Fibromyalgia (FM) is a common condition that affects about five million Americans, often between ages 20 and 45 years old. FM is very difficult to diagnose primarily because there is no definitive test like there is for heart, liver, or kidney disease. Equally challenging is the ability to effectively treat FM as there are frequently other conditions that co-exist with FM that require special treatment considerations. Typically, each FM case is unique with a different group of symptoms and therefore, each person requires individualized care.
Carpal Tunnel Syndrome (CTS) results in pain, numbness, tingling, grip strength weakness, interrupted sleep, and can interfere with work, social family, and recreational activities. Symptoms can radiate up the forearm and into the fingers making tasks that require intricate finger movements very difficult. Many of us know someone who has had carpal tunnel surgery, but what can be done in order to avoid surgery? Let’s find out!
Exercise: The follow five exercises should be performed MANY times a day! The goals are to keep the tendons traveling through the carpal tunnel freely, promote better circulation, remove the pinch on the median nerve, and strengthen muscles. As a general warning, modify or STOP ANY exercise if you feel sharp pain or worsening of symptoms!
People of all ages suffer from neck pain, and many frequently turn to chiropractors for care because it’s been found to be one of the most effective and efficient forms of treatment available, and it carries minimal side effects! It has been projected that by 2030, nearly one in five US residents will be 65 or older. Currently, approximately 14% of the patients treated by chiropractors are 65 or older, making it one of the most frequently utilized forms of complementary and alternative care used by older adults. What kind of care can a senior citizen expect when seeking treatment from a chiropractor? Let’s take a look!
Carpal Tunnel Syndrome (CTS) management strategies were introduced last month, which we will conclude this month with Part 2. In part one, we cited three primary goals of CTS management that include the following: 1) Physical management strategies; 2) Chemical management strategies; and 3) Self-management strategies. All three goals include a component that we as doctors of chiropractic control AND (most important), a component that you the patient controls. We will continue this discussion this month with chemical management strategies.
Fibromyalgia (FM) has been described as being a “myth” as well as “real” (and probably everything in between the two). This is a VERY controversial disorder that some doctors push under the rug by saying, “….there is no such thing,” while others stake their reputation on it. So with this wide variance in attitude and beliefs about FM, what ARE the facts?
Fibromyalgia has been defined as, “…a complex chronic pain disorder that affects an estimated 10 million Americans” (ref: National Fibromyalgia Association). Women are affected the greatest, but it can affect men and children as well. This condition can be subtle, hardly interfering with life and all of its activities to being totally disabling, disallowing participation in work and the most desired aspects of daily living.
DIAGNOSIS: In 1990, the American College of Rheumatology (ACR) introduced the diagnostic criteria for FM. This includes a patients history of “wide spread pain” for at least three months, AND pain in 11 or more of the 18 specifiic tender points using 4 kg of pressure. Due to the significant controversy about the reality of the disease (as stated in the opening paragraph), ONLY a physician knowledgable about FM should make the diagnosis. Along with this diagnostic responsibility, ALL other conditions having similar presenting symptoms as FM, “…must be ruled out” BEFORE making the diagnosis of FM.
SYMPTOMS: Though the hallmark of FM is widespread, generalized pain (in all four body quadrants), a number of other symptoms are common amongst FM sufferers. Some of these include fatigue (moderate to severe), sleep disorders, brain fog, irritable bowel syndrome (IBS), headaches (including migraine), anxiety, depression, and environmental sensitivities. Studies suggest that there is a “neuroendocrine” (nerves and hormones) abnormality that may contribute to the FM symptoms.
CA– USES: Research has found a genetic link, as FM is OFTEN seen in several family members (among siblings and/or mothers and their children). “Secondary fibromyalgia” arises AFTER other health-related issues occur such as physical trauma (like an acute injury or illness), which can act as a “trigger” for initiating FM. Recently, more attention has been directed to the central nervous system as the “underlying mechanism” for developing FM. Here, the threshold or level of a stimulus that triggers a painful response is found to be much lower in FM patients compared to a healthy group of people (this is called “central sensitization”). Thus, a pain response is amplified in the FM patient due to this lowered threshold of pain tolerance.
TREATMENT: As there is NO KNOWN cure for FM, symptomatic support and functional improvement are two important primary goals when treating patients with FM. In the medical world, there are MANY drugs that have been utilized for FM (such as sleep aids, muscle relaxers, anti-inflammatory, analgesics, and anti-depressants / -anxiety meds). ALTERNATIVE therapies include massage therapy, chiropractic, myofascial release, acupuncture, herbal supplements, yoga, and other exercise approaches such as swimming and/or simply walking are popular care options for many FM patients. Increasing rest, pacing daily activities (to avoid “over-use”), stress management (relaxation tapes, exercise, and nutritional support can ALL HELP reduce FM symptoms and improve quality of life!
If you, a friend or family member requires care for Fibromyalgia, we sincerely appreciate the trust and confidence shown by choosing our services!
Sinus headaches refer to pain in the head typically in and around the face. Most of us are knowledgeable about two of our four sinuses: the frontal (forehead) and maxillary (our “cheek bones”). The other two sinuses (called ethmoid and sphenoid) are much less understood. As chiropractors, many patients ask us about sinus problems, as all of us have had a stuffy nose due to a cold and have felt this pain in our face and head. Those of us who have suffered from sinus infections REALLY know how painful sinusitis can get! This month, let’s take a look at our sinuses and what we can do to self-manage the problem.
