Carpal tunnel syndrome (CTS) occurs when the median nerve is compressed at the wrist. However, there are other anatomical locations in which the median nerve can experience interference, and the median nerve is not the only nerve that ventures into the hand. So if you experience a symptom like hand numbness, CTS may not be the culprit…

After CTS, the next most common nerve pinch is the ulnar nerve at the inner elbow, which is technically called “cubital tunnel syndrome” (CuTS). This is often caused from over-use of the arm such as lifting and/or gripping with the palm up. The unique difference between CuTS and CTS is that the pinky and ring finger are affected but NOT the index, middle, and thumb-side ring finger, which are the median nerve-innervated fingers affected by CTS. Because over-use is also a common cause of CTS, these two conditions can co-exist, in which case all five fingers may be affected but not necessary all at the same time.

The shoulder is yet another fairly common location for a pinched nerve and is referred to as “thoracic outlet syndrome” (TOS). The most common nerve pinched here affects the fourth and fifth fingers, similar to CuTS; however, with TOS the upper arm is also affected, not just the elbow to the inner hand.

Another relatively common location for a pinched nerve affecting the arm is at the neck, often from a herniated disk and/or an arthritic spur where the nerve exits the spine. Depending on which nerve is compressed and the amount of compression, the numbness/tingling can affect different parts of the arm and/or hand.

Doctors of chiropractic are trained to differentiate between these various “syndromes” and to safely deliver treatment to the affected joints, muscles, and other soft tissues to reduce pain and restore proper motion so patients can return to their normal activities of daily living.

 

Low back pain (LBP) is VERY common condition, and research shows that up to 50% of the adult population in the United States will experience LBP in any three-month timeframe over the course of a year. Worse, low back pain can persist for months, years, and even longer, significantly reducing one’s ability to work, play, and enjoy life. So, let’s take a look at where LBP can come from…

ANATOMY: There are five lumbar vertebrae located just below the last rib and extending down to the sacrum. The FRONT of the vertebral column is made up of large box-shaped “vertebral bodies” that are strong and made to bear heavy weight. Between the vertebral bodies are shock-absorbing “intervertebral disks” that have a tough outer layer that surrounds a liquid-like center, giving it the ability to absorb vertical loaded pressure.

The spinal cord runs through the MIDDLE of the vertebra through the spinal canal. Nerves also exit the spine at each spinal level.

The BACK of the vertebra is made to protect the spinal cord. There are two gliding joints on the either side (called facet joints) of the vertebrae, which allow us to bend sideways, backwards, forward, or a combination of movements.

Below the lumbar spine sits the sacrum. The sacrum is wedged between the left and right wings of the pelvis, the ilia, forming the sacroiliac joint (SIJ). For many years, anatomists didn’t believe the SIJ could move and thus, could not be a pain generator. More recent research has concluded that not only is there movement in the SIJ but it may be the primary pain generator in up to 30% of lower back pain cases.

CASE STUDIES: Each of the above anatomical structures can be potential causes of LBP, and the presenting patient’s symptoms and clinical signs can help a doctor of chiropractic figure out what’s going on. For example, when a patient states, “My back kills me and the pain shoots down my leg when I bend over and feels better when I bend backwards and leg pain disappears,” this is most often caused by a herniated disk pinching a nerve in the low back.

In the above case, it’s important to examine the nerves that run down the leg, as the nerve can become damaged if too much pressure is exerted on the nerve for too long. Here, your doctor will ask you to walk on your toes and heels, check your reflexes at your knee and heel, and test your ability to feel sensations on the skin. If any of these tests reveal loss of function, the first goal of care will be to remove the pinch on the nerve to restore leg feeling and strength.

On the other hand, when a patient feels better bending over and worse bending backwards, the facet joints and/or the SIJ may be the culprit.

 

DIGESTION: Prolonged sitting is bad enough all by itself, but adding a slouched, slumped posture can distort or compromise the space that houses internal organs and negatively affect MANY vital functions, including digestion. This can lead to complaints including (but not limited to) discomfort, constipation, and heart burn.

BREATHING: Slouching can also reduce the space occupied by the lungs, hindering the ability to take in a deep breath and/or force air out of the lungs. This is the reason why good conductors have their musicians sit up straight with both feet on the floor (it’s not just to “look good”)!

