Health Update: Carpal Tunnel

Exercises For Carpal Tunnel Syndrome

Carpal tunnel syndrome (CTS) is a common condition resulting in hand and sometimes neck and arm complaints. This can include numbness or tingling in the fingers, leading to dexterity problems such as difficulty buttoning clothing or picking up small objects. There are also issues with strength loss / weakness noticed such as when turning door knobs, opening jars, and even problems with turning the key to start a car. One big problem with CTS is people often wait too long before having it treated thinking it will “…go away” or disappear just like it started. CTS rarely gets better without some form of treatment and seeing a chiropractor makes perfect sense prior to considering surgical intervention.

So, the question remains, “what can I do for CTS?” There are several things a CTS sufferer can do to help manage this condition. Some risk factors such as gender and age cannot be changed but other factors can be changed including taking “mini-breaks” throughout the work day and/or work station modifications, managing weight as obesity (defined as a BMI >30 and a waist size >35” for women and >40” for men), wearing a wrist splint, as well as performing exercises to stretch the wrist area.

A study out of the University of Oklahoma reported 2 out of 3 patients with mild to moderate CTS avoided surgery by performing specific exercises. The concept of a 5-minute warm-up stretch each day before starting the workday is similar to a runner stretching before a run to prevent injury.

Step A: Extend and stretch both wrists and fingers acutely as if they

are in a standing push-up position. Hold for a count of 5.

Step B: Straighten both wrists and relax fingers.

Step C: Make a tight fist with both hands.

Step D: Then, bend both wrists down while keeping the fist. Hold for a

count of 5.

Step E: Straighten both wrists and relax fingers, for a count of 5.

Step F: Then, let your arms hang loosely at the side and shake them

for a few seconds.

This exercise should be repeated 10 times and can be repeated several times a day.

Chiropractic is a perfect choice when considering a health care provider for the treatment of CTS as these exercises can easily be taught to you at our office. In addition, many other non-surgical treatment options for CTS are available.

We realize you have a choice in who you consider 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.

YOU MAY BE A CANDIDATE FOR CHIROPRACTIC CARE FOR FIBROMYALGIA! FOR A FREE NO-OBLIGATION CONSULTATION CALL (732) 719-8148

Health Update: Neck Pain

How Can I Get Rid of This Neck Pain?

“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.

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.

YOU MAY BE A CANDIDATE FOR CHIROPRACTIC CARE FOR NECK PAIN!  

FOR A FREE NO-OBLIGATION CONSULTATION CALL 732-984-9597.

Health Update: Carpal Tunnel

Do I Have to Have Surgery For Carpal Tunnel Syndrome?

“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.

 YOU MAY BE A CANDIDATE FOR CHIROPRACTIC CARE FOR CARPAL TUNNEL SYNDROME!  FOR A FREE NO-OBLIGATION CONSULTATION 732-984-9597

Health Update: Carpal Tunnel

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

Do 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…..you 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.

Health Update: Carpal Tunnel

Carpal Tunnel Syndrome (CTS) – Can It Be Prevented?

Carpal Tunnel Syndrome or CTS is a very common problem affecting many workers and is one of the most costly conditions afflicting today’s workforce.  It is most often caused by repetitive activity using rapid movements of the arms and hands and can lead to work loss and disability when not properly managed.  CTS occurs when the median nerve that travels through the carpal tunnel (CT) located on the palm side of the wrist becomes pinched by the swelling of the 9 tendons that also travel through the CT and essentially, pinch the nerve up against the transverse carpal ligament.  This results in numbness, tingling and/or pain of the index, middle and forth fingers.

Other symptoms include sleep interruptions where shaking and flicking of the fingers is required to allow for a return to sleep.  This is frequently caused by sleeping with the wrist in a cocked position, increasing the pressure inside the already swollen carpal tunnel.  This is why a cock-up wrist splint usually helps as it disallows the wrist from bending to the extremes and the nerve is not pressured or pinched as much.  Other symptoms include weakness of the grip, making it a challenge to unscrew a jar, open a door, and even sometimes turn the key when starting a car.  Driving can also be affected as the hands often fall asleep while holding onto a steering wheel.

