Many patients with chronic carpal tunnel syndrome are told they need surgery to relieve the pain. While surgical interventions aim to relieve pressure on the irritated median nerve, the treatment may be too narrow in scope for some patients. Case in point: nearly a third of patients who receive surgery for carpal tunnel report a return in symptoms within two years of surgery.1
Recent research suggests there's more to carpal tunnel than wrist and arm pain: CTS could be related to problems in the neck.
A recent study from Journal of Orthopaedic and Physical Therapy assessed the cervical range of motion in 71 women with carpal tunnel syndrome. Compared to women without CTS, women with carpal tunnel had significantly restricted range of motion. The greater the pain intensity women experienced, the less able they were to perform lateral flexion away from the affected side. There were no major difference among women with minimal, moderate, or severe CTS.
This study confirms what chiropractors have known for years: that wrist pain can often be related to problems in the cervical spine. In fact, the cervical spine may be the source of wrist and arm pain for patients with cervical radiculopathy. That's why chiropractors use a more holistic approach to treating carpal tunnel syndrome, one that involves relieving irritation of the median nerve in addition to addressing any underlying concerns in the neck. Chiropractors can draw on a combination of spinal adjustments, trigger point therapy, exercises, and advice on ways to prevent overuse injuries.
Research shows that this holistic approach is successful for many patients with carpal tunnel. A 2010 study found that trigger point therapy administered by chiropractors resulted in 67% improvement in symptoms.2
In another study published earlier this year, CTS patients who received soft tissue mobilization and other chiropractic treatments had significantly reduced hand pain intensity after just a week of treatment. They also showed signs of reduced pain sensitivity in certain joints of the cervical spine.3
Case studies also suggest that chiropractic can be effective for chronic CTS patients who failed to improve with other methods like surgery, wrist splints, and drugs.4
If you suffer from ongoing wrist pain and CTS, remember that surgery is not your only option for relief. Chiropractic care could address the multifaceted nature of your pain to provide lasting relief of carpal tunnel syndrome.
1. Bessette L, Keller RB, Liang MH, Simmons BP, Fossel AH, Katz JN. Patients’ preferences and their relationship with satisfaction following carpal tunnel release. Journal of Hand Surgery 1997;22:613–20. Quoted in Hains G, et al (2010).
2. Hains G, Descarreaux M, Lamy AM, Hains F. A randomized controlled (intervention) trial of ischemic compression therapy for chronic carpal tunnel syndrome. Journal of the Canadian Chiropractic Association 2010; 54(3): 155–163.
3. De-la-llave-Rincon, A. Response of pain intensity to soft tissue mobilization and neurodynamic technique: a series of 18 patients with chronic carpal tunnel syndrome. Journal of Manipulative and Physiological Therapeutics 2012; doi:10.1016/j.jmpt.2012.06.002.
4. Crafts GJ, et al. Chiropractic management of work-related upper limb disorder complicated by intraossesous ganglion cysts: a case report. Journal of Chiropractic Medicine 2011; 10(3): 166-172.
Everything Is Connected
Back pain is very seldom limited to the back, especially if it goes untreated for too long. Many patients also report that they start to develop problems with their legs and hips over time.
In the study, researchers set out to see if there was a correlation between reported low back pain and future osteoarthritis related problems such as hip or knee trouble. The population-based cohort study indicated that there was a higher incidence of hip osteoarthritis in patients with previously reported low back pain. They did not find a significant correlation with low back pain and future osteoarthritis of the knee joints.
What This Means for You
What does this mean for you if you suffer from low back pain? Though there could be a bigger risk for you to have hip troubles later in life if you suffer from low back pain now, this is not set in stone provided you take measures to care for your lower back as well as your overall bone and muscle health.
Primarily, you need to address whatever is causing your low back pain so it doesn't lead to problems with your hip joints due to overcompensation and unusual wear and tear. Spinal adjustments can help realign the spine and diminish future degeneration of your lower back.
Remember that a strong body can better resist injury and degeneration. Cardio, strength training, balance exercises and stretching for flexibility can keep your body strong and at ideal body weight. Your chiropractor or other healthcare provider can also give you advice on healthy eating habits to ensure optimum nutrition.
Stupar M, Cote P, French MR, Hawker GA. The Association Between Low Back Pain and Osteoarthritis of the Hip and Knee: A Population-Based Cohort Study Journal of Manipulative and Physiological Therapeutics 2010;33(5):349-54.
An estimated 60-80% of people will suffer from low-back pain at least once in their lifetime. However, the treatment of chronic lower back pain is complex, and the outcome remains unpredictable. Doctors are advised to recommend that patients follow a program of active exercise to alleviate their symptoms. However, patients may be reluctant to do so because of their pain.
A recent study compared the effects of chiropractic treatment followed by exercise versus a placebo or 'sham' treatment followed by the same exercise. The researchers hypothesize that chiropractic adjustments – which are believed to induce an immediate analgesic effect – may enhance the benefits of exercise for patients with lower back pain.
