Not only is it important to engage in some type of regular exercise, it’s also important to pay attention to your diet and the foods you eat, both before and after you exercise, and how you eat if you want to tone and lose weight.Food is fuel and your body needs fuel to “go.” However, you don’t want to eat a heavy meal before you work out or all your energy will be directed at digesting your meal, making your workout a lot more strenuous for you. On the other hand, you don’t want to exercise on an empty stomach or you simply won’t have the fuel you need to get through the workout.Some rules of thumb regarding pre- and post-workout eating:Before your workout: • Eating a low-glycemic index meal before exercise reduces blood sugar level spikes and burns twice as much fat as a high-glycemic index meal, according to one UK study conducted at the University of Nottingham. Low-glycemic index foods include muesli, yogurt, whole grains and soy. • Drink plenty of fluids; continue to drink fluids during your workout to remain well-hydrated. Once you feel thirsty, you’re already dehydrated. • Don’t eat a high-fat meal or snack – it takes longer to digest. • Some suggested pre-workout meals include whole grain cereal with fruit and fat-free milk, banana and yogurt, fresh fruit (oranges, bananas) or a multigrain bagel with jelly. • The time you wait between eating and working out depends largely on what you eat. Thirty minutes to one hour is good for a light meal, while three to as many as six hours may be necessary after eating a heavier meal.After your workout: • Replenish fluids lost to sweating during exercise; rehydrate until urine is clear or pale yellow and you are urinating frequently. • It is important to replenish depleted carbohydrate stores (glycogen), which are stored in your muscles, after a workout. Carbohydrates combined with small amounts of protein work best (i.e., bagel with peanut butter, fruit with cheese, cereal with milk). • Replace potassium lost through sweating by eating bananas, yogurt, and raisins or by drinking orange or grapefruit juice.Keep in mind that your workout diet is supposed to support your exercise, weight loss and/or body-toning goals. Please feel free to ask us for our recommendations when you come in for your next chiropractic adjustment.
Monday, May 17, 2010
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Want More Sugar?
Feeling a bit sluggish? Anxious? Depressed? Before you reach for that candy bar or sweet roll as “comfort food,” you’d better read this! And if you would like to continue getting information on your health and nutrition, just sign up to my newsletter.
While sugar may give you the quick “jolt” of energy you need and make you feel better initially, it’s followed by an equally quick “letdown.” Eating sugar causes erratic swings in your blood sugar levels which affect your moods and your energy levels. Many people experience continuous rapid fluctuations as they eat even more sugar to “bounce back” from the lows!The holidays offer prime opportunities for increased sugar consumption. So… before eating another piece of chocolate, another cookie, or another piece of cake… consider these alternatives that give you energy and boost your mood – especially important during this time of the year.
• Drink lots of water (1/2 your body weight in ounces/millilitres per day) to avoid dehydration and combat fatigue.
• Eat foods that are rich in Omega-3 fats (e.g., salmon, walnuts and canola oil) that boost your mood naturally!
• Consider eating a banana or drinking a banana smoothie made with a banana, ice and skim milk. Bananas and green, leafy vegetables help to release more dopamine in the brain, a chemical that has “feel good” effects on mood.
• Try to eat 4-5 meals per day to keep blood sugar levels steady and provide the energy you need to keep you going throughout the day.
• Drink a soothing cup of black tea to calm stress and help you relax.
• Increase the amount of protein in your diet to help you stay alert. Try a grilled chicken sandwich or some black bean soup for lunch to supply the energy to stay focused through the usually “sluggish” afternoon hours.
• Eat an apple or another type of fruit that contains natural sugar, is easily digested, and provides vital nutrition to keep your engine running!
• Don’t skip breakfast. You’ve heard it many times and it’s true – breakfast really is the most important meal of the day. It gives you the fuel you need to get going after the long period of fasting while you’re asleep.
• Eat whole grains found in bread, brown rice, and sugar-free cereals. Whole grains are loaded with essential amino acids that the body isn’t able to produce on its own. Amino acids are vital to the brain because they produce neurotransmitters, which are necessary for proper nervous system function. Whole grains also digest slowly, keeping blood sugar and energy levels balanced throughout the day.
Of course chiropractic care can also help to keep your nervous system running at peak performance, especially important at this time of the year when you’re under some added stress! So make sure you schedule us in too, along with all your other holiday plans
Whiplash – Can This Affect My Memory?
This is a common complaint occurring as a result of a whiplash injury, but it’s not commonly known, leaving those who are suffering wondering, “…what’s wrong with me?” Whiplash is an injury that classically occurs as a result of a car crash at any speed, even at low speed! This is because at low speed, there is little to no damage to the car, and the forces from the crash are not absorbed by the crushing metal. As a result, those forces are transferred to the contents inside the car - that is, the passengers. This sometimes results in a significantly greater injury compared to crashes that occur at twice the speed because the latter results in crushing metal. The actual injury that occurs in whiplash is caused by the sudden, rapid movement of the head resulting in varying degrees of injury to the neck, as well as to the contents inside the skull - that is, the brain. The brain literally “bangs” into the inside walls of the skull when the head is rapidly accelerated during a car crash. The resulting injury is a concussion. What’s interesting is that most patients injured in a car crash often don’t mention a concussion nor is it usually asked about at the doctor’s office as other, more obvious injuries are dwelt with. The condition is usually referred to by one of two names: post-concussive syndrome or mild traumatic brain injury (MTBI).
