Carpal tunnel syndrome occurs when a nerve in the wrist (the median nerve) gets compressed between some bones and soft tissues. The symptoms usually consist of pain, numbness, tingling, weakness and deficits in sensation. Typically, carpal tunnel syndrome is more common in women and often occurs in both hands.

There are many different treatment approaches for carpal tunnel syndrome. For those individuals with significant changes in the hand musculature, an unrelenting symptom pattern and objective confirmation of carpal tunnel syndrome surgery is often indicated. For most people carpal tunnel syndrome can be easily controlled with conservative treatment. At Burlington Sports Therapy we recommend a combination of soft tissue therapy (active release techniques and graston technique) with night splinting. The purpose of the soft tissue therapy is to break-down scar tissue that is impeding the proper function of the median nerve. The night splinting is used to “unload” the nerve and allow it to heal.

Although there is significant evidence supporting night splints for carpal tunnel syndrome, the results of a 2007 paper published in the Archives Physical Medicine Rehabilitation suggest that there may be a right and a wrong way to do this. In this study the authors compared two different approaches for splinting the wrist in patients with carpal tunnel syndrome. Their findings indicated that a splint which keeps a specific segment of the finger extended is more effective, as several studies have shown that this position keeps certain muscles out of the carpal tunnel. Shortening these muscles at night therefore allows the median nerve to have more room in the carpal tunnel without being compressed.

The combination of active release technique, graston technique and night splinting is an effective and evidence based way to conservatively control carpal tunnel syndrome. Keep in mind that there are numerous causes of numbness, tingling, pain and weakness in the wrist and hand. There are other potential entrapment sites of the median nerve and there are other nerves that can create similar symptoms to carpal tunnel syndrome. Ensure that your condition is properly diagnosed by a qualified practitioner; feel free to call our clinic and have one of our doctors examine your condition to see if it is a true carpal tunnel syndrome.

References

Brininger TL, Rogers JC, Holm MB et al. Efficacy of a fabricated customized splint and tendon nerve gliding exercises for the treatment of carpal tunnel syndrome: a randomized controlled trial. Arch Phys Med Rehabil 2007; 88: 1429-1435.

Goodyear-Smith F, Arroll B. What can family physicians offer patients with carpal tunnel syndrome other than surgery? A systematic review of nonsurgical management. Ann Fam Med 2004; 2: 267-273.

Miedany YE, Ashour S, Youssef S, Mehanna A, Meky FA. Clinical diagnosis of carpal tunnel syndrome: old tests - new concepts. Joint Bone Spine 2008; 75: 451-457.

Ugbolue UC, Hsu WH et al. Tendon and nerve displacement at the wrist during finger movements. Clinical Biomechanics 2005; 20: 50-56.

Disclaimer
The purpose of this blog is to educate our patients and those interested in improving their health and wellbeing. We recommend that you always consult with a qualified health care professional before applying any of the topics or suggestions mentioned on this website. This information is not intended to diagnose or treat your condition. Burlington Sports Therapy, Dr. McIntyre or Dr. McDowall accept no responsibility for any complications arising from the use of any suggestions, exercises or topics of discussion on this site.

As mentioned in a previous blog, the transverses abdominis muscle has been shown in the literature to play an important role in controlling the spine (http://www.burlingtonsportstherapy.com/blog/a-strategy-to-prevent-lower-back-injury/).  From this, it has been implicated in many instances of low back pain.  Although it has yet to be determined whether it is a cause of low back pain or it changes as a result of low back pain, it is relatively safe to say that the literature supports retraining this muscle as a potentially helpful approach to rehabilitation of lower back pain for some patients.  A 2010 study published in the Journal of Orthopaedic and Sports Physical Therapy had similar findings to a 2008 study in that athletes with lower back pain could not perform the muscle test for the transverses abdominis as well as those athletes who did not have lower back pain.  So what does a finding like this mean?  The transverses abdominis is not necessarily the most important stabilizing muscle of the lumbar spine.  It is not the only muscle that needs to be trained for patients with lower back pain.  Training the transverses abdominis will not guarantee elimination or total prevention of lower back pain.  These findings suggest that for some patients with lower back pain, retraining of the transverses abdominis can be helpful in re-establishing control of the spine.  This may result in decreased low back pain.  Identifying weakness of the transverses abdominis is paramount to the effectiveness of this approach, since we cannot expect targeting this muscle to be helpful if a person already has normal function in this area.  If you’ve been experiencing lower back pain and are uncertain whether your transverses is doing its job, give us a call, we’ll help you figure it out!