First, an anatomy lesson… As stated above, there are four paired, or sets, of sinuses in our head: Maxillary: Pain/pressure in the cheekbones, sometimes referring pain to the teeth. These drain sideways (if you lay on your side, the side “up” drains down into the downside maxillary sinus and into the nose). Frontal: Pain/pressure in the forehead. These drain downward (when we’re upright, looking straight ahead). Ethmoidal: Pain/pressure between and/or behind the eyes. These drain when we lean forwards. Sphenoidal: Cause pain/pressure behind the eyes, top of the head and/or back of the head (which can be extreme). These drain best when lying face pointing down towards the floor, but they can be stubborn to drain!
Sinusitis, or rhinosinusitis, by definition is an inflammation of the sinus lining (mucous membrane) and is classified as follows: Acute – a new infection which can last up to four weeks and are divided into two types: severe and non-severe; Recurrent acute – four or more separate acute episodes within one year; Subacute – an infection lasting 4-12 weeks; Chronic infections lasting >12 weeks; and Acute exacerbation of chronic sinusitis – recurring bouts of chronic sinusitis.
One cause of sinusitis can include an “URI” (upper respiratory tract infections) most often in the form of a virus (such as rhinovirus — there are over 99 types have been identified, or better known as “the common cold”). Bacteria can also cause a sinus infection. These infections tend to last longer and can follow a viral infection. A third cause is a fungal infection. These are more common in diabetic and other immune deficient patients. Chemical irritants such as cigarette smoke and chlorine fumes can also trigger sinusitis. Chronic sinusitis can be caused by anything that irritates the sinuses for >12 weeks (viruses, bacteria, environmental irritants, tooth infections, and more). Allergies are also a common cause of sinusitis whether they are environmental and/or food/chemical induced.
Chiropractic care for sinusitis includes primarily symptomatic care with sinus drainage techniques such as facial and cranial bone manipulation/mobilization, lymphatic pump and drainage techniques, instruction in self-stretch of the sinuses (such as an outward pull of the cheek bones in different positions of the head), nutritional counseling (such as 1000mg of vitamin C every 2-4 hours) and anti-inflammatory herbs and vitamins (see prior Health Updates), cervical and mid-back manipulation, training in nasal saline rinsing (Nasaline, Nettie Pot), moist heat (towels, steam), and of course, chicken soup! Co-management with your primary care doc may be needed at times, if medications are warranted.
Last month, we covered what Carpal Tunnel Syndrome (CTS) is, its symptoms, causes, who is at risk, and how it's diagnosed. This month, we’ll center our focus on CTS treatment.
How is CTS treated? For the best success, treatment should begin as early as possible. Unfortunately, most people wait a long time before they get to the point where the symptoms interfere with daily activity enough to prompt them to act quickly and make an appointment. Once the cause or causes of CTS are determined, treatment can address ALL the presenting contributing conditions. The FIRST course of care should be NON-SURGICAL, though this is not always practiced – so be aware! Non-surgical care includes the following:
Manipulation: This usually includes adjusting the small bones of the hand, the wrist, the forearm, elbow, shoulder, and/or the neck.
Soft-tissue therapy: This includes loosening up the overly tight forearm muscles where the median nerve runs through (on the palm side of the forearm).
Modalities: Such as electrical stimulation and/or laser/light therapy can be very beneficial in reducing swelling or inflammation. In chronic CTS, ultrasound may be helpful as well.
Nutritional: Nutrients such as vitamin B6 have been shown in studies to be effective in some cases. Also, anti-inflammatory herbs (ginger, turmeric, bioflavinoids) and/or digestive enzymes (bromelain, papain, and others) taken between meals are quite effective.
Anti-inflammatory: The first important distinction is that ice can be very effective depending on how long the CTS has been present. In particular, ice cupping or rubbing ice directly on the skin over the carpal tunnel is the most effective way to use ice as an anti-inflammatory agent. When doing so, you will experience four stages of cooling: Cold, Burning, Achy, Numb or, “C-BAN.” It’s important to remember this as you are REALLY going to want to quit in the burning/achy stages when it feels uncomfortable. Once the skin over the wrist/carpal tunnel gets numb (which takes about four to five minutes) QUIT as the next “stage” of cooling is FROST BITE! Most medical practitioners promote the use of NSAIDs (non-steroidal anti-inflammatory drugs) like Advil, aspirin, or Aleve. However, these carry negative side effects including gastritis (burning in the stomach that can lead to ulcers), or liver and/or kidney damage. Try the nutritional anti-inflammatory approach FIRST as they are extremely helpful without the bad side effect potential!
Diet: An ant-inflammatory diet, like the Paleo-diet or gluten free diet, serves as a great tool in reducing the inflammatory markers in the body. Though only 7-10% of the population has celiac disease (gluten intolerance), it’s been estimated that over 80% of us are gluten “sensitive.” Reducing systemic inflammation can make a BIG DIFFERENCE in the management of many conditions including CTS!
Mechanical: Wrist “cock-up” splints can also be REALLY HELPFUL, especially for nighttime use. The reason for this is because when our wrist is bent forwards or backwards, which frequently occurs when sleeping, the pressure inside the carpal tunnel increases, and over time (minutes to hours), the increased pressure in the tunnel exerts compression on the median nerve which then creates numbness into the thumb, index, third and half of the fourth finger, which can wake you up out of a sound sleep. Keeping the wrist straight at night prevents you from curling your wrist under your jaw while sleeping.
er station, line position, machine controls, pace or rate of repetitive movements, and more) is VERY effective.
NOTE: ALL of the above can be managed through the services offered at our clinic!
We realize you have a choice in whom 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 requires care for Carpal Tunnel Syndrome, we would be honored to render our services.