“Doctor, when I’m reading a book or magazine, sometimes I have to re-read the passage several times before it sinks in. It’s as though I lose my concentration and I can’t focus on what I just read. The other day, I was talking to a group of co-workers and I lost my place in the middle of the discussion and had to ask, ‘…now where was I?’ I notice this is happening a lot since the car accident.”
This can be very embarrassing, frustrating, and scary for patients suffering with MTBI. Other symptoms associated with this include difficulty in focusing (blurred vision), headaches, having difficulty in pronouncing certain words (”tongue twisted”), having difficulty in understanding what was said, difficulty remembering numbers or groups of numbers like phone numbers, addresses, birthdates, and so on. These symptoms can range from mild to severe and can be very disruptive, making work and everyday tasks challenging.
How long does it last? MTBI can completely clear up in 2 to 6 months without problems or, it can hang on for 2 years or longer, and may even become a permanent residual from the car crash. In one study, continued problems after a 2 year time frame were reported in close to 20% of those injured 2 years earlier. This study suggests that about 1 out of 5 may continue to suffer with MTBI and the associated brain-related problems for at least 2 years following a car crash. However, another study reported the long term “higher cognitive function” (such as the ability to communicate through written or spoken language) is usually not affected by whiplash injuries. However, they preface that with by reporting that a more commonly injured group with more mild brain problems was found.
As chiropractors, we are trained to do a thorough history, orthopedic and neurological examination, and ask specific questions about mild traumatic brain injury. It is important to discuss this information with those suffering from whiplash injuries as frequently, MTBI patients think something is “…seriously wrong” and harbor unnecessary anxiety.
We realize that you have a choice in where you choose for your healthcare services. If you, a friend or family member requires care for whiplash, chiropractic care is a logical first choice and we would be honored to offer our services to you.
Whiplash – The Importance of Seatbelts!
In general, the available evidence available is clear - seatbelts save lives! Regarding backseat passengers, wearing a seatbelt is 44% more effective at preventing death than riding unrestrained. Similarly, for those positioned in the rear of a van or sport utility vehicle, the use of rear seatbelts is 73% better at preventing a fatal outcome during a car crash. In more than one half of all fatal car accidents, the victims are not properly restrained. The National Highway Traffic Safety Administration (NHTSA) in 2008 reported the use of seatbelts increased 1% over 2007 with 83% of drivers wearing their seatbelts. The use of seatbelts increased to 90% on highways versus 80% on surface streets (in town). In states where rear seatbelts are required, 85% of adult backseat passengers complied versus states not mandating rear seat seatbelt use where only 66% of the passengers complied. The NHTSA has launched a campaign, “Click It or Ticket” and has provided a guide to seatbelt safety promoting the proper use of the seatbelt and have provided the following safety seatbelts tips:
- Make sure your seat belt fits snugly. Seat belts worn too loosely can cause broken ribs or injuries to your abdomen.
- Place the lap belt low on your hipbones and below your belly. Never put the lap belt across your belly.
- Place the shoulder belt across the center of the chest between the breasts.
- Never slip the upper part of the belt off your shoulder. Seat belts that are worn too high can cause broken ribs or injuries to your belly.
- The most effective safety protection available today for passenger vehicle occupants is lap/shoulder seat belts combined with air bags.
There is a common myth that seatbelts cause injuries at low speeds and therefore, it is better to not wear the seatbelt when simply traveling in town. There is overwhelming evidence in almost all circumstances, seatbelts save lives, even at low speed collisions. Because the forces that occur in low-speed crashes are transferred to the contents due to the lack of crushing metal and less vehicle damage, the occupants of a car struck at a low speed can be thrown about significantly… striking the windshield, side window and other contents inside the car. We realize that you have a choice in where you choose for your healthcare services. If you, a friend or family member requires care for whiplash, chiropractic care is a logical first choice and we would be honored to offer our services to you
Whiplash: Body, Mind and Spirit – What is the Connection?
The treatment of whiplash varies from “watchful waiting” to a multidisciplinary team approach that includes neurology, physical therapy, chiropractic, psychology, and possibly surgery (rare). In a recent article published in the American Journal of Physical Medicine and Rehabilitation (2009, March Vol. 88, No. 3, pp 231-8), the relationship between clinical, psychological and functional health status factors was investigated in a group of patients with chronic whiplash-associated disorder (WAD). A total of 86 patients with chronic WAD participated in the study and outcomes were tracked using questionnaires that measure pain, disability and psychological issues including depression, anxiety and catastrophizing. Physical examination factors included measuring the cervical range of motion. An analysis of the degree of neck disability and the relative contribution of physical vs. psychological factors revealed catastrophizing and depression played greater roles than did cervical range of motion. This suggests psychological factors play an important role in the outcome of whiplash.