References

Hides JA, Boughen CL, Stanton WR et al. A magnetic resonance imaging investigation of the transverses abdominis muscle during drawing-in of the abdominal wall in elite Australian football league players with and without low back pain. Journal of Orthopaedic and Sports Physical Therapy 2010; 40: 4-10.

Hides JA, Stanton WR et al. MRI study of the size, symmetry and function of the trunk muscles among elite cricketers with and without low back pain. British Journal of Sports Medicine 2008; 42: 509-513.

Richardson CA, Snijders CJ, Hides JA et al. The relation between the transverses abdominis muscles, sacroiliac joint mechanics and low back pain. Spine 2002; 27: 399-405.

Disclaimer
The purpose of this blog is to educate our patients and those interested in improving their health and wellbeing. We recommend that you always consult with a qualified health care professional before applying any of the topics or suggestions mentioned on this website. This information is not intended to diagnose or treat your condition. Burlington Sports Therapy, Dr. McIntyre or Dr. McDowall accept no responsibility for any complications arising from the use of any suggestions, exercises or topics of discussion on this site.

Since the World Cup is on everyone’s mind these days, we thought it would be only fitting to make you aware of a crucial paper published in the American Journal of Sports Medicine which analyzed score-celebration injuries among soccer players.

The authors of the study observed professional and amateur soccer players over the course of two seasons, looking at the incidence and nature of injuries sustained by players during their goal celebrations. Over the study period, 152 players were evaluated for injuries sustained in matches. Of these, 6% (9 players) sustained injuries during their goal celebrations. The pertinent findings were as follows…

7 of the 9 players were male and their average age was between 17 and 29.
The injuries happened on real grass in 8 of the 9 cases.
Most injuries occurred in the second half.
Sliding injuries (on the stomach, back or knees) accounted for 5 cases.
Piling up or over-excited teammates were the other major cause.
Injuries included fractures to the ankle, clavicle and rib. Other injuries included knee ligament sprain, lower back strain, and lower limb muscular strains.
Perhaps the most interesting statistic is that the average recovery time for these injuries was 6.2 weeks! Perhaps enough reason to take it easy when celebrating a goal!

References

Zeren B, Oztekin HH. Score-celebration injuries among soccer players. The American Journal of Sports Medicine 2005; 33(8): 1237-1240.

Disclaimer
The purpose of this blog is to educate our patients and those interested in improving their health and wellbeing. We recommend that you always consult with a qualified health care professional before applying any of the topics or suggestions mentioned on this website. This information is not intended to diagnose or treat your condition. Burlington Sports Therapy, Dr. McIntyre or Dr. McDowall accept no responsibility for any complications arising from the use of any suggestions, exercises or topics of discussion on this site.

Whiplash injury is a condition that involves damage to both the muscles and joints in the neck after it has been “whipped” backwards. Most commonly associated with rear-end motor vehicle collisions, whiplash is a common yet often complicated condition to resolve. Due to this, a great deal of literature has been published on this topic and different pieces of the puzzle are slowly being put together. 