MOOD: Did you know that sitting for seven or more hours per day increases the risk of depression by 47% compared with sitting for four hours a day or less? Our energy levels also decrease with prolonged poor posture, further complicating this negative side effect.

WORK PERFORMANCE: Researchers have observed that sitting up straight increases alertness, reduces fatigue, and improves productivity. Moreover, co-workers may conclude that someone slumped over their desk is unmotivated, disinterested, or at the least, tired. Sit/stand workstations are gaining popularity, especially with the availability of low-cost options to transform a traditional desk into a standing desk. Studies show improved work performance when we have the option to change positions as needed during the day. Exercises you can perform at your desk, such as chin retractions, help strengthen the deep neck flexor muscles, which can help reduce poor neck posture. Stretching the chest muscles and keeping the “core” fit with pelvic stabilization exercises are also GREAT methods to improve our sitting posture!

VARICOSE VEINS: Prolonged sitting raises the risk for the formation of spider veins, especially in women, which can lead to varicose veins. Compression from sitting alters the flow of blood into the legs, and a proper fitting chair and sitting “correctly” can reduce the risk of developing circulatory dysfunction leading to varicosities or worse, blood clots.

Low back pain (LBP) is a very common problem that many, if not most of us, have had at some point in life. In fact, about 80% of adults experience LBP in their lifetime, and it’s the leading cause of job-related disability and missed work days. According to the National Institutes of Health, more than 25% of adults have had a recent episode of LBP.

Men and women are equally affected by LBP, which can occur abruptly following a specific incident (such as over lifting), or it can develop slowly over time due to wear and tear. Studies show a sedentary lifestyle during the week can set the stage for developing LBP, especially when it’s followed by strenuous weekend workouts.

Although about 80% of acute LBP (lasting a few days to weeks) resolves with self-care or short-term management, about 20% of those with acute LBP will still have persistent symptoms after a year. So what can be done to manage chronic LBP and prevent disability?

One study looked specifically at maintenance spinal manipulative therapy (SMT) to determine its effectiveness in managing chronic LBP, which they defined as LBP that persists for more than six months. Researchers randomly assigned sixty patients to receive either 1) 12 treatments of sham SMT for one month; 2) 12 treatments of SMT for one month but no treatment thereafter; or 3) 12 treatments for one month followed by SMT twice a month for the following nine months.

The research team found that groups two and three experienced significantly lower pain and disability scores than the sham treatment group at the end of the first month. However, only the third group experienced more improvement in regards to pain and disability at the ten-month evaluation. In the absence of continued SMT, the second group’s pain and disability scores returned back to near pre-treatment scores. The authors concluded that SMT is effective for chronic nonspecific LBP, but to obtain long-term benefit, patients should continue to receive care on an ongoing basis.

 

Around the world, low back pain (LBP) is a leading cause of disability and ranks sixth in terms of “overall disease burden.” Chronic low back pain (cLBP) has a profound socioeconomic impact on individuals, families, and communities—so much so that the World Health Organization has identified LBP as a major disabling condition.

Older people tend to have greater physical disability caused by LBP compared with younger individuals, and old age is often associated with non-recovery and poor outcomes. One study found that more than a quarter of older people in the United States had cLBP upon entering retirement and that baby-boomers (those born between 1946 and 1964) account for 51% of all costs (over $10 billion) associated with cLBP.

So the question of the month is: how safe and effective is chiropractic care for older patients with cLBP? To help answer this question, researchers searched multiple sources for studies that included patients over 55 years of age with cLBP (more than three months of LBP), that utilized some form of manual therapy, that included tools that measured pain and disability, and that utilized a randomized control trial design. Researchers excluded data from experiments in which subjects had prior back surgeries, had pelvis-only pain (e.g. tail bone pain), or had received only a single treatment without follow-up.

Though only four studies met these stringent criteria, the authors did conclude that manual therapies, which include spinal manipulation delivered by doctors of chiropractic, can improve pain and function in older patients with chronic low back pain with very few adverse side effects.

This study supports the benefits of chiropractic care for the aging population and emphasizes the need for effective treatment options for cLBP with a low risk for serious adverse effects. With the size of the senior population expected to double over the next several decades, Chiropractic care will surely continue to play an important role in improving the quality of life of the elderly.