The importance of this is that more than just the physical factors like range of motion should be focused on when treating chronic whiplash patients. Answering the patient’s questions, explaining the mechanism of injury and how that relates to their specific condition, and addressing depression, anxiety, coping, and other psychological issues is very important. Discussing treatment goals with patients is also very important. For example, making light of the injury by stating something like, “…you’ll be fine after the treatments,” may harm the patient as anything short of “fine” may be interpreted as failed treatment by the patient. It is also important not to paint too dismal of a picture as that can have negative psychological effects as well, as this may suggest that they will never improve. Explaining the difference between “hurt” and “harm” is of great value to the chronic whiplash patient as they are often told, “if it hurts, don’t do it.” This sends an unfortunate message to the patient that any activity where an increase in pain occurs is “bad” when in fact, that activity may help the patient get better in the long run. This can make or break an acceptable outcome as many may feel like they shouldn’t do anything and this can lead to unemployment, boredom, and the many psychological issues previously described. The best advice is to remain active and try to ignore discomfort by staying within “reasonable activity boundaries.” Reasonable activity tolerance is learned as time passes and trying different activities for different lengths of time. This type of coaching should be at the center of chronic whiplash management rather than over focusing on physical factors such as range of motion.
If you, a loved one, or a friend is struggling with whiplash residuals from a motor vehicle collision, you can depend on receiving a multi-dimensional chiropractic assessment and therapeutic approach at this office. We sincerely appreciate your confidence in choosing our office for your health care needs!
Neck Pain and Chiropractic Treatment
Sound familiar? This is a “typical” neck pain patient that presents to chiropractic offices around the world. What is different is that every person is unique and each case must be individually managed. For example, some patients “hate doctors” or are extremely anxious about going to any doctor. This might stem back to a prior “bad experience” with a health care provider at a very young age or perhaps even a more recent event. None-the-less, the approach used in this type of presentation may be best if it is very methodical, reassuring, and fully explained. A “low-force” type of manipulation may be best suited for this type of person as “cracking” of the neck may be too frightening for this patient. On the other hand, a different patient may not be happy unless there is a “good crack” and will not be satisfied until a chiropractic adjustment is performed.
It is equally important in both cases that a complete explanation of, 1) What is the condition causing the symptoms? 2) What can be done to treat it (that is, “what are my treatment options”)? 3) Will the proposed treatment “fit” into my busy schedule, financial situation, and my philosophy about health care? Providing answers to these questions will usually end with the best results, as the patient will understand the issues most important to them and will have confidence that those issues are understood and appreciated by the doctor. In both cases, management may include 1) modifying the work station by switching to a head set rather than pinching a phone between the neck and shoulder; 2) evaluating the patient at their work station to check for proper posture at the desk, proper computer monitor positioning, etc. and making modifications as needed; 3) teaching the patient cervical range of motion exercises and other stretches that can be done at the work station, multiple times a day, that only take a minute or two; 4) cervical traction (if this “feels good” when tested during the exam); 5) use of a cervical or contoured pillow; 6) neck / upper body strengthening exercises; 7) the use of ice as needed; 
an anti-inflammatory diet (for example, a gluten-free diet); 9) nutritional supplementation, as indicated. Of course, most of the time, all of these approaches do not have to be included, but are options.
Neck pain, headaches, and upper back pain are conditions are commonly treated by chiropractors. If you, a family member or a friend require care, we sincerely appreciate the trust and confidence shown by choosing our service. We are proud that chiropractic care has consistently scored the highest level of satisfaction when compared to other forms of health care provision and we look forward in serving you and your family presently and in the future.
Whiplash – What is the Best Type of Treatment?
This question was investigated in a published study titled, A symptomatic classification of whiplash injury and the implications for treatment (Journal of Orthopaedic Medicine 1999;21(1):22-25). The authors state conventional [medical] treatment utilized in whiplash care, “is disappointing.” The authors’ reference a study that demonstrated chiropractic treatment benefited 26 of 28 patients with chronic whiplash syndrome. The objective of their study was to determine which type of chronic whiplash patient would benefit the most from chiropractic treatment. They separated patients into one of 3 groups: Group 1: patients with “neck pain radiating in a ‘coat hanger’ distribution, associated with restricted range of neck movement but with no neurological deficit”; Group 2: patients with “neurological symptoms, signs or both in association with neck pain and a restricted range of neck movement”; Group 3: patients who described “severe neck pain but all of whom had a full range of motion and no neurological symptoms or signs distributed over specific myotomes or dermatomes.” These patients also “described an unusual complex of symptoms,” including “blackouts, visual disturbances, nausea, vomiting and chest pain, along with a nondermatomal distribution of pain.”
The patients underwent an average of 19.3 adjustments over the course of 4.1 months (mean). The patients were then surveyed and their improvement was reported:
These findings show the best chiropractic treatment results occur in patients with mechanical neck pain (group 1) and / or those with neurological losses (group 2). The exaggerated group (group 3) was the most challenging and, the only group where a small percentage worsened. The good news is, the number of cases that responded well to chiropractic treatment (groups 1 & 2) far out number those that don’t (group 3). Hence, most patients with whiplash injuries should consider chiropractic as their first choice of health care provision.
If you, a loved one, or a friend is struggling with whiplash residuals from a motor vehicle collision, you can depend on receiving a multi-dimensional chiropractic assessment and therapeutic approach at this office. We sincerely appreciate your confidence in choosing our office for your health care needs!