The study involved patients with chronic, non-specific lower back pain. The first group received spinal adjustments plus active exercise therapy. The second group received a detuned ultrasound 'sham' treatment followed by active exercise. Both groups underwent eight treatment sessions over 4 to 8 weeks.
The analgesic effect of spinal adjustments were measured by evaluating pain intensity both before and immediately after each therapeutic session. Periodically, researchers also evaluated participants' disability, fear-avoidance beliefs, and erector spinae and abdominal muscle endurance (measured with Sorensen and Shirado tests).
The participants who received spinal adjustments experienced a better immediate analgesic effect, along with lower disability and a trend toward lower pain levels. The researchers concluded that manual therapy, immediately followed by active exercise, tends to induce a more significant decrease in pain reduction in patients with chronic lower back pain. These results confirm that chiropractic is an appropriate treatment for chronic low-back pain.
While exercise has long been a crucial component of chiropractic care, this study provides further evidence of the efficacy of combining exercise with chiropractic adjustments for relieving chronic pain.
Balthazard P, et al. Manual therapy followed by specific active exercises versus a placebo followed by specific active exercises on the improvement of functional disability in patients with chronic non specific low back pain: a randomized controlled trial. BMC Musculoskeletal Disorders 2012; 13: 162. doi:10.1186/1471-2474-13-162.
More and more children are receiving chiropractic care and there's a good reason why: chiropractic provides safe, natural treatment for a number of conditions while promoting wellness.
Multiple studies point to the safety of chiropractic for kids. In a 2012 survey of European chiropractors, fewer than 1% of children experienced side effects from chiropractic treatments, and those side effects were all mild,1 This confirms the results of three other studies in which no serious side effects were reported in pediatric patients receiving chiropractic treatment.
Research suggests that chiropractic can safely relieve musculoskeletal pain in children. In a 2003 study, 62% of pediatric patients had substantial reductions in back pain after receiving chiropractic adjustments.3 Treatment of musculoskeletal conditions continues to be the number one reason why children receive chiropractic care.
But chiropractic does more than treat conditions, it can help children improve their health through wellness care. In a 2009 survey, one of the primary reasons why parents took their child to see a chiropractor was for wellness care.4
Current research shows that chiropractic can reduce blood pressure, heart rate, and stress hormones, release endorphins, and boost the immune system.
Whether you're hoping to ease your child's pain or improve their health, chiropractic can help.
1. Marchland A. Chiropractic care of children from birth to adolescence and classification of reported conditions: an Internet cross-sectional survey of 956 European chiropractors. Journal of Manipulative and Physiological Therapeutics 2012; 35 (5):372-380.
2. Humpheys BK. Possible adverse events in children treated by manual therapy: a review. Chiropr Osteopat. 2010;18: doi: 10.1186/1746-1340-18-12.
3. Hayden Ja, Mior SA, Verhoef MJ. Evaluation of chiropractic management of pediatric patients with low back pain: a prospective cohort study. J Manipulative Physiol Ther. 2003 ;26(1):1-8.
4. Alcantara J, Ohm J, Kunz D. The safety and effectiveness of pediatric chiropractic: a survey of chiropractors and parents in a practice-based research network. Explore NY 2009; 5(5): 290-5.
Manual Therapy and Athletes
New research suggests that improved athletic performance could be among the benefits of manual therapy. A recent study sought to gain increased understanding about the potential benefits of spinal adjustments in college football players.
The research involved 115 football players at Virginia Tech who were provided with a total of 1,976 osteopathic manipulative treatments over the course of two football seasons. The players received adjustments in the cervical, lumbar, thoracic, and sacral sections of the spine. After each game, the players’ performance was graded by their coaches.
Both offensive and defensive players showed improved performance following pre-competition manipulative treatments. While the association was relatively small, and not considered statistically significant, the positive correlation suggests that regular spinal adjustments could help athletes’ long-term performance.
Chiropractic and Athletic Performance
Preliminary results from the study were recently published in the Journal of American Osteopathic Association. A similar study, published earlier this year, showed that regular chiropractic treatments improved the performance of professional judo athletes.
Brolinson PG, et al. Precompetition manipulative treatment and performance among virginia tech athletes during 2 consecutive football seasons: a preliminary, retrospective report. Journal of the American Osteopathic Association 2012: 112(9):607-15.
Do you ever experience neck stiffness or pain with your headaches? Recent research suggests that neck and head pain are more related than you think.
One study examined whether headaches and cervical spine impairment were linked in patients with head pain. Of the patients evaluated, 90% had cervicogenic headaches, or headaches linked to neck pain. Furthermore, the severity of patients’ headaches impacted the range of motion in their necks. This study demonstrates the strong relationship between cervical spine (neck) impairment and cervicogenic headaches.
Visit a chiropractor in your area to determine whether your headaches are related to impairment and pain in your neck.
Hall TM, Briffa K, Hopper D, Robinson KW. The relationship between cervicogenic headache and impairment determined by the flexion-rotation test. Journal of Manipulative Physiological Therapy. 2010 Nov-Dec; 33(9):666-71.