The cervical facet joint is a joint at the back of the spine that compresses together when the head is extended. To challenge the right facet joint, we turn the head to the right and extend the neck backward. Likewise, to challenge the left facet joints, we would turn the head to the left and extend the neck backward. A recent study published in the journal Spine investigated the affect of having your head turned when rear-ended and whether or not that made injury to the facet joints worse. Perhaps predictable, this study indeed found that a head-turned posture increases the facet joint injury associated with a rear-end collision. Unfortunately, it is common for drivers to turn their head to the right and look out the rear-view mirror a split second before an impending collision. Of course, we hope that none of us are ever in this situation, but in the unfortunate event of a rear-end collision remember to keep your head straight!

References

Lord SM, Barnsley L, Wallis BJ et al. Chronic cervical zygapophysial joint pain after whiplash. A placebo controlled prevalence study. Spine 1996; 21: 1737-44.

Siegmund GP, Davis MB, Quinn KP et al. Head turned postures increase the risk of cervical facet capsule injury during whiplash. Spine 2008; 33(15): 1643-1649.

Sturzenegger M, Radanov BP, Distefano G. The effect of accident mechanisms and initial findings on the long term course of whiplash injury. Neurology. 1995; 242:443-9.

Disclaimer
The purpose of this blog is to educate our patients and those interested in improving their health and wellbeing. We recommend that you always consult with a qualified health care professional before applying any of the topics or suggestions mentioned on this website. This information is not intended to diagnose or treat your condition. Burlington Sports Therapy, Dr. McIntyre or Dr. McDowall accept no responsibility for any complications arising from the use of any suggestions, exercises or topics of discussion on this site.

The Q-Angle (quadricep angle) is a measurement used by many health care practitioners to assess patello-femoral alignment. It is often mentioned in running magazines and on different websites because of its apparent ability to identify those persons at risk of certain knee injuries. But is it a valid measurement tool?

The basic premise of the Q-Angle is that a higher angle (such as what might be expected in women with a wider pelvis) would affect the way that the patella (knee-cap) lines up with the lower limb. Some practitioners use it to identify those patients at risk of patella-femoral injury. According to the scientific literature though, the Q-Angle is a measurement which over-simplifies knee biomechanics. It only examines a person in one plane of reference (like a two-dimensional object) and does not take into account the complex forces that occur during running, walking and jumping. Numerous publications in very reputable journals have scrutinized its ability to accurately identify those people at risk of injury. Despite this, many practitioners continue to use it and many magazine articles and websites continue to present it as reliable. Perhaps again, an example of something that’s popular but not validated by science.

As always, we do our best to bring you the most current and accurate information both in our clinic and on our website. References are provided below. We encourage your questions or comments!! Want more? Sign up for our complimentary email feed (on the right of the page) which gets sent out every two weeks.

References

Duffey MJ, Martin DF, Cannon DW et al. Etiologic factors associated with anterior knee pain in distance runners. Med Sci Sports Exerc. 2000; 32: 1825-1832.

Nguyen AD, Boling MC, Levine B, Shultz SJ. Relationships between lower extremity alignment and the quadriceps angle. Clinical Journal of Sports Medicine. 2009; 19(3): 201-206.

Thomee R, Renstrom P, Karlsson J et al. Patellofemoral pain syndrome in young women. A clinical analysis of alignment, pain parameters, common symptoms and functional activity level. Scand J Med Sci Sports. 1995; 5: 237-244.

Witvrouw E, Lysens R, Bellemans J et al. Intrinsic risk factors for the development of anterior knee pain in an athletic population. A two-year prospective study. American Journal of Sports Medicine 2000; 28: 480-489.

Disclaimer
The purpose of this blog is to educate our patients and those interested in improving their health and wellbeing. We recommend that you always consult with a qualified health care professional before applying any of the topics or suggestions mentioned on this website. This information is not intended to diagnose or treat your condition. Burlington Sports Therapy, Dr. McIntyre or Dr. McDowall accept no responsibility for any complications arising from the use of any suggestions, exercises or topics of discussion on this site.