Neck Pain and Pinched Nerves
There are two types of conditions that commonly pinch nerves, which generally occur at different times of life - those with a herniated disk (younger > older patients) and those with arthritis (older > younger patients). A combination of the two conditions producing the pinching effect on the nerve can also occur making the diagnosis process a little trickier. The following diagram helps explain these conditions.
Both of these conditions are commonly treated by chiropractors. If you, a family member or a friend requires care, we sincerely appreciate the trust and confidence shown by choosing our service. We are proud that chiropractic care has consistently scored the highest level of satisfaction when compared to other forms of health care provision and look forward in serving you and your family presently and in the future.
Neck Pain – Non-Surgical Treatment Options
As noted in the May, 2009 issue of Consumer’s Report for low back pain, chiropractic was the most sought after form of treatment, but there has been no extensive review of neck pain regarding evidence-based treatment approaches - at least not until February, 2008. An international “team” representing 9 countries screened over 31,000 titles of articles published between 1980 and 2006, reviewed more than 1200 articles and eventually reported on 552 studies in their final report. Their findings included the following:
- In the US, 54% utilized complementary (alternative) treatment approaches compared to 37% that obtained conventional medical care.
- Neck pain was the 2nd most common reason Americans obtained chiropractic care.
- Chiropractic was found to be the most frequently reported form of treatment for upper back or neck pain (ahead of massage therapy, relaxation therapy, acupuncture).
- Those who obtained complementary AND conventional medical care were much more likely to perceive the complementary/alternative therapy as being helpful (61% vs. 6.4% for neck conditions and 39.1% vs. 19% for headaches).
- Women more commonly obtained care than men for neck/shoulder pain (29% vs. 18% men) over a 4-6 year time frame.
- Manual therapy (mobilization, manipulation, stretching) was associated with greater pain reduction in the short-term among patients with acute whiplash when compared with usual medical care, soft collars, passive modalities, or general advice.
- For non-whiplash neck pain (without arm radiating pain), manipulation or mobilization, exercise, low level laser therapy (LLLT), and “…perhaps acupuncture…” were reported as more effective than no treatment, sham, or other alternative interventions.
- For both whiplash and non-traumatic neck pain, supervised exercise with or without manual therapy was favored over usual medical care or no care.
What does all this mean? Simple! Everyone who is suffering from neck or upper back pain should seek chiropractic care which includes manipulation, mobilization, exercise training, and activity modifying advice, as these approaches have been found to be more effective than usual medical care! Why waste time with a “wait and watch” with or without drug intervention approach when the evidence favors chiropractic related interventions. If you, a friend, or a loved one is struggling with neck or upper back pain, we will properly assess your condition and administer the appropriate care that is required. We will coordinate care with other health care services when necessary. This recommendation may represent one of most significant acts of kindness you can offer those that you truly care about.
Whiplash - Important Points To Know
How does it happen? During a car crash, most commonly a rear-end collision. The sudden jolt occurs so fast we cannot brace ourselves adequately and the head accelerates back and forth beyond the limits of the ligaments that hold our bones firmly together (often referred to as a “sprain”). Because of the significant range of motion of the neck, the weight of the head, and how is suspended on the neck, the neck is particularly vulnerable to this type of injury (more commonly worse in woman due to a more slender neck).
What are the symptoms? The primary symptom is neck or upper back pain that may develop immediately or be delayed days, weeks, and sometimes months. A partial list of possible symptoms (each injured person’s symptoms are different) include: muscles spasms, loss of movement, headache, dizziness, concentration &/or memory loss, difficulty swallowing, chewing &/or hoarseness, burning or tingling, shoulder/arm/hand radiating pain, and more.
How is it diagnosed? Even when symptoms do not seem significant, a health care provider can diagnose the condition by taking a careful history and performing a physical exam. X-rays showing a change in the curvature or contour of the neck, &/or MRI or CT scan to better assess the disk and nerve roots when pain radiates down an arm may also be indicated. When persistent concentration/memory loss is present, a consult by a neuropsychologist is helpful.
How is it treated? In most cases, non-surgical methods are usually appropriate. If you go to a medical doctor, typical approaches include a wait & watch approach and/or medications such as anti-inflammatory drugs, pain killers, &/or muscle relaxants. MD’s may refer the patient to physical therapy. When these methods fail, referral to a physiatrist may result in injection therapy (epidural steroid, facet injection, trigger point injections). Chiropractic care includes spinal manipulation, mobilization, soft tissue release techniques, exercise training, activity modification training, and physical therapy modality use (electrical stimulation, traction, ultrasound, low level laser therapy - LLLT, TENS unit). Care may also include a mix of provider approaches, when appropriate.
How can it be prevented? The degree of severity of whiplash can be decreased or maybe avoided completely with the following: the use of seatbelts (especially in high speed collisions), placing the headrest close to the head (<>
Important to know! Chiropractors have a unique advantage over other health care providers as spinal manipulation and other manual therapies have been shown to yield the highest levels of satisfaction and faster recovery rates compared to other forms of health care. If you, a loved one, or a friend is struggling with whiplash residuals from a motor vehicle collision, you can depend on receiving a multi-dimensional assessment and therapeutic approach at this office.
Whiplash – Where Is My Neck Pain Coming From?