It’s well-known that chiropractic is effective for a variety of pain conditions, but over the last few years, more and more studies have found that chiropractic can also help us improve our overall health. Some of these recent studies have shown that chiropractic can alter immune function, affect heart rate, and even reduce blood pressure. A 2011 study from Japan suggests that chiropractic may have an even bigger impact on your body than you think.
Stress is an incredibly important indicator of health, and if there's one thing that will kick your immune system into overdrive, it's chronic spinal pain. Scientists in Japan sought to see whether chiropractic could alter stress levels in 12 men and women with neck pain. To understand how chiropractic impacts anxious emotions, you could ask patients to report their changing moods before and after treatment. But scientists in Japan wanted to get a more objective picture of how chiropractic adjustments impact the nervous system, so they use PET scans to monitor brain activity and salvia samples to track hormone changes.
After receiving a chiropractic neck adjustment, patients had altered brain activity in the parts of the brain responsible for pain processing and stress reactions. They also had significantly reduced cortisol levels, indicating decreased stress. Participants also reported lower pain scores and a better quality of life after treatment.
The findings suggests that chiropractic adjustments affect how our body interprets and copes with pain, which could enhance its response to disease and injury. As scientists learn more about the human body and the role of the nervous system, it’s clear that chiropractic can play a powerful role in promoting true wellness, rather than just symptom relief.
Ogura, Takeshi and Manabu Tashiro, Mehedi,Shoichi Watanuki, Katsuhiko Shibuya, Keiichiro Yamaguchi, Masatoshi Itoh, Hiroshi Fukuda, Kazuhiko Yanai. Cerebral metabolic changes in men after chiropractic spinal manipulation for neck pain. Alternative Therapies. 2011, November/December; 17 (6): 12-17.
Back surgery isn't a magic bullet for relief: studies show that up to 40% of patients continue to suffer from back pain despite having had surgery. Many of these patients are told they need another surgery, but the success rate for second surgeries is even lower.
That was the case for one construction worker in a recent case study who suffered from lumbar disc herniation after failed back surgery. As a manager of his family business, he couldn't take time of work to recover from another surgery, so opted for chiropractic. After 12 weeks of chiropractic care, the man's pain scores went from a 10 out of 10 to a 3 out of 10, and his disability scores dropped by 32%. Nine visits later, he continued to experience no flare-ups in pain.
This case study adds to earlier research showing that patients do not need to resort to revision surgery. Chiropractic can get to the source of back pain to get you back to work sooner.
De Andres J, et al. Patient satisfaction with spinal cord stimulation for failed back surgery syndrome [Article in Spanish.] Revista Española Anestesiolgía y reanimación 2007; 54 (1): 17-22.
Morningstar MW, et al. Manipulation under anesthesia for patients with failed back surgery: retrospective report of 3 cases with 1-year follow-up. Journal of Chiropractic Medicine 2012; 11 (1): 20-35.
Welk, AB. Conservative management of recurrent lumbar disc herniation with epidural fibrosis: a case report. Journal of Chiropractic Medicine 2012; 11: 249-253.
Because injury to the temporomandibular joint (TMJ) is frequently quite painful, we do our best to help our Bradenton, FL patients find relief as quickly and effectively as possible. In fact, Dr. Lee Rangel will tell you that the medical literature shows just how much chiropractic care can help ease pain in the TMJ.
For instance, a study published in Physiotherapy Theory and Practice involved 15 patients with TMJ pain who were treated with neck adjustments, middle-back adjustments, and trigger point therapy via dry needling. Subjects were examined prior to these treatments and at two weeks and two months post-treatment. The authors reported positive results such as reduced discomfort, greater jaw mobility, and lower disability at both follow-ups.
Another research study conducted a review of almost 800 studies involving manual and manipulative therapy for disorders such as TMJ and found similar findings. They concluded that there is a "fair...level of evidence" that chiropractic care can help ease discomfort associated with TMJ and other upper extremity disorders.
This is great news since the causes of TMJ are largely unknown. While trauma to the jaw or neck can cause pain symptoms, there are other causes to consider as well, such as grinding teeth, arthritis, and clenching of the jaw due to tension.
No matter what is making your jaw ache, call Dr. Lee Rangel today and make an appointment to come into our Bradenton, FL office. We'll do our best to help you smile pain-free!
- Gonzalez-Iglesias J et al. (2013, November). Mobilization with movement, thoracic spine manipulation, and dry needling for the management of temporomandibular disorder: a prospective case series. Physiotherapy Theory and Practice;29(8):586-95
- Brantingham J et al. (2013, March-April). Manipulative and multimodal therapy for upper extremity and temporomandibular disorders: a systematic review. Journal of Manipulative and Physiological Therapeutics;36(3):143-201
- Oral Care. WebMD. Retrieved from http://www.webmd.com/oral-health/guide/temporomandibular-disorders-tmd on November 2, 2015