There are many websites and articles that one can access through the internet.  This is not an endorsement for any one site but rather, a review of one site that is available.  The “Fibromyalgia Information Foundation” (www.myalgia.com) offers a lot of information that is very informative and usable.  This includes information on the condition, the diagnosis, treatment, exercise advice and more.  For example, under “Treatment of FM,” it is stated that there is no “cure” for FM. Rather, the goal of treatment is to teach the patient to gain “control” over the condition rather than to have the condition control the patient.  There are four major areas of treatment to concentrate on which include pain management, exercise, sleep, and psyche.  For pain management, there are lists of different medications, manual therapies and physical agents that can be of benefit. Exercise is emphasized to be gentle stretching after warming up and not to exercise too aggressively, so as to avoid irritation. In addition to stretching, light non-impacting aerobic exercise such as walking, water exercises, and/or stationary bike are recommended with a gradual increase in dose.  Starting out at short 3-5 minute sessions, 2-3 times per day and gradually increase the session duration to three, 10 minute sessions/day, then to 2 -15 minute sessions and eventually one 20-30 minute session/day may be wise. 

Regarding sleep, all FM patients complain of interrupted, non-refreshed sleep and improving this pattern is important.  If an underlying condition such as whiplash, back, neck, or shoulder pain is the cause of interrupted sleep, that condition should be managed.  A sleep study to determine if sleep apnea is an issue and the use of a C-pap unit can be quite helpful in gaining restorative sleep.  Multiple medications are listed with dose recommendations that can be shared with your primary care provider. Regarding the “psyche”… Because chronic pain can result in depression, anger, fear, withdrawal and anxiety, management of these issues is important.  Early detection and treatment is ideal.  Interventions can include activity management such as ergonomic modifications both at work and home such as weight lift/carry limits, computer station re-design, the use of headsets vs. phones, and modifying other irritating postures should be considered.  A de-emphasis of medications and long-term health care provision without clear goals is important.  Unless an underlying psychological condition is present, counseling may be non-productive. However, biofeedback and some behavior modification may benefit some patients that are having trouble coping with the pain and it’s effect on their life.

Chiropractic is an important player in the management process of FM and benefits the patient by helping them set realistic goals and offering management strategies to help achieve those goals.  Patients with FM need a “quarterback” to guide them in this process for which chiropractic is a logical choice.

For more information visit www.backsmartchiropractic.com

If chiropractic care helps patients get better faster and costs the patient and/or insurance company less, shouldn’t EVERY low back pain patient FIRST see a chiropractor before any other type of doctor?  That is in fact, what should be done, based on a recent report!

On October 20, 2009, a report was delivered on the impact on population, health and total health care spending.  It was found the addition of chiropractic care for the treatment of neck and low back pain “…will likely increase value-for-dollar in US employer-sponsored health benefit plans.”  Authored by an MD and an MD/PhD, and commissioned by the Foundation for Chiropractic Progress, the findings are clear; chiropractic care achieves higher satisfaction and superior outcomes for both neck and low back pain in a manner more cost effective than other commonly utilized approaches.

The study reviews the fact that low back and neck pain are extremely common conditions consuming large amounts of health care dollars. In 2002, 26% of surveyed US adults reported having back pain in the prior 3 months, 14% had neck pain and the lifetime prevalence of back pain was estimated at 85%.  LBP accounts for 2% of all physician office visits where only routine examinations, hypertension, and diabetes result in more.  Annual national spending is estimated at $85 billion in the US with an inflation-adjusted increase of 65% compared to 1997. Treatment options are diverse ranging from rest to surgery, including many various types of medications.  Chiropractic care, including spinal manipulation and mobilization, is reportedly also widely utilized with almost half of all patients with persisting back pain seeking chiropractic treatment.