After the exam and x-rays, the chiropractor shows you a chart and explains the mechanism of injury that usually occurs in a low speed rear-end collision. A couple of things that were said really hit home in helping you to understand how such a seemingly minor crash can create so much pain. The first is that it is not possible to voluntarily contract a muscle quick enough and “brace” to prevent the acceleration of the head. Upon impact, as the car is propelled forwards, the head initially goes backwards and then when the muscles in front of the neck are stretched to their limits, the head is then “whipped” forwards in a “crack the whip” type of response and all of this takes less than 600-700 milliseconds! Because of the far limits of neck motion being reached during this process, the ligaments that hold the vertebra together are often stretched and/or torn. This can be appreciated on the bending neck x-rays which shows one vertebra sliding forwards on the one below and the angle created being greater when compared to the surrounding vertebra. The second point of discussion that stands out was the fact that your head was rotated at the time of impact from looking in the rearview mirror places the neck at a greater risk of injury because of the twisting motion that occurs during the “crack the whip” process. Another interesting point: because there wasn’t a lot of car damage, the shock and force of the impact was not absorbed by crushing metal and that energy is therefore transferred to the contents in the vehicle, including the occupants. That is why your briefcase ended up on the floor and your glasses flew off during the crash. Another point of discussion was made concerning the difference between genders and the degree of injury, as women are more likely to be injured more severely because of the less muscular and sometimes longer female neck. The degree of injury is also at greater risk when there is osteoarthritis in the neck that pre-exists the crash. An analogy of how a young sapling branch can bend without breaking verses the “old oak branch” which snaps and breaks when its only bent slightly. So, if you are a middle aged, female with a long slender neck with pre-existing arthritis looking in the rearview mirror prior to impact in a rear-end collision, ligament over stretching / tearing is highly probable.
In summary, it is important to obtain prompt evaluation and treatment by your chiropractor as soon as possible as when time passes without treatment, it is more difficult to bring about a reduction of pain and increased motion and, it will generally take longer. Taking medication for pain only postpones the needed process of restoring movement and function of the neck so that should not be the only treatment. In general, a “wait and watch” approach is not wise in these types of injuries. If you or a loved one is suffering with whiplash, sharing this information may be one of most significant acts of kindness that you can give to those that you care about.
After My Car Accident, Why Do I Hurt So Much?
Another well published reason why neck pain can “hurt so much” after a car crash is that the sensory input from the injured area to the brain can be so extreme that it leaves an “imprint” in the sensory portion of the nervous system and it becomes hypersensitive or sensitized, resulting in a lower pain threshold or being more sensitive to pain. This is similar to the “phantom limb” phenomenon that often occurs after a leg is amputated where the brain still “feels” leg pain after the limb has been removed. This has also been reported to be a reason for the significant constellation of symptoms often accompanying “whiplash” injuries. A partial list of associated symptoms with whiplash injuries includes neck pain, headache, TMJ / jaw pain, dizziness, coordination loss, memory loss, cognitive difficulty in formulating thought, communicating, losing your place during conversation, and more.
Understanding whiplash and all of its nuances regarding signs and symptoms, x-ray requirements and measurement techniques, and treatment / management strategies are well understood at this office. Chiropractors have a unique advantage over other health care providers as manual therapies, including spinal manipulation, have been shown to yield higher levels of satisfaction and faster recovery rates compared to other forms of health care. We pride ourselves in performing thorough history and physical examinations, offering high quality evidence-based therapeutic approaches and teaching necessary home-based, self-management procedures. If you, a loved one, or a friend are struggling with whiplash residuals from a motor vehicle collision, you can depend on receiving a multi-dimensional assessment and therapeutic approach at this office.
Could Neck Problems Be Affected By Your Posture?
First, note the position of your head in relation to you shoulders. Is it right above the shoulders or does it lean forward from your chest? If it does, this would be called forward head posture, and can come from a problem in your neck. Lower areas of your spine can also cause this problem. Some of us have increased our weight over the years with much of it added to our abdominal region. Because of this increased core weight, the body must counter-balance the weight gain by causing the lumbar spine to “sway- back.”
While this “sway-back” problem can create pain this the lumbar spine, it can also have far reaching effects in the posture of the neck. Usually someone with a protruding stomach and sway back will have somewhat rounded shoulders and a forward head posture. If treatment is only directed at the neck without considering how other areas may affect the stability of the neck, then the results may be less than optimum.
In an accident, many areas of the body can potentially be injured.
As a chiropractor, I not only look at your primary injuries but also how mechanically one area of the spine can affect a distant area. These more distant areas can cause neck pain by referral or they can impede complete recovery because the body is compensating for abnormal posture or movement elsewhere.
X-rays of the full spine can show this abnormal posture as can a detailed postural analysis from our office.
So do you like what you see when you view your posture from the side? If your posture leaves something to be desired, or you’re wondering whether your neck problem could be improved by changing another part of your spine, then it is important to be thoroughly checked. Just examining the neck after a whiplash may leave some injuries undiscovered. Are there tender spots in other areas of the spine? Does your overall upright posture seem lacking?
Five Exercises to Help Your Neck Stay Pain-Free
Moving your neck slowly through all its ranges is key. It is important to do pure movements rather than combinations, rolling the neck around like a ball and socket joint (such as the hip or shoulder) is to be avoided. Instead, flex the neck forward until your chin touches the top of your chest. Then, slowly bend your neck backwards, chin to the sky These movements should not cause pain if they are done slowly and you have no pre-existing injury.