Pain can also affect the rest of the arm and sometimes the neck area.  The median nerve can also be pinched in more than one place and may include the neck, shoulder, elbow as well as the wrist making it necessary to have all the areas treated for a satisfying result.

People at greatest risk are women > men, workers who handle small tools, computer workers, fast repetitive line workers, and people older than 40 years of age.  People with other health conditions including rheumatoid arthritis, Lymes disease, rubella, pregnancy, birth control pill use, diabetes mellitus and menopause are at an increased risk of developing CTS.  Certain foods such as caffeine, tobacco, and/or alcohol may also contribute to CTS.

Though treatment is very important –the sooner the better- prevention is most important.  In fact, some simple approaches can make a big difference!  Some of these include modifying the position of a computer chair, keyboard, monitor, or mouse (work station modifications), alternate between different tasks to reduce the repetition of work, stretch your forearms and fingers before, during and after work, and treat any underlying conditions.  When symptoms first occur, these recommendations, as well as wearing a night wrist cock-up splint and seeing your chiropractor, will often reverse the condition without difficulty.  If you wait too long and nerve damage occurs, it becomes a more challenging process to manage CTS and at times, even surgery will not be very helpful.

Some of the non-surgical treatment approaches you might expect from your chiropractor include joint manipulation and/or mobilization applied to the neck, wrist, elbow and/or shoulder, the application of physical therapy modalities such as ultrasound, electrical stim, and/or low level laser therapy (“light” therapy), as well as the use of wrist splints.

The University of Maryland Medical Center cites two research articles on chiropractic treatment for CTS. They report good results are usually obtained and that these good results continued for at least 6 months after treatment ended.  The same reference also recommends nutrition and supplements in the management of CTS.  Some of these include: eliminate food allergens (often milk, cheese, eggs, ice cream, glutens/wheat-grains, soy, corn, and preservatives) and eating foods high in B-vitamins (dark leafy greens like spinach, kale, and sea vegetables), anti-oxidants (fruits – blueberries, cherries, tomatoes; vegetables – squash, bell peppers),  avoiding refined foods, using olive oil and adding omega 3 fatty acids to the diet (fish oil).  Other vitamins including a multivitamin, B complex, Vit. C, alpha-lipoic acid, MSM, resveratrol, Vit. D, Co-Q10, magnesium can also really help.

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 CTS, chiropractic care is a logical first choice and we would be honored to offer our services to you.

 YOU MAY BE A CANDIDATE FOR OUR CARPAL TUNNEL SYNDROME PROGRAM
 FOR A FREE NO-OBLIGATION CONSULTATION CALL 732-984-9597

Health Update: Whiplash Part 1

What is the Best Type of Treatment for Whiplash?


Whiplash usually occurs when the head is suddenly whipped or snapped due to a sudden jolt, usually involving a motor vehicle collision. However, it can also occur from a slip and fall injury.  So the question on deck is, which of the health care services best addresses the injured whiplash patient?

This question was investigated in a published study titled, A symptomatic classification of whiplash injury and the implications for treatment (Journal of Orthopaedic Medicine 1999;21(1):22-25).  The authors state conventional medical treatment utilized in whiplash care, "is disappointing."  The authors’ reference a study that demonstrated chiropractic treatment benefited 26 of 28 patients with chronic whiplash syndrome.  The objective of their study was to determine which type of chronic whiplash patient would benefit the most from chiropractic treatment.

They separated patients into one of 3 groups:

Group 1: patients with "neck pain radiating in a 'coat hanger' distribution, associated with restricted range of neck movement but with no neurological deficit."

Group 2: patients with "neurological symptoms, signs or both in association with neck pain and a restricted range of neck movement."

Group 3: patients who described "severe neck pain but all of whom had a full range of motion and no neurological symptoms or signs distributed over specific myotomes or dermatomes." These patients also "described an unusual complex of symptoms," including "blackouts, visual disturbances, nausea, vomiting and chest pain, along with a nondermatomal distribution of pain."