In review of the scientific literature, it is noted that 1) chiropractic care is at least as effective as other widely used therapies for low back pain; 2) Chiropractic care, when combined with other modalities such as exercise, appears to be more effective than other treatments for patients with neck pain.  Other studies reviewed reported patients who had chiropractic coverage included in their insurance benefits found lower costs, reduced imaging studies, less hospitalizations, and surgical procedures compared to those with no chiropractic coverage.  They then utilized a method to compare medical physician care, chiropractic physician care, physiotherapy-led exercise and, manipulation plus physiotherapy-led exercise for low back pain care.  They found adding chiropractic physician care is associated with better outcomes at “…equivalent to an incremental cost-effectiveness ratio of $1837 per QALY (Quality-adjusted Life Year).” 

Learn more www.backsmartchiropractic.com  call 770-888-4288 for a Free Consultation.

So, let’s take a look at the evidence that supports the benefits of chiropractic for CTS:

1) Davis PT, Hulbert JR, Kassak KM, et al. “Comparative efficacy of conservative medical and chiropractic treatments for carpal tunnel syndrome: a randomized clinical trial”

J Manipulative Physiol Ther. 21.5 (June 1997): 317-326.

The most important finding reported in this 91 patient study was that chiropractic treatment was equally effective in reducing CTS symptoms as medical treatment.  The chiropractic care included ultrasound, nighttime wrist supports and manipulation of the wrist, arm and spine.  Medical care included ibuprofen (800 mg, 3x/day for 1 wk, 800 mg, 2x’day for 1 wk, &  800 mg as needed for 7 wks) plus a night wrist splint.  Both groups did equally well but given the side-effect potential of ibuprofen on the stomach, liver, and kidneys, a strong argument for the non-drug, chiropractic approach can be made.

2)  Bonebrake AR, Fernandez JE, Marley RJ et al. “A treatment for carpal tunnel syndrome: evaluation of objective and subjective measures” J Manipulative Physiol Ther. 13.9 (Nov-Dec 1990): 507-520

CTS sufferers (n=38) received chiropractic spinal manipulation and extremity adjusting.  Also,   soft tissue therapy, dietary modifications or supplements (B6) and daily exercises were prescribed. After treatment, results showed improvement in all strength and range of motion measures.  Also, a significant reduction in pain and distress ratings was reported.

3) Mariano KA, McDougle MA, Tanksley GW “Double crush syndrome: chiropractic care of an entrapment neuropathy” J Manipulative Physiol Ther. 14.4 (May 1991):262-5

In 1973, Upton and McComas first proposed the presence of the “double crush syndrome.” Their hypothesis was that when a nerve is pinched anywhere along its route, it makes the rest of the nerve more sensitive to otherwise “normal” stimulation. A case report of a man with both cervical radiculopathy and carpal tunnel syndrome, i.e., “double crush syndrome” was presented. Chiropractic management consisted of chiropractic manipulative therapy as well as ultrasound, electrical nerve stimulation, traction and a wrist splint. The experimental basis, clinical evidence, etiology, symptomatology and findings of this condition are discussed.  The Double Crush Syndrome helps explain why cervical/neck manipulation helps many CTS patients.

There are many additional articles that support the benefits of chiropractic for CTS.   If you, a friend or family member requires care for CTS, we would be honored to offer our services.

 YOU MAY BE A CANDIDATE FOR CHIROPRACTIC CARE FOR CARPAL TUNNEL SYNDROME!  FOR A FREE NO-OBLIGATION CONSULTATION CALL 770-888-4288

Or Visit  www.backsmartchiropractic.com

 So, what is spondylolistesis? It is the sliding forward of one vertebra over another (see arrow). It occurs in about 7% of the western population and up to 30-50% in cultures that carry their young on their back (like a back pack).  It is reported that most people who develop  spondylolisthesis acquire this between ages 6 and 16 due to a developmental weakness in that part of the spine, though the cause can be traumatic, like in Abby’s case where rapid, uncontrolled backward bending occurs.  It can also gradually occur over time (called “degenerative”), usually not found before age 50-60, where no single event can be recalled by the patient. There is also a congenital type that can be hereditary where one is born with it, though most authorities feel it is acquired at an early age.  The good news is that it is often stable and does not require surgery.  In the more severe case, the nerves and/or spinal cord can get pinched in which case surgery is necessary.  The symptoms would then include leg pain, weakness, and/or numbness with or without significant low back pain. Most cases however, can be successfully managed without surgery and do not compromise the nerves or cord. 