The next movement is side bending and is accomplished by trying to bend either ear towards the shoulder. Do this in front of a mirror so that you keep your head straight looking forward. Note whether you can do this the same amount to each side.
The last movement is rotation. Simply rotate your chin slowly so that you are looking over one shoulder. None of these movements should cause pain or make you dizzy. If they do, then it’s a sign you have a neck injury.
An important aspect of neck function is how the shoulder girdle influences neck posture and motion. Try rolling your shoulders forwards and backwards, stretching slowly, to help ease tension at the neck. General exercises such as fast paced walking or hiking are important for your neck too. Remember, your spine is the core of your body and walking is one of the least “injury-producers,” something you can keep up well into your later years.
Lastly, make sure your neck posture is kept upright when you are talking on the phone, driving, reading, doing other tasks, or sleeping. A very small pillow is usually best for sleeping and neck support pillows are available to help maintain the normal forward arch of the neck. A small pillow will allow your head to ease back, relaxing the muscles at the back of the neck.
Torticollis and Whiplash
The spine is meant to move a lot, especially the neck. This is so we can quickly look around, above, and below. When the spine cannot be moved without intense pain, it’s a sign of both a joint and nerve problem. The nerve may be pinched or compressed, stretched, or irritated by chemicals from inflammation/swelling. To protect the nerve, the body puts a splint on it with muscle spasm. This keeps you from moving your head.
If the joint injury is reduced, by aligning the bones of the spine, the healing and scar tissue will stabilize the area in alignment. If the joint is left out of alignment or is hypermobile, this can lead to future degeneration. To get the joint moving and functioning normally again, you need to have motion through the joint adjustment, and exercises to keep activated. One study showed that patients who wear foam collars after whiplash, do worse than patients who were actively mobilized without collars. It may at first seem counterintuitive to move when pain is there, but it’s all about moving within your pain tolerances. Usually small motions are still preserved. Instead many patients wear collars or do not move their neck enough. This causes the muscles to become more inflexible and contracted. Overtime it can lead to substantial weakness and even atrophy (wasting away).
So even in the early stages of a whiplash, when the neck can barely move at all, small movements that are not painful are encouraged. The specific adjustment will reduce the irritation to the nerve that is signaling the muscles to spasm. Once the nerve is freed, then the muscle will usually release. Greater ranges of movement will follow as the body allows. This should not be hurried because the nerve and disk is at risk for re-injury in the very early stages of healing.
Medications and surgery will not correct the alignment of the spine. When the joint is sprained, it needs to be re-aligned to reduce the tension on the ligaments and disk. Your doctor of chiropractic can guide you through this process so the range of motion returns quickly.
Whiplash and Muscle Weakness
While it may seem intuitively obvious that addressing weak neck muscles are important to a full recovery, few patients will do them unless prompted and explained by their doctor. Specific muscles need to be strengthened in a way that does not cause further damage to the ligaments. If the muscles are tight in certain areas, then stretching or deep tissue massage, or trigger point therapy, can help to loosen areas and decrease pain.
But the most important thing you can do on a daily basis is to keep exercising. Studies have shown this to be effective in whiplash treatment when there is a mechanical neck disorder. A specific exercise program can be prescribed by a doctor of chiropractic Special attention should be made to your posture and x-rays, and how specifically you were injured. Only in this way, will the treatment be effective and not risk further trauma.
Exercises such as rolling the head around the shoulders should be avoided since the neck is not a ball and socket joint like the shoulder. In some directions, the joints will have excessive laxity and the muscle exercises should be done in the neutral position versus at the end range or limit.
Because the ligaments are so badly damaged in whiplash, it’s important to maintain the supporting muscles (both strong and flexible), to keep the spine stable and pain free.
Carpal Tunnel Syndrome (CTS) – It’s Rush Hour!
So what does this have to do with CTS? This analogy depicts what essentially happens when CTS occurs. Picture an assembly line worker packaging cookies. The cookies come out of the oven 6 rows deep at a rapid pace. There are normally 6 people working the line, 3 on each side, but for the last two weeks, one of the workers has been out on maternity leave and no one was assigned to that position… leaving 5 workers doing the work 6 people usually share. Let’s say, conservatively, there are 25 cookies packaged per minute. In 60-minutes, 1500 cookies (25×60) are packaged; in an 8 hour day 12,000 cookies are packed, and in a 40 hour work week, 48,000 cookies are packaged (by each worker)! That’s a lot of fast, repetitive movements requiring bending forward and reaching, gripping, and moving the cookies into a tray and then stacking the trays.
If there are workers absent or the employer decides to speed up the line and force overtime, most of the workers will reach their limit and hurt. Especially those with other problems that make them more susceptible to CTS like low thyroid function, diabetes, obesity, age over 50, inflammatory arthritis, when taking birth control pills…..you get the picture!. Hence, when working too fast, just like when there are too many cars on the road during rush hour, the fast paced work inflames the tendons in the carpal tunnel and pinches the nerve. This creates pain and numbness/tingling that either slows the worker down or completely forces him/her to have to take time off from the job. When working at a slower, more comfortable pace, there is less friction between the carpal tunnel tendons and, therefore, no or significantly less nerve compression and CTS signs or symptoms, just like driving through the construction site without slowing down when avoiding rush hour.