The patients underwent an average of 19.3 adjustments over the course of 4.1 months (mean).
The patients were then surveyed and their improvement was reported:

Group 1                                                                                                          
  
38% Asymptomatic
43% Improved by Two Symptom Grades
13% Improved by One Symptom Grade
6% No Improvement

Group 2
24% Asymptomatic
24% Improved by Two Symptom Grades
24% Improved by One Symptom Grade
28% No Improvement

Group 3
0% Asymptomatic
9% Improved by Two Symptom Grades
18% Improved by One Symptom Grade
64% No Improvement
9% Got Worse

These findings show the best chiropractic treatment results occur in patients with mechanical neck pain (group 1) and/or those with neurological losses (group 2).  The exaggerated group (group 3) was the most challenging and, the only group where a small percentage worsened.  The good news is, the number of cases that responded well to chiropractic treatment (groups 1 & 2) far out number those that don’t (group 3).  Hence, most patients with whiplash injuries should consider chiropractic as their first choice of health care provision.

If you, a loved one, or a friend is struggling with whiplash residuals from a motor vehicle collision, you can depend on receiving a multi-dimensional chiropractic assessment and therapeutic approach at Advanced Wellness Marlboro, New Jersey.

New Headache Study Shows the Benefits of Chiropractic Care by Dr. Joseph Cilea


Headaches are a common complaint in patients presenting for professional care, including chiropractic management. Patients with headaches seek chiropractic care because they find manipulation or adjustments applied to the cervical spine and upper back region are highly effective in reducing the intensity, frequency and duration of the headache pain. This is because the cervical spine / neck, is often the origin of the headache as the three nerves in the upper neck (C1, 2 and 3) pass through the thick, overly taught neck muscles in route to the scalp / head. When the muscles of the neck are in spasm, the nerves get “pinched” or squeezed by the overly tight muscles resulting in headache pain. Each nerve runs to a different part of the head and therefore, pain may be described as “…radiating over the top of head (sometimes into the forehead and eyes),” or, into the head and over the ear, sometimes reaching the temple. Also, an area located in the back and side of the head is the area where the C1 nerve innervates, so pain may also be reported in that location. When more than one of the C1-3 nerves is pinched, the whole side to the top of the head may be involved.

In the October 2009 issue of The Spine Journal, Western States Chiropractic College, Center for Outcomes Studies, reported benefits are obtained with the utilization of spinal manipulation in the treatment of chronic cervicogenic headaches. The word “chronic” means at least 3 months of headache pain has been present. This new study compared 2 different doses of therapy using several outcome measures including the pain grade, the number of headaches in the last 4 weeks and the amount of medication utilized. Data was collected every 4 weeks for a 24 week period and patients were treated 1-2 times/week and separated into either an 8 or a 16 treatment session with half the group receiving either spinal manipulative therapy or a minimal light massage (LM) control group.

The results of the study revealed the spinal manipulation group obtained better results than the control group at all time intervals. There was a small benefit in the group that received the greater number of treatments with the mean number of cervicogenic headaches reduced by 50% in both pain intensity and headache frequency.

The importance of this study is significant as there are many side effects to medications frequently utilized in the treatment of headaches. Many patients prefer not taking medications for this reason and spinal manipulation therapy (SMT) offers a perfect remedy for these patients. Couple SMT with dietary management, lifestyle modifications, stress management, and a natural, vitamin/herbal anti-inflammatory (such as ginger, turmeric, boswellia) when needed, a natural, holistic approach to the management of chronic headaches is accomplished.

We are proud that chiropractic care has consistently scored the highest level of satisfaction when compared to other forms of health care provision and look forward in serving you and your family presently and in the future.

Call Now 732-431-2155

I Feel Better. Why Continue?

The biggest mistake patients often make is quitting care too soon. Once symptoms resolve many patients feel they are fixed. This cannot be further from the truth. My years of observing relapses proves this.

It is impossible to correct mechanical flaws in joints, break up scar tissue and adhesion and strengthen the weakened supporting structures in a few visits. Your body is very intelligent and will avoid pain at all costs. Even at the expense of proper biomehanics. Ultimately the body will compensate which will only lead to a problem elsewhere in the body.

The goal needs to be correction of the joint problems and prevention of future problems. This takes time and effort. It is common to think you are fixed when the pain is gone but this is rarely the case.