Chiropractic has been found to be very successful in managing patients with spondylolisthesis as the pain generator is often above or below the slipped vertebra.  In fact, in one report, chiropractic was found to be more beneficial than medical care for this condition (Mierau D, et.al., J Manip Physiol Therap 1987;10:49-55). If you, a family member or a friend require care, 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.                              

YOU MAY BE A CANDIDATE FOR CHIROPRACTIC CARE FOR LOW BACK PAIN!  FOR A FREE NO-OBLIGATION CONSULTATION CALL 770-888-4288  

Or Visit    www.backsmartchiropractic.com

 While treatments traditionally have involved activity modification, night splints, anti-inflammatory medication, and in advanced/severe cases surgery, a recent study comparing different vitamin approaches reports promising results with the use of alpha-lipoic acid (ALA) and gamma-linolenic acid (GLA).  This combination was described as a logical early stage treatment aimed at “neuroprotection” or, to limit and correct nerve damage caused by CTS.  The doses utilized for 90 days in 112 subjects with moderately severe CTS were 600 mg/day of ALA and 360 mg/day of GLA.  This combination was compared against a commonly recommended multiple vitamin B complex that included 150 mg of B6, 100 mg of B1, and 500 mcg of Vit B12 per day for the same 90 day period.  Questionnaires regarding CTS symptoms and function and electromyography (EMG) were utilized to track the outcomes in the study.  The ALA/GLA treated group was statistically significantly improved when compared to the other B-complex vitamin approach.  This included significant improvements in both symptom scores and functional impairment compared to only a slight improvement in the vitamin B group.  Similarly, EMG was significantly improved in the ALA/GLA and unchanged in the vitamin B group.

Because there are many contributing causes of CTS, a multi-dimensional treatment plan will usually yield the best long-term results.  Because repetitive motion / cumulative trauma are often associated with the onset and perpetuation of CTS signs and symptoms, ergonomic issues must be addressed.  This includes perhaps a period of time when slower “light duty” work is necessary and consideration for workstation modifications, when feasible.  Because most people do not ‘run to the doctor’ with the early signs of CTS, over time, many CTS patients develop abnormal movement patterns by minimizing hand/wrist motions. Instead, they start to shrug the shoulder and lean the body to one side.  Hence, management addressing neighboring joint problems at the elbow, shoulder, and neck is needed.  A condition called “double-crush” where the nerve is pinched in more than only at the wrist but also at the elbow, shoulder, and/or neck results in a significantly worse CTS presentation.  These patients require treatment at all areas involved, not just at the wrist if long-term, satisfying results are to be obtained. 

 Metabolic conditions including diabetes mellitus, hypothyroid, obesity, pregnancy, the use of birth control pills, and others also contribute or, can even by themselves cause CTS.  Chiropractic has traditionally viewed the body as a whole, treating the person from the ground upwards paying attention to posture, leg length, pelvic tilt, shoulder and head tilt.  The use of manipulation of not only the wrist and hand, but also the elbow, shoulder, neck and back has yielded the best results rather than focusing only on the hand/wrist.  The traditional use of night splints, work station/ergonomic modifications, as well as diet and exercise are also commonly addressed by chiropractors when managing CTS patients.  We take pride in providing quality, evidence-based care and appreciate the opportunity to do so when patients choose our clinic for their care and we realize there are many healthcare options available. If you, a friend or family member requires care for CTS, we would be honored to offer our services.