Why is this? CTS occurs frequently in people who perform fast, repetitive hand movements like our cookie factory worker. That’s because there are 9 tendons attaching the muscles located in the upper forearm (on the palm side) to the fingers in the hand. These tendons travel very close together, especially as they pass through the carpal tunnel of the wrist. These tendons allow us to pick things up (grip and pinch), shake hands, hold babies delicately and function normally in our daily activities. As these 9 tendons pass through this tight tunnel, when it’s “rush hour” or, when fast, repetitive work is occurring, these 9 tendons rub together and they heat up, swell and the pressure inside the tunnel increases. Because the nerve (median nerve) passes through the same tunnel, as the tendons swell, the nerve is pinched or pressed up against the border of the tunnel and numbness / tingling occurs into the palm and fingers 2-4. We find ourselves dropping things, having a hard time buttoning clothes, threading a needle, opening jars, holding onto a steering wheel, and frequently, we wake up at night needing to shake and flick our fingers to “…wake them up.”
Because these symptoms gradually appear, we usually don’t run to our doctor until several months (and sometimes years) after the symptoms have been present. This makes it more challenging to treat CTS and all patients with these symptoms are encouraged to seek treatment as soon as problems start. There are frequently other problems in the neck, shoulder, and elbow because we tend to compensate, move differently and use other muscles when there is pain so the elbow, shoulder and neck become involved and require attention. This is why a chiropractor who treats all of these areas is the perfect choice. If you, a friend or family member require care for CTS, we would be honored to render our services
Carpal Tunnel Syndrome (CTS) - Can it be Prevented?
Other symptoms include sleep interruptions where shaking and flicking of the fingers is required to allow for a return to sleep. This is frequently caused by sleeping with the wrist in a cocked position, increasing the pressure inside the already swollen carpal tunnel. This is why a cock-up wrist splint usually helps as it disallows the wrist from bending to the extremes and the nerve is not pressured or pinched as much. Other symptoms include weakness of the grip, making it a challenge to unscrew a jar, open a door, and even sometimes turn the key when starting a car. Driving can also be affected as the hands often fall asleep while holding onto a steering wheel.
Pain can also affect the rest of the arm and sometimes the neck area. The median nerve can also be pinched in more than one place and may include the neck, shoulder, elbow as well as the wrist making it necessary to have all the areas treated for a satisfying result.
People at greatest risk are women > men, workers who handle small tools, computer workers, fast repetitive line workers, and people older than 40 years of age. People with other health conditions including rheumatoid arthritis, Lymes disease, rubella, pregnancy, birth control pill use, diabetes mellitus and menopause are at an increased risk of developing CTS. Certain foods such as caffeine, tobacco, and/or alcohol may also contribute to CTS.
Though treatment is very important -the sooner the better- prevention is most important. In fact, some simple approaches can make a big difference! Some of these include modifying the position of a computer chair, keyboard, monitor, or mouse (work station modifications), alternate between different tasks to reduce the repetition of work, stretch your forearms and fingers before, during and after work, and treat any underlying conditions. When symptoms first occur, these recommendations, as well as wearing a night wrist cock-up splint and seeing your chiropractor, will often reverse the condition without difficulty. If you wait too long and nerve damage occurs, it becomes a more challenging process to manage CTS and at times, even surgery will not be very helpful.
Some of the non-surgical treatment approaches you might expect from your chiropractor include joint manipulation and/or mobilization applied to the neck, wrist, elbow and/or shoulder, the application of physical therapy modalities such as ultrasound, electrical stim, and/or low level laser therapy (”light” therapy), as well as the use of wrist splints.
The University of Maryland Medical Center cites two research articles on chiropractic treatment for CTS. They report good results are usually obtained and that these good results continued for at least 6 months after treatment ended. The same reference also recommends nutrition and supplements in the management of CTS. Some of these include: eliminate food allergens (often milk, cheese, eggs, ice cream, glutens/wheat-grains, soy, corn, and preservatives) and eating foods high in B-vitamins (dark leafy greens like spinach, kale, and sea vegetables), anti-oxidants (fruits - blueberries, cherries, tomatoes; vegetables - squash, bell peppers), avoiding refined foods, using olive oil and adding omega 3 fatty acids to the diet (fish oil). Other vitamins including a multivitamin, B complex, Vit. C, alpha-lipoic acid, MSM, resveratrol, Vit. D, Co-Q10, magnesium can also really help.
We realize that you have a choice in where you choose for your healthcare services. If you, a friend or family member requires care for CTS, chiropractic care is a logical first choice and we would be honored to offer our services to you.
Carpal Tunnel Syndrome (CTS) – What, Why, How?
WHY? There are many possible causes but in general, whether its swelling, a spur, or a metabolic condition, the common denominator is median nerve pinch in the confined space within the carpal tunnel. A common cause of swelling can occur with performing repetitive motion work such as line assembly, meat packing, carpentry, and so on, and over time, the tendons inside the tunnel inflame or swell and the median nerve is pressed into the ligament that crosses over the roof of the tunnel on the palm side of the wrist. Once the contents inside the tunnel swell, all positions of the wrist other than neutral or, holding the wrist in line with the forearm further increases the pressure inside the tunnel. That is why sleeping with the wrist cocked in any direction often wakes up CTS patients. Those most at risk are women over 50 years of age. CTS can also be associated with other health conditions including (but not limited to) Lymes Disease, inflammatory arthritis, and hormone-related conditions including pregnancy, taking birth control pills (BCPs), hypothyroidism, diabetes, and menopause. Lifestyle issues that affect CTS may include high caffeine intake, smoking, alcohol consumption, as well as obesity.
