Balance, Chronic Pain and Chiropractic

Posted on December 18, 2010 by admin
I'm not sure about the pregnant conclusions the author drew on this one, except that pregnant people have central nervous systems that should respond the same. Although, I didn't see anywhere that the people receiving chiropractic were pregnant. But it does make sense. Functional spinal segments should deliver more proprioceptive input that should result in more information pertaining to balance. Also, functioning joints should have less pain than non-functioning spinal segments. So it makes sense that someone with chronic pain and balance / dizziness problems would respond to conservative chiropractic adjustments.
~Dr. Michael Haley, Agape Chiropractic, Inc.
 

Balance, Chronic Pain and Chiropractic

By
William J. Owens DC, DAAMLP
Mark Studin DC, FASBE (C), DAAPM, DAAMLP
 

When we age, it seems that there are more and more challenges to our health and well being.  Falling and chronic pain are most likely fighting to be #1 on that list.  Whether there was a prior injury, decades of hard labor, years of inactivity or just simple daily wear and tear, chronic pain is difficult to manage.  Our societal tendencies are to medicate to “make the pain go away,” but the TRUTH is, it is still there, we just feel it less.  What happens to our bodies when year after year, we continue to work through it?  Well, the problem gets worse and we take more pills! 

In a recent study from the University of California’s Geriatric Primary Care lecture, the presenter stated, “Ambulatory elderly fill between 9-13 prescriptions a year…” (Johnston, 2001, slide 3 ).She goes on to state, “Surveys indicate that elders take average of 2-4 nonprescription drugs daily” (Johnston, 2001, slide 5).  Adding additional “pills” to the mix for pain is often not a very good idea.  Although necessary medications are clearly indicated and needed, what are the options for those medications that are optional and potentially dangerous when taken over a long period of time? 

In a recent study published in a chiropractic research journal, the authors stated, “The purpose of this study was to collect preliminary information on the effect of a limited and extended course of chiropractic care on balance, chronic pain, and associated dizziness in a sample of older adults with impaired balance" (Hawk, Cambron, & Pfefer, 2009, p.438). The results showed decreased pain and increased balance (helping to avoid falls).

The authors finally reported, "Another interesting finding in this study that warrants further investigation is that is appeared that for the group on the extended care schedule, pain and disability decreased and remained at a lower level than for the limited care schedule, for the year we followed patients.  This provides preliminary support for chiropractic maintenance care for older adults with chronic pain” (Hawk, Cambron, & Pfefer, 2009, p.445).

This study along with many others concludes that a drug-free approach of chiropractic care is one of the best solutions for pregnant patients with balance disorders and chronic pain. To find a qualified doctor of chiropractic near you go to the US Chiropractic Directory at www.uschirodirectory.comand search your state.

References:

1. Johnston, C. B. (2001, May). Drugs and the Elderly: Practical Considerations. PowerPoint presentation presented at the UCSF Division of Geriatrics Primary Care Lecture Series.
2.  Hawk, C., Cambron, J. A., & Pfefer, M. T. (2009). Pilot study of the effect of a limited and extended course of chiropractic care on balance, chronic pain and dizziness in older adults. Journal of Manipulative and Physiological Therapeutics, 32(6), 438-477.

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Carpal Tunnel Syndrome and Chiropractic

Posted on December 11, 2010 by admin
I have had patients who have had the diagnosis of "carpal tunnel syndrome" when in fact they had radicular symptoms from their necks and got better quickly with conservative chiropractic care. I have also had patients who had the correct diagnosis of carpal tunnel syndrome who also got better with chiropractic care. And then there were a couple who had the correct diagnosis of carpal tunnel syndrome, but who did not get better with chiropractic treatments. I have also seen those who never tried conservative treatment for their symptoms and went straight to surgery. Most have gotten better one way or another. But if conservative chiropractic treatment can fix it more times than not, doesn't it make sense to give it a try before going under the knife?
~Michael Haley, Pompano Beach Chiropractor
 

Carpal Tunnel Syndrome and Chiropractic

By
William J. Owens DC, DAAMLP
Mark Studin DC, FASBE (C), DAAPM, DAAMLP
 

When people experience pain in the wrist, the common assumption is that it is carpal tunnel syndrome.  The wrists are made of 2 rows of 4 bones called the carpal bones.  When you flip your hand over with the palm facing the sky, there is a covering over those bones at the wrist.  To the side of this covering is where you can take your pulse.  One of two major nerves that go to the hand travel between this covering and the carpal bones. The nerve travels with the tendons, which connect muscle to bone, of nine muscles that flex the wrist or bring your fingers toward you.  The nerve is named the median nerve, so carpal tunnel syndrome is the compression of the median nerve between the carpal bones and the covering of the tunnel at the wrist.  This causes numbness and tingling in the thumb, index finger and ½ of the middle finger because that is where the median nerve goes.  Numbness or tingling in any other finger or the palm is not due to carpal tunnel and may be coming from the elbow, shoulder or neck.