 YOU MAY BE A CANDIDATE FOR CHIROPRACTIC CARE FOR CARPAL TUNNEL SYNDROME!  FOR A FREE NO-OBLIGATION CONSULTATION CALL 770-888-4288

or visit us at   www.backsmartchiropractic.com

“I’ve been working on the line for 13 years and started noticing periodic tingling in my fingers.  It didn’t last long and I didn’t think about it much.  It gradually became more frequent and wouldn’t go away when I changed my activity or shook my hand or fingers.  It started to really grab my attention when I started to drop things out of my hand and couldn’t open jars as easily.  That’s when I decided to see what was wrong.  I didn’t know who to go to so I went to my family doctor and he diagnosed carpal tunnel syndrome.  He gave me a splint to wear at night and some anti-inflammatory drugs that irritated my stomach, so I quit the drugs.  The splint helped me sleep and I didn’t wake up as often.  The doctor was talking about surgery to un-pinch the nerve at my wrist if it didn’t get better soon, but I overheard some co-workers talk about seeing a chiropractor for their carpal tunnel problems and how much better they felt so I decided to try it.

            “The chiropractor was very thorough and examined my neck, shoulder, elbow as well as my wrist and hand.  He indicated that several areas were putting pressure on the nerve that goes into the hand and the pinch was not just at the wrist but higher up in my neck, shoulder and forearm.  He said if I wasn’t at least 50% better in 4 weeks, we would talk about other tests and treatment options and investigate it further.  He worked on my neck, shoulder, elbow, forearm and hand, using manipulations and other methods to loosen it up.  He said the nerve was getting pinched by the muscles working too fast and not getting enough rest.  He gave me exercises to do several times a day at work to stretch the forearm muscles and had me continue the use of the brace at night.  He also taught me how to ice massage the wrist for 5 minutes until it got numb, several times a day and he recommended I use vitamin B6, 50mg, three times a day.  After the 3^rd week, I started to notice a decrease in the intensity, frequency and duration of numbness and weakness.  He had me fill out a Carpal Tunnel Questionnaire and my score improved a lot after the first 4 weeks.  He said he may have to evaluate my workstation and make some modifications, if possible.  He asked me a lot about the position of my wrist and hand when I work and didn’t seem to like the type of screw driver I was using.  He called my boss and asked if a different type of screw driver with a power source and a pistol shaped handle could be tried and it was arranged.  That seemed to really make a difference.”

Carpal Tunnel Syndrome or CTS, is a common problem that is usually cumulative, slow and gradual in its onset, and can progress to a point where functions like buttoning shirts, threading a needle, and holding a newspaper are greatly affected.  People usually don’t run to the doctor at the first signs of CTS as the initial symptoms are vague and initially not too impairing.  Over time, CTS can become quite severe and often prompts a surgical recommendation, without trying a non-surgical approach first. 

There are a number of studies published regarding the chiropractic management of CTS that show these non-surgical methods can be quite successful.  One compared medical care consisting of non-steroidal anti-inflammatory drugs and nocturnal wrist splinting to chiropractic care consisting of spine and extremity manipulation, nocturnal wrist splinting, and ultrasound over the wrist.  Both treatment approaches were helpful, suggesting the importance of trying either or even both of these non-surgical treatments prior to proceeding to surgery.

We take pride in providing quality, evidence-based care and appreciate the opportunity to do so when patients choose our clinic for their care.  We realize there are many health care options available and truly appreciate the confidence shown by our patients when choosing our clinic for their health care needs.  If you, a friend or family member requires care for CTS, we would be honored to offer our services.

 YOU MAY BE A CANDIDATE FOR CHIROPRACTIC CARE FOR CARPAL TUNNEL SYNDROME!  FOR A FREE NO-OBLIGATION CONSULTATION CALL 770-888-4288

Or Visit   www.backsmartchiropractic.com