HOW? So the key question is how are we going to help those with CTS? First, we must identify all the possible reasons why CTS developed in the first place and manage those issues. Therefore, an ergonomic (work place) assessment or, discussing and possibly observing the patient at work can be very helpful. Sometimes, a few simple changes to a work station such as moving the monitor of a computer in line with the keyboard/mouse or adjusting the height of the computer can really help. Changing a tool handle type (pistol vs. straight grip), propping up a part that is frequently worked on, moving the product closer to where it is being assembled, eliminate overhead reach requirements, standing on a raised platform, and so on, may be most important in long term results. Identifying and treating any condition that may be participating in the cause like thyroid disease, diabetes, medication (like BCPs), and weight management, is very important. Wearing a night splint is also very productive. Unique to chiropractic, treatments include manipulation of the neck, shoulder, elbow, forearm, wrist and fingers, soft-tissue therapy including massage, mobilizing the forearm muscles and tendons, teaching carpal stretch and other upper extremity exercises, and nutritional counseling. Strategies here can include eliminating any suspected food allergy related products including dairy, glutens (wheat, oats, barley, rye), soy, corn, transfats, preservatives and some chemical additives. Increasing B-vitamins (especially B6), by increasing dark leafy vegetables and, increasing antioxidants including fruits and veggies. An anti-inflammatory vitamin program of fish oil, Vit. D3, magnesium, CoQ10, and a multiple vit./mineral may facilitate as well. Once CTS is controlled, preventing a recurrence is important by promoting good posture, exercise, and sticking with the life style adjustments described above. If you, a friend or family member requires care for CTS, we would be honored to render our services.
Carpal Tunnel Syndrome (CTS) - What Does Research Show?
So often we hear, “…well if it’s so good, show me the proof!” Chiropractic case management of CTS has been well established for many years. And yet, we still hear skepticism from patients, MD’s, insurers, employers, and others about the benefits of chiropractic management of CTS. If we can, “show them the data” regarding the effectiveness of chiropractic for CTS patients, we will finally be able to help more people with this potentially disabling condition.
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.
CTS - Prompt Treatment Is Best!
There are many causes and contributing factors of CTS. The most prevalent cause is mechanical irritation from simply moving the hands too fast for too long, without enough rest. Another risk factor is age (over 50 years old). In this era of an aging workforce, this may be a significant issue. Fast, repetitive movements of the arms and hands are often a direct cause and can be appreciated by watching someone knit rapidly and/or performing line work using fast, repetitive movements. If the hands/wrists have to bend in awkward positions to accomplish a work task, or if a tool that is frequently used places pressure in the palm of the hand, these can also contribute to the onset or perpetuation of CTS. Other conditions can also contribute to CTS including inflammatory arthritis like rheumatoid, diabetes, pregnancy, the use of birth control pills, obesity and hypothyroidism.
The management of CTS is case specific, and is dependant on which of the above mentioned causes or contributors are present. Management of any metabolic disorder such as diabetes or hypothyroid is important, especially compliance with taking appropriate medication, when indicated. The management of weight, hormone replacement therapy, and fluid retention all play a roll in CTS management. Ergonomic or job-related management strategies are very important and can include work station modifications so that unnecessary awkward arm/wrist/hand positions can be avoided. This may require moving the item being worked on to a less stressful position, using a different type of tool handle (screw driver, etc.), changing the height or reach distance at which the material is worked on, and taking “mini-breaks” every ½ to 1 hour when the lack of rest is a contributor. Frequently, the combination of pinching a phone between the head and shoulder, typing data into a computer where the monitor is positioned too high or off to one side, and excessive arm motions using a computer mouse can contribute to pinching the nerve in the neck and/or arm, resulting in CTS. Remedies for this situation include the use of a head set, repositioning the computer monitor so that it is in front of the worker, and using a trackball type of mouse to eliminate arm motion can be extremely helpful. Treatment strategies offered by chiropractors include the use of night splinting to avoid awkward wrist/hand positions during sleep. In addition, manual therapy to the wrist and the tight muscles in the front of the forearm, as well as other nerve constriction areas such as the elbow, shoulder, and neck, manipulation of the joints in hand, wrist, elbow, shoulder, and/or neck, depending on what is unique and needed for that patient, and the use of physiological therapeutics such as low level laser light therapy, electrical stimulation, and/or ultrasound have all been shown to offer beneficial effects. Nutritional recommendations include Vitamin B6 (150mg/day), magnesium, calcium, Co-Q10, omega 3 fatty acids and vitamin D3. Reducing glutens (wheat, oats, barley, and rye) is also very important due to the inflammatory response of these foods. Surgery is typically, the last treatment resort and is appropriate, “when all else fails.” We welcome you to our clinic and are proud to offer you a non-drug, non-surgical solution for CTS and its disabling symptoms.