There are a few common reasons for carpal tunnel syndrome, the primary one being  inflammation or swelling in the tunnel.  This can be due to direct trauma like a wrist injury or a result of a car accident involving your hands twisting on the steering wheel.  Other causes can be overuse, like typing too much on a keyboard, fine movements at work or weakness and overuse of the forearm muscles.  The mild and moderate symptoms can generally be controlled and treated with conservative therapy. More severe cases often require surgery and can only be quantified with a neurological test. Surgery, although necessary in some cases, is a last resort since scar tissue can result from the surgical incision and over time can result in the return of compression of the median nerve in the carpal tunnel.  In the cases of the mild or moderate symptoms, they may be due to improper mechanics of the 8 bones of the wrist.  In these cases, chiropractic management, using the chiropractic adjustment administered to this area, has been shown to be effective in a recent study. 

In this study the authors stated, “From a mechanistic viewpoint, manual therapy techniques designed to release tissue adhesions and increase the range of motion (ROM) of the wrist may alleviate the mechanical compression of the median nerve without the need for surgical interventions" (Burke et al., 2007, p. 51).  They also state, "Interventions were, on average, twice a week for 4 weeks and once a week for 2 additional weeks" (Burke et al., 2007, p. 50). "The improvements detected by our subjective evaluations of the signs and symptoms of CTS and patient satisfaction with the treatment outcomes provided additional evidence for the clinical efficacy of these 2 manual therapies for CTS. The improvements were maintained at 3 months for both treatment interventions” (Burke et al., 2007, p. 50).

The authors related the following statistic, “The American Academy of Neurology and 40% of neurologists in the Netherlands recommend conservative management of CTS before surgical intervention" (Burke et al., 2007, pp. 50-51). An important perspective to have on surgical intervention was also included and the authors stated, “In addition, of patients with failed primary surgical interventions, up to 12% may require a secondary surgical procedure.  Persistent symptoms after a secondary surgical procedure ranged from 25% to 95%" (Burke et al., 2007, p. 51). Therefore, we see that the American Academy of Neurology recommends holding off on surgery until other options are explored. 

In conclusion, the paper reports, “Although the clinical improvements were not different between the 2 manual therapy techniques, which were compared prospectively, the data substantiated the clinical efficacy of conservative treatment options for mild to moderate CTS" (Burke et al., 2007, p. 59). In the end, it was the management of carpal tunnel syndrome by a doctor of chiropractic that was the most important factor; the individual techniques did not matter. 
 
If you are experiencing numbness and tingling into hands or fingers, please discuss this with a doctor of chiropractic.  Conservative care is recommended by the American Academy of Neurology.
 

References:

1.  Burke, J., Buchberger, D. J., Carey-Loghmani, M. T., Dougherty, P. E., Greco, D. S., & Dishman, J. D. (2007). A pilot study comparing two manual therapy interventions for carpal tunnel syndrome. Journal of Manipulative and Physiological Therapeutics, 30(1), 50-61.

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Cervical and Lumbar Disc Herniations and Chiropractic Care

Posted on December 4, 2010 by admin
Many who read this will themselves have had or do have herniated discs. Those that haven’t had them certainly know someone who does. Most people have been in a car accident or have subjected their spines to sufficient force to injure a disc. This study shows the good news that there can be life after herniation. – Pompano Beach Chiropractor Michael Haley

Cervical and Lumbar Disc Herniations and Chiropractic Care

via Research-Chiropractic Conditions Care on 6/29/10
by
William J. Owens DC, DAAMLP
Mark Studin DC, FASBE (C), DAAPM, DAAMLP
 
The term “herniated disc,” refers to localized displacement of nucleus, cartilage, fragmented apophyseal bone, or fragmented annular tissue beyond the intervertebral disc space.[1]Simply stated, the annulus, or outer part of the disc has been torn completely through the wall allowing the inner portion, or the nucleus pulposis material to escape the inner confines in a “focal” or finite direction. Unlike a bulging disc, which an entirely different physiological process and diagnosis, caused by degeneration, a herniated disc is traumatically induced phenomena.
 
