release, as if you’re in “slow motion,” gliding forwards and backwards holding the endpoints for 5-15 seconds per repetition.  Start with 5 reps and over time, gradually increase the reps to 10 and repeat this several times each day.  As a postural retraining process, when you’re sitting in your car, at your desk, watching TV, or in meetings, partially tuck in your chin so that the weight of your head (which is approximately 15 pounds) is centered back over your upper back and not poking forwards.  This will GREATLY reduce the amount of muscle tension that commonly builds up during the day due to the increased muscle activity that is required to hold the weight of the head when it’s too far forward and away from the center of the body.  Constantly remind yourself by maintaining a partial “chin tuck” during the day and perform the gliding exercises periodically, at least 3 times a day.  Be patient as it takes about 3 months for this “new” posture to become automatic and your new “normal” habit.

101 Great Ways to Improve Your Health 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: Carpal Tunnel

Do I Have to Have Surgery For Carpal Tunnel Syndrome?

Matt Furey Carpal Tunnel Syndrome Pain Fix“For the last few months, I’ve been waking up at night with numbness and tingling in my hand.  Lately, I’ve been waking up more often, 3-4 times a night and I’m having a hard time falling back to sleep.  When I drive, my hands fall asleep within a few minutes and I have to shake my hand and fingers to wake them up. This has gotten to the point where I have to do something but I really don’t want surgery.  What are my non-surgical options?”

CTS or, carpal tunnel syndrome is a condition where a nerve (called the median nerve) that travels down from the neck into the arm and through the wrist becomes pinched and inflamed.  Common symptoms include numbness, tingling, dexterity problems (such as difficulty buttoning shirts), and opening jars due to weakness in grip and pinch strength. Sleep interruptions and loss of many daily activities, including work, occur because of CTS.

There are many non-surgical approaches to the treatment of CTS that should be utilized before surgery is considered, according to the American Academy of Neurology.  In one study, 40% of neurologist polled recommended non-surgical care due to the potential side effects of surgery, some of which being severe, resulting in lengthy work loss post-surgically.  A partial list of non-surgical care options include:

1. Rest – Giving the inflamed CTS time to heal is therapeutic but not always an option.

2. Activity/job modifications – Avoiding certain activities or modifying them by taking breaks during the work day, slowing down the pace of the job, altering the position of the job task, such as propping up a part so that the wrists do not have to bend to the extremes,  or when necessary, complete avoidance of the job task.

3. Wrist Splint – This is a brace that maintains the wrist in a neutral position so it cannot easily bend.  When the wrist flexes or extends, the pressure inside the carpal tunnel (on the palm side of the wrist) increases significantly, placing additional pressure on the already pinched median nerve. Wrist splints are especially useful at night.

4. Nerve Gliding Exercises – These are exercises that stretch the wrist joint and muscle tendons (as well as the median nerve inside the carpal tunnel), with the objective of breaking adhesions that limit the normal glide or movement of the nerve in the forearm and wrist.

5. Manual therapy techniques – These include manipulation of the arm including the forearm, wrist, and hand and sometimes the neck and shoulder, when needed.  The objective is to improve the range of motion of the joints and soft tissues that may be participating in the process of median nerve pinching.

6. Anti-inflammatory medication / nutrients – Medications include aspirin, ibuprofen, naproxen and similar prescription drugs.  Nutritional options including herbs (such as ginger, turmeric, boswellia), digestive enzymes, and Vitamin B6 may also help.  Ice is also anti-inflammatory and direct, on-the-skin ice massage is quite effective.

Chiropractic is a perfect choice when considering a health care provider for the treatment of CTS as many of the above non-surgical techniques are utilized by our office.  We realize that you have a choice in who you are considering for your health care provision and we sincerely appreciate your trust in choosing our service for those needs.  If you, a friend or family member require care for CTS, we would be honored to render our services.