The highest prevalence of herniated lumbar discs is among people aged 30–50 years, with a male to female ratio of 2:1. In people aged 25–55 years, about 95% of herniated discs occur at the lower lumbar spine (L4/5 and L5/S1 level); disc herniation above this level is more common in people aged over 55 years.[2] 

Symptoms of a Cervical Herniated Disc 

A cervical (neck) herniated disc will typically cause pain patterns and neurological deficits as follows:[3]

  • C4 – C5(C5 nerve root) – Can cause weakness in the deltoid muscle in the upper arm. Does not usually cause numbness or tingling. Can cause shoulder pain.
  • C5 – C6(C6 nerve root) – Can cause weakness in the biceps (muscles in the front of the upper arms) and wrist extensor muscles. Numbness and tingling along with pain can radiate to the thumb side of the hand. This is one of the most common levels for a cervical disc herniation to occur.
  • C6 – C7(C7 nerve root) – Can cause weakness in the triceps (muscles in the back of the upper arm and extending to the forearm) and the finger extensor muscles. Numbness and tingling along with pain can radiate down the triceps and into the middle finger. This is also one of the most common levels for a cervical disc herniation.
  • C7 – T1(C8 nerve root) – Can cause weakness with handgrip. Numbness and tingling and pain can radiate down the arm to the little finger side of hand.

Symptoms of a Lumbar Herniated Disc 

The most common symptom of a lumbar disc herniation is pain. The pain is usually described as being located in the buttock with radiation down the back of the thigh and sometimes to the outside of the calf. The specific location may vary and depends on which disc is affected (and thus which nerve root is affected). The pain (and other symptoms and signs) come from pressure on the nerve root. The pain frequently starts as simple back pain and progresses to pain in the leg. When the pain moves to the leg, it is not unusual for the back pain to become less severe. Straining such as bowel movement, coughing or sneezing are all things that tend to cause the leg pain to worsen. Very large disc herniations may cause something known as the “cauda equina syndrome”. This is a rare syndrome caused by a very large disc herniation putting pressure on many nerve roots. Signs and symptoms include urinary problems (either retention or incontinence), loss of leg or foot strength, “saddle” anesthesia (loss of sensation in the area of the body that would be in contact with a saddle), decreased rectal sphincter tone and variable amounts of pain (ranging from minimal to severe).[4] 

A research paper published in a Peer Reviewed Medically Indexed Journal (scientific journal,) was conducted to evaluate how patients with disc herniations responded to chiropractic care.  The authors stated “all patients were evaluated before commencement of chiropractic care by MRI scans for presence of disc herniations. Pre-care evaluations also included clinical examination and visual analog scores [asking them to rate their pain by using a number from 0 to 10]. Patients were then treated with a course of care that included traction, flexion distraction [a specific Chiropractic technique], spinal manipulative therapy, physiotherapy and rehabilitative exercises. All patients were re-evaluated by post-care follow-up MRI scans, clinical examination and visual analog scores. Percentage of disc shrinkage on repeat MRI, resolution of clinical examination findings, reduced visual analog pain scores and whether the patient returned to work were all recorded.   This is an important study because it shows MRI scans pre-care and post-care.  

The paper goes on to report “Clinically, 80% of the patients studied had a good clinical outcome with post-care visual analog scores accompanied with resolution of abnormal clinical examination findings. Anatomically, after repeat MRI scans, 63% of the patients studied revealed a reduced size or completely resorbed disc herniation (completely resolved.)  One significant finding was “seventy-eight percent of the patients were able to return to work in their pre-disability occupations.”[5]
 
This study shows that Chiropractic care can be a very important part of treatment in patients, when clinically indicated with disc herniations.  Injuries such as disc herniations can have a negative impact on the ability to work and complete personal tasks.  Evaluating treatment options is paramount when deciding how best to fix the problem especially the non-surgical approach that Chiropractic offers to patients.  If you have an injury to your spine, the first step is making sure that you are diagnosed effectively and efficiently, and then engage in treatment as quickly as possible.   Although Chiropractic is effective in treating conditions in the early and late phases it has been shown to be most effective when started immediately.[6]  

This study, along with many others concludes that a drug-free approach of chiropractic care is one of the best solutions to herniated discs. To find a qualified doctor of chiropractic near you, go to the US Chiropractic Directory at www.USChiroDirectory.comand search your state.

[5]Magnetic resonance imaging and clinical follow-up: study of 27 patients receiving chiropractic care for cervical and lumbar disc herniations. J MANIPULATIVE PHYSIOL THER, 1996 Nov-Dec; 19(9): 597-606
[6]Donald Aspegren, DC, MS, Brian A. Enebo, DC, PhD, Matt Miller, MD,  Linda White, MD, Venu Akuthota, MD, Thomas E. Hyde, DC, and James M. Cox, DC. FUNCTIONAL SCORES AND SUBJECTIVE RESPONSES OF INJURED WORKERS WITH BACK OR NECK PAINTREATED WITH CHIROPRACTIC CARE IN AN INTEGRATIVE PROGRAM: A RETROSPECTIVE ANALYSIS OF 100 CASES.  J Manipulative Physiol Ther 2009;32:765-771.
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